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+</div> + + + <div class="main"> + <div class="flex-container"> + <article id="post"> + + + <div class="post-head"> + <div class="post-info"> + <div class="tag-list"> + + + <span class="post-tag"> + <a href="/tags/Medicine/"> + Medicine + </a> + </span> + + + </div> + <div class="post-title"> + + + 房颤与血栓栓塞:从左心耳血流淤滞到缺血性卒中 + + + </div> + <span class="post-date"> + Aug 18, 2026 + </span> + </div> + <div class="post-img"> + + <div class="h-line-primary"></div> + + </div> +</div> + <div class="post-content"> + <p>房颤并不只是“心跳不规律”。它会破坏心房的有效收缩,使血液在左心耳等部位淤滞;同时,心房结构、内皮功能和凝血状态也会改变。血栓一旦脱落,随血流进入脑动脉,就可能引发缺血性卒中。房颤管理的核心,不是单纯把心率降下来,而是同时评估血栓风险、出血风险、症状和心律状态。</p> +<h2 id="房颤是什么"><a class="header-anchor" href="#房颤是什么">¶</a>房颤是什么</h2> +<p>房颤,即心房颤动,是一种常见的持续性心律失常。正常情况下,心房先有规律地收缩,把血液推入心室;房颤时,心房电活动变得快速、紊乱,心房不再进行有效的整体收缩,心室则以不规则节律搏动。</p> +<p>患者可能感到心悸、胸闷、乏力、活动耐量下降,也可能完全没有症状。无症状并不等于没有风险。房颤对脑卒中的影响,主要来自血流淤滞和血栓形成,而不是来自心跳“乱”本身。</p> +<p>房颤与年龄增长、高血压、心力衰竭、冠心病、瓣膜疾病、糖尿病、肥胖、睡眠呼吸暂停和甲状腺功能异常等因素有关。它还可能形成一个持续恶化的循环:房颤引起心房电和结构重塑,重塑又使房颤更容易持续。<sup class="footnote-ref"><a href="#fn1" id="fnref1">[1]</a></sup><sup class="footnote-ref"><a href="#fn2" id="fnref2">[2]</a></sup></p> +<h2 id="血栓为什么容易在房颤中形成"><a class="header-anchor" href="#血栓为什么容易在房颤中形成">¶</a>血栓为什么容易在房颤中形成</h2> +<p>房颤相关血栓形成,通常可以从三个方面理解:血流淤滞、心房组织改变和凝血倾向增强。这三个方面对应经典的血栓形成机制,即 Virchow 三要素。</p> +<h3 id="血流淤滞是最直接的因素"><a class="header-anchor" href="#血流淤滞是最直接的因素">¶</a>血流淤滞是最直接的因素</h3> +<p>正常心房收缩能够推动血液向前流动。房颤时,心房失去有效机械收缩,尤其是左心耳内的血流速度下降。左心耳是左心房的一个盲袋状结构,解剖形态复杂,血液容易在其中形成涡流和淤积。</p> +<p>房颤患者的血栓并不一定形成在心室,也不一定发生在全身静脉。典型的房颤相关血栓来自左心房,尤其是左心耳。血栓形成后,如果受到心房压力变化、心律恢复或血流剪切力影响,就可能脱落。</p> +<h3 id="心房壁会发生结构和功能改变"><a class="header-anchor" href="#心房壁会发生结构和功能改变">¶</a>心房壁会发生结构和功能改变</h3> +<p>长期房颤可能导致心房扩大、纤维化和局部内皮功能异常。心房内膜受到机械牵张和炎症信号影响后,抗凝和抗血小板的保护性状态可能减弱,促凝状态增强。</p> +<p>房颤与炎症、氧化应激、纤维化和内皮功能障碍之间存在相互作用。现有研究支持“房颤不是单纯电活动异常”的观点:它同时涉及心房结构、代谢、炎症和凝血网络。<sup class="footnote-ref"><a href="#fn1" id="fnref1:1">[1:1]</a></sup><sup class="footnote-ref"><a href="#fn3" id="fnref3">[3]</a></sup></p> +<h3 id="凝血系统可能被进一步激活"><a class="header-anchor" href="#凝血系统可能被进一步激活">¶</a>凝血系统可能被进一步激活</h3> +<p>房颤患者可能出现血小板活化、凝血酶生成增加和纤维蛋白形成增强。高血压、心力衰竭、糖尿病、慢性肾病和高龄等因素,又会进一步提高凝血和血管损伤风险。</p> +<p>因此,房颤相关血栓不是由单一因素造成的。即使患者某一次心电图没有记录到房颤,也不能据此认为血栓风险已经消失。房颤可能具有阵发性,血栓风险还受到基础疾病、既往卒中史和心房结构等因素影响。</p> +<h2 id="血栓如何变成脑卒中"><a class="header-anchor" href="#血栓如何变成脑卒中">¶</a>血栓如何变成脑卒中</h2> +<p>左心房内形成的血栓如果脱落,会进入左心室,再被泵入主动脉。血栓沿动脉进入脑循环后,可能堵塞颈内动脉、大脑中动脉或其他脑动脉分支,造成局部脑组织缺血和坏死。</p> +<p>这类卒中属于心源性栓塞。与某些小动脉粥样硬化性卒中相比,房颤相关卒中往往具有栓子较大、血管阻塞位置较近端、神经功能损害较重等特点,也更容易出现较大的梗死范围。</p> +<p>经典的 Framingham 研究把房颤确定为卒中的独立危险因素。后续指南和综述也持续把卒中预防放在房颤管理的核心位置。<sup class="footnote-ref"><a href="#fn4" id="fnref4">[4]</a></sup><sup class="footnote-ref"><a href="#fn5" id="fnref5">[5]</a></sup></p> +<p>血栓也可能进入其他器官,引起外周动脉栓塞、肠系膜缺血、肾梗死或脾梗死。不过,临床上最受关注的后果仍然是缺血性卒中和短暂性脑缺血发作。</p> +<h2 id="房颤患者的风险并不完全相同"><a class="header-anchor" href="#房颤患者的风险并不完全相同">¶</a>房颤患者的风险并不完全相同</h2> +<p>不能只根据“有没有房颤”判断是否需要抗凝。房颤患者的血栓栓塞风险存在很大差异。</p> +<p>临床通常会使用风险评分工具估计卒中风险。常见因素包括心力衰竭、高血压、年龄、糖尿病、既往卒中或短暂性脑缺血发作、血管疾病以及女性性别等。2023 年美国指南和 2024 年欧洲指南都强调,抗凝决策应以经过验证的卒中风险评估为基础,同时结合患者偏好、出血风险和临床情境。<sup class="footnote-ref"><a href="#fn6" id="fnref6">[6]</a></sup><sup class="footnote-ref"><a href="#fn7" id="fnref7">[7]</a></sup></p> +<p>风险评分的作用是帮助估计总体风险,不是替代临床判断。它也不能回答所有问题。例如,肾功能变化、近期出血、肿瘤、贫血、合并用药和高龄,都可能改变抗凝治疗的实际获益与风险。</p> +<p>出血风险评估同样重要,但“出血风险高”并不自动等于“不能抗凝”。更合理的做法是寻找可纠正因素,例如控制血压、减少不必要的抗血小板药物、避免非甾体抗炎药、处理贫血和改善肾功能监测。</p> +<h2 id="抗凝药为什么能够预防卒中"><a class="header-anchor" href="#抗凝药为什么能够预防卒中">¶</a>抗凝药为什么能够预防卒中</h2> +<p>抗凝药的作用是抑制凝血级联,减少纤维蛋白血栓形成。它并不是把已经形成的血栓“瞬间溶解”,而是降低新血栓形成和原有血栓扩大的概率。</p> +<p>目前,房颤卒中预防常用口服抗凝药包括直接口服抗凝药和华法林。直接口服抗凝药包括直接凝血酶抑制剂以及直接凝血因子 Xa 抑制剂。它们起效较快,通常不需要像华法林那样频繁调整国际标准化比值,但仍需要根据肾功能、年龄、体重、合并用药和适应证选择剂量。</p> +<p>多项随机试验的个体患者数据分析显示,直接口服抗凝药总体上适合用于非瓣膜性房颤的卒中预防,且不同年龄和性别亚组的主要疗效方向相对一致。系统综述和网络荟萃分析也支持口服抗凝药预防房颤相关卒中,但不同药物在胃肠道出血、颅内出血和其他出血结局上并不完全相同。<sup class="footnote-ref"><a href="#fn8" id="fnref8">[8]</a></sup><sup class="footnote-ref"><a href="#fn9" id="fnref9">[9]</a></sup></p> +<p>这并不意味着直接口服抗凝药对所有房颤患者都优于华法林。机械心脏瓣膜患者、部分中重度二尖瓣狭窄患者,以及某些严重肾功能异常患者,需要按照具体指南和专科医生意见选择方案。药物种类不能只凭“新药”或“方便”来决定。</p> +<h2 id="抗血小板药不能简单替代抗凝药"><a class="header-anchor" href="#抗血小板药不能简单替代抗凝药">¶</a>抗血小板药不能简单替代抗凝药</h2> +<p>阿司匹林等抗血小板药主要影响血小板功能,而房颤相关血栓形成往往以凝血和纤维蛋白网络为重要特征。对于需要抗凝的房颤患者,单用抗血小板药通常不能等效替代口服抗凝药。</p> +<p>如果患者同时存在冠状动脉疾病、冠脉支架或急性冠脉综合征,医生可能在特定阶段联合使用抗凝药和抗血小板药。但联合治疗会增加出血风险,疗程和药物组合需要严格限定,不能自行长期叠加。</p> +<h2 id="恢复窦律后,是否可以马上停抗凝"><a class="header-anchor" href="#恢复窦律后,是否可以马上停抗凝">¶</a>恢复窦律后,是否可以马上停抗凝</h2> +<p>通常不能仅因为心律恢复正常,就立即停用抗凝药。</p> +<p>房颤患者的卒中风险不仅由当天是否出现房颤决定,还与既往房颤负荷、心房结构、年龄和伴随疾病有关。部分患者会出现无症状复发,普通门诊心电图也可能无法捕捉阵发性房颤。</p> +<p>因此,抗凝治疗一般根据长期血栓栓塞风险决定,而不是只根据是否成功复律、消融或暂时没有症状决定。2024 年欧洲指南将房颤管理放在 AF-CARE 框架中,强调合并危险因素管理、避免卒中和血栓栓塞、减少症状以及动态评估治疗效果。<sup class="footnote-ref"><a href="#fn7" id="fnref7:1">[7:1]</a></sup></p> +<h2 id="房颤管理不只是“吃抗凝药”"><a class="header-anchor" href="#房颤管理不只是“吃抗凝药”">¶</a>房颤管理不只是“吃抗凝药”</h2> +<p>房颤的完整管理需要同时处理四个问题:评估并降低卒中和血栓栓塞风险;控制心率或恢复并维持窦律,以改善症状和心脏功能;管理高血压、肥胖、睡眠呼吸暂停、糖尿病、心力衰竭和饮酒等危险因素;持续监测药物安全性、肾功能、出血表现和房颤复发。</p> +<p>节律控制可能改善症状,也可能在部分患者中改善长期结局,但它不能自动替代卒中风险评估。消融治疗也不等于血栓风险永久消失。治疗目标应从“消灭一次房颤”转向长期降低房颤负荷、卒中风险和心血管并发症。</p> +<h2 id="需要立刻就医的表现"><a class="header-anchor" href="#需要立刻就医的表现">¶</a>需要立刻就医的表现</h2> +<p>如果房颤患者突然出现单侧肢体无力或麻木、口角歪斜、说话含糊、理解困难、视物异常、行走不稳或突发剧烈头痛,应立即按照卒中急救流程就医。症状即使自行缓解,也可能是短暂性脑缺血发作,不能等待观察。</p> +<p>正在服用抗凝药的患者,如果出现持续性呕血、黑便、血尿、无法止住的鼻出血、严重头痛、意识变化或跌倒撞击头部,也需要尽快就医。不要因为担心出血而自行停药,也不要因为漏服一次而擅自加倍补服。</p> +<h2 id="结语"><a class="header-anchor" href="#结语">¶</a>结语</h2> +<p>房颤与血栓栓塞的关系,可以归纳为一条连续的病理链:<strong>心房失去有效收缩,血流在左心耳等部位淤滞;心房结构、内皮和凝血状态发生改变;血栓形成并可能脱落;栓子进入脑循环后造成缺血性卒中。</strong></p> +<p>真正有价值的房颤管理,不是只关注心电图上的节律,也不是只关注心率数字,而是同时回答三个问题:患者的血栓风险有多高,抗凝的获益是否超过出血风险,以及如何降低房颤本身和相关基础疾病的负荷。对个体患者而言,具体药物、剂量和停药时机必须由医生结合病史、肾功能、年龄、合并用药和出血情况决定。</p> +<h2 id="References"><a class="header-anchor" href="#References">¶</a>References</h2> +<hr class="footnotes-sep"> +<section class="footnotes"> +<ol class="footnotes-list"> +<li id="fn1" class="footnote-item"><p>Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. “Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes.” <em>Circulation Research</em>. 2017;120(9):1501–1517. 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PMID: 22083148. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/22083148/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1161/CIRCULATIONAHA.111.019893">DOI</a> <a href="#fnref2" class="footnote-backref">↩︎</a></p> +</li> +<li id="fn3" class="footnote-item"><p>Ajoolabady A, Nattel S, Lip GYH, Ren J. “Inflammasome Signaling in Atrial Fibrillation: JACC State-of-the-Art Review.” <em>Journal of the American College of Cardiology</em>. 2022;79(23):2349–2366. PMID: 35680186. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/35680186/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1016/j.jacc.2022.03.379">DOI</a> <a href="#fnref3" class="footnote-backref">↩︎</a></p> +</li> +<li id="fn4" class="footnote-item"><p>Wolf PA, Abbott RD, Kannel WB. “Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.” <em>Stroke</em>. 1991;22(8):983–988. PMID: 1866765. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/1866765/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1161/01.STR.22.8.983">DOI</a> <a href="#fnref4" class="footnote-backref">↩︎</a></p> +</li> +<li id="fn5" class="footnote-item"><p>Essa H, Hill AM, Lip GYH. “Atrial fibrillation and stroke.” <em>Cardiac Electrophysiology Clinics</em>. 2021;13(1):243–255. PMID: 33516402. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/33516402/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1016/j.ccep.2020.11.003">DOI</a> <a href="#fnref5" class="footnote-backref">↩︎</a></p> +</li> +<li id="fn6" class="footnote-item"><p>Joglar JA, et al. “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation.” <em>Circulation</em>. 2024;149(1):e1–e156. PMID: 38033089. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/38033089/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1161/CIR.0000000000001193">DOI</a> <a href="#fnref6" class="footnote-backref">↩︎</a></p> +</li> +<li id="fn7" class="footnote-item"><p>Van Gelder IC, et al. “2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the EACTS.” <em>European Heart Journal</em>. 2024;45(36):3314–3414. PMID: 39210723. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/39210723/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1093/eurheartj/ehae176">DOI</a> <a href="#fnref7" class="footnote-backref">↩︎</a> <a href="#fnref7:1" class="footnote-backref">↩︎</a></p> +</li> +<li id="fn8" class="footnote-item"><p>Carnicelli AP, et al. “Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation: Patient-Level Network Meta-Analyses of Randomized Clinical Trials With Interaction Testing by Age and Sex.” <em>Circulation</em>. 2022;145(4):242–255. PMID: 34985309. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/34985309/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1161/CIRCULATIONAHA.121.056355">DOI</a> <a href="#fnref8" class="footnote-backref">↩︎</a></p> +</li> +<li id="fn9" class="footnote-item"><p>López-López JA, et al. “Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis.” <em>BMJ</em>. 2017;359:j5058. PMID: 29183961. <a target="_blank" rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/29183961/">PubMed</a> <a target="_blank" rel="noopener" href="https://doi.org/10.1136/bmj.j5058">DOI</a> <a href="#fnref9" class="footnote-backref">↩︎</a></p> +</li> +</ol> +</section> + +</div> + +<script> + window.onload = detectors(); +</script> + <div class="post-footer"> + <div class="h-line-primary"></div> + <nav class="post-nav"> + <div class="prev-item"> + + </div> + <div class="next-item"> + + <div class="icon arrow-right"></div> + <div class="post-link"> + <a href="/2026/08/15/%E4%BD%93%E8%B4%A8%E6%8C%87%E6%95%B0%E4%B8%8E%E8%A1%80%E8%84%82%E5%BC%82%E5%B8%B8%E7%9A%84%E5%B9%B4%E9%BE%84%E4%BE%9D%E8%B5%96%E6%80%A7%E5%85%B3%E8%81%94/">Next</a> + </div> + + </div> + </nav> +</div> + + + <div class="post-comment"> + + + + + + + +</div> + + +</article> + </div> + </div> + + <div class="footer"> + <div class="flex-container"> + <div class="footer-text"> + + + 韩暮秋 | + + + 希望路过的人可以添点柴火让这里暖和点 + + 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老年人营养不良误区 - - </a> - </div> - - <span class="post-date">Feb 16, 2026</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/2026/page/2/index.html b/archives/2026/page/2/index.html index 186a8f21..e64b3508 100644 --- a/archives/2026/page/2/index.html +++ b/archives/2026/page/2/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2026/02/16/%E8%80%81%E5%B9%B4%E4%BA%BA%E8%90%A5%E5%85%BB%E8%AF%AF%E5%8C%BA/"> + + 老年人营养不良误区 + + </a> + </div> + + <span class="post-date">Feb 16, 2026</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2026/01/09/%E8%8D%AF%E7%89%A9%E7%A0%94%E5%8F%91%E4%B8%AD%E7%9A%84%E5%88%B6%E8%8D%AF%E6%88%90%E6%9C%AC/"> 药物研发中的制药成本 diff --git a/archives/index.html b/archives/index.html index 01746201..229c5976 100644 --- a/archives/index.html +++ b/archives/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2026/08/18/%E6%88%BF%E9%A2%A4%E4%B8%8E%E8%A1%80%E6%A0%93%E6%A0%93%E5%A1%9E%EF%BC%9A%E4%BB%8E%E5%B7%A6%E5%BF%83%E8%80%B3%E8%A1%80%E6%B5%81%E6%B7%A4%E6%BB%9E%E5%88%B0%E7%BC%BA%E8%A1%80%E6%80%A7%E5%8D%92%E4%B8%AD/"> + + 房颤与血栓栓塞:从左心耳血流淤滞到缺血性卒中 + + </a> + </div> + + <span class="post-date">Aug 18, 2026</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2026/08/15/%E4%BD%93%E8%B4%A8%E6%8C%87%E6%95%B0%E4%B8%8E%E8%A1%80%E8%84%82%E5%BC%82%E5%B8%B8%E7%9A%84%E5%B9%B4%E9%BE%84%E4%BE%9D%E8%B5%96%E6%80%A7%E5%85%B3%E8%81%94/"> 体质指数与血脂异常的年龄依赖性关联:患病率轨迹与因果效应修饰 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2026/02/16/%E8%80%81%E5%B9%B4%E4%BA%BA%E8%90%A5%E5%85%BB%E8%AF%AF%E5%8C%BA/"> - - 老年人营养不良误区 - - </a> - </div> - - <span class="post-date">Feb 16, 2026</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/10/index.html b/archives/page/10/index.html index b8b0651a..1bc7423d 100644 --- a/archives/page/10/index.html +++ b/archives/page/10/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2024/06/27/%E4%BA%8C%E3%80%87%E4%BA%8C%E5%9B%9B%E5%B9%B4%E5%85%AD%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B8%83%E6%97%A5/"> + + 二〇二四年六月二十七日 + + </a> + </div> + + <span class="post-date">Jun 27, 2024</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2024/06/27/OCaml-News-2024-5/"> OCaml News 2024-5 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2024/02/26/OCaml-News-2024-3/"> - - OCaml News 2024-3 - - </a> - </div> - - <span class="post-date">Feb 26, 2024</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/11/index.html b/archives/page/11/index.html index 1866a88f..924be0c1 100644 --- a/archives/page/11/index.html +++ b/archives/page/11/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2024/02/26/OCaml-News-2024-3/"> + + OCaml News 2024-3 + + </a> + </div> + + <span class="post-date">Feb 26, 2024</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2024/02/07/%E4%BA%8C%E3%80%87%E4%BA%8C%E5%9B%9B%E5%B9%B4%E4%BA%8C%E6%9C%88%E4%B8%83%E6%97%A5/"> 二〇二四年二月七日 @@ -321,24 +339,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2023/12/01/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%B8%89%E5%B9%B4%E5%8D%81%E4%BA%8C%E6%9C%88%E4%B8%80%E6%97%A5/"> - - 二〇二三年十二月一日 - - </a> - </div> - - <span class="post-date">Dec 1, 2023</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/12/index.html b/archives/page/12/index.html index b3ad6ba6..90c3c41a 100644 --- a/archives/page/12/index.html +++ b/archives/page/12/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2023/12/01/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%B8%89%E5%B9%B4%E5%8D%81%E4%BA%8C%E6%9C%88%E4%B8%80%E6%97%A5/"> + + 二〇二三年十二月一日 + + </a> + </div> + + <span class="post-date">Dec 1, 2023</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2023/11/29/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%B8%89%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B9%9D%E6%97%A5/"> 二〇二三年十一月二十九日 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2023/10/13/%E8%82%9D%E5%8A%9F%E8%83%BD%E6%A3%80%E6%9F%A5%E5%8C%96%E9%AA%8C%E5%8D%95/"> - - 肝功能检查化验单阅读指南 - - </a> - </div> - - <span class="post-date">Oct 13, 2023</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/13/index.html b/archives/page/13/index.html index 27a6bd40..e4ac84d8 100644 --- a/archives/page/13/index.html +++ b/archives/page/13/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2023/10/13/%E8%82%9D%E5%8A%9F%E8%83%BD%E6%A3%80%E6%9F%A5%E5%8C%96%E9%AA%8C%E5%8D%95/"> + + 肝功能检查化验单阅读指南 + + </a> + </div> + + <span class="post-date">Oct 13, 2023</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2023/10/12/%E8%A1%80%E5%B8%B8%E8%A7%84%E5%8C%96%E9%AA%8C%E7%BB%93%E6%9E%9C%E9%98%85%E8%AF%BB%E6%8C%87%E5%8D%97/"> 血常规化验结果阅读指南 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2023/08/01/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%B8%89%E5%B9%B4%E5%85%AB%E6%9C%88%E4%B8%80%E6%97%A5/"> - - 二〇二三年八月一日 - - </a> - </div> - - <span class="post-date">Aug 1, 2023</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/14/index.html b/archives/page/14/index.html index 1dd9b1a4..80ba3c36 100644 --- a/archives/page/14/index.html +++ b/archives/page/14/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2023/08/01/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%B8%89%E5%B9%B4%E5%85%AB%E6%9C%88%E4%B8%80%E6%97%A5/"> + + 二〇二三年八月一日 + + </a> + </div> + + <span class="post-date">Aug 1, 2023</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2023/07/30/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%B8%89%E5%B9%B4%E4%B8%83%E6%9C%88%E4%B8%89%E5%8D%81%E6%97%A5/"> 二零二三年七月三十日 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2023/05/03/Rust-NewType-%E6%A8%A1%E5%BC%8F/"> - - Rust NewType 模式 - - </a> - </div> - - <span class="post-date">May 3, 2023</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/15/index.html b/archives/page/15/index.html index cdf41089..7c496f0b 100644 --- a/archives/page/15/index.html +++ b/archives/page/15/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2023/05/03/Rust-NewType-%E6%A8%A1%E5%BC%8F/"> + + Rust NewType 模式 + + </a> + </div> + + <span class="post-date">May 3, 2023</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2023/05/02/Rust-Partial-%E8%AF%AD%E4%B9%89/"> Rust Partial 语义 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2023/03/01/%E6%B0%94%E8%83%B8/"> - - 气胸 - - </a> - </div> - - <span class="post-date">Mar 1, 2023</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/16/index.html b/archives/page/16/index.html index d4223647..04bb9ca5 100644 --- a/archives/page/16/index.html +++ b/archives/page/16/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2023/03/01/%E6%B0%94%E8%83%B8/"> + + 气胸 + + </a> + </div> + + <span class="post-date">Mar 1, 2023</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2023/03/01/%E7%BA%AF%E7%89%9B%E5%A5%B6%E5%8F%AF%E4%BB%A5%E5%8A%A0%E7%82%B9%E5%95%A5/"> 纯牛奶可以加点啥 @@ -321,24 +339,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2022/11/03/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E6%9C%88%E4%B8%89%E6%97%A5/"> - - 二零二二年十一月月三日 - - </a> - </div> - - <span class="post-date">Nov 3, 2022</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/17/index.html b/archives/page/17/index.html index 2706f5d9..8c0ab24d 100644 --- a/archives/page/17/index.html +++ b/archives/page/17/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2022/11/03/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E6%9C%88%E4%B8%89%E6%97%A5/"> + + 二零二二年十一月月三日 + + </a> + </div> + + <span class="post-date">Nov 3, 2022</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2022/10/01/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E5%8D%81%E6%9C%88%E4%B8%80%E6%97%A5/"> 二零二二年十月一日 @@ -321,26 +339,6 @@ </div> - - - - - <div class="year-title">2020</div> - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2020/12/26/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E9%9B%B6%E5%B9%B4%E5%8D%81%E4%BA%8C%E6%9C%88%E4%BA%8C%E5%8D%81%E5%85%AD%E6%97%A5/"> - - 二零二零年十二月二十六日 - - </a> - </div> - - <span class="post-date">Dec 26, 2020</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/18/index.html b/archives/page/18/index.html index 4fd60d6e..c93e76bf 100644 --- a/archives/page/18/index.html +++ b/archives/page/18/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2020/12/26/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E9%9B%B6%E5%B9%B4%E5%8D%81%E4%BA%8C%E6%9C%88%E4%BA%8C%E5%8D%81%E5%85%AD%E6%97%A5/"> + + 二零二零年十二月二十六日 + + </a> + </div> + + <span class="post-date">Dec 26, 2020</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2020/12/09/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E9%9B%B6%E5%B9%B4%E5%8D%81%E4%BA%8C%E6%9C%88%E4%B9%9D%E6%97%A5/"> 二零二零年十二月九日 diff --git a/archives/page/2/index.html b/archives/page/2/index.html index 4620ab69..fac0106f 100644 --- a/archives/page/2/index.html +++ b/archives/page/2/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2026/02/16/%E8%80%81%E5%B9%B4%E4%BA%BA%E8%90%A5%E5%85%BB%E8%AF%AF%E5%8C%BA/"> + + 老年人营养不良误区 + + </a> + </div> + + <span class="post-date">Feb 16, 2026</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2026/01/09/%E8%8D%AF%E7%89%A9%E7%A0%94%E5%8F%91%E4%B8%AD%E7%9A%84%E5%88%B6%E8%8D%AF%E6%88%90%E6%9C%AC/"> 药物研发中的制药成本 @@ -321,24 +339,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2025/11/27/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%BA%94%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B8%83%E6%97%A5/"> - - 二〇二五年十一月二十七日 - - </a> - </div> - - <span class="post-date">Nov 27, 2025</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/3/index.html b/archives/page/3/index.html index 5d8884f7..2e317604 100644 --- a/archives/page/3/index.html +++ b/archives/page/3/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2025/11/27/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%BA%94%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B8%83%E6%97%A5/"> + + 二〇二五年十一月二十七日 + + </a> + </div> + + <span class="post-date">Nov 27, 2025</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2025/11/26/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%BA%94%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E4%BA%8C%E5%8D%81%E5%85%AD%E6%97%A5/"> 二〇二五年十一月二十六日 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2025/10/19/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%BA%94%E5%B9%B4%E5%8D%81%E6%9C%88%E5%8D%81%E4%B9%9D%E6%97%A5/"> - - 二〇二五年十月十九日 - - </a> - </div> - - <span class="post-date">Oct 19, 2025</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/4/index.html b/archives/page/4/index.html index af944b90..07fa75ec 100644 --- a/archives/page/4/index.html +++ b/archives/page/4/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2025/10/19/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%BA%94%E5%B9%B4%E5%8D%81%E6%9C%88%E5%8D%81%E4%B9%9D%E6%97%A5/"> + + 二〇二五年十月十九日 + + </a> + </div> + + <span class="post-date">Oct 19, 2025</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2025/10/19/%E6%9E%81%E7%AE%80%E4%B8%BB%E4%B9%89%E7%94%9F%E6%B4%BB%E7%9A%84%E6%9C%AC%E8%B4%A8/"> 极简主义生活的本质 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2025/06/30/ibs/"> - - 肠易激综合征 (IBS) 的病理学与药物治疗 - - </a> - </div> - - <span class="post-date">Jun 30, 2025</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/5/index.html b/archives/page/5/index.html index aa30bf6b..d746697f 100644 --- a/archives/page/5/index.html +++ b/archives/page/5/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2025/06/30/ibs/"> + + 肠易激综合征 (IBS) 的病理学与药物治疗 + + </a> + </div> + + <span class="post-date">Jun 30, 2025</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2025/06/29/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%BA%94%E5%B9%B4%E5%85%AD%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B9%9D%E6%97%A5/"> 二〇二五年六月二十九日 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2025/04/02/N-1-selects-problem-%E4%B8%8E-Prisma-ORM/"> - - N+1 selects problem 与 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href="/2025/03/13/%E9%A2%86%E5%9F%9F%E9%A9%B1%E5%8A%A8%E8%AE%BE%E8%AE%A1%E4%B8%AD%E7%9A%84%E2%80%9C%E8%81%9A%E5%90%88%E6%A0%B9%E2%80%9D/"> - - 领域驱动设计中的“聚合根” - - </a> - </div> - - <span class="post-date">Mar 13, 2025</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/7/index.html b/archives/page/7/index.html index 0af7d54a..a5b0eb24 100644 --- a/archives/page/7/index.html +++ b/archives/page/7/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2025/03/13/%E9%A2%86%E5%9F%9F%E9%A9%B1%E5%8A%A8%E8%AE%BE%E8%AE%A1%E4%B8%AD%E7%9A%84%E2%80%9C%E8%81%9A%E5%90%88%E6%A0%B9%E2%80%9D/"> + + 领域驱动设计中的“聚合根” + + </a> + </div> + + <span class="post-date">Mar 13, 2025</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2025/02/24/%E4%BA%8C%E3%80%87%E4%BA%8C%E4%BA%94%E5%B9%B4%E4%BA%8C%E6%9C%88%E4%BA%8C%E5%8D%81%E5%9B%9B%E6%97%A5/"> 二〇二五年二月二十四日 @@ -321,24 +339,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2024/11/17/%E4%BA%8C%E3%80%87%E4%BA%8C%E5%9B%9B%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E5%8D%81%E4%B8%83%E6%97%A5/"> - - 二〇二四年十一月十七日 - - </a> - </div> - - <span class="post-date">Nov 17, 2024</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/8/index.html b/archives/page/8/index.html index a5f5eacb..10fbe68f 100644 --- a/archives/page/8/index.html +++ b/archives/page/8/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2024/11/17/%E4%BA%8C%E3%80%87%E4%BA%8C%E5%9B%9B%E5%B9%B4%E5%8D%81%E4%B8%80%E6%9C%88%E5%8D%81%E4%B8%83%E6%97%A5/"> + + 二〇二四年十一月十七日 + + </a> + </div> + + <span class="post-date">Nov 17, 2024</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2024/11/15/%E8%A5%BF%E6%9F%9A%E5%AF%B9%E8%8D%AF%E7%89%A9%E7%9A%84%E5%BD%B1%E5%93%8D/"> 西柚对药物的影响 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2024/09/12/%E4%BA%8C%E3%80%87%E4%BA%8C%E5%9B%9B%E5%B9%B4%E4%B9%9D%E6%9C%88%E5%8D%81%E4%BA%8C%E6%97%A5/"> - - 二〇二四年九月十二日 - - </a> - </div> - - <span class="post-date">Sep 12, 2024</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/archives/page/9/index.html b/archives/page/9/index.html index a6ef8f62..bf835f24 100644 --- a/archives/page/9/index.html +++ b/archives/page/9/index.html @@ -164,6 +164,24 @@ <div class="post-list-item"> <div class="post-title"> + <a href="/2024/09/12/%E4%BA%8C%E3%80%87%E4%BA%8C%E5%9B%9B%E5%B9%B4%E4%B9%9D%E6%9C%88%E5%8D%81%E4%BA%8C%E6%97%A5/"> + + 二〇二四年九月十二日 + + </a> + </div> + + <span class="post-date">Sep 12, 2024</span> + </div> + + + + + + + + <div class="post-list-item"> + <div class="post-title"> <a href="/2024/09/08/%E4%B8%AD%E8%80%81%E5%B9%B4%E4%BA%BA%E6%B2%89%E8%BF%B7%E6%89%8B%E6%9C%BA%E7%9A%84%E9%97%AE%E9%A2%98/"> 中老年人沉迷手机的问题 @@ -319,24 +337,6 @@ </div> - - - - - - <div class="post-list-item"> - <div class="post-title"> - <a href="/2024/06/27/%E4%BA%8C%E3%80%87%E4%BA%8C%E5%9B%9B%E5%B9%B4%E5%85%AD%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B8%83%E6%97%A5/"> - - 二〇二四年六月二十七日 - - </a> - </div> - - <span class="post-date">Jun 27, 2024</span> - </div> - - <div id="paginator"> <div class=paginator> diff --git a/css/partials/footer.css b/css/partials/footer.css index e69de29b..16f93d9f 100644 --- a/css/partials/footer.css +++ b/css/partials/footer.css @@ -0,0 +1,18 @@ +.footer { + margin-top: auto; + border-top: 1px solid $color-border; +} +.footer .footer-text { + margin-top: $margin-m-0; + margin-bottom: $margin-m-0; +} +@media (max-width: 688px) { + .footer { + margin-top: $margin-l-0; + } + .footer .footer-text { + font-size: 0.625rem; + margin-top: $margin-s-1; + margin-bottom: $margin-s-1; + } +} diff --git a/css/partials/profile.css b/css/partials/profile.css index e69de29b..68487866 100644 --- a/css/partials/profile.css +++ b/css/partials/profile.css @@ -0,0 +1,63 @@ +.profile { + margin-top: 20vh; + display: flex; + flex-direction: row-reverse; + align-items: center; +} +.profile .profile-content { + width: 50%; + margin: 0 $margin-l-0 0 0; +} +.profile .profile-content .profile-title { + margin-top: 0; + margin-bottom: $margin-m-0; +} +.profile .profile-content .profile-body { + margin-top: 0; + margin-bottom: $margin-m-1; + color: $color-text-secondary; +} +.profile .profile-content .profile-link { + margin-top: 0; + margin-bottom: $margin-m-1; + font-size: 0.9375rem; +} +.profile .profile-content .profile-link a { + text-decoration: underline; + text-underline-offset: 3px; + transition: color $transition-duration ease; +} +.profile .profile-content .profile-link a:hover { + color: $color-accent; +} +.profile .profile-image { + width: 50%; + display: flex; + align-items: center; + justify-content: center; +} +.profile .profile-image img { + max-width: 100%; + max-height: 35vh; + object-fit: contain; +} +@media (max-width: 480px) { + .profile { + flex-wrap: wrap; + align-items: flex-start; + margin-top: $margin-l-0; + } + .profile .profile-content { + width: 100%; + margin-top: $margin-m-0; + } + .profile .profile-content .profile-link { + font-size: 0.875rem; + } + .profile .profile-image { + width: 100%; + } + .profile .profile-image img { + max-height: 25vh; + } +} diff --git a/css/post/code.css b/css/post/code.css index e69de29b..84147ae7 100644 --- a/css/post/code.css +++ b/css/post/code.css @@ -0,0 +1,79 @@ +code { + font-weight: 400; +} +.code pre span { + font-weight: 400; +} +.highlight { + margin: 0 0 $margin-m-2 0; + overflow-x: auto; + border: 1px solid $color-border; + border-radius: $margin-s-1; + background-color: $color-code-background; +} +.highlight .line { + width: $margin-l-2; +} +.highlight table { + margin: 0; + border-spacing: 0; + border: none; + background-color: transparent; +} +.highlight td.code { + padding: 0 $margin-s-1 0 $margin-m-0; +} +.highlight pre { + font-weight: 400; + background-color: transparent; +} +td.gutter { + width: $margin-l-0; + padding: 0 $margin-m-0; + vertical-align: top; + position: -webkit-sticky; + position: sticky; + left: 0; + background-color: $color-code-background; + border-right: 1px solid $color-border; + z-index: 1; +} +td.gutter pre { + margin: 0; + color: $color-code-marker; + font-size: $font-size-code; + font-weight: 400; + background-color: transparent; +} +td.code { + vertical-align: top; + background-color: transparent; +} +td.code pre { + margin: 0; + font-weight: 400; + background-color: transparent; +} +pre { + margin: 0; + overflow-x: auto; + font-weight: 400; +} +.highlight code { + background-color: transparent; + padding: 0; +} +@media (max-width: 688px) { + code { + font-size: 0.75rem; + } + .highlight pre { + font-size: 0.75rem; + } + .highlight td.gutter { + width: $margin-m-2; + padding-right: $margin-s-2; + font-size: 0.6875rem; + background-color: $color-code-background; + } +} diff --git a/css/post/mermaid.css b/css/post/mermaid.css index e69de29b..dc40ad43 100644 --- a/css/post/mermaid.css +++ b/css/post/mermaid.css @@ -0,0 +1,88 @@ +.mermaid { + display: flex; + justify-content: center; + align-items: center; + margin: $margin-l-0 auto; + padding: $margin-m-2; + background: $color-text-fourth; + border: $line-third solid $color-border; + border-radius: $margin-s-2; + cursor: pointer; + transition: all $transition-duration ease; + max-width: 100%; + overflow: auto; + position: relative; +} +.mermaid:hover { + border-color: $color-accent; + box-shadow: 0 0.25rem 0.75rem rgba(0,0,0,0.1); +} +.mermaid::after { + content: "点击放大"; + position: absolute; + bottom: $margin-s-2; + right: $margin-s-2; + font-size: $font-size-post-tag; + color: $color-text-secondary; + opacity: 0; + transition: opacity $transition-duration; +} +.mermaid:hover::after { + opacity: 1; +} +.mermaid svg { + max-width: 100%; + height: auto; +} +.mermaid-modal { + display: none; + position: fixed; + top: 0; + left: 0; + width: 100%; + height: 100%; + background: $color-overlay; + z-index: 10000; + justify-content: center; + align-items: center; + padding: $margin-primary; +} +.mermaid-modal.active { + display: flex; +} +.mermaid-modal .mermaid-close { + position: absolute; + top: $margin-m-2; + right: $margin-m-2; + width: 3rem; + height: 3rem; + background: $color-background; + border: $line-third solid $color-border; + border-radius: 50%; + cursor: pointer; + display: flex; + justify-content: center; + align-items: center; + font-size: 1.5rem; + color: $color-text-primary; + transition: all $transition-duration; +} +.mermaid-modal .mermaid-close:hover { + background: $color-accent; + color: $color-background; + border-color: $color-accent; +} +.mermaid-modal .mermaid-content { + max-width: 95vw; + max-height: 90vh; + overflow: auto; + background: $color-background; + padding: $margin-l-0; + border-radius: $margin-s-2; + box-shadow: 0 0.5rem 2rem rgba(0,0,0,0.3); +} +.mermaid-modal .mermaid-content svg { + display: block; + max-width: none; + max-height: none; +} diff --git a/page/12/index.html b/page/12/index.html index 226641fc..4524673b 100644 --- a/page/12/index.html +++ b/page/12/index.html @@ -61,119 +61,7 @@ - <meta name="generator" content="Hexo 6.3.0"><style>mjx-container[jax="SVG"] { - direction: ltr; -} - -mjx-container[jax="SVG"] > svg { - overflow: visible; -} - -mjx-container[jax="SVG"][display="true"] { - display: block; - text-align: center; - margin: 1em 0; -} - -mjx-container[jax="SVG"][justify="left"] { - text-align: left; -} - -mjx-container[jax="SVG"][justify="right"] { - text-align: right; -} - -g[data-mml-node="merror"] > g { - fill: red; - stroke: red; -} - -g[data-mml-node="merror"] > rect[data-background] { - fill: yellow; - stroke: none; -} - -g[data-mml-node="mtable"] > line[data-line] { - stroke-width: 70px; - fill: none; -} - -g[data-mml-node="mtable"] > rect[data-frame] { - stroke-width: 70px; - fill: none; -} - 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-.MathJax path { - stroke-width: 3; -} - -mjx-container[display="true"] { - overflow: auto hidden; -} - -mjx-container[display="true"] + br { - display: none; -} -</style></head> + <meta name="generator" content="Hexo 6.3.0"></head> <body> <div class="wrapper"> @@ -4626,18 +4626,18 @@ NestJS 依赖其底层 HTTP 适配器(默认为 Express)来解析传入的� </categories> </entry> <entry> - <title>二零二二年九月二十二日</title> - <url>/2022/09/22/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E4%B9%9D%E6%9C%88%E4%BA%8C%E5%8D%81%E4%BA%8C%E6%97%A5/</url> - <content><![CDATA[<p>似是而非的脸,和我的吉他,低头呢喃细语,抬头语焉不详,麦浪,烈日,溪水,咳嗽,敲打,药丸碰撞罐壁。</p> + <title>二零二二年八月二十一日</title> + <url>/2022/08/21/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E5%85%AB%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B8%80%E6%97%A5/</url> + <content><![CDATA[<p>不管是什么样的生活,都只是为了让自己满意,我这样活着,没什么不满的,我很痛快。这世上所有东西,我留意它时,它就存在,不留意时,它就是虚无。幸运的是我留意的事物很少,不致于身心劳碌一生奔忙。岁月会锤炼我一副丰满的灵魂和清瘦的欲望。</p> ]]></content> <categories> <category>gallery</category> </categories> </entry> <entry> - <title>二零二二年八月二十一日</title> - <url>/2022/08/21/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E5%85%AB%E6%9C%88%E4%BA%8C%E5%8D%81%E4%B8%80%E6%97%A5/</url> - <content><![CDATA[<p>不管是什么样的生活,都只是为了让自己满意,我这样活着,没什么不满的,我很痛快。这世上所有东西,我留意它时,它就存在,不留意时,它就是虚无。幸运的是我留意的事物很少,不致于身心劳碌一生奔忙。岁月会锤炼我一副丰满的灵魂和清瘦的欲望。</p> + <title>二零二二年九月二十二日</title> + <url>/2022/09/22/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E4%B9%9D%E6%9C%88%E4%BA%8C%E5%8D%81%E4%BA%8C%E6%97%A5/</url> + <content><![CDATA[<p>似是而非的脸,和我的吉他,低头呢喃细语,抬头语焉不详,麦浪,烈日,溪水,咳嗽,敲打,药丸碰撞罐壁。</p> ]]></content> <categories> <category>gallery</category> @@ -6134,6 +6134,85 @@ NestJS 依赖其底层 HTTP 适配器(默认为 Express)来解析传入的� </tags> </entry> <entry> + <title>房颤与血栓栓塞:从左心耳血流淤滞到缺血性卒中</title> + <url>/2026/08/18/%E6%88%BF%E9%A2%A4%E4%B8%8E%E8%A1%80%E6%A0%93%E6%A0%93%E5%A1%9E%EF%BC%9A%E4%BB%8E%E5%B7%A6%E5%BF%83%E8%80%B3%E8%A1%80%E6%B5%81%E6%B7%A4%E6%BB%9E%E5%88%B0%E7%BC%BA%E8%A1%80%E6%80%A7%E5%8D%92%E4%B8%AD/</url> + <content><![CDATA[<p>房颤并不只是“心跳不规律”。它会破坏心房的有效收缩,使血液在左心耳等部位淤滞;同时,心房结构、内皮功能和凝血状态也会改变。血栓一旦脱落,随血流进入脑动脉,就可能引发缺血性卒中。房颤管理的核心,不是单纯把心率降下来,而是同时评估血栓风险、出血风险、症状和心律状态。</p> +<h2 id="房颤是什么"><a class="header-anchor" href="#房颤是什么">¶</a>房颤是什么</h2> +<p>房颤,即心房颤动,是一种常见的持续性心律失常。正常情况下,心房先有规律地收缩,把血液推入心室;房颤时,心房电活动变得快速、紊乱,心房不再进行有效的整体收缩,心室则以不规则节律搏动。</p> +<p>患者可能感到心悸、胸闷、乏力、活动耐量下降,也可能完全没有症状。无症状并不等于没有风险。房颤对脑卒中的影响,主要来自血流淤滞和血栓形成,而不是来自心跳“乱”本身。</p> +<p>房颤与年龄增长、高血压、心力衰竭、冠心病、瓣膜疾病、糖尿病、肥胖、睡眠呼吸暂停和甲状腺功能异常等因素有关。它还可能形成一个持续恶化的循环:房颤引起心房电和结构重塑,重塑又使房颤更容易持续。<sup class="footnote-ref"><a href="#fn1" id="fnref1">[1]</a></sup><sup class="footnote-ref"><a href="#fn2" id="fnref2">[2]</a></sup></p> +<h2 id="血栓为什么容易在房颤中形成"><a class="header-anchor" href="#血栓为什么容易在房颤中形成">¶</a>血栓为什么容易在房颤中形成</h2> +<p>房颤相关血栓形成,通常可以从三个方面理解:血流淤滞、心房组织改变和凝血倾向增强。这三个方面对应经典的血栓形成机制,即 Virchow 三要素。</p> +<h3 id="血流淤滞是最直接的因素"><a class="header-anchor" href="#血流淤滞是最直接的因素">¶</a>血流淤滞是最直接的因素</h3> +<p>正常心房收缩能够推动血液向前流动。房颤时,心房失去有效机械收缩,尤其是左心耳内的血流速度下降。左心耳是左心房的一个盲袋状结构,解剖形态复杂,血液容易在其中形成涡流和淤积。</p> +<p>房颤患者的血栓并不一定形成在心室,也不一定发生在全身静脉。典型的房颤相关血栓来自左心房,尤其是左心耳。血栓形成后,如果受到心房压力变化、心律恢复或血流剪切力影响,就可能脱落。</p> +<h3 id="心房壁会发生结构和功能改变"><a class="header-anchor" href="#心房壁会发生结构和功能改变">¶</a>心房壁会发生结构和功能改变</h3> +<p>长期房颤可能导致心房扩大、纤维化和局部内皮功能异常。心房内膜受到机械牵张和炎症信号影响后,抗凝和抗血小板的保护性状态可能减弱,促凝状态增强。</p> +<p>房颤与炎症、氧化应激、纤维化和内皮功能障碍之间存在相互作用。现有研究支持“房颤不是单纯电活动异常”的观点:它同时涉及心房结构、代谢、炎症和凝血网络。<sup class="footnote-ref"><a href="#fn1" id="fnref1:1">[1:1]</a></sup><sup class="footnote-ref"><a href="#fn3" id="fnref3">[3]</a></sup></p> +<h3 id="凝血系统可能被进一步激活"><a class="header-anchor" href="#凝血系统可能被进一步激活">¶</a>凝血系统可能被进一步激活</h3> +<p>房颤患者可能出现血小板活化、凝血酶生成增加和纤维蛋白形成增强。高血压、心力衰竭、糖尿病、慢性肾病和高龄等因素,又会进一步提高凝血和血管损伤风险。</p> +<p>因此,房颤相关血栓不是由单一因素造成的。即使患者某一次心电图没有记录到房颤,也不能据此认为血栓风险已经消失。房颤可能具有阵发性,血栓风险还受到基础疾病、既往卒中史和心房结构等因素影响。</p> +<h2 id="血栓如何变成脑卒中"><a class="header-anchor" href="#血栓如何变成脑卒中">¶</a>血栓如何变成脑卒中</h2> +<p>左心房内形成的血栓如果脱落,会进入左心室,再被泵入主动脉。血栓沿动脉进入脑循环后,可能堵塞颈内动脉、大脑中动脉或其他脑动脉分支,造成局部脑组织缺血和坏死。</p> +<p>这类卒中属于心源性栓塞。与某些小动脉粥样硬化性卒中相比,房颤相关卒中往往具有栓子较大、血管阻塞位置较近端、神经功能损害较重等特点,也更容易出现较大的梗死范围。</p> +<p>经典的 Framingham 研究把房颤确定为卒中的独立危险因素。后续指南和综述也持续把卒中预防放在房颤管理的核心位置。<sup class="footnote-ref"><a href="#fn4" id="fnref4">[4]</a></sup><sup class="footnote-ref"><a href="#fn5" id="fnref5">[5]</a></sup></p> +<p>血栓也可能进入其他器官,引起外周动脉栓塞、肠系膜缺血、肾梗死或脾梗死。不过,临床上最受关注的后果仍然是缺血性卒中和短暂性脑缺血发作。</p> +<h2 id="房颤患者的风险并不完全相同"><a class="header-anchor" href="#房颤患者的风险并不完全相同">¶</a>房颤患者的风险并不完全相同</h2> +<p>不能只根据“有没有房颤”判断是否需要抗凝。房颤患者的血栓栓塞风险存在很大差异。</p> +<p>临床通常会使用风险评分工具估计卒中风险。常见因素包括心力衰竭、高血压、年龄、糖尿病、既往卒中或短暂性脑缺血发作、血管疾病以及女性性别等。2023 年美国指南和 2024 年欧洲指南都强调,抗凝决策应以经过验证的卒中风险评估为基础,同时结合患者偏好、出血风险和临床情境。<sup class="footnote-ref"><a href="#fn6" id="fnref6">[6]</a></sup><sup class="footnote-ref"><a href="#fn7" id="fnref7">[7]</a></sup></p> +<p>风险评分的作用是帮助估计总体风险,不是替代临床判断。它也不能回答所有问题。例如,肾功能变化、近期出血、肿瘤、贫血、合并用药和高龄,都可能改变抗凝治疗的实际获益与风险。</p> +<p>出血风险评估同样重要,但“出血风险高”并不自动等于“不能抗凝”。更合理的做法是寻找可纠正因素,例如控制血压、减少不必要的抗血小板药物、避免非甾体抗炎药、处理贫血和改善肾功能监测。</p> +<h2 id="抗凝药为什么能够预防卒中"><a class="header-anchor" href="#抗凝药为什么能够预防卒中">¶</a>抗凝药为什么能够预防卒中</h2> +<p>抗凝药的作用是抑制凝血级联,减少纤维蛋白血栓形成。它并不是把已经形成的血栓“瞬间溶解”,而是降低新血栓形成和原有血栓扩大的概率。</p> +<p>目前,房颤卒中预防常用口服抗凝药包括直接口服抗凝药和华法林。直接口服抗凝药包括直接凝血酶抑制剂以及直接凝血因子 Xa 抑制剂。它们起效较快,通常不需要像华法林那样频繁调整国际标准化比值,但仍需要根据肾功能、年龄、体重、合并用药和适应证选择剂量。</p> +<p>多项随机试验的个体患者数据分析显示,直接口服抗凝药总体上适合用于非瓣膜性房颤的卒中预防,且不同年龄和性别亚组的主要疗效方向相对一致。系统综述和网络荟萃分析也支持口服抗凝药预防房颤相关卒中,但不同药物在胃肠道出血、颅内出血和其他出血结局上并不完全相同。<sup class="footnote-ref"><a href="#fn8" id="fnref8">[8]</a></sup><sup class="footnote-ref"><a href="#fn9" id="fnref9">[9]</a></sup></p> +<p>这并不意味着直接口服抗凝药对所有房颤患者都优于华法林。机械心脏瓣膜患者、部分中重度二尖瓣狭窄患者,以及某些严重肾功能异常患者,需要按照具体指南和专科医生意见选择方案。药物种类不能只凭“新药”或“方便”来决定。</p> +<h2 id="抗血小板药不能简单替代抗凝药"><a class="header-anchor" href="#抗血小板药不能简单替代抗凝药">¶</a>抗血小板药不能简单替代抗凝药</h2> +<p>阿司匹林等抗血小板药主要影响血小板功能,而房颤相关血栓形成往往以凝血和纤维蛋白网络为重要特征。对于需要抗凝的房颤患者,单用抗血小板药通常不能等效替代口服抗凝药。</p> +<p>如果患者同时存在冠状动脉疾病、冠脉支架或急性冠脉综合征,医生可能在特定阶段联合使用抗凝药和抗血小板药。但联合治疗会增加出血风险,疗程和药物组合需要严格限定,不能自行长期叠加。</p> +<h2 id="恢复窦律后,是否可以马上停抗凝"><a class="header-anchor" href="#恢复窦律后,是否可以马上停抗凝">¶</a>恢复窦律后,是否可以马上停抗凝</h2> +<p>通常不能仅因为心律恢复正常,就立即停用抗凝药。</p> +<p>房颤患者的卒中风险不仅由当天是否出现房颤决定,还与既往房颤负荷、心房结构、年龄和伴随疾病有关。部分患者会出现无症状复发,普通门诊心电图也可能无法捕捉阵发性房颤。</p> +<p>因此,抗凝治疗一般根据长期血栓栓塞风险决定,而不是只根据是否成功复律、消融或暂时没有症状决定。2024 年欧洲指南将房颤管理放在 AF-CARE 框架中,强调合并危险因素管理、避免卒中和血栓栓塞、减少症状以及动态评估治疗效果。<sup class="footnote-ref"><a href="#fn7" id="fnref7:1">[7:1]</a></sup></p> +<h2 id="房颤管理不只是“吃抗凝药”"><a class="header-anchor" href="#房颤管理不只是“吃抗凝药”">¶</a>房颤管理不只是“吃抗凝药”</h2> +<p>房颤的完整管理需要同时处理四个问题:评估并降低卒中和血栓栓塞风险;控制心率或恢复并维持窦律,以改善症状和心脏功能;管理高血压、肥胖、睡眠呼吸暂停、糖尿病、心力衰竭和饮酒等危险因素;持续监测药物安全性、肾功能、出血表现和房颤复发。</p> +<p>节律控制可能改善症状,也可能在部分患者中改善长期结局,但它不能自动替代卒中风险评估。消融治疗也不等于血栓风险永久消失。治疗目标应从“消灭一次房颤”转向长期降低房颤负荷、卒中风险和心血管并发症。</p> +<h2 id="需要立刻就医的表现"><a class="header-anchor" href="#需要立刻就医的表现">¶</a>需要立刻就医的表现</h2> +<p>如果房颤患者突然出现单侧肢体无力或麻木、口角歪斜、说话含糊、理解困难、视物异常、行走不稳或突发剧烈头痛,应立即按照卒中急救流程就医。症状即使自行缓解,也可能是短暂性脑缺血发作,不能等待观察。</p> +<p>正在服用抗凝药的患者,如果出现持续性呕血、黑便、血尿、无法止住的鼻出血、严重头痛、意识变化或跌倒撞击头部,也需要尽快就医。不要因为担心出血而自行停药,也不要因为漏服一次而擅自加倍补服。</p> +<h2 id="结语"><a class="header-anchor" href="#结语">¶</a>结语</h2> +<p>房颤与血栓栓塞的关系,可以归纳为一条连续的病理链:<strong>心房失去有效收缩,血流在左心耳等部位淤滞;心房结构、内皮和凝血状态发生改变;血栓形成并可能脱落;栓子进入脑循环后造成缺血性卒中。</strong></p> +<p>真正有价值的房颤管理,不是只关注心电图上的节律,也不是只关注心率数字,而是同时回答三个问题:患者的血栓风险有多高,抗凝的获益是否超过出血风险,以及如何降低房颤本身和相关基础疾病的负荷。对个体患者而言,具体药物、剂量和停药时机必须由医生结合病史、肾功能、年龄、合并用药和出血情况决定。</p> +<h2 id="References"><a class="header-anchor" href="#References">¶</a>References</h2> +<hr class="footnotes-sep"> +<section class="footnotes"> +<ol class="footnotes-list"> +<li id="fn1" class="footnote-item"><p>Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. “Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes.” <em>Circulation Research</em>. 2017;120(9):1501–1517. 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