男性，24岁。溺水后发生急性呼吸窘迫综合征。在呼吸室内空气时，

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问题单项选择题

男性，24岁。溺水后发生急性呼吸窘迫综合征。在呼吸室内空气时，血气分析显示：pH7．50，Pa0₂28mmHg。面罩吸80％的氧气后复查血气，结果为pH7．50，PaO₂53mmHg，PaCO₂29mmHg。此患者发生低氧血症最主要的原因是（）

A.气道阻力增加

B.肺内分流（右向左）

C.氧耗量增加

D.低通气

E.心搏出量下降

答案

参考答案：B

解析：

ARDS的主要病理生理机制是肺微血管壁通透性增加，间隙水肿；肺表面活性物质缺失，肺泡群萎陷，使通气血流比例失调，肺内分流增大，导致严重低氧血症。

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单项选择题

男患，58岁，病史：高血压病史10余年。某日早起后突发剧烈头痛、呕吐，2小时后出现神志不清，鼾声呼吸和大小便失禁。查体：血压180/97mmHg，中昏迷，双瞳孔缩小，左侧鼻唇沟浅，左侧下肢外旋位，左侧Babinski征（+），左侧提睾反射消失。抢救该患者首选的程序为（）

A.静滴低分子右旋糖酐补充血容量

B.肌注安定预防抽搐，急查心电图

C.肌注利血平降血压，急行腰椎穿刺

D.静推甘露醇降低颅内压，急查头颅CT检查

E.静脉补钾，防止电解质紊乱

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