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Li Qiang
Intensive Care Unit
About me
Graduated from the Department of Clinical Medicine at Peking University Health Science Center in 1996 with a bachelor's degree. Appointed as an attending physician in the Beijing Health Bureau system in 2001. In 2011, became the chief physician and associate professor in the Critical Care Medicine Department at Peking University Third Hospital. Pursued a master's degree in Surgery at Peking Union Medical College from 2002 to 2005. Published over thirty papers as the lead author in domestic core journals, including three articles in SCI journals.
Proficient in diseases
Proficient in the diagnosis and treatment of critical illnesses such as severe cervical spinal cord injury, various types of shock, severe infections, multiple severe traumas, acute respiratory distress syndrome, acute severe pancreatitis, multiple organ dysfunction syndrome, and critical obstetrics and gynecology pathologies. Skilled in techniques such as cardiopulmonary resuscitation, tracheal intubation, tracheotomy, central venous catheterization, fiberoptic bronchoscopy, hemodynamic monitoring (Swan-Ganz catheter, PICCO hemodynamic monitoring), and blood purification. Able to proficiently handle the rescue and treatment of critically ill patients in departments such as general surgery, orthopedics, urology, obstetrics and gynecology, cardiovascular surgery, gastroenterology, neurology, hematology, and emergency medicine.
Voices
The difference between hypertensive encephalopathy and malignant hypertension
Hypertensive encephalopathy and malignant hypertension are two critical conditions that can occur in patients with hypertension, both triggered by a sudden and drastic increase in blood pressure in a short period. Literally, hypertensive encephalopathy focuses on the severe rise in blood pressure in a short term, causing some damage to the nervous system. The main mechanism is due to the too rapid increase in blood pressure over a short period, exceeding the self-regulation range of cerebral blood vessels. At this time, the pressure in the cerebral vessels increases sharply, causing the components of the blood in the cerebral vessels to spill over into the brain tissue, manifesting some neurological symptoms, mainly severe headache, dizziness, nausea, vomiting, seizures, convulsions, and even herniation of the brain, all due to brain edema and intracranial hypertension. Malignant hypertension covers a broader range than hypertensive encephalopathy. Besides the neurological symptoms mentioned above, it also affects other systems, such as acute proteinuria, renal failure, and acute heart failure, focusing on the impact on multiple systems throughout the body, including the brain. Hypertensive encephalopathy is more focused on the reactions in the brain, so these two conditions have a common pathogenesis but focus on different aspects.
Is late-stage liver cirrhosis with liver failure easy to control?
In the late stages of cirrhosis, when the condition has progressed to liver failure, it becomes very difficult to manage. At this stage, due to liver failure, the first issue to arise is abnormal coagulation function, such as easy bleeding in patients. This will lead to severe hypoalbuminemia, causing swelling throughout the body. Additionally, bilirubin levels are very high, leading to various metabolic diseases, such as metabolic encephalopathy, which affects other organs as well. In the late stages of cirrhosis, there is also a large amount of ascites. At this time, portal hypertension is common, leading to complications such as gastric and esophageal varices rupture, bleeding, and hepatic encephalopathy, making the condition very difficult to control. If the cirrhosis is a benign lesion, at this time, adjusting liver function through methods such as artificial livers or plasma exchange can improve the condition to a manageable extent. It is critical to act quickly to perform a liver transplant, as there are no other effective treatments besides transplant, and the condition is very difficult to control.
Is pulmonary hypertension serious?
Whether pulmonary arterial hypertension (PAH) is serious depends on the cause and the severity of the PAH. It is generally categorized into mild, moderate, and severe. If the PAH is caused by diseases such as pulmonary embolism and is severe, this condition is very serious and may lead to sudden death. If it is chronic pulmonary arterial hypertension with also a severe degree and lasts for a long time, it can lead to right heart failure, and subsequently right heart failure may cause left heart failure, which is also a very serious issue. If the pulmonary hypertension is a reversible, mild condition, such as due to embolism in the pulmonary artery branches which resolves after the embolism is cleared, then the PAH can easily recover, and in this case, it is not serious. However, if it is caused by chronic lung diseases such as chronic obstructive pulmonary disease or pulmonary interstitial fibrosis leading to chronic pulmonary hypertension, it is quite serious because it is a progressively worsening disease. The pulmonary artery pressure will not decrease, and over time it will gradually worsen, eventually leading to heart failure.
Difference between hypertensive encephalopathy and malignant hypertension
The difference between hypertensive encephalopathy and malignant hypertension can be discerned from their names, indicating they are different conditions. Hypertensive encephalopathy refers to a condition where blood pressure rises sharply in a short period, with diastolic pressure exceeding 120 mmHg and systolic pressure exceeding 200 mmHg. This dramatic increase in blood pressure causes cerebral vasospasm and increased cerebral perfusion pressure, leading to various manifestations of cerebral edema, primarily severe headache, nausea, vomiting, seizures, and even brain herniation. The emphasis is on the rapid rise in blood pressure over a short term and its impact on the brain, specifically cerebral edema. Malignant hypertension also involves a rapid increase in blood pressure to extremely high levels over a short period. However, the focus of malignant hypertension is on the impact on multiple organs throughout the body, including the brain, but also severely affecting the heart, potentially causing acute left heart failure and pulmonary edema. In the kidneys, it can lead to acute renal failure, characterized by reduced urine output or anuria. Thus, malignant hypertension emphasizes the effects on multiple vital organs, whereas hypertensive encephalopathy focuses primarily on the impact on the brain and central nervous system. Hence, there are some distinctions between the two conditions.
The difference between lacunar infarction and cerebral infarction
Lacunar stroke is a type of cerebral infarction and is considered the mildest form within strokes. Generally, the area affected by a lacunar infarction is very small, so if it is a single incident or there are not many lacunar strokes, it usually does not cause any symptoms. Many middle-aged and elderly people over the age of fifty or sixty who undergo routine CT scans during physical examinations exhibit signs of lacunar stroke on their CT images, yet most of them do not present any clinical symptoms. Therefore, lacunar stroke may only affect brain function and result in symptoms such as speech difficulties, slow reactions, weakened muscle strength in the limbs, or lack of coordination when there are numerous occurrences. Cerebral infarction can include strokes that affect larger areas of the brain, which are much more severe than lacunar strokes. These larger strokes are sufficient to cause clinical symptoms, which may include hemiplegia, drooping of the corner of the mouth and drooling, abnormal limb movements, and even fatal events in cases of extensive cerebral infarction. Thus, lacunar stroke, being a type of cerebral infarction, represents the mildest form of stroke.
Does it take five years to recover from brainstem hemorrhage?
The recovery period after a brainstem hemorrhage generally refers to the acute stage immediately following the bleeding, which is also the period at risk for rebleeding. This high-risk period typically lasts one to two days. Afterwards, there is a phase of brainstem edema, lasting about 14 days, generally around 7 to 10 days, and usually resolves after two weeks. As the bleeding slowly gets absorbed over time, it typically does not take 5 years. If the bleeding is being absorbed, this usually only takes a few weeks. Once the absorption of the bleed stabilizes, the patient's condition generally becomes relatively stable. If the patient has not woken up, the likeliness of waking up several weeks later is very low. If the patient does wake up, it usually happens within about two weeks, or the bleeding may have been very minor, possibly not even causing unconsciousness. Therefore, if it has been five years and the patient's state of consciousness has not recovered, the likelihood of recovery is extremely minimal, and it is unlikely that there will be any change.
How to treat hypertensive encephalopathy
The treatment goal for hypertensive encephalopathy is mainly to rapidly reduce blood pressure to a reasonable range. Typically, intravenous antihypertensive drugs are administered to decrease blood pressure by 20%-25% within the first hour, followed by oral antihypertensives or continued intravenous treatment to further reduce it to a more reasonable level. Hypertensive encephalopathy often accompanies cerebral edema, and patients may experience increased intracranial pressure. At this point, it is necessary to administer dehydrating agents such as mannitol to treat the cerebral edema. If the patient experiences seizures, which can cause an increase in blood pressure or difficulty in reducing blood pressure, sedative anticonvulsant drugs must be administered to control the seizures. If the patient shows signs of heart failure, diuretic treatment should be initiated. Additionally, high concentration oxygen therapy under high pressure should be administered, which can be delivered through nasal cannula. If nasal oxygen therapy is ineffective, non-invasive ventilation or even intubation with invasive ventilation may be used to provide high concentration positive pressure oxygen therapy.
What causes acute severe pancreatitis?
There are many causes of severe pancreatitis, including the following: The first type is alcoholic pancreatitis, which is caused by heavy drinking leading to pancreatic damage. The second type is pancreatitis due to overeating, where consuming large amounts of food, especially high-fat foods, leads to excessive secretion by the pancreas, resulting in pancreatitis. Another type is biliary pancreatitis, caused by small gallstones from the gallbladder falling into the bile duct. Stones lodged at the opening of the pancreatic and bile ducts cause a secretion disorder in the pancreas, leading to pancreatitis. There is also hyperlipidemic pancreatitis, seen in pregnant women and patients with familial hyperlipidemia. Hyperlipidemia causes blockage of the pancreatic duct, thereby triggering an episode of pancreatitis. Another is traumatic pancreatitis, which is directly caused by external forces leading to compression or contusion injuries of the pancreas. Lastly, there is drug-induced pancreatitis, which occurs when certain medications have a direct toxic effect on the pancreas, causing damage to the pancreatic cells.
How do you get acute severe pancreatitis?
There are many causes of acute severe pancreatitis, and the mechanisms of onset are not completely the same. Biliary pancreatitis is caused by small gallstones falling into the bile duct, becoming lodged at the distal end of the duct. At this time, the opening of the pancreatic duct is blocked, causing a disorder in pancreatic juice secretion, increasing pancreatic duct pressure, and spilling out of the pancreatic duct. This can corrode pancreatic cells and other abdominal organ cells. Alcohol and drug-induced pancreatitis is due to the direct damage of alcohol and drugs to the pancreatic cells, causing the leakage of pancreatic secretions. Overeating-induced pancreatitis is caused by consuming too much food at once, especially a high-fat diet, leading to a massive secretion of pancreatic juice. If there is an obstacle in the expulsion of this juice, it can also lead to pancreatitis. Hyperlipidemic pancreatitis is caused by excessively high blood lipid levels, which form blockages. These lipids obstruct the secretion of the pancreatic duct, causing pancreatitis. In all types of pancreatitis, the leakage of pancreatic secretions corrodes the pancreatic cells and these secretions enter the abdominal cavity, corroding abdominal organs and leading to a series of severe inflammatory responses and potentially leading to abdominal infections.
Why does gastric bleeding also occur when there is bleeding in the brainstem?
This brainstem hemorrhage, as well as other severe cranial traumas or cerebral hemorrhages, if they cause a severe intracranial hypertension, will lead to a condition called stress ulcer, commonly known as Cushing's ulcer. This occurs because the increased intracranial pressure causes ischemia and hypoxia in the gastric mucosa, which then leads to localized, extensive necrosis of the gastric mucosa, resulting in upper gastrointestinal bleeding. This includes brainstem hemorrhages and many other cranial injuries and cerebral hemorrhages with intracranial hypertension as a very common complication. Therefore, it is due to the local ischemia of the gastric mucosa caused by increased intracranial pressure, leading to bleeding caused by gastric acid corrosion.