患者，男性，13岁，因"脊柱侧弯"入院。拟行"脊柱侧弯截骨矫形植骨融合内固定术"。既往有青霉素过敏史，头孢唑林皮试阳性。 围术期预防用抗菌药物的给药时机是（）
A.术前3天
B.术前24小时
C.术前0.5～2小时
D.切皮时
E.手术结束回到病房后
参考答案：C
解析：
本题考查围术期抗菌药物的选择及药学监护。该患者拟行"脊柱侧弯截骨矫形植骨融合内固定术"，具有预防使用抗菌药物的指征，首选头孢菌素。因患者头孢唑林皮试阳性，应首选克林霉素治疗。克林霉素的给药时机是术前0.5～2小时。该患者使用克林霉素时需按年龄和体重计算给药剂量，选择适宜的溶媒和滴速。
术后出现颅内感染，包括可能的致病菌、敏感药物、是否透过血脑屏障，青少年能否使用等。脑脊液细菌培养结果显示对耐甲氧西林金黄色葡萄球菌，应首选万古霉素，因其对耐甲氧西林金黄色葡萄球菌有效，且能透过血脑屏障，可应用于青少年，但需监护其耳、肾毒性。
Monty was the son of a horse trainer. When he was in his ninth grade, he was asked to write a __31__ about what he wanted to be and do when he grew up. That night he wrote a seven-page paper saying that someday he’d __32__ a horse ranch (牧场). He wrote about his dream in great detail and he __33__ drew a picture of a 200-acre ranch with all the buildings. He put a great deal of his __34__ into the project and the next day he handed it in __35__ his teacher. Two days later he received his paper back. On the front page was a large red F with a __36__ that read, “See me after class.” The boy with the dream went to see the teacher after class and asked, “__37__ did I receive an F?” The teacher said, “This is an __38__ dream for a young boy like you. You come from a poor family. Owning a horse ranch requires a lot of __39__. You have to buy the land. You have to pay for other things. There is no__40__ you could ever do it.” Then the teacher added, “__41__ you rewrite this paper with a more realisticgoal, I will reconsider your grade.” The boy went home and thought about __42__ long and hard. He asked his father what he should do. His father said, “Look, son, you have to make up your own mind on this. However, I think it is a very important __43__ for you.” Finally, after sitting with it for a week, the boy turned in the __44__ paper, making no changes at all. He said to the teacher, “You can keep the F and I’ll keep my 45 .”
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