進(jìn)修呼吸治療師系列培訓(xùn)課程課件

1、進(jìn)修呼吸治療師系列培訓(xùn)課程有創(chuàng)提高小測(cè)驗(yàn)進(jìn)修呼吸治療師系列培訓(xùn)課程有創(chuàng)提高小測(cè)驗(yàn)Questions-1流量觸發(fā)靈敏度為3L/min，呼吸機(jī)提供基礎(chǔ)氣流為5L/min，若呼吸回路存在持續(xù)漏氣2L/min，請(qǐng)問患者的吸氣流速至少為多少才能觸發(fā)呼吸機(jī)送氣？ A 1L/min B 2L/min C 3L/min D 7L/min E 8L/minQuestions-1流量觸發(fā)靈敏度為3L/min，呼吸機(jī)提Questions-2流量觸發(fā)靈敏度為3L/min，基礎(chǔ)氣流為5L/min，若此時(shí)外接霧化器行持續(xù)霧化吸入治療，氧氣流速為5L/min，請(qǐng)問患者的吸氣流速至少為多少才能觸發(fā)呼吸機(jī)送氣？ A 3L/mi

2、n B 5L/min C 7L/min D 8L/min E 10L/minQuestions-2流量觸發(fā)靈敏度為3L/min，基礎(chǔ)氣流Questions-3V-A/C模式通氣時(shí)，哪些因素可影響氣道峰壓值？ A PEEP B 吸氣流速 C VT D 呼吸系統(tǒng)順應(yīng)性 E 氣道阻力 F PEEPiQuestions-3V-A/C模式通氣時(shí)，哪些因素可影響氣Questions-4V-A/C模式通氣時(shí)，哪些因素可影響平臺(tái)壓值？ A PEEP B 吸氣流速 C VT D 呼吸系統(tǒng)順應(yīng)性 E 氣道阻力 F PEEPi G 平臺(tái)時(shí)間Questions-4V-A/C模式通氣時(shí)，哪些因素可影響平Question

3、s-5V-A/C模式通氣時(shí)，如預(yù)設(shè)RR為10次/min，患者自主呼吸頻率為5次/min，則呼吸機(jī)的實(shí)際工作頻率為 A 5次/min B 10次/min C 15/min D 10-15/min E 5-10次/minQuestions-5V-A/C模式通氣時(shí)，如預(yù)設(shè)RR為10Questions-6在PCV模式下，若設(shè)置支持壓力不變，哪些因素可以使潮氣量增加？ A 患者自主呼吸努力增強(qiáng) B 胸肺順應(yīng)性下降 C 氣道阻力增加 D PEEPi增加 E PEEP下降 F 呼吸頻率增快Questions-6在PCV模式下，若設(shè)置支持壓力不變，哪臨床呼吸生理與床旁呼吸力學(xué)監(jiān)測(cè)首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院北

4、京呼吸疾病研究所姚 秀 麗2011-03-08臨床呼吸生理與床旁呼吸力學(xué)監(jiān)測(cè)首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院與呼吸力學(xué)相關(guān)的呼吸生理及流體力學(xué)知識(shí)與呼吸力學(xué)相關(guān)的解剖結(jié)構(gòu)解剖結(jié)構(gòu)解剖結(jié)構(gòu)解剖結(jié)構(gòu)進(jìn)修呼吸治療師系列培訓(xùn)課程課件肺通氣的機(jī)制吸氣吸氣肌主動(dòng)收縮 胸廓擴(kuò)張 胸內(nèi)負(fù)壓增加 肺擴(kuò)張 肺容積增加 肺內(nèi)壓下降 與大氣壓產(chǎn)生壓力梯度 氣體進(jìn)入肺泡呼氣膈肌、肋間肌松弛 胸廓彈性回縮 胸內(nèi)負(fù)壓減少 肺回縮 肺容量減小 肺內(nèi)壓升高 與大氣壓產(chǎn)生壓力梯度 氣體排出肺通氣的機(jī)制吸氣肺通氣的動(dòng)力動(dòng)力：驅(qū)動(dòng)壓力中樞驅(qū)動(dòng)力外周驅(qū)動(dòng)力/機(jī)械驅(qū)動(dòng)力與之相關(guān)的壓力：胸內(nèi)壓肺泡內(nèi)壓氣道壓跨肺壓：肺收縮/擴(kuò)張的直接動(dòng)力跨胸壁

5、壓跨胸壓：機(jī)械通氣時(shí)的總驅(qū)動(dòng)壓跨氣道壓肺通氣的動(dòng)力動(dòng)力：驅(qū)動(dòng)壓力肺通氣的阻力肺通氣阻力彈性阻力靜態(tài)阻力，2/3非彈性阻力動(dòng)態(tài)阻力，1/3肺彈性阻力胸廓彈性阻力黏性阻力慣性阻力肺黏性阻力氣道黏性阻力胸廓黏性阻力肺慣性阻力氣道慣性阻力胸廓慣性阻力肺通氣總阻力=肺彈性阻力+胸廓彈性阻力+氣道阻力肺通氣的阻力肺通氣阻力彈性阻力非彈性阻力肺彈性阻力胸廓彈性阻彈性阻力彈性彈性物質(zhì)在外力作用下變形時(shí)，對(duì)抗變形和彈性回位的傾向平靜呼吸時(shí)，約占總阻力的2/3吸氣時(shí)的阻力，呼氣時(shí)的動(dòng)力彈性阻力彈性順應(yīng)性物體的易擴(kuò)張性，指單位壓力改變所引起的容積改變CV/P順應(yīng)性物體的易擴(kuò)張性，指單位壓力改變所引起的容積改變順應(yīng)性

6、彈性阻力的倒數(shù)容積依賴性，比順應(yīng)性靜態(tài)順應(yīng)性氣流阻斷后所測(cè)得的順應(yīng)性動(dòng)態(tài)順應(yīng)性未阻斷氣流所測(cè)得的順應(yīng)性順應(yīng)性彈性阻力的倒數(shù)單肺通氣，順應(yīng)性嚴(yán)重差的肺移植患者通氣狀況 單肺通氣，順應(yīng)性嚴(yán)重差的肺移植患者通氣狀況 影響順應(yīng)性的因素彈性阻力增加（順應(yīng)性降低）肺水腫，實(shí)變，纖維化，肺不張氣胸、胸腔積液脊柱側(cè)彎或其他胸壁畸形肥胖、腹脹動(dòng)態(tài)肺充氣影響順應(yīng)性的因素彈性阻力增加（順應(yīng)性降低）非彈性阻力黏性阻力與慣性阻力以氣道黏性阻力為主（80%90%）平靜呼吸時(shí)，約占總阻力的1/3非彈性阻力黏性阻力與慣性阻力非彈性阻力黏性阻力氣體分子之間、氣體分子與氣道壁之間的摩擦力以及呼吸時(shí)組織發(fā)生相對(duì)位移時(shí)的摩擦阻力氣道

7、阻力、肺組織黏性阻力、胸廓黏性阻力慣性阻力氣流在發(fā)動(dòng)、變速、換向時(shí)由于氣流與組織的慣性所產(chǎn)生的阻止運(yùn)動(dòng)的因素非彈性阻力黏性阻力氣道阻力層流阻力來源于氣體之間的相互摩擦Raw8l/(r4)湍流阻力來源于氣體之間以及氣體與氣道壁之間的相互摩擦Rawvl*摩擦因子/ 42r5層流示意圖湍流示意圖氣體分子之間、氣體分子與氣道壁之間的摩擦力氣道阻力層流湍流層流示意圖湍流示意圖氣體分子之間、氣體分子與不同氣流形態(tài)下壓力與流速關(guān)系層流 P=kv湍流 P=kv2層流：壓力與流速呈線性關(guān)系湍流：壓力隨流速呈指數(shù)性增長不同氣流形態(tài)下壓力與流速關(guān)系層流湍流層流：壓力與流速呈線性關(guān)氣道阻力的分布?xì)獾雷枇Φ姆植細(xì)獾拦軓?/p>

8、與吸呼氣相的關(guān)系影響氣道阻力的因素氣流形態(tài)氣流速度氣道管徑氣道長度氣體的粘性與密度肺容積身材與年齡氣道阻力與肺容積的關(guān)系氣道阻力具有流速與容積依賴性氣道管徑與吸呼氣相的關(guān)系影響氣道阻力的因素氣流形態(tài)氣道阻力與MV時(shí)影響氣道阻力的因素氣道阻力增加與人工氣道有關(guān)管腔狹小，扭曲，貼壁，痰痂形成與氣道有關(guān)氣道痙攣，分泌物增加MV時(shí)影響氣道阻力的因素氣道阻力增加氣道陷閉氣道陷閉床旁呼吸力學(xué)監(jiān)測(cè)床旁呼吸力學(xué)監(jiān)測(cè)呼吸力學(xué)的概念 以物理力學(xué)的觀點(diǎn)和方法對(duì)呼吸運(yùn)動(dòng)進(jìn)行研究的一門學(xué)科 以壓力、容積和流速的相互關(guān)系解釋呼吸運(yùn)動(dòng)現(xiàn)象呼吸力學(xué)的概念 以物理力學(xué)的觀點(diǎn)和方法對(duì)呼吸運(yùn)動(dòng)進(jìn)行動(dòng)態(tài)呼吸力學(xué) 研究壓力與流速的相互

9、關(guān)系靜態(tài)呼吸力學(xué) 研究壓力與容積的相互關(guān)系呼吸力學(xué)的內(nèi)容動(dòng)態(tài)呼吸力學(xué)呼吸力學(xué)的內(nèi)容呼吸力學(xué)的基本特性氣道阻力彈性阻力+PEEPi呼吸力學(xué)的基本特性氣道阻力彈性阻力+PEEPi呼吸力學(xué)的基本特性 P=P摩擦阻力+P彈性阻力i機(jī)械通氣的靈魂-運(yùn)動(dòng)方程呼吸力學(xué)的基本特性 i機(jī)械通氣的靈魂阻力和順應(yīng)性的監(jiān)測(cè)吸氣末阻斷法患者：充分鎮(zhèn)靜模式：容量控制參數(shù)：方波、PEEPe“吸氣末屏氣”阻力和順應(yīng)性的監(jiān)測(cè)吸氣末阻斷法PpeakPplatPpeakPplat計(jì)算公式Raw=(Ppeak-Pplat)/FCst=VT/(Pplat-PEEP-PEEPi)計(jì)算公式Raw=(Ppeak-Pplat)/F注意事項(xiàng)消除

10、自主呼吸的影響足夠的平衡時(shí)間 流速與容積依賴性PEEPPEEPi注意事項(xiàng)消除自主呼吸的影響舉例：設(shè)置：VT 350ml，PEEPe 5cmH2O，F(xiàn)low 30L/min(方波)監(jiān)測(cè)：Ppeak 34cmH2O，Pplat 27cmH2O，PEEPi 5cmH2O請(qǐng)計(jì)算R?C?舉例：設(shè)置：MV時(shí)順應(yīng)性計(jì)算公式總靜態(tài)順應(yīng)性（Cst） =VT/(Pplat-PEEP-PEEPi)總動(dòng)態(tài)順應(yīng)性（Cdyn） =VT/(Ppeak-PEEP-PEEPi)肺靜態(tài)順應(yīng)性（Clst） = VT/(Pplat-Ppl-PEEP-PEEPi)胸壁順應(yīng)性 總順應(yīng)性肺順應(yīng)性MV時(shí)順應(yīng)性計(jì)算公式總靜態(tài)順應(yīng)性（Cst）氣

11、道阻力的計(jì)算方法非MV時(shí)的氣道阻力Raw=Pao-Pal/vMV時(shí)的氣道阻力Raw=Ppeak-Pinit/v呼吸機(jī)監(jiān)測(cè)的為總黏性阻力Raw=Ppeak-Pplat/v氣道阻力的計(jì)算方法非MV時(shí)的氣道阻力呼吸力學(xué)監(jiān)測(cè)的三要素壓力（pressure，）氣道開口壓，食道壓，隆突壓流速（flow，）容積（volume）計(jì)算流量對(duì)時(shí)間的積分呼吸力學(xué)監(jiān)測(cè)的三要素壓力（pressure，）常用壓力指標(biāo)氣道峰壓（Ppeak）氣道平臺(tái)壓（Pplat）氣道平均壓（Pmean)內(nèi)源性呼氣末正壓（PEEPi）呼氣末正壓（PEEP）常用壓力指標(biāo)氣道峰壓（Ppeak）進(jìn)修呼吸治療師系列培訓(xùn)課程課件氣道峰壓（Ppeak）

12、的影響因素定容通氣，方波Ppeak= Flow x Resistance +Volume/compliance+PEEP用于克服氣道阻力、彈性阻力和PEEP影響因素：順應(yīng)性潮氣量PEEPPEEPi氣道和氣管內(nèi)導(dǎo)管阻力吸氣流速氣道峰壓（Ppeak）的影響因素定容通氣，方波氣道峰壓的臨床意義氣道峰壓是設(shè)置壓力報(bào)警限的根據(jù) 實(shí)際氣道峰壓之上5-10cmH2O以不高于45cmH2O為宜 氣道峰壓與肺損傷的關(guān)系 氣道峰壓的臨床意義氣道峰壓是設(shè)置壓力報(bào)警限的根據(jù) 平臺(tái)壓（Pplat）的影響因素定容通氣，方波Pplat=Volume/Compliance+PEEP用于克服彈性阻力和PEEP影響因素：順應(yīng)性P

13、EEP潮氣量平臺(tái)壓（Pplat）的影響因素定容通氣，方波平臺(tái)壓（Pplat）的意義可近似反應(yīng)肺泡壓與肺損傷的關(guān)系更為密切限制平臺(tái)壓不超過30cmH2O 平臺(tái)壓（Pplat）的意義可近似反應(yīng)肺泡壓平臺(tái)壓（Pplat）的監(jiān)測(cè)吸氣末阻斷法患者：充分鎮(zhèn)靜模式：容量控制參數(shù)：方波“吸氣末屏氣”平臺(tái)壓（Pplat）的監(jiān)測(cè)吸氣末阻斷法流速或氣道阻力對(duì)氣道峰壓產(chǎn)生影響，但對(duì)平臺(tái)壓無影響順應(yīng)性的變化對(duì)氣道峰壓和平臺(tái)壓都產(chǎn)生相同影響流速或氣道阻力對(duì)氣道峰壓產(chǎn)生影響，但對(duì)平臺(tái)壓無影響氣道峰壓增加的臨床意義不伴有平臺(tái)壓的增加Ppeak- Pplat = Flow x Resistance用于克服氣道阻力反應(yīng)氣道問題伴

14、有平臺(tái)壓的增加肺實(shí)質(zhì)或間質(zhì)問題肺含氣狀態(tài)變化PpeakPplat氣道峰壓增加的臨床意義不伴有平臺(tái)壓的增加PpeakPplat Paw (cm H2O)NormalNormal PPlat(Normal Compliance)Increased PIPIncreased PTA(increased Airway Resistance)NormalPIPPPlatHigh RawPIPPPlat氣道阻力對(duì)峰壓的影響 Paw (cm H2O)NormalNormal PPl肺順應(yīng)性對(duì)峰壓的影響Time (sec)Paw (cm H2O)Low CompliancePIPPPlatNormalPIPP

15、PlatNormal PPlat(Normal Compliance)Increased PPlat(Decreased Compliance)NormalPIP肺順應(yīng)性對(duì)峰壓的影響Time (sec)Paw (cm H虛點(diǎn)面積在特定的時(shí)間間隔上所計(jì)算的壓力相加求其均數(shù)即平均氣道壓平均氣道壓(Pmean)虛點(diǎn)面積在特定的時(shí)間間隔上所計(jì)算的壓力相加求其均數(shù)即平均氣道平均氣道壓(Pmean)數(shù)個(gè)周期中氣道壓的平均值與影響PIP的因素及吸氣時(shí)間長短有關(guān)近似于平均肺泡壓與對(duì)心血管系統(tǒng)的影響直接相關(guān)平均氣道壓(Pmean)數(shù)個(gè)周期中氣道壓的平均值內(nèi)源性呼氣末正壓（PEEPi）在肺的彈性回縮下導(dǎo)致呼氣末肺

16、泡內(nèi)呈正壓，稱為PEEPi只要呼氣時(shí)間小于肺排空的實(shí)際時(shí)間就會(huì)產(chǎn)生PEEPiPEEPi的存在說明存在動(dòng)態(tài)肺過度充氣（DPH）內(nèi)源性呼氣末正壓（PEEPi）在肺的彈性回縮下導(dǎo)致呼氣末肺泡PEEPi的影響因素氣道阻力增加 呼吸系統(tǒng)彈性下降氣道動(dòng)態(tài)塌陷通氣量過大呼氣時(shí)間不足呼氣肌的作用PEEPi的影響因素氣道阻力增加 PEEPi的臨床意義增加呼吸功,導(dǎo)致呼吸肌疲勞增加肺損傷的危險(xiǎn)性對(duì)循環(huán)系統(tǒng)產(chǎn)生不良影響PEEPi的臨床意義呼氣末肺容積與呼吸系統(tǒng)壓力變化FRCPalv=0PEEPPEEPiVdynVstTotal PEEP呼氣末肺容積與呼吸系統(tǒng)壓力變化FRCPalv=0PEEPPEPEEPi的監(jiān)測(cè)方法

17、:間接觀察 胸圍增大；患者呼吸費(fèi)力；心血管功能惡化；呼氣末有持續(xù)呼氣氣流，呼氣的最后部分突然被吸氣中斷； 壓力控制通氣時(shí)潮氣量或每分通氣量下降；不能用呼吸系統(tǒng)順應(yīng)性下降解釋的平臺(tái)壓升高；容量控制通氣時(shí)氣道壓力升高。 PEEPi的監(jiān)測(cè)方法:間接觀察 胸圍增大；監(jiān)測(cè)有無PEEPi監(jiān)測(cè)有無PEEPi呼氣末阻斷法測(cè)定PEEPi呼氣末阻斷法測(cè)定PEEPi呼氣末阻斷法測(cè)定PEEPi患者：充分鎮(zhèn)靜模式：？參數(shù)：PEEPe全肺平均PEEPi呼氣末阻斷法測(cè)定PEEPi患者：充分鎮(zhèn)靜PEEPe對(duì)PEEPi的影響*PEEPe對(duì)PEEPi的影響* PEEPi的臨床處理降低PEEPiCOPD，哮喘降低氣道阻力 減少分鐘

18、通氣量延長呼氣時(shí)間 消除呼氣肌的作用增加PEEPiARDS，間質(zhì)性肺病延長吸氣時(shí)間PEEPe PEEPi的臨床處理降低PEEPi增加PEEPiPEEPe的作用機(jī)制肺泡上游氣道下游氣道0cmH2OPEEPe 8cmH2OPcritPEEPi 10CmH2OPEEPi 10CmH2OPcritPEEPe的作用機(jī)制肺泡上游氣道下游氣道PEEPe 8cmH呼氣末正壓（PEEP）PEEP的生理學(xué)效應(yīng)COPD：減少呼吸功，防止氣道動(dòng)態(tài)塌陷哮喘：有爭議ARDS：使萎陷肺泡復(fù)張/防止肺泡再萎陷，減少分流，改善V/Q比值和順應(yīng)性呼氣末正壓（PEEP）PEEP的生理學(xué)效應(yīng)流 速吸氣峰流速（PIFR）呼氣峰流速（P

19、EFR）平均吸氣流速（VT/TI）流 速吸氣峰流速（PIFR）流速波形：流速-時(shí)間曲線流速-時(shí)間曲線是反映呼吸機(jī)送氣氣流的流速隨時(shí)間而變化的圖形 所有曲線上方圖形代表吸氣，下方代表呼氣流速波形：流速-時(shí)間曲線流速-時(shí)間曲線是反映呼吸機(jī)送氣氣流的進(jìn)修呼吸治療師系列培訓(xùn)課程課件容 積1VT，VC，F(xiàn)EV1.02分鐘通氣量（VE）3補(bǔ)呼氣容積（ERV）4功能殘氣量（FRC）5呼氣末肺容積（EELV）容 積1VT，VC，F(xiàn)EV1.0呼吸力學(xué)曲線（環(huán)）推算指標(biāo)：順應(yīng)性、呼吸功氣流受限和肺過度充氣的判斷確定潮氣量和最佳PEEP判斷觸發(fā)靈敏度是否合適人機(jī)協(xié)調(diào)的監(jiān)測(cè)氣道分泌物過多的判斷支擴(kuò)藥物效果的判斷呼吸機(jī)

20、管道系統(tǒng)密閉性的判斷呼吸力學(xué)曲線（環(huán)）推算指標(biāo)：順應(yīng)性、呼吸功謝謝您沒有打瞌睡！謝謝您沒有打瞌睡！感謝您的下載，特贈(zèng)送精品文章體能訓(xùn)練技巧-TRX懸掛訓(xùn)練系統(tǒng)工作之余鍛煉身體，若不需要請(qǐng)刪除后使用，謝謝您的理解，祝您生意興隆，事業(yè)高攀。RX 訓(xùn)練帶是源于美國海軍陸戰(zhàn)隊(duì)，剛開始的雛形是以高密度毛巾制成的訓(xùn)練道具，后來，有一名叫蘭迪的美國海豹突擊隊(duì)的指揮官，在退役后重新設(shè)計(jì)了該套裝備和訓(xùn)練計(jì)劃，變成民用的健身課程-“TRX 懸掛訓(xùn)練系統(tǒng)”，整套裝備的主要部分是寬 1.5 英寸，額定張力為 1250 磅的尼龍繩子，長度范圍從 6 英尺調(diào)整至 12 英尺，橡膠把手更適應(yīng)雙手抓縛或是雙腳懸掛等地面訓(xùn)練動(dòng)

21、作，扣鎖由曾用于卡賓槍的材料制成，且易于調(diào)整，其自用不到 2 磅，1 分鐘就能懸掛妥當(dāng)，裝在袋子里便于攜帶到任何地方，可固定在單杠上或卡在門縫里，或系在樹枝上，適合絕大多數(shù)的訓(xùn)練環(huán)境，如果加上啞鈴或健身球一起鍛煉，可增加更高階的難度。 感謝您的下載，特贈(zèng)送精品文章體能RX 訓(xùn)練帶是源于美國海軍懸掛訓(xùn)練：用練習(xí)者自身體重做負(fù)重，能夠允許肌肉在多個(gè)平面上做運(yùn)動(dòng)，同時(shí)保證更多的肌肉和關(guān)節(jié)參與，能夠打造更加結(jié)實(shí)的肌肉，穩(wěn)定靈活的關(guān)節(jié)，堅(jiān)固的核心力量和正確的體態(tài)，幫助在任何運(yùn)動(dòng)項(xiàng)目上獲得更佳的運(yùn)動(dòng)表現(xiàn)，TRX 還是運(yùn)動(dòng)康復(fù)的重要手段之一TRX 動(dòng)作解讀：增加阻力：1.身體角度越大，阻力越大 2.抬起一邊

22、大腿，有助于鍛煉更多平衡力3.離支點(diǎn)越遠(yuǎn)，越吃力，對(duì)穩(wěn)定性要求越高減低難度：一腿向前踮地，有助于身體減重1. chest press/ fly combo(推胸飛鳥組合)：人背向繩子，手臂握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向前，用胸肌發(fā)力慢慢打開雙手并讓它彎曲到 90 度停下，再慢慢還原，然后雙手打開做飛鳥，同時(shí)一腳往前踮地，再還原，交替練習(xí)。懸掛訓(xùn)練：用練習(xí)者自身體重做負(fù)重，能夠允許肌肉在多個(gè)平面上做2. chest press(推胸)：人背向繩子，手臂握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向前，用胸肌發(fā)

23、力慢慢打開雙手并讓它彎曲到 90 度停下，再慢慢還原(難度增加：雙腿合并或單腿抬起，或把身體斜度增加)3. lunge fly(弓步飛鳥)：1.手臂握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，挺胸收腹，身體重心微向前傾，雙手打開做飛鳥，同時(shí)一腳往前踮地。用胸部發(fā)力，再還原4. chest press- single leg extended(推胸-單腿伸展)：人背向繩子，手臂握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，一腳撐地，一腳向前抬起，身體重心微微向前，用胸肌發(fā)力慢慢打開雙手并讓它彎曲到 90 度停下，再慢慢還原.2. chest press(推胸)：人背向繩子，手臂握住繩5. Susp

24、ended incline press-leg up(懸浮上斜推-抬腳)：雙手撐住地面，一腳勾住繩子，穩(wěn)定腹部，另一腿向上抬靠緊固定腿，然后做俯臥撐。6. Atomic push up(俯臥撐收腹)：雙手撐住地面，雙腳勾住繩子，穩(wěn)定腹部，一下俯臥撐，還原后，雙腳以腹部力量靠向胸部，再慢慢伸直還原，交替練習(xí)。7. back row(背部劃船)：手臂握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向后，以背部發(fā)力，手臂夾緊身體兩側(cè)往后收，肩胛骨向后夾，把繩子拉到小腹，保持住再慢慢還原(難度增加：雙腿合并或單腿抬起，或把身體斜度增加)5. Suspended incl

25、ine press-le8. elevated back row(高位劃船)：手臂握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，加大身體斜度，以背部發(fā)力，手臂夾緊身體兩側(cè)往后收，肩胛骨向后夾，把繩子拉到小腹，保持住再慢慢還原9. power pull-single arm(力量拉伸-單臂)：雙腿分開與肩同寬，單手抓住繩子，張開身體，另一邊手臂繞身體旋轉(zhuǎn) 180 度觸摸繩子，完后慢慢還原。10. low deltoid fly(低位三角肌飛鳥)：手臂握住繩子，掌心向上，雙手伸直向前，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向后，直手向下向后滑，慢慢還原。

26、8. elevated back row(高位劃船)11. T deltoid fly(t型三角肌飛鳥)：手臂握住繩子，掌心向上，雙手伸直向前，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向后，張開雙手與身體呈T型，再慢慢還原(難度增加：把身體斜度增加)12. Y deltoid fly(Y型三角肌飛鳥)：手臂握住繩子，掌心向上，雙手伸直向前，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向后，張開雙手與身體呈Y型，再慢慢還原(難度增加：把身體斜度增加)13. W deltoid fly(W型三角肌飛鳥)：手臂握住繩子，掌心向上，雙手伸直向前，肘保持一點(diǎn)彎曲，膝蓋

27、一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向后，張開雙手與身體呈W型，再慢慢還原(難度增加：把身體斜度增加)11. T deltoid fly(t型三角肌飛14. High triceps press(高位肱三頭肌彎曲)：人背向繩子，手臂向前握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向前，然后把肘部彎曲，肱三頭肌發(fā)力，再慢慢還原(難度增加：把身體斜度增加)15. Dips(臂屈伸)：手臂在身體兩側(cè)，雙手握住繩子，雙腿呈箭步姿勢(shì)，然后肱三頭肌和胸肌發(fā)力，雙臂彎曲成 90 度再慢慢還原(難度增加：把一只腿往后抬或兩腿前放或抬高)16. High bicep cu

28、rl(高位肱二頭肌彎曲)：手臂握住繩子，雙手伸直，肘保持一點(diǎn)彎曲，膝蓋一點(diǎn)點(diǎn)彎曲，兩腿跟肩一樣寬，身體重心微微向后，以肱二頭肌發(fā)力，彎曲手臂，再慢慢還原(難度增加：把身體斜度增加)14. High triceps press(高位肱三頭肌彎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本文為 Word 版資料，可以任意修改編輯。如果你看到我上傳的資料這個(gè)后綴，請(qǐng)刪除后使用。高效學(xué)習(xí)方法和技巧學(xué)習(xí)需要方法，找到適合自己的方法，學(xué)習(xí)才能事半功倍。接下來，我結(jié)合我自己的學(xué)習(xí)情況，給大家總結(jié)的高效學(xué)習(xí)五

38、部曲一、預(yù)習(xí)是學(xué)習(xí)的重要環(huán)節(jié)上課前充分預(yù)習(xí)，考試前充分地復(fù)習(xí)，與“打有準(zhǔn)備之仗”有同曲之道。預(yù)習(xí)效果好，聽課才能有針對(duì)性；聽課有針對(duì)性，復(fù)習(xí)才能順利進(jìn)行；復(fù)習(xí)深刻，作業(yè)、考試才能得心應(yīng)手。所以說預(yù)習(xí)是學(xué)生學(xué)習(xí)過程中一個(gè)必不可少的環(huán)節(jié)。二、掌握好高效的聽課方法課上集中精力聽課，是掌握知識(shí)的捷徑。聽講時(shí)，思想上必須與老師講解的思路保持一致，聽老師對(duì)事物是怎樣分析、推理；聽老師解決問題是用什么方法、技巧；聽老師對(duì)問題有哪些提問和解釋。這樣才能把握住聽課的重點(diǎn)。聽講中，要把自己在預(yù)習(xí)中的理解，和老師講解的相比較，看自己和老師有哪些相同點(diǎn)和區(qū)別點(diǎn)。三、合理安排復(fù)習(xí)時(shí)間很多科學(xué)家通過研究發(fā)現(xiàn)，有幾個(gè)時(shí)間段

39、有利于鞏固記憶：一是學(xué)習(xí)后最初幾分鐘內(nèi)，電生理活動(dòng)引起蛋白質(zhì)的合成；二是學(xué)習(xí)后在 48 小時(shí)內(nèi)復(fù)習(xí)；三是一周之后腦突觸發(fā)生永久性變化。根據(jù)人在學(xué)習(xí)過程中這一生理變化，采用復(fù)習(xí)加強(qiáng)記憶就顯得特別重要了。如果我們能夠在學(xué)習(xí)的內(nèi)容即將忘記時(shí)進(jìn)行復(fù)習(xí)，那么復(fù)習(xí)的效果最好，效率也最高。著名的心理學(xué)家艾賓浩斯通過實(shí)驗(yàn)發(fā)現(xiàn)了人的記憶與遺忘規(guī)律。實(shí)驗(yàn)證明：在學(xué)習(xí)僅過了 20 分鐘后，就忘記記憶內(nèi)容的 42%，1 天后忘卻量已經(jīng)達(dá)到了 66%，到了第 31 天，忘卻量高達(dá)79%。他根據(jù)實(shí)驗(yàn)結(jié)果，畫成了著名的遺忘曲線。并表明遺忘的規(guī)律是“先快后慢”。這條規(guī)律提示我們，定要盡早、及時(shí)地對(duì)所學(xué)知識(shí)進(jìn)行復(fù)習(xí)，以便在知識(shí)

40、還在大腦內(nèi)時(shí)就加深印記，否則大腦中已經(jīng)沒有痕跡了，只能再費(fèi)精力重學(xué)。合理安排復(fù)習(xí)時(shí)間特別重要并且必要，制定復(fù)習(xí)計(jì)劃，嚴(yán)格按精英特計(jì)劃執(zhí)行，并力求形成習(xí)慣，是我們每一位學(xué)生都應(yīng)該力求努力做到。我們?yōu)槭裁匆獜?fù)習(xí)呢？因?yàn)槲覀冇洃浶Ч麤]有那么好，不可能過目不忘，所以需要重復(fù)、增強(qiáng)記憶。同時(shí)，復(fù)習(xí)的進(jìn)展也有利于學(xué)習(xí)效率的提高。四、做作業(yè)的科學(xué)方法這里有七種做作業(yè)的技巧：1、先復(fù)習(xí)后做作業(yè)。復(fù)習(xí)是做好作業(yè)的關(guān)鍵，只有復(fù)習(xí)得好，作業(yè)才能做得好。做作業(yè)前先把老師這一節(jié)課所講的內(nèi)容認(rèn)真地看一看，弄清楚基本原理和概念后再去做作業(yè)，作業(yè)才能做得既快又好。2、認(rèn)真審題。 做作業(yè)最關(guān)鍵的步就是審題，連題都判斷錯(cuò)了，作業(yè)

41、內(nèi)容就全錯(cuò)了。首先第步要弄清楚題目的內(nèi)容，所給的條件，什么要求，需要聯(lián)系哪些知識(shí)等等；其次是考慮好解題思路、方法、步驟，要善于把道題分成幾部分，化大為小、化難為易、分清其中的已知和未知，弄清各部分的聯(lián)系，設(shè)計(jì)好整個(gè)解題步驟，定要讓自己做到不明白題意不做題，不清楚方法步驟不下筆。3、細(xì)心的做題。 做題是表達(dá)思路的全過程，這個(gè)過程要求既動(dòng)腦、又動(dòng)手。做題的關(guān)鍵是要保證“規(guī)范”、“準(zhǔn)確”。要做到這兩點(diǎn)就要求學(xué)生認(rèn)真的抄好題，書寫格式必須正確、規(guī)范，嚴(yán)格按照各類題的解題要求，仔細(xì)演算解題的每步，得出正確的結(jié)果。只有平時(shí)做題認(rèn)真細(xì)致，步驟完整，思路正確，表達(dá)嚴(yán)密，準(zhǔn)確無誤，考試時(shí)才能按照這種良好的習(xí)慣進(jìn)

42、行五、重視錯(cuò)題積累在學(xué)習(xí)的過程中，同學(xué)們可能遇到過一錯(cuò)再錯(cuò)的現(xiàn)象究其原因，多數(shù)是由于在學(xué)習(xí)中不求甚解，不注意總結(jié)積累所致。那么，該怎么辦呢？實(shí)踐證明，自編一本“易錯(cuò)題集”是避免做題一錯(cuò)再錯(cuò)的最好辦法。錯(cuò)題本的復(fù)習(xí)方法：1、每周把該周錯(cuò)題本中記錄的題目快速瀏覽一遍；2、每月把該月錯(cuò)題本中記錄的題目再快速瀏覽一遍；3、每個(gè)季度把錯(cuò)題本中三個(gè)月記錄的題目再快速瀏覽一遍；4、大考前把該錯(cuò)題本中的所有題目認(rèn)真復(fù)習(xí)一遍，確保題不二錯(cuò)￥精編資料 歡迎下載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