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B系淋巴细胞其他常用的分化抗原标记有TdT、HLA-DR、CD19、CD22、CD10、CD20以及CD24</sub>，其中CD20</sub>、CD10</sub>出现较晚，至前B淋巴细胞型才出现。 | [
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成熟B淋巴细胞白血病和B细胞性非霍奇金淋巴瘤细胞一样常表达SmIg。 | [
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（四）细胞遗传学检查1.染色体数量异常染色体数＜46条时称为低二倍体，当染色体＜40条时预后较差。 | [
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2.染色体结构异常常见的相对成熟B细胞型ALL染色体异常有t（8；14）、t（2；8）、t（8；22），与B细胞性非霍奇金淋巴瘤相同。 | [
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B系未成熟型ALL常见的染色体结构异常有t（11；v）、t（9；22）、t（1；19）、t（4；11）、t（12；21）等。 | [
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常见的TALL染色体结构异常有t（11；14）、t（8；14）、t（10；14）、t（1；14）t（4；11）等。 | [
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现代白血病诊断应包含形态学（morphology，M）、免疫学（immunology，I）、细胞遗传学（cytogenetics，C）和分子生物学（molecularbiology，M）即MICM综合诊断。 | [
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ALL还应作出临床危险型诊断，以指导临床治疗方案的选择。 | [
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（五）脑脊液检查ALL应常规作脑脊液检查，包括脑脊液常规细胞计数及分类、生化、离心甩片找肿瘤细胞。 | [
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美国国立癌症研究所（NCI）儿童ALL中枢神经系统白血病（CNSL）的诊断标准（表11-11）。 | [
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表11-7中枢神经系统白血病的诊断标准（六）影像学检查胸部X线平片可发现是否同时伴有纵隔增宽和肺门淋巴结增大。 | [
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腹部B型超声或CT可发现部分病例有不同程度的肾脏、肝脏的浸润性病变及腹腔淋巴结肿大骨扫描有异常浓集灶，骨X线平片可有虫蚀样病变或骨骺部白血病线。 | [
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（七）临床危险程度分型小儿ALL有明显影响预后的危险因素，国际上公认的因素包括：①诊断时外周血白细胞计数≥50×109</sup>/L；②年龄＜1岁或＞12岁；③诊断时有CNSL；④染色体核型为t（9；22）或t（4；11）异常者；⑤泼尼松诱导试验60mg/M2</sup>/d×7天，第8天外周血白血病细胞≥1×109</sup>/L（1000/μl），或治疗15～19天时骨髓幼稚淋巴细胞比例仍大于25%。 | [
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具备上述危险因素≥1项者为高危ALL（HR-ALL），提示预后较差，需较强烈的治疗方案；不存在其中任何1项者为标危ALL（SR-ALL），提示预后较好，在合理治疗下，长期无病生存率可达70%～85%。 | [
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近来国际上普遍认可在诱导缓解治疗结束时（诱导28天至35天）骨髓微量白血病残留（MRD）水平低于10-4</sup>时预后好。 | [
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【鉴别诊断】临床诊断ITP、再生障碍性贫血、粒细胞减少症、传染性单核细胞增多症、各种关节炎、类白血病反应时应想到本病，当不能肯定除外白血病时，即应及时作骨髓穿刺涂片进一步明确诊断。 | [
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1.对不明原因的贫血、出血、发热和不能以感染完全解释的发热，以及多脏器浸润症状表现者应考虑本病诊断。 | [
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2.对体格检查中发现有与出血程度不相符的贫血、肝、脾、淋巴结肿大者，尤其有腮腺、睾丸和软组织浸润肿大者，以及伴有骨、关节痛明显者应考虑本病的诊断。 | [
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3.外周血发现≥2个系列异常或见有幼稚细胞者应考虑到本病的可能，进一步作骨髓涂片检查。 | [
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【治疗】（一）治疗原则ALL以化学治疗（化疗）为主要手段。 | [
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化疗的主要原则是按临床危险型选择不同强度的治疗方案，强调早期连续合理强烈化疗和坚持长期持续化疗，同时给予鞘内化疗预防CNSL的发生。 | [
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化疗过程中应密切观察，进行有效的对症治疗和并发症的预防和治疗，包括瘤细胞性栓塞，肿瘤溶解综合征，水、电解质平衡，贫血，出血，DIC，各脏器特别是心、肝、肾正常功能的维持，各种感染及各种化疗药物毒副反应的防治。 | [
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同种异体造血干细胞移植适用于难治性及复发性ALL，宜在CR后进行移植。 | [
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（二）化疗ALL化疗基本组成部分包括诱导缓解治疗、缓解后巩固治疗、CNSL预防性治疗、再诱导治疗、和维持治疗。 | [
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] |
1.诱导缓解治疗ALL诱导缓解治疗首选国内外常用的标准方案VDLP方案：即长春新碱（VCR）1.5mg/m2</sup>，每周1次×4次；柔红霉素（DNR）30mg/m2</sup>，每周1次，共2～3次（HR-ALL用3次，SR-ALL用2次）；左旋-门冬酰胺酶（L-Asparaginase，L-ASP）6000～10000U/m2，隔天1次共6～8次（HR-ALL用8次，SR-ALL用6次）；泼尼松（Prednisone）每天60mg/m2</sup>，分三次口服，共28天，减停7天。 | [
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{
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{
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{
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{
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{
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"entity": "HR-ALL",
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"id": 12,
"entity": "SR-ALL",
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{
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"entity": "泼尼松",
"start_offset": 200,
"end_offset": 203,
"label": "dru"
},
{
"id": 14,
"entity": "Prednisone",
"start_offset": 204,
"end_offset": 214,
"label": "dru"
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] |
2.缓解后巩固治疗推荐用CAT方案，环磷酰胺（CTX）800～1000/m2第1天，阿糖胞苷（Ara-C）每日100mg/m2×7天，每日分2次（q12h），皮下注射；6-硫鸟嘌呤（6-TG）或6-鸟嘌呤（6-MP），每日75mg/m2，晚间顿服×7日；HR-ALL时可采用中、大剂量Ara-C，1～2g/m2，q12h×4～6次，CTX和6-mp同上。 | [
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"entity": "6-硫鸟嘌呤",
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"id": 7,
"entity": "6-TG",
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"id": 8,
"entity": "6-鸟嘌呤",
"start_offset": 97,
"end_offset": 102,
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"id": 9,
"entity": "6-MP",
"start_offset": 103,
"end_offset": 107,
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"id": 10,
"entity": "HR-ALL",
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"entity": "Ara-C",
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"entity": "CTX",
"start_offset": 166,
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{
"id": 13,
"entity": "6-mp",
"start_offset": 170,
"end_offset": 174,
"label": "dru"
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] |
3.CNSL及其他髓外白血病预防采用头颅放疗预防CNSL者越来越少。 | [
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{
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{
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"entity": "CNSL",
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HDMTX在巩固治疗休疗结束后开始，每隔10～15天1次，用3次，高危（HR-ALL）共用5～6次，低危（LR-ALL）共用3～5次。 | [
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{
"id": 2,
"entity": "LR-ALL",
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每次MTX剂量为3000～5000mg（HR）/m2</sup>，1/6静脉推注15分钟（不超过500mg），余量于24小时内均匀滴入。 | [
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{
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"entity": "静脉推注",
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在推注后30～120分钟之间鞘内注入“三联”化疗（见后）。 | [
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"entity": "推注",
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"id": 1,
"entity": "化疗",
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"end_offset": 24,
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于治疗起第37小时用四氢叶酸钙（CF）15mg/m2</sup>共6～8次，首剂静注，以后可改q6h口服。 | [
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"entity": "口服",
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有条件者检测血浆MTX浓度（＜0.1mol/L为无毒性浓度），以调整CF应用的次数和剂量。 | [
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"label": "ite"
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若44小时时＜1mol，68小时时＜0.1mol，则CF用6次即可，否则要延长并增加解救剂量。 | [
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"id": 0,
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预防毒性措施包括水化、碱化，化疗前3天起口服碳酸氢钠0.5～1.0g，每日3次，化疗当天起用5%碳酸氢钠5ml/kg静滴，每天补液1/5张含钠溶液3000ml/m2</sup>，24小时内均匀滴入，共4天。 | [
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"id": 0,
"entity": "水化",
"start_offset": 8,
"end_offset": 10,
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{
"id": 1,
"entity": "碱化",
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{
"id": 2,
"entity": "化疗",
"start_offset": 14,
"end_offset": 16,
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{
"id": 3,
"entity": "碳酸氢钠",
"start_offset": 22,
"end_offset": 26,
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"id": 4,
"entity": "化疗",
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{
"id": 5,
"entity": "碳酸氢钠",
"start_offset": 48,
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{
"id": 6,
"entity": "静滴",
"start_offset": 58,
"end_offset": 60,
"label": "pro"
},
{
"id": 7,
"entity": "含钠溶液",
"start_offset": 69,
"end_offset": 73,
"label": "dru"
}
] |
用药前肝、肾功能必须正常。 | [
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"entity": "肝",
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"end_offset": 4,
"label": "bod"
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{
"id": 1,
"entity": "肾",
"start_offset": 5,
"end_offset": 6,
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] |
鞘内化疗：诱导治疗开始后2～5天起每周鞘内注射MTX、Ara-c、地塞米松（DX）“三联”化疗1次，共5～6次，以后每3月1次至治疗结束。 | [
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"entity": "鞘内化疗",
"start_offset": 0,
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"id": 1,
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"label": "dru"
},
{
"id": 7,
"entity": "化疗",
"start_offset": 45,
"end_offset": 47,
"label": "pro"
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MTX剂量为12.5mg/m2</sup>（最大12.5mg）；Ara-C1mg/kg（最大50mg）；DX0～2岁为2.5mg，＞2岁5mg。 | [
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"id": 0,
"entity": "MTX",
"start_offset": 0,
"end_offset": 3,
"label": "dru"
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{
"id": 1,
"entity": "Ara-C",
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{
"id": 2,
"entity": "DX",
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"end_offset": 54,
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4.再诱导治疗一般在第3次HDMTX+CF10～14天起，HR-ALL的早期强化治疗分2个阶段，第一阶段用VDLP，与诱导治疗的不同之处是DNR和VCR每周1次共2次，泼尼松剂量每天45mg/m2</sup>共14天，逐渐减量，7天内停药，口服。 | [
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"id": 1,
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"start_offset": 69,
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{
"id": 7,
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},
{
"id": 8,
"entity": "泼尼松",
"start_offset": 84,
"end_offset": 87,
"label": "dru"
}
] |
第二阶段用VP-16每次200mg/m2，Ara-c每次300mg/m2，每3天1次，共3次，静滴。 | [
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"entity": "VP-16",
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"entity": "静滴",
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SR-ALL的早期强化只用VDLP。 | [
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"entity": "SR-ALL",
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{
"id": 1,
"entity": "VDLP",
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5.维持治疗MTX肌注或口服20～30mg/m2</sup>每周1次共3周，同时6-巯基嘌呤（6-MP）每天75mg/m2共21天，口服；后接VCR1.5mg/m2</sup>1次，泼尼松剂量每天45mg/m2</sup>共7天；如此每4周1个周期，周而复始，并根据个体外周血白细胞计数调整MTX和6-MP剂量，使白细胞计数维持在（2.8～3.0）×109</sup>/L。 | [
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{
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"entity": "泼尼松",
"start_offset": 91,
"end_offset": 94,
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{
"id": 5,
"entity": "外周血",
"start_offset": 135,
"end_offset": 138,
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{
"id": 6,
"entity": "白细胞",
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{
"id": 9,
"entity": "白细胞",
"start_offset": 157,
"end_offset": 160,
"label": "bod"
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] |
ALL总治疗期限男孩为2.5～3年，女孩2～2.5年。 | [
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"entity": "ALL",
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] |
6.CNSL治疗按剂量“三联”鞘注化疗8次，隔天1次至脑脊液中肿瘤细胞消失（一般鞘注2～3次后脑脊液大多转阴），以后每周2次至总共8次。 | [
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"entity": "CNSL",
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{
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"entity": "鞘注化疗",
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"entity": "脑脊液",
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如CNSL发生在骨髓CR期，则需在脑脊液转阴后增加1次全身强化治疗，以避免CNSL后全身复发，然后作全颅放疗（60</sup>Co或直线加速器）治疗，总剂量为18Gy，分成15次照射，对已有足够身高的大年龄患儿同时作全脊髓放疗，对小年龄患儿则在全颅放疗的同时增加鞘内化疗每周1次共2次。 | [
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"entity": "CNSL",
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{
"id": 1,
"entity": "骨髓",
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{
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{
"id": 7,
"entity": "鞘内化疗",
"start_offset": 131,
"end_offset": 135,
"label": "pro"
}
] |
7.睾丸白血病（TL）治疗睾丸异常肿大，怀疑为TL时，最好能作活检以确诊。 | [
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{
"id": 4,
"entity": "活检",
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] |
如为双侧TL，则作双侧睾丸放疗，总剂量为24～30Gy。 | [
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"entity": "TL",
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{
"id": 1,
"entity": "睾丸放疗",
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"label": "pro"
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] |
若是单侧TL，可作病侧睾丸手术切除。 | [
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{
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如起病时已有TL，应按原治疗方案进行全身性诱导、巩固等治疗，在诱导结束后作TL局部治疗。 | [
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"id": 0,
"entity": "TL",
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"id": 1,
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] |
若CR中发生TL，在治疗TL的同时，给予VDLDX和VP-16+Ara-c方案各一个疗程作全身治疗，以免由TL引发骨髓复发。 | [
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] |
8.并发症的预防及支持治疗（1）防止肿瘤细胞溶解综合征：淋巴细胞白血病细胞对化疗常十分敏感，在化疗开始时大量的肿瘤细胞被药物杀伤破坏肿瘤细胞溶解综合征发肿瘤细胞溶解综合征，此种情况常发生在化疗刚开始1周内，主要表现为高尿酸血症、高血钾、高血磷、低血钠、低血钙等电解质紊乱，酸碱平衡失调和少尿、无尿、DIC等。 | [
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{
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{
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{
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"entity": "无尿",
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{
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"entity": "DIC",
"start_offset": 149,
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"label": "sym"
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] |
为减慢肿瘤细胞溶解的速度，避免肿瘤细胞溶解综合征形成，对于外周血白细胞计数大于50×109</sup>/L者初始化疗应相对减弱，如仅给泼尼松和长春新碱，在3～7天后才给予较强的化疗。 | [
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对所有诱导期第1～2周的新病人均应给予3000ml/m2</sup>水化、5%碳酸氢钠5ml/kg碱化血液和尿液，监测电解质、尿酸、DIC指标，保证水、电解质平衡，同时服用别嘌呤醇200～300mg/（m2</sup>•d），以减少尿酸的形成，防止尿酸性肾小管栓塞所致的肾功能不全。 | [
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"entity": "肾功能不全",
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] |
应用SMZco25～50mg/（kg•d），诱导期可全程应用，缓解后每周用3天，防止发生卡氏肺囊虫肺炎。 | [
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静脉应用丙种球蛋白每次200～400mg/kg可能减少某些感染的机会。 | [
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化疗期间禁止接种活疫苗，以避免疫苗布散感染。 | [
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加强口腔和肛门护理，及时治疗如龋齿等潜在感染灶以减少内源性感染。 | [
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定期进行心、肝、肾功能检查，避免脏器功能不全。 | [
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（4）适当应用造血刺激因子缩短骨髓抑制期，可能减少感染机会。 | [
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可应用粒-单刺激因子或粒细胞刺激因子（GMCSF或G-CSF），对缓解中病人在强化疗48小时后根据化疗强度适时应用3～5μg/（kg•d）至白细胞＞3.0×109</sup>/L。 | [
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（5）血制品应用：在贫血、出血的预防和治疗中十分重要，具体见第十篇第二章第三节。 | [
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9.随访与病人管理应将白血病治疗视作为一个系统性工程，随访及病人管理是其中十分重要的部分，以保证按时实施治疗计划。 | [
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第三节遗传病的产前诊断绝大多数遗传病和遗传代谢病无有效治疗方法，因此在今后很长一段时间内，预防显得更为重要。 | [
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产前诊断（prenataldiagnosis）又称宫内诊断，通过直接或间接对胎儿性别及健康状况进行检测，以防止具有严重遗传病、智力障碍及先天畸形患儿的出生。 | [
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产前诊断是近20年来由细胞遗传学、生化遗传学、分子遗传学等学科和临床医学实践紧密结合起来形成的一门边缘学科，有很强的实际应用价值，是近代医学的一项重大成就。 | [
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一、产前诊断现状目前已有2万多种不同的遗传病，包括单基因病、多基因病和染色体病。 | [
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这些遗传病可在胎内造成流产，出生后也是造成新生儿死亡的原因之一。 | [
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因此，人们希望找到一种早期诊断和治疗这些疾病的方法，产前诊断就是顺应这一要求而发展起来的。 | [
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自20世纪60年代开始经腹壁羊膜腔穿刺术用于产前诊断以来，产前诊断技术发展很快，1966年羊水细胞培养成功后不久，第一例21-三体综合征及半乳糖血症产前诊断成功，标志着宫内诊断的可行性。 | [
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70年代以后，这些技术已广泛应用于临床，随着绒毛、羊水细胞培养、高分辨显带染色体以及重组DNA等技术的广泛应用和不断完善，继之可经胎儿镜取胎儿血标本及经宫颈、经腹壁取绒毛做产前诊断。 | [
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] |
近年来正在发展一种非损伤性产前诊断技术，从孕妇外周血中富集、分离胎儿有核红细胞以及胎儿DNA片段，将来源于胎儿的DNA扩增后进行连锁分析或直接检测突变进行产前基因诊断。 | [
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{
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优生知识和遗传知识的普及使遗传病的产前诊断受到了社会的广泛重视，西欧、北美各国相继建立了产前诊断中心。 | [
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{
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] |
我国有较多省市开展了染色体核型分析，开展了产前诊断。 | [
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}
] |
近年，随着分子生物学技术的发展，北京、上海及广州等地都开展了一些遗传代谢病的产前诊断。 | [
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{
"id": 1,
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] |
二、硬膜下出血随着产科实践的改进，近年由产伤所致的硬膜下出血（subduralhemorrhage）的发生率明显下降，但因其临床后果严重，早期诊断和及时干预十分重要。 | [
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{
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"entity": "subduralhemorrhage",
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] |
【病因与发病机制】硬膜下出血主要由小脑幕或大脑镰撕裂所致。 | [
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"entity": "硬膜下出血",
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{
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"entity": "大脑镰",
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] |
严重的小脑幕撕裂可以致死，特别是伴直窦或横窦撕裂时，血块可流到后颅凹迅速压迫脑干。 | [
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{
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{
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{
"id": 4,
"entity": "脑干",
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] |
多数为小脑幕轻度撕裂所致的幕上或幕下出血。 | [
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出血也可发生在小脑幕的游离缘，特别是小脑幕和大脑镰的连接处，并向前进一步伸展到蛛网膜腔或脑室系统。 | [
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{
"id": 3,
"entity": "大脑镰",
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{
"id": 4,
"entity": "蛛网膜腔",
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{
"id": 5,
"entity": "脑室系统",
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"label": "bod"
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] |
在某些臀位产的患儿，可因枕骨分离伴小脑幕和枕窦撕裂而引起后颅凹大量出血和小脑撕裂。 | [
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{
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{
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{
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"entity": "枕窦",
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{
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{
"id": 5,
"entity": "大量出血",
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{
"id": 6,
"entity": "小脑撕裂",
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] |
单纯的大脑镰撕裂比小脑幕撕裂常见，出血来源于下矢状窦和胼胝体上方的大脑纵裂池，大脑表面的桥静脉破裂也可引起大脑表面的硬膜下血肿。 | [
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{
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{
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{
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"entity": "大脑纵裂池",
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{
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"entity": "大脑",
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{
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"entity": "桥静脉破裂",
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{
"id": 8,
"entity": "硬膜下血肿",
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"label": "dis"
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] |
产伤性颅内出血常同时伴有脑挫伤。 | [
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"entity": "脑挫伤",
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【临床表现】（一）小脑幕撕裂伴后颅凹硬膜下出血常见于难产性臀位牵引，临床表现可有3个阶段：①出生数小时内可无任何症状，此时血肿缓慢增大，通常＜24小时，也可长达3～4天；②随着颅内压增高，后颅凹脑脊液循环通路受阻，出现前囟饱满、激惹或嗜睡等症状；③随着病情进展，出现脑干受压的体征，包括呼吸节律异常、眼动异常、斜视、面瘫和惊厥。 | [
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{
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{
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{
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{
"id": 6,
"entity": "前囟",
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{
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"entity": "前囟饱满、激惹或嗜睡",
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"label": "sym"
},
{
"id": 8,
"entity": "脑干",
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},
{
"id": 9,
"entity": "呼吸节律异常",
"start_offset": 143,
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"label": "sym"
},
{
"id": 10,
"entity": "眼动异常",
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{
"id": 11,
"entity": "斜视",
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{
"id": 12,
"entity": "面瘫",
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"label": "sym"
},
{
"id": 13,
"entity": "惊厥",
"start_offset": 161,
"end_offset": 163,
"label": "sym"
}
] |
（二）小脑幕撕裂伴大量幕下出血出生时即可出现中脑及脑桥上部受压的症状，如木僵、斜视、瞳孔不等大和对光反射迟钝、颈项强直和角弓反张等。 | [
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"id": 0,
"entity": "小脑幕撕裂",
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{
"id": 1,
"entity": "大量幕下出血",
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"label": "dis"
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{
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"entity": "木僵",
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{
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"entity": "斜视",
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{
"id": 4,
"entity": "瞳孔",
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{
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"entity": "瞳孔不等大",
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{
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"entity": "对光反射迟钝",
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{
"id": 7,
"entity": "颈项",
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{
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"entity": "颈项强直",
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{
"id": 9,
"entity": "角弓反张",
"start_offset": 60,
"end_offset": 64,
"label": "sym"
}
] |
如血块增大，可在短期内（数分钟至数小时）出现脑干下部受压的体征，从木僵进入昏迷，瞳孔固定和散大、心动过缓和呼吸不规则，最终呼吸停止而死亡。 | [
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"entity": "血块增大",
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{
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{
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{
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"entity": "心动过缓",
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{
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"entity": "呼吸不规则",
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{
"id": 8,
"entity": "呼吸停止",
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"label": "sym"
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{
"id": 9,
"entity": "死亡",
"start_offset": 66,
"end_offset": 68,
"label": "sym"
}
] |
（三）大脑镰撕裂伴硬膜下出血出生时即可出现双侧弥漫性脑损伤症状，如兴奋、激惹等，如血块伸展到小脑幕下时症状类似于小脑幕撕裂。 | [
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"entity": "大脑镰撕裂",
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{
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{
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{
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{
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{
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{
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"entity": "小脑幕",
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{
"id": 7,
"entity": "小脑幕撕裂",
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"end_offset": 61,
"label": "dis"
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] |
（四）大脑表面硬膜下出血轻度出血可无明显的临床症状，或仅表现兴奋、激惹。 | [
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"entity": "兴奋、激惹",
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] |
局灶性脑定位体征常开始于生后第2或3天，表现为局灶性惊厥、偏瘫、眼向对侧偏斜。 | [
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] |
当发生小脑幕切迹疝时可有瞳孔散大、对光反应减弱或消失等第3对脑神经受压的表现。 | [
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{
"id": 2,
"entity": "脑神经",
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"entity": "瞳孔散大、对光反应减弱或消失等第3对脑神经受压",
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少数病例在新生儿期无任何硬膜下出血的症状、体征，但在数月后发生硬膜下积液。 | [
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"id": 1,
"entity": "硬膜下积液",
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【诊断】硬膜下出血的诊断主要依靠临床症状的识别和影像学检查。 | [
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"entity": "影像学检查",
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CT检查可确定硬膜下出血的部位和程度，但对后颅凹硬膜下出血和小脑出血的诊断价值不及MRI。 | [
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{
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{
"id": 3,
"entity": "小脑出血",
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"label": "dis"
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{
"id": 4,
"entity": "MRI",
"start_offset": 41,
"end_offset": 44,
"label": "pro"
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] |
头颅超声只能检测到伴中线移位的大脑表面的硬膜下血肿，对幕上出血的诊断不及CT，对幕下出血的诊断不及MRI。 | [
{
"id": 0,
"entity": "头颅超声",
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{
"id": 1,
"entity": "硬膜下血肿",
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"label": "dis"
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{
"id": 2,
"entity": "幕上出血",
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"label": "dis"
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{
"id": 3,
"entity": "CT",
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{
"id": 4,
"entity": "幕下出血",
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"label": "dis"
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{
"id": 5,
"entity": "MRI",
"start_offset": 49,
"end_offset": 52,
"label": "pro"
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] |
枕骨分离和颅骨骨折可通过头颅X线片证实。 | [
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"id": 0,
"entity": "枕骨分离",
"start_offset": 0,
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{
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{
"id": 2,
"entity": "头颅X线片",
"start_offset": 12,
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] |
腰椎穿刺对硬膜下出血诊断没有帮助，且有诱发脑疝可能。 | [
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{
"id": 2,
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【治疗】（一）止血可用维生素K1</sub>、酚磺乙胺、氨甲苯酸等。 | [
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"entity": "止血",
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{
"id": 1,
"entity": "维生素K1",
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{
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{
"id": 3,
"entity": "氨甲苯酸",
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] |
（二）降低颅内压如颅内压很高，发生脑疝，可适当使用20%甘露醇。 | [
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"id": 0,
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{
"id": 3,
"entity": "20%甘露醇",
"start_offset": 25,
"end_offset": 31,
"label": "dru"
}
] |
（三）抗惊厥出现惊厥者应及时止惊，可用地西泮类药物。 | [
{
"id": 0,
"entity": "抗惊厥",
"start_offset": 3,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "惊厥",
"start_offset": 8,
"end_offset": 10,
"label": "sym"
},
{
"id": 2,
"entity": "止惊",
"start_offset": 14,
"end_offset": 16,
"label": "pro"
},
{
"id": 3,
"entity": "地西泮类药物",
"start_offset": 19,
"end_offset": 25,
"label": "dru"
}
] |
（四）外科治疗手术指征取决于出血病灶的大小、颅压增高的体征和是否存在脑疝。 | [
{
"id": 0,
"entity": "外科",
"start_offset": 3,
"end_offset": 5,
"label": "dep"
},
{
"id": 1,
"entity": "颅压",
"start_offset": 22,
"end_offset": 24,
"label": "ite"
},
{
"id": 2,
"entity": "脑疝",
"start_offset": 34,
"end_offset": 36,
"label": "dis"
}
] |
大脑表面硬膜下出血伴中线移位，特别是临床症状恶化伴小脑幕切迹疝时，均是急诊硬膜下穿刺或切开引流的指征。 | [
{
"id": 0,
"entity": "大脑",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "硬膜下出血",
"start_offset": 4,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "小脑幕切迹疝",
"start_offset": 25,
"end_offset": 31,
"label": "dis"
},
{
"id": 3,
"entity": "硬膜下穿刺",
"start_offset": 37,
"end_offset": 42,
"label": "pro"
}
] |
位于后颅凹的大量硬膜下出血也需外科手术。 | [
{
"id": 0,
"entity": "后颅凹",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "硬膜下出血",
"start_offset": 8,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "外科手术",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
}
] |
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