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也可形成局限性肉芽肿，后者是机体反应较强的表现，由组织细胞、巨细胞、淋巴样细胞及成纤维细胞组成；隐球菌较少发现，大多存在于巨细胞和组织细胞内，引起脑干的血管炎，导致局部脑组织缺血和软化，脑实质内亦可形成肉芽肿。 | [
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隐球菌也可在血管周围间隙中增殖并在灰质内形成许多肉眼可见的囊肿，囊肿内充满隐球菌。 | [
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肺部病变可以很轻微，仅有少量淋巴细胞浸润。 | [
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慢性病灶常有巨噬细胞浸润，但很少形成化脓灶或呈纤维化者，少数病例可表现为局灶性或广泛性小肉芽肿。 | [
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皮肤病变有肉芽肿及胶质性损害两种类型，后者的组织反应较少，内含大量隐球菌。 | [
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正常人血浆中α2</sub>和γ球蛋白内含抗隐球菌生长因子，具有抑制新型隐球菌生长的能力。 | [
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因此只有在机体抵抗力下降时，血清抗隐球菌能力下降时，病原菌才易进入人体致病。 | [
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【临床表现】（一）肺部感染肺部隐球菌病为亚急性或慢性过程，而且常无症状，可能在偶然胸部X线检查中被发现。 | [
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有报道新型隐球菌可在肺部定植，但不侵袭肺实质。 | [
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明显的肺部病变引起的症状有咳嗽、咯血和胸痛而且伴有全身症状。 | [
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胸部X线最常见的有3种类型：①孤立病灶，类似于肿瘤；②散在的小结节病灶，与其他真菌感染、粟粒性肺结核、结节病相似；③浸润性病灶，与浸润性肺结核类似，要与卡氏肺孢子虫鉴别。 | [
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尽管有的病例可出现空洞，但钙化和纤维化罕见。 | [
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肺部病变在诊断中作为播散性病变的原发病灶比单独感染灶更为常见。 | [
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（二）神经系统表现中枢神经系统是临床上最常见的感染部位。 | [
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长期颅压高可有明显的视神经乳头水肿，晚期视神经继发性萎缩而致视力减退，脑神经受累可出现复视、视野缺损、眼肌麻痹或眼球震颤等表现。 | [
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但有10%的病例完全不出现神经系统症状。 | [
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隐球菌肉芽肿发生在大脑，相应的体征与肿瘤、脓肿、硬膜下血肿或脑疝相似，也可发生脑积水。 | [
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中枢神经系统隐球菌病常被误诊为结核性脑膜炎而延误治疗造成死亡。 | [
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脑脊液检查与结核性脑膜炎不易区分，70%隐球菌性脑膜炎患者脑脊液压力增高。 | [
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慢性患者可在正常范围内，外观清澈、透明或微混，白细胞计数轻至中度增多，早期以中性粒细胞为主，中期以淋巴细胞为主，可达88%～90%，主要为淋巴细胞、单核细胞等。 | [
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糖和氯化物早期变化不明显，中后期明显下降，尤其是糖。 | [
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蛋白常在2g/L以上。 | [
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隐球菌脑膜炎的鉴别包括其他真菌引起的脑膜炎、结核性脑膜炎、布鲁菌病、淋巴瘤和淋巴肉瘤。 | [
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（三）皮肤表现是其他部位隐球菌的一个局部表现，也可经直接接触感染而患病。 | [
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多为血行播散的结果，播散性病变患者中有10%出现隐球菌性皮肤损害。 | [
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从骨骼病灶直接扩散到皮肤也可发生。 | [
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皮损初为软疣样或粉刺状皮疹，结节或脓肿，边界清楚，无红晕，继而中央破溃，溃疡有隆起的乳头瘤样边缘，流出少量带黏液血性的脓液，内含隐球菌。 | [
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"entity": "边界清楚",
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头面部和头皮是最常见的皮损部位，但全身其他部位均可受累。 | [
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（四）脉络膜视网膜炎主要发生在成人，多为播散性疾病的一种征象。 | [
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眼部症状有视力急性减退、眼痛、悬物浮动感、畏光等，检查常有脉络膜炎伴或不伴视网膜炎，而视网膜玻璃体肿块和前葡萄膜炎不多见。 | [
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（五）其他部位的感染播散性病变10%有骨损害，可出现疼痛和肿胀，X线表现与骨源性肉瘤易混淆。 | [
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"id": 2,
"entity": "疼痛",
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可能出现隐球菌病的其他组织器官有心脏、肾上腺、肝、肾、淋巴结和关节等。 | [
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【实验室检查】（一）病原体检查1.真菌检查墨汁染色最敏感，显微镜下见隐球菌圆形孢子，直径5～20μm，内有反光颗粒，外围一层厚膜，有时可见出芽孢子，但无菌丝。 | [
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"entity": "显微镜下见隐球菌圆形孢子",
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... |
取脑脊液3～5ml，离心沉淀后检查最容易发现出芽的真菌，所需的酵母菌的数量至少为103</sup>cuf/ml。 | [
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{
"id": 1,
"entity": "酵母菌",
"start_offset": 31,
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如怀疑肺部隐球菌病，应做痰液、支气管肺泡灌洗液或肺组织的真菌检查。 | [
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2.活组织检查和真菌培养活检组织标本做嗜银染色、爱茜蓝染色、黏蛋白胭脂红染色和嗜碘酸-锡夫染色也可确定病原体。 | [
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"id": 2,
"entity": "嗜银染色",
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溶解离心技术能增加血培养中酵母菌的检出率。 | [
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3.动物接种小白鼠最敏感，将脑脊液或其他标本进行腹腔注射、尾静脉注射或颅内注射，小白鼠在2～8周内死亡，脑内可见大量的隐球菌。 | [
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（二）血清学检查1.抗原检测目前选择的乳胶凝集试验可检测隐球菌的多糖荚膜抗原。 | [
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隐球菌脑膜炎的脑脊液中抗原检测的敏感性至少为90%。 | [
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对诊断肺部隐球菌病患者出现血清隐球菌抗原检测阳性，应高度怀疑有播散性感染的可能。 | [
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{
"id": 2,
"entity": "播散性感染",
"start_offset": 31,
"end_offset": 36,
"la... |
2.抗体检测由于患者血清中可测到的抗体不多，因此检测抗体的阳性率不高，且特异性不强，假阳性太高。 | [
{
"id": 0,
"entity": "抗体检测",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "血清",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "抗体",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
... |
但是抗体检测仍可作为辅助诊断，如抗体检测为阳性，而抗原阴性，说明病情较轻或药物疗效良好。 | [
{
"id": 0,
"entity": "抗体检测",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "抗体检测为阳性，而抗原阴性",
"start_offset": 16,
"end_offset": 29,
"label": "sym"
}
] |
【诊断】确诊新型隐球菌感染必须从体液或组织中分离出病原菌。 | [
{
"id": 0,
"entity": "新型隐球菌感染",
"start_offset": 6,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "从体液或组织中分离出病原菌",
"start_offset": 15,
"end_offset": 28,
"label": "sym"
}
] |
经多次血培养和尿培养，有1/3的非艾滋病患者可作出播散性疾病的诊断。 | [
{
"id": 0,
"entity": "血培养",
"start_offset": 3,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "尿培养",
"start_offset": 7,
"end_offset": 10,
"label": "pro"
},
{
"id": 2,
"entity": "艾滋病",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
... |
对中枢神经系统隐球菌病作出早期正确诊断时，应注意：凡未确诊的脑膜炎、脑炎及脑占位病变，在脑脊液检查时应常规进行真菌检查；结核性脑膜脑炎，抗结核治疗无效应时应怀疑本病；血液性疾病、肿瘤、系统性红斑狼疮、器官移植等，在病程中突然出现头痛、恶心、呕吐应怀疑中枢神经系统隐球菌感染。 | [
{
"id": 0,
"entity": "中枢神经系统隐球菌病",
"start_offset": 1,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "脑膜炎",
"start_offset": 30,
"end_offset": 33,
"label": "dis"
},
{
"id": 2,
"entity": "脑炎",
"start_offset": 34,
"end_offset": 36,
"label": ... |
【治疗】应注意，抗真菌治疗的一个重要的辅助治疗是减少或停用免疫抑制药物，特别是肾上腺皮质类固醇。 | [
{
"id": 0,
"entity": "抗真菌治疗",
"start_offset": 8,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "减少或停用免疫抑制药物",
"start_offset": 24,
"end_offset": 35,
"label": "pro"
},
{
"id": 2,
"entity": "肾上腺皮质类固醇",
"start_offset": 39,
"end_offset": 47,
... |
（一）抗真菌药物1.两性霉素B静脉滴注用于中枢神经系统隐球菌病或其他内脏隐球菌病。 | [
{
"id": 0,
"entity": "两性霉素B",
"start_offset": 10,
"end_offset": 15,
"label": "dru"
},
{
"id": 1,
"entity": "静脉滴注",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "中枢神经系统隐球菌病",
"start_offset": 21,
"end_offset": 31,
"lab... |
用药前必须以5%的葡萄糖稀释至5～10mg/dl，缓缓静脉滴注，隔日一次，每次滴注时间应不少于6小时，滴注速度过快可发生抽搐、心室纤颤、过敏性反应、血压降低和心跳停止。 | [
{
"id": 0,
"entity": "葡萄糖",
"start_offset": 9,
"end_offset": 12,
"label": "dru"
},
{
"id": 1,
"entity": "静脉滴注",
"start_offset": 27,
"end_offset": 31,
"label": "pro"
},
{
"id": 2,
"entity": "滴注",
"start_offset": 39,
"end_offset": 41,
"label": "pro"
... |
反应重者，于静脉滴入氢化可的松或地塞米松，或减少本药的剂量，延长疗程，亦不影响治疗效果。 | [
{
"id": 0,
"entity": "静脉滴入",
"start_offset": 6,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "氢化可的松",
"start_offset": 10,
"end_offset": 15,
"label": "dru"
},
{
"id": 2,
"entity": "地塞米松",
"start_offset": 16,
"end_offset": 20,
"label": "d... |
非HIV感染伴有中枢神经系统或其他症状的播散性隐球菌感染患者可用两性霉素B和氟胞嘧啶联合治疗。 | [
{
"id": 0,
"entity": "HIV感染",
"start_offset": 1,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "中枢神经系统",
"start_offset": 8,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "播散性隐球菌感染",
"start_offset": 20,
"end_offset": 28,
"label"... |
两性霉素B总量应超过15mg/kg，氟胞嘧啶50～150mg/（kg•d）。 | [
{
"id": 0,
"entity": "两性霉素B",
"start_offset": 0,
"end_offset": 5,
"label": "dru"
},
{
"id": 1,
"entity": "氟胞嘧啶",
"start_offset": 18,
"end_offset": 22,
"label": "dru"
}
] |
HIV感染患者播散性隐球菌感染时因复发率较高，需要诱导和维持疗法，最好的方案是两性霉素B伴或不伴氟胞嘧啶。 | [
{
"id": 0,
"entity": "HIV感染",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "播散性隐球菌感染",
"start_offset": 7,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "诱导和维持疗法",
"start_offset": 25,
"end_offset": 32,
"label... |
本药毒性大，适当治疗后即可停药，停药原则是：脑脊液墨汁涂片检查转阴3～4周；临床上可恢复的主要症状体征已消失；总剂量已达1.5～3g；疗程至少6周。 | [
{
"id": 0,
"entity": "脑脊液墨汁涂片检查转阴3～4周",
"start_offset": 22,
"end_offset": 37,
"label": "sym"
}
] |
椎管内注射：限于治疗中枢神经系统隐球菌病。 | [
{
"id": 0,
"entity": "椎管内注射",
"start_offset": 0,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "中枢神经系统隐球菌病",
"start_offset": 10,
"end_offset": 20,
"label": "dis"
}
] |
适用于病情严重或静脉注射未成功者。 | [
{
"id": 0,
"entity": "静脉注射",
"start_offset": 8,
"end_offset": 12,
"label": "pro"
}
] |
注射时，将药物与腰椎穿刺引流出的脑脊液3～5ml混匀后，缓缓注入蛛网膜下腔。 | [
{
"id": 0,
"entity": "注射",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "腰椎穿刺",
"start_offset": 8,
"end_offset": 12,
"label": "pro"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
... |
注意给药过程中的不良反应，如尿潴留甚至暂时性截瘫等，一般立即停药即可缓解。 | [
{
"id": 0,
"entity": "尿潴留",
"start_offset": 14,
"end_offset": 17,
"label": "sym"
},
{
"id": 1,
"entity": "暂时性截瘫",
"start_offset": 19,
"end_offset": 24,
"label": "sym"
}
] |
鞘内注射时加地塞米松每次1～2mg。 | [
{
"id": 0,
"entity": "鞘内注射",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "地塞米松",
"start_offset": 6,
"end_offset": 10,
"label": "dru"
}
] |
2.氟胞嘧啶连续应用具有抗隐球菌的作用，但因耐药性出现很快而较少单独使用。 | [
{
"id": 0,
"entity": "氟胞嘧啶",
"start_offset": 2,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "隐球菌",
"start_offset": 13,
"end_offset": 16,
"label": "mic"
}
] |
在组织中均可达到较高浓度，口服剂量50～100mg/（kg•d），分3～4次服。 | [
{
"id": 0,
"entity": "口服",
"start_offset": 13,
"end_offset": 15,
"label": "pro"
}
] |
3.氟康唑有很好的血-脑屏障通透性，能达到极佳的脑脊液浓度。 | [
{
"id": 0,
"entity": "氟康唑",
"start_offset": 2,
"end_offset": 5,
"label": "dru"
},
{
"id": 1,
"entity": "血-脑屏障",
"start_offset": 9,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 24,
"end_offset": 27,
"label": "bod"
... |
但氟康唑耐药菌株出现应予重视。 | [
{
"id": 0,
"entity": "氟康唑",
"start_offset": 1,
"end_offset": 4,
"label": "dru"
}
] |
该药副作用较轻，少数患者可出现恶心、皮疹、肝酶升高和血钾降低等。 | [
{
"id": 0,
"entity": "恶心",
"start_offset": 15,
"end_offset": 17,
"label": "sym"
},
{
"id": 1,
"entity": "皮疹",
"start_offset": 18,
"end_offset": 20,
"label": "sym"
},
{
"id": 2,
"entity": "肝酶升高",
"start_offset": 21,
"end_offset": 25,
"label": "sym"
... |
4.伊曲康唑是广谱三唑类抗真菌药，不易通过血-脑屏障进入脑脊液，但在脑组织中有较高的浓度。 | [
{
"id": 0,
"entity": "伊曲康唑",
"start_offset": 2,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "广谱三唑类抗真菌药",
"start_offset": 7,
"end_offset": 16,
"label": "dru"
},
{
"id": 2,
"entity": "血-脑屏障",
"start_offset": 21,
"end_offset": 26,
"label":... |
在神经系统隐球菌病的治疗中，主张与两性霉素B合用或作为脑脊液转阴后的维持治疗。 | [
{
"id": 0,
"entity": "神经系统隐球菌病",
"start_offset": 1,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "两性霉素B",
"start_offset": 17,
"end_offset": 22,
"label": "dru"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 27,
"end_offset": 30,
"label": ... |
副作用：少数患者出现恶心、呕吐、皮疹和肝酶升高等，但一般不影响治疗。 | [
{
"id": 0,
"entity": "恶心",
"start_offset": 10,
"end_offset": 12,
"label": "sym"
},
{
"id": 1,
"entity": "呕吐",
"start_offset": 13,
"end_offset": 15,
"label": "sym"
},
{
"id": 2,
"entity": "皮疹",
"start_offset": 16,
"end_offset": 18,
"label": "sym"
... |
经过1～2周治疗后，脑脊液中或原发感染部位的隐球菌培养转阴，说明治疗有效。 | [
{
"id": 0,
"entity": "脑脊液中或原发感染部位的隐球菌培养转阴",
"start_offset": 10,
"end_offset": 29,
"label": "sym"
}
] |
初次治疗应持续至少6周，微生物学检查阴性后最少再治疗4周。 | [
{
"id": 0,
"entity": "微生物学检查阴性",
"start_offset": 12,
"end_offset": 20,
"label": "sym"
}
] |
提示隐球菌预后不良的因素有：①治疗前血清或脑脊液隐球菌抗原滴度≥1∶32；②脑脊液中糖降低；③脑脊液中白细胞＜20/μl；④脑脊液压力增高；⑤治疗前墨汁染色阳性；⑥治疗后血清或脑脊液隐球菌抗原滴度≥1∶8。 | [
{
"id": 0,
"entity": "隐球菌",
"start_offset": 2,
"end_offset": 5,
"label": "mic"
},
{
"id": 1,
"entity": "治疗前血清或脑脊液隐球菌抗原滴度≥1∶32",
"start_offset": 15,
"end_offset": 36,
"label": "sym"
},
{
"id": 2,
"entity": "脑脊液中糖降低；③脑脊液中白细胞＜20/μl",
"start_offset": 38,
"... |
骨骼感染时，除全身抗真菌药外一般均需外科清创；皮肤感染在诊断上需外科活检，药物治疗；脉络膜视网膜炎治疗同样需要全身抗真菌治疗，可用氟康唑或氟胞嘧啶，此两药在玻璃体中可获得高浓度。 | [
{
"id": 0,
"entity": "骨骼感染",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "全身抗真菌药",
"start_offset": 7,
"end_offset": 13,
"label": "dru"
},
{
"id": 2,
"entity": "外科清创",
"start_offset": 18,
"end_offset": 22,
"label": "pr... |
（二）其他疗法局限性病灶如皮肤、胸部肉芽肿及脓疡，或肺部肉芽肿及空洞等在未合并中枢神经系统隐球菌病的情况下，可以考虑手术切除。 | [
{
"id": 0,
"entity": "局限性病灶",
"start_offset": 7,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "皮肤、胸部肉芽肿及脓疡",
"start_offset": 13,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "肺部肉芽肿及空洞",
"start_offset": 26,
"end_offset": 34,
... |
于术前术后均需用两性霉素B，以控制隐球菌感染。 | [
{
"id": 0,
"entity": "两性霉素B",
"start_offset": 8,
"end_offset": 13,
"label": "dru"
},
{
"id": 1,
"entity": "隐球菌感染",
"start_offset": 17,
"end_offset": 22,
"label": "dis"
}
] |
【预后】隐球菌脑膜炎虽然偶见有两年以上仍反复发作而迁延不愈者，但如不治疗多在3个月至半年左右趋于恶化，出现一系列运动障碍如偏瘫、失语、共济失调等；精神错乱以致抽风昏迷，最后因呼吸衰竭死亡。 | [
{
"id": 0,
"entity": "隐球菌脑膜炎",
"start_offset": 4,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "偏瘫",
"start_offset": 61,
"end_offset": 63,
"label": "sym"
},
{
"id": 2,
"entity": "失语",
"start_offset": 64,
"end_offset": 66,
"label": "sym"... |
近40%的患者留有神经系统后遗症，如视神经炎、动眼神经损害，部分有人格和脑功能的改变。 | [
{
"id": 0,
"entity": "神经系统后遗症",
"start_offset": 9,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "视神经炎",
"start_offset": 18,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "动眼神经损害",
"start_offset": 23,
"end_offset": 29,
"label"... |
隐球菌性脑膜炎发生在有基础疾病时的病死率为55%，无基础性疾病的病死率为25%。 | [
{
"id": 0,
"entity": "隐球菌性脑膜炎",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
}
] |
长期应用糖皮质激素及其他免疫抑制剂影响预后，易复发。 | [
{
"id": 0,
"entity": "糖皮质激素",
"start_offset": 4,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "免疫抑制剂",
"start_offset": 12,
"end_offset": 17,
"label": "dru"
}
] |
【预防】新型隐球菌患者无需隔离，目前尚无有效的控制措施，但免疫损伤者应避免接触有鸽子粪便污染的区域。 | [
{
"id": 0,
"entity": "新型隐球菌",
"start_offset": 4,
"end_offset": 9,
"label": "mic"
},
{
"id": 1,
"entity": "隔离",
"start_offset": 13,
"end_offset": 15,
"label": "pro"
},
{
"id": 2,
"entity": "避免接触有鸽子粪便污染的区域",
"start_offset": 35,
"end_offset": 49,
"lab... |
参考文献1.FischM.Surgeryinrhabdomyosarcomaofthebladder，prostateandvagina.WorldJUrol，1995，13（4）：213-2132.GerLP.Cancerpatients'knowledgeoftheirdiagnoses.JFormosMedAssoc，1996，95（8）：605-6113.IczkowskiKA.Inflammatorypseudotumorandsarcomaofurinarybladder：differentialdiagnosisandoutcomeinthirtyeightspindlecellneoplasmas.ModPathol... | [
{
"id": 0,
"entity": "Surgeryinrhabdomyosarcomaofthebladder",
"start_offset": 13,
"end_offset": 50,
"label": "dis"
},
{
"id": 1,
"entity": "Inflammatorypseudotumor",
"start_offset": 195,
"end_offset": 218,
"label": "dis"
},
{
"id": 2,
"entity": "sarcomaofurina... |
JPediatrSurg，1994，29（3）：461-4646.RaneyRBJr.Primarychemotherapywithorwithoutradiationtherapyand/orsurgeryforchildrenwithlocalizedsarcomaofthebladder，prostate，vagina，uterus，andcervix.AcomparisonoftheresultsinIntergroupRhabdomyosarcomaStudiesⅠandⅡ.Cancer，1990，66（10）：2072-20727.RaneyBJr.Sequelaeoftreatmentin109patientsfoll... | [
{
"id": 0,
"entity": "bladder",
"start_offset": 140,
"end_offset": 147,
"label": "bod"
},
{
"id": 1,
"entity": "prostate",
"start_offset": 148,
"end_offset": 156,
"label": "bod"
},
{
"id": 2,
"entity": "vagina",
"start_offset": 157,
"end_offset": 163,
... |
第二节肺的通气-灌流（一）肺通气-灌流比值肺泡从吸入空气获得氧，从血液获得二氧化碳（图8-6）。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "肺",
"start_offset": 13,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
... |
理想状态下整个肺或各个肺泡通气单位的肺泡通气和血液灌流比值应相当（V/Q=1）。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 7,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "肺泡",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "肺泡",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
},
... |
在肺泡和组织部分的氧和二氧化碳交换速率应该相等。 | [
{
"id": 0,
"entity": "肺泡",
"start_offset": 1,
"end_offset": 3,
"label": "bod"
}
] |
如果气体弥散没有障碍，则肺泡和血液间的气体分压趋于平衡，各个气体分压总和为大气压。 | [
{
"id": 0,
"entity": "肺泡",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "血液",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
}
] |
从表8-4中看到，理想状态下肺泡内和动脉气体分压是一致的。 | [
{
"id": 0,
"entity": "肺泡",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "动脉",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
}
] |
在直立状态，上部肺泡含气量多，血流量低，V/Q比值≥1；下部肺泡含气量少，血流量高，V/Q比值＜0.8；仅中部肺组织V/Q接近0.8。 | [
{
"id": 0,
"entity": "肺泡含气量",
"start_offset": 8,
"end_offset": 13,
"label": "ite"
},
{
"id": 1,
"entity": "血流量",
"start_offset": 15,
"end_offset": 18,
"label": "ite"
},
{
"id": 2,
"entity": "肺泡含气量",
"start_offset": 30,
"end_offset": 35,
"label": "i... |
在病变肺，某些肺组织因实变、水肿、不张等病变导致V/Q＜0.8，局部Qs/Qt可以显著上升。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "肺组织",
"start_offset": 7,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "实变",
"start_offset": 11,
"end_offset": 13,
"label": "sym"
},
... |
图8-6肺通气-灌流示意图A.正常的通气-灌流平衡；B.通气障碍：肺泡通气障碍导致氧合受阻，产生功能性分流；C.通气障碍时血液灌流的代偿性改变：通气差的肺泡其血液灌流相应减少，可改善动脉血氧合；D.血液灌流障碍：灌流差的肺泡尽管通气良好，只相当于增大的死腔表8-4海平面大气、肺泡、动静脉血液和组织的气体分压kPa（mmHg）（二）右向左分流右向左分流也称为静脉-动脉分流（Qs/Qt），在健康人大约有3%的混合静脉血不经肺毛细血管直接进入体循环的解剖分流。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 4,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "通气障碍",
"start_offset": 28,
"end_offset": 32,
"label": "sym"
},
{
"id": 2,
"entity": "肺泡通气障碍",
"start_offset": 33,
"end_offset": 39,
"label": "sym"... |
如果患儿为右向左分流的先天性心血管病，或肺部因实变、水肿、不张等病变，流经肺毛细血管的混合静脉血未与肺泡气交换而进入静脉，为肺内分流。 | [
{
"id": 0,
"entity": "右向左分流",
"start_offset": 5,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "先天性心血管病",
"start_offset": 11,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "肺部",
"start_offset": 20,
"end_offset": 22,
"label": "... |
如果分流量增加到＞15%，可以出现低氧血症。 | [
{
"id": 0,
"entity": "低氧血症",
"start_offset": 17,
"end_offset": 21,
"label": "dis"
}
] |
当分流量＞30%，为严重低氧血症，只有吸入高浓度氧（FiO2</sub>＞0.5）才能维持。 | [
{
"id": 0,
"entity": "低氧血症",
"start_offset": 12,
"end_offset": 16,
"label": "dis"
}
] |
四、血小板减少性紫癜血小板减少（＜100×109</sup>/L）是新生儿出血的主要原因之一，新生儿血小板减少的病因很多，发病机制较复杂，临床表现多样。 | [
{
"id": 0,
"entity": "血小板减少性紫癜",
"start_offset": 2,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "血小板",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "血小板",
"start_offset": 50,
"end_offset": 53,
"label": "... |
【病因与发病机制】根据病因和发病机制不同，新生儿血小板减少性紫癜可分为以下几种：1.同族免疫性血小板减少性紫癜发病机制与新生儿Rh或ABO血型不合溶血病相似，为母婴血小板抗原性不合所致。 | [
{
"id": 0,
"entity": "血小板",
"start_offset": 24,
"end_offset": 27,
"label": "bod"
},
{
"id": 1,
"entity": "紫癜",
"start_offset": 30,
"end_offset": 32,
"label": "sym"
},
{
"id": 2,
"entity": "同族免疫性血小板减少性紫癜",
"start_offset": 42,
"end_offset": 55,
"labe... |
2.先天性被动免疫性血小板减少性紫癜因母亲患特发性血小板减少性紫癜，其血中抗血小板抗体通过胎盘进入胎儿血循环，破坏胎儿血小板，如母亲患系统性红斑狼疮，也可产生血小板抗体，通过胎盘，破坏胎儿血小板。 | [
{
"id": 0,
"entity": "先天性被动免疫性血小板减少性紫癜",
"start_offset": 2,
"end_offset": 18,
"label": "dis"
},
{
"id": 1,
"entity": "特发性血小板减少性紫癜",
"start_offset": 22,
"end_offset": 33,
"label": "dis"
},
{
"id": 2,
"entity": "抗血小板抗体",
"start_offset": 37,
"end_offset":... |
3.新生儿溶血病合并血小板减少性紫癜患儿同时存在红细胞和血小板同族免疫抗体。 | [
{
"id": 0,
"entity": "新生儿溶血病合并血小板减少性紫癜",
"start_offset": 2,
"end_offset": 18,
"label": "dis"
},
{
"id": 1,
"entity": "红细胞",
"start_offset": 24,
"end_offset": 27,
"label": "bod"
},
{
"id": 2,
"entity": "血小板",
"start_offset": 28,
"end_offset": 31,
"l... |
4.药物性血小板减少性紫癜分为两种：①先天性：孕母多为过敏体质，在孕后期用过某种药物而被致敏，当再用同一药物时，会产生大量IgG抗体，通过胎盘进入胎儿，破坏血小板；②后天性：出生后新生儿用某些药物，如磺胺、地高辛、吲哚美辛等，产生抗血小板抗体，破坏血小板。 | [
{
"id": 0,
"entity": "药物性血小板减少性紫癜",
"start_offset": 2,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "IgG抗体",
"start_offset": 61,
"end_offset": 66,
"label": "bod"
},
{
"id": 2,
"entity": "血小板",
"start_offset": 78,
"end_offset": 81,
"labe... |
5.感染性血小板减少性紫癜宫内感染以巨细胞病毒、弓形体、风疹、疱疹病毒较为常见，生后感染以细菌感染为主，如败血症、肺炎、细菌性脑膜炎、尿路感染等。 | [
{
"id": 0,
"entity": "感染性血小板减少性紫癜",
"start_offset": 2,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "宫内感染",
"start_offset": 13,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "巨细胞病毒",
"start_offset": 18,
"end_offset": 23,
"lab... |
感染导致血小板减少感染可产生血小板抗体、抑制骨髓产生血小板、毒素破坏等。 | [
{
"id": 0,
"entity": "感染",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "血小板",
"start_offset": 4,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "血小板减少",
"start_offset": 4,
"end_offset": 9,
"label": "sym"
},... |
6.先天性巨核细胞增生不良骨髓巨核细胞减少或缺如，导致血小板减少。 | [
{
"id": 0,
"entity": "先天性巨核细胞增生不良",
"start_offset": 2,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "骨髓",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "巨核细胞",
"start_offset": 15,
"end_offset": 19,
"label"... |
7.遗传性血小板减少性紫癜主要是Wiskott-Aldrich综合征，是一种X连锁隐性遗传病。 | [
{
"id": 0,
"entity": "遗传性血小板减少性紫癜",
"start_offset": 2,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "Wiskott-Aldrich综合征",
"start_offset": 16,
"end_offset": 34,
"label": "dis"
},
{
"id": 2,
"entity": "X连锁隐性遗传病",
"start_offset": 38,
"end_offs... |
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