问题 问答题 简答题

急性心肌梗死诊断

答案

参考答案:

1.临床表现

(1)先兆:急性心肌梗死多为突然起病,少数患者起病隐袭。多数患者发生明显心肌梗死之前数日,有乏力、胸部不适,活动时心悸、气急、烦躁、心绞痛发作规律改变等。

(2)疼痛:胸痛是急性心肌梗死中出现最早最为突出的症状。疼痛部位多与心绞痛相似,但疼痛程度更加剧烈,持续时间更长,可达数小时或数日,休息和含服硝酸甘油不能缓解,患者常常伴有烦躁不安、出汗、恐惧或濒死感。

(3)心力衰竭和休克:心衰和休克理应属于急性心肌梗死的并发症,但由于较常见,且出现较早,症状显著,故亦被列为急性心肌梗死的主要症状。两者的发生率较高,可单独存在或同时出现。急性心肌梗死的休克主要是心源性,由于心肌广泛坏死、心排血量急剧下降所致。严重的心律失常、出汗、呕吐、利尿等引起的血容量不足,反射性血管舒缩功能障碍也参与了休克的发生。心衰主要为左心衰,有时也发生急性肺水肿。

(4)心律失常:较常见,其发生率在80%~90%以上,常发生在起病的1~2周,特别是在起病后24小时或3日之后更为常见;以异位室性期前收缩多见,多源、成对出现或R波落在T波上的室早可能为室颤、室速的先兆。

(5)胃肠症状:心肌梗死早期伴有剧烈疼痛时或下壁心梗者常常出现恶心、呕吐。少数患者恶心、呕吐表现突出,被误诊为胃肠炎。

(6)全身症状:多数患者在发病的第二天开始体温升高,在38℃左右,多在1周内降至正常。此外,尚可有出汗、乏力、头晕等症状。

2.体征:除极早期血压可增高外,几乎所有患者血压都降低。心脏浊音界可正常或轻中度增大。心率多增快,少数减慢。心尖区第一心音减弱可出现房性奔马律,少数有室性奔马律,部分患者起病2~3天出现心包摩擦音。可出现各种心律失常。

3.心电图和血清酶学改变。

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阅读理解。

     Each year, millions of people go abroad to work, study, or travel. It's a great way to find out what life is

like in another part of the world! You're probably hoping to make new friends and learn about the culture in

your host country everything from attitudes and beliefs to social customs and popular foods. But constantly

having to deal with new situations can be frustrating (挫折), even stressful.

     Homesickness, stress, fear, and confusion are all symptoms of "culture shock". At first, you may feel like

getting on the plane and heading home. It's OK to have those feelings,but the following are some tips to help

you handle the challenges that you will face.

     Don't expect to be perfect. You may feel frustrated that you have culture shock, especially since you

probably spent so much time preparing for your trip. No matter how much information you read, or how

well you speak the host language, it is natural to feel over-whelmed sometimes. If you give yourself some

time, things will gradually get easier.

     Have an open mind. While it's certainly OK to feel frustration or confusion in your new surroundings,

try not to form an opinion about the new culture too soon. Don't think of the host as better or worse, just

different-you'll be more willing to try new things.

     Participate. This is obvious, but everybody needs to be reminded. Just watching life go on around you

isn't good enough. You really need to try things for yourself. Don't worry about making a mistake; people

in your host country will generally be very understanding and willing to help if you have question. Your

study abroad experience is fl unique and special time in your life,one that you'll never forget. If you follow

our suggestions, you'll be able to handle it well, and have a wonderful time. Good luck!

1. What is culture shock?

A. Something you feel surprised at.

B. The problems you have when you go to another country.

C. The frightening feelings you have.

D. Something different from your own culture.

2. What should you do when you feel depressed?

A. Go back to your own homeland.

B. Talk to someone about your problem.

C. Give yourself some time to get used to it.

D. Stop thinking of it.

3. Which of the following statements is WRONG?

A. It is natural to feel overwhelmed sometimes.

B. Not everything is perfect.

C. Try to form the opinion about the new culture as soon as possible.

D. Tell others about your problems.

4. What is the main idea of this article? 

A. How to overcome culture shock.

B. Why do people have culture shock.

C. Who might have culture shock.

D. When will you have culture shock.