text stringlengths 4 4.87k | entities list |
|---|---|
目前，儿科患儿ARDS诊断标准主要参考成人，其治疗和预后的研究均有待通过多中心前瞻性临床研究来解答。 | [
{
"id": 0,
"entity": "儿科",
"start_offset": 3,
"end_offset": 5,
"label": "dep"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
}
] |
小儿ARDS病死率和临床转归与基础疾病性质关系非常密切；在农村、内地、边远地区仍多见由感染性肺炎发展为重症肺炎呼吸衰竭和ARDS；在沿海、大城市儿科重症肺炎发病呈渐降趋势，但恶病质病变、依赖免疫抑制疗法的基础疾病中有较高趋势，如白血病、恶性肿瘤、艾滋病、结缔组织病等，且病死率非常高，可以达到80%～90%。 | [
{
"id": 0,
"entity": "小儿ARDS",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "感染性肺炎",
"start_offset": 43,
"end_offset": 48,
"label": "dis"
},
{
"id": 2,
"entity": "重症肺炎呼吸衰竭",
"start_offset": 51,
"end_offset": 59,
"label": "dis"
},
{
"id": 3,
"entity": "ARDS",
"start_offset": 60,
"end_offset": 64,
"label": "dis"
},
{
"id": 4,
"entity": "儿科",
"start_offset": 72,
"end_offset": 74,
"label": "dep"
},
{
"id": 5,
"entity": "重症肺炎",
"start_offset": 74,
"end_offset": 78,
"label": "dis"
},
{
"id": 6,
"entity": "免疫抑制疗法",
"start_offset": 95,
"end_offset": 101,
"label": "pro"
},
{
"id": 7,
"entity": "白血病",
"start_offset": 114,
"end_offset": 117,
"label": "dis"
},
{
"id": 8,
"entity": "恶性肿瘤",
"start_offset": 118,
"end_offset": 122,
"label": "dis"
},
{
"id": 9,
"entity": "艾滋病",
"start_offset": 123,
"end_offset": 126,
"label": "dis"
},
{
"id": 10,
"entity": "结缔组织病",
"start_offset": 127,
"end_offset": 132,
"label": "dis"
}
] |
【病因和发病机制】（一）病因和危险因素小儿ARDS主要致病原因为三大类：感染性肺部损伤、急性创伤性肺损伤以及免疫抑制性肺损伤。 | [
{
"id": 0,
"entity": "小儿ARDS",
"start_offset": 19,
"end_offset": 25,
"label": "dis"
},
{
"id": 1,
"entity": "感染性肺部损伤",
"start_offset": 36,
"end_offset": 43,
"label": "dis"
},
{
"id": 2,
"entity": "急性创伤性肺损伤",
"start_offset": 44,
"end_offset": 52,
"label": "dis"
},
{
"id": 3,
"entity": "免疫抑制性肺损伤",
"start_offset": 54,
"end_offset": 62,
"label": "dis"
}
] |
间接性肺损伤如休克、败血症、创伤和烧伤、大量输血、弥散性血管内凝血、药物性伤害、代谢性疾病等成为致病的主要危险因素。 | [
{
"id": 0,
"entity": "间接性肺损伤",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "休克",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "败血症",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
},
{
"id": 3,
"entity": "创伤",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 4,
"entity": "烧伤",
"start_offset": 17,
"end_offset": 19,
"label": "dis"
},
{
"id": 5,
"entity": "大量输血",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
},
{
"id": 6,
"entity": "血管",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
},
{
"id": 7,
"entity": "弥散性血管内凝血",
"start_offset": 25,
"end_offset": 33,
"label": "sym"
},
{
"id": 8,
"entity": "药物性伤害",
"start_offset": 34,
"end_offset": 39,
"label": "dis"
},
{
"id": 9,
"entity": "代谢性疾病",
"start_offset": 40,
"end_offset": 45,
"label": "dis"
}
] |
近年来，脏器移植手术后抗排斥药物和肿瘤化疗导致免疫功能低下并发肺部感染，主要为真菌、卡氏肺囊虫、条件性致病菌和病毒感染发展为ARDS，其预后差，此类免疫剥夺、免疫低下患儿的急性感染性肺损伤和ARDS，成为制约相关学科发展的重要疾病。 | [
{
"id": 0,
"entity": "脏器移植手术",
"start_offset": 4,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "抗排斥药物",
"start_offset": 11,
"end_offset": 16,
"label": "dru"
},
{
"id": 2,
"entity": "肿瘤化疗",
"start_offset": 17,
"end_offset": 21,
"label": "pro"
},
{
"id": 3,
"entity": "免疫功能低下",
"start_offset": 23,
"end_offset": 29,
"label": "dis"
},
{
"id": 4,
"entity": "肺部感染",
"start_offset": 31,
"end_offset": 35,
"label": "dis"
},
{
"id": 5,
"entity": "真菌",
"start_offset": 39,
"end_offset": 41,
"label": "mic"
},
{
"id": 6,
"entity": "卡氏肺囊虫",
"start_offset": 42,
"end_offset": 47,
"label": "mic"
},
{
"id": 7,
"entity": "条件性致病菌",
"start_offset": 48,
"end_offset": 54,
"label": "mic"
},
{
"id": 8,
"entity": "病毒",
"start_offset": 55,
"end_offset": 57,
"label": "mic"
},
{
"id": 9,
"entity": "ARDS",
"start_offset": 62,
"end_offset": 66,
"label": "dis"
},
{
"id": 10,
"entity": "急性感染性肺损伤",
"start_offset": 86,
"end_offset": 94,
"label": "dis"
},
{
"id": 11,
"entity": "ARDS",
"start_offset": 95,
"end_offset": 99,
"label": "dis"
}
] |
（二）病理生理对肺部的直接或间接损伤、感染或非感染性损伤，在ARDS发生、发展过程中，机制上存在异同。 | [
{
"id": 0,
"entity": "肺部",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 30,
"end_offset": 34,
"label": "dis"
}
] |
主要病理生理机制有以下几方面：1.炎症细胞的迁移与聚集ARDS的本质目前被认为是“全身炎症反应综合征的肺部表现”。 | [
{
"id": 0,
"entity": "炎症细胞的迁移与聚集",
"start_offset": 17,
"end_offset": 27,
"label": "sym"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 27,
"end_offset": 31,
"label": "dis"
},
{
"id": 2,
"entity": "全身炎症反应综合征",
"start_offset": 41,
"end_offset": 50,
"label": "dis"
},
{
"id": 3,
"entity": "肺部",
"start_offset": 51,
"end_offset": 53,
"label": "bod"
}
] |
肺部是急性炎症最重要的效应器官之一，创伤、脓毒血症、急性胰腺炎、理化刺激或体外循环等情况下，内毒素脂多糖（LPS）、C5a、白细胞介素-8（IL-8）、黏附分子等因子作用的参与、调控下，中性粒细胞（PMNs）、肺泡巨噬细胞（AMs）在肺毛细血管、肺泡内大量聚集，附壁、黏附并移行到肺间质，释放产物损伤肺。 | [
{
"id": 0,
"entity": "肺部",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "急性炎症",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 2,
"entity": "创伤",
"start_offset": 18,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "脓毒血症",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
},
{
"id": 4,
"entity": "急性胰腺炎",
"start_offset": 26,
"end_offset": 31,
"label": "dis"
},
{
"id": 5,
"entity": "内毒素脂多糖",
"start_offset": 46,
"end_offset": 52,
"label": "bod"
},
{
"id": 6,
"entity": "LPS",
"start_offset": 53,
"end_offset": 56,
"label": "bod"
},
{
"id": 7,
"entity": "C5a",
"start_offset": 58,
"end_offset": 61,
"label": "bod"
},
{
"id": 8,
"entity": "白细胞介素-8",
"start_offset": 62,
"end_offset": 69,
"label": "bod"
},
{
"id": 9,
"entity": "IL-8",
"start_offset": 70,
"end_offset": 74,
"label": "bod"
},
{
"id": 10,
"entity": "黏附分子",
"start_offset": 76,
"end_offset": 80,
"label": "bod"
},
{
"id": 11,
"entity": "中性粒细胞",
"start_offset": 93,
"end_offset": 98,
"label": "bod"
},
{
"id": 12,
"entity": "PMNs",
"start_offset": 99,
"end_offset": 103,
"label": "bod"
},
{
"id": 13,
"entity": "肺泡巨噬细胞",
"start_offset": 105,
"end_offset": 111,
"label": "bod"
},
{
"id": 14,
"entity": "AMs",
"start_offset": 112,
"end_offset": 115,
"label": "bod"
},
{
"id": 15,
"entity": "肺毛细血管",
"start_offset": 117,
"end_offset": 122,
"label": "bod"
},
{
"id": 16,
"entity": "肺泡",
"start_offset": 123,
"end_offset": 125,
"label": "bod"
},
{
"id": 17,
"entity": "肺间质",
"start_offset": 140,
"end_offset": 143,
"label": "bod"
},
{
"id": 18,
"entity": "肺",
"start_offset": 150,
"end_offset": 151,
"label": "bod"
}
] |
炎症介质释放是启动和推动ARDS“炎症瀑布”、细胞趋化、跨膜迁移和聚集、次级介质释放的重要介导物质；并激活肺部局部凝血机制，导致凝血功能的紊乱，血小板聚集和微栓塞是ARDS常见病理改变（图6-6）。 | [
{
"id": 0,
"entity": "炎症",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 12,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "细胞",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "肺部",
"start_offset": 53,
"end_offset": 55,
"label": "bod"
},
{
"id": 4,
"entity": "凝血功能的紊乱",
"start_offset": 64,
"end_offset": 71,
"label": "sym"
},
{
"id": 5,
"entity": "血小板",
"start_offset": 72,
"end_offset": 75,
"label": "ite"
},
{
"id": 6,
"entity": "血小板聚集",
"start_offset": 72,
"end_offset": 77,
"label": "sym"
},
{
"id": 7,
"entity": "微栓塞",
"start_offset": 78,
"end_offset": 81,
"label": "sym"
},
{
"id": 8,
"entity": "ARDS",
"start_offset": 82,
"end_offset": 86,
"label": "dis"
}
] |
图6-5机体对于直接或间接肺损伤的反应机制2.肺泡高通透性及液体转运障碍肺泡的屏障作用由肺泡上皮细胞和肺泡毛细血管内皮形成，维持气血交换。 | [
{
"id": 0,
"entity": "直接或间接肺损伤",
"start_offset": 8,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "肺泡",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡高通透性及液体转运障碍",
"start_offset": 23,
"end_offset": 36,
"label": "sym"
},
{
"id": 3,
"entity": "肺泡",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 4,
"entity": "肺泡上皮细胞",
"start_offset": 44,
"end_offset": 50,
"label": "bod"
},
{
"id": 5,
"entity": "肺泡毛细血管内皮",
"start_offset": 51,
"end_offset": 59,
"label": "bod"
}
] |
肺血流量与全身血流量相近，大量血流通过肺部，对于维持肺部和全身液体平衡起到重要作用。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 0,
"end_offset": 1,
"label": "bod"
},
{
"id": 1,
"entity": "血流量",
"start_offset": 1,
"end_offset": 4,
"label": "ite"
},
{
"id": 2,
"entity": "血流量",
"start_offset": 7,
"end_offset": 10,
"label": "ite"
},
{
"id": 3,
"entity": "血流",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 4,
"entity": "肺部",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
},
{
"id": 5,
"entity": "肺部",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
}
] |
肺泡上皮细胞和毛细血管形成的屏障保护作用，表现在肺泡上皮细胞（与肺泡巨噬细胞）阻碍外界有害物质进入循环，肺毛细血管网可与血液细胞和血流中有害物质发生反应，并过滤和阻碍循环内有害物质进入肺泡。 | [
{
"id": 0,
"entity": "肺泡上皮细胞",
"start_offset": 0,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "毛细血管",
"start_offset": 7,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡上皮细胞",
"start_offset": 24,
"end_offset": 30,
"label": "bod"
},
{
"id": 3,
"entity": "肺泡巨噬细胞",
"start_offset": 32,
"end_offset": 38,
"label": "bod"
},
{
"id": 4,
"entity": "肺毛细血管网",
"start_offset": 52,
"end_offset": 58,
"label": "bod"
},
{
"id": 5,
"entity": "血液细胞",
"start_offset": 60,
"end_offset": 64,
"label": "bod"
},
{
"id": 6,
"entity": "肺泡",
"start_offset": 92,
"end_offset": 94,
"label": "bod"
}
] |
ARDS的病理、病理生理和临床过程基本上不依赖于特定病因，共同基础是肺泡-毛细血管的急性损伤。 | [
{
"id": 0,
"entity": "ARDS",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "肺泡-毛细血管的急性损伤",
"start_offset": 34,
"end_offset": 46,
"label": "dis"
}
] |
直接和间接损伤以及氧自由基、蛋白酶、细胞因子、花生四烯酸代谢产物以及高荷电产物（如中性粒细胞主要阳离子蛋白）等可以改变膜屏障的通透性；ARDS时，液体清除障碍主要为渗出性肺水肿。 | [
{
"id": 0,
"entity": "氧自由基",
"start_offset": 9,
"end_offset": 13,
"label": "bod"
},
{
"id": 1,
"entity": "蛋白酶",
"start_offset": 14,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "细胞因子",
"start_offset": 18,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "花生四烯酸代谢产物",
"start_offset": 23,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "高荷电产物",
"start_offset": 34,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "中性粒细胞主要阳离子蛋白",
"start_offset": 41,
"end_offset": 53,
"label": "bod"
},
{
"id": 6,
"entity": "膜屏障",
"start_offset": 59,
"end_offset": 62,
"label": "bod"
},
{
"id": 7,
"entity": "ARDS",
"start_offset": 67,
"end_offset": 71,
"label": "dis"
},
{
"id": 8,
"entity": "渗出性肺水肿",
"start_offset": 82,
"end_offset": 88,
"label": "dis"
}
] |
血管渗出液在肺泡间质和肺泡内积聚，严重影响肺顺应性，降低肺功能余气量（FRC），增加无效腔量。 | [
{
"id": 0,
"entity": "血管渗出液",
"start_offset": 0,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "肺泡间质",
"start_offset": 6,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 3,
"entity": "血管渗出液在肺泡间质和肺泡内积聚",
"start_offset": 0,
"end_offset": 16,
"label": "sym"
},
{
"id": 4,
"entity": "肺",
"start_offset": 28,
"end_offset": 29,
"label": "bod"
},
{
"id": 5,
"entity": "降低肺功能余气量",
"start_offset": 26,
"end_offset": 34,
"label": "sym"
}
] |
在血管损伤导致大量渗漏，或持续低氧导致细胞代谢障碍，超过了淋巴管的代偿能力，大量液体将在肺内滞留并大量进入肺泡腔内。 | [
{
"id": 0,
"entity": "血管损伤",
"start_offset": 1,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "持续低氧",
"start_offset": 13,
"end_offset": 17,
"label": "sym"
},
{
"id": 2,
"entity": "细胞代谢障碍",
"start_offset": 19,
"end_offset": 25,
"label": "dis"
},
{
"id": 3,
"entity": "淋巴管",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "肺",
"start_offset": 44,
"end_offset": 45,
"label": "bod"
},
{
"id": 5,
"entity": "肺泡腔",
"start_offset": 53,
"end_offset": 56,
"label": "bod"
}
] |
呼吸膜屏障结构只容许液体通过，使大分子蛋白受阻挡，因此肺泡液和血浆的蛋白比值小于0.5，为静水压水肿漏出液。 | [
{
"id": 0,
"entity": "呼吸膜屏障",
"start_offset": 0,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "大分子蛋白",
"start_offset": 16,
"end_offset": 21,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡液",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 3,
"entity": "血浆",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 4,
"entity": "静水压水肿漏出液",
"start_offset": 45,
"end_offset": 53,
"label": "bod"
}
] |
当心功能不全、静水压增大时，蛋白漏出少，肺泡间质的蛋白稀释，胶体渗透压梯度有利于间质液体向血管内转移，也可以促使液体吸收，也起到代偿作用。 | [
{
"id": 0,
"entity": "心功能不全",
"start_offset": 1,
"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "静水压增大",
"start_offset": 7,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "蛋白",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "蛋白漏出少",
"start_offset": 14,
"end_offset": 19,
"label": "sym"
},
{
"id": 4,
"entity": "肺泡间质",
"start_offset": 20,
"end_offset": 24,
"label": "bod"
},
{
"id": 5,
"entity": "肺泡间质的蛋白稀释",
"start_offset": 20,
"end_offset": 29,
"label": "sym"
},
{
"id": 6,
"entity": "血管",
"start_offset": 45,
"end_offset": 47,
"label": "bod"
}
] |
直接测定肺内液体的蛋白含量，可以判断出肺泡内渗出的性质。 | [
{
"id": 0,
"entity": "肺内液体",
"start_offset": 4,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "蛋白",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
}
] |
如果血管和肺泡损伤导致大分子蛋白也可以通过膜屏障，则肺泡液和血浆的蛋白比值大于0.7，为胶体性水肿渗出液。 | [
{
"id": 0,
"entity": "血管和肺泡损伤",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "肺泡液",
"start_offset": 26,
"end_offset": 29,
"label": "bod"
},
{
"id": 2,
"entity": "血浆",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 3,
"entity": "胶体性水肿渗出液",
"start_offset": 44,
"end_offset": 52,
"label": "bod"
}
] |
当血管在低灌流压力下大量漏出，并失去间质低胶体渗透压保护作用时，大量液体开始迅速在肺内积聚，出现ARDS临床危象。 | [
{
"id": 0,
"entity": "血管",
"start_offset": 1,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "肺",
"start_offset": 41,
"end_offset": 42,
"label": "bod"
},
{
"id": 2,
"entity": "ARDS",
"start_offset": 48,
"end_offset": 52,
"label": "dis"
}
] |
在低氧血症时，肺泡上皮细胞钠-钾-ATP酶活性下降，使电解质和水代谢失平衡，也导致肺水肿。 | [
{
"id": 0,
"entity": "低氧血症",
"start_offset": 1,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "肺泡上皮细胞",
"start_offset": 7,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "钠-钾-ATP酶",
"start_offset": 13,
"end_offset": 21,
"label": "dis"
},
{
"id": 3,
"entity": "肺泡上皮细胞钠-钾-ATP酶活性下降",
"start_offset": 7,
"end_offset": 25,
"label": "sym"
},
{
"id": 4,
"entity": "电解质",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 5,
"entity": "水",
"start_offset": 31,
"end_offset": 32,
"label": "bod"
},
{
"id": 6,
"entity": "电解质和水代谢失平衡",
"start_offset": 27,
"end_offset": 37,
"label": "sym"
},
{
"id": 7,
"entity": "肺水肿",
"start_offset": 41,
"end_offset": 44,
"label": "dis"
}
] |
3.通气-灌流失调ARDS发生后肺泡萎陷可以导致局部肺泡区通气-灌流失调和肺内分流，严重影响气血交换，出现持续低氧血症。 | [
{
"id": 0,
"entity": "通气-灌流失调",
"start_offset": 2,
"end_offset": 9,
"label": "sym"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 9,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 3,
"entity": "肺泡萎陷",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
},
{
"id": 4,
"entity": "肺泡",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 5,
"entity": "局部肺泡区通气-灌流失调",
"start_offset": 24,
"end_offset": 36,
"label": "sym"
},
{
"id": 6,
"entity": "肺",
"start_offset": 37,
"end_offset": 38,
"label": "bod"
},
{
"id": 7,
"entity": "肺内分流",
"start_offset": 37,
"end_offset": 41,
"label": "sym"
},
{
"id": 8,
"entity": "影响气血交换",
"start_offset": 44,
"end_offset": 50,
"label": "sym"
},
{
"id": 9,
"entity": "低氧血症",
"start_offset": 55,
"end_offset": 59,
"label": "dis"
}
] |
正常时肺内动-静脉分流为5%～10%，ARDS时可以达到20%～30%或更高。 | [
{
"id": 0,
"entity": "肺内动-静脉分流",
"start_offset": 3,
"end_offset": 11,
"label": "ite"
},
{
"id": 1,
"entity": "肺内动-静脉分流为5%～10%",
"start_offset": 3,
"end_offset": 18,
"label": "sym"
},
{
"id": 2,
"entity": "ARDS",
"start_offset": 19,
"end_offset": 23,
"label": "dis"
}
] |
测定肺内动静脉分流（Qs/Qt）的公式：Qs/Qt=（CcO2-CaO2）/（CcO2-CvO2）×100%。 | [
{
"id": 0,
"entity": "肺内动静脉分流",
"start_offset": 2,
"end_offset": 9,
"label": "ite"
}
] |
在不能获得混合静脉血时，可吸纯氧15～20分钟后简略估计：Qs/Qt=（700-PaO<sub>2</sub>）×5%。 | [
{
"id": 0,
"entity": "静脉血",
"start_offset": 7,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "吸纯氧",
"start_offset": 13,
"end_offset": 16,
"label": "dru"
}
] |
4.肺血管阻力增加和肺动脉高压持续低氧血症可以导致肺阻力血管平滑肌收缩，增加肺血管阻力，肺血流显著减少，表现为肺动脉高压，进一步加重呼吸功能障碍。 | [
{
"id": 0,
"entity": "肺血管",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "肺血管阻力增加",
"start_offset": 2,
"end_offset": 9,
"label": "sym"
},
{
"id": 2,
"entity": "肺动脉",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 3,
"entity": "肺动脉高压",
"start_offset": 10,
"end_offset": 15,
"label": "sym"
},
{
"id": 4,
"entity": "低氧血症",
"start_offset": 17,
"end_offset": 21,
"label": "dis"
},
{
"id": 5,
"entity": "肺",
"start_offset": 25,
"end_offset": 26,
"label": "bod"
},
{
"id": 6,
"entity": "血管平滑肌",
"start_offset": 28,
"end_offset": 33,
"label": "bod"
},
{
"id": 7,
"entity": "肺血管",
"start_offset": 38,
"end_offset": 41,
"label": "bod"
},
{
"id": 8,
"entity": "肺血流",
"start_offset": 44,
"end_offset": 47,
"label": "ite"
},
{
"id": 9,
"entity": "肺血流显著减少",
"start_offset": 44,
"end_offset": 51,
"label": "sym"
},
{
"id": 10,
"entity": "肺动脉",
"start_offset": 55,
"end_offset": 58,
"label": "bod"
},
{
"id": 11,
"entity": "肺动脉高压",
"start_offset": 55,
"end_offset": 60,
"label": "sym"
},
{
"id": 12,
"entity": "加重呼吸功能障碍",
"start_offset": 64,
"end_offset": 72,
"label": "sym"
}
] |
目前以多普勒彩超技术检查小儿ARDS肺外分流、肺动脉压和肺血管阻力比较安全。 | [
{
"id": 0,
"entity": "多普勒彩超",
"start_offset": 3,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "小儿ARDS",
"start_offset": 12,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "肺",
"start_offset": 18,
"end_offset": 19,
"label": "bod"
},
{
"id": 3,
"entity": "肺动脉压",
"start_offset": 23,
"end_offset": 27,
"label": "ite"
},
{
"id": 4,
"entity": "肺血管阻力",
"start_offset": 28,
"end_offset": 33,
"label": "ite"
}
] |
如果没有此条件，在机械通气时，吸入氧浓度＞0.6时，经皮氧饱和度＞80%，应该考虑存在肺内分流。 | [
{
"id": 0,
"entity": "机械通气",
"start_offset": 9,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "吸入",
"start_offset": 15,
"end_offset": 17,
"label": "pro"
},
{
"id": 2,
"entity": "氧",
"start_offset": 17,
"end_offset": 18,
"label": "dru"
},
{
"id": 3,
"entity": "肺",
"start_offset": 43,
"end_offset": 44,
"label": "bod"
},
{
"id": 4,
"entity": "肺内分流",
"start_offset": 43,
"end_offset": 47,
"label": "sym"
}
] |
5.肺泡损伤和肺表面活性物质功能低下肺泡上皮细胞分Ⅰ型和Ⅱ型，肺泡内表面＞90%为Ⅰ型上皮细胞覆盖，7%为Ⅱ型细胞覆盖。 | [
{
"id": 0,
"entity": "肺泡",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "肺表面活性物质",
"start_offset": 7,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡损伤和肺表面活性物质功能低下",
"start_offset": 2,
"end_offset": 18,
"label": "sym"
},
{
"id": 3,
"entity": "肺泡上皮细胞",
"start_offset": 18,
"end_offset": 24,
"label": "bod"
},
{
"id": 4,
"entity": "肺泡内表面",
"start_offset": 31,
"end_offset": 36,
"label": "bod"
},
{
"id": 5,
"entity": "Ⅰ型上皮细胞",
"start_offset": 41,
"end_offset": 47,
"label": "bod"
},
{
"id": 6,
"entity": "Ⅱ型细胞",
"start_offset": 53,
"end_offset": 57,
"label": "bod"
}
] |
Ⅱ型细胞可以增殖并转化为Ⅰ型细胞，修复损坏的肺泡。 | [
{
"id": 0,
"entity": "Ⅱ型细胞",
"start_offset": 0,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "Ⅰ型细胞",
"start_offset": 12,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
}
] |
但Ⅱ型细胞的主要生理功能为合成和分泌肺表面活性物质。 | [
{
"id": 0,
"entity": "Ⅱ型细胞",
"start_offset": 1,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "肺表面活性物质",
"start_offset": 18,
"end_offset": 25,
"label": "bod"
}
] |
表面活性物质由磷脂和特异蛋白组成，可降低肺泡气液界面表面张力，对于维持肺泡扩张、减少呼吸做功、促进肺液吸收具有重要作用。 | [
{
"id": 0,
"entity": "表面活性物质",
"start_offset": 0,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "磷脂",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "特异蛋白",
"start_offset": 10,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "肺泡",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 4,
"entity": "肺泡",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
},
{
"id": 5,
"entity": "肺液",
"start_offset": 49,
"end_offset": 51,
"label": "bod"
}
] |
直接急性肺损伤主要作用在气道和肺泡，而缺氧可以导致肺泡上皮细胞代谢障碍，高氧及过氧化导致肺泡上皮细胞变性，细菌毒素和促炎症介质抑制作用，均会影响到表面活性物质合成和代谢。 | [
{
"id": 0,
"entity": "直接急性肺损伤",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "气道",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "肺泡上皮细胞",
"start_offset": 25,
"end_offset": 31,
"label": "bod"
},
{
"id": 4,
"entity": "肺泡上皮细胞代谢障碍",
"start_offset": 25,
"end_offset": 35,
"label": "sym"
},
{
"id": 5,
"entity": "肺泡上皮细胞",
"start_offset": 44,
"end_offset": 50,
"label": "bod"
},
{
"id": 6,
"entity": "肺泡上皮细胞变性",
"start_offset": 44,
"end_offset": 52,
"label": "sym"
},
{
"id": 7,
"entity": "细菌毒素",
"start_offset": 53,
"end_offset": 57,
"label": "bod"
},
{
"id": 8,
"entity": "促炎症介质",
"start_offset": 58,
"end_offset": 63,
"label": "bod"
},
{
"id": 9,
"entity": "表面活性物质",
"start_offset": 73,
"end_offset": 79,
"label": "bod"
}
] |
肺泡内液可以稀释表面活性物质，改变其降低表面张力的作用。 | [
{
"id": 0,
"entity": "肺泡内液",
"start_offset": 0,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "表面活性物质",
"start_offset": 8,
"end_offset": 14,
"label": "bod"
}
] |
此外，肺泡内血浆蛋白、代谢产物、细菌毒素可抑制表面活性物质，导致继发性表面活性物质缺乏和功能低下，肺泡因此萎陷。 | [
{
"id": 0,
"entity": "肺泡",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "血浆蛋白",
"start_offset": 6,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "代谢产物",
"start_offset": 11,
"end_offset": 15,
"label": "bod"
},
{
"id": 3,
"entity": "细菌毒素",
"start_offset": 16,
"end_offset": 20,
"label": "bod"
},
{
"id": 4,
"entity": "表面活性物质",
"start_offset": 23,
"end_offset": 29,
"label": "bod"
},
{
"id": 5,
"entity": "表面活性物质",
"start_offset": 35,
"end_offset": 41,
"label": "bod"
},
{
"id": 6,
"entity": "继发性表面活性物质缺乏和功能低下",
"start_offset": 32,
"end_offset": 48,
"label": "sym"
},
{
"id": 7,
"entity": "肺泡",
"start_offset": 49,
"end_offset": 51,
"label": "bod"
},
{
"id": 8,
"entity": "萎陷",
"start_offset": 53,
"end_offset": 55,
"label": "sym"
}
] |
6.血管内皮损伤和血管张力调节功能障碍全身和肺部感染，细菌内毒素可以导致血管扩张和感染性休克。 | [
{
"id": 0,
"entity": "血管",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "血管内皮损伤和血管张力调节功能障碍",
"start_offset": 2,
"end_offset": 19,
"label": "sym"
},
{
"id": 2,
"entity": "全身和肺部感染",
"start_offset": 19,
"end_offset": 26,
"label": "dis"
},
{
"id": 3,
"entity": "细菌",
"start_offset": 27,
"end_offset": 29,
"label": "mic"
},
{
"id": 4,
"entity": "血管",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 5,
"entity": "血管扩张",
"start_offset": 36,
"end_offset": 40,
"label": "sym"
},
{
"id": 6,
"entity": "感染性休克",
"start_offset": 41,
"end_offset": 46,
"label": "dis"
}
] |
持续低氧血症导致大量代谢产物在肺部积聚，造成肺小血管痉挛和阻力增加，肺血流下降，通气-灌流变差，加重低氧血症。 | [
{
"id": 0,
"entity": "低氧血症",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "肺部",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "大量代谢产物在肺部积聚",
"start_offset": 8,
"end_offset": 19,
"label": "sym"
},
{
"id": 3,
"entity": "肺小血管",
"start_offset": 22,
"end_offset": 26,
"label": "bod"
},
{
"id": 4,
"entity": "肺小血管痉挛和阻力增加",
"start_offset": 22,
"end_offset": 33,
"label": "sym"
},
{
"id": 5,
"entity": "肺",
"start_offset": 34,
"end_offset": 35,
"label": "bod"
},
{
"id": 6,
"entity": "肺血流下降",
"start_offset": 34,
"end_offset": 39,
"label": "sym"
},
{
"id": 7,
"entity": "通气-灌流变差",
"start_offset": 40,
"end_offset": 47,
"label": "sym"
},
{
"id": 8,
"entity": "低氧血症",
"start_offset": 50,
"end_offset": 54,
"label": "dis"
},
{
"id": 9,
"entity": "加重低氧血症",
"start_offset": 48,
"end_offset": 54,
"label": "sym"
}
] |
创伤导致大量肠源性毒素、脂肪栓、血小板血栓形成，均会导致肺部血管血流障碍和血管内皮损伤，进一步导致血管通透性增加和肺水肿发生。 | [
{
"id": 0,
"entity": "创伤",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "肠源性毒素",
"start_offset": 6,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "脂肪栓",
"start_offset": 12,
"end_offset": 15,
"label": "bod"
},
{
"id": 3,
"entity": "血小板血栓",
"start_offset": 16,
"end_offset": 21,
"label": "bod"
},
{
"id": 4,
"entity": "大量肠源性毒素、脂肪栓、血小板血栓形成",
"start_offset": 4,
"end_offset": 23,
"label": "sym"
},
{
"id": 5,
"entity": "肺部血管",
"start_offset": 28,
"end_offset": 32,
"label": "bod"
},
{
"id": 6,
"entity": "肺部血管血流障碍和血管内皮损伤",
"start_offset": 28,
"end_offset": 43,
"label": "sym"
},
{
"id": 7,
"entity": "血管",
"start_offset": 49,
"end_offset": 51,
"label": "bod"
},
{
"id": 8,
"entity": "血管通透性增加",
"start_offset": 49,
"end_offset": 56,
"label": "sym"
},
{
"id": 9,
"entity": "肺水肿",
"start_offset": 57,
"end_offset": 60,
"label": "dis"
}
] |
近年研究认为肺毛细血管和肺泡上皮细胞等结构细胞也参与炎症免疫反应，在ARDS的次级炎症反应中具有意义。 | [
{
"id": 0,
"entity": "肺毛细血管",
"start_offset": 6,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "肺泡上皮细胞",
"start_offset": 12,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "炎症",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
},
{
"id": 3,
"entity": "ARDS",
"start_offset": 34,
"end_offset": 38,
"label": "dis"
}
] |
7.肺部损伤导致肺外脏器损伤和功能障碍肺部大量毒素、炎症介质可以不断释放经循环带到肺外脏器，致心、肝、脾、肾、脑、肠道功能障碍和损伤，最终导致多脏器功能不全。 | [
{
"id": 0,
"entity": "肺部损伤",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "肺外脏器",
"start_offset": 8,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "肺外脏器损伤和功能障碍",
"start_offset": 8,
"end_offset": 19,
"label": "sym"
},
{
"id": 3,
"entity": "肺部",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
},
{
"id": 4,
"entity": "毒素",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 5,
"entity": "炎症介质",
"start_offset": 26,
"end_offset": 30,
"label": "bod"
},
{
"id": 6,
"entity": "肺外脏器",
"start_offset": 41,
"end_offset": 45,
"label": "bod"
},
{
"id": 7,
"entity": "心",
"start_offset": 47,
"end_offset": 48,
"label": "bod"
},
{
"id": 8,
"entity": "肝",
"start_offset": 49,
"end_offset": 50,
"label": "bod"
},
{
"id": 9,
"entity": "脾",
"start_offset": 51,
"end_offset": 52,
"label": "bod"
},
{
"id": 10,
"entity": "肾",
"start_offset": 53,
"end_offset": 54,
"label": "bod"
},
{
"id": 11,
"entity": "脑",
"start_offset": 55,
"end_offset": 56,
"label": "bod"
},
{
"id": 12,
"entity": "肠道",
"start_offset": 57,
"end_offset": 59,
"label": "bod"
},
{
"id": 13,
"entity": "肠道功能障碍和损伤",
"start_offset": 57,
"end_offset": 66,
"label": "sym"
},
{
"id": 14,
"entity": "多脏器功能不全",
"start_offset": 71,
"end_offset": 78,
"label": "bod"
}
] |
【病理】主要病理表现为弥漫性肺损害，可以在急性期和慢性期先后出现。 | [
{
"id": 0,
"entity": "弥漫性肺损害",
"start_offset": 11,
"end_offset": 17,
"label": "dis"
}
] |
根据病情进展，将病理演变可分为以下几期：急性渗出期，在ARDS最初1～4天为渗出性病变；增生期，在ARDS第3～10天；慢性纤维化期，在疾病恢复期，此病变一般在持续2周以上才出现。 | [
{
"id": 0,
"entity": "ARDS",
"start_offset": 27,
"end_offset": 31,
"label": "dis"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 49,
"end_offset": 53,
"label": "dis"
}
] |
急性肺损伤（ALI）与急性呼吸窘迫综合征（ARDS）机制和病理上没有本质差异，只是根据改良氧合指数（PaO<sub>2</sub>/FiO<sub>2</sub>）进行的区分，ALI是ARDS的早期表现。 | [
{
"id": 0,
"entity": "急性肺损伤",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "ALI",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "急性呼吸窘迫综合征",
"start_offset": 11,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "ARDS",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
},
{
"id": 4,
"entity": "氧合指数",
"start_offset": 45,
"end_offset": 49,
"label": "ite"
},
{
"id": 5,
"entity": "ALI",
"start_offset": 88,
"end_offset": 91,
"label": "sym"
},
{
"id": 6,
"entity": "ARDS",
"start_offset": 92,
"end_offset": 96,
"label": "dis"
}
] |
【临床表现】小儿起病特点与成人有差别，临床上可先出现肺部感染，或在基础疾病上发生进行性呼吸困难，多见于脓毒症、中毒、严重复合伤等基础疾病。 | [
{
"id": 0,
"entity": "肺部",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 1,
"entity": "肺部感染",
"start_offset": 26,
"end_offset": 30,
"label": "sym"
},
{
"id": 2,
"entity": "进行性呼吸困难",
"start_offset": 40,
"end_offset": 47,
"label": "dis"
},
{
"id": 3,
"entity": "脓毒症",
"start_offset": 51,
"end_offset": 54,
"label": "dis"
},
{
"id": 4,
"entity": "中毒",
"start_offset": 55,
"end_offset": 57,
"label": "dis"
},
{
"id": 5,
"entity": "严重复合伤",
"start_offset": 58,
"end_offset": 63,
"label": "dis"
}
] |
根据下述诊断标准，可能在基础疾病临床不同时期发现ARDS。 | [
{
"id": 0,
"entity": "ARDS",
"start_offset": 24,
"end_offset": 28,
"label": "dis"
}
] |
如果判断尚不明确或属于ARDS早期的急性肺损伤，一般仍作为呼吸衰竭进行处理。 | [
{
"id": 0,
"entity": "ARDS",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "急性肺损伤",
"start_offset": 18,
"end_offset": 23,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 29,
"end_offset": 33,
"label": "dis"
}
] |
初期患儿在原发病基础上突然呼吸加快、气促加重，肺部多无异常发现，X线胸片显示清晰肺野，或仅有肺纹理增多模糊，为间质液体聚集，动脉血PaO<sub>2</sub>和PaCO<sub>2</sub>偏低。 | [
{
"id": 0,
"entity": "突然呼吸加快",
"start_offset": 11,
"end_offset": 17,
"label": "sym"
},
{
"id": 1,
"entity": "气促加重",
"start_offset": 18,
"end_offset": 22,
"label": "sym"
},
{
"id": 2,
"entity": "肺部",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "肺部多无异常发现",
"start_offset": 23,
"end_offset": 31,
"label": "sym"
},
{
"id": 4,
"entity": "X线胸片",
"start_offset": 32,
"end_offset": 36,
"label": "ite"
},
{
"id": 5,
"entity": "X线胸片显示清晰肺野",
"start_offset": 32,
"end_offset": 42,
"label": "sym"
},
{
"id": 6,
"entity": "肺",
"start_offset": 46,
"end_offset": 47,
"label": "bod"
},
{
"id": 7,
"entity": "肺纹理增多模糊",
"start_offset": 46,
"end_offset": 53,
"label": "sym"
},
{
"id": 8,
"entity": "动脉血",
"start_offset": 62,
"end_offset": 65,
"label": "bod"
},
{
"id": 9,
"entity": "PaO<sub>2</sub>",
"start_offset": 65,
"end_offset": 80,
"label": "bod"
},
{
"id": 10,
"entity": "PaCO<sub>2</sub>",
"start_offset": 81,
"end_offset": 97,
"label": "bod"
},
{
"id": 11,
"entity": "动脉血PaO<sub>2</sub>和PaCO<sub>2</sub>偏低",
"start_offset": 62,
"end_offset": 99,
"label": "sym"
}
] |
动脉血PaO<sub>2</sub>和PaCO<sub>2</sub>明显降低，呼吸性碱中毒，氧疗不能改善。 | [
{
"id": 0,
"entity": "动脉血",
"start_offset": 0,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "PaO<sub>2</sub>",
"start_offset": 3,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "PaCO<sub>2</sub>",
"start_offset": 19,
"end_offset": 35,
"label": "bod"
},
{
"id": 3,
"entity": "动脉血PaO<sub>2</sub>和PaCO<sub>2</sub>明显降低",
"start_offset": 0,
"end_offset": 39,
"label": "sym"
},
{
"id": 4,
"entity": "呼吸性碱中毒",
"start_offset": 40,
"end_offset": 46,
"label": "dis"
},
{
"id": 5,
"entity": "氧疗",
"start_offset": 47,
"end_offset": 49,
"label": "pro"
}
] |
（一）急性肺损伤期（ALI）可以有明显的突发致损伤因素，出现与原发于肺部的损伤相关的症状，或表现为早期ARDS的呼吸急促困难，经吸氧无法改善，也可能呼吸窘迫的症状并不明显，容易被临床医师所忽略。 | [
{
"id": 0,
"entity": "ALI",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "肺部",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
},
{
"id": 2,
"entity": "ARDS",
"start_offset": 51,
"end_offset": 55,
"label": "bod"
},
{
"id": 3,
"entity": "呼吸急促困难",
"start_offset": 56,
"end_offset": 62,
"label": "sym"
},
{
"id": 4,
"entity": "吸氧",
"start_offset": 64,
"end_offset": 66,
"label": "pro"
},
{
"id": 5,
"entity": "呼吸窘迫",
"start_offset": 74,
"end_offset": 78,
"label": "sym"
}
] |
（二）潜伏期出现在原发肺损伤后6～48小时，此阶段可以因机械通气或氧疗，使患儿心血管和呼吸功能、血气均出现暂时稳定或有所改善。 | [
{
"id": 0,
"entity": "原发肺损伤",
"start_offset": 9,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "机械通气",
"start_offset": 28,
"end_offset": 32,
"label": "pro"
},
{
"id": 2,
"entity": "氧疗",
"start_offset": 33,
"end_offset": 35,
"label": "pro"
},
{
"id": 3,
"entity": "心血管和呼吸功能、血气均出现暂时稳定或有所改善",
"start_offset": 39,
"end_offset": 62,
"label": "sym"
}
] |
但X线胸片上已经可以出现两肺细颗粒影，为间质水肿的征象，并可能与临床状况并不一致。 | [
{
"id": 0,
"entity": "X线胸片",
"start_offset": 1,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "肺",
"start_offset": 13,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "两肺细颗粒影",
"start_offset": 12,
"end_offset": 18,
"label": "sym"
},
{
"id": 3,
"entity": "间质水肿",
"start_offset": 20,
"end_offset": 24,
"label": "dis"
}
] |
（三）急性呼吸衰竭期出现呼吸急促、呼吸困难、持续低氧血症、酸中毒，胸片显示双侧肺部广泛渗出，由于顺应性下降，大多数依赖高氧和高气道压力进行机械通气等。 | [
{
"id": 0,
"entity": "呼吸急促",
"start_offset": 12,
"end_offset": 16,
"label": "sym"
},
{
"id": 1,
"entity": "呼吸困难",
"start_offset": 17,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "低氧血症",
"start_offset": 24,
"end_offset": 28,
"label": "dis"
},
{
"id": 3,
"entity": "持续低氧血症",
"start_offset": 22,
"end_offset": 28,
"label": "sym"
},
{
"id": 4,
"entity": "酸中毒",
"start_offset": 29,
"end_offset": 32,
"label": "dis"
},
{
"id": 5,
"entity": "胸片",
"start_offset": 33,
"end_offset": 35,
"label": "pro"
},
{
"id": 6,
"entity": "肺部",
"start_offset": 39,
"end_offset": 41,
"label": "bod"
},
{
"id": 7,
"entity": "双侧肺部广泛渗出",
"start_offset": 37,
"end_offset": 45,
"label": "sym"
},
{
"id": 8,
"entity": "顺应性下降",
"start_offset": 48,
"end_offset": 53,
"label": "sym"
},
{
"id": 9,
"entity": "高氧",
"start_offset": 59,
"end_offset": 61,
"label": "dru"
},
{
"id": 10,
"entity": "高气道压力",
"start_offset": 62,
"end_offset": 67,
"label": "pro"
},
{
"id": 11,
"entity": "机械通气",
"start_offset": 69,
"end_offset": 73,
"label": "pro"
}
] |
此时出现肺顺应性显著下降（＜0.5ml/（cmH<sub>2</sub>O•kg）），气道阻力显著上升，并出现严重呼吸窘迫症状。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 4,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "肺顺应性显著下降",
"start_offset": 4,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "气道",
"start_offset": 43,
"end_offset": 45,
"label": "bod"
},
{
"id": 3,
"entity": "气道阻力显著上升",
"start_offset": 43,
"end_offset": 51,
"label": "sym"
},
{
"id": 4,
"entity": "严重呼吸窘迫",
"start_offset": 55,
"end_offset": 61,
"label": "sym"
}
] |
（四）严重生理异常期可以表现为持续低氧血症、高碳酸血症、失代偿性酸中毒、长期呼吸机依赖、间质纤维化，对于呼吸机治疗反应差，或突然性恶化、酸中毒和代谢紊乱，最后导致死亡。 | [
{
"id": 0,
"entity": "低氧血症",
"start_offset": 17,
"end_offset": 21,
"label": "dis"
},
{
"id": 1,
"entity": "高碳酸血症",
"start_offset": 22,
"end_offset": 27,
"label": "dis"
},
{
"id": 2,
"entity": "失代偿性酸中毒",
"start_offset": 28,
"end_offset": 35,
"label": "dis"
},
{
"id": 3,
"entity": "持续低氧血症、高碳酸血症、失代偿性酸中毒",
"start_offset": 15,
"end_offset": 35,
"label": "sym"
},
{
"id": 4,
"entity": "呼吸机",
"start_offset": 38,
"end_offset": 41,
"label": "equ"
},
{
"id": 5,
"entity": "长期呼吸机依赖",
"start_offset": 36,
"end_offset": 43,
"label": "sym"
},
{
"id": 6,
"entity": "间质纤维化",
"start_offset": 44,
"end_offset": 49,
"label": "sym"
},
{
"id": 7,
"entity": "呼吸机",
"start_offset": 52,
"end_offset": 55,
"label": "equ"
},
{
"id": 8,
"entity": "对于呼吸机治疗反应差",
"start_offset": 50,
"end_offset": 60,
"label": "sym"
},
{
"id": 9,
"entity": "突然性恶化",
"start_offset": 62,
"end_offset": 67,
"label": "sym"
},
{
"id": 10,
"entity": "酸中毒",
"start_offset": 68,
"end_offset": 71,
"label": "dis"
},
{
"id": 11,
"entity": "代谢紊乱",
"start_offset": 72,
"end_offset": 76,
"label": "sym"
},
{
"id": 12,
"entity": "死亡",
"start_offset": 81,
"end_offset": 83,
"label": "dis"
}
] |
【实验室检查】反复检查动态血气可以判断全身氧和二氧化碳代谢、酸碱平衡情况。 | [
{
"id": 0,
"entity": "动态血气",
"start_offset": 11,
"end_offset": 15,
"label": "ite"
},
{
"id": 1,
"entity": "氧",
"start_offset": 21,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "二氧化碳",
"start_offset": 23,
"end_offset": 27,
"label": "bod"
}
] |
初期（或ALI期）多表现为持续低氧和低二氧化碳血症，后期低氧加重，并二氧化碳潴留，代谢性或混合性酸中毒。 | [
{
"id": 0,
"entity": "ALI",
"start_offset": 4,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "低氧和低二氧化碳血症",
"start_offset": 15,
"end_offset": 25,
"label": "dis"
},
{
"id": 2,
"entity": "持续低氧和低二氧化碳血症",
"start_offset": 13,
"end_offset": 25,
"label": "sym"
},
{
"id": 3,
"entity": "氧",
"start_offset": 29,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "低氧加重",
"start_offset": 28,
"end_offset": 32,
"label": "sym"
},
{
"id": 5,
"entity": "二氧化碳",
"start_offset": 34,
"end_offset": 38,
"label": "bod"
},
{
"id": 6,
"entity": "二氧化碳潴留",
"start_offset": 34,
"end_offset": 40,
"label": "sym"
},
{
"id": 7,
"entity": "代谢性或混合性酸中毒",
"start_offset": 41,
"end_offset": 51,
"label": "dis"
}
] |
根据改良氧合指数即动脉氧分压与吸入氧浓度比值（PaO<sub>2</sub>/FiO<sub>2</sub>）＜300mmHg提示急性肺损伤的存在，＜200表明符合ARDS诊断（尚须结合临床、放射检查和呼吸机参数判断）。 | [
{
"id": 0,
"entity": "氧合指数",
"start_offset": 4,
"end_offset": 8,
"label": "ite"
},
{
"id": 1,
"entity": "动脉氧分压与吸入氧浓度比值",
"start_offset": 9,
"end_offset": 22,
"label": "ite"
},
{
"id": 2,
"entity": "PaO<sub>2</sub>/FiO<sub>2</sub>",
"start_offset": 23,
"end_offset": 54,
"label": "ite"
},
{
"id": 3,
"entity": "改良氧合指数即动脉氧分压与吸入氧浓度比值（PaO<sub>2</sub>/FiO<sub>2</sub>）＜300mmHg",
"start_offset": 2,
"end_offset": 63,
"label": "sym"
},
{
"id": 4,
"entity": "急性肺损伤",
"start_offset": 65,
"end_offset": 70,
"label": "dis"
},
{
"id": 5,
"entity": "ARDS",
"start_offset": 82,
"end_offset": 86,
"label": "dis"
},
{
"id": 6,
"entity": "呼吸机",
"start_offset": 101,
"end_offset": 104,
"label": "equ"
}
] |
如果是鼻导管或头罩，一般实际吸入氧浓度在40%～70%之间。 | [
{
"id": 0,
"entity": "鼻导管",
"start_offset": 3,
"end_offset": 6,
"label": "equ"
},
{
"id": 1,
"entity": "头罩",
"start_offset": 7,
"end_offset": 9,
"label": "equ"
},
{
"id": 2,
"entity": "吸入",
"start_offset": 14,
"end_offset": 16,
"label": "pro"
},
{
"id": 3,
"entity": "氧",
"start_offset": 16,
"end_offset": 17,
"label": "dru"
}
] |
有条件时可以在鼻旁取样，测定氧浓度，作为判断肺损伤指数（PaO<sub>2</sub>/FiO<sub>2</sub>）的依据。 | [
{
"id": 0,
"entity": "鼻旁",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "氧浓度",
"start_offset": 14,
"end_offset": 17,
"label": "ite"
},
{
"id": 2,
"entity": "肺损伤指数",
"start_offset": 22,
"end_offset": 27,
"label": "ite"
},
{
"id": 3,
"entity": "PaO<sub>2</sub>/FiO<sub>2</sub>",
"start_offset": 28,
"end_offset": 59,
"label": "ite"
}
] |
在持续低氧血症不能纠正时，应该作为气道插管和机械通气治疗的指征。 | [
{
"id": 0,
"entity": "低氧血症",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "气道插管",
"start_offset": 17,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "机械通气治疗",
"start_offset": 22,
"end_offset": 28,
"label": "pro"
}
] |
放射学检查特点：两肺广泛渗出阴影为急性期的特征，表明肺血管向间质及肺泡渗出过程。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 9,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "两肺广泛渗出阴影",
"start_offset": 8,
"end_offset": 16,
"label": "sym"
},
{
"id": 2,
"entity": "肺血管",
"start_offset": 26,
"end_offset": 29,
"label": "bod"
},
{
"id": 3,
"entity": "间质",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "肺泡",
"start_offset": 33,
"end_offset": 35,
"label": "bod"
},
{
"id": 5,
"entity": "肺血管向间质及肺泡渗出",
"start_offset": 26,
"end_offset": 37,
"label": "sym"
}
] |
血管通透性增加时，渗出液先积聚在大血管周围，呈肺纹理增加和微细颗粒状。 | [
{
"id": 0,
"entity": "血管",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "血管通透性增加",
"start_offset": 0,
"end_offset": 7,
"label": "sym"
},
{
"id": 2,
"entity": "渗出液",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 3,
"entity": "大血管",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 4,
"entity": "渗出液先积聚在大血管周围，呈肺纹理增加和微细颗粒状",
"start_offset": 9,
"end_offset": 34,
"label": "sym"
}
] |
随病情发展，可以出现大量肺泡渗出，为斑片状和实变，甚至有胸腔积液。 | [
{
"id": 0,
"entity": "肺泡",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
},
{
"id": 1,
"entity": "大量肺泡渗出，为斑片状和实变",
"start_offset": 10,
"end_offset": 24,
"label": "sym"
},
{
"id": 2,
"entity": "胸腔",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
},
{
"id": 3,
"entity": "胸腔积液",
"start_offset": 28,
"end_offset": 32,
"label": "sym"
}
] |
在疾病后期出现纤维化时，出现肺纹理增粗和小囊泡等慢性病变特征。 | [
{
"id": 0,
"entity": "肺纹理增粗",
"start_offset": 14,
"end_offset": 19,
"label": "sym"
},
{
"id": 1,
"entity": "小囊泡",
"start_offset": 20,
"end_offset": 23,
"label": "sym"
}
] |
对仰卧位出现中背部肺的萎陷，在俯卧位时扩张，可以认为肺萎陷，而不扩张则为实变。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 9,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "仰卧位出现中背部肺的萎陷，在俯卧位时扩张",
"start_offset": 1,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "肺萎陷",
"start_offset": 26,
"end_offset": 29,
"label": "sym"
}
] |
动态放射学检查对于掌握病情发展和治疗效果有非常重要的意义。 | [
{
"id": 0,
"entity": "动态放射学检查",
"start_offset": 0,
"end_offset": 7,
"label": "pro"
}
] |
【诊断】（一）诊断标准1994年，北美呼吸病-欧洲危重病学会专家联席评审会议（AECC）发表了ALI/ARDS诊断共识，该标准不把PEEP和肺顺应性列入。 | [
{
"id": 0,
"entity": "ALI",
"start_offset": 47,
"end_offset": 50,
"label": "dis"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 51,
"end_offset": 55,
"label": "dis"
},
{
"id": 2,
"entity": "PEEP",
"start_offset": 65,
"end_offset": 69,
"label": "ite"
},
{
"id": 3,
"entity": "肺",
"start_offset": 70,
"end_offset": 71,
"label": "bod"
}
] |
1.急性起病有感染、创伤、吸入等诱因。 | [
{
"id": 0,
"entity": "急性起病",
"start_offset": 2,
"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "感染",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "创伤",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 3,
"entity": "吸入",
"start_offset": 13,
"end_offset": 15,
"label": "sym"
}
] |
2.低氧血症PaO<sub>2</sub>/FiO<sub>2</sub>＜40kPa（300mmHg）提示急性肺损伤的存在，＜27kPa（200mmHg）表明有ARDS（不考虑PEEP水平）。 | [
{
"id": 0,
"entity": "低氧血症",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "PaO<sub>2</sub>/FiO<sub>2</sub>＜40kPa（300mmHg）",
"start_offset": 6,
"end_offset": 52,
"label": "sym"
},
{
"id": 2,
"entity": "急性肺损伤",
"start_offset": 54,
"end_offset": 59,
"label": "dis"
},
{
"id": 3,
"entity": "ARDS",
"start_offset": 81,
"end_offset": 85,
"label": "dis"
},
{
"id": 4,
"entity": "PEEP",
"start_offset": 89,
"end_offset": 93,
"label": "ite"
}
] |
3.胸部放射检查两肺广泛渗出阴影。 | [
{
"id": 0,
"entity": "放射检查",
"start_offset": 4,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "肺",
"start_offset": 9,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "胸部放射检查两肺广泛渗出阴影",
"start_offset": 2,
"end_offset": 16,
"label": "sym"
}
] |
4.排除左心功能不全［肺毛细血管楔压＜2.5kPa（18mmHg），或多普勒彩超检查］。 | [
{
"id": 0,
"entity": "左心功能不全",
"start_offset": 4,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "肺毛细血管楔压＜2.5kPa（18mmHg）",
"start_offset": 11,
"end_offset": 33,
"label": "sym"
},
{
"id": 2,
"entity": "多普勒彩超检查",
"start_offset": 35,
"end_offset": 42,
"label": "pro"
}
] |
（二）鉴别诊断1.心源性肺水肿有心脏病史或过量快速输液史，一般呼吸困难、肺部啰音出现伴X线心影显著增大。 | [
{
"id": 0,
"entity": "心源性肺水肿",
"start_offset": 9,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "心脏病",
"start_offset": 16,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸困难",
"start_offset": 31,
"end_offset": 35,
"label": "sym"
},
{
"id": 3,
"entity": "肺部啰音出现",
"start_offset": 36,
"end_offset": 42,
"label": "sym"
},
{
"id": 4,
"entity": "X线",
"start_offset": 43,
"end_offset": 45,
"label": "pro"
},
{
"id": 5,
"entity": "X线心影显著增大",
"start_offset": 43,
"end_offset": 51,
"label": "sym"
}
] |
经氧疗、控制输液量、强心、利尿等措施后，情况会迅速改善。 | [
{
"id": 0,
"entity": "氧疗",
"start_offset": 1,
"end_offset": 3,
"label": "pro"
},
{
"id": 1,
"entity": "控制输液量",
"start_offset": 4,
"end_offset": 9,
"label": "pro"
},
{
"id": 2,
"entity": "强心",
"start_offset": 10,
"end_offset": 12,
"label": "pro"
},
{
"id": 3,
"entity": "利尿",
"start_offset": 13,
"end_offset": 15,
"label": "pro"
}
] |
2.呼吸机相关肺炎（VAP）或呼吸机诱发肺损伤（VILI）为继发性肺炎的一种。 | [
{
"id": 0,
"entity": "呼吸机相关肺炎",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "VAP",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸机诱发肺损伤",
"start_offset": 15,
"end_offset": 23,
"label": "dis"
},
{
"id": 3,
"entity": "VILI",
"start_offset": 24,
"end_offset": 28,
"label": "dis"
},
{
"id": 4,
"entity": "继发性肺炎",
"start_offset": 30,
"end_offset": 35,
"label": "dis"
}
] |
可以在持续呼吸机通气治疗（＞3天）时出现X线胸片弥漫渗出阴影，可以有气道分泌物细菌培养阳性。 | [
{
"id": 0,
"entity": "呼吸机",
"start_offset": 5,
"end_offset": 8,
"label": "equ"
},
{
"id": 1,
"entity": "通气",
"start_offset": 8,
"end_offset": 10,
"label": "pro"
},
{
"id": 2,
"entity": "X线胸片",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
},
{
"id": 3,
"entity": "X线胸片弥漫渗出阴影",
"start_offset": 20,
"end_offset": 30,
"label": "sym"
},
{
"id": 4,
"entity": "气道分泌物",
"start_offset": 34,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "细菌",
"start_offset": 39,
"end_offset": 41,
"label": "mic"
},
{
"id": 6,
"entity": "气道分泌物细菌培养阳性",
"start_offset": 34,
"end_offset": 45,
"label": "sym"
}
] |
如果PaO<sub>2</sub>/FiO<sub>2</sub>＞300，则作为继发性肺炎，＜300mmHg，则按急性肺损伤对待。 | [
{
"id": 0,
"entity": "PaO<sub>2</sub>/FiO<sub>2</sub>＞300",
"start_offset": 2,
"end_offset": 37,
"label": "sym"
},
{
"id": 1,
"entity": "继发性肺炎",
"start_offset": 41,
"end_offset": 46,
"label": "dis"
},
{
"id": 2,
"entity": "急性肺损伤",
"start_offset": 58,
"end_offset": 63,
"label": "dis"
}
] |
气道分泌物细菌培养不作为病因诊断的唯一指标，但应该针对性应用敏感抗生素治疗。 | [
{
"id": 0,
"entity": "气道分泌物",
"start_offset": 0,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "细菌",
"start_offset": 5,
"end_offset": 7,
"label": "mic"
},
{
"id": 2,
"entity": "敏感抗生素",
"start_offset": 30,
"end_offset": 35,
"label": "dru"
}
] |
【治疗】2006年，中华医学会重症医学分会提出了我国急性肺损伤急性呼吸窘迫综合征诊断和治疗指南。 | [
{
"id": 0,
"entity": "急性肺损伤",
"start_offset": 26,
"end_offset": 31,
"label": "dis"
},
{
"id": 1,
"entity": "急性呼吸窘迫综合征",
"start_offset": 31,
"end_offset": 40,
"label": "dis"
}
] |
ARDS治疗的关键在于：①积极控制原发病及其病因，如治疗创伤、控制感染是必要措施，降低全身炎症反应综合征；②氧疗是基本手段，及时纠正严重缺氧，PO<sub>2</sub>达到60～80mmHg，ARDS低氧纠正困难，机械通气支持是有效手段；③采用肺保护性通气策略、肺复张手法等；④防止气压伤、容量伤、生物伤，预防呼吸道继发感染和氧中毒等并发症。 | [
{
"id": 0,
"entity": "ARDS",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "治疗创伤",
"start_offset": 26,
"end_offset": 30,
"label": "pro"
},
{
"id": 2,
"entity": "控制感染",
"start_offset": 31,
"end_offset": 35,
"label": "pro"
},
{
"id": 3,
"entity": "炎症反应综合征",
"start_offset": 45,
"end_offset": 52,
"label": "dis"
},
{
"id": 4,
"entity": "氧疗",
"start_offset": 54,
"end_offset": 56,
"label": "pro"
},
{
"id": 5,
"entity": "纠正严重缺氧",
"start_offset": 64,
"end_offset": 70,
"label": "pro"
},
{
"id": 6,
"entity": "PO<sub>2</sub>",
"start_offset": 71,
"end_offset": 85,
"label": "bod"
},
{
"id": 7,
"entity": "PO<sub>2</sub>达到60～80mmHg",
"start_offset": 71,
"end_offset": 96,
"label": "sym"
},
{
"id": 8,
"entity": "ARDS",
"start_offset": 97,
"end_offset": 101,
"label": "dis"
},
{
"id": 9,
"entity": "低氧纠正困难",
"start_offset": 101,
"end_offset": 107,
"label": "sym"
},
{
"id": 10,
"entity": "机械通气支持",
"start_offset": 108,
"end_offset": 114,
"label": "pro"
},
{
"id": 11,
"entity": "肺保护性通气策略",
"start_offset": 123,
"end_offset": 131,
"label": "pro"
},
{
"id": 12,
"entity": "肺复张手法",
"start_offset": 132,
"end_offset": 137,
"label": "pro"
},
{
"id": 13,
"entity": "防止气压伤、容量伤、生物伤",
"start_offset": 140,
"end_offset": 153,
"label": "pro"
},
{
"id": 14,
"entity": "呼吸道继发感染",
"start_offset": 156,
"end_offset": 163,
"label": "dis"
},
{
"id": 15,
"entity": "氧中毒",
"start_offset": 164,
"end_offset": 167,
"label": "dis"
}
] |
（一）积极治疗原发疾病（二）氧疗和辅助通气一般FiO<sub>2</sub>＞0.6，PaO<sub>2</sub>仍＜8kPa（60mmHg），SaO<sub>2</sub>＜90%时，应对患者采用呼气末正压通气（PEEP）为主的综合治疗。 | [
{
"id": 0,
"entity": "氧疗",
"start_offset": 14,
"end_offset": 16,
"label": "pro"
},
{
"id": 1,
"entity": "辅助通气",
"start_offset": 17,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "FiO<sub>2</sub>",
"start_offset": 23,
"end_offset": 38,
"label": "bod"
},
{
"id": 3,
"entity": "FiO<sub>2</sub>＞0.6",
"start_offset": 23,
"end_offset": 42,
"label": "sym"
},
{
"id": 4,
"entity": "PaO<sub>2</sub>",
"start_offset": 43,
"end_offset": 58,
"label": "bod"
},
{
"id": 5,
"entity": "PaO<sub>2</sub>仍＜8kPa（60mmHg）",
"start_offset": 43,
"end_offset": 72,
"label": "sym"
},
{
"id": 6,
"entity": "SaO<sub>2</sub>",
"start_offset": 73,
"end_offset": 88,
"label": "bod"
},
{
"id": 7,
"entity": "SaO<sub>2</sub>＜90%",
"start_offset": 73,
"end_offset": 92,
"label": "sym"
},
{
"id": 8,
"entity": "呼气末正压通气",
"start_offset": 100,
"end_offset": 107,
"label": "pro"
},
{
"id": 9,
"entity": "PEEP",
"start_offset": 108,
"end_offset": 112,
"label": "pro"
}
] |
这些通气模式的特点：在保持通气量时，显著降低平均气道压（MAP）。 | [
{
"id": 0,
"entity": "平均气道压",
"start_offset": 22,
"end_offset": 27,
"label": "ite"
},
{
"id": 1,
"entity": "MAP",
"start_offset": 28,
"end_offset": 31,
"label": "ite"
},
{
"id": 2,
"entity": "降低平均气道压（MAP）",
"start_offset": 20,
"end_offset": 32,
"label": "sym"
}
] |
在ARDS早期经气道插管吸氧和辅助通气有一定好处。 | [
{
"id": 0,
"entity": "ARDS",
"start_offset": 1,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "气道插管",
"start_offset": 8,
"end_offset": 12,
"label": "equ"
},
{
"id": 2,
"entity": "氧",
"start_offset": 13,
"end_offset": 14,
"label": "dru"
},
{
"id": 3,
"entity": "辅助通气",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
}
] |
首先，可以比较可靠地判断PaO<sub>2</sub>/FiO<sub>2</sub>比值，对病情危重程度有正确掌握；其次，便于处理由于分泌物栓塞、吸入等在气道出现的通气障碍病情恶化时，可以给予有效通气和特殊呼吸支持治疗，防止病情恶化。 | [
{
"id": 0,
"entity": "分泌物",
"start_offset": 68,
"end_offset": 71,
"label": "bod"
},
{
"id": 1,
"entity": "分泌物栓塞、吸入",
"start_offset": 68,
"end_offset": 76,
"label": "sym"
},
{
"id": 2,
"entity": "有效通气",
"start_offset": 97,
"end_offset": 101,
"label": "pro"
},
{
"id": 3,
"entity": "特殊呼吸支持治疗",
"start_offset": 102,
"end_offset": 110,
"label": "pro"
}
] |
（三）无创机械通气（NIV）可避免气管插管和气管切开引起的并发症；近年来，在成人领域得到了广泛的推广应用，但儿童使用的经验较少，年长儿可考虑使用。 | [
{
"id": 0,
"entity": "无创机械通气",
"start_offset": 3,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "NIV",
"start_offset": 10,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "气管插管",
"start_offset": 17,
"end_offset": 21,
"label": "pro"
},
{
"id": 3,
"entity": "气管切开",
"start_offset": 22,
"end_offset": 26,
"label": "pro"
}
] |
应严密监测患者的生命体征及治疗反应，意识不清、休克、气道自洁能力障碍的ALI/ARDS患者不宜应用。 | [
{
"id": 0,
"entity": "意识不清",
"start_offset": 18,
"end_offset": 22,
"label": "sym"
},
{
"id": 1,
"entity": "休克",
"start_offset": 23,
"end_offset": 25,
"label": "sym"
},
{
"id": 2,
"entity": "气道",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "气道自洁能力障碍",
"start_offset": 26,
"end_offset": 34,
"label": "sym"
},
{
"id": 4,
"entity": "ALI",
"start_offset": 35,
"end_offset": 38,
"label": "dis"
},
{
"id": 5,
"entity": "ARDS",
"start_offset": 39,
"end_offset": 43,
"label": "dis"
}
] |
（四）有创气道正压控制通气ARDS患儿应尽早采用有创机械通气支持。 | [
{
"id": 0,
"entity": "有创气道正压控制通气",
"start_offset": 3,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 13,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "有创机械通气支持",
"start_offset": 24,
"end_offset": 32,
"label": "pro"
}
] |
采用肺保护性通气策略：①小潮气量（VT，6～8ml/kg），可采用较快呼吸频率。 | [
{
"id": 0,
"entity": "肺保护性通气策略",
"start_offset": 2,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "潮气量",
"start_offset": 13,
"end_offset": 16,
"label": "ite"
},
{
"id": 2,
"entity": "VT",
"start_offset": 17,
"end_offset": 19,
"label": "ite"
},
{
"id": 3,
"entity": "小潮气量（VT，6～8ml/kg）",
"start_offset": 12,
"end_offset": 29,
"label": "sym"
},
{
"id": 4,
"entity": "较快呼吸频率",
"start_offset": 33,
"end_offset": 39,
"label": "pro"
}
] |
②限制气道峰压（PIP＜30～35cmH<sub>2</sub>O）。 | [
{
"id": 0,
"entity": "限制气道峰压",
"start_offset": 1,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "PIP",
"start_offset": 8,
"end_offset": 11,
"label": "ite"
},
{
"id": 2,
"entity": "cmH<sub>2</sub>O",
"start_offset": 17,
"end_offset": 33,
"label": "ite"
},
{
"id": 3,
"entity": "PIP＜30～35cmH<sub>2</sub>O",
"start_offset": 8,
"end_offset": 33,
"label": "sym"
}
] |
③选择最佳呼气末正压（PEEP，0.2～1kPa）以获得理想的顺应性，防止肺泡塌陷；有条件者可采用肺力学曲线测量低位拐点（LIP）和高位拐点（HIP），以LIP+2cmH2O为最佳PEEP；也可根据表6-6进行设置；以HIP-2cmH<sub>2</sub>O为PIP；④允许性高二氧化碳（使pH＞7.2），低于该值可能需要纠酸；颅内高压是其禁忌症。 | [
{
"id": 0,
"entity": "选择最佳呼气末正压",
"start_offset": 1,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "PEEP",
"start_offset": 11,
"end_offset": 15,
"label": "ite"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 37,
"end_offset": 39,
"label": "bod"
},
{
"id": 3,
"entity": "肺泡塌陷",
"start_offset": 37,
"end_offset": 41,
"label": "sym"
},
{
"id": 4,
"entity": "纠酸",
"start_offset": 162,
"end_offset": 164,
"label": "pro"
},
{
"id": 5,
"entity": "颅内",
"start_offset": 165,
"end_offset": 167,
"label": "bod"
},
{
"id": 6,
"entity": "颅内高压",
"start_offset": 165,
"end_offset": 169,
"label": "sym"
}
] |
在ARDS早期，通过调节潮气量、触发频率，获得稳定的分钟通气量和高同步化。 | [
{
"id": 0,
"entity": "ARDS",
"start_offset": 1,
"end_offset": 5,
"label": "dis"
}
] |
利用呼吸机内置装置或床旁肺流速仪监测呼吸力学，如供气和排气潮气量，气管漏气、分钟通气量，判断动态顺应性和呼吸阻力变化，从而达到缩短通气时间、降低机械通气致肺损伤的危险性。 | [
{
"id": 0,
"entity": "呼吸机",
"start_offset": 2,
"end_offset": 5,
"label": "equ"
},
{
"id": 1,
"entity": "肺流速仪",
"start_offset": 12,
"end_offset": 16,
"label": "equ"
},
{
"id": 2,
"entity": "供气和排气潮气量",
"start_offset": 24,
"end_offset": 32,
"label": "ite"
},
{
"id": 3,
"entity": "气管漏气",
"start_offset": 33,
"end_offset": 37,
"label": "ite"
},
{
"id": 4,
"entity": "分钟通气量",
"start_offset": 38,
"end_offset": 43,
"label": "ite"
},
{
"id": 5,
"entity": "机械通气",
"start_offset": 72,
"end_offset": 76,
"label": "pro"
},
{
"id": 6,
"entity": "肺损伤",
"start_offset": 77,
"end_offset": 80,
"label": "dis"
}
] |
常用的呼吸机治疗参数为：将潮气设置在6～8ml/kg（实际潮气乘以体重），通气频率视体重和病情设定，一般30～40次/分钟，PIP在20～25cmH2O，PEEP根据表6-6设定，保持PaO<sub>2</sub>7～10kPa、PaCO<sub>2</sub>5～7kPa、经皮氧饱和度（SpO<sub>2</sub>）＞90%。 | [
{
"id": 0,
"entity": "呼吸机",
"start_offset": 3,
"end_offset": 6,
"label": "equ"
},
{
"id": 1,
"entity": "潮气",
"start_offset": 29,
"end_offset": 31,
"label": "ite"
},
{
"id": 2,
"entity": "经皮氧饱和度",
"start_offset": 138,
"end_offset": 144,
"label": "ite"
}
] |
设置PEEP兼顾氧合、顺应性和心功能诸方面。 | [
{
"id": 0,
"entity": "PEEP",
"start_offset": 2,
"end_offset": 6,
"label": "ite"
}
] |
调节PEEP与FiO<sub>2</sub>之间应以SpO<sub>2</sub>＞90%作为基本判断指标，设定相对比较低的PEEP和FiO<sub>2</sub>水平，同时不应出现心率明显加快或变慢，否则要考虑PEEP水平偏高，导致回心血量减少、心输出量下降、心率代偿性变化。 | [
{
"id": 0,
"entity": "PEEP",
"start_offset": 2,
"end_offset": 6,
"label": "ite"
},
{
"id": 1,
"entity": "PEEP",
"start_offset": 62,
"end_offset": 66,
"label": "ite"
},
{
"id": 2,
"entity": "PEEP",
"start_offset": 106,
"end_offset": 110,
"label": "ite"
}
] |
呼气末二氧化碳分压（PetCO<sub>2</sub>）的动态变化可间接反映PaCO<sub>2</sub>，并可以判断无效腔量变化（V<sub>D</sub>/V<sub>T</sub>=［PetCO<sub>2</sub>-PaCO<sub>2</sub>］/PaCO<sub>2</sub>×100%），＜0.3为正常，＞0.5一般为严重肺泡通气障碍。 | [
{
"id": 0,
"entity": "呼气末二氧化碳分压",
"start_offset": 0,
"end_offset": 9,
"label": "ite"
},
{
"id": 1,
"entity": "PetCO<sub>2</sub>",
"start_offset": 10,
"end_offset": 27,
"label": "ite"
},
{
"id": 2,
"entity": "V<sub>D</sub>/V<sub>T</sub>",
"start_offset": 67,
"end_offset": 94,
"label": "ite"
},
{
"id": 3,
"entity": "严重肺泡通气障碍",
"start_offset": 170,
"end_offset": 178,
"label": "dis"
}
] |
有创机械通气时应注意采用半卧位（30°～45°），以预防呼吸机相关肺炎（ventilatorassociatedpneumonia，VAP）的发生。 | [
{
"id": 0,
"entity": "呼吸机相关肺炎",
"start_offset": 28,
"end_offset": 35,
"label": "dis"
},
{
"id": 1,
"entity": "ventilatorassociatedpneumonia",
"start_offset": 36,
"end_offset": 65,
"label": "dis"
},
{
"id": 2,
"entity": "VAP",
"start_offset": 66,
"end_offset": 69,
"label": "dis"
}
] |
并合理采用镇静镇痛技术，确保患儿能够耐受机械通气，并保障高恒定PEEP的实施。 | [
{
"id": 0,
"entity": "镇静镇痛技术",
"start_offset": 5,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "机械通气",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
},
{
"id": 2,
"entity": "耐受机械通气",
"start_offset": 18,
"end_offset": 24,
"label": "sym"
},
{
"id": 3,
"entity": "PEEP",
"start_offset": 31,
"end_offset": 35,
"label": "ite"
}
] |
表6-9最佳PEEP设置表（五）肺腹张手法小潮气量通气往往不利于ARDS塌陷肺泡的膨胀；充分复张塌陷肺泡是纠正ARDS低氧血症和保证PEEP效应的重要手段，目前临床常用的肺复张手法包括控制性肺膨胀、PEEP递增法及压力控制法。 | [
{
"id": 0,
"entity": "肺腹张手法",
"start_offset": 16,
"end_offset": 21,
"label": "pro"
},
{
"id": 1,
"entity": "ARDS",
"start_offset": 32,
"end_offset": 36,
"label": "dis"
},
{
"id": 2,
"entity": "ARDS",
"start_offset": 55,
"end_offset": 59,
"label": "dis"
},
{
"id": 3,
"entity": "低氧血症",
"start_offset": 59,
"end_offset": 63,
"label": "dis"
},
{
"id": 4,
"entity": "肺复张手法",
"start_offset": 85,
"end_offset": 90,
"label": "pro"
},
{
"id": 5,
"entity": "控制性肺膨胀",
"start_offset": 92,
"end_offset": 98,
"label": "pro"
},
{
"id": 6,
"entity": "PEEP递增法",
"start_offset": 99,
"end_offset": 106,
"label": "pro"
},
{
"id": 7,
"entity": "压力控制法",
"start_offset": 107,
"end_offset": 112,
"label": "pro"
}
] |
控制性肺膨胀采用恒压通气方式，吸气压为30～45cmH<sub>2</sub>O，持续时间为30～40秒。 | [
{
"id": 0,
"entity": "控制性肺膨胀",
"start_offset": 0,
"end_offset": 6,
"label": "pro"
}
] |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.