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动脉留置导管主要在发病早期稳定后应该及时拔掉，避免医源性损害。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "equ",
"score": 1,
"text": "动脉留置导管"
},
{
"indices": [
25,
26,
27,
28,
29
],
"label": "dis",
"score": 1,
"text": "医源性损害"
}
] |
俯卧位可以应用于机械通气时，可以促进背部肺泡扩张，改善局部肺泡的通气灌流失调。 | [
{
"indices": [
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
18,
19,
20,
21
],
"label": "bod",
"score": 1,
"text": "背部肺泡"
},
{
"indices": [
27,
28,
29,
30
],
"label": "bod",
"score": 1,
"text": "局部肺泡"
},
{
"indices": [
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37
],
"label": "sym",
"score": 1,
"text": "局部肺泡的通气灌流失调"
},
{
"indices": [
32,
33,
34,
35
],
"label": "pro",
"score": 1,
"text": "通气灌流"
}
] |
（五）营养在RDS急性期不给予脂肪乳剂，因脂肪乳剂会对于低氧性肺血流下降产生不利影响。 | [
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
15,
16,
17,
18
],
"label": "dru",
"score": 1,
"text": "脂肪乳剂"
},
{
"indices": [
21,
22,
23,
24
],
"label": "dru",
"score": 1,
"text": "脂肪乳剂"
},
{
"indices": [
28,
29,
30,
31,
32,
33,
34,
35
],
"label": "sym",
"score": 1,
"text": "低氧性肺血流下降"
},
{
"indices": [
31,
32
],
"label": "bod",
"score": 1,
"text": "肺血"
}
] |
对于贫血者，可以输血和补充红细胞成分等，保持红细胞压积在40%～50%。 | [
{
"indices": [
2,
3
],
"label": "dis",
"score": 1,
"text": "贫血"
},
{
"indices": [
8,
9
],
"label": "pro",
"score": 1,
"text": "输血"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "补充红细胞成分"
},
{
"indices": [
22,
23,
24,
25,
26
],
"label": "ite",
"score": 1,
"text": "红细胞压积"
}
] |
（六）抗生素应用如果考虑为GBS感染，在做血培养后应用氨苄西林和庆大霉素预防性治疗。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "抗生素应用"
},
{
"indices": [
13,
14,
15,
16,
17
],
"label": "dis",
"score": 1,
"text": "GBS感染"
},
{
"indices": [
21,
22,
23
],
"label": "pro",
"score": 1,
"text": "血培养"
},
{
"indices": [
27,
28,
29,
30
],
"label": "dru",
"score": 1,
"text": "氨苄西林"
},
{
"indices": [
32,
33,
34,
35
],
"label": "dru",
"score": 1,
"text": "庆大霉素"
},
{
"indices": [
36,
37,
38,
39,
40
],
"label": "pro",
"score": 1,
"text": "预防性治疗"
}
] |
如果血培养阴性，外周白细胞计数为正常范围，可以停用抗生素。 | [
{
"indices": [
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "血培养"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14
],
"label": "ite",
"score": 1,
"text": "外周白细胞计数"
},
{
"indices": [
25,
26,
27
],
"label": "dru",
"score": 1,
"text": "抗生素"
}
] |
一般应用抗生素为1周。 | [
{
"indices": [
4,
5,
6
],
"label": "dru",
"score": 1,
"text": "抗生素"
}
] |
如果母亲在分娩前已经应用过抗生素，对血培养阴性者必须根据临床状况处理。 | [
{
"indices": [
13,
14,
15
],
"label": "dru",
"score": 1,
"text": "抗生素"
},
{
"indices": [
18,
19,
20
],
"label": "pro",
"score": 1,
"text": "血培养"
}
] |
对于呼吸机治疗过程中出现气道清洗液培养细菌阳性，可以根据是否为致病菌和药敏试验结果来决定抗生素是否应用。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "呼吸机治疗"
},
{
"indices": [
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22
],
"label": "sym",
"score": 1,
"text": "气道清洗液培养细菌阳性"
},
{
"indices": [
12,
13,
14,
15,
16,
17,
18
],
"label": "pro",
"score": 1,
"text": "气道清洗液培养"
},
{
"indices": [
19,
20
],
"label": "mic",
"score": 1,
"text": "细菌"
},
{
"indices": [
31,
32,
33
],
"label": "mic",
"score": 1,
"text": "致病菌"
},
{
"indices": [
35,
36,
37,
38
],
"label": "pro",
"score": 1,
"text": "药敏试验"
},
{
"indices": [
44,
45,
46
],
"label": "equ",
"score": 1,
"text": "抗生素"
}
] |
（七）肺表面活性物质治疗20世纪80～90年代，国际儿科新生儿医学最突出成果是应用外源性肺表面活性物质（pulmonarysurfactant）对RDS的研究在临床预防和治疗的成功。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
},
{
"indices": [
26,
27
],
"label": "dep",
"score": 1,
"text": "儿科"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49,
50
],
"label": "dru",
"score": 1,
"text": "外源性肺表面活性物质"
},
{
"indices": [
52,
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69,
70
],
"label": "dru",
"score": 1,
"text": "pulmonarysurfactant"
},
{
"indices": [
73,
74,
75
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
1959年，美国MaryEllenAvery医师首次提出HMD的病因是肺表面活性物质缺乏。 | [
{
"indices": [
28,
29,
30
],
"label": "dis",
"score": 1,
"text": "HMD"
},
{
"indices": [
35,
36,
37,
38,
39,
40,
41
],
"label": "bod",
"score": 1,
"text": "肺表面活性物质"
},
{
"indices": [
35,
36,
37,
38,
39,
40,
41,
42,
43
],
"label": "sym",
"score": 1,
"text": "肺表面活性物质缺乏"
}
] |
1980年，日本藤原泽郎（TetsuroFujiwara）医师首次报道了应用牛肺表面活性物质制剂治疗10例HMD成功。 | [
{
"indices": [
38,
39,
40,
41,
42,
43,
44,
45,
46,
47
],
"label": "dru",
"score": 1,
"text": "牛肺表面活性物质制剂"
},
{
"indices": [
53,
54,
55
],
"label": "dis",
"score": 1,
"text": "HMD"
}
] |
1990年以来，发达国家和地区已普遍应用肺表面活性物质预防和治疗RDS。 | [
{
"indices": [
20,
21,
22,
23,
24,
25,
26
],
"label": "dru",
"score": 1,
"text": "肺表面活性物质"
},
{
"indices": [
32,
33,
34
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
1.肺表面活性物质制剂目前国外常规应用的肺表面活性物质制剂为牛和猪肺提取物，富含磷脂和一定量的SP-B和C，不含SP-A，其中以Survanta（牛肺，美国）、Infasurf（小牛肺、美国）、Curosurf（猪肺，意大利）为代表。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "dru",
"score": 1,
"text": "肺表面活性物质制剂"
},
{
"indices": [
20,
21,
22,
23,
24,
25,
26,
27,
28
],
"label": "dru",
"score": 1,
"text": "肺表面活性物质制剂"
},
{
"indices": [
30,
31,
32,
33,
34,
35,
36
],
"label": "dru",
"score": 1,
"text": "牛和猪肺提取物"
},
{
"indices": [
64,
65,
66,
67,
68,
69,
70,
71
],
"label": "dru",
"score": 1,
"text": "Survanta"
},
{
"indices": [
80,
81,
82,
83,
84,
85,
86,
87
],
"label": "dru",
"score": 1,
"text": "Infasurf"
},
{
"indices": [
97,
98,
99,
100,
101,
102,
103,
104
],
"label": "dru",
"score": 1,
"text": "Curosurf"
}
] |
肺表面活性物质制剂应用指征仅限于新生儿RDS，但也有应用于新生儿和婴幼儿肺部炎症、吸入性损伤等的报道，有一定疗效。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8
],
"label": "dru",
"score": 1,
"text": "肺表面活性物质制剂"
},
{
"indices": [
16,
17,
18,
19,
20,
21
],
"label": "dis",
"score": 1,
"text": "新生儿RDS"
},
{
"indices": [
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "dis",
"score": 1,
"text": "新生儿和婴幼儿肺部炎症"
},
{
"indices": [
41,
42,
43,
44,
45
],
"label": "dis",
"score": 1,
"text": "吸入性损伤"
}
] |
外源性肺表面活性物质的代谢主要为肺泡Ⅱ型上皮细胞的摄取和再利用。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "bod",
"score": 1,
"text": "外源性肺表面活性物质"
},
{
"indices": [
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "bod",
"score": 1,
"text": "肺泡Ⅱ型上皮细胞"
}
] |
动物研究显示治疗剂量的肺表面活性物质磷脂的生物半衰期为30～40小时，肺内清除速率为每小时2%～4%。 | [
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25
],
"label": "ite",
"score": 1,
"text": "肺表面活性物质磷脂的生物半衰期"
},
{
"indices": [
35,
36,
37,
38,
39,
40
],
"label": "ite",
"score": 1,
"text": "肺内清除速率"
}
] |
应用稳定同位素的人体研究发现，新生儿肺通过摄取原料合成肺表面活性物质磷脂（磷脂酰胆碱）的速率为每天肺内总量的2%～4%，或4.2mg/（kg•d），但半衰期长达5～6天。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "应用稳定同位素的人体研究"
},
{
"indices": [
18
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45
],
"label": "ite",
"score": 1,
"text": "摄取原料合成肺表面活性物质磷脂（磷脂酰胆碱）的速率"
},
{
"indices": [
49,
50,
51,
52
],
"label": "ite",
"score": 1,
"text": "肺内总量"
},
{
"indices": [
75,
76,
77
],
"label": "ite",
"score": 1,
"text": "半衰期"
}
] |
2.肺表面活性物质预防性治疗RDS的指征出生体重1000克以下常规应用，一般在出生后15～30分钟气道插管后滴入100mg/kg，以防止RDS的发生。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质预防性治疗"
},
{
"indices": [
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
20,
21,
22,
23
],
"label": "ite",
"score": 1,
"text": "出生体重"
},
{
"indices": [
49,
50,
51,
52
],
"label": "pro",
"score": 1,
"text": "气道插管"
},
{
"indices": [
54,
55
],
"label": "pro",
"score": 1,
"text": "滴入"
},
{
"indices": [
68,
69,
70
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
临床试验的的结论表明对于部分婴儿是有利的，但从经济上看，可能对相当一部分原本不发生RDS的婴儿做了不必要的治疗，因而不主张广泛使用，而局限于对小胎龄极低出生体重儿和珍贵儿有选择地使用。 | [
{
"indices": [
41,
42,
43
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
71,
72,
73,
74,
75,
76,
77,
78,
79,
80
],
"label": "dis",
"score": 1,
"text": "小胎龄极低出生体重儿"
},
{
"indices": [
82,
83,
84
],
"label": "dis",
"score": 1,
"text": "珍贵儿"
}
] |
对于胎龄在30～35周、中度呼吸困难的RDS患儿，即使单纯呼吸机治疗，也可以在3～4天后恢复，而不需要依赖外源性表面活性物质治疗。 | [
{
"indices": [
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "中度呼吸困难"
},
{
"indices": [
19,
20,
21
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
27,
28,
29,
30,
31,
32,
33
],
"label": "pro",
"score": 1,
"text": "单纯呼吸机治疗"
},
{
"indices": [
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63
],
"label": "pro",
"score": 1,
"text": "外源性表面活性物质治疗"
}
] |
3.表面活性物质救治性（rescue）治疗RDS的指征对于已经出现RDS临床征象的早产儿，可以在机械通气下气道滴入100～200mg/kg，并调节呼吸机参数，保持合适的通气压力，避免出现气漏等并发症。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dru",
"score": 1,
"text": "表面活性物质"
},
{
"indices": [
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
33,
34,
35
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
41,
42,
43
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
48,
49,
50,
51
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
53,
54,
55,
56
],
"label": "pro",
"score": 1,
"text": "气道滴入"
},
{
"indices": [
73,
74,
75
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
84,
85,
86,
87
],
"label": "ite",
"score": 1,
"text": "通气压力"
},
{
"indices": [
93,
94,
95,
96,
97,
98
],
"label": "sym",
"score": 1,
"text": "气漏等并发症"
}
] |
肺表面活性物质治疗的疗效首先为用药后短时期内氧合状况的改善。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25
],
"label": "ite",
"score": 1,
"text": "用药后短时期内氧合状况"
}
] |
可以表现为血氧分压的迅速提高，一般给药后几分钟到1～2小时内可以使动脉氧分压提高50%以上，吸入氧浓度下调10%～20%以上。 | [
{
"indices": [
5,
6,
7,
8
],
"label": "ite",
"score": 1,
"text": "血氧分压"
},
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "sym",
"score": 1,
"text": "血氧分压的迅速提高"
},
{
"indices": [
33,
34,
35,
36,
37
],
"label": "ite",
"score": 1,
"text": "动脉氧分压"
},
{
"indices": [
46,
47,
48,
49,
50
],
"label": "ite",
"score": 1,
"text": "吸入氧浓度"
}
] |
相应的可以将机械通气的吸气峰压减少3～4cmH<sub>2</sub>O。 | [
{
"indices": [
6,
7,
8,
9
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
11,
12,
13,
14
],
"label": "ite",
"score": 1,
"text": "吸气峰压"
}
] |
疗效不佳的原因，除了表面活性物质制剂本身外，主要与RDS肺内有肺表面活性物质耗竭，缺氧对肺泡组织细胞合成肺表面活性物质的抑制，肺泡毛细血管高通透性致大量血浆蛋白渗出，抑制内源性肺表面活性物质活性有关。 | [
{
"indices": [
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "dru",
"score": 1,
"text": "表面活性物质制剂"
},
{
"indices": [
25,
26,
27
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
28,
29,
30,
31,
32,
33,
34,
35,
36,
37
],
"label": "bod",
"score": 1,
"text": "肺内有肺表面活性物质"
},
{
"indices": [
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "肺内有肺表面活性物质耗竭"
},
{
"indices": [
41,
42
],
"label": "sym",
"score": 1,
"text": "缺氧"
},
{
"indices": [
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58,
59,
60,
61
],
"label": "sym",
"score": 1,
"text": "肺泡组织细胞合成肺表面活性物质的抑制"
},
{
"indices": [
44,
45,
46,
47,
48,
49
],
"label": "bod",
"score": 1,
"text": "肺泡组织细胞"
},
{
"indices": [
52,
53,
54,
55,
56,
57,
58
],
"label": "bod",
"score": 1,
"text": "肺表面活性物质"
},
{
"indices": [
63,
64,
65,
66,
67,
68
],
"label": "bod",
"score": 1,
"text": "肺泡毛细血管"
},
{
"indices": [
63,
64,
65,
66,
67,
68,
69,
70,
71,
72
],
"label": "sym",
"score": 1,
"text": "肺泡毛细血管高通透性"
},
{
"indices": [
74,
75,
76,
77,
78,
79,
80,
81
],
"label": "sym",
"score": 1,
"text": "大量血浆蛋白渗出"
},
{
"indices": [
76,
77,
78,
79
],
"label": "bod",
"score": 1,
"text": "血浆蛋白"
},
{
"indices": [
83,
84,
85,
86,
87,
88,
89,
90,
91,
92,
93,
94,
95,
96
],
"label": "sym",
"score": 1,
"text": "抑制内源性肺表面活性物质活性"
},
{
"indices": [
85,
86,
87,
88,
89,
90,
91,
92,
93,
94
],
"label": "bod",
"score": 1,
"text": "内源性肺表面活性物质"
}
] |
（一）支气管肺发育不良（bronchopulmonarydysplasia，BPD）为继发性慢性肺部病变，早产儿特别是经较长时间氧疗和机械通气可诱发，表现为生后2～3周对机械通气和吸入氧的依赖，严重病例肺部有放射学上纤维化的表现。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "支气管肺发育不良"
},
{
"indices": [
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36
],
"label": "dis",
"score": 1,
"text": "bronchopulmonarydysplasia"
},
{
"indices": [
38,
39,
40
],
"label": "dis",
"score": 1,
"text": "BPD"
},
{
"indices": [
43,
44,
45,
46,
47,
48,
49,
50,
51
],
"label": "dis",
"score": 1,
"text": "继发性慢性肺部病变"
},
{
"indices": [
53,
54,
55
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
60,
61,
62,
63,
64,
65
],
"label": "pro",
"score": 1,
"text": "较长时间氧疗"
},
{
"indices": [
67,
68,
69,
70
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
85,
86,
87,
88
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
90,
91,
92
],
"label": "pro",
"score": 1,
"text": "吸入氧"
},
{
"indices": [
101,
102
],
"label": "bod",
"score": 1,
"text": "肺部"
},
{
"indices": [
101,
102,
103,
104,
105,
106,
107,
108,
109,
110
],
"label": "sym",
"score": 1,
"text": "肺部有放射学上纤维化"
}
] |
呋塞米，静脉1mg/kg，一天2次，口服2mg/（kg•d）；氢氯噻嗪，2mg/kg，一天2次，与氯化钾同时服用；氨茶碱剂量控制以血浓度保持为12～15mg/L为安全有效。 | [
{
"indices": [
0,
1,
2
],
"label": "dru",
"score": 1,
"text": "呋塞米"
},
{
"indices": [
4,
5
],
"label": "bod",
"score": 1,
"text": "静脉"
},
{
"indices": [
18,
19
],
"label": "pro",
"score": 1,
"text": "口服"
},
{
"indices": [
31,
32,
33,
34
],
"label": "dru",
"score": 1,
"text": "氢氯噻嗪"
},
{
"indices": [
49,
50,
51
],
"label": "dru",
"score": 1,
"text": "氯化钾"
},
{
"indices": [
52,
53,
54,
55
],
"label": "pro",
"score": 1,
"text": "同时服用"
},
{
"indices": [
57,
58,
59
],
"label": "dru",
"score": 1,
"text": "氨茶碱"
},
{
"indices": [
65,
66,
67
],
"label": "ite",
"score": 1,
"text": "血浓度"
}
] |
地塞米松治疗在出生后第4周开始，0.25mg/kg，一天2次，每1～2天剂量减半至0.01～0.02mg/kg，一天2次，总疗程在5～7天，以尽量减少皮质激素的不良反应，如高血糖、消化道出血、肾上腺皮质功能抑制、败血症、生长迟缓等。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "地塞米松治疗"
},
{
"indices": [
75,
76,
77,
78
],
"label": "dru",
"score": 1,
"text": "皮质激素"
},
{
"indices": [
86,
87,
88
],
"label": "dis",
"score": 1,
"text": "高血糖"
},
{
"indices": [
90,
91,
92,
93,
94
],
"label": "dis",
"score": 1,
"text": "消化道出血"
},
{
"indices": [
96,
97,
98,
99,
100
],
"label": "bod",
"score": 1,
"text": "肾上腺皮质"
},
{
"indices": [
96,
97,
98,
99,
100,
101,
102,
103,
104
],
"label": "sym",
"score": 1,
"text": "肾上腺皮质功能抑制"
},
{
"indices": [
106,
107,
108
],
"label": "dis",
"score": 1,
"text": "败血症"
},
{
"indices": [
110,
111,
112,
113
],
"label": "sym",
"score": 1,
"text": "生长迟缓"
}
] |
如果皮质激素治疗7天无效，应放弃该疗法。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "皮质激素治疗"
}
] |
治疗效果以小儿依赖呼吸机和高氧治疗的状况缓解、体重增加、没有感染等并发症来判断。 | [
{
"indices": [
9,
10,
11
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
13,
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "高氧治疗"
},
{
"indices": [
23,
24,
25,
26
],
"label": "sym",
"score": 1,
"text": "体重增加"
},
{
"indices": [
23,
24
],
"label": "ite",
"score": 1,
"text": "体重"
},
{
"indices": [
30,
31
],
"label": "dis",
"score": 1,
"text": "感染"
}
] |
（二）气胸及纵隔气漏气胸和气漏（纵隔气肿、间质气肿）是RDS的主要并发症，一般需要行胸腔插管闭式引流。 | [
{
"indices": [
3,
4
],
"label": "dis",
"score": 1,
"text": "气胸"
},
{
"indices": [
6,
7,
8,
9
],
"label": "sym",
"score": 1,
"text": "纵隔气漏"
},
{
"indices": [
6,
7
],
"label": "bod",
"score": 1,
"text": "纵隔"
},
{
"indices": [
10,
11
],
"label": "dis",
"score": 1,
"text": "气胸"
},
{
"indices": [
13,
14
],
"label": "sym",
"score": 1,
"text": "气漏"
},
{
"indices": [
16,
17,
18,
19
],
"label": "sym",
"score": 1,
"text": "纵隔气肿"
},
{
"indices": [
16,
17
],
"label": "bod",
"score": 1,
"text": "纵隔"
},
{
"indices": [
21,
22,
23,
24
],
"label": "sym",
"score": 1,
"text": "间质气肿"
},
{
"indices": [
21,
22
],
"label": "bod",
"score": 1,
"text": "间质"
},
{
"indices": [
27,
28,
29
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
42,
43,
44,
45,
46,
47,
48,
49
],
"label": "pro",
"score": 1,
"text": "胸腔插管闭式引流"
}
] |
主要预防手段为柔和的复苏手法和小潮气量机械通气，或采用新型CPAP装置，可以通过稳定通气压力降低其发生率。 | [
{
"indices": [
7,
8,
9,
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "柔和的复苏手法"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21,
22
],
"label": "pro",
"score": 1,
"text": "小潮气量机械通气"
},
{
"indices": [
27,
28,
29,
30,
31,
32,
33,
34
],
"label": "equ",
"score": 1,
"text": "新型CPAP装置"
},
{
"indices": [
40,
41,
42,
43,
44,
45
],
"label": "pro",
"score": 1,
"text": "稳定通气压力"
}
] |
目前，经肺表面活性物质治疗后的发生率可以减到10%以下。 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
}
] |
（三）肺出血肺出血为严重临床并发症，一般止血药物往往难以奏效。 | [
{
"indices": [
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "肺出血"
},
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "肺出血"
},
{
"indices": [
20,
21,
22,
23
],
"label": "dru",
"score": 1,
"text": "止血药物"
}
] |
约有2%～7%的经肺表面活性物质治疗的新生儿可以并发肺出血。 | [
{
"indices": [
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
},
{
"indices": [
26,
27,
28
],
"label": "dis",
"score": 1,
"text": "肺出血"
}
] |
有报道应用肺表面活性物质制剂治疗肺出血有效，但对于早产极低出生体重儿预后差。 | [
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "dru",
"score": 1,
"text": "肺表面活性物质制剂"
},
{
"indices": [
16,
17,
18
],
"label": "dis",
"score": 1,
"text": "肺出血"
},
{
"indices": [
25,
26,
27,
28,
29,
30,
31,
32,
33
],
"label": "dis",
"score": 1,
"text": "早产极低出生体重儿"
}
] |
（四）持续动脉导管开放持续动脉导管开放（PDA）多见于经肺表面活性物质治疗后的RDS患儿。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "sym",
"score": 1,
"text": "持续动脉导管开放"
},
{
"indices": [
5,
6,
7,
8
],
"label": "bod",
"score": 1,
"text": "动脉导管"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "持续动脉导管开放"
},
{
"indices": [
13,
14,
15,
16
],
"label": "bod",
"score": 1,
"text": "动脉导管"
},
{
"indices": [
20,
21,
22
],
"label": "sym",
"score": 1,
"text": "PDA"
},
{
"indices": [
28,
29,
30,
31,
32,
33,
34,
35,
36
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
},
{
"indices": [
39,
40,
41
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
为使关闭动脉导管，可以在出生后第3天起，静脉给予吲哚美辛（indomethacin）或布洛芬（ibuprofen）治疗。 | [
{
"indices": [
4,
5,
6,
7
],
"label": "bod",
"score": 1,
"text": "动脉导管"
},
{
"indices": [
20,
21,
22,
23
],
"label": "pro",
"score": 1,
"text": "静脉给予"
},
{
"indices": [
24,
25,
26,
27
],
"label": "dru",
"score": 1,
"text": "吲哚美辛"
},
{
"indices": [
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40
],
"label": "dru",
"score": 1,
"text": "indomethacin"
},
{
"indices": [
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58
],
"label": "pro",
"score": 1,
"text": "布洛芬（ibuprofen）治疗"
}
] |
如果无效，可以手术结扎使之关闭。 | [
{
"indices": [
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "手术结扎"
}
] |
【足月儿RDS】（一）足月儿原发性RDS一般见于窒息后有肺水肿的足月儿。 | [
{
"indices": [
1,
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "足月儿RDS"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18,
19
],
"label": "dis",
"score": 1,
"text": "足月儿原发性RDS"
},
{
"indices": [
24,
25
],
"label": "dis",
"score": 1,
"text": "窒息"
},
{
"indices": [
28,
29,
30
],
"label": "dis",
"score": 1,
"text": "肺水肿"
}
] |
大部分没有胎粪污染羊水，而无早产儿发生RDS的情况，但可以有产前和产时窒息史，使肺泡上皮细胞的肺液清除功能下降。 | [
{
"indices": [
5,
6,
7,
8,
9,
10
],
"label": "sym",
"score": 1,
"text": "胎粪污染羊水"
},
{
"indices": [
5,
6
],
"label": "bod",
"score": 1,
"text": "胎粪"
},
{
"indices": [
9,
10
],
"label": "bod",
"score": 1,
"text": "羊水"
},
{
"indices": [
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
19,
20,
21
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
30,
31,
32,
33,
34,
35,
36
],
"label": "sym",
"score": 1,
"text": "产前和产时窒息"
},
{
"indices": [
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54
],
"label": "sym",
"score": 1,
"text": "肺泡上皮细胞的肺液清除功能下降"
},
{
"indices": [
40,
41,
42,
43,
44,
45,
46,
47,
48
],
"label": "bod",
"score": 1,
"text": "肺泡上皮细胞的肺液"
}
] |
同时，可以有胸片肺野渗出似炎症、心影大、二尖瓣和三尖瓣关闭不全、低血压、肝脏增大、少尿等症状。 | [
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13,
14
],
"label": "sym",
"score": 1,
"text": "胸片肺野渗出似炎症"
},
{
"indices": [
6,
7
],
"label": "pro",
"score": 1,
"text": "胸片"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "心影大"
},
{
"indices": [
16,
17
],
"label": "ite",
"score": 1,
"text": "心影"
},
{
"indices": [
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30
],
"label": "sym",
"score": 1,
"text": "二尖瓣和三尖瓣关闭不全"
},
{
"indices": [
20,
21,
22
],
"label": "bod",
"score": 1,
"text": "二尖瓣"
},
{
"indices": [
24,
25,
26
],
"label": "bod",
"score": 1,
"text": "三尖瓣"
},
{
"indices": [
32,
33,
34
],
"label": "dis",
"score": 1,
"text": "低血压"
},
{
"indices": [
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "肝脏增大"
},
{
"indices": [
36,
37
],
"label": "bod",
"score": 1,
"text": "肝脏"
},
{
"indices": [
41,
42
],
"label": "sym",
"score": 1,
"text": "少尿"
},
{
"indices": [
42
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
彩超检查可以发现心脏收缩力和心输出量下降等。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "pro",
"score": 1,
"text": "彩超检查"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19
],
"label": "sym",
"score": 1,
"text": "彩超检查可以发现心脏收缩力和心输出量下降"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "ite",
"score": 1,
"text": "心脏收缩力"
},
{
"indices": [
14,
15,
16,
17
],
"label": "ite",
"score": 1,
"text": "心输出量"
}
] |
但一般在机械通气和纠正低氧、酸中毒后，会在24小时恢复。 | [
{
"indices": [
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
9,
10,
11,
12,
13,
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "纠正低氧、酸中毒"
}
] |
（二）足月儿获得性RDS随着年龄的增加，发生RDS的比例逐渐降低，但是由于非医学适应证剖宫产比例的增高，即使达37周，发生RDS的比例仍可达4%左右。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "足月儿获得性RDS"
},
{
"indices": [
22,
23,
24
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
61,
62,
63
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
此类患儿与早产儿RDS在临床症状和放射学检查上相似，而不同于窒息后肺水肿，其没有窒息史及心功能低下。 | [
{
"indices": [
5,
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "早产儿RDS"
},
{
"indices": [
17,
18,
19,
20,
21
],
"label": "pro",
"score": 1,
"text": "放射学检查"
},
{
"indices": [
30,
31
],
"label": "dis",
"score": 1,
"text": "窒息"
},
{
"indices": [
33,
34,
35
],
"label": "dis",
"score": 1,
"text": "肺水肿"
},
{
"indices": [
40,
41
],
"label": "dis",
"score": 1,
"text": "窒息"
},
{
"indices": [
44,
45,
46,
47,
48
],
"label": "sym",
"score": 1,
"text": "心功能低下"
},
{
"indices": [
44
],
"label": "bod",
"score": 1,
"text": "心"
}
] |
可能为表面活性物质相对缺乏，可以考虑用外源性表面活性物质治疗，如果效果不好，则可以用高频震荡通气（HFOV）等治疗手段。 | [
{
"indices": [
3,
4,
5,
6,
7,
8
],
"label": "bod",
"score": 1,
"text": "表面活性物质"
},
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "sym",
"score": 1,
"text": "表面活性物质相对缺乏"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29
],
"label": "pro",
"score": 1,
"text": "外源性表面活性物质治疗"
},
{
"indices": [
42,
43,
44,
45,
46,
47
],
"label": "pro",
"score": 1,
"text": "高频震荡通气"
},
{
"indices": [
49,
50,
51,
52
],
"label": "pro",
"score": 1,
"text": "HFOV"
}
] |
（三）先天性肺泡蛋白沉积症和表面活性物质蛋白B缺乏发病原因为调控SP-B合成的DNA序列碱基突变。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "先天性肺泡蛋白沉积症"
},
{
"indices": [
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24
],
"label": "dis",
"score": 1,
"text": "表面活性物质蛋白B缺乏"
},
{
"indices": [
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45,
46,
47
],
"label": "sym",
"score": 1,
"text": "调控SP-B合成的DNA序列碱基突变"
},
{
"indices": [
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45
],
"label": "bod",
"score": 1,
"text": "调控SP-B合成的DNA序列碱基"
}
] |
临床上表现为足月出生小儿进行性呼吸困难，经任何治疗干预无效。 | [
{
"indices": [
12,
13,
14,
15,
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "进行性呼吸困难"
}
] |
肺病理表现类似早产儿RDS，肺活检发现SP-B蛋白和SP-BmRNA缺乏，而前SP-C（proSPC）基因表达提高。 | [
{
"indices": [
0
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
0,
1,
2,
3,
4
],
"label": "sym",
"score": 1,
"text": "肺病理表现"
},
{
"indices": [
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "早产儿RDS"
},
{
"indices": [
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "肺活检"
},
{
"indices": [
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35
],
"label": "sym",
"score": 1,
"text": "肺活检发现SP-B蛋白和SP-BmRNA缺乏"
},
{
"indices": [
19,
20,
21,
22,
23,
24
],
"label": "ite",
"score": 1,
"text": "SP-B蛋白"
},
{
"indices": [
26,
27,
28,
29,
30,
31,
32,
33
],
"label": "ite",
"score": 1,
"text": "SP-BmRNA"
},
{
"indices": [
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56
],
"label": "sym",
"score": 1,
"text": "前SP-C（proSPC）基因表达提高"
},
{
"indices": [
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54
],
"label": "ite",
"score": 1,
"text": "前SP-C（proSPC）基因表达"
}
] |
肺组织病理类似肺泡蛋白沉积症。 | [
{
"indices": [
0,
1,
2
],
"label": "bod",
"score": 1,
"text": "肺组织"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "sym",
"score": 1,
"text": "肺组织病理类似肺泡蛋白沉积症"
},
{
"indices": [
7,
8,
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "肺泡蛋白沉积症"
}
] |
外源性肺表面活性物质治疗仅能暂时缓解症状，不能治愈，患儿多在1岁内死亡，或者依赖肺移植。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "外源性肺表面活性物质治疗"
},
{
"indices": [
40,
41,
42
],
"label": "pro",
"score": 1,
"text": "肺移植"
}
] |
六、对重复肾活检的认识重复肾活检的目的在于了解疾病的演变过程，观察药物治疗效果及判断预后，在临床及科研工作中有重要的价值。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "重复肾活检"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "重复肾活检"
}
] |
除一些列为临床观察及科研的病例行重复肾活检外，无论哪种类型的肾脏疾病，只要治疗效果不佳，经过一定时期的随访，病理类型有可能发生变化者，均为重复肾活检的对象。 | [
{
"indices": [
16,
17,
18,
19,
20
],
"label": "pro",
"score": 1,
"text": "重复肾活检"
},
{
"indices": [
30,
31,
32,
33
],
"label": "dis",
"score": 1,
"text": "肾脏疾病"
},
{
"indices": [
69,
70,
71,
72,
73
],
"label": "pro",
"score": 1,
"text": "重复肾活检"
}
] |
当然患者的临床及其他实验室检查条件必须符合一般肾活检的指征。 | [
{
"indices": [
10,
11,
12,
13,
14
],
"label": "pro",
"score": 1,
"text": "实验室检查"
},
{
"indices": [
23,
24,
25
],
"label": "pro",
"score": 1,
"text": "肾活检"
}
] |
临床工作中，较常进行重复肾活检的疾病包括下述三种：①各种原发及继发性肾小球疾病，如新月体性肾炎、抗GBM肾炎、狼疮性肾炎、紫癜性肾炎和坏死性血管炎肾损害等；②经正规治疗临床症状不缓解，血尿、蛋白尿持续者，如以蛋白尿为主的局灶节段性肾小球肾炎、膜性肾病、系膜病变及以血尿为主的IgA肾炎等；③临床过程发生突然变化如肾移植后排斥等。 | [
{
"indices": [
10,
11,
12,
13,
14
],
"label": "pro",
"score": 1,
"text": "重复肾活检"
},
{
"indices": [
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38
],
"label": "dis",
"score": 1,
"text": "原发及继发性肾小球疾病"
},
{
"indices": [
41,
42,
43,
44,
45,
46
],
"label": "dis",
"score": 1,
"text": "新月体性肾炎"
},
{
"indices": [
48,
49,
50,
51,
52,
53
],
"label": "dis",
"score": 1,
"text": "抗GBM肾炎"
},
{
"indices": [
55,
56,
57,
58,
59
],
"label": "dis",
"score": 1,
"text": "狼疮性肾炎"
},
{
"indices": [
61,
62,
63,
64,
65
],
"label": "dis",
"score": 1,
"text": "紫癜性肾炎"
},
{
"indices": [
67,
68,
69,
70,
71,
72,
73,
74,
75
],
"label": "dis",
"score": 1,
"text": "坏死性血管炎肾损害"
},
{
"indices": [
92,
93
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
92
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
93
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
95,
96,
97
],
"label": "sym",
"score": 1,
"text": "蛋白尿"
},
{
"indices": [
95,
96
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
97
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
104,
105,
106
],
"label": "sym",
"score": 1,
"text": "蛋白尿"
},
{
"indices": [
104,
105
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
106
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
110,
111,
112,
113,
114,
115,
116,
117,
118,
119
],
"label": "dis",
"score": 1,
"text": "局灶节段性肾小球肾炎"
},
{
"indices": [
121,
122,
123,
124
],
"label": "dis",
"score": 1,
"text": "膜性肾病"
},
{
"indices": [
126,
127,
128,
129
],
"label": "dis",
"score": 1,
"text": "系膜病变"
},
{
"indices": [
132,
133
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
132
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
133
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
137,
138,
139,
140,
141
],
"label": "dis",
"score": 1,
"text": "IgA肾炎"
},
{
"indices": [
156,
157,
158
],
"label": "pro",
"score": 1,
"text": "肾移植"
}
] |
二、新生儿后期贫血新生儿后期贫血主要是指出生1周以后发生的贫血，一般多为慢性贫血，主要有以下几种类型：（一）新生儿生理性贫血新生儿生理性贫血是指足月儿生后6～12周时血红蛋白下降至95～110g/L，主要原因有：在宫内，胎儿血氧饱和度约50%，相对缺氧状态使促红细胞生成素含量较高，红细胞较多，出生后血氧饱和度显著增高，促红细胞生成素分泌明显减少，红细胞产生减少。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "新生儿后期贫血"
},
{
"indices": [
9,
10,
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "新生儿后期贫血"
},
{
"indices": [
29,
30
],
"label": "dis",
"score": 1,
"text": "贫血"
},
{
"indices": [
36,
37,
38,
39
],
"label": "dis",
"score": 1,
"text": "慢性贫血"
},
{
"indices": [
54,
55,
56,
57,
58,
59,
60,
61
],
"label": "dis",
"score": 1,
"text": "新生儿生理性贫血"
},
{
"indices": [
62,
63,
64,
65,
66,
67,
68,
69
],
"label": "dis",
"score": 1,
"text": "新生儿生理性贫血"
},
{
"indices": [
83,
84,
85,
86,
87,
88,
89,
90,
91,
92,
93,
94,
95,
96,
97,
98
],
"label": "sym",
"score": 1,
"text": "血红蛋白下降至95～110g/L"
},
{
"indices": [
83,
84,
85,
86
],
"label": "ite",
"score": 1,
"text": "血红蛋白"
},
{
"indices": [
107,
108
],
"label": "bod",
"score": 1,
"text": "宫内"
},
{
"indices": [
110,
111,
112,
113,
114,
115,
116,
117,
118,
119,
120
],
"label": "sym",
"score": 1,
"text": "胎儿血氧饱和度约50%"
},
{
"indices": [
110,
111,
112,
113,
114,
115,
116
],
"label": "ite",
"score": 1,
"text": "胎儿血氧饱和度"
},
{
"indices": [
122,
123,
124,
125,
126,
127
],
"label": "sym",
"score": 1,
"text": "相对缺氧状态"
},
{
"indices": [
129,
130,
131,
132,
133,
134,
135
],
"label": "bod",
"score": 1,
"text": "促红细胞生成素"
},
{
"indices": [
129,
130,
131,
132,
133,
134,
135,
136,
137,
138,
139
],
"label": "sym",
"score": 1,
"text": "促红细胞生成素含量较高"
},
{
"indices": [
141,
142,
143
],
"label": "bod",
"score": 1,
"text": "红细胞"
},
{
"indices": [
141,
142,
143,
144,
145
],
"label": "sym",
"score": 1,
"text": "红细胞较多"
},
{
"indices": [
150,
151,
152,
153,
154
],
"label": "ite",
"score": 1,
"text": "血氧饱和度"
},
{
"indices": [
150,
151,
152,
153,
154,
155,
156,
157,
158
],
"label": "sym",
"score": 1,
"text": "血氧饱和度显著增高"
},
{
"indices": [
160,
161,
162,
163,
164,
165,
166
],
"label": "bod",
"score": 1,
"text": "促红细胞生成素"
},
{
"indices": [
160,
161,
162,
163,
164,
165,
166,
167,
168,
169,
170,
171,
172
],
"label": "sym",
"score": 1,
"text": "促红细胞生成素分泌明显减少"
},
{
"indices": [
174,
175,
176
],
"label": "bod",
"score": 1,
"text": "红细胞"
},
{
"indices": [
174,
175,
176,
177,
178,
179,
180
],
"label": "sym",
"score": 1,
"text": "红细胞产生减少"
}
] |
新生儿红细胞寿命较短。 | [
{
"indices": [
3,
4,
5
],
"label": "bod",
"score": 1,
"text": "红细胞"
}
] |
（二）早产儿贫血早产儿贫血是早产儿（尤其是极低出生体重儿）的常见现象，严重者影响早产儿的生长发育，因此早产儿贫血并非生理性。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "早产儿贫血"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "早产儿贫血"
},
{
"indices": [
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
21,
22,
23,
24,
25,
26,
27
],
"label": "dis",
"score": 1,
"text": "极低出生体重儿"
},
{
"indices": [
40,
41,
42
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
51,
52,
53,
54,
55
],
"label": "dis",
"score": 1,
"text": "早产儿贫血"
}
] |
早产儿贫血的主要临床表现为苍白、气急、心率增快、烦躁不安或淡漠、食欲下降、喂养困难、体重不增。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "dis",
"score": 1,
"text": "早产儿贫血"
},
{
"indices": [
13,
14
],
"label": "sym",
"score": 1,
"text": "苍白"
},
{
"indices": [
16,
17
],
"label": "sym",
"score": 1,
"text": "气急"
},
{
"indices": [
19,
20,
21,
22
],
"label": "sym",
"score": 1,
"text": "心率增快"
},
{
"indices": [
19,
20
],
"label": "ite",
"score": 1,
"text": "心率"
},
{
"indices": [
24,
25,
26,
27
],
"label": "sym",
"score": 1,
"text": "烦躁不安"
},
{
"indices": [
29,
30
],
"label": "sym",
"score": 1,
"text": "淡漠"
},
{
"indices": [
32,
33,
34,
35
],
"label": "sym",
"score": 1,
"text": "食欲下降"
},
{
"indices": [
37,
38,
39,
40
],
"label": "sym",
"score": 1,
"text": "喂养困难"
},
{
"indices": [
42,
43,
44,
45
],
"label": "sym",
"score": 1,
"text": "体重不增"
},
{
"indices": [
42,
43
],
"label": "ite",
"score": 1,
"text": "体重"
}
] |
胎龄越小，出生体重越低，贫血出现越早，程度越严重，持续时间越长。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "sym",
"score": 1,
"text": "胎龄越小，出生体重越低"
},
{
"indices": [
7,
8
],
"label": "bod",
"score": 1,
"text": "体重"
},
{
"indices": [
12,
13
],
"label": "dis",
"score": 1,
"text": "贫血"
}
] |
（三）新生儿晚期贫血晚期贫血是指部分Rh血型不合溶血病患儿在生后2～6周发生明显贫血。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "新生儿晚期贫血"
},
{
"indices": [
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "晚期贫血"
},
{
"indices": [
18,
19,
20,
21,
22,
23,
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "Rh血型不合溶血病"
},
{
"indices": [
40,
41
],
"label": "dis",
"score": 1,
"text": "贫血"
}
] |
这是由于部分Rh血型不合溶血病患儿早期症状不严重，不需换血治疗，但Rh血型抗体却在体内持续存在较长时间（超过1～2个月），继续溶血而导致晚期贫血。 | [
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "Rh血型不合溶血病"
},
{
"indices": [
27,
28,
29,
30
],
"label": "pro",
"score": 1,
"text": "换血治疗"
},
{
"indices": [
33,
34,
35,
36,
37,
38
],
"label": "bod",
"score": 1,
"text": "Rh血型抗体"
},
{
"indices": [
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58,
59
],
"label": "sym",
"score": 1,
"text": "Rh血型抗体却在体内持续存在较长时间（超过1～2个月）"
},
{
"indices": [
41,
42
],
"label": "bod",
"score": 1,
"text": "体内"
},
{
"indices": [
63,
64
],
"label": "sym",
"score": 1,
"text": "溶血"
},
{
"indices": [
64
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
68,
69,
70,
71
],
"label": "dis",
"score": 1,
"text": "晚期贫血"
}
] |
第五节微生物学检查呼吸道感染的病原学诊断极为重要，在指导抗生素的合理应用和疾病的预防中起关键作用。 | [
{
"indices": [
4,
5,
6,
7,
8,
9
],
"label": "pro",
"score": 1,
"text": "微生物学检查"
},
{
"indices": [
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "呼吸道感染"
},
{
"indices": [
16,
17,
18,
19,
20
],
"label": "pro",
"score": 1,
"text": "病原学诊断"
},
{
"indices": [
29,
30,
31
],
"label": "dru",
"score": 1,
"text": "抗生素"
}
] |
具体方法因病原菌而异。 | [
{
"indices": [
5,
6,
7
],
"label": "mic",
"score": 1,
"text": "病原菌"
}
] |
一、细菌学检查对上呼吸道标本培养结果的解释要特别小心，因为上呼吸道正常情况下就存在许多微生物，包括小儿肺炎常见的病原菌，如肺炎链球菌、流感嗜血杆菌等。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "细菌学检查"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "上呼吸道标本培养"
},
{
"indices": [
29,
30,
31,
32
],
"label": "bod",
"score": 1,
"text": "上呼吸道"
},
{
"indices": [
49,
50,
51,
52
],
"label": "dis",
"score": 1,
"text": "小儿肺炎"
},
{
"indices": [
56,
57,
58
],
"label": "mic",
"score": 1,
"text": "病原菌"
},
{
"indices": [
61,
62,
63,
64,
65
],
"label": "mic",
"score": 1,
"text": "肺炎链球菌"
},
{
"indices": [
67,
68,
69,
70,
71,
72
],
"label": "mic",
"score": 1,
"text": "流感嗜血杆菌"
}
] |
因而从呼吸道分泌物中分离出细菌并不代表它们在呼吸道感染中的致病作用。 | [
{
"indices": [
3,
4,
5,
6,
7,
8
],
"label": "bod",
"score": 1,
"text": "呼吸道分泌物"
},
{
"indices": [
13,
14
],
"label": "mic",
"score": 1,
"text": "细菌"
},
{
"indices": [
22,
23,
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "呼吸道感染"
}
] |
咽拭子细菌培养主要应用于链球菌咽炎的诊断。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "咽拭子细菌培养"
},
{
"indices": [
12,
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "链球菌咽炎"
}
] |
要压下舌根以免被口腔菌污染。 | [
{
"indices": [
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "压下舌根"
},
{
"indices": [
8,
9,
10
],
"label": "mic",
"score": 1,
"text": "口腔菌"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "sym",
"score": 1,
"text": "口腔菌污染"
}
] |
正常情况下喉、气管以下均为无菌区，这些部位采集的标本均可送细菌室分析，一旦培养阳性，理论上均有诊断意义。 | [
{
"indices": [
5
],
"label": "bod",
"score": 1,
"text": "喉"
},
{
"indices": [
7,
8
],
"label": "bod",
"score": 1,
"text": "气管"
},
{
"indices": [
14
],
"label": "mic",
"score": 1,
"text": "菌"
},
{
"indices": [
29,
30
],
"label": "mic",
"score": 1,
"text": "细菌"
}
] |
但在实际操作过程中，无一例外地受到口腔、鼻咽部细菌的污染，有时送检的可能不是痰液，而是唾液。 | [
{
"indices": [
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27
],
"label": "sym",
"score": 1,
"text": "口腔、鼻咽部细菌的污染"
},
{
"indices": [
17,
18
],
"label": "bod",
"score": 1,
"text": "口腔"
},
{
"indices": [
20,
21,
22,
23,
24
],
"label": "mic",
"score": 1,
"text": "鼻咽部细菌"
},
{
"indices": [
38,
39
],
"label": "bod",
"score": 1,
"text": "痰液"
},
{
"indices": [
43,
44
],
"label": "bod",
"score": 1,
"text": "唾液"
}
] |
在细菌室，送检标本最多的是痰，而痰中培养出的细菌种类和数量与通过肺穿刺所得的结果一致性很差。 | [
{
"indices": [
1,
2
],
"label": "mic",
"score": 1,
"text": "细菌"
},
{
"indices": [
13
],
"label": "bod",
"score": 1,
"text": "痰"
},
{
"indices": [
16
],
"label": "bod",
"score": 1,
"text": "痰"
},
{
"indices": [
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44
],
"label": "sym",
"score": 1,
"text": "痰中培养出的细菌种类和数量与通过肺穿刺所得的结果一致性很差"
},
{
"indices": [
22,
23
],
"label": "mic",
"score": 1,
"text": "细菌"
},
{
"indices": [
32,
33,
34
],
"label": "pro",
"score": 1,
"text": "肺穿刺"
}
] |
因而必须用直接Gram染色镜检筛选痰标本，以确定痰标本的质量。 | [
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13,
14
],
"label": "pro",
"score": 1,
"text": "直接Gram染色镜检"
},
{
"indices": [
17
],
"label": "bod",
"score": 1,
"text": "痰"
},
{
"indices": [
24
],
"label": "bod",
"score": 1,
"text": "痰"
}
] |
在低倍镜下（100倍）检查每个视野的鳞状上皮细胞如超过10个（也有人认为超过25个），即可判定为不合格痰标本。 | [
{
"indices": [
1,
2,
3
],
"label": "equ",
"score": 1,
"text": "低倍镜"
},
{
"indices": [
18,
19,
20,
21,
22,
23
],
"label": "ite",
"score": 1,
"text": "鳞状上皮细胞"
},
{
"indices": [
51
],
"label": "bod",
"score": 1,
"text": "痰"
}
] |
除一般培养外，可根据病例情况进行特殊培养，如结核菌培养、厌氧菌培养。 | [
{
"indices": [
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "一般培养"
},
{
"indices": [
16,
17,
18,
19
],
"label": "pro",
"score": 1,
"text": "特殊培养"
},
{
"indices": [
22,
23,
24,
25,
26
],
"label": "pro",
"score": 1,
"text": "结核菌培养"
},
{
"indices": [
28,
29,
30,
31,
32
],
"label": "pro",
"score": 1,
"text": "厌氧菌培养"
}
] |
痰定量培养可提供较为正确的病原学诊断，一般认为当细菌数超过10<sup>5</sup>CFU/ml时有诊断意义。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "痰定量培养"
},
{
"indices": [
13,
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "病原学诊断"
},
{
"indices": [
24,
25,
26
],
"label": "ite",
"score": 1,
"text": "细菌数"
},
{
"indices": [
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48
],
"label": "sym",
"score": 1,
"text": "细菌数超过10<sup>5</sup>CFU/ml"
}
] |
为减少标本受污染的机会，可通过纤维支气管镜下保护性毛刷或特殊的气囊导管进行支气管肺泡灌洗取得标本进行培养，亦可通过肺穿刺吸引获取标本。 | [
{
"indices": [
15,
16,
17,
18,
19,
20
],
"label": "equ",
"score": 1,
"text": "纤维支气管镜"
},
{
"indices": [
22,
23,
24,
25,
26
],
"label": "equ",
"score": 1,
"text": "保护性毛刷"
},
{
"indices": [
28,
29,
30,
31,
32,
33,
34
],
"label": "equ",
"score": 1,
"text": "特殊的气囊导管"
},
{
"indices": [
37,
38,
39,
40,
41,
42,
43
],
"label": "pro",
"score": 1,
"text": "支气管肺泡灌洗"
},
{
"indices": [
57,
58,
59
],
"label": "pro",
"score": 1,
"text": "肺穿刺"
}
] |
胸水、血培养阳性可作为细菌性肺炎的重要诊断依据，但其阳性率不高。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "胸水、血培养阳性"
},
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "胸水、血培养"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "细菌性肺炎"
}
] |
此外亦可通过乳胶凝集试验、对流免疫电泳等血清学方法测定血液或尿液中的细菌抗原进行诊断。 | [
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "乳胶凝集试验"
},
{
"indices": [
13,
14,
15,
16,
17,
18
],
"label": "pro",
"score": 1,
"text": "对流免疫电泳"
},
{
"indices": [
20,
21,
22,
23,
24
],
"label": "pro",
"score": 1,
"text": "血清学方法"
},
{
"indices": [
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37
],
"label": "ite",
"score": 1,
"text": "血液或尿液中的细菌抗原"
}
] |
活泼好动，活动范围增大，大脑思维能力明显增强，智力发育迅速，是学习知识和培养生活自理能力的良好阶段。 | [
{
"indices": [
12,
13
],
"label": "bod",
"score": 1,
"text": "大脑"
}
] |
此期的儿童易缺乏的营养素为钙、铁、锌、维生素A和维生素B2</sub>等，而且正值乳牙更换期，充足供给钙质可保证恒牙的正常生长。 | [
{
"indices": [
9,
10,
11
],
"label": "dru",
"score": 1,
"text": "营养素"
},
{
"indices": [
13
],
"label": "dru",
"score": 1,
"text": "钙"
},
{
"indices": [
15
],
"label": "dru",
"score": 1,
"text": "铁"
},
{
"indices": [
17
],
"label": "dru",
"score": 1,
"text": "锌"
},
{
"indices": [
19,
20,
21,
22
],
"label": "dru",
"score": 1,
"text": "维生素A"
},
{
"indices": [
24,
25,
26,
27,
28
],
"label": "dru",
"score": 1,
"text": "维生素B2"
},
{
"indices": [
41,
42
],
"label": "bod",
"score": 1,
"text": "乳牙"
},
{
"indices": [
51,
52
],
"label": "dru",
"score": 1,
"text": "钙质"
},
{
"indices": [
56,
57
],
"label": "bod",
"score": 1,
"text": "恒牙"
}
] |
五、肾活检绝对及相对禁忌证（一）绝对禁忌证指临床上有明显出血倾向的患者，孤立肾或对侧肾脏已切除者、多囊肾或肾脏囊性病变、肾脏肿瘤以及动脉瘤也都不宜行肾活检。 | [
{
"indices": [
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "肾活检"
},
{
"indices": [
26,
27,
28,
29,
30,
31
],
"label": "sym",
"score": 1,
"text": "明显出血倾向"
},
{
"indices": [
29
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
36,
37,
38
],
"label": "sym",
"score": 1,
"text": "孤立肾"
},
{
"indices": [
38
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
40,
41,
42,
43
],
"label": "bod",
"score": 1,
"text": "对侧肾脏"
},
{
"indices": [
49,
50,
51
],
"label": "dis",
"score": 1,
"text": "多囊肾"
},
{
"indices": [
53,
54,
55,
56,
57,
58
],
"label": "dis",
"score": 1,
"text": "肾脏囊性病变"
},
{
"indices": [
60,
61,
62,
63
],
"label": "dis",
"score": 1,
"text": "肾脏肿瘤"
},
{
"indices": [
66,
67,
68
],
"label": "dis",
"score": 1,
"text": "动脉瘤"
},
{
"indices": [
74,
75,
76
],
"label": "pro",
"score": 1,
"text": "肾活检"
}
] |
（二）相对或暂时禁忌证1.终末期肾脏疾病慢性肾衰竭时作肾活检危险性大，易出现并发症，由于肾脏萎缩常使穿刺成功率降低，即使取得足够的肾组织，但由于病变严重，正常结构消失，已被纤维化的组织所替代，因而难以确定原发病，因此过去此类疾病不列为肾活检的指征。 | [
{
"indices": [
13,
14,
15,
16,
17,
18,
19
],
"label": "dis",
"score": 1,
"text": "终末期肾脏疾病"
},
{
"indices": [
20,
21,
22,
23,
24
],
"label": "dis",
"score": 1,
"text": "慢性肾衰竭"
},
{
"indices": [
27,
28,
29
],
"label": "pro",
"score": 1,
"text": "肾活检"
},
{
"indices": [
44,
45,
46,
47
],
"label": "dis",
"score": 1,
"text": "肾脏萎缩"
},
{
"indices": [
50,
51
],
"label": "pro",
"score": 1,
"text": "穿刺"
},
{
"indices": [
65,
66,
67
],
"label": "bod",
"score": 1,
"text": "肾组织"
},
{
"indices": [
77,
78,
79,
80,
81,
82,
83,
84,
85,
86,
87,
88,
89,
90,
91,
92,
93,
94
],
"label": "sym",
"score": 1,
"text": "正常结构消失，已被纤维化的组织所替代"
},
{
"indices": [
90,
91
],
"label": "bod",
"score": 1,
"text": "组织"
},
{
"indices": [
117,
118,
119
],
"label": "pro",
"score": 1,
"text": "肾活检"
}
] |
近年来，由于对慢性肾衰竭患者治疗的进展、透析疗法的普及以及穿刺的安全性也有所提高，因此，我们主张对肾脏大小尚在正常范围内的肾衰竭患者应争取作肾活检，以确定是否存在活动性、可逆性病变。 | [
{
"indices": [
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "慢性肾衰竭"
},
{
"indices": [
20,
21,
22,
23
],
"label": "pro",
"score": 1,
"text": "透析疗法"
},
{
"indices": [
29,
30
],
"label": "pro",
"score": 1,
"text": "穿刺"
},
{
"indices": [
49,
50
],
"label": "bod",
"score": 1,
"text": "肾脏"
},
{
"indices": [
61,
62,
63
],
"label": "dis",
"score": 1,
"text": "肾衰竭"
},
{
"indices": [
70,
71,
72
],
"label": "pro",
"score": 1,
"text": "肾活检"
},
{
"indices": [
81,
82,
83,
84,
85,
86,
87,
88,
89
],
"label": "sym",
"score": 1,
"text": "活动性、可逆性病变"
}
] |
对于萎缩肾，目前仍认为是穿刺的禁忌证。 | [
{
"indices": [
2,
3,
4
],
"label": "bod",
"score": 1,
"text": "萎缩肾"
},
{
"indices": [
12,
13
],
"label": "pro",
"score": 1,
"text": "穿刺"
}
] |
2.对侧肾功能不良为防止穿刺发生并发症，应避免行健侧。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "对侧肾功能不良"
},
{
"indices": [
2,
3,
4
],
"label": "bod",
"score": 1,
"text": "对侧肾"
},
{
"indices": [
12,
13
],
"label": "pro",
"score": 1,
"text": "穿刺"
},
{
"indices": [
24,
25
],
"label": "bod",
"score": 1,
"text": "健侧"
}
] |
3.肾脏感染性病变如肾结核、脓肿和活动性肾盂肾炎，穿刺易致感染扩散，因此不做肾穿刺。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "肾脏感染性病变"
},
{
"indices": [
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "肾结核"
},
{
"indices": [
14,
15
],
"label": "sym",
"score": 1,
"text": "脓肿"
},
{
"indices": [
17,
18,
19,
20,
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "活动性肾盂肾炎"
},
{
"indices": [
25,
26
],
"label": "pro",
"score": 1,
"text": "穿刺"
},
{
"indices": [
29,
30
],
"label": "dis",
"score": 1,
"text": "感染"
},
{
"indices": [
38,
39,
40
],
"label": "pro",
"score": 1,
"text": "肾穿刺"
}
] |
4.难以控制的高血压穿刺后出血机会明显增多。 | [
{
"indices": [
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "高血压"
},
{
"indices": [
10,
11
],
"label": "pro",
"score": 1,
"text": "穿刺"
},
{
"indices": [
13,
14,
15,
16,
17,
18,
19,
20
],
"label": "sym",
"score": 1,
"text": "出血机会明显增多"
},
{
"indices": [
14
],
"label": "bod",
"score": 1,
"text": "血"
}
] |
5.肾活检的相对禁忌证还包括严重贫血、血容量不足、心功能不全以及肾钙化等。 | [
{
"indices": [
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "肾活检"
},
{
"indices": [
14,
15,
16,
17
],
"label": "dis",
"score": 1,
"text": "严重贫血"
},
{
"indices": [
19,
20,
21,
22,
23
],
"label": "sym",
"score": 1,
"text": "血容量不足"
},
{
"indices": [
19
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
25,
26,
27,
28,
29
],
"label": "dis",
"score": 1,
"text": "心功能不全"
},
{
"indices": [
32,
33,
34
],
"label": "sym",
"score": 1,
"text": "肾钙化"
},
{
"indices": [
32
],
"label": "bod",
"score": 1,
"text": "肾"
}
] |
九、水痘肺炎水痘肺炎（varicellapneumonia）由水痘-带状疱疹病毒引起，为全身性疾病，可发生支气管炎和间质性肺炎。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "水痘肺炎"
},
{
"indices": [
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "水痘肺炎"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28
],
"label": "dis",
"score": 1,
"text": "varicellapneumonia"
},
{
"indices": [
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "mic",
"score": 1,
"text": "水痘-带状疱疹病毒"
},
{
"indices": [
44,
45,
46,
47,
48
],
"label": "dis",
"score": 1,
"text": "全身性疾病"
},
{
"indices": [
53,
54,
55,
56
],
"label": "dis",
"score": 1,
"text": "支气管炎"
},
{
"indices": [
58,
59,
60,
61,
62
],
"label": "dis",
"score": 1,
"text": "间质性肺炎"
}
] |
年龄越小越易发生肺炎。 | [
{
"indices": [
8,
9
],
"label": "dis",
"score": 1,
"text": "肺炎"
}
] |
多在水痘发生1周内，表现咳嗽，肺部有湿性啰音，X线检查呈现双肺野结节性浸润阴影。 | [
{
"indices": [
2,
3
],
"label": "dis",
"score": 1,
"text": "水痘"
},
{
"indices": [
12,
13
],
"label": "sym",
"score": 1,
"text": "咳嗽"
},
{
"indices": [
15,
16
],
"label": "bod",
"score": 1,
"text": "肺部"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21
],
"label": "sym",
"score": 1,
"text": "肺部有湿性啰音"
},
{
"indices": [
23,
24,
25,
26
],
"label": "pro",
"score": 1,
"text": "X线检查"
},
{
"indices": [
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38
],
"label": "sym",
"score": 1,
"text": "X线检查呈现双肺野结节性浸润阴影"
},
{
"indices": [
29,
30
],
"label": "bod",
"score": 1,
"text": "双肺"
}
] |
水痘患儿如出现呼吸道症状和体征，应考虑本病。 | [
{
"indices": [
0,
1
],
"label": "dis",
"score": 1,
"text": "水痘"
},
{
"indices": [
7,
8,
9
],
"label": "bod",
"score": 1,
"text": "呼吸道"
},
{
"indices": [
7,
8,
9,
10,
11,
12,
13,
14
],
"label": "sym",
"score": 1,
"text": "呼吸道症状和体征"
}
] |
部分年幼婴儿，水痘肺炎可出现在皮疹之前，极易误诊和漏诊。 | [
{
"indices": [
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "水痘肺炎"
},
{
"indices": [
15,
16
],
"label": "sym",
"score": 1,
"text": "皮疹"
},
{
"indices": [
15
],
"label": "bod",
"score": 1,
"text": "皮"
}
] |
因而有明确水痘接触史者，如发生肺炎，亦应考虑本病，并予以隔离。 | [
{
"indices": [
5,
6
],
"label": "dis",
"score": 1,
"text": "水痘"
},
{
"indices": [
15,
16
],
"label": "dis",
"score": 1,
"text": "肺炎"
}
] |
二、供肾的选择儿童肾移植具有更广泛的供肾来源，成人供肾移植给10岁以上的儿童，技术操作与成人肾移植无差别；成人肾移植给婴幼儿需克服手术操作中的一些困难；体重7～8kg以下的婴幼儿宜使用儿童供肾；取自5岁以下小儿的尸体肾移植给年龄较大的儿童可获满意的肾功能。 | [
{
"indices": [
3
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "儿童肾移植"
},
{
"indices": [
19
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
26
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
27,
28
],
"label": "pro",
"score": 1,
"text": "移植"
},
{
"indices": [
44,
45,
46,
47,
48
],
"label": "pro",
"score": 1,
"text": "成人肾移植"
},
{
"indices": [
55,
56,
57
],
"label": "pro",
"score": 1,
"text": "肾移植"
},
{
"indices": [
65,
66
],
"label": "pro",
"score": 1,
"text": "手术"
},
{
"indices": [
95
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
108,
109,
110
],
"label": "pro",
"score": 1,
"text": "肾移植"
},
{
"indices": [
124
],
"label": "bod",
"score": 1,
"text": "肾"
}
] |
儿童肾移植更容易从亲属中获取活体肾移植，无论在组织相容性还是缩短缺血时间上都更具优越性，从而降低排斥反应的发生率。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "儿童肾移植"
},
{
"indices": [
16,
17,
18
],
"label": "pro",
"score": 1,
"text": "肾移植"
},
{
"indices": [
23,
24
],
"label": "bod",
"score": 1,
"text": "组织"
},
{
"indices": [
32,
33
],
"label": "sym",
"score": 1,
"text": "缺血"
},
{
"indices": [
33
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
48,
49,
50,
51
],
"label": "sym",
"score": 1,
"text": "排斥反应"
}
] |
另有成功病例报道将新生儿尸体双肾连同主动脉、腔静脉一并切下并移植给先天性马蹄肾肾衰竭的患儿。 | [
{
"indices": [
14,
15
],
"label": "bod",
"score": 1,
"text": "双肾"
},
{
"indices": [
18,
19,
20
],
"label": "bod",
"score": 1,
"text": "主动脉"
},
{
"indices": [
22,
23,
24
],
"label": "bod",
"score": 1,
"text": "腔静脉"
},
{
"indices": [
33,
34,
35,
36,
37,
38,
39,
40,
41
],
"label": "dis",
"score": 1,
"text": "先天性马蹄肾肾衰竭"
}
] |
三、葡萄糖-6-磷酸脱氢酶缺陷症红细胞葡萄糖-6-磷酸脱氢酶（glucose-6-phosphatedehydrogenase，G-6-PD）缺陷症是一种常见伴性不完全显性遗传性红细胞膜酶缺陷病，此类缺陷遍布全世界，据统计约有2亿多人具有此类缺陷。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "葡萄糖-6-磷酸脱氢酶缺陷症"
},
{
"indices": [
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73
],
"label": "dis",
"score": 1,
"text": "红细胞葡萄糖-6-磷酸脱氢酶（glucose-6-phosphatedehydrogenase，G-6-PD）缺陷症"
},
{
"indices": [
79,
80,
81,
82,
83,
84,
85,
86,
87,
88,
89,
90,
91,
92,
93,
94,
95,
96
],
"label": "dis",
"score": 1,
"text": "伴性不完全显性遗传性红细胞膜酶缺陷病"
},
{
"indices": [
100,
101
],
"label": "dis",
"score": 1,
"text": "缺陷"
},
{
"indices": [
121,
122
],
"label": "dis",
"score": 1,
"text": "缺陷"
}
] |