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年长儿多见鼻病毒感染。 | [
{
"indices": [
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "鼻病毒感染"
}
] |
2.支原体感染由于婴幼儿免疫系统不成熟，支原体可以引起婴幼儿呼吸道慢性感染，若处理不恰当，可以导致反复不愈的咳嗽和喘息。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "支原体感染"
},
{
"indices": [
12,
13,
14,
15
],
"label": "bod",
"score": 1,
"text": "免疫系统"
},
{
"indices": [
12,
13,
14,
1... |
3.呼吸道局灶性感染慢性鼻窦炎、鼻炎、中耳炎、慢性扁桃体炎，是常见的儿童上呼吸道慢性局灶性病变，一方面可以引起反复的感染，另一方面又可以通过神经反射引起反复的咳喘，需要对这些病灶进行及时处理。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "呼吸道局灶性感染"
},
{
"indices": [
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "慢性鼻窦炎"
},
{
"indices"... |
（二）吸入过敏物质持续低浓度变应原吸入可以诱发慢性气道变应性炎症，促进气道高反应形成，但短时间吸入高浓度变应原可以诱发急性哮喘发作。 | [
{
"indices": [
5,
6
],
"label": "sym",
"score": 1,
"text": "过敏"
},
{
"indices": [
23,
24,
25,
26,
27,
28,
29,
30,
31
],
"label": "dis",
"score": 1,
"text": "慢性气道变应性炎症"
},
{
"indices": [
35,
... |
这类诱因诱发的哮喘发作较为突然，无上呼吸道感染症状，多数在环境中过敏原浓度较高的季节发作。 | [
{
"indices": [
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "哮喘发作"
},
{
"indices": [
17,
18,
19,
20,
21,
22
],
"label": "dis",
"score": 1,
"text": "上呼吸道感染"
},
{
"indices": [
32,
33
]... |
（三）胃食管反流由于解剖结构的原因，也有医源性因素（如应用氨茶碱、β受体兴奋药等）可以引起胃食管反流，在婴幼儿尤为多见，它是导致喘息反复不愈的重要原因之一。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "胃食管反流"
},
{
"indices": [
29,
30,
31
],
"label": "dru",
"score": 1,
"text": "氨茶碱"
},
{
"indices": [
33,
34,
35,
36,
37... |
临床上多表现为入睡中出现剧烈的咳嗽、喘息，平时有回奶或呕吐现象。 | [
{
"indices": [
7,
8,
9,
10,
11,
12,
13,
14,
15,
16
],
"label": "sym",
"score": 1,
"text": "入睡中出现剧烈的咳嗽"
},
{
"indices": [
18,
19
],
"label": "sym",
"score": 1,
"text": "喘息"
},
{
"indices": [
... |
（四）其他吸入刺激性气体或剧烈运动、哭闹，以及油漆、煤烟、冷空气吸入均可作为非特异性刺激物诱发哮喘发作，其中油漆散发的气体可触发严重而持续的咳喘发作，应尽量避免。 | [
{
"indices": [
47,
48,
49,
50
],
"label": "dis",
"score": 1,
"text": "哮喘发作"
},
{
"indices": [
64,
65,
66,
67,
68,
69,
70,
71,
72,
73
],
"label": "sym",
"score": 1,
"text": "严重而持续的咳喘发作"
}... |
剧烈运动、哭闹使呼吸运动加快，呼吸道温度降低或呼吸道内液体渗透压改变，而诱发哮喘发作。 | [
{
"indices": [
8,
9,
10,
11,
12,
13
],
"label": "sym",
"score": 1,
"text": "呼吸运动加快"
},
{
"indices": [
15,
16,
17
],
"label": "bod",
"score": 1,
"text": "呼吸道"
},
{
"indices": [
15,
16,
17,
... |
三、抗胆碱能药物正常人的气道有静态张力，主要受胆碱能神经（迷走神经）的控制。 | [
{
"indices": [
3,
4,
5,
6,
7,
8
],
"label": "dru",
"score": 1,
"text": "抗胆碱能药物"
},
{
"indices": [
13,
14
],
"label": "bod",
"score": 1,
"text": "气道"
},
{
"indices": [
24,
25,
26,
27,
28
... |
哮喘患儿可能由于气道上皮破坏，神经末梢暴露或其他原因，使胆碱能神经的张力及反射加强，是引起气道高反应的重要因素之一；临床常用的抗胆碱能药物主要为阿托品和溴化异丙托品。 | [
{
"indices": [
0,
1
],
"label": "dis",
"score": 1,
"text": "哮喘"
},
{
"indices": [
8,
9,
10,
11
],
"label": "bod",
"score": 1,
"text": "气道上皮"
},
{
"indices": [
8,
9,
10,
11,
12,
13
],
"... |
阿托品为叔胺类复合物，脂溶性强，容易从黏膜吸收，可以口服给药；但由于其体内分布广泛，系统性不良反应较多；而且可以进入血脑屏障，引起疲劳、烦躁、头痛症状，目前已很少用于哮喘的治疗。 | [
{
"indices": [
0,
1,
2
],
"label": "dru",
"score": 1,
"text": "阿托品"
},
{
"indices": [
4,
5,
6,
7,
8,
9
],
"label": "dru",
"score": 1,
"text": "叔胺类复合物"
},
{
"indices": [
19,
20
],
"label": "b... |
溴化异丙托品为季胺类化合物，水溶性强，不容易吸收，全身不良反应小，但局部作用强；而且对支气管平滑肌M受体的选择性强，对分泌腺的影响小，不易出现气道分泌物干结现象。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "dru",
"score": 1,
"text": "溴化异丙托品"
},
{
"indices": [
7,
8,
9,
10,
11,
12
],
"label": "dru",
"score": 1,
"text": "季胺类化合物"
},
{
"indices": [
25... |
由于胆碱能神经在气道的分布不均匀，在大气道分布多，而在小气道分布少，因此应用抗胆碱药后，主要使大气道松弛；当大气道收缩明显时，才有一定的松弛作用。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dru",
"score": 1,
"text": "胆碱能神经"
},
{
"indices": [
8,
9
],
"label": "bod",
"score": 1,
"text": "气道"
},
{
"indices": [
18,
19,
20
],
"label": "bod",
"... |
β肾上腺素受体激动药则对大、小气道均有明显的松弛作用，这与抗胆碱药有所不同。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "dru",
"score": 1,
"text": "β肾上腺素受体激动药"
},
{
"indices": [
12,
13,
14,
15,
16
],
"label": "bod",
"score": 1,
"text": "大、小气道"
... |
一般在哮喘治疗中抗胆碱药与β<sub>2</sub>受体激动剂合用而起到相互协同作用。 | [
{
"indices": [
3,
4
],
"label": "dis",
"score": 1,
"text": "哮喘"
},
{
"indices": [
8,
9,
10,
11
],
"label": "dru",
"score": 1,
"text": "抗胆碱药"
},
{
"indices": [
13,
14,
15,
16,
17,
18,
19,... |
现有剂型为：①爱全乐pMDI：20μg/揿，1～2揿/次，3～4次/天；②爱全乐溶液：0.025%溶液，＜2岁0.5ml，＞2岁1ml，＜4次/天，喷射雾化吸入。 | [
{
"indices": [
7,
8,
9,
10,
11,
12,
13
],
"label": "dru",
"score": 1,
"text": "爱全乐pMDI"
},
{
"indices": [
37,
38,
39,
40,
41
],
"label": "dru",
"score": 1,
"text": "爱全乐溶液"
},
{
"indices": [
... |
第八节新生儿呕吐呕吐是新生儿期常见症状，是一系列复杂的神经反射活动。 | [
{
"indices": [
6,
7
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
8,
9
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
27,
28
],
"label": "bod",
"score": 1,
"text": "神经"
}
] |
新生儿胃容量小、胃呈横位、贲门括约肌发育不完善、幽门括约肌发育较好、肠道蠕动的神经调节功能较差，由于这些解剖生理特点，新生儿容易发生呕吐。 | [
{
"indices": [
3
],
"label": "bod",
"score": 1,
"text": "胃"
},
{
"indices": [
8
],
"label": "bod",
"score": 1,
"text": "胃"
},
{
"indices": [
13,
14,
15,
16,
17
],
"label": "bod",
"score": 1,
"text": "贲门括约肌"... |
【病因】（一）消化系统疾病各种消化系统疾病都可引起呕吐，主要有消化道先天畸形、梗阻、炎症、感染、出血、功能失调等。 | [
{
"indices": [
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "消化系统疾病"
},
{
"indices": [
15,
16,
17,
18,
19,
20
],
"label": "dis",
"score": 1,
"text": "消化系统疾病"
},
{
"indices": [
... |
1.消化系统功能紊乱如吞咽功能不协调、胃食管反流、贲门失弛缓症、幽门痉挛、胎粪性便秘、胎粪排出延迟等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "消化系统功能紊乱"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "吞咽功能不协调"
... |
2.消化道黏膜受刺激如咽下综合征、胃出血、应激性溃疡、牛奶过敏等。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "bod",
"score": 1,
"text": "消化道黏膜"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "咽下综合征"
},
{
"indices": [
17,
18,
... |
3.消化系统感染及炎症如急性胃炎、急性肠炎、坏死性小肠结肠炎、腹膜炎等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "消化系统感染"
},
{
"indices": [
9,
10
],
"label": "dis",
"score": 1,
"text": "炎症"
},
{
"indices": [
12,
13,
14,
15
],
... |
4.消化道梗阻多数为先天畸形所致。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "消化道梗阻"
},
{
"indices": [
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "先天畸形"
}
] |
少见疾病有嵌顿疝、肠套叠等。 | [
{
"indices": [
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "嵌顿疝"
},
{
"indices": [
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "肠套叠"
}
] |
（二）全身性疾病许多全身性疾病可引起呕吐，常见的有以下几方面：1.感染新生儿感染常引起呕吐，如败血症、呼吸道感染、泌尿系统感染等。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "全身性疾病"
},
{
"indices": [
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "全身性疾病"
},
{
"indices": [
18,
19
],
... |
2.颅内压增高引起颅内压增高的疾病多会导致呕吐，如中枢神经系统感染、脑水肿、脑积水、颅内出血、颅内肿瘤等。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "颅内压增高"
},
{
"indices": [
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "颅内压增高"
},
{
"indices": [
21,
22
],
... |
3.先天性代谢性疾病一些先天性代谢性疾病由于代谢紊乱而导致呕吐，如氨基酸代谢疾病（高氨血症、苯丙酮尿症、甘氨酸血症）、糖代谢疾病（半乳糖血症、枫糖尿症）、肾上腺皮质增生症等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "先天性代谢性疾病"
},
{
"indices": [
12,
13,
14,
15,
16,
17,
18,
19
],
"label": "dis",
"score": 1,
"text": ... |
（三）其他因素一些疾病因素也可引起新生儿呕吐。 | [
{
"indices": [
20,
21
],
"label": "sym",
"score": 1,
"text": "呕吐"
}
] |
2.药物许多药物可引起消化道反应，发生呕吐，如红霉素、两性霉素B等。 | [
{
"indices": [
11,
12,
13
],
"label": "bod",
"score": 1,
"text": "消化道"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "sym",
"score": 1,
"text": "消化道反应"
},
{
"indices": [
19,
20
],
"label": "sym... |
【临床特点】（一）溢乳和喂养不当1.溢乳新生儿溢乳比较常见，但溢乳没有神经反射参与，不属于真正的呕吐。 | [
{
"indices": [
9,
10
],
"label": "sym",
"score": 1,
"text": "溢乳"
},
{
"indices": [
18,
19
],
"label": "sym",
"score": 1,
"text": "溢乳"
},
{
"indices": [
23,
24
],
"label": "sym",
"score": 1,
"text": "溢乳"
},
{
... |
溢乳的原因与食管弹力组织和肌肉发育不完善有关。 | [
{
"indices": [
0,
1
],
"label": "sym",
"score": 1,
"text": "溢乳"
},
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "bod",
"score": 1,
"text": "食管弹力组织"
},
{
"indices": [
6,
7,
8,
9,
10,
... |
溢乳多发生在喂奶后不久，乳汁从口角边溢出，喂奶后体位改变可引起溢乳。 | [
{
"indices": [
0,
1
],
"label": "sym",
"score": 1,
"text": "溢乳"
},
{
"indices": [
7
],
"label": "bod",
"score": 1,
"text": "奶"
},
{
"indices": [
12,
13
],
"label": "bod",
"score": 1,
"text": "乳汁"
},
{
"indices"... |
2.喂养不当新生儿喂养不当非常多见，主要原因有：喂奶次数过于频繁，喂奶量太多，浓度不适合，牛乳太热或太凉，配方乳多变；奶嘴孔过大或过小，乳母乳头下陷；喂奶后平卧，体位多动。 | [
{
"indices": [
70,
71,
72,
73
],
"label": "sym",
"score": 1,
"text": "乳头下陷"
},
{
"indices": [
70,
71
],
"label": "bod",
"score": 1,
"text": "乳头"
}
] |
（二）与内科疾病有关的呕吐1.吞咽功能不协调喂奶时即呕吐，常伴有呛咳或吸入，一部分乳汁从鼻孔流出。 | [
{
"indices": [
4,
5
],
"label": "dep",
"score": 1,
"text": "内科"
},
{
"indices": [
11,
12
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
15,
16,
17,
18,
19,
20,
21
],
"label": ... |
2.胃食管反流（GER）是新生儿呕吐的常见原因，尤其是早产儿。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "胃食管反流"
},
{
"indices": [
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "GER"
},
{
"indices": [
16,
17
],
"label": "sym",
... |
主要与新生儿食管下端括约肌较松弛、胃排空延迟、腹内压增高等因素有关。 | [
{
"indices": [
6,
7,
8,
9,
10,
11,
12
],
"label": "bod",
"score": 1,
"text": "食管下端括约肌"
},
{
"indices": [
17
],
"label": "bod",
"score": 1,
"text": "胃"
},
{
"indices": [
23,
24,
25,
26,
2... |
常在喂奶后不久出现呕吐或表现为溢乳，呕吐物常为不带胆汁的奶液。 | [
{
"indices": [
9,
10
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
15,
16
],
"label": "sym",
"score": 1,
"text": "溢乳"
},
{
"indices": [
18,
19,
20
],
"label": "bod",
"score": 1,
"text": "呕吐物... |
3.胃黏膜受刺激出生时咽下羊水或产道血液，刺激胃黏膜引起呕吐。 | [
{
"indices": [
2,
3,
4
],
"label": "bod",
"score": 1,
"text": "胃黏膜"
},
{
"indices": [
13,
14
],
"label": "bod",
"score": 1,
"text": "羊水"
},
{
"indices": [
16,
17,
18,
19
],
"label": "bod",
"score": ... |
未开奶前即可出现呕吐，开奶后呕吐加重，呕吐物为泡沫样黏液或带血性，用生理盐水洗胃1～2次，呕吐即可停止。 | [
{
"indices": [
8,
9
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "呕吐加重"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
2... |
4.幽门痉挛为幽门神经肌肉功能暂时性失调所致，解剖结构无异常。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "幽门痉挛"
},
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19
],
"label": "sym",
"score":... |
呕吐常发生在生后2～3周，呈间隙性，可为喷射状，呕吐物不含胆汁，与幽门肥厚性狭窄较难鉴别，试用1∶1000阿托品可缓解。 | [
{
"indices": [
0,
1
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
20,
21,
22
],
"label": "sym",
"score": 1,
"text": "喷射状"
},
{
"indices": [
24,
25,
26,
27,
28,
29,
30
],
... |
5.胎粪延迟排出正常新生儿在生后24小时内开始排胎粪，3天排完。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "胎粪延迟排出"
},
{
"indices": [
2,
3
],
"label": "bod",
"score": 1,
"text": "胎粪"
},
{
"indices": [
24,
25
],
"label": "bod",
"... |
6.感染性疾病肠道内感染或肠道外感染均可引起新生儿呕吐，常伴有感染表现如神萎、食欲缺乏，肠道内感染伴有腹泻、腹胀。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "感染性疾病"
},
{
"indices": [
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "肠道内感染"
},
{
"indices": [
13,
14,
15,... |
7.先天性代谢性疾病发生呕吐时间无规律性，一般呕吐较频繁和剧烈，常伴有其他代谢病的临床表现，如酸中毒、电解质紊乱、脱水、肝脾大等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "先天性代谢性疾病"
},
{
"indices": [
12,
13
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
23,
24,
25,... |
（三）与外科疾病有关的呕吐1.食管闭锁和食管气管瘘食管闭锁者第一次喂奶（或喂水）时即发生呕吐，伴食管气管瘘者喂奶时出现呼吸困难、青紫，肺部闻湿啰音，每次喂奶时均出现类似情况。 | [
{
"indices": [
4,
5
],
"label": "dep",
"score": 1,
"text": "外科"
},
{
"indices": [
11,
12
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
15,
16,
17,
18
],
"label": "dis",
"score": 1,
"te... |
2.幽门肥厚性狭窄常于生后第2周左右开始出现呕吐，呕吐量多，呕吐物为乳汁或乳凝块，酸臭味，无胆汁。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "幽门肥厚性狭窄"
},
{
"indices": [
22,
23
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
25,
26,
27,
28
... |
呕吐常呈进行性加重，伴脱水、电解质紊乱、营养不良。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "呕吐常呈进行性加重"
},
{
"indices": [
11,
12
],
"label": "sym",
"score": 1,
"text": "脱水"
},
{
"indices": [
14,
15,... |
腹部可见明显的胃型，右上腹可触及枣核大小的肿块。 | [
{
"indices": [
0,
1
],
"label": "bod",
"score": 1,
"text": "腹部"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "腹部可见明显的胃型"
},
{
"indices": [
7
],
"l... |
3.十二指肠和小肠疾病患儿常有严重呕吐，呕吐物有绿色胆汁，位置较高者生后不久即呕吐，腹胀不明显，位置较低者呕吐出现晚一些，呕吐物为棕色粪便样物质，混有深色胆汁，腹胀明显，肠鸣音活跃，可见肠型、肠蠕动波。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "十二指肠和小肠疾病"
},
{
"indices": [
15,
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "严重呕吐"
},
{
"indices"... |
4.直肠肛门疾病一般先有腹胀，后出现呕吐，肠鸣音活跃，腹部平片显示肠腔扩张，多个液平。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "直肠肛门疾病"
},
{
"indices": [
12,
13
],
"label": "sym",
"score": 1,
"text": "腹胀"
},
{
"indices": [
12
],
"label": "bod",
"score": ... |
先天性巨结肠患儿生后便秘，灌肠后腹胀减轻。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "先天性巨结肠"
},
{
"indices": [
10,
11
],
"label": "sym",
"score": 1,
"text": "便秘"
},
{
"indices": [
13,
14
],
"label": "pro",
... |
（四）呕吐所致的并发症新生儿呕吐时常发生一些并发症，需密切注意。 | [
{
"indices": [
3,
4
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
14,
15
],
"label": "sym",
"score": 1,
"text": "呕吐"
}
] |
1.窒息与猝死新生儿呕吐会使呕吐物进入呼吸道，发生窒息，如呕吐物多、没有及时发现可导致猝死。 | [
{
"indices": [
2,
3
],
"label": "dis",
"score": 1,
"text": "窒息"
},
{
"indices": [
5,
6
],
"label": "dis",
"score": 1,
"text": "猝死"
},
{
"indices": [
10,
11
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
... |
2.吸入综合征呕吐物进入气道可发生吸入性肺炎，出现咳嗽、呼吸困难，长时间反复吸入可使吸入性肺炎迁延不愈。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "吸入综合征"
},
{
"indices": [
7,
8,
9
],
"label": "bod",
"score": 1,
"text": "呕吐物"
},
{
"indices": [
7,
8,
9,
10,
11,
... |
3.呼吸暂停早产儿呕吐可发生呼吸暂停。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "呼吸暂停"
},
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "早产儿"
},
{
"indices": [
9,
10
],
"label": "sym",
"score": 1,
... |
4.出血剧烈呕吐可导致胃黏膜损伤，发生出血，呕吐物呈血性。 | [
{
"indices": [
2,
3
],
"label": "sym",
"score": 1,
"text": "出血"
},
{
"indices": [
3
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "剧烈呕吐"
},... |
5.水电解质紊乱呕吐较频繁者，因丧失大量水分和电解质，导致水电解质平衡紊乱，患儿出现脱水、酸中毒、低钠血症等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "水电解质紊乱"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "sym",
"score": 1,
"text": "呕吐较频繁"
},
{
"indices": [
16,
17... |
【诊断与鉴别诊断】要详细询问病史，了解分娩时情况、发生呕吐的时间、呕吐特点、伴随症状等，仔细体格检查，初步考虑呕吐的定位和性质，并做进一步的检查，以明确诊断。 | [
{
"indices": [
27,
28
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
33,
34
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
46,
47,
48,
49
],
"label": "pro",
"score": 1,
"... |
（一）定位根据呕吐发生的时间、呕吐特点、呕吐物、是否有腹胀、肠型、便秘等情况，初步判断消化道疾病的位置。 | [
{
"indices": [
7,
8
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
15,
16
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
20,
21,
22
],
"label": "bod",
"score": 1,
"text": "呕吐物"... |
1.上消化道呕吐出现时间早，呕吐物为乳汁或乳凝块，不含胆汁，腹胀不明显。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "bod",
"score": 1,
"text": "上消化道"
},
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "sym",
"score": 1,
"text": "上消化道呕吐"
},
{
"indices": [
14,
15,
16,
... |
2.下消化道生后1～2天即呕吐，呕吐物含较多胆汁，腹胀不明显，提示病变在十二指肠或空肠上段。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "bod",
"score": 1,
"text": "下消化道"
},
{
"indices": [
13,
14
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
16,
17,
18,
19,
20,
21,
22,... |
如呕吐物含黄绿色粪便样物质，腹部有较细的肠型和肠蠕动，提示病变在空肠下段或回肠。 | [
{
"indices": [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "sym",
"score": 1,
"text": "呕吐物含黄绿色粪便样物质"
},
{
"indices": [
1,
2,
3
],
"label": "bod",
"score": 1,
"text": "呕吐物"
},... |
而直肠病变的呕吐常发生在出生3天以后，呕吐物含棕色粪便样物质，腹胀明显，肠型较粗大，可触及粪块。 | [
{
"indices": [
1,
2,
3,
4
],
"label": "dis",
"score": 1,
"text": "直肠病变"
},
{
"indices": [
6,
7
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
19,
20,
21,
22,
23,
24,
25,
... |
（二）定性为使呕吐原发病得到及时治疗，要鉴别是内科疾病还是外科疾病所致。 | [
{
"indices": [
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "呕吐原发病"
},
{
"indices": [
23,
24
],
"label": "dep",
"score": 1,
"text": "内科"
},
{
"indices": [
29,
30
],
"label": "dep",
"score"... |
1.内科疾病呕吐症状不剧烈，呕吐次数不频繁，呕吐物常不含胆汁或粪便，有较明显的消化系统以外的症状和体征，常提示呕吐为内科疾病所致。 | [
{
"indices": [
2,
3
],
"label": "dep",
"score": 1,
"text": "内科"
},
{
"indices": [
6,
7,
8,
9,
10,
11,
12
],
"label": "sym",
"score": 1,
"text": "呕吐症状不剧烈"
},
{
"indices": [
14,
15,
16,
17... |
2.外科疾病呕吐出现早，频繁，较剧烈，呕吐物含胆汁、血液或粪便，伴脱水和电解质紊乱，常提示呕吐为外科疾病所致。 | [
{
"indices": [
2,
3
],
"label": "dep",
"score": 1,
"text": "外科"
},
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "sym",
"score": 1,
"text": "呕吐出现早，频繁，较剧烈"
},
{
... |
（三）进一步检查对呕吐原发病的位置和性质有初步判断后，应及时做进一步的检查，以明确诊断。 | [
{
"indices": [
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "呕吐原发病"
}
] |
1.消化道影像学检查对消化道先天畸形的诊断有很大的帮助。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "pro",
"score": 1,
"text": "消化道影像学检查"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17
],
"label": "dis",
"score": 1,
"text": "消化道先天畸形"
... |
对胃食管反流，可做放射性核素检查。 | [
{
"indices": [
1,
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "胃食管反流"
},
{
"indices": [
9,
10,
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "放射性核素检查"
}
] |
对胃十二指肠、小肠部位的先天畸形，钡餐造影可帮助诊断，须注意检查结束时应洗胃，将胃内钡剂洗出，防止呕吐时钡剂。 | [
{
"indices": [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "胃十二指肠、小肠部位的先天畸形"
},
{
"indices": [
17,
18,
19,
20
],
"label":... |
2.中枢神经系统检查如怀疑中枢感染，应查脑脊液，对颅内出血或其他占位病变，应做头颅B超或CT检查。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "pro",
"score": 1,
"text": "中枢神经系统检查"
},
{
"indices": [
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "中枢感染"
},
{
"indices": [
2... |
3.血气分析及生化检查可了解患儿是否存在酸中毒、电解质紊乱。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "血气分析"
},
{
"indices": [
7,
8,
9,
10
],
"label": "ite",
"score": 1,
"text": "生化检查"
},
{
"indices": [
20,
21,
22
],
"label": "... |
4.内分泌及遗传代谢病检查如已排除消化道、中枢神经等疾病，而患儿仍然频繁呕吐，应进一步做内分泌、代谢病方面检查，如血氨、血糖等。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12
],
"label": "pro",
"score": 1,
"text": "内分泌及遗传代谢病检查"
},
{
"indices": [
17,
18,
19
],
"label": "bod",
"score": 1,
"text": "消化道"
},
{
... |
【治疗】（一）对症治疗1.禁食对一些病因未清楚、怀疑外科疾病、消化道出血，可先行禁食，以免加重病情，同时给予补液，保证营养供给。 | [
{
"indices": [
13,
14
],
"label": "pro",
"score": 1,
"text": "禁食"
},
{
"indices": [
26,
27
],
"label": "dep",
"score": 1,
"text": "外科"
},
{
"indices": [
31,
32,
33,
34,
35
],
"label": "dis",
"score"... |
2.洗胃对咽下综合征可先洗胃，用温生理盐水，一般洗2～3次即可，如洗胃后仍呕吐，应考虑其他疾病。 | [
{
"indices": [
2,
3
],
"label": "pro",
"score": 1,
"text": "洗胃"
},
{
"indices": [
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "咽下综合征"
},
{
"indices": [
12,
13
],
"label": "pro",
"score": 1,... |
3.胃肠减压对外科疾病、呕吐较频繁、腹胀者，可先行胃肠减压，缓解症状，同时做有关检查。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "胃肠减压"
},
{
"indices": [
7,
8
],
"label": "dep",
"score": 1,
"text": "外科"
},
{
"indices": [
12,
13,
14,
15,
16
],
"label": "s... |
4.解痉止吐对病因诊断为胃食管反流，可用胃动力制剂或解痉剂。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "解痉止吐"
},
{
"indices": [
12,
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "胃食管反流"
},
{
"indices": [
20,
21,
22,
... |
5.体位对呕吐患儿，应提高头部和上身的体位，一般30°左右。 | [
{
"indices": [
5,
6
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18,
19,
20
],
"label": "pro",
"score": 1,
"text": "提高头部和上身的体位"
}
] |
6.纠正水、电解质紊乱呕吐导致水、电解质紊乱，应及时纠正。 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "水、电解质紊乱"
},
{
"indices": [
11,
12
],
"label": "sym",
"score": 1,
"text": "呕吐"
},
{
"indices": [
15,
16,
17,
18... |
（二）病因治疗1.手术对外科疾病需手术治疗，手术时机根据病情而定。 | [
{
"indices": [
9,
10
],
"label": "pro",
"score": 1,
"text": "手术"
},
{
"indices": [
12,
13
],
"label": "dep",
"score": 1,
"text": "外科"
},
{
"indices": [
17,
18,
19,
20
],
"label": "pro",
"score": 1,
"t... |
2.抗感染对消化道感染或其他部位感染所致者，应给抗生素治疗。 | [
{
"indices": [
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "抗感染"
},
{
"indices": [
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "消化道感染"
},
{
"indices": [
16,
17
],
"label": "dis",
... |
3.止血消化道出血者，可用维生素K<sub>1</sub>、酚磺乙胺等止血。 | [
{
"indices": [
2,
3
],
"label": "pro",
"score": 1,
"text": "止血"
},
{
"indices": [
4,
5,
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "消化道出血"
},
{
"indices": [
13,
14,
15,
16
],
"label": "d... |
4.解除颅内高压脑水肿者用20%甘露醇每次0.5g/kg，每6～8小时1次，呋塞米每次0.5mg/kg，每天1～2次。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "解除颅内高压"
},
{
"indices": [
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "脑水肿"
},
{
"indices": [
13,
14,
15,
16,
... |
颅内占位病变行手术治疗，脑积水行引流术。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "颅内占位病变"
},
{
"indices": [
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "手术治疗"
},
{
"indices": [
12,
13,
14
... |
十、L型菌肺炎L型菌肺炎是临床上难治性呼吸道感染的病原体之一。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "L型菌肺炎"
},
{
"indices": [
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "L型菌肺炎"
},
{
"indices": [
16,
17,
18,... |
患儿常有肺炎不能解释的迁延发热，或原发病已愈，找不到继续发热的原因。 | [
{
"indices": [
4,
5
],
"label": "dis",
"score": 1,
"text": "肺炎"
},
{
"indices": [
11,
12,
13,
14
],
"label": "sym",
"score": 1,
"text": "迁延发热"
},
{
"indices": [
28,
29
],
"label": "sym",
"score": 1,
"... |
病情多不重，β-内酰胺类抗生素治疗无效。 | [
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16
],
"label": "pro",
"score": 1,
"text": "β-内酰胺类抗生素治疗"
}
] |
X线改变无特异性，多呈间质性肺炎改变。 | [
{
"indices": [
0,
1
],
"label": "pro",
"score": 1,
"text": "X线"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "间质性肺炎"
}
] |
三、各型结核的治疗方案（表7-7）表7-1各型结核的治疗方案 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "结核的治疗方案"
},
{
"indices": [
23,
24,
25,
26,
27,
28,
29
],
"label": "pro",
"score": 1,
"text": "结核的治疗方案"
}
] |
第六章风湿性疾病相关的实验室检查风湿性疾病（rheumaticdiseases）包含一大类慢性全身性疾病，人们认识这类疾病经历了漫长的实践、变迁过程。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "风湿性疾病"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "实验室检查"
},
{
"indices": [
16,
17,
... |
在命名上，西方与中国古代医学早有“风湿病”的名称，但两者在概念及内容上大相径庭，不可类比。 | [
{
"indices": [
17,
18,
19
],
"label": "dis",
"score": 1,
"text": "风湿病"
}
] |
本章中“风湿性疾病”仅涉及现代医学的“风湿病”范畴。 | [
{
"indices": [
4,
5,
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "风湿性疾病"
},
{
"indices": [
19,
20,
21
],
"label": "dis",
"score": 1,
"text": "风湿病"
}
] |
西方医学中，经典称谓的风湿病泛指“以疼痛为核心的骨、关节及肌肉等慢性疾病”。 | [
{
"indices": [
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "风湿病"
},
{
"indices": [
18,
19
],
"label": "sym",
"score": 1,
"text": "疼痛"
},
{
"indices": [
24
],
"label": "bod",
"score": 1,
"text": "骨"
},
{... |
至1941年Klemperer总结了系统性红斑狼疮和硬皮病经验以及Klinge的研究成果，认为风湿性疾病均为机体胶原组织病理损伤的结果，因此提出“胶原性疾病”的概念。 | [
{
"indices": [
18,
19,
20,
21,
22,
23,
24
],
"label": "dis",
"score": 1,
"text": "系统性红斑狼疮"
},
{
"indices": [
26,
27,
28
],
"label": "dis",
"score": 1,
"text": "硬皮病"
},
{
"indices": [
47,
48,
... |
但后来多数人认为风湿性疾病并不仅限于累及胶原组织，它可以是更广泛的结缔组织损伤。 | [
{
"indices": [
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "风湿性疾病"
},
{
"indices": [
18,
19,
20,
21,
22,
23
],
"label": "sym",
"score": 1,
"text": "累及胶原组织"
},
{
"indices": [
20,
... |
为此Ehrich建议将“胶原性疾病”更名为“结缔组织病”，故此命名又沿用了几十年。 | [
{
"indices": [
12,
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "胶原性疾病"
},
{
"indices": [
22,
23,
24,
25,
26
],
"label": "dis",
"score": 1,
"text": "结缔组织病"
}
] |
至20世纪中后期，大量的临床研究与实验研究发现，在很多结缔组织病病人体内能检出针对自身抗原的自身抗体和与自身细胞反应的致敏淋巴细胞以及病变组织中有各种抗体，补体与免疫复合物沉积及免疫活性细胞浸润，因而主张将结缔组织病更名为“自身免疫性疾病”。 | [
{
"indices": [
27,
28,
29,
30,
31
],
"label": "dis",
"score": 1,
"text": "结缔组织病"
},
{
"indices": [
39,
40,
41,
42,
43,
44,
45,
46,
47,
48,
49
],
"label": "bod",
"score": 1,
"te... |
20世纪末众多临床学家认为“结缔组织病”与“自身免疫性疾病”的命名强调了病理学与免疫学研究结果，但都不能全部涵盖风湿性疾病的特征，故主张仍使用风湿性疾病的名称。 | [
{
"indices": [
14,
15,
16,
17,
18
],
"label": "dis",
"score": 1,
"text": "结缔组织病"
},
{
"indices": [
22,
23,
24,
25,
26,
27,
28
],
"label": "dis",
"score": 1,
"text": "自身免疫性疾病"
},
{
"indices": [... |
但现代风湿病概念已特指自身免疫耐受破坏后，发生自身免疫损伤的一类风湿性疾病。 | [
{
"indices": [
3,
4,
5
],
"label": "dis",
"score": 1,
"text": "风湿病"
},
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18
],
"label": "sym",
"score": 1,
"text": "自身免疫耐受破坏"
},
{
"indices": [
23,
... |
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