o******u
发帖数: 60 | 1 我目前還卡在SVT跟VT 區別...
....四步法都不是百試百靈........... |
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s********p
发帖数: 1319 | 3 冠脉是沿着心外膜向心内膜通过逐级分支最终向心内膜供血的。使得心内膜下心肌最容
易缺血；收缩期对冠脉的挤压，更使得心内膜的血供受损最严重。
图A，心内膜下心肌缺血，局部的综合心电向量背离损伤区导联，ST段压低。病理生理
基础：AS斑块活跃，血小板激活，冠脉管腔严重狭窄，但冠脉没全闭，表现为ST
Segment 压低，即ACS中的NESTMI。溶栓的禁忌——因为，这种情况下血小板血栓即白
色血栓是病理基础，此时如果用了溶栓药，溶解不了这种血栓，但会打破纤溶和抗纤溶
之间本来就已经在高水平上脆弱的平衡——这种情况下溶栓，凝血和抗纤溶系统过度激
活，促进闭塞性血栓形成，大悲剧。正确的治疗选择：强力抗血小板，择期血运重建。
图B，闭塞血栓，透壁缺血，局部的综合心电向量正对着损伤区导联，ST抬高，ACS STEMI。
病理生理基础：AS斑块活跃，血小板过度激活，冠脉全闭，纤维蛋白铰链后，网罗了不少
红细胞，混合血栓。由于冠脉全闭、血供丧失，心肌开始向死亡演进，理论上的时间窗是3
小时左右，此时，必须尽快开通血管，如果估计PCI不能及时到位，没有任何犹豫，立
即溶栓，当然同时也得强力抗血小板——哪怕... 阅读全帖 |
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n*****n
发帖数: 119 | 4 别处看到的，觉得还不错，不排除有些拼写错误~
POMR (Problem-Oriented Medical Records)表格式住院病历
Biographical data:
一般项目：
Name Age Sex Marital status Nativity Race
姓名 年龄 性别 婚否 籍贯 民族
Occupation Date of admission Informant History
职业 入院日期 病史叙述者 病史
Chief complaint
主诉
History of present illness
现病史
Past history
既往史：
Previous health status: well ordinary bad Infectious diseases
平素健康状况： 良好 一般 较差 传染病史
Immunizations Allergies: N Y clinical manifestation
预防接种史 过敏史 无 有 临床表现
allergen: Trauma: Surgery:
过敏原 外伤... 阅读全帖 |
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S**********e
发帖数: 1325 | 7 Bump!
Dr. Tullo's stuff is always cool! I just love him! |
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Y*Z
发帖数: 51 | 8 Thank you Knockingdown. It is a wonderful link. Greatly benefitted.
Look forward to more to come. |
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u*****o
发帖数: 125 | 9 A 14 year old boy is brought to the physician for an exam prior to
participation on a basketball team. He has a history of recurrent otitis
media since infant. He underwent tonsillectomy 7 years ago for snoring
associated with obstructive sleep apnea. Growth and development are
appropriate for age. Audio is like aortic stenosis. Which of the following
is the most appropriate next step in management:
A. Approve basketball participation
B. Chest x-ray
C. Exercise stress test
D. ECG
E. Echocardiogr... 阅读全帖 |
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x*******8
发帖数: 68 | 10 24 hours after hospitalization for fixation of a femoral fracture, a 35
year old construction worker has nausea, agitation, and insomnia. His blood
pressure is 150/100. He is oriented but anxious. Which of the following is
the most appropriate next step in diagnosis?
A . inquire about recent alcohol intake
B. examination of a urine specimen for fat bodies
C. Leukocyte count with differential
D ECG
E pulmonary arteriography |
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x*******8
发帖数: 68 | 11 another one. 2-8
A 50 year old man has a cardiac arrest during sexual intercourse. He is
promptly resuscitated and recovers uneventfully from an acute anterior wall
myocardial infarction. At discharge from the hospital, he and his wife
inquire about the safety of future sexual intercourse. Which of the
following is the most appropriate advice?
A psychiatric consultation
B sexual intercourse should be performed while wearing an ambulatory ECG
monitor
C will be safe when exercise tolenrance impr... 阅读全帖 |
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f****i
发帖数: 129 | 12 17. A 42-year-old woman comes for a follow-up examination.
Two weeks ago,
her blood pressure was 152/94 mm Hg during a routine
visit. Her blood
pressure today is 150/94 mm Hg, pulse is 76/min, and
respirations are
14/min. Examination shows no other abnormalities.
Serum studies show:
Na+ 142 mEq/L
Cl– 105 mEq/L
K+ 4 mEq/L
HCO3– 26 mEq/L
Urea nitrogen (BUN) 12 mg/dL
Glucose 101 mg/dL
Creatinine 0.8 mg/dL
An ECG shows no abnormalities. Which of the following
is the most
appropriate next step in man... 阅读全帖 |
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w***0
发帖数: 222 | 13 来自主题: MedicalCareer版 - 请求帮助 what I got from your post--
exercise intolerance, intermittent facial edema and "vertigo or syncopal (
near) episode"? Normal CT (cardiac?) and ECG with LV hypertrophy (?) but
ECHO normal function (?)
it is still may or may not. first you should tell people here why you or the
physician believe this is THE cardiac issue? you may have to provide more
information....
like age, vertigo timing, other history (smoking, disease, etc).
Nevertheless, based on what you said above, it does sound pulmonary... 阅读全帖 |
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d****y
发帖数: 2180 | 14 选A还是E？
Paracentesis 虽说是比较general 的抽液，在这题可以理解为心包抽液吗？
18. A 50-year-old woman has had progressive dyspnea over the past 2
weeks
and constant, sharp chest pain for 4 days. The pain is localized to the
center of the chest and is worse while supine. She underwent a right,
modified radical mastectomy and adjuvant chemotherapy for breast cancer
3
years ago. She has a history of hypothyroidism treated with thyroid
replacement therapy. She has smoked one pack of cigarettes daily for 30
years and drinks t... 阅读全帖 |
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s*****1
发帖数: 273 | 15 如果大家有iphone，ipad并不是必须。但又大又超清晰ipad3的屏幕带来的享受还是很
值的。
我自己买了一个最便宜的ipad3 （$499）.
从两年前开始，一路ipad1， 2 使用下来，感觉很好。苹果的软件选择真是别家没得比
的。
日常用途
Email， 上网， 用dropbox, evernote, CHM+, Kindle 看资料，viber, google voice
, skype 交流
, USA today, ABC player, podcast， nietflix， TED, this American life 和 60
minutes, 随
时可以听/看到， 用零碎时间了解美国文化和学习语言。
对我而言，相对laptop和smart phone，更喜欢IPAD3集下面三点于一身。
1. 便携
2. 屏幕够大超清晰
3. 随时启动
==
下面是我在用的apps.
Merriam-Webster dictionary
Atomic web (Browser for checking ERAS website)
drug pronunciations
medic... 阅读全帖 |
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m******r
发帖数: 1904 | 16 1.没用过。不懂。
2.Common abbreviations for SP note
BP Blood pressure
P pulse
R respiatory rate
T temperature
yo year-old
m male
f female
b black
w white
L left
R right
hx history
h/o history of
c/o complaining of
NL normal limits
WNL within normal limits
Ø without or no
+ positive
- negative
Abd abdomen
AIDS acquired immune deficiency... 阅读全帖 |
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l******g
发帖数: 278 | 17 Three days after undergoing colectomy for colon cancer, a 77-year-old
woman has the sudden onset of severe shortness of breath. She says she
cannot catch her breath. Current medications include subcutaneous heparin
and patient-controlled morphine. Her temperature is 37°C (98.6°F), pulse
is 140/min, respirations are 28/min, and blood pressure is 110/60 mm Hg.
Pulse oximetry on room air shows an oxygen saturation of 89%. Breath sounds
are decreased on the right. Abdominal examination shows an ... 阅读全帖 |
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J**b
发帖数: 182 | 18 some more:
7.“reciproca” change in lead I with inferior wall STeMI:
A. Elevated ST segment
B. Low-voltage QRS
C. Wide QRS
D. Depressed ST segment
E. Irregular narrow QRS
8. Ventricular ectopy:
A. Elevated ST segment
B. Low-voltage QRS
C. Wide QRS
D. Depressed ST segment
E. Irregular narrow QRS
9. All of the following are true EXCEPT
A. The AV node is usually perfused by the posterior descending coronary
artery
B. The right ventricular bundle has an ante... 阅读全帖 |
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J**b
发帖数: 182 | 19 One more about ECG, please see attached picture.
9. This patient’s EKG demonstrates all of the following EXCEPT
A. Acute ischemic changes in leads II, III and aVF
B. Reciprocal changes in leads V4, V5, V6
C. Intact conduction system
D. Acute ischemic changes in leads I and aVL
E. Normal ventricular rate
which
headache.
be |
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h*******y
发帖数: 1220 | 20 One more about ECG, please see attached picture.
9. This patient’s EKG demonstrates all of the following EXCEPT
A. Acute ischemic changes in leads II, III and aVF
B. Reciprocal changes in leads V4, V5, V6
C. Intact conduction system
D. Acute ischemic changes in leads I and aVL
E. Normal ventricular rate
wild guess A, this is the same one as No 3, right? |
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m******r
发帖数: 1904 | 21 ☆─────────────────────────────────────☆
oldclock (oldclock) 于 (Wed Apr 18 10:59:11 2012, 美东) 提到:
1。step2 CS的UW video要单买还是在CS的UW题库里都包括了？
2。patient note可以写ABBREVIATIONS吗？除了FA上的ABBREVIATIONS，还有其他哪些
地方的ABBREVIATIONS可以用呢？
3。此外，看到麦地里有提到过patient note用子弹体方式书写，什莫是子弹体啊？哪
里可以找到范文呢？ 给扫扫盲吧。
多谢各位了！
☆─────────────────────────────────────☆
medwater (小麦) 于 (Wed Apr 18 11:08:03 2012, 美东) 提到:
1.没用过。不懂。
2.Common abbreviations for SP note
BP Blood pressure
P pulse
R respiatory rat... 阅读全帖 |
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h*******y
发帖数: 1220 | 22 sudden onset, radiates into both arms ass. diaphoresis. resolves
spontaneously,
Cholesterol 240 mg/dl
ECG: 1st degree AV block / no ischemic changes
Picture of his mouth
whats the best next step of management?
a. cardiac catheterization
b. ICU + cardiac enzyme
c. Contrast chest CT
d. TPA
e. Upper endoscopy |
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r******y
发帖数: 146 | 23 今天和一个med student聊天，他掏出iPad给我演示学校送的学习解剖的App，当场被迷
住了。名字叫Essential Anatomy 2，$24.99，在Apple的App Store上。记得学CNS
neural pathways的迷惑吗，一级级下传，一个个孔出来，一头雾水；记得学ECG、CXR
的时候，对4个chambers位置的疑惑吗。这个app里头，完全是3D，可以转到任何角度观
察，可以剥去或者半透明显示覆盖的结构，图像质量无与伦比。支持按系统搜索/显示
，解释详尽，允许拷屏，有发音。要是早有这个app，3年前复习Step1的时候就容易多
了。强烈推荐！
下面附张screen shot: the relative position of the right and left atria is
shown w/o the presence of the right and left ventricles. |
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h****8
发帖数: 278 | 24 A 57-year-old man is brought to the emergency department 30 minutes after he
was found on the floor of his house; he has left hip pain and shortness of
breath. He has renal failure but has missed his last two dialysis treatments
. His renal failure was caused by inadvertent ingestion of ethylene glycol.
His renal function did not improve, and he is currently on the
transplantation list. Medications include amlodipine and doxazosin. On
arrival, his temperature is 37.5 C (99.5 F), blood pressure i... 阅读全帖 |
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o***D
发帖数: 85 | 25 有人以前去过吗？感觉如何？
主要觉得价格不菲。地方又比较偏远
他们说有个什么ECG certificate. 这个证书有什么用吗？ |
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g****g
发帖数: 411 | 27 Please give your opinion and explanation, thanks in advance.
Question:
You are reading a study assessing whether ECG during graded treadmill
exercise stress testing can predict clinically significant(75% or more)
coronary artery stenosis as shown by arteriography(the gold standard). The
subjects are men, ages 55 to 75 years, with chest pain who were referred to
a cardiac center. Prevalence of greater than 75% stenosis in the study group
was 53%. Results of the study are as follows:
Sensitivi... 阅读全帖 |
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g****g
发帖数: 411 | 28 Please give your opinion and explanation, thanks in advance.
Question:
You are reading a study assessing whether ECG during graded treadmill
exercise stress testing can predict clinically significant(75% or more)
coronary artery stenosis as shown by arteriography(the gold standard). The
subjects are men, ages 55 to 75 years, with chest pain who were referred to
a cardiac center. Prevalence of greater than 75% stenosis in the study group
was 53%. Results of the study are as follows:
Sensitivi... 阅读全帖 |
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d****n
发帖数: 18 | 29 上学的时候 没学好 现在看英文书 还是理解不透 大家分享分享经验 谢谢 |
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d****n
发帖数: 18 | 30 看的人多 大家说说 怎么能看的又快 判断的又准啊 |
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s*******y
发帖数: 1739 | 31 帮你顶!!!!我反正没别的办法,死记硬背,先搞清楚那几个波产生原理可能有利于理解.还有好多复杂EKG
就是四不象,很难判断,还要结合临床症状分析,不过护士不需要掌握那么复杂就是了,会
几个基本的明显的平常工作就能应付 |
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f*******m
发帖数: 587 | 32 其实心电图就是要从最基本的开始理解，理解好了就好记了 |
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b******u
发帖数: 158 | 33 今天学习了，知道了很多“内幕”。
原来TELE是这样的啊，我前两天还在PRECONFERENCE上大讲我想找TELE的工作呢，汗一
下，看来新生还是免进的好。不过我也对CARDIAC FLOOR比较感兴趣，觉得看ECG好象很
深奥一样。嗯，再想想。 |
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Q*****3
发帖数: 218 | 34 谢谢大家的答疑。
我是正在上felx-ed 的课。觉得还算可以，主要是我在上课前把课本里某些我没有工作
经验的章节都看过一遍。个人觉得他们选用的课本不怎么样，我用的是自己以前买的，
再参考着看flex-ed指定的课本学习。
另外给向学习EKG的JM 推荐一本书，我从医版上看过来的，他们resident都用这本书。
THE ONLY EKG BOOK YOU'LL EVER NEED BY THALER。这本书深浅结合，很好懂。大家
可以看看。我以前在TELE 刚入门上课的时候用的是 ECGS MADE EASY BY BARBARA
AEHLER。 这本书入门可以，但是如果在ICU上班，前一本书帮助更大些。
行, |
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l******i
发帖数: 39 | 35 http://www.globalrph.com/abbrev.htm 这个Website很好。
这些是些常用的：
* Ac: before meals
* ad lib: at will, as desired
* adm: admission, admitted
* ASAP: as soon as possible
* Bid: twice a day
* Bm: bowel movement
* BP: blood pressure
* BRP: bathroom privileges
* C: Centigrade, Celsius
* Cap: capsule
* CC: chief complaint
* cc: cubic centimeter
* c/o: complains of
* C02: carbon dioxide
* CPR: cardiopulmonary resuscitation
* CXR: chest x-ray
... 阅读全帖 |
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j**********t
发帖数: 3480 | 36 我们这里在医生给医嘱前，护士可以直接给epi和CPR，假如无pulse。Lifepack可以设
置成dummy模式，就像一般的AED一样，就无所谓分析ECG了。 |
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j**********t
发帖数: 3480 | 37 我们这里在医生给医嘱前，护士可以直接给epi和CPR，假如无pulse。Lifepack可以设
置成dummy模式，就像一般的AED一样，就无所谓分析ECG了。 |
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f****o
发帖数: 2770 | 38 我讲话难听由于家庭遗传，真不好意思。
我吧书本上的东西全部贴出来，你能看懂多少算多少吧。
Heart Failure
DEFINITION
Heart failure (HF) is a clinical syndrome caused by the inability of the
heart to pump sufficient blood to meet the metabolic needs of the body.
Heart failure can result from any disorder that reduces ventricular filling
(diastolic dysfunction) and/or myocardial contractility (systolic
dysfunction).
PATHOPHYSIOLOGY
Causes of systolic dysfunction (decreased contractility) are reduction in
muscle mass (e.g., myocardial infarctio... 阅读全帖 |
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u*******s
发帖数: 688 | 39 这个房颤是阵发，还是持续?
1.先看看病人的CHA2DS2-VASc分数决定中风的风险，(>2就可以用anticoag),再根据肾
功能决定anticoag的选择和剂量。（warfarin, or dabigatran, apixaban, or
rivaroxaban）
2.rate control (resting <80) with beta blockers or non-dihydropydirine CCB。
这个病人只吃amiodarone，但是amiodarone的pk/pd比较难掌握，毒性比较难manage，
应该在别的药物都fail的情况下才考虑的。所以不应该第一时间就上amiodarone.
3.rhythm control要根据病人的心脏其他情况来选择，比如MI, CAD的状况。可以考虑
sotalol，但是要经常监控ECG。
amiodarone虽然是很有效的rhythm control，但是drug interaction和副作用等毒性很
多，有明显的qt prolongation,所以不是常用的第一选择。
还有就是2014年的指南中不再用aspirin了... 阅读全帖 |
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g**r
发帖数: 425 | 40 是CT吗？如果是，SAP要明确说明如何处理。
比如ECG，TRIPLEX的就是说好要做均值的。
如果是LAB,SAP里面要写清楚这种情况怎么处理：是用均值，是用第一次，还是用最后
一次，还是只其中有一次DM把它叫做“SCHEDULED”而你只用这个SCHEDULED，都写清楚。
如果是SCHEDULED只能有一个数据，拿到了三个，打回DM去。 |
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s**********8
发帖数: 25265 | 41 Frequently Asked Questions About the IRB:
The following is a compilation of questions frequently asked regarding
Institutional Review Boards, human subject protection and compliance with
federal regulations. These questions are organized according to whether they
pertain to:
I. Institutional Review Board regulations;
II. Informed Consent regulations;
III. Clinical investigations involving drugs;
IV. Clinical investigations involving medical devices; and
V. Other
I. INSTITUTIONAL REV... 阅读全帖 |
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s**********8
发帖数: 25265 | 42 Investigator's brochure
From Wikipedia, the free encyclopediaJump to: navigation, search
Some of this article's sections are empty. Please add content to empty
sections. (May 2011)
This article needs additional citations for verification. Please help
improve this article by adding reliable references. Unsourced material may
be challenged and removed. (September 2009)
The Investigator's Brochure (IB) is a comprehensive document summarizing the
body of information about an investigational product ... 阅读全帖 |
|
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w*****3
发帖数: 910 | 44 不知道这职位的帖子为啥被站长直接删掉。
如果不违背MITBBS站基本原则。
我们这里还是鼓励发工作机会的帖子。
鼓励各种信息，交流的帖子。
历到
of
monitor |
|
e*****m
发帖数: 320 | 45 多谢版大～
这个帖子我在JOBHUNTING版上发过之后，还另外转载到了EE和贵版，都分别被删掉了。
问过EE版大说是站长删掉了，因为有专门的JOB版。
不过我还是JOB版上偏编程的讨论比较多，像我们这种职位很容易就被冲掉了。 |
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g*2
发帖数: 658 | 47 刚看到有趣病例活动，想到 broken heart syndrome。 在我短短的几个月住院第一年
中，居然看到了2例。 一例是copd induced, 例外一例可能是GBS induced.
basically broken heart syndrome is transient stress induced cardiomyopathy,
aka Takotsubo cardiomyopathy/apical ballooning syndrome
a sudden onset of congestive heart failure associated with ECG changes
suggestive of an anterior wall myocardial infarction. in my 1st case, pt's
ECHO when admitted showed basal segment thickening w/ remaining hypokinetic
ventricle walls, severely decreased LV systolic ... 阅读全帖 |
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s********p
发帖数: 1319 | 48 双管的现在不流行了。
现在又回到单管的去了——这两年AHA听诊器的展台上，都很少有双管的。
以前还有带模拟导联ECG的听诊器，洋气但不实用——没有长II导或者V1导联，怎么分
析心律失常啊！ |
|
d****y
发帖数: 2180 | 49 选A还是E？
Paracentesis 虽说是比较general 的抽液，在这题可以理解为心包抽液吗？
18. A 50-year-old woman has had progressive dyspnea over the past 2
weeks
and constant, sharp chest pain for 4 days. The pain is localized to the
center of the chest and is worse while supine. She underwent a right,
modified radical mastectomy and adjuvant chemotherapy for breast cancer
3
years ago. She has a history of hypothyroidism treated with thyroid
replacement therapy. She has smoked one pack of cigarettes daily for 30
years and drinks t... 阅读全帖 |
|
h**s
发帖数: 1757 | 50 诗歌，你为啥就肯定是心包积液呢？ 只是因为x-ray? MTB 2 心包填塞的诊断就是echo, 心包狭窄的诊断是X-ray. 对不啦？
而且这个病人两周了。即使心包
积液也有耐受了，可以等一下的吧？
还有如果心包积液多的话，ECG 不是R波多样性嘛？ |
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