【正文】 國印第安人、亞洲印第安人等具有較高的胰島素抵抗發(fā)生率。 (2)肥胖 肥胖引起的胰島素抵抗以抑制肝葡萄糖輸出和促進脂肪組織和肌肉葡萄糖攝取的胰島素功能受損為特點。研究發(fā)現(xiàn)，減輕或增加體重可增強或降低胰島素敏感性， 肥胖和胰島素抵抗呈因果關(guān)系。肥胖引起胰島素抵抗主要通過游離脂肪酸和脂肪細胞因子（瘦素、脂聯(lián)素、抵抗素、腫瘤壞死因子 α）兩個途徑來實現(xiàn)。 （ 3）吸煙 運用第十三章知識分析并回答問題（臨床案例13— 1） 男性患者， 58 歲， 3 個月來自覺全身乏力，食欲不振，腹脹，惡心、嘔吐，常有鼻出血。近半月來腹脹加劇而入院。既往有慢性活動型肝炎史。體檢：營養(yǎng)差，面色萎黃，鞏膜輕度黃染，面部及上胸部可見蜘蛛痣，腹部脹滿，有明顯移動性濁音，下肢輕度凹陷性水腫。實驗室檢查： HBsAg(+)紅細胞 3x1012／ L(300 萬／mm3)，血紅蛋白 109 g／ L(10g／ d1)，血小板 61x109／L( 萬／ mm3)，血清膽紅素 51μ mol／ L(3mg／ d1)，血鉀 ，血漿白蛋白 25g／ L(2． 5g／ d1)，球蛋白 40g/()。入院后給予腹腔放液 1500ml 及大量利尿劑呋塞米等治療，次日患者陷入昏迷狀態(tài)，經(jīng)應(yīng)用谷氨酸鉀治療，神志一度清醒。以后突然大量嘔血，輸入庫存血 200ml，搶救無效死亡。試分析： 問題： (1)該患者有何種疾病 ?依據(jù)為何 ? (2)分析本例的水、電解質(zhì)平衡紊亂的類型。 (3)分析本病例引 起昏迷的誘發(fā)因素。 (4)治療中有無失誤之處，提出你的正確治療措施。 參考答案 ： （ 1）該患者有慢性活動型肝炎，肝硬化，伴肝功能不全。依據(jù)：現(xiàn)病史（ 3 個月來自覺全身乏力，食欲不振，腹脹，惡心、嘔吐，常有鼻出血；既往有慢性活動型肝炎史。體檢：營養(yǎng)差，面色萎黃，鞏膜輕度黃染，面部及上胸部可見蜘蛛痣，腹部脹滿，有明顯移動性濁音，下肢輕度凹陷性水腫。實驗室檢查： HBsAg(+)紅細胞 3x1012／ L(300 萬／ mm3)，血紅蛋白 109 g／ L(10g／d1)，血小板 61x109／ L( 萬／ mm3)，血清膽紅素 51μ mol／ L(3mg／ d1)，血鉀 ，血漿白蛋白 25g／ L(／ d1)，球蛋白 40g/()。 （ 2）該患者出現(xiàn)低鉀血癥，可能有低鈉血癥。 （ 3）本病例引起昏迷的誘發(fā)因素是給予腹腔放液1500ml 及大量利尿劑呋塞米等治療，沒有補充鉀而出現(xiàn)低鉀性堿中毒，促進氨的吸收誘發(fā)肝性腦?。涣硗饪赡苡捎诔鲅a(chǎn)氨增加。 （ 4）治療有失誤之處。針對目前患者情況，應(yīng)該輸注白蛋白，不應(yīng)大劑量使用利尿劑呋塞米，可適當用保鉀利尿劑；搶救不應(yīng)僅僅輸 200ml 庫存血，應(yīng)在大量不足液體時，輸注血小板，同 時采取止血措施。 這僅僅是答案要點，希望各位老師和同學們繼續(xù)豐富內(nèi)容。 請您刪除一下內(nèi)容， O(∩_∩)O 謝謝?。。?2021年中央電大期末復(fù)習考試小抄大全，電大期末考試必備小抄，電大考試必過小抄 Shanghai’s Suzhou Creek has witnessed much of the city’s history. Zhou Wenting travels this storied body of water and finds its most fascinating spots. Some lucky cities can boast a great body of water, like London with the river Thames and Paris with the river Seine. Shanghai is privileged enough to have two great bodies of water: Huangpu River and Suzhou River became famous when colonists established clusters of grand buildings on its banks on what became known as the bund. Today, the bund overlooks the breathtaking skyline of Lujiazui financial district. Shanghai’s other body of water, however, Suzhou Creek, has been somewhat overshadowed. Suzhou Creek links the inland cities of Jiangsu province with Shanghai. When the British colonists, who arrived in the city after it was opened as a mercial port in 1843 found they could reach Suzhou, Jiangsu province, via the creek, they named it Suzhou Creek. Thanks to its location, a large amount of cargo and travelers were transported via the creek before rail links were established. But after a century of being utilized as a waterway to transport goods and labor, the creek grew dark and smelly. Industrial factories were established along the banks. In the 1990s it became a key task of the city government to clean the creek. Suzhou Creek, which snakes 17 km from the iconic Waibaidu Bridge downtown to the outer ring road in west Shanghai, maps the changing periods of the city’s history, including the imprints of the concessions, the beginning of industrialization and the improvement in people’s living conditions. Where the Bund began Inbetween the shopping street of East Nanjing Road and the Bund, are a cluster of streets that give me the illusion that I am no longer in modern Shanghai. The streets are narrow and old and crisscross each other. Any old residential house may turn out to be a former office of the British, constructed in the 1880s. Pawnshops and hardware stores that are hard to find elsewhere, are plentiful here. This area, at the confluence of Huangpu River and Suzhou Creek, is called the Bund Origin. Countless tour buses stop at the site every day and visitors from around the world get off to see this place, the starting point of the concessions in the city. It all started in 1872, when the former British Consulate General was constructed and the Bund began its transformation into an the financial street of the East. Now the site of the former consulate is called “No 1 Waitanyuan”, which translates to “the Bund Origin”, to honor its beginnings. The entire plex of this historical site prises of five buildings, the former British Consulate General, the official residence of the consul, the former Union Church, the church apartments and the former Shanghai Rowing Club. The size of the courtyard is equivalent to that of four standard soccer fields. The building of the former consulate is a twostorey masonry building on an Hshaped plan in typical English renaissance style. The building is designed with a fivearch verandah on the ground floor with a raised terrace facing the garden, while the facade features an entry portico beneath a colonnaded loggia. It has been turned into a caf233。 where dinner and afternoon tea are available. Visitors can choose to sit indoors or outdoors to enjoy the magnificent gardens with nearly 30 ancient trees. Yuanmingyuan Road behind the plex is also a historical site. The road has been revamped as a pedestrian shopping street and highend brands have seized the best spots. Altogether, 14 old buildings, including those used for offices and residences constructed during 1920s and 1930s, remain. Today, it is a popular location for mercial fashion photo shoots. New Tian’an Church, or Union Church, stands at the intersection of Yuanmingyuan Road and Suzhou Creek. The church, designed in the