男性，35岁，患类风湿关节炎半年，因症状明显而经常服用扶他林等NSAIDs类药物，导致NSAIDs相关溃疡，但患者尚不能中止NSAIDs治疗，针对溃疡最好加用
A．硫糖铝
B．枸橼酸铋钾
C．米索前列醇
D．奥美拉唑
参考答案：C
解析： 保护胃黏膜药物(1)硫糖铝的抗溃疡机制主要与其粘附覆盖在溃疡而上阻止胃酸/胃蛋白酶侵蚀溃疡面、促进内源性前列腺素合成和刺激表皮生长因子分泌等有关。硫糖铝全身不良反应少，但便秘常见。(2)枸橼酸铋钾(胶体次枸橼酸铋)除具类似硫糖铝的作用机制外，并有较强抑制幽门螺杆菌作用。短期服用除舌苔发黑外很少有不良反应；长期服用可能发生铋在体内过量积蓄而引起神经毒性，故不宜长期服用。(3)米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液和碳酸氢盐分泌和增加黏膜血流等作用；腹泻是常见不良反应，因会引起子宫收缩故孕妇忌服。
| 完形填空 I finished my last work of the week and could hardly wait to get home, take off my nursing shoes, and relax. As I _1_ my car, I saw one of my _2_ standing by the bus stop. I thought it would only take a couple of extra minutes to give her a ride home, and _3_, it was too cold to be standing outside on the coldest _4_ in January. I didn't know where she lived, but I was _5_ I would be able to find my way back. We _6_ about our work as I drove and _7_ we knew it, we arrived at her house. I started driving back. _8_ looked familiar, but at first that didn't _9_ me. But soon I _10_ something wrong. I recognized nothing. But I told myself to stay _11_. I was _12_ neighborhoods, streets and even streetlights. I no longer knew where I was now. How could I be so stupid! I looked down at my _13_. It was now 2:30 a.m. My gas was slowly running out. I _14_ the car and turned off the engine. In total defeat, I put my head down on the wheel, _15_. Then I raised my head and saw a(n) _16_ down the road in front of me. I turned my headlights on. A car! I drove a little _17_, got out of my car and knocked on the window of that car. An elderly man _18_ rolled his window down. I said that I didn't know how to get back into town. In silence, he started driving. I ran back to my car and drove behind him. Finally I _19_ a familiar street. As I turned to head home, the car disappeared. Then I _20_ my driveway (车道) when the warning light for my gas tank (汽油箱) turned on. Though so many years have passed, I still thank the old man from my deepest heart. | ||||
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