问题 问答题 简答题

常见三音心律的产生机理,听诊特点及临床意义

答案

参考答案:

1)舒张期额外心音:

①奔马律:心率在100次/分以上,在S2之后出现病理性S或S,分别形成室性奔马律(舒张早期奔马律)或房性奔马律(舒张晚期奔马律)。室性奔马律提示左室舒张期容量负荷过重,心肌功能严重障碍。房性奔马律提示心室收缩期压力负荷过重,室壁顺应性降低,见于压力负荷过重引起心肌肥厚的心脏病。

②其他:包括开瓣音、心包叩击音、肿瘤扑落音等。开瓣音见于二尖瓣狭窄,在心尖内侧最清晰,高调、拍击样,说明二尖瓣弹性和活动尚好;心包叩击音见于缩窄性心包炎,在心尖部和胸骨下段左缘最清晰,较强、短促;肿瘤扑落音见于左房黏液瘤,在心尖部及胸骨左缘3~4肋间最清晰,可随体位变动而变化,调低。

2)收缩期额外心音:

①收缩早期喷射音(收缩早期喀嚓音):心底部最清晰,分为肺动脉喷射音和主动脉喷射音。分别见于肺动脉压增高和高血压以及主动脉瓣病变;

②收缩中晚期喀嚓音:见于二尖瓣脱垂,呈高调、"张帆"样声响,在心尖部及内侧清晰,随体位而变化,常合并收缩晚期杂音。

填空题
填空题

a. The government is desperate to sell the most troubled of South Korea’s big companies to foreigners. This, ministers believe, is the best way to accelerate the corporate restructuring begun in the wake of the Asian financial crisis in 1997, and to clear the way for more sustainable economic growth.
b. GM’s deal with Daewoo Motor marks the end of an even longer and more painful process. Ford almost bought the car maker two years ago, but pulled out after deciding that Daewoo would be too hard to turn round.
c. Micron had offered to pay about MYM3.4 billion for Hynix’s core memory business, and to take a minority stake in the non—memory arm. Analysts predict that the government will put pressure on creditors to rescue a deal with Micron or seek a new buyer, as liquidation is too risky to contemplate in an election year.
d. This week, after months of on—off talks with foreign suitors, the government’s plans moved a big step forward, and then an equally big step back.
e. But GM has much work to do to rebuild Daewoo’s damaged brand image and domestic market share, which hovers around 10% after reaching a high of 37% in 1998. GM has to fill holes in product lines by introducing sport—utility and multi—purpose vehicles, says Nick Reilly, former chief executive of Vauxhall, GM’s British subsidiary, and chief—executive— designate of GM—Daewoo now that he has sealed the deal.
f. GM has struck a good deal. Together with various undisclosed partners, it will hold a 67% stake in a new company, tentatively named GM—Daewoo. The American car maker will pay MYM251m for its own stake of 42%, but it will also assume MYM573m of Daewoo Motor’s debts. The acquisition is a key part of GM’s global expansion. The company has been trying to strengthen its foothold in Asia for some time.
g. On April 30th General Motors (GM) signed a contract to buy the bankrupt Daewoo Motor. But on the same day, the board of Hynix, a cash—strapped memory—chip giant, shocked the markets by rejecting a proposed takeover by Micron Technology, an American competitor.
h. His management team can expect trouble from South Korea’s aggressive unions along the way. In a sign of things to come, the signing ceremony was moved to a secret location after a group of union activists occupied the hotel where it was due to take place.
i. Buying a presence in South Korea was seen as particularly urgent, since imports account for only 3% of the 1.5mcars sold in the country each year. GM hopes to use Daewoo’s production lines to make budget cars that will be sold under the Daewoo brand in most markets.
j. GM had been talking with Daewoo for over a year. It has agreed to buy two of the company’s four domestic car plants, a factory in Vietnam, a parts unit in the Netherlands and nine overseassales arms (all in Europe except one, in Puerto Rico of all places). Between them, the two domestic factories can churn out a combined 530,000 cars and 30,000 commercial vehicles a year.

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