临床执业（助理）历年真题训练营 ——第21期 （循环系统01）
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="http://mmbiz.qpic.cn/mmbiz_png/rgHLFUHstmCwr08e2Wict3ZKCjH0kC2vcricbUlUz81icib4gYnDpZgToVvTtkZwmdFNXvurSYRd1bB90mS1sJHoyg/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">考<span style="color: black;"><strong style="color: blue;">医师资格</strong></span>关注<span style="color: black;"><strong style="color: blue;">医考之声</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">每日</span>都有<span style="color: black;"><strong style="color: blue;">考点精华</strong></span><strong style="color: blue;">与<span style="color: black;">真题解析</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▼</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/rgHLFUHstmDakcxny24qqT3MibEA0xpkMsePuYHdAib4POmaDN7TsO4UVDvLVsw8TVkrB0Y4ibOWzSIx5ECuGDdaw/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.急性肺水肿<span style="color: black;">救治</span>时不宜<span style="color: black;">选择</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．氨茶碱 B．吗啡</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．呋塞米 D．硝普钠</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．依那普利</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：E</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急性的肺水肿<span style="color: black;">能够</span>说明是急性左心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">急性左心衰禁止用两种药</span></strong><span style="color: black;">：<span style="color: black;">β受体阻滞剂</span>（XX洛尔）和<span style="color: black;">ACEI</span>（XX普利）<span style="color: black;">ARB</span>（XX坦）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">ACEI扩张外周小动脉，<span style="color: black;">引起</span>血压急剧下降</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">β受体阻滞剂<span style="color: black;">亦</span>是降低心率，使得心输出量下降，<span style="color: black;">引起</span>血压进一步下降</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.诊断心力衰竭首选的<span style="color: black;">检测</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．胸壁X线片 B．超声心动图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．左心室造影 D．心电图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．运动负荷实验</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰首选：超声心动图（UCG）</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">收缩功能：<span style="color: black;">评估</span>心脏收缩功能的<span style="color: black;">重点</span>指标是射血分数（EF）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">舒张功能：<span style="color: black;">评估</span>心脏舒张功能的<span style="color: black;">重点</span>指标是 E/A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.<span style="color: black;">剧烈</span>提示<span style="color: black;">病人</span>左心功能衰竭的体征是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．心包叩击音 B．A2亢进</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．舒张<span style="color: black;">初期</span>奔马律 D．开瓣音</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．心尖部<span style="color: black;">第1</span>心音<span style="color: black;">加强</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">听诊中奔马律最有助于提示心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">临床表现中：<span style="color: black;">显现</span>肺水肿<span style="color: black;">或</span>肝颈静脉回流征阳性判断左心衰和右心衰最佳</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.单纯左心衰竭的典型体征是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．下垂性对<span style="color: black;">叫作</span>性水肿 B．颈静脉怒张</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．双肺底闻及湿啰音 D．胸腔积液</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．肝颈静脉回流征阳性</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">左心衰竭</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">症状：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">劳力性<span style="color: black;">呼气</span>困难</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">--夜间阵发性<span style="color: black;">呼气</span>困难</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">--端坐<span style="color: black;">呼气</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">--肺水肿（粉红色<span style="color: black;">泡泡</span>痰)</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">最早</span><span style="color: black;">的是<span style="color: black;">劳力性<span style="color: black;">呼气</span>困难</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">最典型</span><span style="color: black;">的是<span style="color: black;">夜间阵发性</span><span style="color: black;">呼气</span>困难。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">最特异</span><span style="color: black;">的是<span style="color: black;">粉红色<span style="color: black;">泡泡</span>痰</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5.改善急性左心衰竭症状最有效的<span style="color: black;">药品</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．利尿剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B．洋地黄</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．钙离子拮抗剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D．β肾上腺素能受体阻滞剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．血管紧张素转换酶<span style="color: black;">控制</span>剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰后的心脏就相当于一批疲惫不堪的马，应该先卸下石头（利尿），再让他歇一歇（扩血管），歇歇以后再给他来一鞭（强心），<span style="color: black;">次序</span><span style="color: black;">不可</span>乱，<span style="color: black;">不可</span>不让他<span style="color: black;">休憩</span>，直接给他一鞭子（强心），他分分钟死给你看</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6.老年心力衰竭<span style="color: black;">病人</span>症状加重的最<span style="color: black;">平常</span>诱因是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．过度<span style="color: black;">疲劳</span> B．摄入液体<span style="color: black;">太多</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．心肌缺血 D．<span style="color: black;">呼气</span>道感染</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．室性期前收缩</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：D</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">咱们</span>来回顾一下心衰的<span style="color: black;">各样</span>因：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">病因：</span></strong><span style="color: black;">病因又<span style="color: black;">能够</span>分为<strong style="color: blue;">内因</strong>和<strong style="color: blue;">外因</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">内因（心肌损害）：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心肌收缩力减弱（内因）</span><span style="color: black;">：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">冠心病心肌缺血和心梗最<span style="color: black;">平常</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">外因（负荷重，分为前负荷和后负荷）</span><span style="color: black;">：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">诱因：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">感染、<span style="color: black;">心率</span>失常和治疗<span style="color: black;">欠妥</span></span><span style="color: black;">依次是心力衰竭最<span style="color: black;">重点</span>的<span style="color: black;">诱因</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">呼气</span>道感染是最<span style="color: black;">平常</span>最<span style="color: black;">要紧</span>的诱因。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">7.右心衰竭<span style="color: black;">病人</span>水肿<span style="color: black;">一般</span><span style="color: black;">首要</span>出<span style="color: black;">此刻</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．眼睑 B．双手</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．颜面 D．腹部</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．身体最低部位</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：E</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心源性水肿<span style="color: black;">显现</span>身体最低部位</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肾源性水肿<span style="color: black;">显现</span>眼睑</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8.<span style="color: black;">导致</span>左室后负荷<span style="color: black;">升高</span>的<span style="color: black;">重点</span><span style="color: black;">原因</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．肺循环高压 B．体循环高压</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．回心血量<span style="color: black;">增多</span> D．红细胞压积增大</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．主动脉瓣关闭不全</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">后负荷（压力负荷）<span style="color: black;">增多</span>：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（1）高血压和主动脉瓣狭窄（<span style="color: black;">左心室后负荷</span>）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（2）肺动脉高压和肺动脉瓣狭窄（<span style="color: black;">右心室后负荷</span>）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">9.不是<span style="color: black;">因为</span>前负荷<span style="color: black;">增多</span><span style="color: black;">导致</span>心力衰竭的<span style="color: black;">疾患</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．主动脉瓣狭窄 B．动静脉瘘</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．二尖瓣返流 D．室间隔<span style="color: black;">缺失</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．甲状腺功能亢进症</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">前负荷是容量负荷，和血容量<span style="color: black;">相关</span>，</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">后负荷是压力负荷，和血压<span style="color: black;">相关</span>，</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">主动脉瓣狭窄是<span style="color: black;">左心室后负荷，不属于</span>前负荷（容量负荷），</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">主动脉瓣狭窄，左心室射<span style="color: black;">流血</span>的压力就<span style="color: black;">增多</span>了，<span style="color: black;">因此</span>是后负荷，</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">相比<span style="color: black;">来讲</span>，主动脉瓣关闭不全是前负荷<span style="color: black;">增多</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">10．最有助于提示<span style="color: black;">病人</span>左心衰竭的体征是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．心尖部<span style="color: black;">第1</span>心音<span style="color: black;">加强</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B．开瓣音</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．舒张<span style="color: black;">初期</span>奔马律</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D．心包叩击音</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．主动脉瓣第二心音亢进</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">听诊中奔马律最有助于提示心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">临床表现中：<span style="color: black;">显现</span>肺水肿<span style="color: black;">或</span>肝颈静脉回流征阳性判断左心衰和右心衰最佳</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">11.心力衰竭合并肾衰竭<span style="color: black;">病人</span>利尿<span style="color: black;">药品</span>首选</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．阿米洛利 B．氨苯碟啶</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．呋塞米 D．螺内酯</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．氢氯噻嗪</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肾衰竭后，排尿量减少，血容量<span style="color: black;">增多</span>，加重心衰的临床表现，这个时候<span style="color: black;">一般</span><span style="color: black;">选取</span>利尿剂缓解心衰的症状，<span style="color: black;">选取</span>哪种利尿剂呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">利尿剂分为噻嗪类利尿剂（氢氯噻嗪）、袢利尿剂（呋塞米）和保钾利尿剂（氨苯碟啶、螺内酯、阿米洛利）三类，</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肾衰时钾排泄<span style="color: black;">阻碍</span>，可<span style="color: black;">引起</span>高钾血症，保钾利尿剂肯定<span style="color: black;">不可</span>用</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肾衰时尿酸<span style="color: black;">亦</span>会<span style="color: black;">增多</span>，而噻嗪类利尿剂可<span style="color: black;">导致</span>高尿酸血症，合并肾衰尿酸排泄<span style="color: black;">阻碍</span>，加重痛风<span style="color: black;">爆发</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">因此</span><span style="color: black;">选取</span>呋塞米，既<span style="color: black;">能够</span><span style="color: black;">处理</span>高钾血症又<span style="color: black;">能够</span><span style="color: black;">处理</span>高尿酸血症</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">12.最易<span style="color: black;">导致</span>急性心力衰竭的<span style="color: black;">心率</span>失常是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．窦性心动过缓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B．一度房室传导阻滞</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．偶发室性期前收缩</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D．快速心房颤动</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．偶发房性期前收缩</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：D</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心力衰竭的本来射血量减少，房颤，心房不会射血，还会减少心房收缩的射血量，万一房颤传导到心室，心室射血量会进一步减少，<span style="color: black;">因此</span>最容易<span style="color: black;">导致</span>急性心力衰竭的是房颤</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">13.左心衰竭<span style="color: black;">病人</span>合并右心衰竭后，可能减轻左心衰竭时的临床症状是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．恶心 B．喘憋</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．肝肿大 D．下肢水肿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．颈静脉充盈</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">右心衰后，右心射不<span style="color: black;">流血</span>到肺里面了，当然憋喘肺水肿的<span style="color: black;">状况</span>会好<span style="color: black;">非常多</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">14.左心衰竭最早<span style="color: black;">显现</span>的症状是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．劳力性<span style="color: black;">呼气</span>困难 B．少尿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．端坐<span style="color: black;">呼气</span> D．咯血</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．夜间阵发性<span style="color: black;">呼气</span>困难</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">显现</span>的临床表现是：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">劳力性<span style="color: black;">呼气</span>困难</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">--夜间阵发性<span style="color: black;">呼气</span>困难</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">--端坐<span style="color: black;">呼气</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">--肺水肿（粉红色<span style="color: black;">泡泡</span>痰)</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">15.男，56岁。充血性心力衰竭，心率<span style="color: black;">长时间</span>维持在100～110/分，口服地高辛0.25mg1次／日，治疗2周后心率<span style="color: black;">没</span><span style="color: black;">显著</span>下降，为了<span style="color: black;">掌控</span>心率应<span style="color: black;">首要</span>采取的<span style="color: black;">办法</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．<span style="color: black;">增多</span>地高辛用量 B．加用普罗帕酮</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．加用胺碘酮 D．加用维拉帕米</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．β受体阻断药</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：E</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">充血性心力衰竭，心率<span style="color: black;">长时间</span>维持在100～110/分，说明不是急性心衰，而心率有这么快，首选β受体阻断药</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">16.男，56岁。间断活动时憋喘1年余，近期加重，重体力活动即感喘憋，有夜间憋醒。既往高血压病8年余，糖尿病4年余。查体：BP150/lOOmmHg，双肺<span style="color: black;">呼气</span>音清。心率76次／分，律齐。<span style="color: black;">病人</span>经<span style="color: black;">药品</span>治疗症状好转，为改善预后<span style="color: black;">必须</span><span style="color: black;">长时间</span><span style="color: black;">运用</span>的<span style="color: black;">药品</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> A．洋地黄类<span style="color: black;">药品</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> B．肾上腺素能受体激动剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> C．磷酸二酯酶<span style="color: black;">控制</span>剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> D．利尿剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> E．血管紧张素转换酶<span style="color: black;">控制</span>剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：E</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">改善预后的<span style="color: black;">药品</span>有：<span style="color: black;">ACEI 醛固酮受体拮抗剂 β受体阻滞剂</span>（这三者被誉为心衰治疗的<span style="color: black;">金三角</span>）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">17.男，50岁．活动后心悸、气短5年，加重伴少尿 l周。查体：双肺底可闻及细湿啰音，心尖搏动于左第5肋间锁骨中线外2cm，范围较弥散，心率106次／分，律不齐，双下肢凹陷性水肿。最有助于确诊的<span style="color: black;">检测</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A．超声心动图 B．血常规</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C．尿常规 D．心电图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E．胸部X线片</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案:A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">活动后心悸、气短5年说明有慢性心衰病史，</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">加重伴少尿 l周，双肺底可闻及细湿啰音说明<span style="color: black;">1星期</span>急性<span style="color: black;">爆发</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰的诊断：首选超声心动图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">心衰首选：超声心动图（UCG）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">收缩功能：<span style="color: black;">评估</span>心脏收缩功能的<span style="color: black;">重点</span>指标是射血分数（EF）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">舒张功能：<span style="color: black;">评估</span>心脏舒张功能的<span style="color: black;">重点</span>指标是 E/A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">18.男，50岁，急性心肌梗死<span style="color: black;">病人</span>。突然<span style="color: black;">显现</span>胸闷、气喘、大汗淋漓，查体：BP150/90mmHg．<span style="color: black;">没</span>颈静脉怒张，两肺满布干湿啰音，心率120次／分，<span style="color: black;">第1</span>心音低钝。最可能的诊断是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> A．急性左心衰竭 B．肺炎</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> C．肺血栓栓塞症 D．支气管哮喘</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> E．心脏游离壁破裂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">向下滑动 查看答案解析</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">↓↓↓</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">答案：A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急性心肌梗死病史，两肺满布干湿啰音说明<span style="color: black;">出现</span>了急性心梗并发急性心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">考<span style="color: black;"><strong style="color: blue;">医师资格</strong></span>关注<span style="color: black;"><strong style="color: blue;">医考之声</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">每日</span>都有<span style="color: black;"><strong style="color: blue;">考点精华</strong></span><strong style="color: blue;">与<span style="color: black;">真题解析</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▼</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="http://mmbiz.qpic.cn/mmbiz_png/rgHLFUHstmDakcxny24qqT3MibEA0xpkMsePuYHdAib4POmaDN7TsO4UVDvLVsw8TVkrB0Y4ibOWzSIx5ECuGDdaw/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p>
请问、你好、求解、谁知道等。 在遇到你之前，我对人世间是否有真正的圣人是怀疑的。
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