问题 多项选择题 案例分析题

患者男性,62岁,因“原发性肝癌,乙型病毒性肝炎后肝硬化”来诊。行原位肝移植术。术后常规免疫抑制治疗,他克莫司+吗替麦考酚酯+甲泼尼龙。术后第9日,患者的血红蛋白开始下降,胆红素逐渐上升。第11日,血红蛋白降至67g/L,血清总胆红素升至295.67mmol/L。患者呈贫血貌,乏力,皮肤巩膜黄染。急行胆道造影及胸、腹CT检查,排除胆道并发症、腹腔及消化道出血或全身感染可能。患者转氨酶持续下降,胆汁量及颜色正常,不考虑排斥反应。遂给予A型浓缩红细胞2U,术后12日,血红蛋白降至52g/L,血清总胆红素282.34mmol/L。抗人球蛋白试验(Coomb):直接抗人球蛋白阳性,间接抗人球蛋白阴性,考虑为免疫性溶血性贫血。

针对患者,可采用的治疗方法为()

A.糖皮质激素

B.输血

C.脾切除

D.免疫抑制剂

E.静脉滴注人免疫球蛋白

F.预防感染

G.去铁胺

H.保肝治疗

答案

参考答案:A, B, D, E, F, H

选择题
单项选择题

At the tail end of the 19th century, Friedrich Nietzsche suggested that natural history— which he saw as a war against fear and superstition-ought to be narrated "in such a way that everyone who hears it is irresistibly inspired to strive after spiritual and bodily health and vigour," and he grumbled that artists had yet to discover the right language to do this. "None the less," Nietzsche admitted, "the English have taken admirable steps in the direction of that ideal... the reason is that they [natural history books] are written by their most distinguished scholars—whole, complete and fulfilling natures. "
The English language tradition of nature writing and narrating natural history is gloriously rich, and although it may not make any bold claims to improving health and wellbeing, it does a good job—for readers and the subjects of the writing. Where the insights of field naturalists meet the legacy of poets such as Clare, Wordsworth, Hughes and Heaney, there emerges a language as vivid as any cultural achievement.
That this language is still alive and kicking and read every day in a newspaper is astounding. So to hold a century’s worth of country diaries is, for an interloper like me, both an inspiring and humbling experience. But is this the best way of representing nature, or is it a cultural default Will the next century of writers want to shake loose from this tradition What happens next
Over the years, nature writers and country diarists have developed an increasingly sophisticated ecological literacy of the world around them through the naming of things and an understanding of the relationships between them. They find ways of linking simple observations to bigger issues by remaining in the present, the particular. For writers of my generation, a nostalgia for lost wildlife and habitats and the business of bearing witness to a war of attrition in the countryside colours what we’re about. The anxieties of future generations may not be the same.
Articulating the "wild" as a qualitative character of nature and context for the more quantitative notion of biodiversity will, I believe, become a more dynamic cultural project. The re-wilding of lands and seas, coupled with a re-wilding of experience and language, offers fertile ground for writers. A response to the anxieties springing from climate change, and a general fear of nature answering our continued environmental injustices with violence, will need a reassessment of our feelings for the nature we like—cultural landscapes, continuity, native species-as well as the nature we don’t like—rising seas, droughts, "invasive" species.
Whether future writers take their sensibilities for a walk and, like a pack of wayward dogs unleashed, let them loose in hills and woods to sniff out some fugitive truth hiding in the undergrowth, or choose to honestly recount the this-is-where-I-am, this-is-what-I-see approach, they will be hitched to the values implicit in the language they use. They should challenge these. Perhaps they will see our natural history as a contributor to the commodification of nature and the obsessive managerialism of our times. Perhaps they will see our romanticism as a blanket thrown over the traumatised victim of the countryside. But maybe they will follow threads we found in the writings of others and find their own way to wonder.

Which of the following statements is NOT in agreement with the author’s view

A.The English tradition of nature writing should be reflected and reconsidered.

B.The values implicit in the language of natural history should be challenged.

C.The re-wilding of human experience and language will greatly benefit us.

D.The re-wilding of lands and seas will bring us more disasters.