【文章內(nèi)容簡(jiǎn)介】 ①分析此病人出現(xiàn)極度呼吸困難、發(fā)生甘的原因。②如何護(hù)理留置胸腔閉式引流管的病人?答：適應(yīng)證：急性膿胸、胸外傷、肺及其他胸腔手術(shù)后、氣胸（尤張力性）。禁忌證：結(jié)核性膿胸。注意點(diǎn)：①保持引流管通暢，不使受壓、扭轉(zhuǎn)，逐日記錄引流量及其性質(zhì)和變化。②每日幫助患者起坐及變換體位，使引流充分通暢。③如系急性膿胸，術(shù)中宜取分泌物作常規(guī)檢驗(yàn)、細(xì)菌培養(yǎng)及藥物敏感度試驗(yàn)。如為張力性氣胸，可于病側(cè)鎖骨中線第2前肋間、腋前線或腋中線的第4或第5肋間處置管。 ④定期胸部X線攝片，了解肺膨脹和胸膜腔積液情況。男性， 73歲，河南林縣人，因進(jìn)行性吞咽困難3個(gè)月就診， 目前能進(jìn)流食。既往吸煙50年，每日1包口平時(shí)喜食脂制食品口其 弟因食管癌去世。身高1. 75肌體重50kgo食管鏡檢查提示食管中段癌。擬行食管手術(shù)人院。問:①分析此病人病史中與食管癌發(fā)病相關(guān)的因素。②此病人術(shù)前最主要的問題是什么?③主要術(shù)前準(zhǔn)備有哪些？答：　　食管其他病變：某些食管病變，如食管賁門失弛緩癥、食管炎、食管良性狹窄、食管粘膜白斑等食管病的患者，其食管癌的發(fā)病率較高，可能與食管粘膜病變?cè)馐荛L(zhǎng)期刺激有關(guān)。 　　微量元素：據(jù)流行病學(xué)調(diào)查發(fā)現(xiàn)，食管癌高發(fā)區(qū)水土中的鉬、銅、鈷、錳、鐵、鎳、鋅等微量元素含量偏低，可能與食管癌發(fā)病有關(guān)。缺鉬時(shí)植物中硝酸鹽積聚，在一定條件下會(huì)促進(jìn)亞硝酸胺致癌物的生成。 　　遺傳因素：食管癌高發(fā)區(qū)患者有陽性家族史者可達(dá)27%~61%，患者家族的外周淋巴細(xì)胞染色體畸變率較高。可見，遺傳因素在食管癌的發(fā)病中有一定關(guān)系，也可能是內(nèi)外因素的共同作用。食管癌病人應(yīng)在術(shù)前做充分準(zhǔn)備，以提高手術(shù)成功率，降低術(shù)后并發(fā)癥的發(fā)生率。?、偈中g(shù)前各項(xiàng)常規(guī)檢查：每個(gè)患者應(yīng)于術(shù)前作血、尿、大便常規(guī)檢查，肝、腎功能檢查，及心電圖、胸片、腹部B超檢查。對(duì)于60歲以上的病人及有慢性支氣管炎、肺氣腫的病人應(yīng)作肺功能檢查。②適應(yīng)手術(shù)后變化的鍛煉：多數(shù)病人不習(xí)慣在床上大小便，手術(shù)前應(yīng)練習(xí)。手術(shù)后常因切口疼痛而不愿咳嗽，故應(yīng)在手術(shù)前學(xué)習(xí)正確的咳嗽和咯痰的方法。有吸煙習(xí)慣的人，至少于術(shù)前2周停止吸煙。③施行手術(shù)前，應(yīng)做好血型鑒定及交叉配血試驗(yàn)，并備好一定數(shù)量全血。部分食管癌病人進(jìn)食困難，易有水電解質(zhì)代謝及酸堿平衡失調(diào)，應(yīng)予以糾正。　④防治感染：食管癌手術(shù)為操作時(shí)間較長(zhǎng)的大手術(shù)，可以預(yù)防性應(yīng)用抗生素。許多食管癌病人年齡較大，易于并發(fā)呼吸系統(tǒng)感染，術(shù)前就應(yīng)當(dāng)用抗生素治療。⑤改善營(yíng)養(yǎng)狀況：食管癌病人往往處于營(yíng)養(yǎng)不良的狀態(tài)，蛋白質(zhì)缺乏，并常伴有血容量不足，耐受術(shù)中、術(shù)后失血或休克的能力降低。蛋白質(zhì)缺乏也常引起組織水腫，影響愈合。營(yíng)養(yǎng)不良的病人，容易并發(fā)嚴(yán)重感染，所以術(shù)前最好予以適當(dāng)?shù)臓I(yíng)養(yǎng)支持，必要時(shí)可輸血。⑥心血管系統(tǒng)疾?。盒g(shù)前發(fā)現(xiàn)有高血壓的病人，如在213/136千帕以下者，可不用降壓藥物，如高血壓較明顯，可在術(shù)前適當(dāng)應(yīng)用降壓藥，但不要求血壓降至正常。冠心病患者容易發(fā)生心搏驟停，手術(shù)耐受力較差。急性心肌梗塞病人的手術(shù)耐受力很差，6個(gè)月內(nèi)最好不施行擇期手術(shù)；6個(gè)月以上，只要沒有心絞痛發(fā)作，在監(jiān)測(cè)條件下，可以施行手術(shù)。心力衰竭病人對(duì)手術(shù)不耐受，除非是急癥搶救，都必須在心力衰竭控制一段時(shí)間，最好是3～4周后，再施行手術(shù)。⑦呼吸系統(tǒng)疾?。簢?yán)重肺功能不全或極差者，手術(shù)并發(fā)癥及死亡率都高，應(yīng)在肺功能改善后手術(shù)。合并其他呼吸系統(tǒng)疾病，如哮喘、阻塞性肺病、肺部感染等，應(yīng)于處理后再手術(shù)。⑧糖尿?。禾悄虿∪?，無論Ⅰ型或Ⅱ型，術(shù)前均應(yīng)使用胰島素，使血糖穩(wěn)定在輕度升高狀態(tài)(100～200毫克/分升)，這樣不僅對(duì)人體無害，且不至因胰島素過多而發(fā)生低血糖，也不至因胰島素過少而發(fā)生酸中毒。手術(shù)應(yīng)當(dāng)盡早施行，以縮短禁食時(shí)間，避免酮體生成。手術(shù)完畢后，應(yīng)監(jiān)測(cè)血糖及尿糖，及時(shí)調(diào)整胰島素用量。⑨其他疾病：如肝臟疾病、腎臟疾病、腎上腺皮質(zhì)功能不足等，均應(yīng)處理。有口腔內(nèi)感染的病人，術(shù)前應(yīng)做必要治療，以減少術(shù)后食管內(nèi)感染的機(jī)會(huì)?？傊彻馨┑氖中g(shù)是相對(duì)復(fù)雜的較大手術(shù)，術(shù)前準(zhǔn)備繁瑣、細(xì)致，應(yīng)在臨床醫(yī)生的指導(dǎo)下，盡可能做得充分。請(qǐng)您刪除一下內(nèi)容，O(∩_∩)O謝謝?。?！2016年中央電大期末復(fù)習(xí)考試小抄大全，電大期末考試必備小抄，電大考試必過小抄Basketball can make a true claim to being the only major sport that is an American invention. From high school to the professional level, basketball attracts a large following for live games as well as television coverage of events like the National Collegiate Athletic Association (NCAA) annual tournament and the National Basketball Association (NBA) and Women39。s National Basketball Association (WNBA) playoffs. And it has also made American heroes out of its player and coach legends like Michael Jordan, Larry Bird, Earvin Magic Johnson, Sheryl Swoopes, and other great players. At the heart of the game is the playing space and the equipment. The space is a rectangular, indoor court. The principal pieces of equipment are the two elevated baskets, one at each end (in the long direction) of the court, and the basketball itself. The ball is spherical in shape and is inflated. Basketballs range in size from in (7276 cm) in circumference, and in weight from 1822 oz (510624 g). For players below the high school level, a smaller ball is used, but the ball in men39。s games measures in (7576 cm) in circumference, and a women39。s ball is in (7274 cm) in circumference. The covering of the ball is leather, rubber, position, or synthetic, although leather covers only are dictated by rules for college play, unless the teams agree otherwise. Orange is the regulation color. At all levels of play, the home team provides the ball. Inflation of the ball is based on the height of the ball39。s bounce. Inside the covering or casing, a rubber bladder holds air. The ball must be inflated to a pressure sufficient to make it rebound to a height (measured to the top of the ball) of 4954 in ( m) when it is dropped on a solid wooden floor from a starting height of 6 ft ( m) measured from the bottom of the ball. The factory must test the balls, and the air pressure that makes the ball legal in keeping with the bounce test is stamped on the ball. During the intensity of high school and college tourneys and the professional playoffs, this inflated sphere mands considerable attention. Basketball is one of few sports with a known date of birth. On December 1, 1891, in Springfield, Massachusetts, James Naismith hung two halfbushel peach baskets at the opposite ends of a gymnasium and outlined 13 rules based on five principles to his students at the International Training School of the Young Men39。s Christian Association (YMCA), which later became Springfield College. Naismith (18611939) was a physical education teacher who was seeking a team sport with limited physical contact but a lot of running, jumping, shooting, and the handeye coordination required in handling a ball. The peach baskets he hung as goals gave the sport the name of basketball. His students were excited about the game, and Christmas vacation gave them the chance to tell their friends and people at their local YMCAs about the game. The association leaders wrote to Naismith asking for copies of the rules, and they were published in the Triangle, the school newspaper, on January 15,1892. Naismith39。s five basic principles center on the ball, which was described as large, light, and handled with the hands. Players could not move the ball by running alone, and none of the players was restricted against handling the ball. The playing area was also open to all players, but there was to be no physical contact between players。 the ball was the objective. To score, the ball had to be shot through a horizontal, elevated goal. The team with the most points at the end of an allotted time period wins. Early in the history of basketball, the local YMCAs provided the gymnasiums, and membership in the organization grew rapidly. The size of the local gym dictated the number of players。 smaller gyms used five players on a side, and the larger gyms allowed seven to nine. The team size became generally established as five in 1895, and, in 1897, this was made formal in the rules. The YMCA lost interest in supporting the game because 1020 basketball players monopolized a gymnasium previously used by many more in a variety of activities. YMCA membership dropped, and basketball enthusiasts played in local halls. This led to the building of basket