摘要
医学的发展史,也是思维的发展史,重症思维具有其特殊性和专业性,运用自然辩证法指导重症临床思维具有重要意义,本研究通过实例来演绎这种思维模式的临床运用,希望对青年重症医师良好思维模式的养成起到一定帮助。选择2022年6月11日聊城市人民医院收治的1例青年男性患者作为研究对象,患者既往存在不明原因的慢性二氧化碳潴留,近期出现心、脑功能异常,曾于多家医院就诊,未明确病因。本次因急性肺性脑病入住本院重症监护病房(ICU)。入院后给予机械通气、改善代谢等治疗措施后好转。在重症辩证思维指导下,从病理生理学角度分析病情,推断患者为呼吸肌功能障碍所致通气不足。结合患者存在多系统病变,累及脑、心、眼肌、呼吸肌等多个肌群,运用辩证思维中的一元论,即多系统病变往往存在单一根本致病因素,根据症状、体征的共同特点,寻找共同的病理生理机制,高度怀疑患者为先天性肌病综合征。经院内多学科协作诊疗(MDT),制定诊断流程,先后给予肌肉活检、肌电图、基因检测,发现在患者TPM2基因处出现1个杂合变异,判定为致病性变异。运用归纳和演绎思维方式,认为其临床特征与先天性肌病相匹配,考虑为杆状体肌病4型。本例患者的诊治过程是辩证思维在疑难危重症患者中成功应用的典范,值得效仿和推广。
The development history of medicine is also the development history of thinking.Critical thinking has its particularity and professionalism.It is of great significance to use dialectics of nature to guide critical clinical thinking.We use an example to deduce the clinical application of this thinking mode.We hope it can help the development of a good thinking mode of young intensivists.A young male patient admitted to Liaocheng People's Hospital on June 11,2022 was selected as the study object.The patient had unexplained chronic carbon dioxide storage in the past.He recently developed abnormal brain and cardiac function.He was treated in many other hospitals,but the cause was still unknown.This time,he was admitted to the intensive care unit(ICU)of our hospital due to acute pulmonary encephalopathy.The patient's condition improved after being given mechanical ventilation and improved metabolism.Under the guidance of critical dialectical thinking,we analyzed the condition from the perspective of pathophysiology and inferred that the patient was ventilatory disorder caused by respiratory muscle dysfunction.We used the monism of dialectical thinking,that is,there is often a single fundamental pathogenic factor in multi-system lesions,and we should seek a common pathophysiological mechanism according to the common characteristics of symptoms and signs.Considering that the patient had multi-system lesions involving multiple muscle groups such as brain,heart,eye muscles and respiratory muscles,we highly suspected that the patient had a congenital myopathy syndrome.The diagnosis process was formulated by multidisciplinary treatment(MDT)in our hospital,muscle biopsy,electromyography,and genetic testing were performed successively,and it was found that the patient had a heterozygous variant in the TPM2 gene,,the patient was determined to have a pathogenic variant.Using inductive and deductive thinking,the clinical features were considered to match those of congenital myopathy,and baculosome myopathy type 4 was considered.
作者
张丽娜
吴铁军
杨浛艺
Zhang Lina;Wu Tiejun;Yang Hanyi(Department of Intensive Care Unit,Liaocheng People's Hospital,Liaocheng 252000,Shandong,China;Affiliated Hospital of Weifang Medical College(Clinical Medical College),Weifang Medical School,Weifang 261000,Shandong,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2023年第4期484-487,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
山东省医药卫生科技发展计划项目(202117010418)
山东省自然基金面上项目(ZR2021MH303)
中华国际医学交流基金会中青年医学研究专项基金(Z-2018-35-2004)。
关键词
重症思维
辨证分析
追根溯源
Clinical thinking
Dialectical analysis
Tracing source
