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与H7N9抗争的82天

2017-08-11 13:47:59   中国青年网

重症医学科二病区主任陈淼皱眉,多器官功能障碍综合征(MODS)病死率高达67%,4个以上器官受损时,死亡率几乎是100%。老李命悬一线。医生再次下达病危通知书。

“决不放弃,我们得拼命往前走。”

老李的女儿在病房外,已经焦急等待了十几天,她3年没有见过父亲了。这次恐怕连父亲最后一面也见不到了。她跑到医院大厅的花园,一个人哭了半小时,然后拿起手机,给亲人打电话,开始做后事准备。在浙江打工的家人纷纷赶回来,希望跟老李见最后一面。

老李的情况恶化了,又一个严重的并发症出现。他的双腿很快出现血斑,医生判断,凝血出现问题。

“乳酸上升了不少,但血红蛋白下降那么多,是不是哪里有看不见的出血。”

“可能。”

“似乎腹腔出血了,颜色不算淡。”

腹腔大出血。病人肚子隆起了一个水球,像怀孕5个月的孕妇。

抽血!抽血!抽血!医师进行腹腔穿刺,吸出了大量的血。最大时出血量每小时2000ml,这相当于一个70公斤病人总血量的三分之一。

止血!止血!止血!血浆、凝血因子、免疫球蛋白,一袋袋血制品被输入老李体内。

专家们第一次遇到H7N9病人出现腹腔大出血,查阅资料,与国内同行交流,都没有发现类似案例,闯关再次受挫。“让人匪夷所思的并发症”。

老李的肺在出血,黏膜、眼眶、皮肤、口腔都在出血,这个现象被人们俗称为“七窍出血”。

医生李康描述当时的紧急情况,“就好像我有5个瓶子,却只有4个瓶盖。”

陈淼后来回忆,老李有69天都在输血和输血制品,“他身体里的血,已经换过很多回了。”

通过微信账号“白衣战士1”和“白衣战士2”,ICU病房里的护士医生与病房外的专家随时交流,在一个H7N9临床组工作群,人员很快增加到67人。即使在晚上,微信群里关于救治的讨论也从没间断过。

老李的胃肠道也淤血了,无法进食,先靠肠外营养。医生介绍,肠外营养有很多禁忌症,每天给予的量要把控得特别好。如果过多会导致肝细胞的带伤受损,甚至导致肝衰。

气管被切开以后,老李不能说话。为了跟他交流,舒缓他的情绪,医生们拿来专门的小黑板,上面标有各种表情。老李通过点头或者摇头来选择,医生根据不同的表情评定他的疼痛程度。

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