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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
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.
Precursors of respiratory failure
Respiratory failure can be a very acute condition, or it may evolve gradually due to chronic diseases. The basic precursors of respiratory failure generally include hypoxia or hypercapnia. In the early stages of hypoxia, patients may experience excitement or irritability, characterized by rapid breathing and possibly sweating due to the effort of breathing. Symptoms include accelerated breathing and hypoxia; the patient’s lips may also turn blue. If the level of carbon dioxide increases, once past the initial period of excitement and as the hypoxia worsens, the person may become listless. Gradually, their consciousness may become unclear, manifesting as drowsiness or possibly even coma.
Can I drink fish soup with brainstem hemorrhage?
The patient experienced a brainstem hemorrhage, and if the bleeding is extensive, it's possible that the patient could be in a deep coma. In more severe cases, brain death could occur, where the patient would not be able to breathe on their own. Since the pathology mainly occurs in the brain, when the patient is in a coma, they are certainly not able to eat by themselves. At this time, feeding usually involves the insertion of a tube through the nose down to the stomach, called a nasogastric tube. Through this tube, food is delivered directly to the stomach, allowing for gastrointestinal nutrition. Commonly, the gastrointestinal function of such patients remains normal, so it is possible to administer liquid nutrition through the nasogastric tube, such as nutrient solutions or fish soup, without any issues.
Symptoms of stroke worsened in the elderly
Elderly people who experience a cerebral infarction (stroke) may show several typical symptoms if the condition worsens. Firstly, their speech may suddenly become unclear, accompanied by a slight drooping of the mouth and drooling. Another symptom is difficulty in extending the tongue straight out, as it may not align centrally. Additionally, there may be weakness in the limbs. These symptoms indicate the presence of a new cerebral infarction lesion. In such cases, it is crucial to promptly go to the hospital for a head CT scan or an MRI to determine whether the scope of the stroke has expanded or if a new stroke has occurred.
How long does it take to cure acute severe pancreatitis?
Acute severe pancreatitis is a disease with a long treatment period and high treatment costs. Acute severe pancreatitis is pathologically staged, generally divided into the organ failure phase, also known as the inflammatory response phase. Typically, this occurs within 7 days after the onset of severe pancreatitis, during which there is a massive release of inflammatory factors, causing multiple organ failures. This stage is perilous and often requires the support of multiple organ functions, such as ventilators and hemofiltration treatments. After this inflammatory response phase, it transitions into a chronic phase of abdominal infection, which occurs approximately one week to one or two months after the onset. At this time, there is a large amount of effusion in the abdominal cavity, and some of the effusion may develop secondary infections. The main treatment at this stage involves puncture drainage of the effusion. Once an infection is detected, puncture drainage is performed on the infected site to manage the infection. Therefore, the treatment period for severe pancreatitis primarily depends on the duration of organ function support, recovery time of organ functions, and the severity of the infection. Some organ function support may be prolonged, requiring several months, and sometimes irreversible conditions occur, such as acute renal failure transitioning into chronic renal failure. Abdominal infections are more complex. If the infection is severe and recurrent, long-term puncture drainage or surgical removal of the infection may be necessary, often requiring several months of treatment.
The difference between severe pancreatitis and mild pancreatitis
Generally speaking, mild pancreatitis is just a local inflammation of the pancreas, usually manifested as upper abdominal pain, nausea, vomiting, and bloating — symptoms of the gastrointestinal tract. Severe pancreatitis, however, is much more serious than mild pancreatitis. In severe pancreatitis, not only is the pain in the local pancreas area more intense and the abdominal bloating more pronounced, but there is also a lot of effusion accumulating in the abdomen. Severe pancreatitis can also affect many other organs, such as the lungs, which are most commonly affected. It can lead to patients developing acute respiratory distress syndrome, characterized by severe hypoxemia, with many patients requiring mechanical ventilation treatment. Another organ that is commonly affected is the kidney, with many patients with severe pancreatitis experiencing acute renal failure, reduced urine output, or even anuria. Severe pancreatitis can also affect the heart, brain, and other organs, leading to functional abnormalities in these organs. Therefore, besides affecting the local pancreas, severe pancreatitis can involve other important organs, resulting in multiple organ dysfunctions.