第一篇：考博英语语法重点总结

考博辅导：考博英语语法重点总结（3）

过去分词与形容词的语义差：

1.Destructive:causing damage to people or things the destructive power of modern weapons Damaged: being in a bad state emotionally damaged children 2.Respected:admired by many because of achievements

He’s one of the most respected managers in the game.Respectful: feeling or showing respect They listened in respectful silence.3.Preferred : Her own preferred methods of exercise are hiking and long cycle rides.Preferable: A big earthquake a long way off is preferable to a smaller one nearby.Preferential: Bank officials denied giving the senator any preferential treatment.4.Unimagined:Others see a new golden age of business and technology that will lift the market to unimagined heights.Unimaginative:That means the traditional office layout of lined-up cubicles and work stations is seen as rigid and unimaginative.5.Loving: She was a devoted wife and a very loving mother.Lovable: a sweet lovable child Lovely: We had a lovely holiday.6.Tolerated: While Patches are generally well tolerated they are not always suitable for everyone.Tolerant: trees that are tolerant of salt sea winds Tolerable: All in all, it was better to have a tolerable tenement than the ideal which no one could afford.虚拟语气

非谓语动词主要包括不定式、动名词和现在分词。为了区分这三种不同的非谓语动词的用法和含义，我们将分别从三种非谓语动词在句子中做主语、宾语、宾语补足语、定语、状语、表语以及一些特殊结构句型等角度来区分其用法和细微含义。1．不定式和动名词作主语的区别

(1)动名词作主语通常表示抽象动作；而不定式作主语表示具体动作。Smoking is prohibited(禁止)here．这里禁止抽烟。(抽象)It is not very good for you to smoke so much．你抽这么多烟对你身体很不好。(具体)

(2)动名词作主语时，通常用以表示一件已知的事或经验。

不定式短语通常用来表示一件未完成的事或目的。

Climbing mountains is interesting．爬山很有趣。(经验)

Driving a car during the rush hour is tiring．在高峰时刻开车令人厌烦。(经验)（3）不定式做主语，一般用it当形式主语，把作主语的不定式短语后置。

It took me only five minutes to finish the job.2．不定式、动名词和分词作表语的区别

(1)不定式作表语

1)不定式作表语一般表示具体动作，特别是表示将来的动作。

To do two things at a time is to do neither．--次做两件事等于未做。

What I would suggest is to start work at once.我的建议是立刻开始干。

2）如果主语是不定式（表示条件），表语也是不定式（表示结果）。

To see is to believe.百闻不如一见。

To work means to earn a living．工作就是为了生活。

3)如果主语是以aim，duty，hope，idea，happiness，job，plan，problem，purpose，thing，wish等为中心的名词，或以what引导的名词性从句，不定式作表语是对主语起补充说明作用。

His wish is to buy a luxurious car in the near future．他的希望是在不远的将来买一辆豪华轿车。

The function of Louis Sullivan’s architecture was to provide large uninterrupted floor areas and to allow ample light into the interior.The most important thing is to negotiate with them about the future of the plant．

(2)动名词作表语：动名词作表语，表示抽象的一般性的行为。

Our work is serving the people．我们的工作是为人民服务。

His hobby is collecting stamps．他的爱好是集邮。

(注)动名词作表语时与进行时态中的现在分词形式相同，但其所属结构迥异，进行时态说明动作是由主语完成的。动名词做表语，说明主语的性质或情况。

People cannot but feel puzzled，for they simply cannot understand how he could have made such a stupid mistake.His victory in the final was no more convincing than I had expected．

(3)分词作表语

分词做表语有两种情况，一种是现在分词做表语，一种是过去分词做表语，这两者区别是考试中经常考到的地方。一般来说，表示心理状态的动词如excite，interest等都是及物动词，汉语意思不是“激动”，“高兴”，而是“使激动”、“使高兴”，因而现在分词应该是“令人激动的”、“令人高兴的”，过去分词则是“感到激动的”和“感到高兴的”。所以，凡表示“令人……的”都是-ing形式，凡是表示“感到……”都用-ed形式。换句话说，若人对……感兴趣，就是somebody is interested in...,若人/物本身有兴趣时，就是说sb./sth.is interesting.这类词常见的有：

interesting使人感到高兴--interested感到高兴的exciting令人激动的--excited感到激动的

delighting令人高兴的--delighted感到高兴的

disappointing令人失望的--disappointed感到失望的encouraging令人鼓舞的--encouraged感到鼓舞的pleasing令人愉快的--pleased感到愉快的puzzling令人费解的--puzzled感到费解的satisfying令人满意的---satisfied感到满意的surprising令人惊异的--surprised感到惊异的worrying令人担心的--worried感到担心的 Travelling is interesting but tiring．旅行是有趣的，但是使人疲劳。

The pupils will get confused if they are made to learn too much．如果要学生学得太多，他们会感到糊涂的。

The argument is very convincing．他的论点很令人信服。

They were very excited at the news．听到这个消息，他们非常激动。

3．不定式和动名词作宾语的区别

英语中大多数动词既可跟不定式，也可跟动名词作直接宾语，但有些动词要求：

(1)不定式做宾语和宾语补足语

1)下面的动词要求不定式做宾语

attempt企图 enable能够 neglect忽视

afford负担得起 demand要求 long渴望

arrange安排 destine注定 mean意欲，打算

begin开始 expect期望 omit忽略，漏

appear似乎，显得 determine决定 manage设法

cease停止 hate憎恨，厌恶 pretend假装

ask问 dread害怕 need需要

agree同意 desire愿望 love爱

swear宣誓 volunteer志愿 wish希望 bear承受 endeavor努力 offer提供

beg请求 fail不能 plan计划

bother扰乱；烦恼 forget忘记 prefer喜欢，宁愿

care关心，喜欢 happen碰巧 prepare准备

decide决定 learn学习regret抱歉，遗憾

choose选择 hesitate犹豫 profess表明

claim要求 hope希望 promise承诺，允许

start开始 undertake承接 want想要

consent同意，赞同 intend想要 refuse拒绝

decide决定 learn学习vow起

contrive设法，图谋 incline有…倾向 propose提议

seek找，寻觅 try试图

2)下面的动词要求不定式做宾补：动词+宾语+动词不定式

ask要求，邀请 get请，得到 prompt促使

allow允许 forbid禁止 prefer喜欢，宁愿

announce宣布 force强迫 press迫使

bride 收买 inspire鼓舞 request请求

assist协助 hate憎恶 pronounce断定，表示

advise劝告 exhort告诫，勉励 pray请求

authorize授权，委托 help帮助 recommend劝告，推荐

bear容忍 implore恳求 remind提醒

beg请求 induce引诱 report报告

compel强迫 invite吸引，邀请，summon传唤

command命令 intend想要，企图 show 显示

drive驱赶 mean意欲，打算 train训练

cause引起 instruct指示 require要求 deserve应受 leave使，让 tell告诉

direct指导 like喜欢 tempt劝诱

entitle有资格 order命令 warn告诫

enable使能够 need需要 urge激励，力说

encourage鼓励 oblige不得不 want想要

condemn指责，谴责 lead引起，使得 teach教

entreat恳求 permit允许 wish希望

(2)有少数动词只能用动名词作宾语

acknowledge承认，自认 cease 停止 mention说到，讲到

admit 承认 tolerate忍受 dislike不喜欢，讨厌

advocate：提倡，主张 complete完成 dread可怕

appreciate 感激，欣赏 confess坦白 endure忍受

avoid避免 contemplate细想 enjoy享有，喜爱

bear忍受 defer拖延 envy嫉妒

can’t help不禁 delay延迟 escape逃跑，逃避

can’t stand受不了 deny否认 excuse借口

consider 考虑 detest嫌恶 fancy幻想，爱好

favor 造成，偏爱 mind 介意 repent悔悟

figure描绘，计算 miss错过 resent怨恨

finish完成，结束不得 pardon原谅，饶恕 resist抵抗，阻止

forgive原谅 permit 允许 resume恢复

imagine设想 postpone延迟，延期 risk冒险

involve卷入，包含 practise 实行，实践 suggest建议

hate讨厌 prevent阻止 save营救，储蓄

keep保持 quit放弃停止 stand坚持，忍受

loathe非常讨厌，厌恶 recall回想

例如：I appreciate having been given the opportunity to study abroad two years ago.我很感激两年前给我出国学习的机会。

(3)有些动词后使用动名词和动词不定式作宾语的差别

1）forget to do 忘记要去做某事（此事未做）

forget doing忘记做过某事（此事已做过或已发生）

2）stop to do 停止、中断（某件事），目的是去做另一件事

stop doing 停止正在或经常做的事

3）remember to do 记住去做某事（未做）

remember doing记得做过某事(已做)

4)regret to do对要做的事遗憾

regret doing对做过的事遗憾、后悔

5）try to do努力、企图做某事

try doing试验、试一试某种办法

6)mean to do打算，有意要…

mean doing意味着

7）go on to do 继而（去做另外一件事情）

go on doing 继续（原先没有做完的事情）

8）propose to do 打算（要做某事）proposing doing建议（做某事）

9)like /love/hate/ prefer +to do 表示具体行为；+doing sth 表示抽象、倾向概念

（注)如果这些动词前有should一词，其后宾语只跟不定式，不能跟动名词。例如：

I should like to see him tomorrow．

10)need, want, deserve +动名词表被动意义；+不定式被动态表示“要(修、清理等)”意思。

Don’t you remember seeing the man before?你不记得以前见过那个人吗?

You must remember to leave tomorrow．你可要记着是明天动身。

I don’t regret telling her what I thought．我不后悔给她讲过我的想法。(已讲过)

I regret to have to do this，but I have no choice．我很遗憾必须这样去做，我实在没办法。(未做但要做)

You must try to be more careful．你可要多加小心。

Let’s try doing the work some other way．让我们试一试用另外一种办法来做这工作。

I didn’t mean to hurt your feeling．我没想要伤害你的感情。

This illness will mean(your)going to hospital．得了这种病(你)就要进医院。

第二篇：考博英语语法重点总结(6)

考博辅导：考博英语语法重点总结（6）

目标测试

1．______in the matriculation for postgraduate in a short time is really a hard nut．

A．To make high scores

B．Making high scores

C．To make low goal

D．Making low goal

2．I found ________ to answer all the questions within the time given．

A．no possibility

B．there was impossibility

C．impossible

D．it impossible

3．The students expected there _____ more reviewing classes before the final exams．

A．is

B．being

C．have been

D．to be

4．You’re going to England next year． You should now practise ______English as much as possible．

A．speak

B．to speak

C．speaking

D．Speak about

5．If we don’t start out now, we must risk ______ the train．

A．miss

B．missing

C．being missed

D．to miss

6． The flexibility of film allows the artist _______ unstrained imagination to the animation of cartoon characters．

A．to bring

B．brining

C．is brought

D．brings

7．Although the lecture had already been on for five minutes，I still was not able to find a chair____． A．to sit

B．for to sit on

C．to sit on

D．for sitting

8． Surely her daughter would make an even bigger effort ______ her?

A．please

B．pleased

C．to please

D．having pleased

9．Lots of empty boots were found under the old man’s be D．He must have done nothing but ______．

A．drink

B．to drink

C．drinking

D．drunk

10．The local health organization is reported ___ twenty-five years age when Dr． Adudon became its first president．

A．to be set up

B．being set up

C．to have been set up

D．having been set up

11．I heard him __the door

A．locking

B．to lock

C．lock D．being locking

12．He does nothing but___

A．complaining

B．to complaining

C．complain

D．to complain

13．The students expected there___ more reviewing classes before the final exam．

A．is

B．being

C．have been

D．to be

14． The bank is reported in the local newspaper ___ in broad daylight yesterday．

A．to be robbed

B．robbed

C．to have been robbed

D．having been robbed

15．I appreciated ______the opportunity to study abroad two years ago．

A．having been given

B．having been

C．to have been given

D．to have given

16．There is no point ___further．

A．argue

B．to argue

C．arguing

D．being arguing

17．Nowhere in nature is aluminum found free, owing to its always ___with other elements, most commonly with oxygen．

A．combined

B．having combined C．combine

D．being combined

18．They stopped ___, but now I’m getting intereste D． A．listening

B．to listen

C．listen

D．having listening

19．I am sorry to hear that you resorted ___

A．to cheat

B．to cheating

C．cheating

D．cheat

20．He wasn’t asked to take on the chairmanship of the society, ___ insufficiently popular with all members．

A．being considered

B．considering．

C．to be considered

D．having considered

21．___of the burden of ice , the balloon climber up and drifted to the South．

A．To be free

B．Freeing

C．To free

D．Freed

22．___exceptions, the rule may stan D． A．Allow for

B．Allowing for C．To allow

D．To allow for

23．All flights___ because of the snowstorm, we decided to take the train．

A．were canceled

B．had been canceled

C．having canceled D．having been canceled

24．John painted her sitting in a chair with her hands ___

A．folding

B．to have folded

C．to fold

D．folded

25．It’s easy to blame the decline of conversation on the pace of modern life and on the vague changes ___place in our ever-changing worl D． A．taking

B．to take

C．take

D．taken

26．I worked so late in the office last night that I hardly had time __the last bus．

A．to have caught

B．to catch

C．catching

D．having caught

27．I have got a loaf of bread;now I’m looking for a knife____．

A．to cut it with

B．to cut with it

C．with it to cut

D．it to cut with

28．The function of Louis Sullivan’s architecture was ___large uninterrupted floor areas and to allow ample light into the interior．

A．to provide

B．providing

C．having providing

D．provide

29．His victory in the final was no more ____than I had expecte D． A．convincing

B．convinced C．to convince

D．being convincing

30．I recommend you ___ what he says．

A．do

B．doing

C．to do

D．to doing

31．How about ____ there?

A．to go

B．go

C．going

D．to going

32．He is an ___teacher．

A．advancing

B．advanced

C．being advancing

D．advance

33．The Portuguese give a great deal of credit to one man for having promoted sea travel, that man ___prince Henry the navigator, who lived in the 15th century A．was

B．being

C．is

D．having been

34．I have no idea of ___it．

21．___of the burden of ice , the balloon climber up and drifted to the South．

A．To be free

B．Freeing

C．To free

D．Freed

22．___exceptions, the rule may stan D． A．Allow for

B．Allowing for C．To allow

D．To allow for

23．All flights___ because of the snowstorm, we decided to take the train．

A．were canceled

B．had been canceled

C．having canceled

D．having been canceled

24．John painted her sitting in a chair with her hands ___

A．folding

B．to have folded

C．to fold

D．folded

25．It’s easy to blame the decline of conversation on the pace of modern life and on the vague changes ___place in our ever-changing worl D． A．taking

B．to take

C．take

D．taken

26．I worked so late in the office last night that I hardly had time __the last bus．

A．to have caught

B．to catch

C．catching

D．having caught

27．I have got a loaf of bread;now I’m looking for a knife____．

A．to cut it with

B．to cut with it

C．with it to cut

D．it to cut with

28．The function of Louis Sullivan’s architecture was ___large uninterrupted floor areas and to allow ample light into the interior．

A．to provide

B．providing

C．having providing

D．provide

29．His victory in the final was no more ____than I had expecte D． A．convincing

B．convinced

C．to convince

D．being convincing

30．I recommend you ___ what he says．

A．do

B．doing

C．to do

D．to doing

31．How about ____ there?

A．to go

B．go

C．going

D．to going

32．He is an ___teacher．

A．advancing

B．advanced

C．being advancing

D．advance

33The Portuguese give a great deal of credit to one man for having promoted sea travel, that man ___prince Henry the navigator, who lived in the 15th century． A．was

B．being

C．is

D．having been

第三篇：初二英语语法知识重点总结

初二英语语法知识重点总结

一、知识强化

1．掌握本单元的重点词汇及句型。

2．谈论最好做某事和正确做某事，培养提高自己的交际能力。

3．正确使用should和ought to。

二、重难点知识讲解

1．First, we decided to elect the chief editor.首先我们决定选出主编。

decide 动词，意为“决定”，常用结构：

decide(not)to do sth.决定(不)做某事

decide on doing sth 决定做某事

decide + 疑问代词/副词＋不定式

决定……

decide＋从句

决定……

e.g.I decided to go to Beijing on Monday.我决定星期一去北京。

He has decided on going for a trip next week.他已决定下周去旅行。

He decided when to go to Beijing.他已经决定了什么时候去北京。

We decided that we didn’t take part in the basketball match.我们决定不参加篮球比赛。

2．We should choose Joyce because she has experience.我们应该选乔伊斯因为她很有经验。

（1）experience n.经验；经历

①经验(不可数名词)

e.g.He is a math teacher with 5 years’ experience.他是一名有五年工作经验的数学老师。

②经历(可数名词)

e.g.It was a strange experience.真是一次奇特的经历。

Please tell us your experiences in America.请你告诉我们你在美洲的经历。

（2）experience v.体验；经历

e.g.Our country has experienced great changes in the last thirty years.我国在过去三十年经历了巨大变化。

3．Then we all voted for her.然后我们都投票赞成（选乔伊斯为主编）。

vote for sb.意为“投票赞成某人”。

e.g.I shall vote for Ben because he has experience.我将投票选本因为他有经验。

Vote for Johnson—the people’s friend!

请投约翰逊一票——他是人民的支持者。

vote against 意为“投票反对”。

e.g.People vote against Henry.人们投票反对亨利。

4．Then Joyce took charge of the meeting.于是，乔伊斯主持会议。

take charge of意为“主管，主持；负责”。

e.g.Who will take charge of the meeting?

谁将主持这次会议？

She took charge of the family business after her father died.父亲去世后，家务事全由她负责。

The department was badly organized until she took charge(of it).这个部门在她负责管理以前组织工作做得很差。

5．Then the others voted for me.于是其他人投票选我。

句中的the others指参加会议的除我以外的所有人即：Lucy, Joyce, Tony和Jessica。

辨析：other, the other, the others与another

（1）other表示“其他的”，表示泛指，没有特定的范围。

e.g.Lei Feng always helped other people.雷锋总是帮助别人。(指其他的任何人)

（2）the other意为“另一个”，一般用于两者之间。其句型为：one…the other…一个……另一个……

e.g.The old man has two sons.One is a soldier, the other is a worker.那位老人有两个儿子，一个是士兵，另一个是工人。

注意：the other和other后均可加名词，但意思有所不同，“the other＋名词”表示一定范围内除一部分外其余的全部，而“other＋名词”表示除去部分以后的另一些，但不是剩下的全部。

（3）the others 特指一定范围内的其余的全部人或事物。

e.g.I have three pencils.One is long, and the others are short.我有三支铅笔，一支是长的，另外（两个）是短的。（代词）

（4）another表示三者或三者以上的其他任何一个，意为“再一；又一”。

e.g.Would you like another cup of tea?

你还要一杯茶吗?

6．You will be responsible for different sections of the paper.你们将负责报纸的不同部分。

be responsible for意为“对……负责”。

e.g.Who is responsible for breaking the mirror?

镜子是谁打破的?

The bus driver is responsible for the passengers safety.公共汽车司机应对乘客的安全负责。

7．Should it be free for readers, or should they pay for it?

读者应免费阅读还是花钱购买呢？

辨析：pay, spend, cost与take

四个单词都可以表示“花费”，但用法却不尽相同。

（1）pay的基本用法是：

①pay(sb.)money for sth.付钱(给某人)买某物。

e.g.I have to pay them 20 pounds for this room each month.我每个月要付给他们20英镑的房租。

②pay for sth.付某物的钱

e.g.I have to pay for the lost book.我不得不赔偿丢失的书款。

③pay for sb.替某人付钱

e.g.Don’t worry!I’ll pay for you.别担心，我会给你付钱的。

（2）spend的主语必须是人，常用于以下结构：

①spend time/ money on sth.在某物上花费时间/ 金钱。

e.g.I spent two hours on this maths problem.这道数学题花了我两个小时。

②spend time/ money(in)doing sth.花费时间/金钱做某事。

e.g.They spent two years(in)building this bridge.造这座桥花了他们两年时间。

（3）cost的主语是物或某种活动，还可以表示“值”，常见的用法如下：

①“sth.cost(sb.)＋金钱”表示“某物花了(某人)多少钱”。

e.g.A new computer costs a lot of money.买一台新电脑要花一大笔钱。

②“(doing)sth.cost(sb.)＋时间”表示“(做某事)某物花了(某人)多少时间”

e.g.Remembering these new words cost him a lot of time.他花了大量的时间才记住了这些新单词。

（4）take 常见的用法有以下几种：

①“It takes/took sb.＋时间＋ to do sth.”表示“做某事花了某人多少时间”。

e.g.It took them three years to build this road.他们用了三年时间修完了这条路。

②“doing sth.takes sb.＋时间”表示“做某事花了某人多少时间”。

e.g.Repairing this car took him the whole afternoon.他花了一整下午修这辆小汽车。

8．Well, I usually try to get one for free from outside the library…

哦，我通常试图从图书馆外免费拿一份……

try to do sth.,意为“尽力、设法去做某事”，强调付出一定的努力或想方设法地去完成。

I’ll try to come early tomorrow.我明天尽量早点儿来。

辨析：try doing sth.意为“尝试着做某事”，不一定付出很大努力。

e.g.If you like, you can try watching it.如果你喜欢，你可以试着看一下。

拓展：

①try/do one’s best to do sth.意为“尽某人全力去做某事”。

e.g.We should try our best to practice speaking English.我们应尽力来练习说英语。

②try on意为“试穿”。

e.g.Can I try it on?

我可以试穿一下吗?

③try也可用作名词，意为“尝试”。

e.g.I can’t open this door—will you have a try?

我打不开这扇门——你来试试行吗?

9．I also have the habit of reading English for half an hour every morning.我也有每天早上读半小时英语的习惯。

have the habit of doing…意为“有干某事的习惯”。

e.g.My mother has the habit of getting up early.我妈妈有早起的习惯。

He has habit of smoking during meals.他有吃饭时吸烟的习惯。

10．Were you nervous before the speech? 在演讲前你紧张吗?

nervous意为“焦虑的，紧张的”，形容词作表语，可以与动词get/ feel，系动词be连用。

e.g.Don’t be nervous!The doctor just wants to help you.别紧张!医生只是想帮助你。

I felt very nervous when I went into his office.当我走进他的办公室时，我感到很紧张。

11．She was on her way to the library to return the books.她正走在去图书馆还书的路上。

（1）the way to…意为“去……的路”。其中the可以用物主代词替换。如果表示地点的词是副词home, there, here等时，则不用介词to。way为名词，意为“路；道路”，其常用的搭配还有on one’s way to＋n.或on one’s way＋adv.，意为“在去……的路上”。

e.g.I see some beautiful flowers on my may home.在回家的路上，我看到一些美丽的花。

On my way to the school I met my head teacher.上学路上我遇到了班主任。

（2）return在句中意为“归还”，相当于give sth.back.e.g.Return the book to the library.把书归还给图书馆。

12．but I haven’t felt lonely at all.但我一点也不感到孤独。

（1）辨析：lonely与alone

①lonely一般只用作形容词，表示“孤单的，孤独的，寂寞的”，在句中既可作表语，又可作定语。lonely修饰物时，意为“荒凉的”。

e.g.When his wife and two little children left him, he was very lonely.妻子和两个孩子离他而去后，他很孤独。

This is a lonely mountain village.这是一个荒凉的小山村。

②alone作形容词时，意为“单独的，独自的；独一无二的”，通常只用作表语。用作副词，表示“独自地，单独地”之意，相当于by oneself。此外，alone用在名词或代词之后，意为“只有，唯有，仅仅”。

e.g.Tom alone knew what had happened.只有汤姆知道发生了什么事。

③lonely指人孤独寂寞，或指地方荒无人烟，有浓厚的伤感色彩。alone表示“单独，独自一人”，不含感情色彩。

e.g.He doesn’t feel lonely though he lives alone.尽管他独自生活，但他并不感到孤独。

（2）not…at all 意为“一点……也不；根本不”，是完全否定。

e.g.I don’t like it /them at all.我根本不喜欢它（它们）。

He can not swim at all.他根本就不会游泳。

She doesn’t love me at all.她根本就不爱我。

三、语法点拨——should与ought to的用法

1．一般说来，两者可替换，只是ought to语气稍重。

e.g.You ought to(should)go and see Mary sometime.你应该什么时候去看看玛丽。

The train ought to(should)have arrived at six.火车本应该6点钟到的。

Such things ought not to be allowed.这种事情是不允许的。

2．表示出于法令规则、行为准则、道德责任等客观情况而“应该”做某事时，一般应用ought to，若用should则含有个人意见，强调主观看法。

e.g.We ought to go and see Mary tomorrow, but I don’t think we will.明天我们按理应该去看看玛丽，但是我认为我们不会去(此句不宜用should)。

3．在公告、须知或条例中，出于礼貌，常用should。如：

e.g.You should not run alongside the swimming-pool.不准在游泳池边奔跑。

第四篇：考博作文总结

考博作文模板总结：

第一段 As is vividly depicted in the picture,，which seems to be humorous and ridiculous but thought-provoking on second thoughts.The most striking feature that impresses me deeply is that unbelievably, Recent few years has witnessed a phenomenon of 主题 which seems to be disastrous to inpidual survival and prosperity.(4)This phenomenon of 主题 should be condemned severely or made illegal.There is no doubt that its symbolic meaning subtly conveyed should be given deep consideration.中间段落从两方面论证问题的危害，并举例论证，预测危害的趋势

To account for the above-mentioned phenomenon, several serious effects have been put forward.To begin with,主题 not only results does harm to our physical and mental health but also results in a frustrating and humiliating life.In addition, nothing is more harmful than主题 to contradict with a harmonious society.Last but not the least, no issue is as harmful as 主题 to increase family burdens, which is a threatening situation we are unwilling to see.No better illustration of this idea can be thought than the example mentioned below.According to a survey made by China Daily, 63.93% of young people who have ever experienced主题will live a dull life or even feel loss of hope about the future.If we cannot take useful means, we may not control this trend, and some undesirable results may come out unexpectedly, we will see the gloomy future of something.最后一段要强调解决问题，谈的两点建议通常是提高人们的意识，加强执法

From what have been discussed above, it is therefore, necessary that some effective measures are taken to prevent主题.(2)On the one hand, we should be sensible to strengthen the enforcement of the laws to protect something.(3)On the other hand, it is demanding for us to keep people aware of the importance of saving somebody out of the evil hands of destruction.(4)However, it is easier said than done.(5)Although the fight against it is long-standing and tremendous one,our efforts will eventually pay off.(6)Only when you attention to it can you see a colorful and harmonious future better sooner or later.积极有利型的文章 以团队精神为例子

As is vividly depicted in the picture,(描述图画).The most striking feature is(图画重点信息).There is no doubt that its symbolic meaning subtly conveyed should be given deep consideration.As is symbolically revealed in the set of drawings, the fact that(重复上面的图画信息)profoundly indicates that team work is momentous(重要的)and fundamental to any one who undertakes great deeds.Undoubtedly, it is team work that keeps us continually doing something valuable and admirable in spite of difficulty, that makes us still full of energy to face the coming challenges and competition and that offers us the foundation for the coming success.If we don not cooperate sincerely, we will live a dull and depressing life and feel frustrated and humiliated or feel loss of hope about the future.As far as I am concerned, there are several advantages that can be given as below.To begin with, nothing is more beneficial than team work to overcome our defects and improve our efficiency.Secondly, no issue is as good as team work to make our life more colorful and energetic.No better illustration of this idea can be thought than the example mentioned below.A person who is assigned various jobs along the production lines will make a mess just because no one can be proficient in all the things.Only by cooperating with other people can you put your capacities into full play and can you be the winner in the society.From what have been discussed above,it admits of no doubt that in doing things whether great or small there are more or less difficulties, it is much better for one to involve yourself into a team work.It is therefore, necessary that some effective measures are taken to make your team work more efficient.On the one hand, we should be sensible to be receptive to other people’s opinions and benefits.On the other hand, it is demanding for us to be always helpful and honest to other people.However, it is easier said than done.Practice is the most important factor.Only when you pay attention to it can you make it better sooner or later.(1)不同观点列举型（选择型）

There is a widespread concern over the issue that __作文题目_____.But it is well known that the opinion concerning this hot topic varies from person to person.A majority of people think that _ 观点一________.In their views there are 2 factors contributing to this attitude as follows: in the first place, ___原因一_______.Furthermore, in the second place, ___原因二_____.So it goes without saying that ___观点一_____.People, however, differ in their opinions on this

matter.Some people hold the idea that ___观点二_______.In their point of view, on the one hand，___原因一_______.On the other hand, ____原因二_____.Therefore, there is no doubt that ___观点二______.As far as I am concerned, I firmly support the view that __观点一或二______.It is not only because ________, but also because _________.The more _______, the more ________.（2）利弊型的议论文

Nowadays, there is a widespread concern over(the issue that)___作文题目______.In fact, there are both advantages and disadvantages in __题目议题_____.Generally speaking, it is widely believed there are several positive aspects as follows.Firstly, ___优点一______.And secondly ___优点二_____.Just As a popular saying goes, “every coin has two sides”, __讨论议题______ is no exception, and in another word, it still has negative aspects.To begin with, ___缺点一______.In addition, ____缺点二______.To sum up, we should try to bring the advantages of __讨论议题____ into full play, and reduce the disadvantages to the minimum at the same time.In that case, we will definitely make a better use of the ____讨论议题___.（3）答题性议论文

Currently, there is a widespread concern over(the issue that)__作文题目_______.It is really an important concern to every one of us.As a result, we must spare no efforts to take some measures to solve this problem.As we know that there are many steps which can be taken to undo this problem.First of all, __途径一______.In addition, another way contributing to success of the solving problem is ___途径二_____.Above all, to solve the problem of ___作文题目______, we should find a number of various ways.But as far as I am concerned, I would prefer to solve the problem in this way, that is to say, ____方法_____.（4）谚语警句性议论文

It is well know to us that the proverb: “ ___谚语_______” has a profound significance and value not only in our job but also in our study.It means ____谚语的含义_______.The saying can be illustrated through a series of examples as follows.(also theoretically)A case in point is ___例子一______.Therefore, it is goes without saying that it is of great of importance to practice the proverb ____谚语_____.With the rapid development of science and technology in China, an increasing number of people come to realize that it is also of practical use to stick to the saying: ____谚语_____.The more we are aware of the significance of this famous saying, the more benefits we will get in our daily study and job.（5）图表作文的框架

As is shown/indicated/illustrated by the figure/percentage in the

table(graph/picture/pie/chart), ___作文题目的议题_____ has been on rise/ decrease(goesup/increases/drops/decreases),significantly/dramatically/steadily rising/decreasing from______ in _______ to ______ in _____.From the sharp/marked decline/ rise in the chart, it goes without saying that ________.There are at least two good reasons accounting for ______.On the one hand, ________.On the other hand, _______ is due to the fact that ________.In addition, ________ is responsible for _______.Maybe there are some other reasons to show ________.But it is generally

believed that the above mentioned reasons are commonly convincing.As far as I am concerned, I hold the point of view that _______.I am sure my opinion is both sound and well-grounded.（6）实用性写作（申请信)

Your address Month, Date, year Receiver's address Dear...，I am extremely pleased to hear from you./ to see your advertisement for the position in....And I would like to write a letter to tell you that.../ I am confident that I am suitable for the kind of the job you are advertising..../ I feel I am competent to meet the requirements you have listed.On the one hand,....On the other hand,....I am enclosing my resume for your kind consideration and reference.I shall be much obliged if you will offer me a precious opportunity to an interview.I will greatly appreciate a response from you at your earliest convenience/ I am looking forward to your replies at your earliest convenience.Best regards for your health and success.Sincerely yours，X X X

第五篇：血液、内分泌、风湿-考博重点总结

输血的意义：可以改善循环、增加携氧能力、提高血浆蛋白、增进免疫力和凝血功能。

主要适应症有：急性出血；贫血或低蛋白血症；重症感染；凝血机制障碍。

输血不良反应和并发症

输血不当有可能发生不良反应和并发症，甚至有致命的危险。主要的反应和并发症有：

一.溶血性不良反应 输血中或输血后，输入的红细胞或受血者本身的红细胞被过量破坏，即发生输血相关性溶血。

（一）急性输血相关性溶血 指在输血中或输血后数分钟至数小时内发生的溶血。常出现寒战、高热、心悸、气短、腰背痛、血红蛋白尿，甚至尿闭、急性肾衰竭和DIC表现。实验室检查提示血管内溶血。

主要原因有：1.供、受血者血型不合；2.血液保存、运输、处理不当；3.受血者患溶血性疾病。

处理方法：立即停止输血，应用大剂量糖皮质激素，碱化尿液、利尿，保证血容量和水电解质平衡，纠正低血压，防治肾衰竭和DIC，必要时透析，血浆置换或换血疗法。

（二）慢性输血相关性溶血

常表现为输血数日后出现黄疸、网织红细胞升高。多见于稀有血型不合、首次输血后致敏产生同种抗体、再次输该供者红细胞后发生 同种免疫性溶血。二.非溶血性不良反应

（一）发热 非溶血性发热是最常见的输血反应，发生率高达40%以上。主要表现为输血过程中发热、寒战；暂时停止输血，用解热镇痛药或糖皮质激素治疗有效。

发生原因有：1.血制品中含致热源。2.受血者多次受血后产生同种白细胞或血小板抗体。

（二）过敏反应 输血过程中或之后，受血者出现荨麻疹、血管神经性水肿、重者为全身皮疹、喉头水肿、支气管痉挛、血压下降等。

产生原因：1.所输血液或血制品含过敏原；2.受血者为高敏体质或多次受血致敏。

（三）传播疾病 感染病毒性肝炎、获得性免疫缺陷综合征、巨细胞病毒感染、梅毒感染、疟原虫感染等。

（四）其他：一次输血过量可引起急性心功能不全、左心衰、肺水肿。多次输血或红细胞，可致受血者铁负荷过重；大量输血引起的枸橼酸盐中毒、出血倾向及高血钾症；长期输血后发生的含铁血黄素沉着症和继发性血色病。成分血的适应征和输血指南

1.成分血的适应征

1.1全血（WB）

需交叉配血

200ml为1个单位（u）。有效成分主要是红细胞、血浆蛋白、稳定的凝血因子。

适应证：严重的急性失血（失血量超过自身血容量30%时）；

体外循环； 换血治疗。

目的：用于补充红细胞、稳定的凝血因子和扩容。

剂量：成人（60kg）每输入1u大约可提高Hb5g/L、HCT0.015；

儿童每kg体重6ml输入，大约可提高Hb10g/L。1.2.悬浮红细胞（CRCs）

需交叉配血

全血200ml移去血浆在剩下的浓缩红细胞中加入添加剂（晶体盐保存液约50ml）即成悬浮红细胞液1个单位（u）。

适应证：适用于临床各科输血。

1.外伤、手术、消化道、呼吸道、产科大出血需输血的； 2.容量正常的贫血需输血的； 3.心、肝、肾功能不全需输血的； 4.特别适用于儿童慢性贫血。

剂量：儿童 增加Hb(g/l)所需血量=0.6×体重（kg）

婴儿 每kg体重输红细胞10ml可使Hb升高30g/l 输注：输前将血袋反复颠倒数次，使红细胞与添加剂充分混匀；必要时边输边摇。1.3.浓缩红细胞（CRC）

需交叉配血

将新鲜全血或保存不久的库血经离心后将血浆移去，剩下的红细胞和少量的血浆即浓缩红细胞。HCT70—80%。

1u容量为120ml±10%，含200ml全血中的红细胞、30ml血浆、15ml抗凝剂。

适应证：同红悬液。

输注：通过Y型管加生理盐水输注，一般1u CRC加50ml生理盐水。1.4.少白细胞的红细胞（LPRC）

要求ABO血型相同

使用白细胞滤器可去除99.9%的白细胞，红细胞回收率90%以上。1u总量约120ml 红细胞60—80ml 生理盐水50ml。适用于临床各科输血，同CRC。

优点：1.降低非溶血性输血发热反应的发生；

2.降低了输血后移植物抗宿主病（GVHD）的发生； 3.防止部分输血相关病毒的传染；

4.预防HLA同种异体免疫反应引起的血小板输注无效。1.5.洗涤红细胞（WRC）

要求主侧配血

全血经离心去除血浆和白细胞，再用无菌生理盐水洗涤3—6次（一般洗3次），最后加 50ml生理盐水悬浮即得。

1u量为120ml±10%，其中红细胞60—70ml、生理盐水50ml。适应证：1.输全血或血浆发生过敏反应者；

2.自身免疫性溶血性贫血和PNH； 3.高钾血症及肝肾功障碍者；

4.由于反复输血产生白细胞或血小板抗体引起输血发热的患者可试用；

剂量:输注时量要比其它红细胞成分大一些。1.6． 血小板（PLT）

AB0血型相同，交叉配血

10手工法由200ml全血制备的浓缩血小板为1U,容量为20-30ml，血小板≥2.0╳10个，9红细胞≤1.0╳10个。

11机采1个（袋）为1个治疗量，血小板≥2.5╳10个，纯度高，半透明，橙黄，白细胞及红细胞极少。

适应证：治疗性输注及预防性输注

91.PLT<20╳10/L伴严重出血；

92.大量输血致PLT稀释性减少计数<50╳10/L； 3.血小板不低，但功能异常致严重出血者； 4.急性ITP有大出血或需进行手术时；

95.预防性输注：a.PLT<10╳10/L； b.PLT<20╳10/L，伴导致PLT消耗或破坏的情况，如感染，发

热，脾肿大，DIC等； c.PLT<50╳10/L，需进行创伤性检查或手术；

2119 剂量：每m体表面积输入血小板1.0╳10,输注后1h外周血小板增高（5-10）╳10/L，11成人每次输机采血小板2.5╳10(1个治疗量)，儿童可将1个治疗量分成2-4袋，分次输注。输入的血小板存活期5天，故2～3d输注1次，直到出血停止。CCI=（输注后血小板计数-输注前血小板计数）（1011）×体表面积(M2)/输入血小板总数(1011)注：输注后血小板计数为输注后1h测定值．CCI＞10者为输注有效。

1.7．新鲜冰冻血浆（FFP）

要求ABO相同或相容

新鲜冰冻血浆中含：白蛋白、免疫球蛋白、补体、凝血因子，纤维蛋白，蛋白酶抑制

物，转运蛋白和尚未确定的功能蛋白。适应证：WHO规定

1.补充多种凝血因子缺乏，如肝病，双香豆素抗凝治疗过量，接受大剂量输血 的受血者凝血因子稀释性减少； 2．DIC；

3．血栓性血小板减少性紫癜（TTP）。4.补充：⑴无相应浓缩的凝血因子时；

⑵AT-Ⅲ缺乏，无浓缩剂的情况下；

⑶血浆置换。

禁忌：1.血浆过敏；

2．扩容。效果差，风险大，使用代血浆，白蛋白等最好；

3．补充白蛋白，白蛋白浓度低，且可能增加水钠潴留和发生输血不良反应； 4．增强免疫力； 5．严重心肾功不全。

剂量：首次10-15ml/kg,维持5-10ml/kg,速度10ml/min,大多受血者凝血因子被提高

到正常水平的25%以上，并能止血。

输注注意：1.血浆融化，直到完全融化后，立即输注，若不能及时输注，应将血浆

暂时放在4℃，但应＜24h,>24h→FP，<5d；

2．不能在室温下自然融化，以免有大量FIB析出

3．融化后应尽快输注，以免蛋白变性，凝血因子丧失活性，4．要求与受血者ABO相同或相容，AB→所有，A→A.O,B→B.O,O→O； 5．输前肉眼观察为淡黄色，半透明，颜色异常，凝块不能输。6．目前FFP国内滥用，多是补充血容量，营养，替代白蛋白等。1.8．普通冰冻血浆（FP）

要求ABO血型相同

适用于1.主要用于补充稳定的凝血因子如：Ⅱ、Ⅶ、Ⅸ、Ⅹ； 2．手术，外伤，烧伤，肠梗等大出血或血浆大量丢失。1.9．冷沉淀（Cory）

要求ABO相同或相容

国内通常以400ml新鲜全血（6-8h内）血浆为1个制备单位，主要含Ⅷ因子、VWF因 子、FIB及纤维蛋白稳定因子和纤维结合蛋白。适应证：1.甲型血友病及Ⅷ因子缺乏； 2．血管性血友病（vWD）； 3．纤维蛋白原缺乏症；

4．局部使用促进创口、溃疡修复。1.10.白蛋白（Alb）

适应证：（1）主要适应证 补充血管内外的白蛋白缺乏

①扩充血容量是使用白蛋白的主要临床指针。对血容量损失50%～80%的

患者需加输5%白蛋白，使血浆蛋白维持在52g/L以上，血容量损失＞80%的患者可考虑输部分全血和FFP（补充凝血因子）。在输20%或25%的白蛋白时应同时补充适量的晶体溶液以防脱水。②白蛋白的丢失。

③体外循环 用晶体液和白蛋白作为泵底液要比全血更安全、更能为患者接受，特别是有明显的血液稀释时使用。保持HCT 0.20，Alb25～30g/L。④血浆置换。

（2）相对适应证 辅助治疗：如对成人呼吸窘迫综合征、脑水肿改善症状。

作“化学缓冲剂”：如在新生儿溶血病时用白蛋白带负电荷

结合胆红素。

手术后或创伤后：用于改善预后，尚未肯定。

剂量：所需白蛋白量（g）=〔期望白蛋白浓度(g/L)－输前白蛋白浓度(g/L)〕×体重(kg)

×0.08 输注：除有特殊要求，一般不使用输血器。速度根据病情调节，快速扩容时要快。血容

量正常或轻度减少时5%的白蛋白输注速度为2～4ml/min，25%的白蛋白输注速度 为1ml/min，儿童是成人的1/2～1/3。

1.11.免疫球蛋白（IG）

⑴正常人免疫球蛋白即肌肉注射免疫球蛋白（IMIG）,曾称丙种球蛋白。国内一般是10% 的免疫球蛋白，主要是IgG，有抗病毒、细菌和毒素的抗体，IgM、IgA含量很少。由 于正常人免疫球蛋白抗补体活性高只能肌注，禁止静脉注射。

⑵静脉注射免疫球蛋白（IVIG）,它是以千人份以上健康人血浆为原料，将IgG聚合 体去除或降低其补体活性而制备的，宜静脉注射。静脉注射IgG能使循环中的抗体水平迅速升高，同时也使运用大剂量IgG治疗某些疾病成为可能。IVIG的主要作用是 补充免疫抗体和进行免疫调节。

⑶特异性免疫球蛋白，含大量的特异性抗体，比正常人的免疫球蛋白所含的特异性抗 体高，对某些疾病的治疗要优于正常免疫球蛋白。目前国内有抗狂犬病、抗乙型肝炎、抗破伤风、抗RhD免疫球蛋白等。

上述各种免疫球蛋白从制备之日在2～8℃可保存3年。

适应证：原发性或获得性免疫缺陷性疾病，自身免疫性疾病，特异性的被动免疫和其

它疾病。

剂量：IMIG可0.3～0.6g/次，必要时加倍。

IVIG要单独输注，避免与其它溶液混合,若是冻干粉剂可配成5%或10%的溶液使用。常用剂量100mg/kg，每3～4周静脉注射1次，一般提高患者IgG水平2～4g/L即可。静脉注射开始时应低速，前30min为0.01～0.02ml/min，无不良反应可提速到0.02～0.04ml/min。

特异性免疫球蛋白使用参考有关说明书。

1.12.此外尚有：冰冻红细胞（FTRC），浓缩白细胞悬液（GRANS），新鲜体液血浆（FLP）凝

血因子制剂如纤维蛋白原浓缩剂、Ⅷ浓缩剂、Ⅸ浓缩剂、凝血酶原复合物、纤维蛋白胶、抗凝血酶Ⅲ浓缩剂等。

2.输血指南

2.1输红细胞的指征

用于需要提高血液携氧能力，血容量基本正常或低血容量已被纠正的患者。低血容量患

者可配晶体液或胶体液应用。

1． 血红蛋白＞100g/L,不必输血。

2． 血红蛋白＜70g/L,应考虑输浓缩红细胞。

3． 血红蛋白在70~100g/L 之间，根据患者代偿能力、一般情况和病情决定是否输血。

4.烧伤病人Hct小于0.30时，可输注悬浮红细胞，使Hct到达0.35以上为宜。5.妊娠＜36周，Hb≤50g/L，或Hb在50～70g/L,伴有心力衰竭或缺氧的临床证据时；

妊娠≥36周，Hb≤60g/L，或血红蛋白在60～80g/L,伴有心力衰竭或缺氧的临床证据时均可输注悬浮红细胞。

6.急性大出血，出血量＞30%血容量，可输全血。

急性大量失血时红细胞补充参考量

失血量 补充红细胞量 ＜1000ml 不输血

1000～2000ml 3～5个单位 2000～4000ml 5～15个单位 ＞4000ml ＞15个单位

2.2输血小板的指征

用于患者血小板数量减少或功能异常伴有出血倾向或表现。

1． 术前、大量输血，血小板计数＜50×109/L，应考虑输。2.败血症、骨髓抑制，血小板计数＜20×109/L，应考虑输。3.特发性血小板减少性紫癜。4． 尿毒症。

5． 血小板计数在10~50×109/L之间，根据临床出血情况决定。

6． 如术中出现不可控渗血，确定血小板功能低下，输血小板不受上述限制。

7.血小板计数＜5×109/L，无论有无出血，应立即输注。2.3 输新鲜冰冻血浆（FFP）的指征

用于凝血因子缺乏的患者。

1． PT或APTT＞正常1.5倍，创面弥漫性渗血。

2． 患者急性大出血输入大量库存全血或浓缩红细胞后（出血量或输血量相当于患者自

身血容量）。

3.抗凝血酶Ⅲ缺乏。

3． 病史或临床过程表现有先天性或获得性凝血功能障碍。

4． 紧急对抗华法令的抗凝血作用（FFP：5~8ml/kg）。2.4 输普通冰冻血浆（FP）的指征 补充稳定的凝血因子和血浆蛋白。

1.主要用于补充稳定的凝血因子如：Ⅱ、Ⅶ、Ⅸ、Ⅹ； 2．手术，外伤，烧伤，肠梗等大出血或血浆大量丢失。2.5 输冷沉淀（Cory）的指征

1.血友病A。

2.血管性血友病。

3.活动性出血并纤维蛋白原缺乏。4.尿毒症致血小板功能障碍。2.6 内科输血指征

1.慢性贫血伴缺氧症状。血红蛋白＜60g/L或红细胞压积＜0.2时可考虑输注红细胞。2.内科急性出血引起血红蛋白和血容量的迅速下降并伴有缺氧症状。血红蛋白＜70g/L 或红细胞压积＜0.22，或出现失血性休克时考虑输全血。

3.用晶体液或并用胶体液扩容仍是治疗失血性休克的主要输血方案。

4.如果没有引起输血无效的因素，一般慢性骨髓造血功能障碍者每2周输红细胞2u； 造血物质缺乏的患者需要输血时往往输1次红细胞就行了。

2.7 新生儿失血超过血容量的10%时，应当补充红细胞，不应以Hb作为固定的输血指征。

足月新生儿Hb＜145g/L即为贫血。贫血程度可分为轻度145-120g/L,中度120-100g/L 和重度＜100g/L。

中度以上贫血可考虑输血，而一周以内新生儿Hb＜145g/L以下时也应考虑输红细胞悬 液。当新生儿溶血病未达到换血指征或换血后未达到再次换血指征，应予输血维持其 正常Hb水平，以输注悬浮红细胞为好。

ABO血型溶血患儿在病程2周内宜输注O型洗涤红细胞，2周后可输同血型红细胞。Rh血型溶血者，2周内也宜输注Rh阴性、ABO同型或O型红细胞，2周后输入Rh同型红细胞，尽量减少输血次数，并随时观察患儿有无溶血症状加剧，应予及时处理。新生儿溶血病的换血指征：

① 产前已诊断为ABO或Rh血型不合溶血病，新生儿出生时Hb＜120g/L、伴水

肿、肝脾肿大者；

② 贫血严重，伴充血性心力衰竭；

③ 出生后黄胆急剧加重，12h血清总胆红素＞205μmol/L,24h＞273μmol/L,36h＞308μmol/L； ④ 血清总胆红素＞342μmol/L； ⑤ 出现胆红素脑病者。

特发性血小板减少性紫癜

特发性血小板减少性紫癜是一因血小板免疫性破坏，导致外周血中血小板减少的出血性疾病。以广泛皮肤黏膜及内脏出血、血小板减少、骨髓巨核细胞发育障碍、血小板生存时间缩短及血小板自身抗体出现为特征。

发病机制：

1.感染：细菌或病毒。其佐证有：A.约80%的急性ITP在发病前2周左右有上呼吸道感染史；B.慢性ITP患者，常因感染而致病情加重；C.病毒感染后发生的ITP患者，血中可发现抗病毒抗体或免疫复合物

2.免疫因素：病毒与相应抗体形成免疫复合物，后者与血小板膜的Fc受体结合；病毒使血小板抗原性发生改变，导致自身抗体形成，从而影响巨核细胞生产血小板；血小板与血小板相关抗体或补体相结合；

3.肝与脾作用：脾可产生血小板相关抗体，1/3血小板瘀滞于脾。肝脏在血小板的破坏中有类似脾的作用。

4.其他因素：雌激素抑制血小板生产，并刺激单核-巨噬细胞清除已与抗体结合的血小板。毛细血管脆性增加。

诊断标准：

1.广泛出血累及皮肤、粘膜及内脏

2.多次化验检查血小板计数减少

3.脾脏不增大或仅有轻度增大

4.骨髓检查巨核细胞增多或正常，有成熟障碍

5.以下五点中应具备任何一点：（1）泼尼松治疗有效；（2）切脾治疗有效；

（3）血小板相关抗体阳性；（4）血小板相关补体阳性；（5）血小板寿命测定缩短。

6.排除继发性血小板减少症

治疗：

一.一般治疗：出血严重者应注意休息。血小板低于20*109/L者，应严格卧床，避免外伤。可应用止血药物。

二.糖皮质激素：一般情况下为首选治疗，近期有效率为80% 作用机制：1.减少血小板相关抗体生成及减轻抗原抗体反应；2.抑制单核-巨噬细胞系统对血小板的破坏；3.改善毛细血管通透性；4.刺激骨髓造血及血小板向外周血的释放。

剂量与用法：常用30-60mg/d，分次或顿服，病情严重时以等量地塞米松或甲泼尼龙静脉滴注，好转后改口服。待血小板升至正常或接近正常后，逐步减量（每周5mg），最后以5-10mg/d维持，持续3-6个月。

三.脾切除：脾切除有效率约70-90%，无效者对糖皮质激素的需要量亦可减少。适应证：1.正规糖皮质激素治疗3-6个月无效； 2.糖皮质激素维持量持续大于30mg/d； 3.糖皮质激素使用有禁忌症；

禁忌证：1.年龄＜2岁；2.妊娠期；3.其他因疾病不能耐受手术者 四.免疫抑制剂治疗：不宜作为首选

适应证：1.糖皮质激素或脾切除疗效不佳者；2.有使用糖皮质激素或脾切除禁忌证；3.与糖皮质激素合用以提高疗效及减少糖皮质激素用量。

主要药物：1.长春新碱：每次1mg，每周1次，静脉注射，4-6周为一疗程。

2.环磷酰胺：50-100mg/d，口服，3-6周为一疗程，出现疗效后逐渐减量，维持4-6周。3.硫唑嘌啉：100-200mg/d，口服，3-6周为一疗程，随后以25-50mg/d维持8-12周。4.环孢素：主要用于难治性ITP的治疗。250-500mg/d，口服，3-6周为一疗程。五.其他：合成雄激素制剂（达那唑），中医药

六.急症的处理：适用于1.血小板低于20*109/L者，2.出血严重广泛者，3.疑有或已发生颅内出血者，4.近期将实施手术或分娩者

1.血小板输注：成人按10-20单位/次给予，根据病情可重复使用

2.静脉注射丙种球蛋白

0.4g/kg，静脉滴注，4-5日为一疗程。1个月后可重复。

3.血浆置换：3-5日内连续3次以上，每次置换3000ml血浆，可有效清除血浆中的血小板抗体

4.大剂量甲泼尼龙 1g/d，静脉注射，3-5次为一疗程，可通过抑制单核-巨噬细胞系统对血小板的破坏而发挥治疗作用。

多发性骨髓瘤

多发性骨髓瘤（multiple myeloma，MM）是浆细胞的恶性肿瘤。骨髓瘤细胞在骨髓内克隆性增殖，引起溶骨性骨骼破坏；骨髓瘤细胞分泌单株免疫球蛋白，正常的多株免疫球蛋白合成受抑，本周蛋白随尿液排出；常伴有贫血，肾衰竭和骨髓瘤细胞髓外浸润所致的各种损害。我国MM发病率约为1/10万，低于西方工业发达国家（约4/10万）。发病年龄大多在50～60岁之间，40岁以下者较少见，男女之比为3：2。

【病因和发病机制】

病因不明。有学者认为人类8型疱疹病毒（human herpesvirus-8，HHV-8）参与了MM的发生。骨髓瘤细胞起源于B记忆细胞或幼浆细胞。细胞因子白介素-6（IL-6）是促进B细胞分化成浆细胞的调节因子。进展性MM患者骨髓中IL-6异常升高，提示以IL-6为中心的细胞因子网络失调导致骨髓瘤细胞增生。

【病理生理和临床表现】

（一）骨髓瘤细胞对骨骼和其他组织器官的浸润与破坏

1．骨骼破坏

骨髓瘤细胞在骨髓中增生，刺激由基质细胞衍变而来的成骨细胞过度表达IL-6，激活破骨细胞，导致骨质疏松及溶骨性破坏。

骨痛为常见症状，随病情发展而加重。疼痛部位多在骶部，其次为胸廓和肢体。活动或扭伤后剧痛者有自发性骨折的可能，多发生在肋骨、锁骨、下胸椎和上腰椎。多处肋骨或脊柱骨折可引起胸廓或脊柱畸形。骨髓瘤细胞浸润引起胸、肋、锁骨连接处发生串珠样结节者为本病的特征之一，如浸润骨髓可引起骨髓病性贫血。单个骨骼损害称为孤立性骨髓瘤。

2．髓外浸润

①器官肿大如淋巴结、肾和肝脾肿大。②神经损害胸、腰椎破坏压迫脊髓所致截瘫较常见，其次为神经根受累。脑神经瘫痪较少见。多发性神经病变，呈双侧对称性远端感觉和运动障碍。如同时有多发性神经病变、器官肿大、内分泌病、单株免疫球蛋白血症和皮肤改变者，称为POEMS综合征。③髓外骨髓瘤

孤立性病变位于口腔及呼吸道等软组织中。④浆细胞白血病

系骨髓瘤细胞浸润外周血所致，浆细胞超过2.0×109/L时即可诊断