进修呼吸治疗师系列培训课程课件

1、进修呼吸治疗师系列培训课程有创提高小测验进修呼吸治疗师系列培训课程有创提高小测验Questions-1流量触发灵敏度为3L/min，呼吸机提供基础气流为5L/min，若呼吸回路存在持续漏气2L/min，请问患者的吸气流速至少为多少才能触发呼吸机送气？ A 1L/min B 2L/min C 3L/min D 7L/min E 8L/minQuestions-1流量触发灵敏度为3L/min，呼吸机提Questions-2流量触发灵敏度为3L/min，基础气流为5L/min，若此时外接雾化器行持续雾化吸入治疗，氧气流速为5L/min，请问患者的吸气流速至少为多少才能触发呼吸机送气？ A 3L/mi

2、n B 5L/min C 7L/min D 8L/min E 10L/minQuestions-2流量触发灵敏度为3L/min，基础气流Questions-3V-A/C模式通气时，哪些因素可影响气道峰压值？ A PEEP B 吸气流速 C VT D 呼吸系统顺应性 E 气道阻力 F PEEPiQuestions-3V-A/C模式通气时，哪些因素可影响气Questions-4V-A/C模式通气时，哪些因素可影响平台压值？ A PEEP B 吸气流速 C VT D 呼吸系统顺应性 E 气道阻力 F PEEPi G 平台时间Questions-4V-A/C模式通气时，哪些因素可影响平Question

3、s-5V-A/C模式通气时，如预设RR为10次/min，患者自主呼吸频率为5次/min，则呼吸机的实际工作频率为 A 5次/min B 10次/min C 15/min D 10-15/min E 5-10次/minQuestions-5V-A/C模式通气时，如预设RR为10Questions-6在PCV模式下，若设置支持压力不变，哪些因素可以使潮气量增加？ A 患者自主呼吸努力增强 B 胸肺顺应性下降 C 气道阻力增加 D PEEPi增加 E PEEP下降 F 呼吸频率增快Questions-6在PCV模式下，若设置支持压力不变，哪临床呼吸生理与床旁呼吸力学监测首都医科大学附属北京朝阳医院北

4、京呼吸疾病研究所姚 秀 丽2011-03-08临床呼吸生理与床旁呼吸力学监测首都医科大学附属北京朝阳医院与呼吸力学相关的呼吸生理及流体力学知识与呼吸力学相关的解剖结构解剖结构解剖结构解剖结构进修呼吸治疗师系列培训课程课件肺通气的机制吸气吸气肌主动收缩 胸廓扩张 胸内负压增加 肺扩张 肺容积增加 肺内压下降 与大气压产生压力梯度 气体进入肺泡呼气膈肌、肋间肌松弛 胸廓弹性回缩 胸内负压减少 肺回缩 肺容量减小 肺内压升高 与大气压产生压力梯度 气体排出肺通气的机制吸气肺通气的动力动力：驱动压力中枢驱动力外周驱动力/机械驱动力与之相关的压力：胸内压肺泡内压气道压跨肺压：肺收缩/扩张的直接动力跨胸壁

5、压跨胸压：机械通气时的总驱动压跨气道压肺通气的动力动力：驱动压力肺通气的阻力肺通气阻力弹性阻力静态阻力，2/3非弹性阻力动态阻力，1/3肺弹性阻力胸廓弹性阻力黏性阻力惯性阻力肺黏性阻力气道黏性阻力胸廓黏性阻力肺惯性阻力气道惯性阻力胸廓惯性阻力肺通气总阻力=肺弹性阻力+胸廓弹性阻力+气道阻力肺通气的阻力肺通气阻力弹性阻力非弹性阻力肺弹性阻力胸廓弹性阻弹性阻力弹性弹性物质在外力作用下变形时，对抗变形和弹性回位的倾向平静呼吸时，约占总阻力的2/3吸气时的阻力，呼气时的动力弹性阻力弹性顺应性物体的易扩张性，指单位压力改变所引起的容积改变CV/P顺应性物体的易扩张性，指单位压力改变所引起的容积改变顺应性

6、弹性阻力的倒数容积依赖性，比顺应性静态顺应性气流阻断后所测得的顺应性动态顺应性未阻断气流所测得的顺应性顺应性弹性阻力的倒数单肺通气，顺应性严重差的肺移植患者通气状况 单肺通气，顺应性严重差的肺移植患者通气状况 影响顺应性的因素弹性阻力增加（顺应性降低）肺水肿，实变，纤维化，肺不张气胸、胸腔积液脊柱侧弯或其他胸壁畸形肥胖、腹胀动态肺充气影响顺应性的因素弹性阻力增加（顺应性降低）非弹性阻力黏性阻力与惯性阻力以气道黏性阻力为主（80%90%）平静呼吸时，约占总阻力的1/3非弹性阻力黏性阻力与惯性阻力非弹性阻力黏性阻力气体分子之间、气体分子与气道壁之间的摩擦力以及呼吸时组织发生相对位移时的摩擦阻力气道

7、阻力、肺组织黏性阻力、胸廓黏性阻力惯性阻力气流在发动、变速、换向时由于气流与组织的惯性所产生的阻止运动的因素非弹性阻力黏性阻力气道阻力层流阻力来源于气体之间的相互摩擦Raw8l/(r4)湍流阻力来源于气体之间以及气体与气道壁之间的相互摩擦Rawvl*摩擦因子/ 42r5层流示意图湍流示意图气体分子之间、气体分子与气道壁之间的摩擦力气道阻力层流湍流层流示意图湍流示意图气体分子之间、气体分子与不同气流形态下压力与流速关系层流 P=kv湍流 P=kv2层流：压力与流速呈线性关系湍流：压力随流速呈指数性增长不同气流形态下压力与流速关系层流湍流层流：压力与流速呈线性关气道阻力的分布气道阻力的分布气道管径

8、与吸呼气相的关系影响气道阻力的因素气流形态气流速度气道管径气道长度气体的粘性与密度肺容积身材与年龄气道阻力与肺容积的关系气道阻力具有流速与容积依赖性气道管径与吸呼气相的关系影响气道阻力的因素气流形态气道阻力与MV时影响气道阻力的因素气道阻力增加与人工气道有关管腔狭小，扭曲，贴壁，痰痂形成与气道有关气道痉挛，分泌物增加MV时影响气道阻力的因素气道阻力增加气道陷闭气道陷闭床旁呼吸力学监测床旁呼吸力学监测呼吸力学的概念 以物理力学的观点和方法对呼吸运动进行研究的一门学科 以压力、容积和流速的相互关系解释呼吸运动现象呼吸力学的概念 以物理力学的观点和方法对呼吸运动进行动态呼吸力学 研究压力与流速的相互

9、关系静态呼吸力学 研究压力与容积的相互关系呼吸力学的内容动态呼吸力学呼吸力学的内容呼吸力学的基本特性气道阻力弹性阻力+PEEPi呼吸力学的基本特性气道阻力弹性阻力+PEEPi呼吸力学的基本特性 P=P摩擦阻力+P弹性阻力i机械通气的灵魂-运动方程呼吸力学的基本特性 i机械通气的灵魂阻力和顺应性的监测吸气末阻断法患者：充分镇静模式：容量控制参数：方波、PEEPe“吸气末屏气”阻力和顺应性的监测吸气末阻断法PpeakPplatPpeakPplat计算公式Raw=(Ppeak-Pplat)/FCst=VT/(Pplat-PEEP-PEEPi)计算公式Raw=(Ppeak-Pplat)/F注意事项消除

10、自主呼吸的影响足够的平衡时间 流速与容积依赖性PEEPPEEPi注意事项消除自主呼吸的影响举例：设置：VT 350ml，PEEPe 5cmH2O，Flow 30L/min(方波)监测：Ppeak 34cmH2O，Pplat 27cmH2O，PEEPi 5cmH2O请计算R?C?举例：设置：MV时顺应性计算公式总静态顺应性（Cst） =VT/(Pplat-PEEP-PEEPi)总动态顺应性（Cdyn） =VT/(Ppeak-PEEP-PEEPi)肺静态顺应性（Clst） = VT/(Pplat-Ppl-PEEP-PEEPi)胸壁顺应性 总顺应性肺顺应性MV时顺应性计算公式总静态顺应性（Cst）气

11、道阻力的计算方法非MV时的气道阻力Raw=Pao-Pal/vMV时的气道阻力Raw=Ppeak-Pinit/v呼吸机监测的为总黏性阻力Raw=Ppeak-Pplat/v气道阻力的计算方法非MV时的气道阻力呼吸力学监测的三要素压力（pressure，）气道开口压，食道压，隆突压流速（flow，）容积（volume）计算流量对时间的积分呼吸力学监测的三要素压力（pressure，）常用压力指标气道峰压（Ppeak）气道平台压（Pplat）气道平均压（Pmean)内源性呼气末正压（PEEPi）呼气末正压（PEEP）常用压力指标气道峰压（Ppeak）进修呼吸治疗师系列培训课程课件气道峰压（Ppeak）

12、的影响因素定容通气，方波Ppeak= Flow x Resistance +Volume/compliance+PEEP用于克服气道阻力、弹性阻力和PEEP影响因素：顺应性潮气量PEEPPEEPi气道和气管内导管阻力吸气流速气道峰压（Ppeak）的影响因素定容通气，方波气道峰压的临床意义气道峰压是设置压力报警限的根据 实际气道峰压之上5-10cmH2O以不高于45cmH2O为宜 气道峰压与肺损伤的关系 气道峰压的临床意义气道峰压是设置压力报警限的根据 平台压（Pplat）的影响因素定容通气，方波Pplat=Volume/Compliance+PEEP用于克服弹性阻力和PEEP影响因素：顺应性P

13、EEP潮气量平台压（Pplat）的影响因素定容通气，方波平台压（Pplat）的意义可近似反应肺泡压与肺损伤的关系更为密切限制平台压不超过30cmH2O 平台压（Pplat）的意义可近似反应肺泡压平台压（Pplat）的监测吸气末阻断法患者：充分镇静模式：容量控制参数：方波“吸气末屏气”平台压（Pplat）的监测吸气末阻断法流速或气道阻力对气道峰压产生影响，但对平台压无影响顺应性的变化对气道峰压和平台压都产生相同影响流速或气道阻力对气道峰压产生影响，但对平台压无影响气道峰压增加的临床意义不伴有平台压的增加Ppeak- Pplat = Flow x Resistance用于克服气道阻力反应气道问题伴

14、有平台压的增加肺实质或间质问题肺含气状态变化PpeakPplat气道峰压增加的临床意义不伴有平台压的增加PpeakPplat Paw (cm H2O)NormalNormal PPlat(Normal Compliance)Increased PIPIncreased PTA(increased Airway Resistance)NormalPIPPPlatHigh RawPIPPPlat气道阻力对峰压的影响 Paw (cm H2O)NormalNormal PPl肺顺应性对峰压的影响Time (sec)Paw (cm H2O)Low CompliancePIPPPlatNormalPIPP

15、PlatNormal PPlat(Normal Compliance)Increased PPlat(Decreased Compliance)NormalPIP肺顺应性对峰压的影响Time (sec)Paw (cm H虚点面积在特定的时间间隔上所计算的压力相加求其均数即平均气道压平均气道压(Pmean)虚点面积在特定的时间间隔上所计算的压力相加求其均数即平均气道平均气道压(Pmean)数个周期中气道压的平均值与影响PIP的因素及吸气时间长短有关近似于平均肺泡压与对心血管系统的影响直接相关平均气道压(Pmean)数个周期中气道压的平均值内源性呼气末正压（PEEPi）在肺的弹性回缩下导致呼气末肺

16、泡内呈正压，称为PEEPi只要呼气时间小于肺排空的实际时间就会产生PEEPiPEEPi的存在说明存在动态肺过度充气（DPH）内源性呼气末正压（PEEPi）在肺的弹性回缩下导致呼气末肺泡PEEPi的影响因素气道阻力增加 呼吸系统弹性下降气道动态塌陷通气量过大呼气时间不足呼气肌的作用PEEPi的影响因素气道阻力增加 PEEPi的临床意义增加呼吸功,导致呼吸肌疲劳增加肺损伤的危险性对循环系统产生不良影响PEEPi的临床意义呼气末肺容积与呼吸系统压力变化FRCPalv=0PEEPPEEPiVdynVstTotal PEEP呼气末肺容积与呼吸系统压力变化FRCPalv=0PEEPPEPEEPi的监测方法

17、:间接观察 胸围增大；患者呼吸费力；心血管功能恶化；呼气末有持续呼气气流，呼气的最后部分突然被吸气中断； 压力控制通气时潮气量或每分通气量下降；不能用呼吸系统顺应性下降解释的平台压升高；容量控制通气时气道压力升高。 PEEPi的监测方法:间接观察 胸围增大；监测有无PEEPi监测有无PEEPi呼气末阻断法测定PEEPi呼气末阻断法测定PEEPi呼气末阻断法测定PEEPi患者：充分镇静模式：？参数：PEEPe全肺平均PEEPi呼气末阻断法测定PEEPi患者：充分镇静PEEPe对PEEPi的影响*PEEPe对PEEPi的影响* PEEPi的临床处理降低PEEPiCOPD，哮喘降低气道阻力 减少分钟

18、通气量延长呼气时间 消除呼气肌的作用增加PEEPiARDS，间质性肺病延长吸气时间PEEPe PEEPi的临床处理降低PEEPi增加PEEPiPEEPe的作用机制肺泡上游气道下游气道0cmH2OPEEPe 8cmH2OPcritPEEPi 10CmH2OPEEPi 10CmH2OPcritPEEPe的作用机制肺泡上游气道下游气道PEEPe 8cmH呼气末正压（PEEP）PEEP的生理学效应COPD：减少呼吸功，防止气道动态塌陷哮喘：有争议ARDS：使萎陷肺泡复张/防止肺泡再萎陷，减少分流，改善V/Q比值和顺应性呼气末正压（PEEP）PEEP的生理学效应流 速吸气峰流速（PIFR）呼气峰流速（P

19、EFR）平均吸气流速（VT/TI）流 速吸气峰流速（PIFR）流速波形：流速-时间曲线流速-时间曲线是反映呼吸机送气气流的流速随时间而变化的图形 所有曲线上方图形代表吸气，下方代表呼气流速波形：流速-时间曲线流速-时间曲线是反映呼吸机送气气流的进修呼吸治疗师系列培训课程课件容 积1VT，VC，FEV1.02分钟通气量（VE）3补呼气容积（ERV）4功能残气量（FRC）5呼气末肺容积（EELV）容 积1VT，VC，FEV1.0呼吸力学曲线（环）推算指标：顺应性、呼吸功气流受限和肺过度充气的判断确定潮气量和最佳PEEP判断触发灵敏度是否合适人机协调的监测气道分泌物过多的判断支扩药物效果的判断呼吸机

20、管道系统密闭性的判断呼吸力学曲线（环）推算指标：顺应性、呼吸功谢谢您没有打瞌睡！谢谢您没有打瞌睡！感谢您的下载，特赠送精品文章体能训练技巧-TRX悬挂训练系统工作之余锻炼身体，若不需要请删除后使用，谢谢您的理解，祝您生意兴隆，事业高攀。RX 训练带是源于美国海军陆战队，刚开始的雏形是以高密度毛巾制成的训练道具，后来，有一名叫兰迪的美国海豹突击队的指挥官，在退役后重新设计了该套装备和训练计划，变成民用的健身课程-“TRX 悬挂训练系统”，整套装备的主要部分是宽 1.5 英寸，额定张力为 1250 磅的尼龙绳子，长度范围从 6 英尺调整至 12 英尺，橡胶把手更适应双手抓缚或是双脚悬挂等地面训练动

21、作，扣锁由曾用于卡宾枪的材料制成，且易于调整，其自用不到 2 磅，1 分钟就能悬挂妥当，装在袋子里便于携带到任何地方，可固定在单杠上或卡在门缝里，或系在树枝上，适合绝大多数的训练环境，如果加上哑铃或健身球一起锻炼，可增加更高阶的难度。 感谢您的下载，特赠送精品文章体能RX 训练带是源于美国海军悬挂训练：用练习者自身体重做负重，能够允许肌肉在多个平面上做运动，同时保证更多的肌肉和关节参与，能够打造更加结实的肌肉，稳定灵活的关节，坚固的核心力量和正确的体态，帮助在任何运动项目上获得更佳的运动表现，TRX 还是运动康复的重要手段之一TRX 动作解读：增加阻力：1.身体角度越大，阻力越大 2.抬起一边

22、大腿，有助于锻炼更多平衡力3.离支点越远，越吃力，对稳定性要求越高减低难度：一腿向前踮地，有助于身体减重1. chest press/ fly combo(推胸飞鸟组合)：人背向绳子，手臂握住绳子，双手伸直，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向前，用胸肌发力慢慢打开双手并让它弯曲到 90 度停下，再慢慢还原，然后双手打开做飞鸟，同时一脚往前踮地，再还原，交替练习。悬挂训练：用练习者自身体重做负重，能够允许肌肉在多个平面上做2. chest press(推胸)：人背向绳子，手臂握住绳子，双手伸直，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向前，用胸肌发

23、力慢慢打开双手并让它弯曲到 90 度停下，再慢慢还原(难度增加：双腿合并或单腿抬起，或把身体斜度增加)3. lunge fly(弓步飞鸟)：1.手臂握住绳子，双手伸直，肘保持一点弯曲，挺胸收腹，身体重心微向前倾，双手打开做飞鸟，同时一脚往前踮地。用胸部发力，再还原4. chest press- single leg extended(推胸-单腿伸展)：人背向绳子，手臂握住绳子，双手伸直，肘保持一点弯曲，膝盖一点点弯曲，一脚撑地，一脚向前抬起，身体重心微微向前，用胸肌发力慢慢打开双手并让它弯曲到 90 度停下，再慢慢还原.2. chest press(推胸)：人背向绳子，手臂握住绳5. Susp

24、ended incline press-leg up(悬浮上斜推-抬脚)：双手撑住地面，一脚勾住绳子，稳定腹部，另一腿向上抬靠紧固定腿，然后做俯卧撑。6. Atomic push up(俯卧撑收腹)：双手撑住地面，双脚勾住绳子，稳定腹部，一下俯卧撑，还原后，双脚以腹部力量靠向胸部，再慢慢伸直还原，交替练习。7. back row(背部划船)：手臂握住绳子，双手伸直，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向后，以背部发力，手臂夹紧身体两侧往后收，肩胛骨向后夹，把绳子拉到小腹，保持住再慢慢还原(难度增加：双腿合并或单腿抬起，或把身体斜度增加)5. Suspended incl

25、ine press-le8. elevated back row(高位划船)：手臂握住绳子，双手伸直，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，加大身体斜度，以背部发力，手臂夹紧身体两侧往后收，肩胛骨向后夹，把绳子拉到小腹，保持住再慢慢还原9. power pull-single arm(力量拉伸-单臂)：双腿分开与肩同宽，单手抓住绳子，张开身体，另一边手臂绕身体旋转 180 度触摸绳子，完后慢慢还原。10. low deltoid fly(低位三角肌飞鸟)：手臂握住绳子，掌心向上，双手伸直向前，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向后，直手向下向后滑，慢慢还原。

26、8. elevated back row(高位划船)11. T deltoid fly(t型三角肌飞鸟)：手臂握住绳子，掌心向上，双手伸直向前，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向后，张开双手与身体呈T型，再慢慢还原(难度增加：把身体斜度增加)12. Y deltoid fly(Y型三角肌飞鸟)：手臂握住绳子，掌心向上，双手伸直向前，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向后，张开双手与身体呈Y型，再慢慢还原(难度增加：把身体斜度增加)13. W deltoid fly(W型三角肌飞鸟)：手臂握住绳子，掌心向上，双手伸直向前，肘保持一点弯曲，膝盖

27、一点点弯曲，两腿跟肩一样宽，身体重心微微向后，张开双手与身体呈W型，再慢慢还原(难度增加：把身体斜度增加)11. T deltoid fly(t型三角肌飞14. High triceps press(高位肱三头肌弯曲)：人背向绳子，手臂向前握住绳子，双手伸直，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向前，然后把肘部弯曲，肱三头肌发力，再慢慢还原(难度增加：把身体斜度增加)15. Dips(臂屈伸)：手臂在身体两侧，双手握住绳子，双腿呈箭步姿势，然后肱三头肌和胸肌发力，双臂弯曲成 90 度再慢慢还原(难度增加：把一只腿往后抬或两腿前放或抬高)16. High bicep cu

28、rl(高位肱二头肌弯曲)：手臂握住绳子，双手伸直，肘保持一点弯曲，膝盖一点点弯曲，两腿跟肩一样宽，身体重心微微向后，以肱二头肌发力，弯曲手臂，再慢慢还原(难度增加：把身体斜度增加)14. High triceps press(高位肱三头肌弯There are moments in life when you miss someone so much that you just want to pick themfrom your dreams and hug them for real! Dream what you want to dream;go where you wantto go;b

29、e wh you want to be,because you have only one life and one chance to do all thethings you want to do.May you have enough happiness to make you sweet,enough trialsto make you strong,enough sorrow to keep you human,enough hope to make you happy?Always put yourself in othersshoes.If you feel that it hu

30、rts you,it probably hurts the otherperson, too.The happiest of people dont necessarily have the best of everything;they justmake the most of everything that comes along their way.Happiness lies for those whocry,those who hurt, those who have searched,and those who have tried,for only they canappreci

31、ate the importance of peoplewho have touched their lives.Love begins with asmile,grows with a kiss and ends with a tear.The brightest future will always be based on aforgotten past, you cant go on well in lifeuntil you let go of your past failures and heartaches.When you were born,you were crying an

32、d everyone around you was smiling.Live your life sothat when you die,youre the one who is smiling and everyone around you is cryig.Please sendthis message to those people who mean something to you,to those who have touched yourlife in one way or another,to those who make you smile when you really ne

33、ed it,to those thatmake you see the brighter side of things when you are really down,to those who you want tolet them know that you appreciate their friendship.And if you dont, dont worry,nothing badwill happen to you,you will just miss out on the opportunity to brighten someones day withthis messag

34、e.Since we went to school, we have access to English all the time, because it isone of the necessary subjects. Before we attend college, we keep our attention on thegrammar, but now college means the new stage and we should pay attention to practicalEnglish. Here are some suggestions.First, it is im

35、portant to speak out loudly. The purpose oflearning English is to communicate with foreigners, so as to get to know more about theworld. Grammar is not the only thing we care about. What we should do is to open ourmouths and improve our ability to use spoken English. It begins with reading textbooks

36、. Whenwe listen to the tapes and repeat many times, then our d.President Trump, as he often does,had a few things to sayAfter admitting that he had been lonely over the holidays, Trump tookadvantage of his first public appearance of the new year Wednesday to air lingeringgrievances, make multiple fa

37、lse claims and reinforce recent decisions that have rattledfinancial markets and his partys leaders.As he held forth for more than 90 minutes before asmall pool ofThere are moments in life when本文为 Word 版资料，可以任意修改编辑。如果你看到我上传的资料这个后缀，请删除后使用。高效学习方法和技巧学习需要方法，找到适合自己的方法，学习才能事半功倍。接下来，我结合我自己的学习情况，给大家总结的高效学习五

38、部曲一、预习是学习的重要环节上课前充分预习，考试前充分地复习，与“打有准备之仗”有同曲之道。预习效果好，听课才能有针对性；听课有针对性，复习才能顺利进行；复习深刻，作业、考试才能得心应手。所以说预习是学生学习过程中一个必不可少的环节。二、掌握好高效的听课方法课上集中精力听课，是掌握知识的捷径。听讲时，思想上必须与老师讲解的思路保持一致，听老师对事物是怎样分析、推理；听老师解决问题是用什么方法、技巧；听老师对问题有哪些提问和解释。这样才能把握住听课的重点。听讲中，要把自己在预习中的理解，和老师讲解的相比较，看自己和老师有哪些相同点和区别点。三、合理安排复习时间很多科学家通过研究发现，有几个时间段

39、有利于巩固记忆：一是学习后最初几分钟内，电生理活动引起蛋白质的合成；二是学习后在 48 小时内复习；三是一周之后脑突触发生永久性变化。根据人在学习过程中这一生理变化，采用复习加强记忆就显得特别重要了。如果我们能够在学习的内容即将忘记时进行复习，那么复习的效果最好，效率也最高。著名的心理学家艾宾浩斯通过实验发现了人的记忆与遗忘规律。实验证明：在学习仅过了 20 分钟后，就忘记记忆内容的 42%，1 天后忘却量已经达到了 66%，到了第 31 天，忘却量高达79%。他根据实验结果，画成了著名的遗忘曲线。并表明遗忘的规律是“先快后慢”。这条规律提示我们，定要尽早、及时地对所学知识进行复习，以便在知识

40、还在大脑内时就加深印记，否则大脑中已经没有痕迹了，只能再费精力重学。合理安排复习时间特别重要并且必要，制定复习计划，严格按精英特计划执行，并力求形成习惯，是我们每一位学生都应该力求努力做到。我们为什么要复习呢？因为我们记忆效果没有那么好，不可能过目不忘，所以需要重复、增强记忆。同时，复习的进展也有利于学习效率的提高。四、做作业的科学方法这里有七种做作业的技巧：1、先复习后做作业。复习是做好作业的关键，只有复习得好，作业才能做得好。做作业前先把老师这一节课所讲的内容认真地看一看，弄清楚基本原理和概念后再去做作业，作业才能做得既快又好。2、认真审题。 做作业最关键的步就是审题，连题都判断错了，作业

41、内容就全错了。首先第步要弄清楚题目的内容，所给的条件，什么要求，需要联系哪些知识等等；其次是考虑好解题思路、方法、步骤，要善于把道题分成几部分，化大为小、化难为易、分清其中的已知和未知，弄清各部分的联系，设计好整个解题步骤，定要让自己做到不明白题意不做题，不清楚方法步骤不下笔。3、细心的做题。 做题是表达思路的全过程，这个过程要求既动脑、又动手。做题的关键是要保证“规范”、“准确”。要做到这两点就要求学生认真的抄好题，书写格式必须正确、规范，严格按照各类题的解题要求，仔细演算解题的每步，得出正确的结果。只有平时做题认真细致，步骤完整，思路正确，表达严密，准确无误，考试时才能按照这种良好的习惯进

42、行五、重视错题积累在学习的过程中，同学们可能遇到过一错再错的现象究其原因，多数是由于在学习中不求甚解，不注意总结积累所致。那么，该怎么办呢？实践证明，自编一本“易错题集”是避免做题一错再错的最好办法。错题本的复习方法：1、每周把该周错题本中记录的题目快速浏览一遍；2、每月把该月错题本中记录的题目再快速浏览一遍；3、每个季度把错题本中三个月记录的题目再快速浏览一遍；4、大考前把该错题本中的所有题目认真复习一遍，确保题不二错￥精编资料 欢迎下载There are moments in life when you miss someone so much that you just want to

43、pick them from your dreams and hug them for real! Dream what you want to dream;go where you want to go;bewhat you want to be,because you have only one life and one chance to do all the things you want to do.May you have enough happiness to make you sweet,enough trials to make youstrong,enough sorrow

44、 to keep you human,enough hope to make you happy? Always put yourself in othersshoes.If you feel that it hurts you,it probably hurts the other person, too.The happiestof people dont necessarily have the best of everything;they just make the most of everything that comes along their way.Happiness lie

45、s for those who cry,those who hurt, those who havesearched,and those who have tried,for only they can appreciate the importance of peoplewho have touched their lives.Love begins with a smile,grows with a kiss and ends with a tear.The brightestfuture will always be based on a forgotten past, you cant

46、 go on well in lifeuntil you let go of your past failures and heartaches.When you were born,you were crying and everyone around youwas smiling.Live your life so that when you die,youre the one who is smiling and everyone around you is cryig.Please send this message to those people who mean something

47、 to you,to those whohave touched your life in one way or another,to those who make you smile when you really need it,to those that make you see the brighter side of things when you are really down,to those whoyou want to let them know that you appreciate their friendship.And if you dont, dont worry,

48、nothing bad will happen to you,you will just miss out on the opportunity to brighten someones daywith this message.Since we went to school, we have access to English all the time, because it is one of the necessary subjects. Before we attend college, we keep our attention on the grammar, butnow coll

49、ege means the new stage and we should pay attention to practical English. Here are some suggestions.First, it is important to speak out loudly. The purpose of learning English is tocommunicate with foreigners, so as to get to know more about the world. Grammar is not the only thing we care about. Wh

50、at we should do is to open our mouths and improve our ability to usespoken English. It begins with reading textbooks. When we listen to the tapes and repeat many times, then our d.President Trump, as he often does, had a few things to sayAfter admitting that hehad been lonely over the holidays, Trum

51、p took advantage of his first public appearance of the new year Wednesday to air lingering grievances, make multiple false claims and reinforce recentdecisions that have rattled financial markets and his partys leaders.As he held forth for more than 90 minutes before a small pool of reporters and ph

52、otographers, members of his Cabinet,ostensibly called to the White House for a meeting, sat quietly around a long conference table.Trump defended his decision last month to withdraw U.S. troops from Syria and sharply cut thedeployment to Afghanistan, moves that disturbed Republican allies in Congres

53、s and prompted the resignation of Defense Secretary James N. Mattis. In doing so, he contradicted his own recentclaim that the U.S. had achieved its objectives of total victory over Islamic State militants in Syria.“Look, we dont want Syria,” he continued. “Were talking about sand and death. Thats w

54、hat weretalking about. Were not talking about vast wealth. Were talking about sand and death,” he said, seemingly contrasting the war-wracked country with Iraq and its vast oil reserves.Iran “can dowhat they want there, frankly,” he added, a comment likely to unnerve officials in Israel, who have wo

55、rried that a U.S. withdrawal from its positions in eastern Syria would allow Iran to expand itsinfluence there.“Its not my fault,” he said. “I didnt put us there.”Trump offered little further clarity on the U.S. withdrawal from Syria, which he initially said would take place in 30 days, saying nowth

56、at the pullout will “take place over a period of time.”Later, in a long riff about Afghanistan, Trump seemed to endorse Moscows 1979 invasion of the country an act that the U.S. viewed as anattempt to spread communism and waged a long, covert operation to combat during the Carter and Reagan administ

57、rations.“The reason Russia was in Afghanistan was because terrorists weregoing into Russia,” Trump said, making a case to leave the policing of hot spots in the Mideast and Central Asia to countries in the region. “They were right to be there. The problem is it was atough fight.”The Soviet Union eve

58、ntually was bankrupted by its Afghan war, Trump added. “Russia used to be the Soviet Union. Afghanistan made it Russia, because they went bankrupt fightingin Afghanistan.”Historians generally agree that the Russian invasion and subsequent occupation of much of Afghanistan was one of several factors

59、that contributed to the collapse of the SovietUnion, although the country never went bankrupt.For years, Republicans have credited President Reagan with bringing an end to the Soviet Union by his aggressive increase in U.S. militaryspending.Trumps comments stood in stark contrast to the view Mattis

60、espoused in the resignation letter he presented last month after failing to convince the president to hold off on withdrawingfrom Syria.“We must do everything possible to advance an international order that is most conducive to our security, prosperity and values, and we are strengthened in this eff