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在口服用药时应考虑下列因素：新生儿的胃液分泌、肠蠕动和胆汁分泌功能均较婴儿或儿童低下，胃排空时间较短；婴儿和儿童胃液分泌、肠蠕动和胆汁分泌功能正常，胃排空时间增加。 | [
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小婴儿喂药时最好将小儿抱起或头略抬高，以免呛咳将药吐出。 | [
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病情需要时可采用鼻饲给药。 | [
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第七章消化性溃疡消化性溃疡（pepticulcer，PU）是指那些接触消化液（胃酸和胃蛋白酶）的胃肠黏膜及其深层组织的一种局限性黏膜缺损，其深度达到或穿透黏膜肌层。 | [
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本病95%以上发生在胃和十二指肠，即又称胃溃疡和十二指肠溃疡。 | [
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近年来随着诊断技术的进步，尤为消化内镜在儿科的普及应用，该病的检出率明显上升，上海瑞金医院溃疡病平均检出率占胃镜检查的12%；成人中报道约有10%的人在其一生中有过溃疡病。 | [
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【病因及发病机制】消化性溃疡的病因繁多，有遗传、精神、环境、饮食、吸烟及内分泌等因素，迄今尚无定论，发病机制多倾向于攻击因素-防御因素失衡学说。 | [
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正常情况下胃黏膜分泌黏液，良好的血液运输、旺盛的细胞更新能力及胃液分泌的调节机制等防御因素处于优势，或与盐酸、胃蛋白酶及幽门螺杆菌等攻击因素保持平衡；一旦攻击因素增强或（和）防御因素削弱则可形成溃疡。 | [
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目前认为，在上述因素中两大环境因素对大多数溃疡患者的发病有重要意义，即幽门螺杆菌感染与非甾体类抗炎药（NSAIDs）的使用。 | [
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（一）致消化性溃疡的有害因素消化性溃疡形成的基本因素是胃酸及胃蛋白酶分泌增加。 | [
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1.胃酸1910年Schwartz提出“无酸无溃疡”的名言，现在仍然正确。 | [
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胃酸是由胃黏膜的壁细胞分泌，壁细胞上有3种受体即乙酰胆碱受体、胃泌素受体及组胺受体。 | [
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这3种受体在接受相应物质乙酰胆碱、胃泌素及组胺的刺激后产生泌酸效应。 | [
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迷走神经活动亦与胃酸分泌有关。 | [
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（1）壁细胞泌酸过程可分3步：①组胺、胆碱能递质或胃泌素与细胞底一边膜上的相应受体结合；②经第二信息（AMP、Ca2+</sup>）介导，使刺激信号由细胞内向细胞顶端膜传递；③在刺激下，使H+-K+-ATP酶移至分泌性微管，将H+从胞浆泵向胃腔，生成胃酸。 | [
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一般情况下组胺、乙酰胆碱和胃泌素除单独地促进胃酸分泌外，还有协同作用。 | [
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（2）正常人平均每日胃液分泌量1000～1500ml，盐酸40mmol/L；十二指肠溃疡（duodenalulcer，DU）患者每日胃液分泌量1500～2000ml，盐酸40～80mmol/L；而胃溃疡（gastriculcer，GU）患者每日胃液分泌量及盐酸多在正常范围。 | [
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胃酸分泌随着年龄改变而变化，小儿出生时胃液呈碱性，24～48小时游离酸分泌达高峰，此认为与来自母体的胃泌素通过胎盘有直接关系，2天后母体胃泌素减少，胃酸降低。 | [
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所以新生儿在出生2天后就可发生急性胃溃疡及胃穿孔。 | [
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由于胃酸分泌随年龄增加，年长儿消化性溃疡较婴儿多。 | [
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（3）胃酸增高的原因1）壁细胞数量增加：正常男性为1.09×109</sup>，女性为0.82×109</sup>。 | [
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而DU为1.8×109</sup>（增加1倍多），GU为0.8×109</sup>（接近正常）。 | [
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2）促胃泌素：人促胃泌素G17（胃窦部最高）或G34（十二指肠最高），DU患者促胃泌素无增加。 | [
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有人提出DU患者胃酸分泌增高可能与壁细胞对胃泌素刺激敏感有关。 | [
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Isenberg和Grossman曾给DU及非溃疡（NUD）患者注射8个不同剂量的促胃泌素，结果达到最大胃酸分泌量（MAO）时促胃液素半数有效量NDU的均值为148.2±30.3，DU为60.5±96，说明DU患者酸分泌过高是壁细胞对促胃液素敏感所致。 | [
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3）驱动胃酸分泌增加的其他因素：神经、内分泌及旁分泌等因素可影响胃酸分泌增加，消化性溃疡患者基础胃酸分泌量分泌的紧张度增加，敏感性也增加。 | [
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2.胃蛋白酶胃壁主细胞分泌胃蛋白酶原，按照免疫化学分型，分为蛋白酶原Ⅰ（PGⅠ）和蛋白酶原Ⅱ（PGⅡ）。 | [
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PGⅠ存在5种亚型，分布于胃体主细胞，PGⅡ存在于胃体及胃窦。 | [
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应用放免法可在30%～50%DU患者血中测出PGⅠ升高，当达到130μg/L，其致DU的危险较正常人增高3倍。 | [
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PGⅡ升高时致GU危险性增高3倍。 | [
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胃蛋白酶的消化作用是与胃酸紧密联系在一起的，当胃酸pH1.8～2.5时胃蛋白酶活性达到最佳状态，当pH＞4时胃蛋白酶失去活性，不起消化作用。 | [
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故消化作用必须有足够的酸使pH达到3以下才能激活胃蛋白酶，胃酸与胃蛋白酶共同作用产生溃疡，但胃酸是主要因素。 | [
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小儿出生时胃液中胃蛋白酶含量极微，以后缓慢增加，至青春期达到成人水平。 | [
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3.胆汁酸盐胆汁与胃溃疡的关系早有报道。 | [
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在胃窦或十二指肠发生动力紊乱时，胆汁反流入胃，引起胃黏膜损伤，特别是胆汁和胰液在十二指肠互相混合生成溶血卵磷脂，后者破坏胃黏膜屏障，使氢离子反向弥散而损害胃黏膜。 | [
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现认为胆汁对胃黏膜的损伤，主要是由胆汁酸（胆盐）所致。 | [
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胆盐有增加胃内氢离子的反向弥散和降低黏膜电位差的作用，与胃内的酸性环境和胆汁的浓度有密切关系。 | [
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动物实验表明氢离子反向弥散在胆汁高浓度和pH2的条件下反应最显著，低浓度和pH8的条件下反应轻微。 | [
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胆汁酸刺激肥大细胞释放组胺，组胺可使胃黏膜血管扩张，毛细血管壁的通透性增加，导致黏膜水肿、出血、发炎及糜烂，在这样的情况下黏膜很容易发展成溃疡。 | [
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},
{
"id": 2,
"entity": "组胺",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
}... |
4.幽门螺杆菌感染幽门螺杆菌与慢性胃炎密切相关，抑制幽门螺杆菌使原发性消化性溃疡愈合率增加，消除幽门螺杆菌以后溃疡复发率显著下降，细菌的消除以及胃十二指肠炎的消退在很多研究中与溃疡不复发有关。 | [
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},
{
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"entity": "慢性胃炎",
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"label": "... |
文献报道，在未服用ASA及其他NSAIDs的胃十二指肠溃疡患者中，90%以上均有幽门螺杆菌感染引起的慢性活动性胃炎，仅约5%～10%的十二指肠溃疡患者及30%的胃溃疡患者无明确的幽门螺杆菌感染的证据。 | [
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"id": 0,
"entity": "ASA",
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"label": "dru"
},
{
"id": 1,
"entity": "其他NSAIDs",
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"label": "dru"
},
{
"id": 2,
"entity": "胃十二指肠溃疡",
"start_offset": 22,
"end_offset": 29,
"label... |
且根除幽门螺杆菌后消化性溃疡1年复发率＜10%，而幽门螺杆菌（+）的消化性溃疡愈合后1年复发率50%左右，2年复发率几乎达100%，所以，无酸无溃疡，有被“无幽门螺杆菌感染无溃疡”取代或者两者并存的趋势。 | [
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"entity": "幽门螺杆菌",
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{
"id": 1,
"entity": "消化性溃疡",
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},
{
"id": 2,
"entity": "幽门螺杆菌",
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"end_offset": 30,
"label": "m... |
幽门螺杆菌感染在胃黏膜的改变很大程度上可能与幽门螺杆菌的产物（细胞毒素及尿素酶）以及炎症过程有关。 | [
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{
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{
"id": 2,
"entity": "幽门螺杆菌",
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"label": "m... |
幽门螺杆菌感染和黏膜的炎症可破坏胃及十二指肠黏膜屏障的完整性，DU不伴幽门螺杆菌少见，但不清楚的是为什么只有一小部分感染了幽门螺杆菌的患者发展为消化性溃疡，其发病机制如何？ | [
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{
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... |
（1）幽门螺杆菌菌株：不同的幽门螺杆菌菌株有不同的致病性，产生不同的临床结果，具有细胞空泡毒素（CagA及VagA）的幽门螺杆菌菌株感染，使患溃疡的机会增加。 | [
{
"id": 0,
"entity": "幽门螺杆菌菌株",
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},
{
"id": 1,
"entity": "幽门螺杆菌菌株",
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"label": "mic"
},
{
"id": 2,
"entity": "细胞空泡",
"start_offset": 41,
"end_offset": 45,
"label... |
目前已发现儿童溃疡患者感染此菌比例很高。 | [
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（2）宿主的遗传易感性：O型血的人较其他血型者DU发生率高30%～40%，血型物质不分泌型者发生DU的可能性高40%～50%，也有研究认为幽门螺杆菌感染和不同的血型抗原是DU发生中两个独立的因素。 | [
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{
"id": 1,
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"label": "dis"
},
{
"id": 2,
"entity": "血型物质",
"start_offset": 37,
"end_offset": 41,
"label": "bod"
... |
（3）炎症反应：中性粒细胞引起氧化反应。 | [
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{
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"entity": "中性粒细胞",
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] |
幽门螺杆菌表面蛋白质激活单核细胞和巨噬细胞，分泌IL-1及TNF，合成血小板激活因子而产生严重的病理反应。 | [
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{
"id": 1,
"entity": "单核细胞",
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"label": "bod"
},
{
"id": 2,
"entity": "巨噬细胞",
"start_offset": 17,
"end_offset": 21,
"label... |
（4）酸分泌反应：有报道幽门螺杆菌感染者，食物蛋白胨等可引起胃窦G细胞促胃泌素的释放增加，细菌消除后恢复正常。 | [
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更多认为幽门螺杆菌感染导致胃窦部炎症，使胃窦部胃泌素释放增加，生长抑素分泌下降而致胃酸分泌增加。 | [
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{
"id": 2,
"entity": "胃窦部胃泌素释放增加",
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"l... |
（5）十二指肠的胃上皮化生：幽门螺杆菌引起十二指肠胃黏膜化生，使十二指肠碳酸氢盐分泌降低，胃酸分泌增加。 | [
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{
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{
"id": 2,
"entity": "幽门螺杆菌",
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另有人认为幽门螺杆菌产生的细胞空泡毒素在胃液中释放与激活，通过幽门到肠管，活化的空泡毒素在未被肠内一些蛋白酶消化前，即引起十二指肠上皮细胞空泡形成，于是在十二指肠缺乏幽门螺杆菌存在的条件下导致十二指肠溃疡。 | [
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{
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"label": "mic"
},
{
"id": 2,
"entity": "肠管",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
... |
5.药物因素引起消化性溃疡的药物中较重要的有三类：①阿司匹林（ASA）；②非甾体抗炎药物（NSAIDs），如吲哚美辛及保泰松；③肾上腺皮质激素。 | [
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{
"id": 1,
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"label": "dru"
},
{
"id": 2,
"entity": "ASA",
"start_offset": 31,
"end_offset": 34,
"label": "dr... |
ASA及大多数其他NSAIDs与消化性溃疡的相互作用表现在几个方面：小剂量时可致血小板功能障碍；稍大剂量可引起急性浅表性胃黏膜糜烂致出血，约2/3长期使用NSAIDs的患者存在胃十二指肠黏膜病变，其中大多数为浅表损害，约1/4长期应用药物的患者有溃疡病。 | [
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{
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"label": "dru"
},
{
"id": 2,
"entity": "消化性溃疡",
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"label": "... |
但ASA/NSAIDs致胃溃疡机制尚不清楚，现认为是这些药物直接损伤胃黏膜，除使氢离子逆向弥散增加之外，还可抑制前列腺素合成，使胃酸及胃蛋白酶分泌增加，胃黏膜血液供应障碍，胃黏膜屏障功能下降。 | [
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},
{
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"entity": "胃溃疡",
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"label": "dis"... |
6.遗传因素（1）GU和DU同胞患病比一般人群高1.8倍和2.6倍，GU易患GU、DU易患DU。 | [
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{
"id": 2,
"entity": "GU",
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}... |
儿童中DU患儿家族史明显。 | [
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"id": 0,
"entity": "DU",
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] |
O型血发生PUD高于其他血型35%左右，主要为DU；且溃疡伴出血、穿孔，并发症者以O型多见。 | [
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{
"id": 2,
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}... |
调查发现，DU患儿男性多于女性，48.08%系DU家族史，家族发病率一级家属＞二级家属＞三级家属，一级家属的发病率高于普通人群的11倍，O型血多见，占患儿的44.23%，且症状严重。 | [
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{
"id": 1,
"entity": "DU",
"start_offset": 23,
"end_offset": 25,
"label": "dis"
}
] |
HLA血清分型发现HLA-B5、HLA-B12、HLA-BW35与DU有相关性。 | [
{
"id": 0,
"entity": "DU",
"start_offset": 33,
"end_offset": 35,
"label": "dis"
}
] |
HLA-DQA1*03基因与DU有关。 | [
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上海市瑞金医院对十二指肠溃疡患儿HLA-DQA1基因，DU患儿*</sup>03等位基因频率明显低于健康正常儿童，提示*</sup>03基因对DU有重要的抵抗作用。 | [
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{
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"label": "ite"
},
{
"id": 2,
"entity": "HLA-DQA1基",
"start_offset": 16,
"end_offset": 25,
... |
（3）胃蛋白酶原（PG）是胃蛋白酶前体，分泌PGⅠ及PGⅡ，家系调查发现DU患者一半血清中PGⅠ含量增高，在高PGⅠ后代，50%也显示高PGⅠ，表明PGⅠ血症患者为单染色体显性遗传，支持DU遗传基因存在。 | [
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},
{
"id": 2,
"entity": "胃蛋白酶前体",
"start_offset": 13,
"end_offset": 19,
"label": "bod... |
7.精神因素15年前，对胃造瘘患者观察发现，人胃黏膜随人的情绪变化而出现不同的反应，兴奋时，胃黏膜充血，胃液分泌增多，胃运动加强；而抑郁和绝望时，胃黏膜苍白，胃运动减慢。 | [
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},
{
"id": 2,
"entity": "胃黏膜充血",
"start_offset": 46,
"end_offset": 51,
"label": "sy... |
胃肠道的功能，包括胃液分泌及胃肠运动都会在情绪、催眠和生物反馈抑制的影响下发生变化。 | [
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{
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... |
应激时，胃酸分泌增加，胰腺分泌下降，胃的排空率明显下降，溃疡患者在应激时产生的恐惧程度高于健康人群。 | [
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{
"id": 2,
"entity": "胃的排空率明显下降",
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"la... |
Mark等分析发现：溃疡患者多疑、固执，有较强的依赖感，处理事物能力差，不成熟，易冲动，易感到孤独，自我控制能力差，易处于受压和焦虑的状态。 | [
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{
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{
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... |
学龄儿童消化性溃疡发病率增加与学习负担过重、精神压力和心理因素逐渐复杂有关。 | [
{
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] |
8.食物因素中国南方食米区，消化性溃疡发病率较食面食为主的北方地区为高。 | [
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] |
乱吃冷饮，嗜好辛辣食品或暴饮暴食，早餐不吃，晚上贪吃，过食油炸食物、含汽饮料等不良习惯都对胃黏膜造成直接损伤。 | [
{
"id": 0,
"entity": "胃黏膜",
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"label": "bod"
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] |
（二）消化性溃疡的防御因素1.胃黏膜屏障作用胃黏膜屏障是由黏膜表层上皮细胞的细胞膜及细胞间隙的紧密连接所组成，黏膜抵抗氢离子反渗的作用过程有三个部分：①维持胃液中氢离子浓度与胃壁组织液中氢离子浓度的梯度差；②抵挡氢离子逆向弥散及其他有害物质如胆汁、药物及胃蛋白酶对黏膜的损害；③上皮和黏膜/黏膜下血循环营养黏膜，并促进愈合。 | [
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{
"id": 2,
"entity": "胃黏膜屏障",
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"label": "... |
2.黏液屏障作用胃黏膜表面覆盖着一层黏液，是由黏膜上皮细胞及胃隐窝处颈黏膜细胞分泌，内含大分子物质如糖蛋白、黏多糖、蛋白质及磷脂等，其厚度约为上皮细胞的10～20倍。 | [
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{
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{
"id": 2,
"entity": "黏液",
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"end_offset": 20,
"label": "bod"
... |
使其下面的黏膜与胃腔内容物隔离，阻挡氢离子及胃蛋白酶的损害。 | [
{
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"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "胃腔",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "胃蛋白酶",
"start_offset": 22,
"end_offset": 26,
"label": "bod"
}... |
3.碳酸氢盐分泌胃和十二指肠黏膜近端还能分泌小量碳酸氢盐进入黏膜层，中和黏膜层表面的酸，使上皮细胞表面能经常维持pH6～8的范围，抵挡氢离子的逆向弥散作用。 | [
{
"id": 0,
"entity": "碳酸氢盐",
"start_offset": 2,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "胃和十二指肠黏膜",
"start_offset": 8,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "碳酸氢盐",
"start_offset": 24,
"end_offset": 28,
"label": "... |
4.胃黏膜血液供应与上皮细胞再生能力胃、十二指肠黏膜层有丰富的血液供应，向黏膜细胞输送足够的营养物质及不断清除代谢产物，使上皮细胞及时更新。 | [
{
"id": 0,
"entity": "胃黏膜血液",
"start_offset": 2,
"end_offset": 7,
"label": "ite"
},
{
"id": 1,
"entity": "上皮细胞",
"start_offset": 10,
"end_offset": 14,
"label": "ite"
},
{
"id": 2,
"entity": "胃、十二指肠黏膜层",
"start_offset": 18,
"end_offset": 27,
"label"... |
动物实验证实黏膜损伤后能在30分钟内迅速修复。 | [
{
"id": 0,
"entity": "黏膜损伤",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
}
] |
因此脱落与更新之间维持在平衡状态，从而保持了黏膜的完整性。 | [
{
"id": 0,
"entity": "黏膜",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
}
] |
当胃黏膜供血不足，黏膜缺血坏死，细胞再生更新延缓时，则有可能形成溃疡。 | [
{
"id": 0,
"entity": "胃黏膜",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "黏膜",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "溃疡",
"start_offset": 32,
"end_offset": 34,
"label": "dis"
}
... |
5.前列腺素作用胃黏膜上皮细胞有不断合成及释放内源性前列腺素（PG）的作用，主要是PGE2</sub>；后者具有防止各种有害物质对消化道上皮细胞损伤和酸坏死的作用，这种作用称为细胞保护。 | [
{
"id": 0,
"entity": "前列腺素",
"start_offset": 2,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "胃黏膜上皮细胞",
"start_offset": 8,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "内源性前列腺素",
"start_offset": 23,
"end_offset": 30,
"label":... |
具体表现为：①保护胃黏膜免遭有毒物质的损害；②减少NSAIDs所致消化道出血，凡在酸性pH下不解离并溶于脂肪的物质，在胃内很容易进入黏膜细胞，一旦进入细胞后，由于pH的改变而发生解离，其通透性降低，潴留在黏膜细胞内起毒性作用，如NSAIDs。 | [
{
"id": 0,
"entity": "胃黏膜",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "NSAIDs",
"start_offset": 25,
"end_offset": 31,
"label": "dis"
},
{
"id": 2,
"entity": "消化道出血",
"start_offset": 33,
"end_offset": 38,
"label": "... |
PG细胞保护作用的机制：①促使胃黏膜上皮细胞分泌黏液及；②抑制基础胃酸及进餐后胃酸分泌；③加强黏膜的血液循环和蛋白质合成；④促进表面活性磷脂的释放，从而加强了胃黏膜表面的流水性；⑤清除氧自由基。 | [
{
"id": 0,
"entity": "PG细胞",
"start_offset": 0,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "胃黏膜上皮细胞",
"start_offset": 15,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "黏液",
"start_offset": 24,
"end_offset": 26,
"label": "bo... |
非甾体类消炎药抑制前列腺素合成，故可诱发溃疡。 | [
{
"id": 0,
"entity": "非甾体类消炎药",
"start_offset": 0,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "前列腺素",
"start_offset": 9,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "溃疡",
"start_offset": 20,
"end_offset": 22,
"label": "dis... |
除前列腺素外，一些脑肠肽如生长抑素、胰多肽及脑啡肽等也有细胞保护作用。 | [
{
"id": 0,
"entity": "前列腺素",
"start_offset": 1,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "脑肠肽",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "生长抑素",
"start_offset": 13,
"end_offset": 17,
"label": "bod"
... |
6.表皮生长因子表皮生长因子（EGF）是从唾液腺、十二指肠黏液中的Brunner腺及胰腺等组织分泌的多肽。 | [
{
"id": 0,
"entity": "表皮生长因子",
"start_offset": 2,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "表皮生长因子",
"start_offset": 8,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "EGF",
"start_offset": 15,
"end_offset": 18,
"label": "b... |
已有不少报道，EGF在胃肠道内与胃黏膜的特异受体结合而发挥细胞保护作用。 | [
{
"id": 0,
"entity": "EGF",
"start_offset": 7,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "胃肠道",
"start_offset": 11,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "胃黏膜",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
... |
如给予外源性的EGF后，能明显减轻乙醇及阿司匹林等有害物质对胃黏膜的损伤，初步的临床观察给消化性溃疡患者口服EGF后，可促进溃疡愈合。 | [
{
"id": 0,
"entity": "EGF",
"start_offset": 7,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "乙醇",
"start_offset": 17,
"end_offset": 19,
"label": "dru"
},
{
"id": 2,
"entity": "阿司匹林",
"start_offset": 20,
"end_offset": 24,
"label": "dru"
... |
EGF保护胃黏膜促进溃疡愈合的作用，可能与EGF参与胃黏膜上皮细胞再生的调节，刺激消化道黏膜DNA合成，促进上皮再生与痊愈有关，也有报道EGF可使胃黏膜血流量增多。 | [
{
"id": 0,
"entity": "EGF",
"start_offset": 0,
"end_offset": 3,
"label": "dru"
},
{
"id": 1,
"entity": "胃黏膜",
"start_offset": 5,
"end_offset": 8,
"label": "bod"
},
{
"id": 2,
"entity": "EGF",
"start_offset": 21,
"end_offset": 24,
"label": "dru"
}... |
【临床表现】（一）症状与体征小儿消化性溃疡临床表现各种各样，不同的年龄症状差异较大。 | [
{
"id": 0,
"entity": "消化性溃疡",
"start_offset": 16,
"end_offset": 21,
"label": "dis"
}
] |
1.新生儿期以突发性上消化道出血或穿孔为主要特征，常急性起病，以呕血、便血、腹胀及腹膜炎表现为主，易被误诊。 | [
{
"id": 0,
"entity": "突发性上消化道出血或穿孔",
"start_offset": 7,
"end_offset": 19,
"label": "sym"
},
{
"id": 1,
"entity": "呕血",
"start_offset": 32,
"end_offset": 34,
"label": "sym"
},
{
"id": 2,
"entity": "便血",
"start_offset": 35,
"end_offset": 37,
"label":... |
此期多为急性应激性溃疡，死亡率较高。 | [
{
"id": 0,
"entity": "急性应激性溃疡",
"start_offset": 4,
"end_offset": 11,
"label": "dis"
}
] |
2.婴幼儿期此期患儿以急性起病多见，突然呕血、黑便，前期可能有食欲减退、呕吐和腹痛，生长发育迟缓等。 | [
{
"id": 0,
"entity": "突然呕血",
"start_offset": 18,
"end_offset": 22,
"label": "sym"
},
{
"id": 1,
"entity": "黑便",
"start_offset": 23,
"end_offset": 25,
"label": "sym"
},
{
"id": 2,
"entity": "食欲减退",
"start_offset": 31,
"end_offset": 35,
"label": "sym... |
3.学龄前期原发性溃疡逐渐增多，此期腹痛症状明显，多位于脐周，呈间歇性发作，与饮食关系不明确，恶心、呕吐与上消化道出血也较常见。 | [
{
"id": 0,
"entity": "原发性溃疡",
"start_offset": 6,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "腹痛症状明显，多位于脐周，呈间歇性发作",
"start_offset": 18,
"end_offset": 37,
"label": "sym"
},
{
"id": 2,
"entity": "恶心",
"start_offset": 47,
"end_offset": 49,
... |
4.学龄期以十二指肠溃疡多见，随着年龄递增，临床表现与成人接近，症状以上腹痛和脐周腹痛为主，有时有夜间痛，或泛酸、嗳气或慢性贫血。 | [
{
"id": 0,
"entity": "十二指肠溃疡",
"start_offset": 6,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "腹痛",
"start_offset": 36,
"end_offset": 38,
"label": "sym"
},
{
"id": 2,
"entity": "脐周腹痛",
"start_offset": 39,
"end_offset": 43,
"label": "sy... |
少数人表现无痛性黑便、昏厥，甚至休克。 | [
{
"id": 0,
"entity": "无痛性黑便",
"start_offset": 5,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "昏厥",
"start_offset": 11,
"end_offset": 13,
"label": "sym"
},
{
"id": 2,
"entity": "休克",
"start_offset": 16,
"end_offset": 18,
"label": "sym"
... |
（二）并发症1.出血出血的并发症有时可以是溃疡的首发症状，而无任何前驱表现。 | [
{
"id": 0,
"entity": "出血",
"start_offset": 8,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "出血",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "溃疡",
"start_offset": 21,
"end_offset": 23,
"label": "dis"
}... |
2.穿孔穿孔较出血少见得多，溃疡穿孔常突然发生，可无任何先兆症状。 | [
{
"id": 0,
"entity": "穿孔",
"start_offset": 2,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "穿孔",
"start_offset": 4,
"end_offset": 6,
"label": "dis"
},
{
"id": 2,
"entity": "出血",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{... |
少数儿童可无溃疡病史，以穿孔并发症为首发症状。 | [
{
"id": 0,
"entity": "溃疡",
"start_offset": 6,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "穿孔",
"start_offset": 12,
"end_offset": 14,
"label": "dis"
}
] |
经手术证实为十二指肠溃疡伴穿孔。 | [
{
"id": 0,
"entity": "十二指肠溃疡",
"start_offset": 6,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "穿孔",
"start_offset": 13,
"end_offset": 15,
"label": "dis"
}
] |
在新生儿早期也可见应激性胃溃疡穿孔，表现腹痛、腹胀。 | [
{
"id": 0,
"entity": "应激性胃溃疡穿孔",
"start_offset": 9,
"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "腹痛",
"start_offset": 20,
"end_offset": 22,
"label": "sym"
}
] |
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