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4.血管扩张剂硝普钠及肼屈嗪可有效扩张外周血管，从而降低后负荷，增加心输出量及减低充盈压。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dru",
"score": 1,
"text": "血管扩张剂"
},
{
"indices": [
7,
8,
9
],
"label": "dru",
"score": 1,
"text": "硝普钠"
},
{
"indices": [
11,
12,
13
],
"label": "d... |
ACE抑制剂还有一定的抑制甚至逆转心肌病时的心室重塑作用。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "dru",
"score": 1,
"text": "ACE抑制剂"
},
{
"indices": [
17,
18,
19
],
"label": "dis",
"score": 1,
"text": "心肌病"
},
{
"indices": [
22,
23
],
"label":... |
5.其他治疗扩张性心肌病因心腔扩大血流淤滞，有可能发生血栓形成。 | [
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "扩张性心肌病"
},
{
"indices": [
13,
14,
15,
16
],
"label": "sym",
"score": 1,
"text": "心腔扩大"
},
{
"indices": [
13,
14
],... |
药物的选择依心动过速的原因而定。 | [
{
"indices": [
6,
7,
8,
9
],
"label": "sym",
"score": 1,
"text": "心动过速"
},
{
"indices": [
6
],
"label": "bod",
"score": 1,
"text": "心"
}
] |
6.心脏移植儿童心脏移植近年已增加，且改善了严重心肌病患儿的存活率。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "心脏移植"
},
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "儿童心脏移植"
},
{
"indices": [
22,
23,
24,... |
因此，重症心肌病患儿如积极的内科治疗无效，应考虑心脏移植。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "重症心肌病"
},
{
"indices": [
14,
15
],
"label": "dep",
"score": 1,
"text": "内科"
},
{
"indices": [
24,
25,
26,
27
],
"label": ... |
二、营养素的主要功能和角色营养素主要功能除了作为能源物质外，其次还作为“建筑”材料，构成和修补机体组织、满足生长发育以及合成机体的免疫物质和激素等。 | [
{
"indices": [
2,
3,
4
],
"label": "dru",
"score": 1,
"text": "营养素"
},
{
"indices": [
47,
48,
49,
50
],
"label": "bod",
"score": 1,
"text": "机体组织"
},
{
"indices": [
65,
66,
67,
68
],
"label"... |
第四节支原体肺炎支原体肺炎（mycoplasmalpneumonia）由肺炎支原体（mycoplasmapneumoniae，MP）引起。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "支原体肺炎"
},
{
"indices": [
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "支原体肺炎"
},
{
"indices": [
14,
15,
16... |
北京首都儿科研究所报道，MP肺炎占住院儿童肺炎的19.2%～21.9%。 | [
{
"indices": [
4,
5
],
"label": "dep",
"score": 1,
"text": "儿科"
},
{
"indices": [
12,
13,
14,
15
],
"label": "dis",
"score": 1,
"text": "MP肺炎"
},
{
"indices": [
19,
20,
21,
22
],
"label": "dis",
... |
北美和欧洲的研究表明，MP占肺炎的15.0%～34.3%，并随年龄增长而增多。 | [
{
"indices": [
11,
12
],
"label": "mic",
"score": 1,
"text": "MP"
},
{
"indices": [
14,
15
],
"label": "dis",
"score": 1,
"text": "肺炎"
}
] |
【病因】该病病原体为MP，它是介于细菌和病毒之间的一种微生物，能在细胞外独立生活，具有RNA和DNA。 | [
{
"indices": [
6,
7,
8
],
"label": "mic",
"score": 1,
"text": "病原体"
},
{
"indices": [
10,
11
],
"label": "mic",
"score": 1,
"text": "MP"
},
{
"indices": [
17,
18
],
"label": "mic",
"score": 1,
"text": "细菌"
... |
患儿常有发热、畏寒、头痛、咽痛、咳嗽、全身不适、疲乏、食欲缺乏、恶心、呕吐、腹泻等症状，但鼻部卡他症状少见。 | [
{
"indices": [
4,
5
],
"label": "sym",
"score": 1,
"text": "发热"
},
{
"indices": [
7,
8
],
"label": "sym",
"score": 1,
"text": "畏寒"
},
{
"indices": [
10,
11
],
"label": "sym",
"score": 1,
"text": "头痛"
},
{
... |
婴幼儿可表现为憋气，年长儿可感胸闷、胸痛。 | [
{
"indices": [
7,
8
],
"label": "sym",
"score": 1,
"text": "憋气"
},
{
"indices": [
15,
16
],
"label": "sym",
"score": 1,
"text": "胸闷"
},
{
"indices": [
15
],
"label": "bod",
"score": 1,
"text": "胸"
},
{
"indices... |
年长患儿肺部常无阳性体征，这是本病的特点之一。 | [
{
"indices": [
4,
5
],
"label": "bod",
"score": 1,
"text": "肺部"
}
] |
少数病例呼吸音减弱，有干、湿啰音，这些体征常在X线改变之后出现。 | [
{
"indices": [
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "呼吸音减弱"
},
{
"indices": [
11,
12,
13,
14,
15
],
"label": "sym",
"score": 1,
"text": "干、湿啰音"
},
{
"indices": [
23,
24
],
... |
此外，可发生肺脓疡、胸膜炎、肺不张、支气管扩张症、弥漫性间质性肺纤维化等。 | [
{
"indices": [
6,
7,
8
],
"label": "dis",
"score": 1,
"text": "肺脓疡"
},
{
"indices": [
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "胸膜炎"
},
{
"indices": [
14,
15,
16
],
"label": "dis",
"score":... |
本病尚可并发神经系统、血液系统、心血管系统、皮肤、肌肉和关节等肺外并发症，如脑膜脑炎、神经根神经炎、心肌炎、心包炎、肾炎、血小板减少、溶血性贫血、噬血细胞综合征及皮疹，尤其是Stevens-Johnson综合征。 | [
{
"indices": [
6,
7,
8,
9
],
"label": "bod",
"score": 1,
"text": "神经系统"
},
{
"indices": [
11,
12,
13,
14
],
"label": "bod",
"score": 1,
"text": "血液系统"
},
{
"indices": [
16,
17,
18,
19,
2... |
多发生在呼吸道症状出现后10天左右。 | [
{
"indices": [
4,
5,
6
],
"label": "bod",
"score": 1,
"text": "呼吸道"
},
{
"indices": [
4,
5,
6,
7,
8
],
"label": "sym",
"score": 1,
"text": "呼吸道症状"
}
] |
【实验室检查】X线胸部摄片多表现为单侧病变，大多数侵犯下叶，以右下叶为多，常呈淡薄片状或云雾状浸润，从肺门延伸至肺野，呈支气管肺炎的改变。 | [
{
"indices": [
7,
8,
9,
10,
11,
12
],
"label": "pro",
"score": 1,
"text": "X线胸部摄片"
},
{
"indices": [
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20
],
"lab... |
少数呈均匀的实变阴影，类似大叶性肺炎。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9
],
"label": "sym",
"score": 1,
"text": "均匀的实变阴影"
},
{
"indices": [
13,
14,
15,
16,
17
],
"label": "dis",
"score": 1,
"text": "大叶性肺炎"
}
] |
外周血白细胞计数大多正常，但也有白细胞减少或偏高者。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7
],
"label": "ite",
"score": 1,
"text": "外周血白细胞计数"
},
{
"indices": [
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "sym",
"score": 1,
"text": ... |
部分患儿血清转氨酶、乳酸脱氢酶、碱性磷酸酶增高。 | [
{
"indices": [
4,
5,
6,
7,
8
],
"label": "bod",
"score": 1,
"text": "血清转氨酶"
},
{
"indices": [
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
... |
血清抗体可通过补体结合试验、间接血球凝集试验、酶联免疫吸附试验、间接免疫荧光试验等方法测定，或通过检测抗原得到早期诊断。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "ite",
"score": 1,
"text": "血清抗体"
},
{
"indices": [
7,
8,
9,
10,
11,
12
],
"label": "pro",
"score": 1,
"text": "补体结合试验"
},
{
"indices": [
14,
15,
16... |
【诊断与鉴别诊断】根据以下临床特征可初步诊断：①多发年龄5～18岁；②咳嗽突出而持久；③肺部体征少而X线改变出现早且严重；④用青霉素无效，红霉素治疗效果好；⑤外周血白细胞计数正常或升高；⑥血清冷凝集阳性。 | [
{
"indices": [
35,
36,
37,
38,
39,
40,
41
],
"label": "sym",
"score": 1,
"text": "咳嗽突出而持久"
},
{
"indices": [
44,
45
],
"label": "bod",
"score": 1,
"text": "肺部"
},
{
"indices": [
44,
45,
46,
... |
确诊必须靠呼吸道分泌物中检出MP及特异性抗体IgM检查阳性。 | [
{
"indices": [
5,
6,
7,
8,
9,
10
],
"label": "bod",
"score": 1,
"text": "呼吸道分泌物"
},
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "sym",
"score": 1,
"t... |
早期诊断法有ELISA法、单克隆抗体法检测MP抗原，特异IgM及PCR法检测DNA等。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "pro",
"score": 1,
"text": "早期诊断法"
},
{
"indices": [
6,
7,
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "ELISA法"
},
{
"indices": [
13,
14,... |
【治疗】首选大环内酯类抗生素如红霉素，疗程一般较长，不少于2周，停药过早易于复发。 | [
{
"indices": [
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "dru",
"score": 1,
"text": "大环内酯类抗生素"
},
{
"indices": [
15,
16,
17
],
"label": "dru",
"score": 1,
"text": "红霉素"
}
] |
近年来研究表明新合成的大环内酯类抗生素阿奇霉素、克拉霉素等具有与红霉素同等的抗菌活性，而且耐受性较好。 | [
{
"indices": [
11,
12,
13,
14,
15,
16,
17,
18
],
"label": "dru",
"score": 1,
"text": "大环内酯类抗生素"
},
{
"indices": [
19,
20,
21,
22
],
"label": "dru",
"score": 1,
"text": "阿奇霉素"
},
{
"indices": [... |
近年来有人认为重症MP肺炎的发病可能与人体免疫反应有关，因此，对急性期病情较重者，或肺部病变迁延而出现肺不张、肺间质纤维化，支气管扩张者，或有肺外并发症者，可应用肾上腺皮质激素口服或静脉用药，一般疗程为3～5天。 | [
{
"indices": [
7,
8,
9,
10,
11,
12
],
"label": "dis",
"score": 1,
"text": "重症MP肺炎"
},
{
"indices": [
42,
43
],
"label": "bod",
"score": 1,
"text": "肺部"
},
{
"indices": [
51,
52,
53
],
"label... |
第十四章病毒性脑膜炎、脑炎第一节中枢神经系统病毒感染概述中枢神经系统病毒感染的临床表现多种多样，以急性无菌性脑膜炎或脑炎最为常见。 | [
{
"indices": [
4,
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "病毒性脑膜炎"
},
{
"indices": [
11,
12
],
"label": "dis",
"score": 1,
"text": "脑炎"
},
{
"indices": [
16,
17,
18,
19,
20,... |
可以引起中枢神经系统感染的病毒多种多样，常见者包括单纯疱疹病毒（herpessimplexvirus，HSV）、肠道病毒以及EB病毒（Epstein-Barrvirus，EBV）等。 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "中枢神经系统感染"
},
{
"indices": [
13,
14
],
"label": "mic",
"score": 1,
"text": "病毒"
},
{
"indices": [
27,
28,
2... |
除少数病毒外，中枢神经系统病毒感染的治疗缺乏特效方法。 | [
{
"indices": [
3,
4
],
"label": "mic",
"score": 1,
"text": "病毒"
},
{
"indices": [
7,
8,
9,
10,
11,
12,
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "中枢神经系统病毒感染"
}
] |
例如虫媒病毒感染好发于相应虫媒生活的地域和季节。 | [
{
"indices": [
2,
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "虫媒病毒感染"
},
{
"indices": [
13,
14
],
"label": "mic",
"score": 1,
"text": "虫媒"
}
] |
多数中枢神经系统病毒感染累及所有年龄人群，无明显的季节或地域差异，例如单纯疱疹病毒性脑炎。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "中枢神经系统病毒感染"
},
{
"indices": [
35,
36,
37,
38,
39,
40,
41,
42,
43
],
"label": "di... |
我国近年来随着脊髓灰质炎病毒疫苗的强化接种，野病毒株感染者已经消失。 | [
{
"indices": [
7,
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "dru",
"score": 1,
"text": "脊髓灰质炎病毒疫苗"
},
{
"indices": [
17,
18,
19,
20
],
"label": "pro",
"score": 1,
"text": "强化接种"
},
{
"ind... |
目前疱疹病毒、肠道病毒（除脊髓灰质炎病毒外）和呼吸道病毒（如腺病毒）等几类病毒感染占本病的大多数。 | [
{
"indices": [
2,
3,
4,
5
],
"label": "mic",
"score": 1,
"text": "疱疹病毒"
},
{
"indices": [
7,
8,
9,
10
],
"label": "mic",
"score": 1,
"text": "肠道病毒"
},
{
"indices": [
13,
14,
15,
16,
17,
... |
【临床分类】根据起病和病程特点，神经系统病毒感染一般可分为四类：急性、亚急性、慢性和胚胎脑病（表16-16）。 | [
{
"indices": [
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "神经系统病毒感染"
},
{
"indices": [
32,
33,
34,
35,
36,
37,
38,
39,
40,
41,
42,
43,
... |
首先根据核酸类型，再根据核酸分子量、结构、衣壳的对称型、壳粒数、包膜和病毒形态与大小等进一步分类。 | [
{
"indices": [
4,
5
],
"label": "mic",
"score": 1,
"text": "核酸"
},
{
"indices": [
12,
13
],
"label": "mic",
"score": 1,
"text": "核酸"
},
{
"indices": [
21,
22
],
"label": "mic",
"score": 1,
"text": "衣壳"
},
{
... |
比病毒更小的传染因子被称为亚病毒（subvirus），包括类病毒（viroid）、拟病毒（virusoid）和朊病毒。 | [
{
"indices": [
1,
2
],
"label": "mic",
"score": 1,
"text": "病毒"
},
{
"indices": [
6,
7,
8,
9
],
"label": "mic",
"score": 1,
"text": "传染因子"
},
{
"indices": [
13,
14,
15
],
"label": "mic",
"score": 1,... |
其中朊病毒是1982年美国学者Prusiner首先报道的一种对核酸酶有抵抗性的感染性蛋白质，被称为朊蛋白（prion），是引起疯牛（羊）病和人类CJD及库鲁（Kuru）病等中枢神经系统慢感染（以前称为慢病毒感染）的致癌因子表16-9神经系统病毒感染的临床类型与疾病*</sup>由朊蛋白（prion）感染所致表16-10DNA病毒的分类【常见病毒所致神经系统感染的临床特点】不同病毒所致神经系统感染的临床特点有所差异（表16-16）。 | [
{
"indices": [
2,
3,
4
],
"label": "mic",
"score": 1,
"text": "朊病毒"
},
{
"indices": [
31,
32,
33
],
"label": "mic",
"score": 1,
"text": "核酸酶"
},
{
"indices": [
39,
40,
41,
42,
43,
44
],
... |
表16-11RNA病毒的分类表16-12常见病毒与神经系统疾病+++，关系极密切；++，关系密切；+，有一定关系；？ | [
{
"indices": [
6,
7,
8,
9,
10
],
"label": "mic",
"score": 1,
"text": "RNA病毒"
},
{
"indices": [
22,
23
],
"label": "mic",
"score": 1,
"text": "病毒"
},
{
"indices": [
25,
26,
27,
28,
29,
30... |
五、经导管关闭房间隔缺损及室间隔缺损房间隔缺损与室间缺损是常见的先天性心脏病，通常需要开胸体外转流下进行直视关闭术。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "pro",
"score": 1,
"text": "经导管关闭"
},
{
"indices": [
7,
8,
9,
10,
11
],
"label": "dis",
"score": 1,
"text": "房间隔缺损"
},
{
"indices": [
13,
14,
15,... |
虽然手术死亡率低，但仍有一定的并发症、切口瘢痕形成与术后远期影响等问题。 | [
{
"indices": [
2,
3
],
"label": "pro",
"score": 1,
"text": "手术"
},
{
"indices": [
19,
20,
21,
22,
23,
24
],
"label": "sym",
"score": 1,
"text": "切口瘢痕形成"
}
] |
因此，经导管关闭房、室间隔缺损一直为先天性心脏病介入性治疗研究的热点。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "经导管关闭"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "房、室间隔缺损"
},
{
"indices": [
... |
另外，随着先天性心脏病手术技术的进展，复杂型心脏病应用生理纠正术，如高危单心室病人作Fontan手术后有较高的并发症及死亡率，术后多死于低心排伴中心静脉压增高。 | [
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13,
14
],
"label": "pro",
"score": 1,
"text": "先天性心脏病手术技术"
},
{
"indices": [
19,
20,
21,
22,
23,
24
],
"label": "dis",
"score": 1,
"te... |
因此，设计开窗的Fontan手术，术时于左右心房之间的房间隔补片上留有直径4～6mm的小窗，术后使留有不同程度的心房水平右向左分流，以维持左心室负荷、心排量及限制中心静脉压增加。 | [
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "pro",
"score": 1,
"text": "开窗的Fontan手术"
},
{
"indices": [
20,
21,
22,
23,
24,
25,
26,
27,
28,
29... |
一旦病人术后循环获得调整，数天或数月后用导管法关闭房间隔交通。 | [
{
"indices": [
20,
21,
22
],
"label": "pro",
"score": 1,
"text": "导管法"
},
{
"indices": [
25,
26,
27
],
"label": "bod",
"score": 1,
"text": "房间隔"
}
] |
由于这些病人再次开胸手术较困难及危险性较大，而经导管关闭房间隔缺损为最好选择，因此促进了非开胸关闭的装置和技术的研究。 | [
{
"indices": [
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "开胸手术"
},
{
"indices": [
23,
24,
25,
26,
27,
28,
29,
30,
31,
32
],
"label": "pro",
"score": 1,
"text": "经导管关闭房间隔缺损"
},
... |
经导管关闭术的指征仍在研究中。 | [
{
"indices": [
0,
1,
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "经导管关闭术"
}
] |
室间隔缺损的堵塞器安置较房间隔缺损困难，并发症亦较多，目前进行的病例还不多，尚缺乏中远期随访。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "dis",
"score": 1,
"text": "室间隔缺损"
},
{
"indices": [
6,
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "堵塞器安置"
},
{
"indices": [
12,
13,
14,
... |
（一）经导管房间隔缺损关闭术1976年，King及Mille首次报道经静脉双伞堵塞装置关闭继发孔型房间隔缺损获得成功，但需7.7mm（23F）递送系统。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "经导管房间隔缺损关闭术"
},
{
"indices": [
35,
36,
37,
38,
39,
40,
41,
42
],
"label": "... |
随后Rashkind等应用堵塞动脉导管未闭的双伞装置关闭房间隔缺损，先后经单面伞状带钩的堵塞装置，双伞无钩的堵塞器，但仍需3.33mm（10F）递送系统。 | [
{
"indices": [
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25
],
"label": "equ",
"score": 1,
"text": "堵塞动脉导管未闭的双伞装置"
},
{
"indices": [
28,
29,
30,
31,
32
],
"label": "d... |
以后Lock等改进该装置，成为蚌壳状式闭合器，以适合房间隔缺损的需要，但关闭房间隔缺损的结果仍不尽满意。 | [
{
"indices": [
15,
16,
17,
18,
19,
20,
21
],
"label": "equ",
"score": 1,
"text": "蚌壳状式闭合器"
},
{
"indices": [
26,
27,
28,
29,
30
],
"label": "dis",
"score": 1,
"text": "房间隔缺损"
},
{
"indices": [... |
为此，Sideris等研制成纽扣式双盘堵塞装置，该装置较以上的堵塞器安置方便、安全，而且可使递送系统的直径减至2.67mm（8F），使该技术适合婴儿病人使用，但并发症仍较高，且残余分流率也高。 | [
{
"indices": [
14,
15,
16,
17,
18,
19,
20,
21,
22
],
"label": "equ",
"score": 1,
"text": "纽扣式双盘堵塞装置"
},
{
"indices": [
31,
32,
33
],
"label": "equ",
"score": 1,
"text": "堵塞器"
},
{
"indices": [... |
1998年Amplatzer双盘自膨性房间隔堵塞装置（AGAmedicalcorporation）面世，由于其具有自膨性、自向心性、完全封堵率高、并发症少、操作方便、递送导管小等优点而迅速风靡全球。 | [
{
"indices": [
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25
],
"label": "equ",
"score": 1,
"text": "双盘自膨性房间隔堵塞装置"
},
{
"indices": [
27,
28,
29,
30,
31,
32,
33,
34,
... |
作者所在单位的临床应用表明技术成功率达100%，即刻残余分流率＜7%，随访1月分流全部消失，无并发症发生，因而该术值得推广，但其中长期疗效尚需进一步随访研究。 | [
{
"indices": [
26,
27,
28,
29,
30,
31,
32,
33
],
"label": "sym",
"score": 1,
"text": "残余分流率＜7%"
},
{
"indices": [
26,
27,
28,
29
],
"label": "ite",
"score": 1,
"text": "残余分流"
},
{
"indices": [... |
1.适应证及禁忌证（适用于Amplatzer双盘自膨性房间隔缺损堵塞装置）（1）适应证：①继发孔型房间隔缺损；②小儿病例通常直径≤30mm；③右室扩大有右室容量负荷增加的证据；④左向右分流；⑤缺损边缘至冠状窦、房室瓣和右上叶肺静脉的距离≥5mm。 | [
{
"indices": [
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,
34,
35
],
"label": "equ",
"score": 1,
"text": "Amplatzer双盘自... |
（2）禁忌证：①伴有需胸外科手术的先天性心脏畸形；②原发孔型房间隔缺损；③静脉窦型房间隔缺损；④肺静脉异位引流（完全性或部分性）；⑤严重肺动脉高压/双向或右向左分流。 | [
{
"indices": [
11,
12,
13
],
"label": "dep",
"score": 1,
"text": "胸外科"
},
{
"indices": [
17,
18,
19,
20,
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "先天性心脏畸形"
},
{
"indices": [
26,
27,
... |
2.方法全麻下经皮股静脉穿刺，各心腔全套血流动力学检查，包括压力及血氧饱和度检测。 | [
{
"indices": [
4,
5
],
"label": "pro",
"score": 1,
"text": "全麻"
},
{
"indices": [
7,
8,
9,
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "经皮股静脉穿刺"
},
{
"indices": [
15,
16,
17,
1... |
四腔位行右上肺静脉造影以确定房间隔缺损大小，并与食管超声结果相比较。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "四腔位行右上肺静脉造影"
},
{
"indices": [
14,
15,
16,
17,
18
],
"label": "dis",
"score": 1,
"text":... |
然后用球囊测量导管跨房间隔缺损以稀释造影剂扩张球囊，球囊两侧二凹陷点间的距离为房间隔缺损伸展直径。 | [
{
"indices": [
3,
4
],
"label": "equ",
"score": 1,
"text": "球囊"
},
{
"indices": [
7,
8
],
"label": "equ",
"score": 1,
"text": "导管"
},
{
"indices": [
10,
11,
12,
13,
14
],
"label": "dis",
"score": 1,... |
同时在透视及食管超声下测量。 | [
{
"indices": [
3,
4
],
"label": "pro",
"score": 1,
"text": "透视"
},
{
"indices": [
6,
7,
8,
9
],
"label": "pro",
"score": 1,
"text": "食管超声"
}
] |
再以同样量造影剂在体外扩张球囊，用测量板测量轻度变形时的球囊直径。 | [
{
"indices": [
5,
6,
7
],
"label": "dru",
"score": 1,
"text": "造影剂"
},
{
"indices": [
13,
14
],
"label": "equ",
"score": 1,
"text": "球囊"
},
{
"indices": [
17,
18,
19
],
"label": "equ",
"score": 1,
"te... |
选择腰部直径等于或大于房间隔缺损伸展直径1～2mm的Amplatzer房间隔缺损封堵器。 | [
{
"indices": [
2,
3,
4,
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,
30,
31,
... |
装置经股静脉途径在长引导鞘内推送，在透视及食管超声监视下先在左心房内释放左侧盘，回撤系统，使腰部卡于房间隔缺损，然后释放右盘。 | [
{
"indices": [
3,
4,
5
],
"label": "bod",
"score": 1,
"text": "股静脉"
},
{
"indices": [
9,
10,
11,
12
],
"label": "equ",
"score": 1,
"text": "长引导鞘"
},
{
"indices": [
18,
19
],
"label": "pro",
"score":... |
3.疗效评价由于该法设计合理，操作较稳定安全，根据大系列报道该堵塞装置技术成功率高达97%，一年完全堵塞率达94.9%，但远期随访，包括血流动力学、心功能等其结果尚待进一步评价。 | [
{
"indices": [
31,
32,
33,
34
],
"label": "equ",
"score": 1,
"text": "堵塞装置"
},
{
"indices": [
68,
69,
70,
71,
72
],
"label": "pro",
"score": 1,
"text": "血流动力学"
},
{
"indices": [
74,
75,
76
... |
4.并发症由于Amplatzer堵塞器操作方便、安全、成功率高，因此该法并发症较少。 | [
{
"indices": [
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18
],
"label": "equ",
"score": 1,
"text": "Amplatzer堵塞器"
}
] |
除术时有一过性心律失常外，偶有堵塞器脱落、心包填塞、二尖瓣关闭不全、局部血管并发症等。 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10
],
"label": "sym",
"score": 1,
"text": "一过性心律失常"
},
{
"indices": [
15,
16,
17,
18,
19
],
"label": "sym",
"score": 1,
"text": "堵塞器脱落"
},
{
"indices": [
... |
5.随访术前3天及术后3～6个月内口服阿司匹林3～5mg/（kg•d）预防血小板在堵塞器上过度凝聚。 | [
{
"indices": [
17,
18
],
"label": "pro",
"score": 1,
"text": "口服"
},
{
"indices": [
19,
20,
21,
22
],
"label": "dru",
"score": 1,
"text": "阿司匹林"
},
{
"indices": [
37,
38,
39,
40,
41,
42,
... |
术前后常规抗生素静脉点滴以预防感染。 | [
{
"indices": [
5,
6,
7
],
"label": "dru",
"score": 1,
"text": "抗生素"
},
{
"indices": [
8,
9,
10,
11
],
"label": "pro",
"score": 1,
"text": "静脉点滴"
},
{
"indices": [
15,
16
],
"label": "dis",
"score": ... |
术后1月、3月、6月、1年门诊随访。 | [
{
"indices": [
13,
14
],
"label": "dep",
"score": 1,
"text": "门诊"
}
] |
随访内容包括超声心动图、胸片、心电图及血常规等，以确定是否有残余分流、装置异位及溶血等并发症。 | [
{
"indices": [
6,
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "超声心动图"
},
{
"indices": [
12,
13
],
"label": "pro",
"score": 1,
"text": "胸片"
},
{
"indices": [
15,
16,
17
],
"label": "pro",
... |
（二）经导管室间隔缺损关闭术自1988年Lock等首先报道应用双伞堵塞装置经导管关闭室间隔缺损以来，目前已有多种室间隔缺损封堵装置问世，包括蚌壳状封堵装置、Rashkind动脉导管未闭封堵装置、纽扣式补片装置以及近期推出的Amplatzer室间隔缺损封堵装置等。 | [
{
"indices": [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "pro",
"score": 1,
"text": "经导管室间隔缺损关闭术"
},
{
"indices": [
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
... |
由于经导管堵塞技术的复杂性、效果不确切及经验有限，目前尚不能确定哪一种装置更优越，或是否经导管室间隔缺损关闭术优于外科手术。 | [
{
"indices": [
2,
3,
4,
5,
6,
7,
8
],
"label": "pro",
"score": 1,
"text": "经导管堵塞技术"
},
{
"indices": [
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54
],
"label": "pro",
"sco... |
目前可经导管关闭的室间隔缺损的类型主要为肌部室间隔缺损及部分膜部室间隔缺损。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "pro",
"score": 1,
"text": "经导管关闭"
},
{
"indices": [
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "室间隔缺损"
},
{
"indices": [
20,
21,
2... |
第四节军团菌感染1976年美国费城暴发军团菌肺炎，军团菌肺炎是一种以肺部感染为主、伴全身多系统损害的急性传染病，可引起任何年龄的感染。 | [
{
"indices": [
3,
4,
5,
6,
7
],
"label": "dis",
"score": 1,
"text": "军团菌感染"
},
{
"indices": [
19,
20,
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "军团菌肺炎"
},
{
"indices": [
25,
26,
... |
在儿童的肺部感染性疾病中也很重要。 | [
{
"indices": [
4,
5,
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "肺部感染性疾病"
}
] |
【病原与流行病学】军团菌是一种机会致病菌，有42个种，64个血清型，其中至少19个种与人类疾病有关。 | [
{
"indices": [
9,
10,
11
],
"label": "mic",
"score": 1,
"text": "军团菌"
},
{
"indices": [
15,
16,
17,
18,
19
],
"label": "mic",
"score": 1,
"text": "机会致病菌"
},
{
"indices": [
30,
31
],
"label": "bod"... |
与人类关系最为密切的为嗜肺军团菌种（Legionellapneumophile，Lp），已发现15个血清型（L1～L15）。 | [
{
"indices": [
11,
12,
13,
14,
15
],
"label": "mic",
"score": 1,
"text": "嗜肺军团菌"
},
{
"indices": [
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31,
32,
33,... |
军团菌为需氧革兰染色阴性杆菌，是一种人类单核细胞和巨噬细胞的兼性细胞内寄生菌，培养和分离困难。 | [
{
"indices": [
0,
1,
2
],
"label": "mic",
"score": 1,
"text": "军团菌"
},
{
"indices": [
4,
5,
6,
7,
8,
9,
10,
11,
12,
13
],
"label": "mic",
"score": 1,
"text": "需氧革兰染色阴性杆菌"
},
{
"indices":... |
流行病学调查发现军团菌暴发与冷却塔、热水系统、温泉浴等水装置或花盆肥料有关。 | [
{
"indices": [
8,
9,
10
],
"label": "mic",
"score": 1,
"text": "军团菌"
}
] |
儿童感染军团菌的危险因素有慢性疾患及应用免疫抑制剂。 | [
{
"indices": [
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "感染军团菌"
},
{
"indices": [
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "慢性疾患"
},
{
"indices": [
20,
21,
22,
2... |
新生儿军团菌病的高危因素有早产、先天性心脏病、支气管发育不良和接受激素治疗。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "新生儿军团菌病"
},
{
"indices": [
13,
14
],
"label": "dis",
"score": 1,
"text": "早产"
},
{
"indices": [
16,
17,
18,
19,... |
小儿军团菌肺炎病情相对较重。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "dis",
"score": 1,
"text": "小儿军团菌肺炎"
}
] |
污染有军团菌的直径小于5μm的小颗粒气溶胶可直接穿入支气管和肺部造成感染。 | [
{
"indices": [
3,
4,
5
],
"label": "mic",
"score": 1,
"text": "军团菌"
},
{
"indices": [
26,
27,
28
],
"label": "bod",
"score": 1,
"text": "支气管"
},
{
"indices": [
30,
31
],
"label": "bod",
"score": 1,
"t... |
军团菌产生的有害物质可造成组织损伤：外膜蛋白MIP可促进吞噬细胞对细菌的摄入并破坏细胞的杀菌功能；Lp的外毒素有消化卵黄囊和灭活抗糜蛋白酶的作用；脂多糖Lps作为内毒素有利于细菌黏附宿主细胞，保护细菌免受细胞内酶的破坏，促进单核/吞噬细胞对细菌的摄入，阻止吞噬体与溶酶体的融合；磷酸酶和蛋白酶影响吞噬细胞的杀菌功能。 | [
{
"indices": [
0,
1,
2
],
"label": "mic",
"score": 1,
"text": "军团菌"
},
{
"indices": [
13,
14,
15,
16
],
"label": "dis",
"score": 1,
"text": "组织损伤"
},
{
"indices": [
28,
29,
30,
31
],
"label"... |
【病理改变】肺炎急性期为多灶性纤维素性化脓性炎症，分两型：Ⅰ型为急性纤维素性化脓性肺炎95%，以大量纤维素渗出，中性粒细胞崩解，细胞碎片及巨噬细胞为主；Ⅱ型为急性弥漫性肺泡损伤。 | [
{
"indices": [
6,
7
],
"label": "dis",
"score": 1,
"text": "肺炎"
},
{
"indices": [
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23
],
"label": "dis",
"score": 1,
"text": "多灶性纤维素性化脓性炎症"
},
... |
病变中可见肺泡上皮增生、脱屑及透明膜形成，严重者可致蜂窝肺。 | [
{
"indices": [
5,
6,
7,
8,
9,
10
],
"label": "dis",
"score": 1,
"text": "肺泡上皮增生"
},
{
"indices": [
12,
13
],
"label": "sym",
"score": 1,
"text": "脱屑"
},
{
"indices": [
13
],
"label": "bod",
"score":... |
急性后期为机化性肺炎。 | [
{
"indices": [
5,
6,
7,
8,
9
],
"label": "dis",
"score": 1,
"text": "机化性肺炎"
}
] |
胸膜病变为浆液性、浆液纤维素性胸膜炎或化脓性胸膜炎。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "dis",
"score": 1,
"text": "胸膜病变"
},
{
"indices": [
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17
],
"label": "dis",
"score": 1,
"te... |
开始有短暂不适，急起高热，体温最高可达40℃以上，伴寒战，干咳，全身肌肉酸痛明显，恶心、腹痛、腹泻等胃肠道症状显著。 | [
{
"indices": [
0,
1,
2,
3,
4,
5,
6
],
"label": "sym",
"score": 1,
"text": "开始有短暂不适"
},
{
"indices": [
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
... |
军团菌肺炎临床表现复杂，病情程度差异悬殊，轻者无明显临床症状，重者可引起以肺部感染为主的多器官损害，如ARDS、急性肾衰竭、休克和弥漫性血管内凝血。 | [
{
"indices": [
0,
1,
2,
3,
4
],
"label": "dis",
"score": 1,
"text": "军团菌肺炎"
},
{
"indices": [
37,
38,
39,
40
],
"label": "dis",
"score": 1,
"text": "肺部感染"
},
{
"indices": [
44,
45,
46,
4... |
常有以下较为特殊的临床表现：①与高热不相称的相对缓脉；②剧烈胸痛，在成人易误诊为肺栓塞；③胃肠道症状显著，为水样便，呈无菌性腹泻；④电解质紊乱，可合并低钠血症、低钾血症，此项表现有助于诊断和鉴别诊断；⑤多汗症状突出。 | [
{
"indices": [
16,
17,
18,
19,
20,
21,
22,
23,
24,
25
],
"label": "sym",
"score": 1,
"text": "高热不相称的相对缓脉"
},
{
"indices": [
28,
29,
30,
31
],
"label": "sym",
"score": 1,
"text": "剧烈胸痛"
}... |
【影像学检查】X线的表现呈多样性、缺乏特异性，可见斑片影、纱网影、边缘清楚的小结节影、条索影、弥漫肺浸润影等，胸腔积液相对多见。 | [
{
"indices": [
1,
2,
3,
4,
5
],
"label": "pro",
"score": 1,
"text": "影像学检查"
},
{
"indices": [
7,
8
],
"label": "pro",
"score": 1,
"text": "X线"
},
{
"indices": [
25,
26,
27
],
"label": "sym",
"... |
肺CT可发现早期病灶。 | [
{
"indices": [
0,
1,
2
],
"label": "pro",
"score": 1,
"text": "肺CT"
},
{
"indices": [
0,
1,
2,
3,
4,
5,
6,
7,
8,
9
],
"label": "sym",
"score": 1,
"text": "肺CT可发现早期病灶"
},
{
"indices": [
... |
吸收较慢，有人认为军团菌肺炎的吸收是最慢的。 | [
{
"indices": [
0,
1,
2,
3
],
"label": "sym",
"score": 1,
"text": "吸收较慢"
},
{
"indices": [
9,
10,
11,
12,
13
],
"label": "dis",
"score": 1,
"text": "军团菌肺炎"
},
{
"indices": [
15,
16,
17,
1... |
【诊断】根据国内1992年制定的军团菌肺炎诊断标准：①临床表现如发热、寒战、咳嗽、胸痛等呼吸道感染症状；②X线胸片具有炎性阴影；③呼吸道分泌物、痰、血或胸水在活性炭母浸液琼脂培养基BCYE或其他特殊培养基上培养有军团菌生长；④呼吸道分泌物直接荧光法DFA检查阳性；⑤血间接荧光法IFA检查前后2次抗体滴度呈4倍或以上增高，达1∶128或以上；血试管凝集实验TAT检查前后2次抗体滴度呈4倍或以上增高，达1∶160或以上；血微量凝集实验MAA检查前后2次抗体滴度呈4倍或以上增高，达1∶64或以上。 | [
{
"indices": [
16,
17,
18,
19,
20
],
"label": "dis",
"score": 1,
"text": "军团菌肺炎"
},
{
"indices": [
32,
33
],
"label": "sym",
"score": 1,
"text": "发热"
},
{
"indices": [
35,
36
],
"label": "sym",
"sco... |
凡具有以上①、②项，同时具有③、④、⑤项中任何一项者，即可诊断为军团菌肺炎。 | [
{
"indices": [
32,
33,
34,
35,
36
],
"label": "dis",
"score": 1,
"text": "军团菌肺炎"
}
] |
对于IFA或TAT效价有一次增高，IFA=1∶256或TAT=1∶320，同时有临床及X线胸片炎症表现的病例可考虑为可疑军团菌肺炎。 | [
{
"indices": [
2,
3,
4
],
"label": "ite",
"score": 1,
"text": "IFA"
},
{
"indices": [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
],
"label": "sym",
"score": 1,
"text"... |
【治疗】（1）抗菌治疗。 | [
{
"indices": [
7,
8,
9,
10
],
"label": "pro",
"score": 1,
"text": "抗菌治疗"
}
] |
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