问题 多项选择题 案例分析题

患者女,67岁,因“COPD恶化和肺炎”住院。期间行气管内插管机械通气。虽然临床症状好转,但试图停止机械通气时不成功。住院期间行气管造口术15d。现医师希望行非侵入性通气。血氧计监测血氧饱和度(SpO2),红外线二氧化碳监测仪连接到通气装置监测终末潮气二氧化碳分压(PETCO2)。第15天实验室检查:pH7.41~7.45,FiO20.40,HCO332~36mmol/L,COHb1.5%~1.8%,PaCO256~63mmHg,高铁血红蛋白(MetHb)0.8~1.0,PaO270~88mmHg,Hb132~134g/L,SaO290%~93%。

如果你希望患者自主呼吸,不用机械通气仅保持插管作预警装置。适合的方法是(提示接下来几天患者保持稳定,机械通气逐渐减慢,直至停止使用。住院3周后,只用最小的通气支持(IMV模式,R4次/min),患者无不适。非侵入性检验:FIO20.30,SpO293%,PETCO234mmHg,血浆CO36mmol/L。)()

A.在移除通气装置前插入一个动脉管,自主性呼吸1h后复查血气,如果可以接受则拔管

B.自主性呼吸1h后单次查动脉血气,如果可以接受则拔管

C.第1个小时自主呼吸15min,第2个小时自主呼吸30min,第3个小时自主呼吸45min,第4个小时自主呼吸60min,如果每次非侵入性检测值可以接受则拔管

D.随着非侵入性检测和自主呼吸,15min后如果适应,SpO2和PETCO2可接受则拔管

E.随着非侵入性检测和自主呼吸,1h后如果适应,SpO2和PETCO2可接受则拔管

F.随着非侵入性检测和自主呼吸,30min后如果适应,SpO2和PETCO2可接受则拔管

答案

参考答案:E

阅读理解

阅读理解。

    I'm Mary. I have a piece of good news to tell you. My parents bought a new flat in

the centre of the city. The rooms are not big, but they are all comfortable. There are

more rooms than our old flat. I am excited (激动) because I have my own bedroom.

In the old flat, I share the bedroom with my sister.

    My favourite room in the new flat is my bedroom. I can be alone (单独) in it. It is

my own small world. I can listen to music, read comics and chat with my friends on

the phone. I can also look for things on the Internet and send e-mails to my e-friends.

    Kitchen is my favourite room, too. I like helping my mother with the cooking. She is

not only a good teacher but also a good cook. She often teaches me how to make some

different dishes. She lived in Sichuan when she was a child. So she likes hot food and

she can cook very delicious hot food.

1. What's Mary's new flat like? [ ]

A. Big and comfortable

B. Small and not comfortable

C. Big but not comfortable

D. Small but comfortable

2. Mary can do the following things in the bedroom except (除了) _____. [ ]

A. play the piano

B. chat with her friends

C. send e-mails

D. listen to music

3. Which room does Mary like best? [ ]

A. The kitchen

B. Her bedroom

C. The sitting room

D. Both A and B

4. What does Mary's mother do? [ ]

A. A teacher.

B. A nurse.

C. A housewife.

D. A worker.

5. Where did Mary's mother live when she was a child? [ ]

A. The old flat

B. The centre of the city

C. Sichuan

D. The new flat

单项选择题