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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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"text": "间歇指令通气"
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"indices": [
... |
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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"label": "pro",
"score": 1,
"text": "IMV"
},
{
"indices": [
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
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],
"label": "pro",
"... |
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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"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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24
],
"label": "pro",
... |
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": [
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8,
9,
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],
"label": "sym",
"score": 1,
"text": "无自主呼吸"
},
{
"indices": [
21,
22,
23
],
"label": "pro",
"score": 1,
"text": "IMV"
},
{
"indices": [
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],
"label"... |
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。 | [
{
"indices": [
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],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
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],
"label": "dis",
"score": 1,
"text": "小气道损伤"
},
{
"indices": [
38,
39,
40,
41,
... |
（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":... |
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。 | [
{
"indices": [
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9,
10
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
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31
],
"label": "equ",
"score": 1,
"text": "呼吸机"
},
{
"indices": [
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],
"label": "pro",
... |
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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"label": "pro",
"score": 1,
"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"
},
{
"indices": [
... |
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。 | [
{
"indices": [
2,
3,
4,
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],
"label": "pro",
"score": 1,
"text": "辅助通气"
},
{
"indices": [
17,
18,
19,
20
],
"label": "pro",
"score": 1,
"text": "机械通气"
},
{
"indices": [
22,
23,
24,
25
],
... |
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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],
"label": "pro",
"score": 1,
"text": "A/C"
},
{
"indices": [
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],
"label": "pro",
"score": 1,
"text": "辅助通气"
},
{
"indices": [
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],
"label": "p... |
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。 | [
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"score": 1,
"text": "A/C"
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{
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],
"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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"score": 1,
"text": "自主呼吸较强和较快"
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{
"indices": [
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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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"score": 1,
"text": "压力支持通气"
},
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"indices": [
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16,
17,
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19,
20,
21,
22,
23,
24,
25,
26,
... |
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。 | [
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"label": "dis",
"score": 1,
"text": "结核病"
},
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"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
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19,
20,
21... |
全身各个器官都可累及，以肺结核病为最常见。 | [
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"label": "bod",
"score": 1,
"text": "全身"
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],
"label": "sym",
"score": 1,
"text": "全身各个器官都可累及"
},
{
"indices": [
4,
... |
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": [
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],
"label": "mic",
"score": 1,
"text": "耐药结核菌株"
},
{
"indices": [
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25,
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],
"label": "dis",
"score": 1,
"text": "结核病"
},
{
"indices": [
28,
29,
30
... |
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。 | [
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"text": "感染性疾病"
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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。 | [
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"text": "结核病"
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] |
同样，我国结核病流行形势也十分严峻。 | [
{
"indices": [
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],
"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。 | [
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"label": "dru",
"score": 1,
"text": "卡介苗"
},
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"indices": [
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"label": "pro",
"score": 1,
"text": "接种"
},
{
"indices": [
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19,
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21
],
"label": "pro",
... |
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。 | [
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"label": "dis",
"score": 1,
"text": "病原结核病"
},
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"indices": [
8,
9
],
"label": "mic",
"score": 1,
"text": "病原"
},
{
"indices": [
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14
],
"label": "m... |
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": [
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],
"label": "mic",
"score": 1,
"text": "结核杆菌"
},
{
"indices": [
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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。 | [
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"indices": [
2,
3,
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],
"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。 | [
{
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6,
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],
"label": "dis",
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"text": "结核病"
},
{
"indices": [
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12,
13
],
"label": "mic",
"score": 1,
"text": "分枝杆菌"
},
{
"indices": [
17,
18,
19,
20
],
"label"... |
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。 | [
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"indices": [
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"label": "mic",
"score": 1,
"text": "分枝杆菌"
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"indices": [
11,
12,
13,
14
],
"label": "dis",
"score": 1,
"text": "免疫缺陷"
},
{
"indices": [
23,
24,
25,
26,
2... |
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。 | [
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"label": "pro",
"score": 1,
"text": "小儿血尿的鉴别诊断"
},
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"indices": [
12
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
12,
13
],
... |
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。 | [
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8,
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],
"label": "sym",
"score": 1,
"text": "真性血尿"
},
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"indices": [
8
],
"label": "bod",
"score": 1,
"text": "血"
},
{
"indices": [
9
],
"label": "bod",
"score": 1,
"text": "尿"
},
{
"... |
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"
... |
鉴别点在于尿镜检时无红细胞。 | [
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5,
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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",
... |
出血量超过1ml/L尿液，则可见肉眼血尿。 | [
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"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": [... |
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,
... |
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",
... |
【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... |
但最多见的是肾小球性血尿。 | [
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"indices": [
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],
"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",
... |
（一）肾小球性血尿指血尿部位来源于肾小球。 | [
{
"indices": [
3,
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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",
"s... |
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",
"sco... |
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,
... |
（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": "bo... |
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,
... |
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,
... |
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"... |
【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": [
... |
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... |
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"
},... |
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": "... |
（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,... |
（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,
1... |
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... |
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"... |
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"
},
{... |
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,
... |
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
],
... |
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,... |
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",
"s... |
【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,
... |
（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,
... |
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": [
... |
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,
... |
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,
... |
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": [
2... |
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,
... |
（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... |
（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,
... |
（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
],
... |
（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",
... |
（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": [
... |
【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... |
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... |
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,
... |
（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,
... |
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... |
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"... |
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... |
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"
},
{
"indice... |
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... |
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": [
... |
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": ... |
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": [
... |
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"... |
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
],... |
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,
... |
（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,
... |
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... |
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"
},
... |
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"... |
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,
2... |
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,
... |
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"... |
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