问题 单项选择题

18岁男性胰岛素依赖型糖尿病患者,2天前中断胰岛素后出现昏迷,血糖420mg/dl (23mmol/L),经抢救并静脉滴注碳酸氢钠后血糖下降,神志好转,酸中毒减轻,但不久又进入昏迷,其最可能的原因是

A.并发脑水肿

B.并发低血糖

C.并发脑血管意外

D.并发乳酸酸中毒

答案

参考答案:A

解析:
最大可能是脑水肿,由于血糖下降过快,输注碳酸氢钠过早过多,虽然血糖下降、酸中毒减轻,神志一过性好转,但由于发生了脑水肿,很快又进入昏迷。不大可能由高血糖突然并发低血糖,也不会在酸中毒减轻的情况下又并发乳酸酸中毒昏迷,并发脑血管意外和并发肾功能衰竭均无病史资料提供,所以可能性亦不大。该患者因为中断胰岛素而昏迷。补救办法以再给胰岛素为宜,而静脉滴注碳酸氢钠可能过早或过量。CO2经血脑屏障的弥散能力强于HCO3ˉ,快速补碱后,血pH上升,而脑脊液的pH仍较低,引起脑细胞酸中毒,会加重昏迷;回升的pH和保持低浓度的2,3-DPG均能加强 Hb与O2的亲和力,不利于氧的释放,因而组织供氧受影响,有诱发和加重脑水肿的危险;过多的碱可促进K+向细胞内转移和诱发反跳性碱中毒。以上诸项都提示过早过快补碱是有危险的。

阅读理解

Ron loved basketball. One afternoon on his way to a basketball game, he was walking and dreaming about playing college basketball the following year. As Ron was walking to the game, a car hit him so hard that he was thrown three feet into the air.

Ron woke up in a hospital room. When he learned that both his legs were broken, he realized his college basketball dreams were over. Ron did what the doctors told him, but his progress was slow. When he left the hospital, Ron was sent to a health center for physical treatment.

A week after he arrived there, he met Sunny. Sunny was a coach.His legs were hurt  paralysed(瘫痪的) from a skiing accident. Even though he couldn’t move his legs, Sunny coached of a basketball team called the Suns. Everybody on the team played from a wheelchair. Sunny invited Tony to join the game. Tony played badly, but for the first time since the accident, he stopped feeling sorry for himself.

After becoming a part of the Suns, Ron improved quickly. Basketball was like   medicine for him. And whenever Ron became depressed or angry, Sunny was there to encourage and help him. The day before Ron left the center, he had dinner with Sunny. He asked Sunny how he managed to be generous and cheerful, even with his paralysis.

Sunny smiled and said, “It’s really quite easy. When you keep your face to the sun, the shadows(阴影) fall behind.”

小题1:What happened to Ron on his way to a basketball game?

A.A car hit him.

B.He met his coach.

C.His doctor called him.

D.He fell down and cut his foot.小题2: The underlined word “depressed” means ___ in Chinese.

A.懒惰的

B.好奇的

C.沮丧的

D.激动的小题3:What is the most important thing we can learn from the story?

A.Basketball can teach people about life.

B.Keep smiling when you face difficulties.

C.Life is more difficult for the paralysed.

D.Skiing is more dangerous than basketball.

单项选择题