问题 问答题 简答题

简述术中发生喉痉挛和支气管痉挛的原因、表现及处理。

答案

参考答案:

原因:正常情况下声门闭合反射是使声门关闭,以防异物或分泌物吸入气道。喉痉挛则是因支配咽部的迷走神经兴奋性增强,使咽部应激性增高,致使声门关闭活动增强。硫喷妥钠是引起喉痉挛的常用全麻药。喉痉挛多发生于全麻Ⅰ~Ⅱ期麻醉深度,其诱发原因是低氧血症、高二氧化碳血症、口咽部分泌物与反流胃内容刺激咽喉部,口咽通气道、直接喉镜、气管插管操作等直接刺激喉部均可诱发喉痉挛,浅麻醉下进行手术操作如扩张肛门括约肌等均可引起反射性喉痉挛。

表现:轻度喉痉挛仅吸气时呈现喉鸣,中度喉痉挛吸气和呼气都出现喉鸣音,重度喉痉挛声门紧闭气道完全阻塞。

处理:轻度喉痉挛在去除局部刺激后会自行缓解,中度者需用面罩加压吸氧治疗,重度者可用粗静脉输液针行环甲膜穿刺吸氧,或静注琥珀胆碱迅速解除痉挛,然后加夺吸氧或立即行气管插管进行人工通气。

单项选择题 A1/A2型题
单项选择题

On the first Earth Day, the U.S. was a poisoned nation. Dense air pollution blanketed cities like Los Angeles, where smog alerts were a fact of life. Dangerous pesticides like DDT were still in use, and water pollution was rampant—symbolized by raging fires on Cleveland’s Cuyahoga River. But the green movement that was energized by Earth Day— and the landmark federal actions that followed it—changed much of that. Today air pollution is down significantly in most urban areas, the water is cleaner, and even the Cuyahoga is home to fish again.

But if the land is healing, Americans may be sickening. Since World War Ⅱ, production of industrial chemicals has risen rapidly, and the U.S. generates or imports some 19 billion kg of them per day. These aren’t the sorts of chemicals that come to mind when we picture pollution—huge plants spilling contaminated wastewater into rivers. Rather, they’re the molecules that make good on the old "better living through chemistry" promise, appearing in items like unbreakable baby bottles and big-screen TVs. Those chemicals have a, habit of finding their way out of everyday products and into the environment—and ultimately into living organisms. A recent biomonitoring survey found traces of 212 environmental chemicals in Americans—including toxic metals, pesticides, etc. "It’s not the environment that’s contaminated so much," says the director of the Cincinnati Children’s Environmental Health Center. "It’s us."

As scientists get better at detecting the chemicals in our bodies, they’re discovering that even tiny quantities of toxins can have a potentially serious impact on our health—and our children’s future. Chemicals like bisphenol A (BPA) and phthalates—key ingredients in modern plastics—may disrupt the delicate endocrine system. A host of modern ills that have been rising unchecked for a generation—obesity, diabetes, attention-deficit disorder —could have chemical connections. "We don’t give environmental exposure the attention it deserves," says Dr. Philip Landrigan. "But there’s an emerging understanding that kids are uniquely susceptible to environmental hazards."

Washington has been slow to arrive at that conclusion. The Toxic Substances Control Act (TSCA), the 34-year-old vehicle for federal chemical regulation, has generally been a failure. The burden of proving chemicals dangerous falls almost entirely on the government. And the Environmental Protection Agency (EPA) has been able to issue restrictions on only a handful of chemicals and has lacked the power to ban even some dangerous cancer-causing substances.

But change is coming. The Obama Administration is taking a closer look at chemicals. More important, Congress may finally be ready to act. "We can’t permit this assault on our children’s health—and our own health—to continue," says Senator Frank Lautenberg.

Which of the following is true according to Paragraph 1()

A. Earth Day is the only day for people to participate in green movement

B. Earth Day motivated people to change the polluted environment

C. Los Angeles once had environmental problems like water pollution

D. The raging fires on Cleveland’s Cuyahoga River resulted from smog