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（二）间歇指令通气间歇指令通气（intermittentmandatoryventilation，IMV）也称为间歇正压通气（intermittentpositivepressureventilation，IPPV）。 | [
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"text": "间歇指令通气"
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"label": "pro",
"score": 1,
"text": "间歇指令通气"
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42,
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],
"label": "pro",
"score": 1,
"text": "intermittentmandatoryventilation"
},
{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "IMV"
},
{
"indices": [
56,
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60,
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],
"label": "pro",
"score": 1,
"text": "间歇正压通气"
},
{
"indices": [
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"label": "pro",
"score": 1,
"text": "intermittentpositivepressureventilation"
},
{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "IPPV"
}
] |
IMV是指呼吸机以预设的频率、压力和吸、呼气时间对患儿施以正压通气，患儿如有自主呼吸，则按自己的频率和形式进行呼吸，其总的通气量=患儿自主呼吸的通气量+呼吸机正压通气量；患儿接受正压通气的频率=呼吸机的预设频率。 | [
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"indices": [
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"label": "pro",
"score": 1,
"text": "IMV"
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{
"indices": [
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "正压通气"
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{
"indices": [
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "正压通气"
},
{
"indices": [
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
}
] |
当应用较高频率IMV时，呼吸机可提供完全的通气支持。 | [
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"indices": [
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],
"label": "pro",
"score": 1,
"text": "IMV"
},
{
"indices": [
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
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"indices": [
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22,
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],
"label": "pro",
"score": 1,
"text": "通气支持"
}
] |
因此，当患儿无自主呼吸时，可应用较高频率的IMV；随着自主呼吸的出现和增强，应相应减低IMV的频率，撤机前则可使IMV的频率降到5～10次/分，减少呼吸机的正压通气，以增强患儿自主呼吸的能力，达到依靠自主呼吸能保证气体交换的目的。 | [
{
"indices": [
6,
7,
8,
9,
10
],
"label": "sym",
"score": 1,
"text": "无自主呼吸"
},
{
"indices": [
21,
22,
23
],
"label": "pro",
"score": 1,
"text": "IMV"
},
{
"indices": [
43,
44,
45
],
"label": "pro",
"score": 1,
"text": "IMV"
},
{
"indices": [
56,
57,
58
],
"label": "pro",
"score": 1,
"text": "IMV"
},
{
"indices": [
74,
75,
76
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
78,
79,
80,
81
],
"label": "pro",
"score": 1,
"text": "正压通气"
}
] |
此方式由于呼吸机送气经常与患儿的呼气相冲突即人机不同步，故可导致小气道损伤、慢性肺疾病、脑室内出血和脑室周围白质软化等的发生。 | [
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"indices": [
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"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
32,
33,
34,
35,
36
],
"label": "dis",
"score": 1,
"text": "小气道损伤"
},
{
"indices": [
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39,
40,
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],
"label": "dis",
"score": 1,
"text": "慢性肺疾病"
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"indices": [
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],
"label": "dis",
"score": 1,
"text": "脑室内出血"
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"indices": [
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],
"label": "sym",
"score": 1,
"text": "脑室周围白质软化"
},
{
"indices": [
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51,
52,
53,
54,
55
],
"label": "bod",
"score": 1,
"text": "脑室周围白质"
}
] |
（三）同步间歇指令通气同步间歇指令通气（synchronizedintermittentmandatoryventilation，SIMV）是指呼吸机通过识别患儿吸气初期气道压力或气体流速或腹部阻抗的变化，触发呼吸机以预设的频率进行机械通气，即与患儿吸气同步；当患儿呼吸暂停或无自主呼吸时，呼吸机则以设定的频率控制通气。 | [
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"text": "同步间歇指令通气"
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"label": "pro",
"score": 1,
"text": "同步间歇指令通气"
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],
"label": "pro",
"score": 1,
"text": "synchronizedintermittentmandatoryventilation"
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"indices": [
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],
"label": "pro",
"score": 1,
"text": "SIMV"
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{
"indices": [
72,
73,
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
85,
86
],
"label": "bod",
"score": 1,
"text": "气道"
},
{
"indices": [
95,
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],
"label": "bod",
"score": 1,
"text": "腹部"
},
{
"indices": [
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106,
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
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117,
118,
119
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
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134,
135,
136
],
"label": "dis",
"score": 1,
"text": "呼吸暂停"
},
{
"indices": [
138,
139,
140,
141,
142
],
"label": "sym",
"score": 1,
"text": "无自主呼吸"
},
{
"indices": [
145,
146,
147
],
"label": "equ",
"score": 1,
"text": "呼吸机"
}
] |
患儿的吸气只有在呼吸机按预设频率送气前的较短时间内才能触发呼吸机的机械通气，因此，患儿接受正压通气的频率=呼吸机的预设频率。 | [
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"indices": [
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"label": "equ",
"score": 1,
"text": "呼吸机"
},
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"indices": [
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30,
31
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
33,
34,
35,
36
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
45,
46,
47,
48
],
"label": "pro",
"score": 1,
"text": "正压通气"
},
{
"indices": [
53,
54,
55
],
"label": "equ",
"score": 1,
"text": "呼吸机"
}
] |
SIMV从根本上解决了人机不同步现象，从而避免了IMV的副作用。 | [
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"text": "SIMV"
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{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "IMV"
}
] |
（四）助-控制通气助-控制通气（assist/controlventilation，A/C）也称为同步间歇正压通气（synchronizedintermittentpositivepressureventilation，SIPPV）。 | [
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"label": "pro",
"score": 1,
"text": "助-控制通气"
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"indices": [
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],
"label": "pro",
"score": 1,
"text": "助-控制通气"
},
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"indices": [
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38,
39,
40
],
"label": "pro",
"score": 1,
"text": "assist/controlventilation"
},
{
"indices": [
42,
43,
44
],
"label": "pro",
"score": 1,
"text": "A/C"
},
{
"indices": [
49,
50,
51,
52,
53,
54,
55,
56
],
"label": "pro",
"score": 1,
"text": "同步间歇正压通气"
},
{
"indices": [
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61,
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102,
103,
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107,
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],
"label": "pro",
"score": 1,
"text": "synchronizedintermittentpositivepressureventilation"
},
{
"indices": [
110,
111,
112,
113,
114
],
"label": "pro",
"score": 1,
"text": "SIPPV"
}
] |
所谓辅助通气是指患儿的自主吸气触发机械通气，机械通气的频率是由自主呼吸的频率所决定；所谓控制通气是指呼吸机按预设的频率进行机械通气。 | [
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"label": "pro",
"score": 1,
"text": "辅助通气"
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{
"indices": [
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"label": "pro",
"score": 1,
"text": "机械通气"
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"indices": [
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"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
44,
45,
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],
"label": "pro",
"score": 1,
"text": "控制通气"
},
{
"indices": [
50,
51,
52
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
61,
62,
63,
64
],
"label": "pro",
"score": 1,
"text": "机械通气"
}
] |
A/C是将辅助通气与控制通气相结合的通气模式，当自主呼吸较强时，依靠自主吸气触发机械通气，提供与自主呼吸频率相同并且同步的机械通气；当呼吸微弱或无自主呼吸时，呼吸机则按预设的通气频率进行机械通气，以保证患儿需要的通气量。 | [
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"indices": [
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2
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"label": "pro",
"score": 1,
"text": "A/C"
},
{
"indices": [
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7,
8
],
"label": "pro",
"score": 1,
"text": "辅助通气"
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{
"indices": [
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13
],
"label": "pro",
"score": 1,
"text": "控制通气"
},
{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
61,
62,
63,
64
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
67,
68,
69,
70
],
"label": "sym",
"score": 1,
"text": "呼吸微弱"
},
{
"indices": [
72,
73,
74,
75,
76
],
"label": "sym",
"score": 1,
"text": "无自主呼吸"
},
{
"indices": [
79,
80,
81
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
93,
94,
95,
96
],
"label": "pro",
"score": 1,
"text": "机械通气"
}
] |
因此，应用A/C模式时，患儿接受机械通气的频率≥预设的频率。 | [
{
"indices": [
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "A/C"
},
{
"indices": [
16,
17,
18,
19
],
"label": "pro",
"score": 1,
"text": "机械通气"
}
] |
当患儿自主呼吸较强和较快时，由于患儿接受机械通气的频率大于预设频率，可产生过度通气，故应及时调低压力或降低触发敏感度（增大其负值），一般触发敏感度设置既要避免过度敏感，导致过多触发，也要避免触发敏感度过低，造成费力触发。 | [
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"indices": [
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10,
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],
"label": "sym",
"score": 1,
"text": "自主呼吸较强和较快"
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"indices": [
20,
21,
22,
23
],
"label": "pro",
"score": 1,
"text": "机械通气"
}
] |
此外，有关压力支持通气（pressuresupportventilation，PSV）、容量控制通气（volume-controlventilation，VCV）、压力调节容量控制通气（pressureregulatedvolume-controlventilation，PRVC）、适应性支持通气（adaptivesupportventilation，ASV）、压力释放通气（pressurereleaseventilation，FRV）、双相气道正压通气（biphasicpositiveairwaypressure，BI-PAP）、指令分钟通气（mandatoryminuteventilation，MMV）、容量支持通气（vo1umesupportventilation，VSV）及成比率通气（proportionalassistedventilation，PAV）等通气模式，在新生儿不常用或不宜使用，故在此不一一赘述。 | [
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"text": "压力支持通气"
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"label": "pro",
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"text": "pressuresupportventilation"
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{
"indices": [
39,
40,
41
],
"label": "pro",
"score": 1,
"text": "PSV"
},
{
"indices": [
44,
45,
46,
47,
48,
49
],
"label": "pro",
"score": 1,
"text": "容量控制通气"
},
{
"indices": [
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58,
59,
60,
61,
62,
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65,
66,
67,
68,
69,
70,
71,
72,
73,
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75
],
"label": "pro",
"score": 1,
"text": "volume-controlventilation"
},
{
"indices": [
77,
78,
79
],
"label": "pro",
"score": 1,
"text": "VCV"
},
{
"indices": [
82,
83,
84,
85,
86,
87,
88,
89,
90,
91
],
"label": "pro",
"score": 1,
"text": "压力调节容量控制通气"
},
{
"indices": [
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100,
101,
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125,
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127,
128,
129,
130,
131,
132,
133,
134
],
"label": "pro",
"score": 1,
"text": "pressureregulatedvolume-controlventilation"
},
{
"indices": [
136,
137,
138,
139
],
"label": "pro",
"score": 1,
"text": "PRVC"
},
{
"indices": [
142,
143,
144,
145,
146,
147,
148
],
"label": "pro",
"score": 1,
"text": "适应性支持通气"
},
{
"indices": [
150,
151,
152,
153,
154,
155,
156,
157,
158,
159,
160,
161,
162,
163,
164,
165,
166,
167,
168,
169,
170,
171,
172,
173,
174,
175
],
"label": "pro",
"score": 1,
"text": "adaptivesupportventilation"
},
{
"indices": [
177,
178,
179
],
"label": "pro",
"score": 1,
"text": "ASV"
},
{
"indices": [
182,
183,
184,
185,
186,
187
],
"label": "pro",
"score": 1,
"text": "压力释放通气"
},
{
"indices": [
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190,
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192,
193,
194,
195,
196,
197,
198,
199,
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205,
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207,
208,
209,
210,
211,
212,
213,
214
],
"label": "pro",
"score": 1,
"text": "pressurereleaseventilation"
},
{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "FRV"
},
{
"indices": [
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227,
228
],
"label": "pro",
"score": 1,
"text": "双相气道正压通气"
},
{
"indices": [
230,
231,
232,
233,
234,
235,
236,
237,
238,
239,
240,
241,
242,
243,
244,
245,
246,
247,
248,
249,
250,
251,
252,
253,
254,
255,
256,
257,
258,
259
],
"label": "pro",
"score": 1,
"text": "biphasicpositiveairwaypressure"
},
{
"indices": [
261,
262,
263,
264,
265,
266
],
"label": "pro",
"score": 1,
"text": "BI-PAP"
},
{
"indices": [
269,
270,
271,
272,
273,
274
],
"label": "pro",
"score": 1,
"text": "指令分钟通气"
},
{
"indices": [
276,
277,
278,
279,
280,
281,
282,
283,
284,
285,
286,
287,
288,
289,
290,
291,
292,
293,
294,
295,
296,
297,
298,
299,
300,
301
],
"label": "pro",
"score": 1,
"text": "mandatoryminuteventilation"
},
{
"indices": [
303,
304,
305
],
"label": "pro",
"score": 1,
"text": "MMV"
},
{
"indices": [
308,
309,
310,
311,
312,
313
],
"label": "pro",
"score": 1,
"text": "容量支持通气"
},
{
"indices": [
315,
316,
317,
318,
319,
320,
321,
322,
323,
324,
325,
326,
327,
328,
329,
330,
331,
332,
333,
334,
335,
336,
337,
338
],
"label": "pro",
"score": 1,
"text": "vo1umesupportventilation"
},
{
"indices": [
340,
341,
342
],
"label": "pro",
"score": 1,
"text": "VSV"
},
{
"indices": [
345,
346,
347,
348,
349
],
"label": "pro",
"score": 1,
"text": "成比率通气"
},
{
"indices": [
351,
352,
353,
354,
355,
356,
357,
358,
359,
360,
361,
362,
363,
364,
365,
366,
367,
368,
369,
370,
371,
372,
373,
374,
375,
376,
377,
378,
379,
380,
381
],
"label": "pro",
"score": 1,
"text": "proportionalassistedventilation"
},
{
"indices": [
383,
384,
385
],
"label": "pro",
"score": 1,
"text": "PAV"
}
] |
第九章结核病第一节概况结核病（tuberculosis）是由结核杆菌感染引起的慢性感染性疾病。 | [
{
"indices": [
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "tuberculosis"
},
{
"indices": [
30,
31,
32,
33,
34,
35
],
"label": "dis",
"score": 1,
"text": "结核杆菌感染"
},
{
"indices": [
39,
40,
41,
42,
43,
44,
45
],
"label": "dis",
"score": 1,
"text": "慢性感染性疾病"
}
] |
全身各个器官都可累及，以肺结核病为最常见。 | [
{
"indices": [
0,
1
],
"label": "bod",
"score": 1,
"text": "全身"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "sym",
"score": 1,
"text": "全身各个器官都可累及"
},
{
"indices": [
4,
5
],
"label": "bod",
"score": 1,
"text": "器官"
},
{
"indices": [
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "肺结核病"
}
] |
目前在全球范围内，由于耐药结核菌株的出现与扩展，结核病与艾滋病的双重感染，许多国家结核病控制规划不完善，使得全球结核病疫情明显上升并呈持续上升的趋势。 | [
{
"indices": [
11,
12,
13,
14,
15,
16
],
"label": "mic",
"score": 1,
"text": "耐药结核菌株"
},
{
"indices": [
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
28,
29,
30
],
"label": "dis",
"score": 1,
"text": "艾滋病"
},
{
"indices": [
32,
33,
34,
35
],
"label": "dis",
"score": 1,
"text": "双重感染"
},
{
"indices": [
41,
42,
43
],
"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
56,
57,
58
],
"label": "dis",
"score": 1,
"text": "结核病"
}
] |
在全球所有感染性疾病中，结核病已成为成年人的首要死因。 | [
{
"indices": [
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "感染性疾病"
},
{
"indices": [
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "结核病"
}
] |
世界卫生组织于1993年4月向全世界宣布：全球处于结核病紧急状态。 | [
{
"indices": [
25,
26,
27
],
"label": "dis",
"score": 1,
"text": "结核病"
}
] |
同样，我国结核病流行形势也十分严峻。 | [
{
"indices": [
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "结核病"
}
] |
30年来由于推广了卡介苗接种及应用抗结核治疗，结核病流行情况大为好转，但由于人口众多，结核病仍为我国常见病。 | [
{
"indices": [
9,
10,
11
],
"label": "dru",
"score": 1,
"text": "卡介苗"
},
{
"indices": [
12,
13
],
"label": "pro",
"score": 1,
"text": "接种"
},
{
"indices": [
17,
18,
19,
20,
21
],
"label": "pro",
"score": 1,
"text": "抗结核治疗"
},
{
"indices": [
23,
24,
25
],
"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
43,
44,
45
],
"label": "dis",
"score": 1,
"text": "结核病"
}
] |
一、病原结核病的病原为结核杆菌，包括结核分枝杆菌、牛型分枝杆菌和非洲分枝杆菌，属放线菌目、分枝杆菌科。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "病原结核病"
},
{
"indices": [
8,
9
],
"label": "mic",
"score": 1,
"text": "病原"
},
{
"indices": [
11,
12,
13,
14
],
"label": "mic",
"score": 1,
"text": "结核杆菌"
},
{
"indices": [
18,
19,
20,
21,
22,
23
],
"label": "mic",
"score": 1,
"text": "结核分枝杆菌"
},
{
"indices": [
25,
26,
27,
28,
29,
30
],
"label": "mic",
"score": 1,
"text": "牛型分枝杆菌"
},
{
"indices": [
32,
33,
34,
35,
36,
37
],
"label": "mic",
"score": 1,
"text": "非洲分枝杆菌"
},
{
"indices": [
40,
41,
42,
43
],
"label": "mic",
"score": 1,
"text": "放线菌目"
},
{
"indices": [
45,
46,
47,
48,
49
],
"label": "mic",
"score": 1,
"text": "分枝杆菌科"
}
] |
结核杆菌为无芽胞、不运动、多形性，长2～4μm，稍弯曲的革兰弱阳性杆菌。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "mic",
"score": 1,
"text": "结核杆菌"
},
{
"indices": [
28,
29,
30,
31,
32,
33,
34
],
"label": "mic",
"score": 1,
"text": "革兰弱阳性杆菌"
}
] |
所有分枝杆菌均具有抗酸特性。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "mic",
"score": 1,
"text": "分枝杆菌"
}
] |
除了上述引起结核病的分枝杆菌，其他分枝杆菌则称为非结核分枝杆菌。 | [
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
10,
11,
12,
13
],
"label": "mic",
"score": 1,
"text": "分枝杆菌"
},
{
"indices": [
17,
18,
19,
20
],
"label": "mic",
"score": 1,
"text": "分枝杆菌"
},
{
"indices": [
24,
25,
26,
27,
28,
29,
30
],
"label": "mic",
"score": 1,
"text": "非结核分枝杆菌"
}
] |
这些分枝杆菌在健康人或免疫缺陷的患者，可以引起局限性病变，如局部的淋巴结炎。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "mic",
"score": 1,
"text": "分枝杆菌"
},
{
"indices": [
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "免疫缺陷"
},
{
"indices": [
23,
24,
25,
26,
27
],
"label": "dis",
"score": 1,
"text": "局限性病变"
},
{
"indices": [
33,
34,
35,
36
],
"label": "dis",
"score": 1,
"text": "淋巴结炎"
}
] |
第十章小儿血尿的鉴别诊断血尿（hematuria）是儿科泌尿系统疾病最常见的症状，可分为肉眼及镜下血尿。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "小儿血尿的鉴别诊断"
},
{
"indices": [
12
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
12,
13
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
13
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "sym",
"score": 1,
"text": "hematuria"
},
{
"indices": [
26,
27,
28,
29,
30,
31,
32,
33
],
"label": "dis",
"score": 1,
"text": "儿科泌尿系统疾病"
},
{
"indices": [
44,
45,
46,
47,
48,
49,
50
],
"label": "sym",
"score": 1,
"text": "肉眼及镜下血尿"
},
{
"indices": [
44,
45
],
"label": "bod",
"score": 1,
"text": "肉眼"
},
{
"indices": [
47
],
"label": "equ",
"score": 1,
"text": "镜"
},
{
"indices": [
49
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
50
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
首先要鉴别是真性血尿还是假性血尿，假性血尿（falsehematuria）常可见于：①非泌尿道出血：阴道出血混入，尤其青春期女孩应排除月经污染。 | [
{
"indices": [
6,
7,
8,
9
],
"label": "sym",
"score": 1,
"text": "真性血尿"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
9
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
12,
13,
14,
15
],
"label": "sym",
"score": 1,
"text": "假性血尿"
},
{
"indices": [
14
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
15
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
17,
18,
19,
20
],
"label": "sym",
"score": 1,
"text": "假性血尿"
},
{
"indices": [
19
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
20
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35
],
"label": "sym",
"score": 1,
"text": "falsehematuria"
},
{
"indices": [
43,
44,
45,
46,
47,
48
],
"label": "sym",
"score": 1,
"text": "非泌尿道出血"
},
{
"indices": [
44,
45,
46
],
"label": "bod",
"score": 1,
"text": "泌尿道"
},
{
"indices": [
48
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
50,
51
],
"label": "bod",
"score": 1,
"text": "阴道"
},
{
"indices": [
50,
51,
52,
53
],
"label": "sym",
"score": 1,
"text": "阴道出血"
},
{
"indices": [
53
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
67,
68,
69,
70
],
"label": "sym",
"score": 1,
"text": "月经污染"
},
{
"indices": [
67,
68
],
"label": "bod",
"score": 1,
"text": "月经"
}
] |
②红色尿：机体某些代谢产物如卟啉尿可使尿呈红色，酚红、刚果红、氨基比林及柔红霉素等也可使尿呈红色；新生儿期由于尿中排出较多尿酸盐也可使尿布红染；红色尿还见于血红蛋白尿及肌红蛋白尿；某些食物、蔬菜中的色素也使尿呈红色。 | [
{
"indices": [
1,
2,
3
],
"label": "sym",
"score": 1,
"text": "红色尿"
},
{
"indices": [
3
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
14,
15,
16
],
"label": "sym",
"score": 1,
"text": "卟啉尿"
},
{
"indices": [
16
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
19
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29
],
"label": "sym",
"score": 1,
"text": "尿呈红色，酚红、刚果红"
},
{
"indices": [
31,
32,
33,
34
],
"label": "dru",
"score": 1,
"text": "氨基比林"
},
{
"indices": [
36,
37,
38,
39
],
"label": "dru",
"score": 1,
"text": "柔红霉素"
},
{
"indices": [
44,
45,
46,
47
],
"label": "sym",
"score": 1,
"text": "尿呈红色"
},
{
"indices": [
44
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
55,
56
],
"label": "bod",
"score": 1,
"text": "尿中"
},
{
"indices": [
55,
56,
57,
58,
59,
60,
61,
62,
63
],
"label": "sym",
"score": 1,
"text": "尿中排出较多尿酸盐"
},
{
"indices": [
61,
62,
63
],
"label": "bod",
"score": 1,
"text": "尿酸盐"
},
{
"indices": [
67
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
72,
73,
74
],
"label": "sym",
"score": 1,
"text": "红色尿"
},
{
"indices": [
74
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
78,
79,
80,
81,
82
],
"label": "sym",
"score": 1,
"text": "血红蛋白尿"
},
{
"indices": [
78,
79,
80,
81
],
"label": "bod",
"score": 1,
"text": "血红蛋白"
},
{
"indices": [
82
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
84,
85,
86,
87,
88
],
"label": "sym",
"score": 1,
"text": "肌红蛋白尿"
},
{
"indices": [
84,
85,
86,
87
],
"label": "bod",
"score": 1,
"text": "肌红蛋白"
},
{
"indices": [
88
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
103,
104,
105,
106
],
"label": "sym",
"score": 1,
"text": "尿呈红色"
},
{
"indices": [
103
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
鉴别点在于尿镜检时无红细胞。 | [
{
"indices": [
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "尿镜检"
},
{
"indices": [
10,
11,
12
],
"label": "bod",
"score": 1,
"text": "红细胞"
}
] |
血尿的检查方法及标准为：取10ml清洁新鲜中段尿（以晨尿为好），以1500转/min离心5分钟，取沉渣镜检，正常人红细胞仅为0～2个/高倍视野（HPF），当红细胞＞3个/HPF则考虑有病理意义。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "血尿的检查"
},
{
"indices": [
21,
22,
23
],
"label": "bod",
"score": 1,
"text": "中段尿"
},
{
"indices": [
26,
27
],
"label": "bod",
"score": 1,
"text": "晨尿"
},
{
"indices": [
51,
52
],
"label": "pro",
"score": 1,
"text": "镜检"
},
{
"indices": [
57,
58,
59
],
"label": "bod",
"score": 1,
"text": "红细胞"
},
{
"indices": [
78,
79,
80
],
"label": "bod",
"score": 1,
"text": "红细胞"
},
{
"indices": [
78,
79,
80,
81,
82,
83,
84,
85,
86,
87
],
"label": "sym",
"score": 1,
"text": "红细胞＞3个/HPF"
}
] |
出血量超过1ml/L尿液，则可见肉眼血尿。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "sym",
"score": 1,
"text": "出血量超过1ml/L尿液"
},
{
"indices": [
1
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
10,
11
],
"label": "bod",
"score": 1,
"text": "尿液"
},
{
"indices": [
16,
17,
18,
19
],
"label": "sym",
"score": 1,
"text": "肉眼血尿"
},
{
"indices": [
18
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
19
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
大量出血呈烟灰水样，酸性尿时色较暗红，肉眼血尿放置久也呈暗红色。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "大量出血呈烟灰水样"
},
{
"indices": [
3
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "酸性尿时色较暗红"
},
{
"indices": [
10,
11,
12
],
"label": "bod",
"score": 1,
"text": "酸性尿"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30
],
"label": "sym",
"score": 1,
"text": "肉眼血尿放置久也呈暗红色"
},
{
"indices": [
21
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
22
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
病毒感染及剧烈运动后偶有一过性血尿，排除方法为3次以上尿镜检。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "dis",
"score": 1,
"text": "病毒感染"
},
{
"indices": [
12,
13,
14,
15,
16
],
"label": "sym",
"score": 1,
"text": "一过性血尿"
},
{
"indices": [
15
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
16
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
27,
28,
29
],
"label": "pro",
"score": 1,
"text": "尿镜检"
}
] |
【病因】血尿病因复杂，泌尿系统各部位的炎症、畸形、结石、外伤及肿瘤等均可引起血尿，还可见于全身血液系统疾病时因凝血机制障碍而致血尿。 | [
{
"indices": [
4,
5
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
4
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
5
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18,
19,
20
],
"label": "sym",
"score": 1,
"text": "泌尿系统各部位的炎症"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17
],
"label": "bod",
"score": 1,
"text": "泌尿系统各部位"
},
{
"indices": [
22,
23
],
"label": "dis",
"score": 1,
"text": "畸形"
},
{
"indices": [
25,
26
],
"label": "dis",
"score": 1,
"text": "结石"
},
{
"indices": [
28,
29
],
"label": "dis",
"score": 1,
"text": "外伤"
},
{
"indices": [
31,
32
],
"label": "dis",
"score": 1,
"text": "肿瘤"
},
{
"indices": [
38,
39
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
38
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
39
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
45,
46,
47,
48,
49,
50,
51,
52
],
"label": "dis",
"score": 1,
"text": "全身血液系统疾病"
},
{
"indices": [
55,
56,
57,
58,
59,
60
],
"label": "dis",
"score": 1,
"text": "凝血机制障碍"
},
{
"indices": [
63,
64
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
63
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
64
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
但最多见的是肾小球性血尿。 | [
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "sym",
"score": 1,
"text": "肾小球性血尿"
},
{
"indices": [
6,
7,
8
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
10
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
11
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
（一）肾小球性血尿指血尿部位来源于肾小球。 | [
{
"indices": [
3,
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "肾小球性血尿"
},
{
"indices": [
3,
4,
5
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
7
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
10,
11
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
10
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
11
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
17,
18,
19
],
"label": "bod",
"score": 1,
"text": "肾小球"
}
] |
1.原发性肾小球疾病如急性、慢性肾小球肾炎，肾病综合征（肾病），急进性肾炎，IgA肾病，遗传性肾炎等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "原发性肾小球疾病"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18,
19,
20
],
"label": "dis",
"score": 1,
"text": "急性、慢性肾小球肾炎"
},
{
"indices": [
22,
23,
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "肾病综合征"
},
{
"indices": [
28,
29
],
"label": "dis",
"score": 1,
"text": "肾病"
},
{
"indices": [
32,
33,
34,
35,
36
],
"label": "dis",
"score": 1,
"text": "急进性肾炎"
},
{
"indices": [
38,
39,
40,
41,
42
],
"label": "dis",
"score": 1,
"text": "IgA肾病"
},
{
"indices": [
44,
45,
46,
47,
48
],
"label": "dis",
"score": 1,
"text": "遗传性肾炎"
}
] |
2.继发性肾小球疾病如系统性红斑狼疮肾炎（LN），紫癜肾炎，乙型肝炎相关性肾炎，溶血尿毒综合征（HUS），肺出血肾炎综合征等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "继发性肾小球疾病"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18,
19
],
"label": "dis",
"score": 1,
"text": "系统性红斑狼疮肾炎"
},
{
"indices": [
21,
22
],
"label": "dis",
"score": 1,
"text": "LN"
},
{
"indices": [
25,
26,
27,
28
],
"label": "dis",
"score": 1,
"text": "紫癜肾炎"
},
{
"indices": [
30,
31,
32,
33,
34,
35,
36,
37,
38
],
"label": "dis",
"score": 1,
"text": "乙型肝炎相关性肾炎"
},
{
"indices": [
40,
41,
42,
43,
44,
45,
46
],
"label": "dis",
"score": 1,
"text": "溶血尿毒综合征"
},
{
"indices": [
48,
49,
50
],
"label": "dis",
"score": 1,
"text": "HUS"
},
{
"indices": [
53,
54,
55,
56,
57,
58,
59,
60
],
"label": "dis",
"score": 1,
"text": "肺出血肾炎综合征"
}
] |
（二）非肾小球性血尿血尿来源于肾小球以下泌尿系统，肾盏、肾盂、输尿管、膀胱或尿道。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9
],
"label": "sym",
"score": 1,
"text": "非肾小球性血尿"
},
{
"indices": [
4,
5,
6
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
9
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
10,
11
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
10
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
11
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "bod",
"score": 1,
"text": "肾小球以下泌尿系统"
},
{
"indices": [
25,
26
],
"label": "bod",
"score": 1,
"text": "肾盏"
},
{
"indices": [
28,
29
],
"label": "bod",
"score": 1,
"text": "肾盂"
},
{
"indices": [
31,
32,
33
],
"label": "bod",
"score": 1,
"text": "输尿管"
},
{
"indices": [
35,
36
],
"label": "bod",
"score": 1,
"text": "膀胱"
},
{
"indices": [
38,
39
],
"label": "bod",
"score": 1,
"text": "尿道"
}
] |
1.泌尿道急性及慢性感染。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "泌尿道急性及慢性感染"
}
] |
2.肾盂、膀胱及输尿管结石。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "肾盂、膀胱及输尿管结石"
}
] |
3.特发性高钙尿症。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "特发性高钙尿症"
}
] |
4.左肾静脉压迫综合征（leftrenalveinentrapmentsyndrome，或称胡桃夹现象nutcrackerphenomenon）。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "左肾静脉压迫综合征"
},
{
"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,
37,
38,
39,
40,
41,
42
],
"label": "dis",
"score": 1,
"text": "leftrenalveinentrapmentsyndrome"
},
{
"indices": [
46,
47,
48,
49,
50
],
"label": "sym",
"score": 1,
"text": "胡桃夹现象"
},
{
"indices": [
51,
52,
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69,
70
],
"label": "sym",
"score": 1,
"text": "nutcrackerphenomenon"
}
] |
6.肿瘤、外伤及异物。 | [
{
"indices": [
2,
3
],
"label": "dis",
"score": 1,
"text": "肿瘤"
},
{
"indices": [
5,
6
],
"label": "dis",
"score": 1,
"text": "外伤"
},
{
"indices": [
8,
9
],
"label": "sym",
"score": 1,
"text": "异物"
}
] |
7.药物所致肾及膀胱损伤如环磷酰胺、磺胺类、氨基糖苷类抗生素如庆大霉素等。 | [
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "肾及膀胱损伤"
},
{
"indices": [
13,
14,
15,
16
],
"label": "dru",
"score": 1,
"text": "环磷酰胺"
},
{
"indices": [
18,
19,
20
],
"label": "dru",
"score": 1,
"text": "磺胺类"
},
{
"indices": [
22,
23,
24,
25,
26,
27,
28,
29
],
"label": "dru",
"score": 1,
"text": "氨基糖苷类抗生素"
},
{
"indices": [
31,
32,
33,
34
],
"label": "dru",
"score": 1,
"text": "庆大霉素"
}
] |
8.结核、原虫及螺旋体等感染。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "结核、原虫及螺旋体等感染"
}
] |
9.全身疾病引起的出血，如血小板减少性紫癜、新生儿自然出血症及血友病等。 | [
{
"indices": [
2,
3
],
"label": "bod",
"score": 1,
"text": "全身"
},
{
"indices": [
9,
10
],
"label": "sym",
"score": 1,
"text": "出血"
},
{
"indices": [
10
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
13,
14,
15,
16,
17,
18,
19,
20
],
"label": "dis",
"score": 1,
"text": "血小板减少性紫癜"
},
{
"indices": [
22,
23,
24,
25,
26,
27,
28,
29
],
"label": "dis",
"score": 1,
"text": "新生儿自然出血症"
},
{
"indices": [
31,
32,
33
],
"label": "dis",
"score": 1,
"text": "血友病"
}
] |
【诊断与鉴别诊断】病史及体检1.血尿有关病史既往有无肉眼血尿发作史和常规尿检查史；家族中有无肾脏病史及尿毒症者、有无耳聋患者；发病有无前驱感染及诱因；有无发热、皮疹、关节肿痛，便血或咯血史；抗生素、磺胺类药物及环磷酰胺等药物应用史。 | [
{
"indices": [
16,
17
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
16
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
17
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
26,
27,
28,
29
],
"label": "sym",
"score": 1,
"text": "肉眼血尿"
},
{
"indices": [
28
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
29
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
34,
35,
36,
37,
38
],
"label": "ite",
"score": 1,
"text": "常规尿检查"
},
{
"indices": [
46,
47,
48
],
"label": "dis",
"score": 1,
"text": "肾脏病"
},
{
"indices": [
51,
52,
53
],
"label": "dis",
"score": 1,
"text": "尿毒症"
},
{
"indices": [
58,
59
],
"label": "sym",
"score": 1,
"text": "耳聋"
},
{
"indices": [
58
],
"label": "bod",
"score": 1,
"text": "耳"
},
{
"indices": [
67,
68,
69,
70
],
"label": "dis",
"score": 1,
"text": "前驱感染"
},
{
"indices": [
77,
78
],
"label": "sym",
"score": 1,
"text": "发热"
},
{
"indices": [
80,
81
],
"label": "sym",
"score": 1,
"text": "皮疹"
},
{
"indices": [
80
],
"label": "bod",
"score": 1,
"text": "皮"
},
{
"indices": [
83,
84
],
"label": "bod",
"score": 1,
"text": "关节"
},
{
"indices": [
83,
84,
85,
86
],
"label": "sym",
"score": 1,
"text": "关节肿痛"
},
{
"indices": [
88,
89
],
"label": "sym",
"score": 1,
"text": "便血"
},
{
"indices": [
88
],
"label": "bod",
"score": 1,
"text": "便"
},
{
"indices": [
89
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
91,
92
],
"label": "sym",
"score": 1,
"text": "咯血"
},
{
"indices": [
92
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
95,
96,
97
],
"label": "dru",
"score": 1,
"text": "抗生素"
},
{
"indices": [
99,
100,
101,
102,
103
],
"label": "dru",
"score": 1,
"text": "磺胺类药物"
},
{
"indices": [
105,
106,
107,
108
],
"label": "dru",
"score": 1,
"text": "环磷酰胺"
}
] |
引起血尿的原因按年龄来分：①新生儿期：可见于新生儿出血、严重缺氧、窒息、肾静脉血栓及急性肾乳头坏死等；②婴幼儿期最常见泌尿系感染及先天性尿路畸形，其次为肾胚胎瘤、肾母细胞瘤、HUS及重症遗传性肾炎，部分良性家族性血尿也在3岁前起病；③儿童期最常见为急性肾炎综合征及各类原发及继发性肾小球肾炎，其次为泌尿系感染、家族性良性血尿、遗传性进行性肾炎、高钙尿症及左肾静脉扩张等。 | [
{
"indices": [
2,
3
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
2
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
3
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
22,
23,
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "新生儿出血"
},
{
"indices": [
28,
29,
30,
31
],
"label": "sym",
"score": 1,
"text": "严重缺氧"
},
{
"indices": [
33,
34
],
"label": "dis",
"score": 1,
"text": "窒息"
},
{
"indices": [
36,
37,
38,
39,
40
],
"label": "dis",
"score": 1,
"text": "肾静脉血栓"
},
{
"indices": [
42,
43,
44,
45,
46,
47,
48
],
"label": "dis",
"score": 1,
"text": "急性肾乳头坏死"
},
{
"indices": [
59,
60,
61,
62,
63
],
"label": "dis",
"score": 1,
"text": "泌尿系感染"
},
{
"indices": [
65,
66,
67,
68,
69,
70,
71
],
"label": "dis",
"score": 1,
"text": "先天性尿路畸形"
},
{
"indices": [
76,
77,
78,
79
],
"label": "dis",
"score": 1,
"text": "肾胚胎瘤"
},
{
"indices": [
81,
82,
83,
84,
85
],
"label": "dis",
"score": 1,
"text": "肾母细胞瘤"
},
{
"indices": [
87,
88,
89
],
"label": "dis",
"score": 1,
"text": "HUS"
},
{
"indices": [
91,
92,
93,
94,
95,
96,
97
],
"label": "dis",
"score": 1,
"text": "重症遗传性肾炎"
},
{
"indices": [
101,
102,
103,
104,
105,
106,
107
],
"label": "dis",
"score": 1,
"text": "良性家族性血尿"
},
{
"indices": [
124,
125,
126,
127,
128,
129,
130
],
"label": "dis",
"score": 1,
"text": "急性肾炎综合征"
},
{
"indices": [
134,
135,
136,
137,
138,
139,
140,
141,
142,
143,
144
],
"label": "dis",
"score": 1,
"text": "原发及继发性肾小球肾炎"
},
{
"indices": [
149,
150,
151,
152,
153
],
"label": "dis",
"score": 1,
"text": "泌尿系感染"
},
{
"indices": [
155,
156,
157,
158,
159,
160,
161
],
"label": "dis",
"score": 1,
"text": "家族性良性血尿"
},
{
"indices": [
163,
164,
165,
166,
167,
168,
169,
170
],
"label": "dis",
"score": 1,
"text": "遗传性进行性肾炎"
},
{
"indices": [
172,
173,
174,
175
],
"label": "dis",
"score": 1,
"text": "高钙尿症"
},
{
"indices": [
177,
178,
179,
180,
181,
182
],
"label": "sym",
"score": 1,
"text": "左肾静脉扩张"
},
{
"indices": [
177,
178,
179,
180
],
"label": "bod",
"score": 1,
"text": "左肾静脉"
}
] |
2.体格检查对血尿的初诊患儿要做全面的体格检查，包括生长发育状况，有无水肿、高血压及贫血貌；皮肤有无出血点、瘀斑及皮疹；腹部有无包块，肾区有无叩击痛；有无耳聋，特别是神经性耳聋，眼疾等；并检查外生殖器，特别是男孩有无包茎及包皮粘连。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "体格检查"
},
{
"indices": [
7,
8
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
7
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
19,
20,
21,
22
],
"label": "pro",
"score": 1,
"text": "体格检查"
},
{
"indices": [
35,
36
],
"label": "sym",
"score": 1,
"text": "水肿"
},
{
"indices": [
38,
39,
40
],
"label": "dis",
"score": 1,
"text": "高血压"
},
{
"indices": [
42,
43
],
"label": "dis",
"score": 1,
"text": "贫血"
},
{
"indices": [
46,
47
],
"label": "bod",
"score": 1,
"text": "皮肤"
},
{
"indices": [
50,
51,
52
],
"label": "sym",
"score": 1,
"text": "出血点"
},
{
"indices": [
51
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
54,
55
],
"label": "sym",
"score": 1,
"text": "瘀斑"
},
{
"indices": [
57,
58
],
"label": "sym",
"score": 1,
"text": "皮疹"
},
{
"indices": [
57
],
"label": "bod",
"score": 1,
"text": "皮"
},
{
"indices": [
60,
61
],
"label": "bod",
"score": 1,
"text": "腹部"
},
{
"indices": [
64,
65
],
"label": "sym",
"score": 1,
"text": "包块"
},
{
"indices": [
67,
68
],
"label": "bod",
"score": 1,
"text": "肾区"
},
{
"indices": [
71,
72,
73
],
"label": "sym",
"score": 1,
"text": "叩击痛"
},
{
"indices": [
77,
78
],
"label": "sym",
"score": 1,
"text": "耳聋"
},
{
"indices": [
77
],
"label": "bod",
"score": 1,
"text": "耳"
},
{
"indices": [
83,
84,
85,
86,
87
],
"label": "dis",
"score": 1,
"text": "神经性耳聋"
},
{
"indices": [
89,
90
],
"label": "dis",
"score": 1,
"text": "眼疾"
},
{
"indices": [
94,
95,
96,
97,
98,
99
],
"label": "pro",
"score": 1,
"text": "检查外生殖器"
},
{
"indices": [
108,
109
],
"label": "bod",
"score": 1,
"text": "包茎"
},
{
"indices": [
108,
109,
110,
111,
112,
113,
114
],
"label": "sym",
"score": 1,
"text": "包茎及包皮粘连"
},
{
"indices": [
111,
112
],
"label": "bod",
"score": 1,
"text": "包皮"
}
] |
3.结合病史、临床表现及体格检查综合分析（1）血尿和感染有关：急性肾炎综合征常有较明显的前驱感染病史；病毒感染如腮腺炎或EB病毒感染可出现一过性血尿；细菌性心内膜炎可伴肾梗死出现血尿；流行性出血热有出血、发热和肾衰竭；HUS常有肠道感染史；肾结核不仅有血尿，更多伴脓尿；最常见的泌尿系感染可由细菌、病毒及衣原体等引起，表现血尿伴尿路刺激症状，但小婴儿可仅表现为发热、拒食、哭闹及体重不增等。 | [
{
"indices": [
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "体格检查"
},
{
"indices": [
23,
24
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
23
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
24
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
26,
27
],
"label": "dis",
"score": 1,
"text": "感染"
},
{
"indices": [
31,
32,
33,
34,
35,
36,
37
],
"label": "dis",
"score": 1,
"text": "急性肾炎综合征"
},
{
"indices": [
44,
45,
46,
47
],
"label": "dis",
"score": 1,
"text": "前驱感染"
},
{
"indices": [
51,
52,
53,
54
],
"label": "dis",
"score": 1,
"text": "病毒感染"
},
{
"indices": [
56,
57,
58
],
"label": "dis",
"score": 1,
"text": "腮腺炎"
},
{
"indices": [
60,
61,
62,
63,
64,
65
],
"label": "dis",
"score": 1,
"text": "EB病毒感染"
},
{
"indices": [
69,
70,
71,
72,
73
],
"label": "sym",
"score": 1,
"text": "一过性血尿"
},
{
"indices": [
72
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
73
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
75,
76,
77,
78,
79,
80,
81
],
"label": "dis",
"score": 1,
"text": "细菌性心内膜炎"
},
{
"indices": [
84,
85,
86
],
"label": "dis",
"score": 1,
"text": "肾梗死"
},
{
"indices": [
89,
90
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
89
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
90
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
92,
93,
94,
95,
96,
97
],
"label": "dis",
"score": 1,
"text": "流行性出血热"
},
{
"indices": [
99,
100
],
"label": "sym",
"score": 1,
"text": "出血"
},
{
"indices": [
100
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
102,
103
],
"label": "sym",
"score": 1,
"text": "发热"
},
{
"indices": [
105,
106,
107
],
"label": "dis",
"score": 1,
"text": "肾衰竭"
},
{
"indices": [
109,
110,
111
],
"label": "dis",
"score": 1,
"text": "HUS"
},
{
"indices": [
114,
115,
116,
117
],
"label": "dis",
"score": 1,
"text": "肠道感染"
},
{
"indices": [
120,
121,
122
],
"label": "dis",
"score": 1,
"text": "肾结核"
},
{
"indices": [
126,
127
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
126
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
127
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
132,
133
],
"label": "sym",
"score": 1,
"text": "脓尿"
},
{
"indices": [
133
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
139,
140,
141,
142,
143
],
"label": "dis",
"score": 1,
"text": "泌尿系感染"
},
{
"indices": [
146,
147
],
"label": "mic",
"score": 1,
"text": "细菌"
},
{
"indices": [
149,
150
],
"label": "mic",
"score": 1,
"text": "病毒"
},
{
"indices": [
152,
153,
154
],
"label": "mic",
"score": 1,
"text": "衣原体"
},
{
"indices": [
161,
162
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
161
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
162
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
164,
165,
166,
167
],
"label": "sym",
"score": 1,
"text": "尿路刺激"
},
{
"indices": [
164,
165
],
"label": "bod",
"score": 1,
"text": "尿路"
},
{
"indices": [
180,
181
],
"label": "sym",
"score": 1,
"text": "发热"
},
{
"indices": [
183,
184
],
"label": "sym",
"score": 1,
"text": "拒食"
},
{
"indices": [
186,
187
],
"label": "sym",
"score": 1,
"text": "哭闹"
},
{
"indices": [
189,
190,
191,
192
],
"label": "sym",
"score": 1,
"text": "体重不增"
},
{
"indices": [
189,
190
],
"label": "ite",
"score": 1,
"text": "体重"
}
] |
（2）血尿伴蛋白尿、水肿和高血压：最常见为急性肾炎综合征，当血清补体C3下降且在8周内恢复正常，并有血清抗“O”升高，则可确诊为急性链球菌感染后肾小球肾炎；当血尿伴有进行性少尿及肾功能急骤恶化者考虑急进性肾炎可能性大；儿童期发作性肉眼血尿且和上呼吸道关系密切，则应考虑IgA肾病；持续低补体伴血尿及中度以上蛋白尿多见于膜增殖性肾炎；生长发育障碍、中度以上贫血、持续高血压及肾功能不全首先想到慢性肾炎；血尿伴大量蛋白尿则为肾炎性肾病，病理可见多种形态改变，特别应注意微小病变也有13%可出现镜下血尿。 | [
{
"indices": [
3,
4
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
3
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
4
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "蛋白尿"
},
{
"indices": [
6,
7
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
10,
11
],
"label": "sym",
"score": 1,
"text": "水肿"
},
{
"indices": [
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "高血压"
},
{
"indices": [
21,
22,
23,
24,
25,
26,
27
],
"label": "dis",
"score": 1,
"text": "急性肾炎综合征"
},
{
"indices": [
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45,
46
],
"label": "sym",
"score": 1,
"text": "血清补体C3下降且在8周内恢复正常"
},
{
"indices": [
30,
31,
32,
33,
34,
35
],
"label": "bod",
"score": 1,
"text": "血清补体C3"
},
{
"indices": [
50,
51,
52,
53,
54,
55,
56,
57
],
"label": "sym",
"score": 1,
"text": "血清抗“O”升高"
},
{
"indices": [
50,
51
],
"label": "bod",
"score": 1,
"text": "血清"
},
{
"indices": [
64,
65,
66,
67,
68,
69,
70
],
"label": "dis",
"score": 1,
"text": "急性链球菌感染"
},
{
"indices": [
72,
73,
74,
75,
76
],
"label": "dis",
"score": 1,
"text": "肾小球肾炎"
},
{
"indices": [
79,
80
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
79
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
80
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
83,
84,
85,
86,
87
],
"label": "sym",
"score": 1,
"text": "进行性少尿"
},
{
"indices": [
87
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
89,
90,
91,
92,
93,
94,
95
],
"label": "sym",
"score": 1,
"text": "肾功能急骤恶化"
},
{
"indices": [
89
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
99,
100,
101,
102,
103
],
"label": "dis",
"score": 1,
"text": "急进性肾炎"
},
{
"indices": [
112,
113,
114,
115,
116,
117,
118
],
"label": "sym",
"score": 1,
"text": "发作性肉眼血尿"
},
{
"indices": [
117
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
118
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
121,
122,
123,
124
],
"label": "bod",
"score": 1,
"text": "上呼吸道"
},
{
"indices": [
134,
135,
136,
137,
138
],
"label": "dis",
"score": 1,
"text": "IgA肾病"
},
{
"indices": [
140,
141,
142,
143,
144
],
"label": "sym",
"score": 1,
"text": "持续低补体"
},
{
"indices": [
143,
144
],
"label": "bod",
"score": 1,
"text": "补体"
},
{
"indices": [
146,
147
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
146
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
147
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
149,
150,
151,
152,
153,
154,
155
],
"label": "sym",
"score": 1,
"text": "中度以上蛋白尿"
},
{
"indices": [
153,
154
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
155
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
159,
160,
161,
162,
163,
164
],
"label": "dis",
"score": 1,
"text": "膜增殖性肾炎"
},
{
"indices": [
166,
167,
168,
169,
170,
171
],
"label": "dis",
"score": 1,
"text": "生长发育障碍"
},
{
"indices": [
173,
174,
175,
176,
177,
178
],
"label": "dis",
"score": 1,
"text": "中度以上贫血"
},
{
"indices": [
182,
183,
184
],
"label": "dis",
"score": 1,
"text": "高血压"
},
{
"indices": [
186,
187,
188,
189,
190
],
"label": "dis",
"score": 1,
"text": "肾功能不全"
},
{
"indices": [
195,
196,
197,
198
],
"label": "dis",
"score": 1,
"text": "慢性肾炎"
},
{
"indices": [
200,
201
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
200
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
201
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
203,
204,
205,
206,
207
],
"label": "sym",
"score": 1,
"text": "大量蛋白尿"
},
{
"indices": [
205,
206
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
207
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
210,
211,
212,
213,
214
],
"label": "dis",
"score": 1,
"text": "肾炎性肾病"
},
{
"indices": [
244,
245,
246,
247
],
"label": "sym",
"score": 1,
"text": "镜下血尿"
},
{
"indices": [
244
],
"label": "equ",
"score": 1,
"text": "镜"
},
{
"indices": [
246
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
247
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
（3）系统性疾病及遗传性疾病的肾损害：典型的紫癜肾炎及LN不难诊断，但应注意不典型病例及急、重型病例。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "系统性疾病"
},
{
"indices": [
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "遗传性疾病"
},
{
"indices": [
15,
16,
17
],
"label": "dis",
"score": 1,
"text": "肾损害"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25
],
"label": "dis",
"score": 1,
"text": "典型的紫癜肾炎"
},
{
"indices": [
27,
28
],
"label": "dis",
"score": 1,
"text": "LN"
}
] |
我科有持续三年血尿伴轻～中度蛋白尿，反复查抗核抗体阴性，最终靠肾活体组织检查为典型免疫荧光表现，始确诊为LN的病例，更有学龄前4～5岁儿童以全身皮疹、贫血及镜下血尿起病的LN者；血尿伴不明原因的发热、消瘦、贫血及咯血史应疑为肺出血肾炎综合征；发热伴面、颈及上胸部潮红，热退后出现低血压、休克、少尿，继而出现血尿应考虑流行性出血热；HUS除血尿及少尿外还有皮肤黏膜出血及黄疸；家族性良性血尿常有明确家族史，当同时伴耳聋、眼疾及肾功能进行性恶化者，尤其是男孩，最多见为Alport综合征。 | [
{
"indices": [
7,
8
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
7
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
10,
11,
12,
13,
14,
15,
16
],
"label": "sym",
"score": 1,
"text": "轻～中度蛋白尿"
},
{
"indices": [
14,
15
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
16
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
21,
22,
23,
24
],
"label": "ite",
"score": 1,
"text": "抗核抗体"
},
{
"indices": [
31,
32,
33,
34,
35,
36,
37
],
"label": "pro",
"score": 1,
"text": "肾活体组织检查"
},
{
"indices": [
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45,
46
],
"label": "sym",
"score": 1,
"text": "肾活体组织检查为典型免疫荧光表现"
},
{
"indices": [
52,
53
],
"label": "dis",
"score": 1,
"text": "LN"
},
{
"indices": [
70,
71,
72,
73
],
"label": "sym",
"score": 1,
"text": "全身皮疹"
},
{
"indices": [
70,
71,
72
],
"label": "bod",
"score": 1,
"text": "全身皮"
},
{
"indices": [
75,
76
],
"label": "dis",
"score": 1,
"text": "贫血"
},
{
"indices": [
78,
79,
80,
81
],
"label": "sym",
"score": 1,
"text": "镜下血尿"
},
{
"indices": [
78
],
"label": "equ",
"score": 1,
"text": "镜"
},
{
"indices": [
80
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
81
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
85,
86
],
"label": "dis",
"score": 1,
"text": "LN"
},
{
"indices": [
89,
90
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
89
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
90
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
97,
98
],
"label": "sym",
"score": 1,
"text": "发热"
},
{
"indices": [
100,
101
],
"label": "sym",
"score": 1,
"text": "消瘦"
},
{
"indices": [
103,
104
],
"label": "dis",
"score": 1,
"text": "贫血"
},
{
"indices": [
106,
107
],
"label": "sym",
"score": 1,
"text": "咯血"
},
{
"indices": [
107
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
112,
113,
114,
115,
116,
117,
118,
119
],
"label": "dis",
"score": 1,
"text": "肺出血肾炎综合征"
},
{
"indices": [
121,
122
],
"label": "sym",
"score": 1,
"text": "发热"
},
{
"indices": [
124,
125,
126,
127,
128,
129,
130
],
"label": "bod",
"score": 1,
"text": "面、颈及上胸部"
},
{
"indices": [
124,
125,
126,
127,
128,
129,
130,
131,
132
],
"label": "sym",
"score": 1,
"text": "面、颈及上胸部潮红"
},
{
"indices": [
139,
140,
141
],
"label": "dis",
"score": 1,
"text": "低血压"
},
{
"indices": [
143,
144
],
"label": "dis",
"score": 1,
"text": "休克"
},
{
"indices": [
146,
147
],
"label": "sym",
"score": 1,
"text": "少尿"
},
{
"indices": [
147
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
153,
154
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
153
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
154
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
158,
159,
160,
161,
162,
163
],
"label": "dis",
"score": 1,
"text": "流行性出血热"
},
{
"indices": [
165,
166,
167
],
"label": "dis",
"score": 1,
"text": "HUS"
},
{
"indices": [
169,
170
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
169
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
170
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
172,
173
],
"label": "sym",
"score": 1,
"text": "少尿"
},
{
"indices": [
173
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
177,
178,
179,
180,
181,
182
],
"label": "dis",
"score": 1,
"text": "皮肤黏膜出血"
},
{
"indices": [
184,
185
],
"label": "dis",
"score": 1,
"text": "黄疸"
},
{
"indices": [
187,
188,
189,
190,
191,
192,
193
],
"label": "sym",
"score": 1,
"text": "家族性良性血尿"
},
{
"indices": [
192
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
193
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
206,
207
],
"label": "sym",
"score": 1,
"text": "耳聋"
},
{
"indices": [
206
],
"label": "bod",
"score": 1,
"text": "耳"
},
{
"indices": [
209,
210
],
"label": "dis",
"score": 1,
"text": "眼疾"
},
{
"indices": [
212,
213,
214,
215,
216,
217,
218,
219
],
"label": "sym",
"score": 1,
"text": "肾功能进行性恶化"
},
{
"indices": [
212
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
232,
233,
234,
235,
236,
237,
238,
239,
240
],
"label": "dis",
"score": 1,
"text": "Alport综合征"
}
] |
4.特殊类型血尿包括特发性高钙尿及胡桃夹现象。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "特殊类型血尿"
},
{
"indices": [
6
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
7
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
10,
11,
12,
13,
14,
15
],
"label": "sym",
"score": 1,
"text": "特发性高钙尿"
},
{
"indices": [
14
],
"label": "bod",
"score": 1,
"text": "钙"
},
{
"indices": [
15
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
17,
18,
19,
20,
21
],
"label": "sym",
"score": 1,
"text": "胡桃夹现象"
}
] |
后者需通过尿红细胞形态、尿Ca/Cr比值、24小时尿钙定量及腹部B超鉴别。 | [
{
"indices": [
5,
6,
7,
8,
9,
10
],
"label": "ite",
"score": 1,
"text": "尿红细胞形态"
},
{
"indices": [
12,
13,
14,
15,
16,
17,
18,
19
],
"label": "ite",
"score": 1,
"text": "尿Ca/Cr比值"
},
{
"indices": [
21,
22,
23,
24,
25,
26,
27,
28
],
"label": "ite",
"score": 1,
"text": "24小时尿钙定量"
},
{
"indices": [
30,
31,
32,
33
],
"label": "pro",
"score": 1,
"text": "腹部B超"
}
] |
5.肉眼观察带有血凝块多来自下泌尿道，血块或混合黏膜样物质多来自膀胱，滴血多来自尿道。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "sym",
"score": 1,
"text": "肉眼观察带有血凝块"
},
{
"indices": [
2,
3
],
"label": "bod",
"score": 1,
"text": "肉眼"
},
{
"indices": [
8,
9,
10
],
"label": "bod",
"score": 1,
"text": "血凝块"
},
{
"indices": [
14,
15,
16,
17
],
"label": "bod",
"score": 1,
"text": "下泌尿道"
},
{
"indices": [
19,
20
],
"label": "bod",
"score": 1,
"text": "血块"
},
{
"indices": [
22,
23,
24,
25,
26,
27,
28
],
"label": "bod",
"score": 1,
"text": "混合黏膜样物质"
},
{
"indices": [
32,
33
],
"label": "bod",
"score": 1,
"text": "膀胱"
},
{
"indices": [
35,
36
],
"label": "bod",
"score": 1,
"text": "滴血"
},
{
"indices": [
40,
41
],
"label": "bod",
"score": 1,
"text": "尿道"
}
] |
尿三杯试验：用三只白色透明容器收集患儿排尿过程中的初、中、终段的尿液（初及中段尿液不得少于20ml）。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "尿三杯试验"
},
{
"indices": [
9,
10,
11,
12,
13,
14
],
"label": "equ",
"score": 1,
"text": "白色透明容器"
},
{
"indices": [
20
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
32,
33
],
"label": "bod",
"score": 1,
"text": "尿液"
},
{
"indices": [
39,
40
],
"label": "bod",
"score": 1,
"text": "尿液"
}
] |
仅有初段血尿表示病变在尿道；终末滴血示病变在膀胱颈部和三角区、后尿道及前列腺等处；全程血尿则提示肾、输尿管或膀胱。 | [
{
"indices": [
4,
5
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
4
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
5
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "sym",
"score": 1,
"text": "病变在尿道"
},
{
"indices": [
11,
12
],
"label": "bod",
"score": 1,
"text": "尿道"
},
{
"indices": [
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "终末滴血示病变在膀胱颈部和三角区、后尿道及前列腺等处"
},
{
"indices": [
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "终末滴血"
},
{
"indices": [
22,
23,
24,
25
],
"label": "bod",
"score": 1,
"text": "膀胱颈部"
},
{
"indices": [
27,
28,
29
],
"label": "bod",
"score": 1,
"text": "三角区"
},
{
"indices": [
31,
32,
33
],
"label": "bod",
"score": 1,
"text": "后尿道"
},
{
"indices": [
35,
36,
37
],
"label": "bod",
"score": 1,
"text": "前列腺"
},
{
"indices": [
43,
44
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
43
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
44
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
48
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
50,
51,
52
],
"label": "bod",
"score": 1,
"text": "输尿管"
},
{
"indices": [
54,
55
],
"label": "bod",
"score": 1,
"text": "膀胱"
}
] |
6.肾小球性血尿特点肾小球性血尿为全程血尿，无血凝块；可有肾区钝痛；常合并蛋白尿及管型，特别是有红细胞管型更说明血尿来自肾实质；尿沉渣红细胞形态及容积分布曲线检查符合肾小球血尿。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "肾小球性血尿"
},
{
"indices": [
2,
3,
4
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
6
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
7
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
10,
11,
12,
13,
14,
15
],
"label": "sym",
"score": 1,
"text": "肾小球性血尿"
},
{
"indices": [
10,
11,
12
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
14
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
15
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
19,
20
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
19
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
20
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
23,
24,
25
],
"label": "bod",
"score": 1,
"text": "血凝块"
},
{
"indices": [
29,
30
],
"label": "bod",
"score": 1,
"text": "肾区"
},
{
"indices": [
29,
30,
31,
32
],
"label": "sym",
"score": 1,
"text": "肾区钝痛"
},
{
"indices": [
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "蛋白尿"
},
{
"indices": [
37,
38
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
39
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
41,
42
],
"label": "sym",
"score": 1,
"text": "管型"
},
{
"indices": [
48,
49,
50,
51,
52
],
"label": "sym",
"score": 1,
"text": "红细胞管型"
},
{
"indices": [
48,
49,
50
],
"label": "bod",
"score": 1,
"text": "红细胞"
},
{
"indices": [
56,
57
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
56
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
57
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
60,
61,
62
],
"label": "bod",
"score": 1,
"text": "肾实质"
},
{
"indices": [
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75,
76,
77,
78,
79,
80
],
"label": "pro",
"score": 1,
"text": "尿沉渣红细胞形态及容积分布曲线检查"
},
{
"indices": [
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75,
76,
77,
78,
79,
80,
81,
82,
83,
84,
85,
86,
87
],
"label": "sym",
"score": 1,
"text": "尿沉渣红细胞形态及容积分布曲线检查符合肾小球血尿"
},
{
"indices": [
83,
84,
85
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
86
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
87
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
【有关实验室检查】（一）尿常规检查常用多联试纸法，可作为过筛及普查，敏感性为90%，但假阳性较高，需进一步做尿沉渣镜检以明确，当离心尿红细胞＞3个/HPF且三次以上则有病理意义；血尿如伴蛋白尿及红细胞管型则多为肾小球病变。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "实验室检查"
},
{
"indices": [
12,
13,
14,
15,
16
],
"label": "ite",
"score": 1,
"text": "尿常规检查"
},
{
"indices": [
19,
20,
21,
22,
23
],
"label": "pro",
"score": 1,
"text": "多联试纸法"
},
{
"indices": [
54,
55,
56,
57,
58
],
"label": "pro",
"score": 1,
"text": "尿沉渣镜检"
},
{
"indices": [
64,
65,
66,
67,
68,
69
],
"label": "ite",
"score": 1,
"text": "离心尿红细胞"
},
{
"indices": [
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75,
76,
77,
78,
79,
80,
81
],
"label": "sym",
"score": 1,
"text": "离心尿红细胞＞3个/HPF且三次以上"
},
{
"indices": [
89,
90
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
89
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
90
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
93,
94,
95
],
"label": "sym",
"score": 1,
"text": "蛋白尿"
},
{
"indices": [
93,
94
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
95
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
97,
98,
99,
100,
101
],
"label": "sym",
"score": 1,
"text": "红细胞管型"
},
{
"indices": [
97,
98,
99
],
"label": "ite",
"score": 1,
"text": "红细胞"
},
{
"indices": [
105,
106,
107,
108,
109
],
"label": "dis",
"score": 1,
"text": "肾小球病变"
}
] |
（二）尿红细胞形态近年来采用相差显微镜及扫描电镜观察尿红细胞形态变化，肾实质病变时红细胞通过基底膜受挤压，并受肾小管渗透压作用而变形，故认为当尿中红细胞形态以变形红细胞为主时属肾小球性血尿，其变形程度和肾病变严重性相一致。 | [
{
"indices": [
3,
4,
5,
6,
7,
8
],
"label": "ite",
"score": 1,
"text": "尿红细胞形态"
},
{
"indices": [
14,
15,
16,
17,
18
],
"label": "equ",
"score": 1,
"text": "相差显微镜"
},
{
"indices": [
20,
21,
22,
23
],
"label": "equ",
"score": 1,
"text": "扫描电镜"
},
{
"indices": [
26,
27,
28,
29,
30,
31
],
"label": "ite",
"score": 1,
"text": "尿红细胞形态"
},
{
"indices": [
35,
36,
37,
38,
39
],
"label": "dis",
"score": 1,
"text": "肾实质病变"
},
{
"indices": [
41,
42,
43
],
"label": "bod",
"score": 1,
"text": "红细胞"
},
{
"indices": [
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
],
"label": "sym",
"score": 1,
"text": "红细胞通过基底膜受挤压，并受肾小管渗透压作用而变形"
},
{
"indices": [
46,
47,
48
],
"label": "bod",
"score": 1,
"text": "基底膜"
},
{
"indices": [
55,
56,
57
],
"label": "bod",
"score": 1,
"text": "肾小管"
},
{
"indices": [
71,
72,
73,
74,
75,
76,
77,
78,
79,
80,
81,
82,
83,
84,
85
],
"label": "sym",
"score": 1,
"text": "尿中红细胞形态以变形红细胞为主"
},
{
"indices": [
71,
72,
73,
74,
75,
76,
77
],
"label": "ite",
"score": 1,
"text": "尿中红细胞形态"
},
{
"indices": [
79,
80,
81,
82,
83
],
"label": "bod",
"score": 1,
"text": "变形红细胞"
},
{
"indices": [
88,
89,
90,
91,
92,
93
],
"label": "sym",
"score": 1,
"text": "肾小球性血尿"
},
{
"indices": [
88,
89,
90
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
92
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
93
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
101,
102,
103
],
"label": "dis",
"score": 1,
"text": "肾病变"
}
] |
而红细胞形态基本正常、均一则为非肾小球性血尿，多由尿路血管破裂出血而造成。 | [
{
"indices": [
1,
2,
3,
4,
5
],
"label": "ite",
"score": 1,
"text": "红细胞形态"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21
],
"label": "sym",
"score": 1,
"text": "非肾小球性血尿"
},
{
"indices": [
16,
17,
18
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
20
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
21
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
25,
26,
27,
28
],
"label": "bod",
"score": 1,
"text": "尿路血管"
},
{
"indices": [
25,
26,
27,
28,
29,
30,
31,
32
],
"label": "sym",
"score": 1,
"text": "尿路血管破裂出血"
},
{
"indices": [
32
],
"label": "bod",
"score": 1,
"text": "血"
}
] |
当红细胞形态严重变形呈芽胞、环状及穿孔等改变，称为严重变形红细胞，当其数目＞30%以上考虑为肾性血尿，如以均一型红细胞为主，或变形红细胞数目＜10%应考虑为非肾性血尿。 | [
{
"indices": [
1,
2,
3,
4,
5
],
"label": "ite",
"score": 1,
"text": "红细胞形态"
},
{
"indices": [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21
],
"label": "sym",
"score": 1,
"text": "红细胞形态严重变形呈芽胞、环状及穿孔等改变"
},
{
"indices": [
25,
26,
27,
28,
29,
30,
31
],
"label": "sym",
"score": 1,
"text": "严重变形红细胞"
},
{
"indices": [
29,
30,
31
],
"label": "bod",
"score": 1,
"text": "红细胞"
},
{
"indices": [
46,
47,
48,
49
],
"label": "sym",
"score": 1,
"text": "肾性血尿"
},
{
"indices": [
46
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
48
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
49
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
53,
54,
55,
56,
57,
58
],
"label": "bod",
"score": 1,
"text": "均一型红细胞"
},
{
"indices": [
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73
],
"label": "sym",
"score": 1,
"text": "变形红细胞数目＜10%"
},
{
"indices": [
63,
64,
65,
66,
67,
68,
69
],
"label": "ite",
"score": 1,
"text": "变形红细胞数目"
},
{
"indices": [
78,
79,
80,
81,
82
],
"label": "sym",
"score": 1,
"text": "非肾性血尿"
},
{
"indices": [
79
],
"label": "bod",
"score": 1,
"text": "肾"
},
{
"indices": [
81
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
82
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
临床诊断符合率各家报告均在95%左右，但需注意尿中红细胞＜8000个/ml及低比重时不可靠。 | [
{
"indices": [
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40
],
"label": "sym",
"score": 1,
"text": "尿中红细胞＜8000个/ml及低比重"
},
{
"indices": [
23,
24,
25,
26,
27
],
"label": "ite",
"score": 1,
"text": "尿中红细胞"
}
] |
血细胞自动分析仪测定尿红细胞形态容积分布曲线，对判断血尿来源有一定意义，当尿红细胞平均容积（MCV）＜72fl，且呈小细胞分布，则说明为肾小球血尿。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7
],
"label": "equ",
"score": 1,
"text": "血细胞自动分析仪"
},
{
"indices": [
10,
11,
12,
13
],
"label": "bod",
"score": 1,
"text": "尿红细胞"
},
{
"indices": [
26,
27
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
26
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
27
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
37,
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54
],
"label": "sym",
"score": 1,
"text": "尿红细胞平均容积（MCV）＜72fl"
},
{
"indices": [
37,
38,
39,
40,
41,
42,
43,
44
],
"label": "ite",
"score": 1,
"text": "尿红细胞平均容积"
},
{
"indices": [
46,
47,
48
],
"label": "ite",
"score": 1,
"text": "MCV"
},
{
"indices": [
57,
58,
59,
60,
61,
62
],
"label": "sym",
"score": 1,
"text": "呈小细胞分布"
},
{
"indices": [
58,
59,
60
],
"label": "bod",
"score": 1,
"text": "小细胞"
},
{
"indices": [
68,
69,
70,
71,
72
],
"label": "sym",
"score": 1,
"text": "肾小球血尿"
},
{
"indices": [
68,
69,
70
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
71
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
72
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
本法不受、尿比重、pH及主观影响，有一定临床应用价值。 | [
{
"indices": [
5,
6,
7
],
"label": "ite",
"score": 1,
"text": "尿比重"
},
{
"indices": [
9,
10
],
"label": "ite",
"score": 1,
"text": "pH"
}
] |
（三）血常规及相应的血液系统检查如贫血程度、生血状况（网织红细胞计数、血小板计数、出凝血时间、凝血酶原时间、纤维蛋白原水平及血浆抗凝血酶-Ⅲ（AT-Ⅲ）等对于以血尿表现的各类原发及继发性肾炎、肾衰竭、合并血栓，或全身血液疾病所致血尿的诊断及鉴别诊断有意义。 | [
{
"indices": [
3,
4,
5
],
"label": "ite",
"score": 1,
"text": "血常规"
},
{
"indices": [
10,
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "血液系统检查"
},
{
"indices": [
17,
18,
19,
20
],
"label": "ite",
"score": 1,
"text": "贫血程度"
},
{
"indices": [
22,
23,
24,
25
],
"label": "ite",
"score": 1,
"text": "生血状况"
},
{
"indices": [
27,
28,
29,
30,
31,
32,
33
],
"label": "ite",
"score": 1,
"text": "网织红细胞计数"
},
{
"indices": [
35,
36,
37,
38,
39
],
"label": "ite",
"score": 1,
"text": "血小板计数"
},
{
"indices": [
41,
42,
43,
44,
45
],
"label": "ite",
"score": 1,
"text": "出凝血时间"
},
{
"indices": [
47,
48,
49,
50,
51,
52
],
"label": "ite",
"score": 1,
"text": "凝血酶原时间"
},
{
"indices": [
54,
55,
56,
57,
58,
59,
60
],
"label": "ite",
"score": 1,
"text": "纤维蛋白原水平"
},
{
"indices": [
62,
63,
64,
65,
66,
67,
68,
69
],
"label": "ite",
"score": 1,
"text": "血浆抗凝血酶-Ⅲ"
},
{
"indices": [
71,
72,
73,
74
],
"label": "ite",
"score": 1,
"text": "AT-Ⅲ"
},
{
"indices": [
80,
81
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
80
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
81
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
87,
88,
89,
90,
91,
92,
93,
94
],
"label": "dis",
"score": 1,
"text": "原发及继发性肾炎"
},
{
"indices": [
96,
97,
98
],
"label": "dis",
"score": 1,
"text": "肾衰竭"
},
{
"indices": [
102,
103
],
"label": "sym",
"score": 1,
"text": "血栓"
},
{
"indices": [
102
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
106,
107,
108,
109,
110,
111
],
"label": "dis",
"score": 1,
"text": "全身血液疾病"
},
{
"indices": [
114,
115
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
114
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
115
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
（四）其他肾性血尿相关化验血尿伴蛋白尿要进一步测定24小时尿蛋白定量，当尿蛋白＞1g/24h多明确有肾实质病变；ASO、血补体C3及乙型肝炎相关抗原测定可鉴别肾炎性质；BUN、Cr及Ccr等指标可判断肾功能受损。 | [
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "pro",
"score": 1,
"text": "肾性血尿相关化验"
},
{
"indices": [
13,
14
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
13
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
14
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "蛋白尿"
},
{
"indices": [
16,
17
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
18
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
25,
26,
27,
28,
29,
30,
31,
32,
33
],
"label": "ite",
"score": 1,
"text": "24小时尿蛋白定量"
},
{
"indices": [
36,
37,
38
],
"label": "ite",
"score": 1,
"text": "尿蛋白"
},
{
"indices": [
36,
37,
38,
39,
40,
41,
42,
43,
44,
45
],
"label": "sym",
"score": 1,
"text": "尿蛋白＞1g/24h"
},
{
"indices": [
50,
51,
52,
53,
54
],
"label": "dis",
"score": 1,
"text": "肾实质病变"
},
{
"indices": [
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75
],
"label": "pro",
"score": 1,
"text": "ASO、血补体C3及乙型肝炎相关抗原测定"
},
{
"indices": [
79,
80
],
"label": "dis",
"score": 1,
"text": "肾炎"
},
{
"indices": [
84,
85,
86
],
"label": "ite",
"score": 1,
"text": "BUN"
},
{
"indices": [
88,
89
],
"label": "ite",
"score": 1,
"text": "Cr"
},
{
"indices": [
91,
92,
93
],
"label": "ite",
"score": 1,
"text": "Ccr"
},
{
"indices": [
100,
101,
102,
103,
104
],
"label": "dis",
"score": 1,
"text": "肾功能受损"
}
] |
（五）尿钙测定当随意尿Ca/Cr＞0.21时，则进一步测定24小时尿钙定量，当尿Ca＞4mg/（kg•d）则应疑为高钙尿症，应查2～3次才能确定。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "ite",
"score": 1,
"text": "尿钙测定"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20
],
"label": "sym",
"score": 1,
"text": "随意尿Ca/Cr＞0.21"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "ite",
"score": 1,
"text": "随意尿Ca/Cr"
},
{
"indices": [
27,
28,
29,
30,
31,
32,
33,
34,
35,
36
],
"label": "ite",
"score": 1,
"text": "测定24小时尿钙定量"
},
{
"indices": [
39,
40,
41
],
"label": "ite",
"score": 1,
"text": "尿Ca"
},
{
"indices": [
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52
],
"label": "sym",
"score": 1,
"text": "尿Ca＞4mg/（kg•d）"
},
{
"indices": [
57,
58,
59,
60
],
"label": "dis",
"score": 1,
"text": "高钙尿症"
}
] |
（六）尿细菌检查尿沉渣涂片找细菌、尿细菌计数及尿培养以确定泌尿系感染引起血尿的病因，反复发作者要除外伴有膀胱输尿管反流。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "尿细菌检查"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "pro",
"score": 1,
"text": "尿沉渣涂片"
},
{
"indices": [
14,
15
],
"label": "mic",
"score": 1,
"text": "细菌"
},
{
"indices": [
17,
18,
19,
20,
21
],
"label": "ite",
"score": 1,
"text": "尿细菌计数"
},
{
"indices": [
23,
24,
25
],
"label": "pro",
"score": 1,
"text": "尿培养"
},
{
"indices": [
29,
30,
31,
32,
33
],
"label": "dis",
"score": 1,
"text": "泌尿系感染"
},
{
"indices": [
36,
37
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
36
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
37
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
52,
53,
54,
55,
56,
57,
58
],
"label": "dis",
"score": 1,
"text": "膀胱输尿管反流"
}
] |
（七）特殊检查疑为结石引起做腹部平片；B型超声可观察肾脏大小、结构、肾静脉扩张、结石、畸形及肿物，对血尿诊断及鉴别诊断极为重要；静脉肾盂造影及膀胱逆行造影根据需要选用；数字减影血管造影可明确有无动静脉瘘、血管病变及血栓等；肾CT检查可除外占位性病变，但小儿应用较少。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "特殊检查"
},
{
"indices": [
9,
10
],
"label": "dis",
"score": 1,
"text": "结石"
},
{
"indices": [
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "腹部平片"
},
{
"indices": [
19,
20,
21,
22
],
"label": "pro",
"score": 1,
"text": "B型超声"
},
{
"indices": [
26,
27
],
"label": "bod",
"score": 1,
"text": "肾脏"
},
{
"indices": [
34,
35,
36
],
"label": "bod",
"score": 1,
"text": "肾静脉"
},
{
"indices": [
34,
35,
36,
37,
38
],
"label": "sym",
"score": 1,
"text": "肾静脉扩张"
},
{
"indices": [
40,
41
],
"label": "dis",
"score": 1,
"text": "结石"
},
{
"indices": [
43,
44
],
"label": "dis",
"score": 1,
"text": "畸形"
},
{
"indices": [
46,
47
],
"label": "sym",
"score": 1,
"text": "肿物"
},
{
"indices": [
50,
51
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
50
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
51
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
64,
65,
66,
67,
68,
69
],
"label": "pro",
"score": 1,
"text": "静脉肾盂造影"
},
{
"indices": [
71,
72,
73,
74,
75,
76
],
"label": "pro",
"score": 1,
"text": "膀胱逆行造影"
},
{
"indices": [
84,
85,
86,
87,
88,
89,
90,
91
],
"label": "pro",
"score": 1,
"text": "数字减影血管造影"
},
{
"indices": [
97,
98,
99,
100
],
"label": "dis",
"score": 1,
"text": "动静脉瘘"
},
{
"indices": [
102,
103,
104,
105
],
"label": "dis",
"score": 1,
"text": "血管病变"
},
{
"indices": [
107,
108
],
"label": "sym",
"score": 1,
"text": "血栓"
},
{
"indices": [
107
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
111,
112,
113,
114,
115
],
"label": "pro",
"score": 1,
"text": "肾CT检查"
},
{
"indices": [
119,
120,
121,
122,
123
],
"label": "dis",
"score": 1,
"text": "占位性病变"
}
] |
（八）肾活体组织检查可明确肾小球血尿的病因，对指导治疗及判断预后有一定帮助，以下指征可考虑做肾活体组织检查：①血尿伴尿蛋白定量＞1～2g/24h，或伴高血压及氮质血症者；②伴持续补体C3下降者；③有肾炎家族史者；凡尿中的红细胞数量超过正常而无明确的临床症状、实验室改变及肾功能异常者，称为单纯性血尿，如持续半年以上，也应考虑肾活体组织检查。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9
],
"label": "pro",
"score": 1,
"text": "肾活体组织检查"
},
{
"indices": [
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "肾小球血尿"
},
{
"indices": [
13,
14,
15
],
"label": "bod",
"score": 1,
"text": "肾小球"
},
{
"indices": [
16
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
17
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
46,
47,
48,
49,
50,
51,
52
],
"label": "pro",
"score": 1,
"text": "肾活体组织检查"
},
{
"indices": [
55,
56,
57,
58,
59,
60,
61,
62
],
"label": "ite",
"score": 1,
"text": "血尿伴尿蛋白定量"
},
{
"indices": [
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69,
70,
71
],
"label": "sym",
"score": 1,
"text": "血尿伴尿蛋白定量＞1～2g/24h"
},
{
"indices": [
75,
76,
77
],
"label": "dis",
"score": 1,
"text": "高血压"
},
{
"indices": [
79,
80,
81,
82
],
"label": "dis",
"score": 1,
"text": "氮质血症"
},
{
"indices": [
87,
88,
89,
90,
91,
92,
93,
94
],
"label": "sym",
"score": 1,
"text": "持续补体C3下降"
},
{
"indices": [
89,
90,
91,
92
],
"label": "ite",
"score": 1,
"text": "补体C3"
},
{
"indices": [
99,
100
],
"label": "dis",
"score": 1,
"text": "肾炎"
},
{
"indices": [
107,
108,
109,
110,
111,
112,
113,
114
],
"label": "ite",
"score": 1,
"text": "尿中的红细胞数量"
},
{
"indices": [
107,
108,
109,
110,
111,
112,
113,
114,
115,
116,
117,
118
],
"label": "sym",
"score": 1,
"text": "尿中的红细胞数量超过正常"
},
{
"indices": [
135,
136,
137
],
"label": "ite",
"score": 1,
"text": "肾功能"
},
{
"indices": [
135,
136,
137,
138,
139
],
"label": "sym",
"score": 1,
"text": "肾功能异常"
},
{
"indices": [
144,
145,
146,
147,
148
],
"label": "sym",
"score": 1,
"text": "单纯性血尿"
},
{
"indices": [
147
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
148
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
162,
163,
164,
165,
166,
167,
168
],
"label": "pro",
"score": 1,
"text": "肾活体组织检查"
}
] |
【治疗和预后】血尿较重时适当注意休息，根据不同病因予以相应治疗。 | [
{
"indices": [
7,
8
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
7
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
12,
13,
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "适当注意休息"
}
] |
血尿是一个多病因的复杂问题，诊断不明确者应长期随访，特别是血尿伴蛋白尿者。 | [
{
"indices": [
0,
1
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
0
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
1
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
29,
30
],
"label": "sym",
"score": 1,
"text": "血尿"
},
{
"indices": [
29
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
30
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"indices": [
32,
33,
34
],
"label": "sym",
"score": 1,
"text": "蛋白尿"
},
{
"indices": [
32,
33
],
"label": "bod",
"score": 1,
"text": "蛋白"
},
{
"indices": [
34
],
"label": "bod",
"score": 1,
"text": "尿"
}
] |
二、诊断和鉴别诊断（一）临床诊断根据以上呼吸系统表现，加上神经系统、心血管、内脏功能变化的表现，结合血气分析分析，可以初步做出呼吸衰竭的临床诊断。 | [
{
"indices": [
20,
21,
22,
23
],
"label": "bod",
"score": 1,
"text": "呼吸系统"
},
{
"indices": [
29,
30,
31,
32
],
"label": "bod",
"score": 1,
"text": "神经系统"
},
{
"indices": [
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43
],
"label": "sym",
"score": 1,
"text": "神经系统、心血管、内脏功能变化"
},
{
"indices": [
34,
35,
36
],
"label": "bod",
"score": 1,
"text": "心血管"
},
{
"indices": [
38,
39
],
"label": "bod",
"score": 1,
"text": "内脏"
},
{
"indices": [
50,
51,
52,
53
],
"label": "pro",
"score": 1,
"text": "血气分析"
},
{
"indices": [
63,
64,
65,
66
],
"label": "dis",
"score": 1,
"text": "呼吸衰竭"
}
] |
（二）血气分析诊断一般认为在海平面大气压水平，吸入空气时，PaCO<sub>2</sub>＞8kPa，PaO<sub>2</sub>＜6.67kPa，提示呼吸衰竭。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "血气分析"
},
{
"indices": [
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49
],
"label": "sym",
"score": 1,
"text": "PaCO<sub>2</sub>＞8kPa"
},
{
"indices": [
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
44
],
"label": "ite",
"score": 1,
"text": "PaCO<sub>2</sub>"
},
{
"indices": [
51,
52,
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73
],
"label": "sym",
"score": 1,
"text": "PaO<sub>2</sub>＜6.67kPa"
},
{
"indices": [
51,
52,
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65
],
"label": "ite",
"score": 1,
"text": "PaO<sub>2</sub>"
},
{
"indices": [
77,
78,
79,
80
],
"label": "dis",
"score": 1,
"text": "呼吸衰竭"
}
] |
对于小儿急性和慢性呼吸衰竭的血气检查主要有以下特点。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "小儿急性和慢性呼吸衰竭"
},
{
"indices": [
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "血气检查"
}
] |
1.呼吸性酸中毒动脉血pH＜7.35，PaCO<sub>2</sub>＞7kPa，PaO<sub>2</sub>＞8kPa，BE＞-5mmol/L，＞20mmol/L。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "呼吸性酸中毒"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "动脉血pH＜7.35"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "ite",
"score": 1,
"text": "动脉血pH"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "PaCO<sub>2</sub>＞7kPa"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34
],
"label": "ite",
"score": 1,
"text": "PaCO<sub>2</sub>"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58,
59,
60
],
"label": "sym",
"score": 1,
"text": "PaO<sub>2</sub>＞8kPa"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55
],
"label": "ite",
"score": 1,
"text": "PaO<sub>2</sub>"
},
{
"indices": [
62,
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75,
76,
77,
78,
79,
80,
81,
82
],
"label": "sym",
"score": 1,
"text": "BE＞-5mmol/L，＞20mmol/L"
},
{
"indices": [
62,
63
],
"label": "ite",
"score": 1,
"text": "BE"
}
] |
多见于急性梗阻性通气障碍、通气-灌流失调。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "急性梗阻性通气障碍"
},
{
"indices": [
13,
14,
15,
16,
17,
18,
19
],
"label": "sym",
"score": 1,
"text": "通气-灌流失调"
},
{
"indices": [
13,
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "通气-灌流"
}
] |
2.混合性酸中毒动脉血pH<7.25，PaCO<sub>2</sub>＞7kPa，PaO<sub>2</sub>＜8kPa，BE＜-5mmol/L，＜20mmol/L。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "混合性酸中毒"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "动脉血pH<7.25"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "ite",
"score": 1,
"text": "动脉血pH"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "PaCO<sub>2</sub>＞7kPa"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34
],
"label": "ite",
"score": 1,
"text": "PaCO<sub>2</sub>"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58,
59,
60
],
"label": "sym",
"score": 1,
"text": "PaO<sub>2</sub>＜8kPa"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55
],
"label": "ite",
"score": 1,
"text": "PaO<sub>2</sub>"
},
{
"indices": [
62,
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75,
76,
77,
78,
79,
80,
81,
82
],
"label": "sym",
"score": 1,
"text": "BE＜-5mmol/L，＜20mmol/L"
},
{
"indices": [
62,
63
],
"label": "ite",
"score": 1,
"text": "BE"
}
] |
多见于持续低氧血症伴通气、换气障碍，严重通气-灌流失调。 | [
{
"indices": [
3,
4,
5,
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "持续低氧血症"
},
{
"indices": [
10,
11,
12,
13,
14,
15,
16
],
"label": "sym",
"score": 1,
"text": "通气、换气障碍"
},
{
"indices": [
18,
19,
20,
21,
22,
23,
24,
25,
26
],
"label": "sym",
"score": 1,
"text": "严重通气-灌流失调"
},
{
"indices": [
20,
21,
22,
23,
24
],
"label": "pro",
"score": 1,
"text": "通气-灌流"
}
] |
3.呼吸性碱中毒动脉血pH＞7.45，PaCO<sub>2</sub>＜4kPa，PaO<sub>2</sub>＞8kPa，BE＞5mmol/L，＜20mmol/L。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "呼吸性碱中毒"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "动脉血pH＞7.45"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "ite",
"score": 1,
"text": "动脉血pH"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "PaCO<sub>2</sub>＜4kPa"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34
],
"label": "ite",
"score": 1,
"text": "PaCO<sub>2</sub>"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58,
59,
60
],
"label": "sym",
"score": 1,
"text": "PaO<sub>2</sub>＞8kPa"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55
],
"label": "ite",
"score": 1,
"text": "PaO<sub>2</sub>"
},
{
"indices": [
62,
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75,
76,
77,
78,
79,
80,
81
],
"label": "sym",
"score": 1,
"text": "BE＞5mmol/L，＜20mmol/L"
},
{
"indices": [
62,
63
],
"label": "ite",
"score": 1,
"text": "BE"
}
] |
多见于机械通气过度时。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "机械通气"
}
] |
4.代谢性酸中毒合并呼吸性碱中毒表现为动脉血pH＜7.45，PaCO2＜4kPa，PaO2＞8kPa，BE＜-5mmol/L，＜20mmol/L。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "代谢性酸中毒"
},
{
"indices": [
10,
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "呼吸性碱中毒"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28
],
"label": "sym",
"score": 1,
"text": "动脉血pH＜7.45"
},
{
"indices": [
19,
20,
21,
22,
23
],
"label": "ite",
"score": 1,
"text": "动脉血pH"
},
{
"indices": [
30,
31,
32,
33,
34,
35,
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "PaCO2＜4kPa"
},
{
"indices": [
30,
31,
32,
33,
34
],
"label": "ite",
"score": 1,
"text": "PaCO2"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47,
48,
49
],
"label": "sym",
"score": 1,
"text": "PaO2＞8kPa"
},
{
"indices": [
41,
42,
43,
44
],
"label": "ite",
"score": 1,
"text": "PaO2"
},
{
"indices": [
51,
52,
53,
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65,
66,
67,
68,
69,
70,
71
],
"label": "sym",
"score": 1,
"text": "BE＜-5mmol/L，＜20mmol/L"
},
{
"indices": [
51,
52
],
"label": "ite",
"score": 1,
"text": "BE"
}
] |
可见于呼吸衰竭应用利尿剂后，以及机械通气纠正呼吸性酸中毒后。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "呼吸衰竭"
},
{
"indices": [
9,
10,
11
],
"label": "dru",
"score": 1,
"text": "利尿剂"
},
{
"indices": [
16,
17,
18,
19
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
22,
23,
24,
25,
26,
27
],
"label": "dis",
"score": 1,
"text": "呼吸性酸中毒"
}
] |
5.代谢性碱中毒合并呼吸性酸中毒发生代谢性碱中毒的原因与长时间应用碱液、呋塞米、甘露醇、肾上腺皮质激素等药物，吐泻引起的低钾，机械通气掌握不当，以及肾脏调节慢等有关。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "代谢性碱中毒"
},
{
"indices": [
10,
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "呼吸性酸中毒"
},
{
"indices": [
18,
19,
20,
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "代谢性碱中毒"
},
{
"indices": [
33,
34
],
"label": "dru",
"score": 1,
"text": "碱液"
},
{
"indices": [
36,
37,
38
],
"label": "dru",
"score": 1,
"text": "呋塞米"
},
{
"indices": [
40,
41,
42
],
"label": "dru",
"score": 1,
"text": "甘露醇"
},
{
"indices": [
44,
45,
46,
47,
48,
49,
50
],
"label": "dru",
"score": 1,
"text": "肾上腺皮质激素"
},
{
"indices": [
55,
56
],
"label": "sym",
"score": 1,
"text": "吐泻"
},
{
"indices": [
60,
61
],
"label": "sym",
"score": 1,
"text": "低钾"
},
{
"indices": [
61
],
"label": "bod",
"score": 1,
"text": "钾"
},
{
"indices": [
63,
64,
65,
66
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
74,
75,
76,
77,
78
],
"label": "sym",
"score": 1,
"text": "肾脏调节慢"
},
{
"indices": [
74,
75
],
"label": "bod",
"score": 1,
"text": "肾脏"
}
] |
6.氧合指数（oxygenationindex，OI）结合血气参数和机械通气参数可以判断呼吸衰竭的危重程度，可以采用OI［OI=FiO<sub>2</sub>×MAP×100/PaO<sub>2</sub>，MAP为平均气道压（cmH<sub>2</sub>O），可以从呼吸机直接读取，PaO<sub>2</sub>单位mmHg］。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "ite",
"score": 1,
"text": "氧合指数"
},
{
"indices": [
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22
],
"label": "ite",
"score": 1,
"text": "oxygenationindex"
},
{
"indices": [
24,
25
],
"label": "ite",
"score": 1,
"text": "OI"
},
{
"indices": [
29,
30,
31,
32
],
"label": "ite",
"score": 1,
"text": "血气参数"
},
{
"indices": [
34,
35,
36,
37,
38,
39
],
"label": "ite",
"score": 1,
"text": "机械通气参数"
},
{
"indices": [
44,
45,
46,
47
],
"label": "dis",
"score": 1,
"text": "呼吸衰竭"
},
{
"indices": [
58,
59
],
"label": "ite",
"score": 1,
"text": "OI"
},
{
"indices": [
61,
62,
63,
64,
65,
66,
67,
68,
69,
70,
71,
72,
73,
74,
75,
76,
77,
78,
79,
80,
81,
82,
83,
84,
85,
86,
87,
88,
89,
90,
91,
92,
93,
94,
95,
96,
97,
98,
99,
100,
101,
102
],
"label": "ite",
"score": 1,
"text": "OI=FiO<sub>2</sub>×MAP×100/PaO<sub>2</sub>"
},
{
"indices": [
104,
105,
106
],
"label": "ite",
"score": 1,
"text": "MAP"
},
{
"indices": [
108,
109,
110,
111,
112
],
"label": "ite",
"score": 1,
"text": "平均气道压"
},
{
"indices": [
114,
115,
116,
117,
118,
119,
120,
121,
122,
123,
124,
125,
126,
127,
128,
129
],
"label": "ite",
"score": 1,
"text": "cmH<sub>2</sub>O"
},
{
"indices": [
135,
136,
137
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
143,
144,
145,
146,
147,
148,
149,
150,
151,
152,
153,
154,
155,
156,
157
],
"label": "ite",
"score": 1,
"text": "PaO<sub>2</sub>"
}
] |
OI＜5，正常或轻度呼吸功能不全；OI=5～10，呼吸功能不全和呼吸衰竭，如果气体交换有明显障碍，需要机械通气；OI=10～20，中-重度呼吸衰竭，依赖机械通气；OI=20～30，严重呼吸衰竭，可能伴有肺内静-动脉分流，有应用气道滴入肺表面活性物质治疗指征。 | [
{
"indices": [
0,
1
],
"label": "ite",
"score": 1,
"text": "OI"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "轻度呼吸功能不全"
},
{
"indices": [
17,
18
],
"label": "ite",
"score": 1,
"text": "OI"
},
{
"indices": [
17,
18,
19,
20,
21,
22,
23
],
"label": "sym",
"score": 1,
"text": "OI=5～10"
},
{
"indices": [
25,
26,
27,
28,
29,
30
],
"label": "dis",
"score": 1,
"text": "呼吸功能不全"
},
{
"indices": [
32,
33,
34,
35
],
"label": "dis",
"score": 1,
"text": "呼吸衰竭"
},
{
"indices": [
39,
40,
41,
42,
43,
44,
45,
46,
47
],
"label": "sym",
"score": 1,
"text": "气体交换有明显障碍"
},
{
"indices": [
51,
52,
53,
54
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
56,
57
],
"label": "ite",
"score": 1,
"text": "OI"
},
{
"indices": [
56,
57,
58,
59,
60,
61,
62,
63
],
"label": "sym",
"score": 1,
"text": "OI=10～20"
},
{
"indices": [
65,
66,
67,
68,
69,
70,
71,
72
],
"label": "dis",
"score": 1,
"text": "中-重度呼吸衰竭"
},
{
"indices": [
76,
77,
78,
79
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
81,
82
],
"label": "ite",
"score": 1,
"text": "OI"
},
{
"indices": [
81,
82,
83,
84,
85,
86,
87,
88
],
"label": "sym",
"score": 1,
"text": "OI=20～30"
},
{
"indices": [
90,
91,
92,
93,
94,
95
],
"label": "dis",
"score": 1,
"text": "严重呼吸衰竭"
},
{
"indices": [
101,
102,
103,
104,
105,
106
],
"label": "bod",
"score": 1,
"text": "肺内静-动脉"
},
{
"indices": [
101,
102,
103,
104,
105,
106,
107,
108
],
"label": "sym",
"score": 1,
"text": "肺内静-动脉分流"
},
{
"indices": [
113,
114,
115,
116
],
"label": "pro",
"score": 1,
"text": "气道滴入"
},
{
"indices": [
117,
118,
119,
120,
121,
122,
123,
124,
125
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
}
] |
OI=30～40，严重呼吸衰竭伴有肺动脉高压和肺外右向左分流，有吸入一氧化氮，体外膜肺等特殊呼吸治疗、生命支持治疗指征。 | [
{
"indices": [
0,
1
],
"label": "ite",
"score": 1,
"text": "OI"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "OI=30～40"
},
{
"indices": [
9,
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "严重呼吸衰竭"
},
{
"indices": [
17,
18,
19,
20,
21
],
"label": "dis",
"score": 1,
"text": "肺动脉高压"
},
{
"indices": [
23,
24,
25,
26,
27,
28,
29
],
"label": "sym",
"score": 1,
"text": "肺外右向左分流"
},
{
"indices": [
23,
24
],
"label": "bod",
"score": 1,
"text": "肺外"
},
{
"indices": [
32,
33
],
"label": "pro",
"score": 1,
"text": "吸入"
},
{
"indices": [
34,
35,
36,
37
],
"label": "dru",
"score": 1,
"text": "一氧化氮"
},
{
"indices": [
39,
40,
41,
42
],
"label": "pro",
"score": 1,
"text": "体外膜肺"
},
{
"indices": [
44,
45,
46,
47,
48,
49
],
"label": "pro",
"score": 1,
"text": "特殊呼吸治疗"
},
{
"indices": [
51,
52,
53,
54,
55,
56
],
"label": "pro",
"score": 1,
"text": "生命支持治疗"
}
] |
（三）鉴别诊断1.呼吸功能不全单纯使用血气值作为呼吸衰竭的诊断依据并不十分准确。 | [
{
"indices": [
9,
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "呼吸功能不全"
},
{
"indices": [
19,
20,
21
],
"label": "ite",
"score": 1,
"text": "血气值"
},
{
"indices": [
24,
25,
26,
27
],
"label": "dis",
"score": 1,
"text": "呼吸衰竭"
}
] |
比如在吸入30%～40%氧后30～60分钟，患儿PaO<sub>2</sub>＞8kPa，有可能为呼吸功能不全。 | [
{
"indices": [
3,
4
],
"label": "pro",
"score": 1,
"text": "吸入"
},
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "dru",
"score": 1,
"text": "30%～40%氧"
},
{
"indices": [
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43
],
"label": "sym",
"score": 1,
"text": "PaO<sub>2</sub>＞8kPa"
},
{
"indices": [
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38
],
"label": "ite",
"score": 1,
"text": "PaO<sub>2</sub>"
},
{
"indices": [
49,
50,
51,
52,
53,
54
],
"label": "dis",
"score": 1,
"text": "呼吸功能不全"
}
] |
因此，在对呼吸困难症状出现时，采用持续非介入性正压通气、或气道插管机械通气和气道清洗使黏稠分泌物导致的气道阻塞复通后，呼吸困难症状迅速缓解。 | [
{
"indices": [
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "呼吸困难"
},
{
"indices": [
17,
18,
19,
20,
21,
22,
23,
24,
25,
26
],
"label": "pro",
"score": 1,
"text": "持续非介入性正压通气"
},
{
"indices": [
29,
30,
31,
32,
33,
34,
35,
36
],
"label": "pro",
"score": 1,
"text": "气道插管机械通气"
},
{
"indices": [
38,
39,
40,
41
],
"label": "pro",
"score": 1,
"text": "气道清洗"
},
{
"indices": [
43,
44,
45,
46,
47
],
"label": "bod",
"score": 1,
"text": "黏稠分泌物"
},
{
"indices": [
51,
52,
53,
54
],
"label": "sym",
"score": 1,
"text": "气道阻塞"
},
{
"indices": [
51,
52
],
"label": "bod",
"score": 1,
"text": "气道"
},
{
"indices": [
59,
60,
61,
62
],
"label": "sym",
"score": 1,
"text": "呼吸困难"
}
] |
因此，需要与单纯性原发于肺部或肺外疾病演变发展的严重呼吸困难加以区别。 | [
{
"indices": [
12,
13,
14,
15,
16,
17,
18
],
"label": "dis",
"score": 1,
"text": "肺部或肺外疾病"
},
{
"indices": [
24,
25,
26,
27,
28,
29
],
"label": "sym",
"score": 1,
"text": "严重呼吸困难"
}
] |
2.急性呼吸窘迫综合征（ARDS）ARDS是与肺部和其他脏器感染等有关的急性肺部炎症损伤导致的临床综合征，因肺泡-毛细血管通透性增加而有严重肺水肿。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "急性呼吸窘迫综合征（ARDS）"
},
{
"indices": [
17,
18,
19,
20
],
"label": "dis",
"score": 1,
"text": "ARDS"
},
{
"indices": [
23,
24
],
"label": "bod",
"score": 1,
"text": "肺部"
},
{
"indices": [
28,
29,
30,
31
],
"label": "dis",
"score": 1,
"text": "脏器感染"
},
{
"indices": [
36,
37,
38,
39,
40,
41,
42,
43
],
"label": "dis",
"score": 1,
"text": "急性肺部炎症损伤"
},
{
"indices": [
54,
55,
56,
57,
58,
59,
60,
61,
62,
63,
64,
65
],
"label": "sym",
"score": 1,
"text": "肺泡-毛细血管通透性增加"
},
{
"indices": [
54,
55
],
"label": "bod",
"score": 1,
"text": "肺泡"
},
{
"indices": [
57,
58,
59,
60
],
"label": "bod",
"score": 1,
"text": "毛细血管"
},
{
"indices": [
68,
69,
70,
71,
72
],
"label": "dis",
"score": 1,
"text": "严重肺水肿"
}
] |
小儿ARDS多为急性起病，主要表现为呼吸窘迫症状，放射学检查为双侧肺弥漫性炎症和渗出改变，血气分析提示严重低氧血症，PaO<sub>2</sub>/FiO<sub>2</sub>＜27kPa（200mmHg）。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "小儿ARDS"
},
{
"indices": [
18,
19,
20,
21
],
"label": "dis",
"score": 1,
"text": "呼吸窘迫"
},
{
"indices": [
25,
26,
27,
28,
29
],
"label": "pro",
"score": 1,
"text": "放射学检查"
},
{
"indices": [
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43
],
"label": "sym",
"score": 1,
"text": "放射学检查为双侧肺弥漫性炎症和渗出改变"
},
{
"indices": [
31,
32,
33,
34,
35,
36,
37,
38
],
"label": "dis",
"score": 1,
"text": "双侧肺弥漫性炎症"
},
{
"indices": [
45,
46,
47,
48
],
"label": "pro",
"score": 1,
"text": "血气分析"
},
{
"indices": [
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56
],
"label": "sym",
"score": 1,
"text": "血气分析提示严重低氧血症"
},
{
"indices": [
51,
52,
53,
54,
55,
56
],
"label": "dis",
"score": 1,
"text": "严重低氧血症"
}
] |
可以合并严重肺内分流和肺动脉高压，应用常规机械通气往往效果差。 | [
{
"indices": [
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "严重肺内分流"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "肺动脉高压"
},
{
"indices": [
21,
22,
23,
24
],
"label": "pro",
"score": 1,
"text": "机械通气"
}
] |
随着急救技术的提高和肺保护性策略的应用，临床预后已有明显改善。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "急救技术"
},
{
"indices": [
10,
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "肺保护性策略"
}
] |
3.感染性休克和全身性炎症反应综合征小儿感染性休克时可因心肌麻痹、肺血管痉挛、全身炎症反应时毒素刺激等，导致肺部严重损伤和呼吸功能障碍。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "感染性休克"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "dis",
"score": 1,
"text": "全身性炎症反应综合征"
},
{
"indices": [
18,
19,
20,
21,
22,
23,
24
],
"label": "dis",
"score": 1,
"text": "小儿感染性休克"
},
{
"indices": [
28,
29,
30,
31
],
"label": "dis",
"score": 1,
"text": "心肌麻痹"
},
{
"indices": [
33,
34,
35,
36,
37
],
"label": "dis",
"score": 1,
"text": "肺血管痉挛"
},
{
"indices": [
39,
40,
41,
42
],
"label": "dis",
"score": 1,
"text": "全身炎症"
},
{
"indices": [
46,
47,
48,
49
],
"label": "sym",
"score": 1,
"text": "毒素刺激"
},
{
"indices": [
54,
55,
56,
57,
58,
59
],
"label": "dis",
"score": 1,
"text": "肺部严重损伤"
},
{
"indices": [
61,
62,
63,
64,
65,
66
],
"label": "dis",
"score": 1,
"text": "呼吸功能障碍"
}
] |