【2117】国内外相左(1 / 1)

抗排斥药物是大多数会导致孕妇流产和胎儿致畸。如果非要妊娠不服用这些药物的结果将有可能是得不偿失,导致病人病情在怀孕期间急速恶化一样等死。

在这样的前提下,像这种能获得广泛医学信息的患者,自然而然会做出对自己的最优选择,干脆怀了再说,反正迟早都要做心肺移植了。

只是这患者唯独没想到,国内医生说她可以在术前做非移植的手术治病。

“张主任认为可以不做移植,国外医生认为必须做移植?”杜海威再确定下自己听见的信息有没有误差。

国外医学较为发达,国内医生一直是向国外先进医学学习。病人大多数在医学上崇洋媚外的心理国内医生可以理解。病人早前在国外定居就医,先听从国外医生专业意见没错。杜海威现在多问一句更没错。

“是。”都叶青点头,“我们张主任仔仔细细研判她的病情后,认为这个患者以前是心脏病患者做过一次二尖瓣置换术。这次病情恶化是由于在国外换的人工机械瓣出问题了,再次狭窄并且有血栓发生,情况较为危急了,三尖瓣出现了返流才导致的重度肺动脉高压。患者整个病情综合来看,属于继发性肺动脉高压的可能性很高,可以尝试先做心脏手术来改善病况的。国外医生是认为她的肺血管发生实质性改变了,必须做移植手术。”

肺动脉高压做不做肺移植,这个争议点可能是在国内和国外医生对这位患者肺动脉血管病变的判定上。即:是否把患者的肺动脉血管判死刑了。如果认为其血管缩小狭窄的病理实质改变无法逆转,内科是没有神药可以对付肺血管的这种实质病理改变。这也是原发性肺动脉高压后来被称之为特发性肺动脉高压的原因,查不明病因,无药可治只能做移植。.xqqxδ捌

外科的话不可能说去完全切除这些肺血管加以改造。在上次肺介入手术中,我们可以直观地感受到肺血管的分布好比茂盛的大树枝叶密密麻麻几乎遍布整個肺组织,切除这些血管等同于切除整个肺。要切除整个肺找代替品,只能是双肺移植了。

张华耀不能说赌,是凭借自己的技术和经验判断这个患者的肺血管,尚未发生不可逆转的改变,可以做尝试。究竟国陟的医生和国外的医生谁对谁错,这一时半会儿真不能下结论。最后的判断结果是要等手术做完了再看患者后续的情况来定。

不管怎样,患者只听见可以不做移植了,哪怕是豪赌一把都愿意啪啦啪啦跑回国内找张华耀了。

这事情充分说明了,患者对医生的需求永远不会是看国内或是国外的医生,是谁行谁上。

在场听的杜蒙恩簇簇眉头,眨眨眼:被谢同学取巧的答案说中了,是心脏病患者,属继发性肺动脉高压。而且是人家张大佬这个大大佬力撑的学术结果。谢同学这哪里只是学术一根筋,是聪明派。

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