问题 多项选择题

患者患有高血压病、心衰,长期用降压药合并利尿剂,速尿每日2次,口服。

最近患者自感全身无力明显,应注意是否出现().

A.高血钾

B.低血钾

C.高血钠

D.低血钠

E.高钙血症

答案

参考答案:B, D

解析:1.速尿引起的水与电解质紊乱包括:低血容量,低血钾(症状为恶心、呕吐、腹胀、肌无力及心律失常等,严重时可引起心肌、骨骼肌及肾小管的器质性损害及肝昏迷),低血钠,低氯碱血症等。 2.急性左心衰的治疗应立即选用快作用强利尿药;常用髓袢利尿药,如静注呋塞米(速尿)20~40mg,以期迅速减少有效循环血量,减轻心脏前负荷和肺淤血及水肿。其他治疗药物包括吗啡镇静止痛、强心苷强心、硝普钠扩血管等。 3.心力衰竭是高血压病的主要并发症,也是高血压病发展的结果之一。长期高血压可累及心脏,使其损害并致心肌肥厚。在药物使用中,最好选择具有双相作用的降压药物,既能有效地降压,又能治疗心衰,最适合的药物是血管紧张素转换酶抑制剂(ACEI),这类药能明显改善左心室收缩功能、降低心脏射血压力,从而改善心衰症状,是目前能有效降低心衰患者致残率和死亡率的一线药物,临床上将其作为治疗高血压、并发心力衰竭的首选药物。其他如β受体阻滞剂、血管紧张素Ⅱ受体拮抗剂、α受体阻滞剂也可以用于治疗高血压合并心衰。钙通道阻滞剂有负性肌力作用,能导致心肌收缩力的明显抑制,因此左心功能不全的患者应尽量避免应用钙通道阻滞剂。 4.β受体阻滞剂是一种很强的负性肌力药,以往一直被禁用于心衰治疗。β受体阻滞剂治疗心衰的临床试验亦表明,治疗初期对心功能有明显的抑制作用,左心室射血分数(LVEF)降低。但长期治疗(>3个月时)则改善心功能,LVEF明显增加。这种急性药理作用与长期治疗截然不同的效应,被认为是内源性心肌功能的“生物学效应”,而且是一种时间依赖性的生物学效应。长期应用β受体阻滞剂能降低心室肌重量和容量,改善心室形状,也就是逆转心室重塑。服用时应从小剂量开始,能安全有效地治疗高血压并发心衰,可降低心脏性死亡的危险性,以及心衰患者的住院率。目前应用于心衰的β受体阻滞剂有:选择性β受体阻滞剂美托洛尔、比索洛尔;兼有β、β和α受体阻滞作用的制剂卡维地洛、布新洛尔(bucindolol)。 5.α肾上腺素能受体阻滞剂,常用的有哌唑嗪、多沙唑嗪、乌拉地尔等。它可明显松弛平滑肌,导致血压下降;同时能降低膀胱颈、 * * 内压和排尿阻力,从而减轻或解除前列腺增生症状。

单项选择题
阅读理解

根据短文内容,从短文后的选项中选出能填入空白处的最佳选项,选项中有两项为多余选项。 (请把本题答案涂在答题卡上,若所用的答题卡没有E、F、G选项,则选E涂为AB,选F涂为AC,选G涂为AD。)

Any car accident is frightening, but an accident in which your vehicle is thrown into the water, with you trapped inside, is absolutely terrifying.   1  However, most deaths result from panic, without a plan or understanding what is happening to the car in the water. By adopting a brace (支撑) position, acting decisively and getting out fast, you can save yourself from a sinking vehicle.

Brace yourself for impact (撞击力). As soon as you're aware that you're going off the road and into a body of water, adopt a brace position. The impact could set off the airbag system in your vehicle, so you should place both hands on the steering wheel in the "ten and two" position.

Undo your seatbelt.   2  Untie the children, starting with the oldest first. Forget the cell phone call. Your car isn't going to wait for you to make the call.

  3  Leave the door alone at this stage and concentrate on the window. A car's electrical system should work for up to three minutes in water, so try the method of opening it electronically first. Many people don't think about the window as an escape option either because of panic or misinformation about doors and sinking.

Break the window. If you aren't able to open the window, or it only opens halfway, you'll need to break it with an object or your foot. It may feel counter-intuitive (有悖常理的) to let water into the car.   4    

Escape when the car has equalized. If it has reached the dramatic stage where the car cabin has been filled with water and it has become balanced, you must move quickly and effectively to ensure your survival.   5  While there is still air in the car, take slow, deep breaths and focus on what you're doing.

A. Open the window as soon as you hit the water.

B. Surviving a sinking car is not as difficult as you think.

C. It takes 60 to 120 seconds for a car to fill up with water usually.

D. Such accidents are particularly dangerous to the risk of drowning.

E. In conclusion, if you know what to do in the water, you will be safe.

F. This is the first thing to attend to, yet it often gets forgotten in the panic.

G. But the sooner the window is open, the sooner you can escape directly through it.