text stringlengths 4 500 | ents list |
|---|---|
此时应及时处理原发病因，采取抗感染和抗休克措施，解除导致呼吸功能障碍的主要原因。 | [
{
"indices": [
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "抗感染"
},
{
"indices": [
18,
19,
20,
21,
22
],
"label": "pro",
"score": 1,
"text": "抗休克措施"
},
{
"indices": [
28,
29,
30,
31,
... |
第八节肺的神经内分泌调节功能（一）呼吸道上皮细胞中的神经内分泌细胞分泌5-羟色胺，具有收缩血管、刺激肺呼吸作用在肺血管内皮被单胺氧化酶降解而灭活。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9
],
"label": "bod",
"score": 1,
"text": "肺的神经内分泌"
},
{
"indices": [
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
... |
血液中的去甲肾上腺素也在肺血管内皮中被单胺氧化酶和儿茶酚胺甲基转化酶降解。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "bod",
"score": 1,
"text": "血液中的去甲肾上腺素"
},
{
"indices": [
12,
13,
14,
15,
16,
17
],
"label": "bod",
"score": 1,
"text": ... |
循环中95%血管紧张素Ⅰ（AT-Ⅰ）在肺内皮细胞的血管紧张素转化酶作用下，由10肽变为8肽的AT-Ⅱ和7肽的AT-Ⅲ，活性分别提高50倍或25～30倍。 | [
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "bod",
"score": 1,
"text": "血管紧张素Ⅰ"
},
{
"indices": [
13,
14,
15,
16
],
"label": "bod",
"score": 1,
"text": "AT-Ⅰ"
},
{
"indices": [
19,
20,
... |
肺内产生的或循环中的前列腺素如PGE、PGF也在肺血管内皮降解和灭活，但PGI2</sub>则不被灭活。 | [
{
"indices": [
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1
],
"label": "bod",
"score": 1,
"text": "肺内"
},
{
"indices": [
10,
11,
12,
13
],
"label": "bod",
"score": 1,
"text": "前列腺素"
},
{
"indices": [
15,
16,
17
],
"label": "bod",
"score"... |
（二）肥大细胞和IgE肥大细胞多分布在小支气管和细支气管黏膜浅层，其细胞质含有异染颗粒。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "bod",
"score": 1,
"text": "肥大细胞"
},
{
"indices": [
8,
9,
10
],
"label": "bod",
"score": 1,
"text": "IgE"
},
{
"indices": [
11,
12,
13,
14
],
"label": "... |
肥大细胞膜表面有大量IgE的Fc段受体。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "bod",
"score": 1,
"text": "肥大细胞膜表面"
},
{
"indices": [
10,
11,
12,
13,
14,
15,
16,
17,
18
],
"label": "bod",
"score": 1,
"text": ... |
当IgE与受体结合后，肥大细胞即致敏，在同种小剂量抗原与细胞膜表面结合的IgE再次结合时，诱发经钙离子介导的细胞脱颗粒作用。 | [
{
"indices": [
1,
2,
3
],
"label": "bod",
"score": 1,
"text": "IgE"
},
{
"indices": [
5,
6
],
"label": "bod",
"score": 1,
"text": "受体"
},
{
"indices": [
11,
12,
13,
14
],
"label": "bod",
"score": 1,... |
（三）肺巨噬细胞巨噬细胞在肺组织内分布不同，肺泡内者称为肺泡巨噬细胞，直径20～40μm，具有活跃的吞噬功能，可以清除细菌、病毒、吸入物颗粒、衰老坏死的细胞，抗肿瘤，调节肺表面活性物质磷脂代谢。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "bod",
"score": 1,
"text": "肺巨噬细胞"
},
{
"indices": [
8,
9,
10,
11
],
"label": "bod",
"score": 1,
"text": "巨噬细胞"
},
{
"indices": [
13,
14,
15
],
... |
巨噬细胞-粒细胞集落刺激因子调节巨噬细胞功能。 | [
{
"indices": [
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1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "bod",
"score": 1,
"text": "巨噬细胞-粒细胞集落刺激因子"
},
{
"indices": [
16,
17,
18,
19
],
"label": "bod",
... |
先天性巨噬细胞-粒细胞集落刺激因子缺陷，可以使肺泡巨噬细胞无功能，导致肺泡磷脂代谢异常，可能为肺泡蛋白沉积症的发生原因。 | [
{
"indices": [
0,
1,
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3,
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7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "先天性巨噬细胞-粒细胞集落刺激因子缺陷"
},
{
"indices": [
0,
... |
第五节新生儿呼吸窘迫综合征新生儿呼吸窘迫综合征（respiratorydistresssyndrome，RDS），也称为肺透明膜病（hyalinemembranedisease，HMD）。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "新生儿呼吸窘迫综合征"
},
{
"indices": [
13,
14,
15,
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18,
19,
20,
21,
22
],
"... |
其基本特点为肺发育不成熟、肺表面活性物质缺乏而导致的肺泡不张、肺液转运障碍、肺毛细血管-肺泡间高通透性渗出性病变。 | [
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "sym",
"score": 1,
"text": "肺发育不成熟"
},
{
"indices": [
6
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
13,
14,
15,
16,
17,
18,... |
以机械通气和肺表面活性物质替代疗法治疗为主的呼吸治疗和危重监护技术，已经能够使90%以上的RDS患儿存活。 | [
{
"indices": [
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质替代疗法"
... |
【临床流行病学】RDS主要发生在早产儿，其发生率和严重程度与胎龄及出生体重呈反比。 | [
{
"indices": [
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9,
10
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
16,
17,
18
],
"label": "dis",
"score": 1,
"text": "早产儿"
}
] |
2006年，EuroNeoStat的数据显示RDS发病率在胎龄23～25周早产儿为91%，26～27周88%，28～29周74%，30～31周52%。 | [
{
"indices": [
22,
23,
24
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
37,
38,
39
],
"label": "dis",
"score": 1,
"text": "早产儿"
}
] |
RDS发病率占所有新生儿的1%，尤其多见于胎龄32周以下的早产儿。 | [
{
"indices": [
0,
1,
2
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
29,
30,
31
],
"label": "dis",
"score": 1,
"text": "早产儿"
}
] |
美国资料显示，在胎龄29周内出生的早产儿中RDS的发病率可以高达60%，但在胎龄40周时基本不发生。 | [
{
"indices": [
17,
18,
19
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
发生RDS的高危因素包括男性、双胎，前一胎有RDS病史、母亲患糖尿病、剖宫产且无产程发动等。 | [
{
"indices": [
2,
3,
4
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
22,
23,
24
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
31,
32,
33
],
"label": "dis",
"score":... |
低龄怀孕、孕期吸烟、吸毒、药物、妊娠高血压等也与RDS发生相关。 | [
{
"indices": [
16,
17,
18,
19,
20
],
"label": "dis",
"score": 1,
"text": "妊娠高血压"
},
{
"indices": [
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
羊膜早破（分娩前24～48小时）则会降低RDS发生的危险性，可能为胎儿处于应激下，肾上腺激素分泌，促进了肺成熟；但一般认为胎儿宫内窘迫与RDS的发生没有直接关系，但会影响到早产儿生后早期的呼吸适应，如呼吸费力和肺液清除延缓等，其发生可以达50%。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "sym",
"score": 1,
"text": "羊膜早破"
},
{
"indices": [
0,
1
],
"label": "bod",
"score": 1,
"text": "羊膜"
},
{
"indices": [
20,
21,
22
],
"label": "dis",
"score": 1,... |
肺表面活性物质可以降低RDS病死率。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "bod",
"score": 1,
"text": "肺表面活性物质"
},
{
"indices": [
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
Curosurf（固尔苏）临床研究中对照组病死率为50%，治疗组为30%，使RDS净存活率提高20%。 | [
{
"indices": [
38,
39,
40
],
"label": "dis",
"score": 1,
"text": "RDS"
}
] |
20世纪90年代初的临床研究表明，肺表面活性物质治疗使RDS的生存率提高到75%，在多剂量治疗时可以提高到80%～90%。 | [
{
"indices": [
17,
18,
19,
20,
21,
22,
23,
24,
25
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
},
{
"indices": [
27,
28,
29
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [... |
美国在20世纪80年代末开始常规应用肺表面活性物质治疗RDS，在1989—1990年间1岁以下婴儿病死率由8.5%下降为6.3%，主要为RDS死亡率的下降。 | [
{
"indices": [
18,
19,
20,
21,
22,
23,
24,
25,
26
],
"label": "pro",
"score": 1,
"text": "肺表面活性物质治疗"
},
{
"indices": [
27,
28,
29
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [... |
【病因及发病机制】1.因肺发育不成熟，过低的表面活性物质使肺泡气液界面表面张力升高，肺泡萎陷，使功能余气量下降，肺顺应性曲线下移，顺应性下降，无效腔通气，呼吸做功显著增加，能量耗竭，导致全身脏器功能衰竭。 | [
{
"indices": [
12
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "肺发育不成熟"
},
{
"indices": [
22,
23,
24,
25,
26,
... |
2.不成熟肺的肺泡数量和通气面积太少，肺泡间隔宽，气体弥散和交换严重不足。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "不成熟肺的肺泡数量和通气面积太少"
},
{
"indices": [
2,
3,
4,
5,
6,
... |
3.呼气末肺泡萎陷，通气困难，出现低氧血症，使肺泡上皮细胞合成表面活性物质能力下降。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "呼气末肺泡萎陷"
},
{
"indices": [
5,
6
],
"label": "bod",
"score": 1,
"text": "肺泡"
},
{
"indices": [
10,
11,
12,
13
... |
4.持续低氧导致肺血管痉挛，出现肺动脉高压，肺血流减少，肺外右向左分流，肺内动静脉分流，使通气-灌流比例失调，影响气血交换。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "sym",
"score": 1,
"text": "持续低氧"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "肺血管痉挛"
},
{
"indices": [
16,
17,
18,
19... |
5.持续低氧和酸中毒可以造成心肌损害，心输出量下降，全身性低血压、低灌流，最后出现以呼吸衰竭为主的多脏器衰竭。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "sym",
"score": 1,
"text": "持续低氧"
},
{
"indices": [
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "酸中毒"
},
{
"indices": [
14,
15,
16,
17
],
"label": "d... |
【病理组织学】大体解剖时，肺多为实变，外观显暗红色，水中下沉。 | [
{
"indices": [
13
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29
],
"label": "sym",
"sc... |
机械通气后的肺泡可以局部扩张，未经机械通气的RDS患儿肺主要表现为不张、充血和水肿。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
6,
7
],
"label": "bod",
"score": 1,
"text": "肺泡"
},
{
"indices": [
17,
18,
19,
20
],
"label": "pro",
"... |
显微镜下肺泡萎陷，上皮细胞多立方状、少扁平状，肺泡间隔宽、充气少，细小支气管、肺泡导管和肺泡扩张，上皮细胞脱落坏死，有呈嗜伊红色膜内衬，为透明膜形成。 | [
{
"indices": [
0,
1,
2
],
"label": "equ",
"score": 1,
"text": "显微镜"
},
{
"indices": [
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "肺泡萎陷"
},
{
"indices": [
4,
5
],
"label": "bod",
"score": 1,
... |
已经通过气的肺则主要为小气道损伤，为肺泡不张的继发性改变。 | [
{
"indices": [
6
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "小气道损伤"
},
{
"indices": [
18,
19,
20,
21
],
"label": "sym",
... |
肺微血管和毛细血管中可以有血栓形成、出血。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "bod",
"score": 1,
"text": "肺微血管"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16
],
"lab... |
【病理生理】由于肺表面活性物质的分泌合成作用下降，肺表面活性物质再循环途径的阻断，或者因肺泡腔内液体过多（转运障碍、高渗出），均可以使肺表面活性物质不足。 | [
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "sym",
"score": 1,
"text": "肺表面活性物质的分泌合成作用下降"
},
{
"indices": [
8,
9,
10,
11,
... |
病理性渗出液含大量血浆蛋白，在肺泡腔内干扰和抑制肺表面活性物质功能。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "bod",
"score": 1,
"text": "病理性渗出液"
},
{
"indices": [
9,
10,
11,
12
],
"label": "bod",
"score": 1,
"text": "血浆蛋白"
},
{
"indices": [
15,
16,
17... |
出生时吸入、肺炎、肺发育不良、肺出血以及窒息缺氧性损害等出生早期病况均可与上述病理生理相关。 | [
{
"indices": [
6,
7
],
"label": "dis",
"score": 1,
"text": "肺炎"
},
{
"indices": [
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "肺发育不良"
},
{
"indices": [
15,
16,
17
],
"label": "dis",
... |
早产儿肺内肺表面活性物质的磷脂总量只有足月儿的10%～30%或更低，且缺乏SP-A、B、C等主要肺表面活性物质蛋白，因而在数量和质量上均劣于足月儿，是发生RDS的主要原因。 | [
{
"indices": [
0,
1,
2
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
3,
4
],
"label": "bod",
"score": 1,
"text": "肺内"
},
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
... |
应用外源性肺表面活性物质制剂可以迅速提高肺内的肺表面活性物质含量。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "dru",
"score": 1,
"text": "外源性肺表面活性物质制剂"
},
{
"indices": [
20,
21,
22,
23,
24,
25,
26,
27,
28,
... |
将肺表面活性物质经气道滴入RDS患儿肺内后，肺表面活性物质磷脂会立即被肺泡上皮细胞摄取，并逐渐强化内源性肺表面活性物质的功能活性，特别是促使SP-A、B、C的合成分泌。 | [
{
"indices": [
1,
2,
3,
4,
5,
6,
7
],
"label": "bod",
"score": 1,
"text": "肺表面活性物质"
},
{
"indices": [
9,
10
],
"label": "bod",
"score": 1,
"text": "气道"
},
{
"indices": [
13,
14,
15
],
... |
【临床表现】RDS主要发生在早产儿，尤其在胎龄小于32周、出生体重低于2000g的早产儿。 | [
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
41,
42,
43
],
"label": "dis",
"score":... |
可以是刚一出生即出现症状或出生后6小时内发病，表现为呼吸困难症状，如呼吸频率加快（＞60次/分）或呼吸浅弱，鼻翼扇动，呼气呻吟，锁骨上、肋间和胸骨下吸气性凹陷（“三凹征”），青紫。 | [
{
"indices": [
26,
27,
28,
29,
30,
31
],
"label": "sym",
"score": 1,
"text": "呼吸困难症状"
},
{
"indices": [
34,
35,
36,
37,
38,
39
],
"label": "sym",
"score": 1,
"text": "呼吸频率加快"
},
{
"indices": [... |
这类症状呈进行性加重，并可发生呼吸暂停。 | [
{
"indices": [
15,
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "呼吸暂停"
}
] |
典型的X线胸片显示RDS早期的肺部网状细颗粒影和后期的毛玻璃状（“白肺”）征象以及相对增强的支气管充气征，伴早产儿胸廓和肺容积偏小特征。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "X线胸片"
},
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
... |
血气分析显示酸中毒、低氧血症和高碳酸血症。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "pro",
"score": 1,
"text": "血气分析"
},
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "酸中毒"
},
{
"indices": [
10,
11,
12,
13
],
"label": "d... |
如果持续低氧血症和酸中毒不能纠正，患儿可以并发肺动脉高压、呼吸与心力衰竭，可在48～72小时内死亡。 | [
{
"indices": [
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "低氧血症"
},
{
"indices": [
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "酸中毒"
},
{
"indices": [
23,
24,
25,
26,
27
],
... |
经辅助或强制通气的患儿在3～5天后，随内源性肺表面活性物质增多，症状会好转，表现为自限性恢复的特点。 | [
{
"indices": [
1,
2,
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "辅助或强制通气"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30
],
"label": "sym"... |
【实验室检查】（一）卵磷脂/鞘磷脂比（L/S）羊水中L/S比值＜1，胎儿发生RDS危险性可达100%；L/S＞2，发生RDS的危险性＜1%。 | [
{
"indices": [
1,
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "实验室检查"
},
{
"indices": [
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22
],
"label": "ite",
"sco... |
同一胎龄小儿的L/S可以变化很大，因此单纯用L/S不能判断是否发生RDS，但可以作为预防的指征。 | [
{
"indices": [
7,
8,
9
],
"label": "ite",
"score": 1,
"text": "L/S"
},
{
"indices": [
22,
23,
24
],
"label": "ite",
"score": 1,
"text": "L/S"
},
{
"indices": [
33,
34,
35
],
"label": "dis",
"score":... |
羊水中磷脂酰甘油（PG）和SP-A也可以作为判断肺成熟的辅助指标，两者在接近出生前偏低，提示肺不成熟。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7
],
"label": "ite",
"score": 1,
"text": "羊水中磷脂酰甘油"
},
{
"indices": [
9,
10
],
"label": "ite",
"score": 1,
"text": "PG"
},
{
"indices": [
13,
14,
15,
... |
在肺不成熟的胎儿，如果L/S、PG、SP-A均很低，发生RDS的危险性非常高。 | [
{
"indices": [
1
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
1,
2,
3,
4
],
"label": "sym",
"score": 1,
"text": "肺不成熟"
},
{
"indices": [
11,
12,
13
],
"label": "ite",
"score": 1,
"text... |
测定气道吸出液或出生后早期胃液的以上指标，也可以辅助判断RDS治疗效果及转归。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "测定气道吸出液"
},
{
"indices": [
13,
14
],
"label": "bod",
"score": 1,
"text": "胃液"
},
{
"indices": [
28,
29,
30
],
... |
也有研究应用显微镜微泡计数法，检测气道清洗液或胃液中微小气泡与大气泡比例，间接判断内源性肺表面活性物质含量与活性，可有助于床旁快速判断RDS疾病程度和治疗效果。 | [
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "显微镜微泡计数法"
},
{
"indices": [
17,
18,
19,
20,
21
],
"label": "ite",
"score": 1,
"text": "气道清洗液"
},
{
"indi... |
（二）血气分析为最主要实验室检查。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "血气分析"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "实验室检查"
}
] |
患儿呼吸治疗时必须测定动脉血氧分压（PaO2</sub>）、二氧化碳分压（PaCO2</sub>）和pH。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "呼吸治疗"
},
{
"indices": [
11,
12,
13,
14,
15,
16
],
"label": "ite",
"score": 1,
"text": "动脉血氧分压"
},
{
"indices": [
18,
19,
... |
发病早期，PaO2</sub>＜6.5kPa（50mmHg），PaCO2</sub>＞8kPa（60mmHg），pH＜7.20，BE＜-5.0mmol/L，应考虑低氧血症、高碳酸血症、代谢性酸中毒，经吸氧或辅助通气治疗无改善，可转为气道插管和呼吸机治疗，避免发生严重呼吸衰竭。 | [
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29
],
"label": "sym",
"score": 1,
"text"... |
一般在开始机械通气后1～3小时以及随后2～3天的每12～24小时，需要检查动脉血气值，以判断病情转归和调节呼吸机参数，以保持合适的通气量和氧供。 | [
{
"indices": [
5,
6,
7,
8
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
37,
38,
39,
40,
41
],
"label": "ite",
"score": 1,
"text": "动脉血气值"
},
{
"indices": [
53,
54,
55
],
... |
【诊断与鉴别诊断】根据上述临床表现及胸部X线的表现，诊断不难。 | [
{
"indices": [
18,
19,
20,
21
],
"label": "pro",
"score": 1,
"text": "胸部X线"
}
] |
需要鉴别诊断的疾病有：（一）新生儿湿肺又称暂时性呼吸困难或肺液转运障碍。 | [
{
"indices": [
14,
15,
16,
17,
18
],
"label": "dis",
"score": 1,
"text": "新生儿湿肺"
},
{
"indices": [
21,
22,
23,
24,
25,
26,
27
],
"label": "sym",
"score": 1,
"text": "暂时性呼吸困难"
},
{
"indices": [... |
X线胸片特征为肺门纹理增强，肺泡、叶间、间质积液，肺血管充血，肺气肿等。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "pro",
"score": 1,
"text": "X线胸片"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "sym",
"score": 1,
"text": ... |
如果经吸氧临床症状没有改善或吸氧加重时，宜采用持续气道正压通气（CPAP）或气道插管机械通气治疗，一般24～72小时X线检查见肺液快速吸收和呼吸急促症状的缓解。 | [
{
"indices": [
3,
4
],
"label": "pro",
"score": 1,
"text": "吸氧"
},
{
"indices": [
14,
15
],
"label": "pro",
"score": 1,
"text": "吸氧"
},
{
"indices": [
23,
24,
25,
26,
27,
28,
29,
30
],
... |
（二）B族溶血性链球菌（GBS）肺炎可见于早产、近足月和足月新生儿，母亲妊娠后期有感染及羊膜早破史，临床发病特点同早产儿RDS，可以有细菌培养阳性。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "dis",
"score": 1,
"text": "B族溶血性链球菌（GBS）肺炎"
},
{
"indices": [
21,
22
],
"label": "dis",
"score... |
胸部X线检查表现为肺叶或节段炎症特征及肺泡萎陷征，临床有感染征象，病程1～2周。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "胸部X线检查"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
... |
治疗以出生后最初3天采用联合广谱抗生素，如氨苄西林加庆大霉素，随后应用7～10天氨苄西林或青霉素，剂量要參考最小抑菌浓度，避免因剂量偏低导致失去作用。 | [
{
"indices": [
12,
13,
14,
15,
16,
17,
18
],
"label": "dru",
"score": 1,
"text": "联合广谱抗生素"
},
{
"indices": [
21,
22,
23,
24
],
"label": "dru",
"score": 1,
"text": "氨苄西林"
},
{
"indices": [
26,
... |
（三）遗传性SP-B缺乏症又称为“先天性肺表面活性物质蛋白缺乏症”，于1993年在美国发现，目前全世界有100多例经分子生物学技术诊断明确的患儿。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "遗传性SP-B缺乏症"
},
{
"indices": [
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
... |
发病原因为调控SP-B合成的DNA序列碱基突变。 | [
{
"indices": [
7,
8,
9,
10
],
"label": "bod",
"score": 1,
"text": "SP-B"
},
{
"indices": [
14,
15,
16,
17,
18,
19,
20,
21,
22
],
"label": "sym",
"score": 1,
"text": "DNA序列碱基突变"
},
{
"ind... |
临床上表现为足月出生的小儿出现进行性呼吸困难，经任何治疗干预无效。 | [
{
"indices": [
15,
16,
17,
18,
19,
20,
21
],
"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，并可以伴前SP-C合成与表达的异常，其肺组织病理类似肺泡蛋白沉积症。 | [
{
"indices": [
0
],
"label": "bod",
"score": 1,
"text": "肺"
},
{
"indices": [
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "RDS"
... |
外源性肺表面活性物质治疗仅能暂时缓解症状，患儿多依赖肺移植，否则多在1岁内死亡。 | [
{
"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": [
26,
27,
28
],
"label": "pro",
"score": 1,
"text": "肺移植"
... |
【预防】预防RDS的主要手段包括预期产程并及时做好接生和早产儿复苏急救准备，还可以通过产前评估、产前母体糖皮质激素以及出生后肺表面活性物质的预防性给药，达到预防RDS发生的目的。 | [
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26
],
"label": "pro",
"score": 1,
"text": "预期产程并及时做好接生"
},
... |
肺表面活性物质在妊娠22～24周胎儿肺中出现，25周左右已可在羊水中检测出，在32～35周大量合成。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "ite",
"score": 1,
"text": "肺表面活性物质"
},
{
"indices": [
18,
19
],
"label": "bod",
"score": 1,
"text": "肺中"
},
{
"indices": [
31,
32,
33
],
... |
肺表面活性物质在足月出生的新生儿肺内非常丰富，且具有很高的表面活性，但在32周以下出生的早产儿，特别是28周以下出生、体重低于1000g的超低出生体重儿，60%～80%可以发生呼吸窘迫。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "bod",
"score": 1,
"text": "肺表面活性物质"
},
{
"indices": [
16,
17
],
"label": "bod",
"score": 1,
"text": "肺内"
},
{
"indices": [
44,
45,
46
],
... |
产前给予糖皮质激素治疗，一般产前使用激素的最佳时间为分娩前24小时～7天，给予地塞米松每次6mg，2～4次，每次间隔12～24小时；或倍他米松，每次12mg，每天1次，共2次，可以显著降低24～34周早产新生儿RDS发生率和新生儿死亡接近50%，并可以减少新生儿脑室内出血。 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "糖皮质激素治疗"
},
{
"indices": [
18,
19
],
"label": "dru",
"score": 1,
"text": "激素"
},
{
"indices": [
39,
40,
41,
42... |
对于早产儿出生后立即预防性气道内给予肺表面活性物质可以减少RDS发生。 | [
{
"indices": [
2,
3,
4
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "pro",
"score": 1,
"text": "预防性气道内给予"
},
{
"indices": [
18,
... |
【治疗】（一）辅助呼吸治疗1.氧疗可以部分改善低氧血症，其作用原理为提高局部通气-灌流差的肺泡内氧分压，使局部痉挛血管舒张，减少右向左分流，提高动脉氧饱和度。 | [
{
"indices": [
7,
8,
9,
10,
11,
12
],
"label": "pro",
"score": 1,
"text": "辅助呼吸治疗"
},
{
"indices": [
15,
16
],
"label": "pro",
"score": 1,
"text": "氧疗"
},
{
"indices": [
23,
24,
25,
26
],
... |
持续高氧（FiO<sub>2</sub>＞0.5）24小时以上可以导致肺水肿和炎症，严重者出现支气管发育不良（BPD）和眼球后视神经血管损害。 | [
{
"indices": [
35,
36,
37
],
"label": "dis",
"score": 1,
"text": "肺水肿"
},
{
"indices": [
39,
40
],
"label": "dis",
"score": 1,
"text": "炎症"
},
{
"indices": [
47,
48,
49,
50,
51,
52,
53
],
... |
2.经鼻持续气道正压通气（CPAP）简易水封瓶CPAP装置，或带有湿化器的专用CPAP装置产品，比较简单，使用方便，但存在氧浓度无法控制和调节、压力不稳定、易诱发气胸等并发症的缺点。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "经鼻持续气道正压通气"
},
{
"indices": [
13,
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "CPAP"
},
{
... |
CPAP装置供氧浓度连续可调（21%～100%），气流流量可变（0～12L/min），并具有供气压力上限报警和安全卸压（11cmH2</sub>O）阀门装置，在治疗中可以保持供气压力稳定，显著提高使用的安全性和有效性，减少气胸等并发症，尤其适用于<1500g体重的早产儿和极低出生体重儿。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "equ",
"score": 1,
"text": "CPAP装置"
},
{
"indices": [
7
],
"label": "dru",
"score": 1,
"text": "氧"
},
{
"indices": [
46,
47,
48,
49,
50,
51,
... |
经1～3天治疗后，如果PEEP可以下调至0～1cmH2</sub>O以下，供氧浓度在25%以下，仍可维持SpO2</sub>达到88%～93%，可以转为短时间头罩吸氧至停止呼吸治疗。 | [
{
"indices": [
11,
12,
13,
14
],
"label": "ite",
"score": 1,
"text": "PEEP"
},
{
"indices": [
38
],
"label": "dru",
"score": 1,
"text": "氧"
},
{
"indices": [
52,
53,
54,
55
],
"label": "ite",
"score... |
3.气道插管和呼吸机治疗应用指征一般考虑经头罩或CPAP治疗6～12小时以上病情无改善，且继续加重，可以考虑气道插管和机械通气。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "气道插管"
},
{
"indices": [
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "呼吸机治疗"
},
{
"indices": [
21,
22
],
"label": ... |
临床采用机械通气的一般原则为：FiO<sub>2</sub>＞0.5，呼吸机参数设定为吸气时间（Ti）最初在0.3～0.4秒，呼气末正压（PEEP）在3～6cmH<sub>2</sub>O，通气频率（f）为50～60次/分，气道峰压（PIP）在20～30cmH<sub>2</sub>O，以可见胸廓运动为适宜，潮气量（V<sub>T</sub>）通气6～8ml/kg体重，达到PaO<sub>2</sub>在50～70mmHg，PaCO<sub>2</sub>在45～55mmHg。 | [
{
"indices": [
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
15,
16,
17
],
"label": "ite",
"score": 1,
"text": "FiO"
},
{
"indices": [
35,
36,
37
],
"label": "equ",
... |
如果出现呼吸对抗，可以考虑采用镇静剂和肌肉松弛剂，或调节同步触发通气。 | [
{
"indices": [
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "呼吸对抗"
},
{
"indices": [
15,
16,
17
],
"label": "dru",
"score": 1,
"text": "镇静剂"
},
{
"indices": [
19,
20,
21,
22,
23
],
... |
严重呼吸衰竭时伴有肺动脉高压者，可以吸入一氧化氮（NO），高频振荡通气（HFOV）也可以治疗早产儿RDS，在缺乏肺表面活性物质制剂或常频机械通气效果不良时选用HFOV，可能迅速改善通气障碍，缩短呼吸机治疗时间，并降低CLD发生危险性。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "严重呼吸衰竭"
},
{
"indices": [
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "肺动脉高压"
},
{
"indices": [
20,
2... |
参数调节原则上以动脉PaCO<sub>2</sub>不出现急剧变化为适宜，避免导致脑血流迅速下降，诱发继发性缺血缺氧性脑损伤。 | [
{
"indices": [
8,
9,
10,
11,
12,
13
],
"label": "ite",
"score": 1,
"text": "动脉PaCO"
},
{
"indices": [
41,
42,
43,
44,
45,
46,
47
],
"label": "sym",
"score": 1,
"text": "脑血流迅速下降"
},
{
"in... |
（二）液体治疗由于RDS早期有肺液转运障碍和肺血管高通透性水肿，出生后最初3天进液量可以控制在50～70ml/（kg•d），然后逐渐提高到80～100ml/（kg•d）。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "液体治疗"
},
{
"indices": [
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
15,
16
],
"label": "bod",
"score": ... |
密切监测血电解质，酌情给予钠盐，避免因皮肤薄、非显性失水等原因导致高钠血症和脑损害。 | [
{
"indices": [
4,
5,
6,
7
],
"label": "ite",
"score": 1,
"text": "血电解质"
},
{
"indices": [
11,
12,
13,
14
],
"label": "pro",
"score": 1,
"text": "给予钠盐"
},
{
"indices": [
19,
20,
21
],
"label"... |
在用补液治疗高钠血症时，可能会导致高血糖，可以视情况经胃管输入液体。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "补液治疗"
},
{
"indices": [
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "高钠血症"
},
{
"indices": [
17,
18,
19
],
"label": "d... |
补充胶体液亦应谨慎，因由于高血管通透性会使输入蛋白沉着于肺间质，使间质胶体渗透压增加，加重间质肺液滞留。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "补充胶体液"
},
{
"indices": [
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
... |
碳酸氢钠液可以稀释后缓慢静脉推注，不主张持续滴注。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "dru",
"score": 1,
"text": "碳酸氢钠液"
},
{
"indices": [
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "静脉推注"
},
{
"indices": [
20,
21,
22,
2... |
RDS患儿会因低氧血症使细胞钠-钾ATP酶功能低下和肾功能不全，出现高钾血症，因此出生早期不必补钾。 | [
{
"indices": [
0,
1,
2
],
"label": "dis",
"score": 1,
"text": "RDS"
},
{
"indices": [
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "低氧血症"
},
{
"indices": [
12,
13,
14,
15,
16,
17,
... |
出生后会出现短时间甲状旁腺功能低下，可以适当补充钙剂。 | [
{
"indices": [
9,
10,
11,
12,
13,
14,
15,
16
],
"label": "sym",
"score": 1,
"text": "甲状旁腺功能低下"
},
{
"indices": [
9,
10,
11,
12
],
"label": "bod",
"score": 1,
"text": "甲状旁腺"
},
{
"indices": [
... |
（三）血压维持早产儿外周血压低于30mmHg时，脑血流低灌注可以导致脑损伤。 | [
{
"indices": [
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "血压维持"
},
{
"indices": [
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
10,
11,
12,
13
],
"label": "i... |
低血压可能与血容量过低有关。 | [
{
"indices": [
0,
1,
2
],
"label": "dis",
"score": 1,
"text": "低血压"
},
{
"indices": [
6,
7,
8,
9,
10
],
"label": "sym",
"score": 1,
"text": "血容量过低"
},
{
"indices": [
6
],
"label": "bod",
"score": 1,... |
可以按10～20ml/kg输入血浆等液体以提高血压，同时给予多巴胺和多巴酚丁胺5～15μg/（kg•min）。 | [
{
"indices": [
13,
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "输入血浆"
},
{
"indices": [
23,
24
],
"label": "ite",
"score": 1,
"text": "血压"
},
{
"indices": [
30,
31,
32
],
"label": "dru",
"scor... |
纠正低血压要避免剧烈血压波动，否则会诱发脑出血。 | [
{
"indices": [
2,
3,
4
],
"label": "dis",
"score": 1,
"text": "低血压"
},
{
"indices": [
8,
9,
10,
11,
12,
13
],
"label": "sym",
"score": 1,
"text": "剧烈血压波动"
},
{
"indices": [
10,
11
],
"label"... |
在有肺动脉高压时，目前不主张用全身性扩张血管药物，因可造成全身血管舒张导致低血压。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "肺动脉高压"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "dru",
"score": 1,
"text": "全身性扩张血管药物"
},
{... |
可以考虑应用关闭动脉导管药物和吸入NO等治疗方式。 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "应用关闭动脉导管药物"
},
{
"indices": [
15,
16,
17,
18
],
"label": "pro",
"score": 1,
"text": "吸入NO"
}
] |
（四）护理对极低体重新生儿RDS，可通过伺服控制方式，调节环境温度在36.5～37℃，控制肛温在37℃。 | [
{
"indices": [
3,
4
],
"label": "pro",
"score": 1,
"text": "护理"
},
{
"indices": [
6,
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "极低体重新生儿"
},
{
"indices": [
13,
14,
15
],
... |
不主张反复气道吸引、改变体位等护理，以减少因过多刺激带来脑血流剧烈波动导致颅内出血。 | [
{
"indices": [
3,
4,
5,
6,
7,
8
],
"label": "pro",
"score": 1,
"text": "反复气道吸引"
},
{
"indices": [
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "改变体位"
},
{
"indices": [
15,
16
],
... |
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