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0);">的</span>測試題，讓你在平時復(fù)習(xí)的同時，更好地吸收和鞏固相關(guān)知識點(diǎn)。持之以恒，讓你每天都有進(jìn)步！</p><p style="text-align:center"><a href="/upload/resources/image/2023/08/29/756605.png?1693300792723" target="_blank"><img src="/upload/resources/image/2023/08/29/756605.png?1693300792723" title="臨床執(zhí)業(yè)醫(yī)師低正確率測試題" alt="臨床執(zhí)業(yè)醫(yī)師低正確率測試題" suffix="png"/></a></p><section data-id="1657" style="outline: rgb(15, 174, 255) dotted 1px;"><section style="padding: 1px; border: 1px solid rgb(30, 47, 225); box-sizing: border-box;"><section style="padding: 1px; border: 1px solid rgb(30, 47, 225); box-sizing: border-box;"><section style="padding: 10px; border: 1px solid rgb(30, 47, 225); box-sizing: border-box;"><p style="text-align: left;"><span style="line-height: 150%;">49.男，87歲。<a href="http://thedailypurge.net/jibing/gaoxueya/" target="_blank" title="高血壓" class="hotLink">高血壓</a>病史10余年，長期服用鈣通道阻滯劑，1個月前因血壓控制不滿意加用美托洛爾25mg Bid，近1周乏力、倦怠、間斷黑矇。查體：BP 110/70mmHg，心率50次/分，心律不齊，各瓣膜區(qū)未聞及雜音。心電圖示“PR間期逐漸延長直至QRS波群脫落”。最恰當(dāng)?shù)奶幚硎?</span></p><p style="text-align: left;"><span style="line-height: 150%;">A.植入永久起搏器 </span></p><p style="text-align: left;"><span style="line-height: 150%;">B.停用美托洛爾 </span></p><p style="text-align: left;"><span style="line-height: 150%;">C.將美托洛爾更換為地爾硫（卓艸）30mg Tid </span></p><p style="text-align: left;"><span style="line-height: 150%;">D.將美托洛爾調(diào)整為12.5mg Bid </span></p><p style="text-align: left;"><span style="line-height: 150%;">E.將美托洛爾調(diào)整為25mg Qd </span></p><p style="text-align: left;"><span style="line-height: 150%;">【正確答案】D</span></p><p style="text-align: left;"><span style="line-height: 150%;">【答案解析】</span></p><p style="text-align: left;"><span style="line-height: 150%;">A選項(xiàng)——該患者出現(xiàn)二度I型房室傳導(dǎo)阻滯是因?yàn)棣率荏w拮抗劑的不良反應(yīng)，不需要使用永久起搏器。 </span></p><p style="text-align: left;"><span style="line-height: 150%;">B選項(xiàng)——美托洛爾不能直接停藥，否則會使心率反跳，顯著增加心肌耗氧，甚至?xí)T發(fā)患者出現(xiàn)<a href="http://thedailypurge.net/jibing/xinjiaotong/" target="_blank" title="心絞痛" class="hotLink">心絞痛</a>，因此β受體阻滯劑要緩慢停藥。</span></p><p style="text-align: left;"><span style="line-height: 150%;">C選項(xiàng)——將美托洛爾更換為地爾硫（卓艸）相當(dāng)于直接停藥，也是不安全的。</span></p><p style="text-align: left;"><span style="line-height: 150%;">D選項(xiàng)——老年患者，10多年的<a href="http://thedailypurge.net/jibing/gaoxueya/" target="_blank" title="高血壓" class="hotLink">高血壓</a>病史，長期服用鈣通道阻滯劑，加用美托洛爾（β受體拮抗劑）后出現(xiàn)乏力、倦怠、間斷黑矇（β受體拮抗劑的不良反應(yīng)），心電圖示“PR間期逐漸延長直至QRS波群脫落”（二度I型房室傳導(dǎo)阻滯）。結(jié)合上述病史、臨床表現(xiàn)和實(shí)驗(yàn)室檢查，患者的表現(xiàn)最可能為美托洛爾的不良反應(yīng)。但是美托洛爾不能直接停藥，需要緩慢停藥，所以是減量。</span></p><p style="text-align: left;"><span style="line-height: 150%;">E選項(xiàng)——美托洛爾應(yīng)該減少每次服用的量而不是服用的次數(shù)。</span></p></section></section></section></section><p style="text-align: left;">網(wǎng)校2023<a href="http://thedailypurge.net/linchuangyishi/" target="_blank" title="臨床執(zhí)業(yè)醫(yī)師" class="hotLink">臨床執(zhí)業(yè)醫(yī)師</a><strong><span 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