Physician Day | Chen Lei: TBO is not what you think

Cover Journalist Ning Zhi

August 19 is the Fifth Chinese Physician's Day. There is such a group of doctors around us, where everyone invisible, firmly adhere to the safety defense line of infectious diseases, and silently dedicate in their posts.

In this special day, we interviewed Chen Lei, director of the TB of Chengdu Public Health Clinical Medical Center. She told everyone the true side of the tuberculosis.

Imagination: TB is tuberculosis?

True: Can infect various organs of the whole body, most patients are incurable diseases

Tuberculosis is an ancient infectious disease that humans have been wrapped around for thousands of years. In the tuberculosis area of ​​the Chengdu Public Health Clinical Medical Center, many patients with tuberculosis from Southwest China such as Guizhou, Yunnan come here.

When it comes to tuberculosis, many people think of tuberculosis, and some of the historical celebrities we know died in tuberculosis. What are the changes in the current tuberculosis? Or is it mainly for tuberculosis patients?

Chen Lei has worked in the first line of tuberculosis for nearly 30 years. She told reporters: "In the past, there were many patients with tuberculosis, but now there are very few patients with tuberculosis. Now most tuberculosis patients have a variety of complications, such as at the same time with heart disease , Liver disease, kidney disease, and systemic immune system disease; patients infected with tuberculosis bacteria can accumulate all organs of the whole body, such as skull, spine, bone joints, skin, heart, etc. Many patients in the hospital are incurable. "

From the perspective of the patient's population, most of the patients have been preliminary treatment before, and now they have been raised to resist patients and patients. Chen Lei introduced that drug -resistant patients refer to the internal tuberculosis bacteria to one or more anti -tuberculosis drug resistance, and the treatment is more difficult. The patient is the first patient who fails to improve or repeatedly treated.

Chen Lei introduced that in the 1980s and 1990s, the patients visited by the Chengdu Public Health Center only stayed in Chengdu and the surrounding surroundings. With the development of the hospital, more than three quarters of the patients who were admitted now came from outside. The level of technical forces and overall scientific research is constantly improving, the entire medical team has been exercised, and the reputation of hospitals is also increasing. "

Chen Lei (first right)

Imagination: Is the tuberculosis diagnosis very simple?

True: Using the "Eighteen Weapons" and the rich clinical experience of doctors can be confirmed to be diagnosed

"The diagnosis of tuberculosis is very difficult. Some patients really need to traverse thousands of mountains to diagnose." Chen Lei gave an example to reporters that a 10 -year -old boy outside Sichuan Province was swollen and painful due to your feet. The pain was almost paralyzed. His parents took him to Chengdu, Sichuan to seek medical treatment from thousands of miles away, but many large hospitals could not be diagnosed. Essence Children have no effect after a few months of treatment.

Just as the doctors were helpless, because there was a check and tuberculosis in all the examinations, and some hospitals invited Chen Lei to go to the consultation. At the Chengdu Public Health Center, the tuberculosis doctors have done further examination for the child. After the cocoon peeling, the diagnosis is finally clearly diagnosed as tuberculosis. Finally, it is treated with tuberculosis. The effect is very good. The child can stand up.

Why is the diagnosis of tuberculosis? Chen Lei pointed out that on the one hand, many general hospitals do not have special technical equipment, no tuberculosis bacteria, let alone more difficult drug -resistant tuberculosis bacteria; on the other hand, patients are expensive for examination costs, long examination time, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance, such as resistance to resistance. A drug sensitivity examination of the medicine can only be produced for two months, and many patients have given up.

Chen Lei also said frankly that even if all the "eighteen weapons" diagnosed with tuberculosis were used, it may not be able to obtain very accurate results. "There are many patients with the results of the examination of patients, such as imaging, symptoms like tuberculosis, but the results of the examination are negative, or the result of genetic testing is drug -resistant bacteria, but the results of phlegm culture are not. Therefore, tuberculosis disease is not. The diagnosis must not only use various instruments and the clinical experience of doctors in order to finally get clinical diagnosis. "

Regarding the current situation of difficulty in the diagnosis of tuberculosis, Chen Lei Liu showed some concerns. "Many patients first consultations are drug -resistant tuberculosis. If the first diagnosis is not allowed, treatment is difficult to have effect."

Imagination: It can't be cured for the first time, just be cured next time?

True: secondary treatment is more likely to develop into drug -resistant tuberculosis, and the difficulty and cost of treatment

Most of the tuberculosis patients who have failed for the first time will develop into a drug -resistant tuberculosis. Chen Lei pointed out that once it develops into a drug -resistant tuberculosis, the difficulty and cost of treatment are higher. Like the core drug of drug -resistant tuberculosis, Beidamoline, treatment for 6 months, the cost of this drug alone reaches more than 70,000 yuan, and a considerable part of it Patients cannot be reimbursed.

For the first time of treatment, the diagnosis of tuberculosis must be accurate, and the patient's compliance must be high. Chen Lei said, "During the treatment, many patients stopped the drugs in the middle of the way because the drug toxic and side reactions such as nausea and vomiting, severe drug gastritis, etc., and did not come for treatment after stopping the drug. In this way, the first treatment fails, and then the treatment is a drug resistance. "

Chen Lei emphasized whether patients can recover, and their compliance is very important. She was very impressed. There was a 3 -year -old tuberculosis girl who suffered from acute meningitis. She had a high fever and coma, convulsions, and was extremely dangerous. After a standard diagnosis, the doctor started treatment after checking the disease.

"Girl parents listen to the doctor very much, and take their children to the hospital regularly every month. In the second month after treatment, the girl's liver has toxicity. We can not leave Chengdu after explaining to the parents. They really have to rent a house in Chengdu. After the adjustment of this treatment plan, after a few months of treatment, the child jumped alive, singing and dancing is not a problem. "Chen Lei was very emotional. Their compliance was very good. There was no complaint from the beginning to the end. After stopping the medicine, I also listened to the doctor's regular medical examination. Chen Lei explained that tuberculosis is very difficult to entangle. Even if it is cured, there are still a few patients who will recur, so it takes two years to observe after stopping the drug. "If the patient trusts the doctor, the compliance is good, the effect is very good, ","

Patients express my gratitude to the doctor through painting

Imagination: Just take a medicine for tuberculosis?

True: Need to cooperate with doctors and patients to spend one after another

Chen Lei encountered many patients in clinical practice to "tuberculosis, just take a medicine." However, the treatment process is not simply imagined. She admits that the tuberculosis does not have a standard pitch. Doctors can only adjust the treatment plan to very effective and safe only by doing all the difficulties and hardships.

Chen Lei said that the most common difficulty is that the drugs of tuberculosis are very toxic. After taking multiple organ systems, one or more adverse reactions may occur. If you do n’t stop medicine, the liver problem will increase. On the one hand, the tuberculosis, the other is the liver, and the two sides should be balanced. Doctors are treated like a wire. "

In Chen Lei's view, patients should not be blinded by doctors, but should participate in the treatment throughout the process. "The hospital is like a battlefield. The doctor is like an instructor. The patient is a warrior. The family members of the patient are logistical forces. All diseases and difficulties are spent by patients; doctors have experienced the life and death of countless patients, knowing how you can survive. Instructor and warriors must fully trust each other in front of the disease in order to achieve the final victory in a battle and a battle. "

The treatment of tuberculosis is less than half a year, as many as 2 years. Chen Lei said: "Like in our ward, we will guide patients to look at the science book of tuberculosis, and understand the disease. In such a long battle, the patient can cooperate with treatment well."

Character extension/

At the Chengdu Public Health Center, many difficult tuberculosis was diagnosed here, and patients in foreign countries often came.

Like other tuberculosis experts in the hospital, every time Chen Lei goes to the clinic, there are many patients who come from far away but cannot be hung up. Because he can't bear it, no matter how busy Chen Lei is, he will find a way to see them.

Chen Lei said: "As a doctor, the first must be courageous. For us, patients' lives are more important than anything. The second must be pragmatic and aggressive. On the basis of clinical work Clinical to scientific research to clinical, so that more patients benefit. "

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