问题 单项选择题

女,17岁,两周前感冒,一天来胸闷、气短、头晕,行走时出现眼前发黑。查体BP85/50mmHg,心律不整,心率36次/分、心电图为m度房室传导阻滞、多源性室性心律,应选用的最佳治疗方案是()

A.阿托品静注

B.异丙基肾上腺素静点

C.利多卡因静点

D.多巴胺静点

E.以上都不是

答案

参考答案:E

解析:患者心动过缓,并出现胸闷、头晕、眼前发黑等心脑组织缺氧的症状,血压偏低,心电图呈现Ⅲ度房室传导阻滞、多源性室性心律。结合患者为年轻女性,两周前有上呼吸道感染史,其病因诊断最大可能为急性病毒性心肌炎并发重症心律失常。由于患者有完全性房室传导阻滞,心律为多源性的室性心律,其起搏点极为不稳定,随时有可能出现心脏骤停或心室纤颤。同时患者已经出现了心脑供血不足的临床征象,血压低,必须在尽量短的时间内提高心室率,保持稳定的心律。选项A采用阿托品静注是一项正确的措施,但它不能保证有效地、稳定地提高及保持心室率。选项B对一般完全性房室传导阻滞伴缓慢心室率的患者是可以采用的。但本例在心率过缓的同时还伴有多源性室性心律,起搏点不稳定,应用异丙基肾上腺素较容易诱发室性心动过速或心室纤颤。在患有完全性房室传导阻滞,心室率极慢时,不应首选利多卡因,所以,选项C不是最佳选择。选项D采用多巴胺提高血压是合适的,但单纯提高血压并不能改善患者心脑缺氧的症状,更不能解决心室率过缓的问题。对于本例患者最佳的治疗选择应是立即植入心内膜起搏电极行临时心脏起搏,确保稳定的心室律和心室率。

单项选择题
阅读理解

阅读短文,选出最佳答案。

I Don’t Think I Wrote Wrong

Lao Yang was born in a small town. He liked reading when he studied at school. He thought the writers were respected(尊敬) and could get a lot of money. He wrote a lot of stories and posted them to the editorial departments (编辑部) but didn’t receive any answers.

Now he works in a factory. He’s busy at work. When he’s free, he always reads something. He always remembers he hoped to be a writer when he was young. One day, Xiao Ping, his ten-year-old daughter, came back. She looked worried and didn’t eat anything. She said Miss GAO, her Chinese teacher, told them to write a solicit article(征文) “My Father” that evening. But she did not know what to write.

“That’s easy,” said Lao Yang. “Let me help you.”

Then he sat down to write the solicit article at once. He easily finished it on time. He was sure Miss GAO would like it. But one afternoon he asked his daughter if the article had been chosen to post to the editorial department.

“My teacher said your article digressed from the subject(离题),” said the girl.

“I don’t think so,” Lao Yang shouted angrily. “I described(描写) just my father!”

1. Lao Yang wrote a lot of stories because _______.

A. he likes reading           B. he learned much at school

C. he wanted to be a writer    D. he wanted to help others

2. Lao Yang posted the stories to the editorial departments, _______.

A. and he got a lot of money         B. and he became a famous man

C. and he was respected          D. but he failed

3. As _______, Lao Yang decided to help his daughter.

A. he was a writer                B. he was free  

C. he wanted to realize his ideal     D. he wanted to make his daughter happy

4. Lao Yang hoped _______.

A. his article could surprise the teacher     B. his article could be chosen

C. the children could like his article        D. everyone could soon know him

60. Lao Yang’s solicit article digressed from the subject _______.

A. because he couldn’t write it at all       B. because he didn’t know his father well

C. because it was too bad to be chosen      D. just because he described his father