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            【福建成人高考】2019年專升本醫學綜合之周圍神經系統(二)

            福建成人高考信息網www.laiwobuy.com 發布時間: 2018年11月13日

              三、胸神經前支

              (一)行程、分布

              胸神經前支共12對,第1~11對行于肋問隙,稱肋間神經,第12對行于第12肋下,稱為肋下神經。肋間神經在肋問內、外肌之間沿肋溝前行,于腋前線處發出外側皮支。上6對在胸骨側緣淺出,下6對向前下行于腹內斜肌與腹橫肌之間入腹直肌鞘,于腹白線附近淺出。

              (二)肌支支配肋間肌、腹前外側肌群。

              (三)皮支

              皮支呈節段性分布于胸腹壁皮膚:

              胸骨角平面——胸2;

              乳頭平面——胸4;

              劍突平面——胸6;

              肋弓平面——胸8;

              臍的平面——胸10;

              恥骨聯合與臍相連線巾點平面——胸12。

              四、股神經

              ①股神經股神經于腰大肌與髂肌之間下行,經腹股溝韌帶深面、股動脈外側人大腿股三角。終支稱隱神經。肌支配股四頭肌;皮支(隱神經)分布于小腿內側和足內緣皮膚。

              ②損傷

              運動障礙 大腿前群肌萎縮,抬腿困難,不能伸小腿。膝反射消失。

              感覺障礙 主要見于大腿前面和小腿內側面皮膚。

              五、坐骨神經

              坐骨神經是全身最粗大的神經,自梨狀肌下孔出盆腔,在臀大肌深面下降,經大轉子與坐骨結節之間達股后,于股后群肌問下降,分支支配股后群肌。至腘窩上二方分為脛神經與腓總神經。

              (一)脛神經

              沿胭窩正中下降,在小腿后群肌的深、淺兩層之間下行,分支分布于小腿后群肌和小腿后面的皮膚。脛神經經內踝后方入足底,分為足底內側神經和足底外側神經,分布于足底肌和皮膚。

              (二)腓總神經

              沿胭窩外側緣下降,繞過腓骨頸分為深、淺兩支。

              1.腓深神經位于小腿前群肌深面,伴脛前動脈下行,分支支配小腿前群肌、足背肌及第1~2趾背相對緣的皮膚。

              2.腓淺神經穿小腿外側群肌下降。主干至小腿中、下1/3交界處,穿出深筋膜至淺筋內膜下行,經踝關節前方至足背。下降過程中,分支分布于小腿肌外側群、小腿前外側面、足背及第2~5趾背相對緣的皮膚。

              3.腓總神經損傷

              (1)小腿前、外側肌群癱瘓,小腿后群肌因失去拮抗肌而過度牽拉造成足跖屈(足下垂)和內翻位,即所渭“馬蹄內翻足”畸形。

            胃液的主要成分及其生理作用。

              胃液中的主要成分及生理作用為:

              1)、鹽酸:殺死入胃細菌,激活胃蛋白酶原,提供胃蛋白酶分解蛋白質所需的酸性環境,促進小腸對鐵和鈣的吸收,入小腸后引起促胰液素等激素的釋放。

              2)、胃蛋白酶原:被激活后能水解蛋白質,主要作用于蛋白質及多肽分子中含苯丙氨酸和酪氨酸的肽鍵上,其主要產物是月示和月東。

              3)、黏液:覆蓋在胃黏膜表面形成一凝膠層,減少食物對胃黏膜的機械損傷;與胃黏膜分泌的HCO3-一起構成“黏液——碳酸氫鹽屏障”,對保護胃黏膜免受胃酸和胃蛋白酶的侵蝕有重要意義。

              4)、內因子:與維生素B12結合形成復合物,保護它不被小腸內水解酶破壞,當復合物運至回腸后,便與回腸黏膜受體結合而促進維生素B12的吸收。

              大量出汗而飲水過少時,尿量有何變化?

              汗為低滲溶液,大量出汗而飲水過少時,尿液排出量減少,其滲透壓升高。

              大量出汗:

              1)、組織液晶體滲透壓升高,水的滲透作用使血漿晶體滲透壓也升高,下丘腦滲透壓感受器興奮。

              2)、血容量減少,心房及胸內大靜脈血管的容積感受器對視上核和室旁核的抑制作用減弱。

              上述兩種途徑均使視上核和室旁核合成和分泌ADH增加,血液中ADH濃度升高,使遠曲小管和集合管對水的通透性增加,水重吸收增加,尿量減少,尿滲透壓升高。

              此外,大量出汗,還可能使血漿膠體滲透壓升高,腎小球有效濾過壓降低,原尿生成減少,尿量減少。



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