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（二）活检技术可用毛刷和针吸取病理标本，主要用于细胞学检查。
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活检钳则用于支气管黏膜和肺组织活检。
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（三）病原学检测技术由于下呼吸道的致病菌与咽部存在的细菌并不一致，因而传统的咽拭子或痰培养对下呼吸道感染病原菌的诊断并不可靠。
|
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"entity": "致病菌",
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"entity": "咽部",
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"entity": "细菌",
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"entity": "下呼吸道感染",
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"entity": "病原菌",
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纤维支气管镜下气管内导管吸引或毛刷可取得下呼吸道标本。
|
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防污染毛刷、尤其是双腔管保护性标本刷（protectedspecimenbrush，PSB）的应用使污染率明显下降。
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由于毛刷隐藏在双层套管中，顶端有聚乙二醇堵塞，可避免咽喉部污染。
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20世纪90年代以来，采用顶端带气囊的防污染导管进行支气管肺泡灌洗（bronchoalveolarlavage，BAL），既可获得大量的灌洗液（BALF）标本，又可使污染率下降至2%。
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"entity": "BALF",
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但在儿童由于受到小儿纤维支气管镜本身的制约，以上防污染方法尚无法应用，仍只能通过活检孔取样。
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在取样前应尽量避免通过活检孔吸引上呼吸道分泌物。
|
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（四）BAL将纤维支气管镜伸至段或亚段支气管开口处，根据年龄每次注入生理盐水5～20ml，随即负压吸引，共2～3次。
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BALF除病原学检查外，还可进行免疫、炎症细胞等分析研究。
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BAL作为支气管肺局部治疗方法，可有效清除下呼吸道黏稠分泌物、改善气道阻塞并注药治疗顽固性肺部炎症，对控制支气管肺内化脓性感染、治疗阻塞性肺不张或肺气肿有明显效果。
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一般先用0.5ml/kg的生理盐水多次冲洗，再用活检钳或毛刷清除肉芽和脓苔，然后再次冲洗。
|
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有专家认为，在管腔干净后可向局部气道注入青霉素、庆大霉素、甲硝唑或头孢菌素等，但其有效性、安全性与必要性尚有待研究。
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（五）钳取深部支气管异物与硬质支气管镜相比，纤维支气管镜具有能够弯曲、深入、直观、且可越过异物从异物远端进行注气、注液治疗等优势，可钳取异物，或应用支气管冲洗加吸引的方法取异物。
|
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纤维支气管镜已成为诊断和治疗支气管深部异物的一种有效手段。
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二、产时出血（一）头颅血肿和帽状腱膜下出血为胎儿头颅在产道受压、牵拉、器械助产等所致，随着产前诊断、产程监护、手术方式的改进，本病发生率已明显减少。
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【临床表现】1.头颅血肿又称骨膜下血肿，常位于一侧或两侧顶骨部，局部皮肤不肿、不变色骨膜下出血缓慢，血肿多在生后数小时或2～3天才明显，1周内达最大范围，以后渐吸收缩小。
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血肿界限清楚，不越过骨缝，有波动感，局部皮肤颜色无改变，此可与头皮水肿及帽状腱膜下血肿骨缝，头皮水肿出生时即发现，界限不分明，压之柔软且可凹，无波动感，局部皮肤可呈红或紫色。
|
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"entity": "无波动感",
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头颅血肿位于枕骨部位者，需与脑膜膨出鉴别，后者随呼吸有起伏感，头颅X线片可见局部颅骨有缺损头颅血肿颅骨完整，偶见颅骨有线样骨折。
|
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巨大头颅血肿可致失血性贫血及高胆红素血症。
|
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头颅血肿吸收较慢，因大小不同可在2周～3个月左右消退。
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吸收时先在血肿边缘形成隆起的骨化的硬边，中央凹陷，呈火山口样改变。
|
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2.帽状腱膜下血肿生后不久即见头皮局限性肿胀，出血可通过软组织扩散，出血量较少时，血肿范围较局限；出血量多时，肿胀范围逐渐扩大，可累及整个头皮，甚至波及额、眼周、枕或颈背部。
|
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"entity": "颈背部",
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血肿有波动感，常使前囟不易扪清，所覆皮肤可呈青紫色。
|
[
{
"id": 0,
"entity": "血肿",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "前囟",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "皮肤",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
}
] |
出血严重时可致贫血或低血容量休克，若不及时治疗可引起死亡。
|
[
{
"id": 0,
"entity": "贫血",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "低血容量休克",
"start_offset": 10,
"end_offset": 16,
"label": "dis"
}
] |
【治疗】头颅血肿多可自行吸收，无需特殊治疗，出血较多引起贫血时，可适量输血；引起高胆红素血症时，需进行光疗。
|
[
{
"id": 0,
"entity": "头颅血肿",
"start_offset": 4,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "贫血",
"start_offset": 28,
"end_offset": 30,
"label": "dis"
},
{
"id": 2,
"entity": "输血",
"start_offset": 35,
"end_offset": 37,
"label": "pro"
},
{
"id": 3,
"entity": "高胆红素血症",
"start_offset": 40,
"end_offset": 46,
"label": "dis"
},
{
"id": 4,
"entity": "光疗",
"start_offset": 51,
"end_offset": 53,
"label": "pro"
}
] |
为避免感染不应抽吸血肿，若2个月后头颅血肿仍巨大，可手术清除之。
|
[
{
"id": 0,
"entity": "血肿",
"start_offset": 9,
"end_offset": 11,
"label": "sym"
},
{
"id": 1,
"entity": "头颅血肿",
"start_offset": 17,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "手术",
"start_offset": 26,
"end_offset": 28,
"label": "pro"
}
] |
可用维生素K1</sub>治疗，以防止因发生新生儿出血症而引起出血加重。
|
[
{
"id": 0,
"entity": "维生素K1</sub>",
"start_offset": 2,
"end_offset": 13,
"label": "dru"
},
{
"id": 1,
"entity": "新生儿出血症",
"start_offset": 22,
"end_offset": 28,
"label": "dis"
}
] |
（二）内脏出血新生儿内脏出血主要发生在产时，常由产伤引起，生后1～3天即发生贫血、失血性休克等严重临床表现，有时内脏出血不容易及时发现，导致死亡，应予以重视。
|
[
{
"id": 0,
"entity": "内脏出血",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "新生儿内脏出血",
"start_offset": 7,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "贫血",
"start_offset": 38,
"end_offset": 40,
"label": "dis"
},
{
"id": 3,
"entity": "失血性休克",
"start_offset": 41,
"end_offset": 46,
"label": "dis"
},
{
"id": 4,
"entity": "内脏出血",
"start_offset": 56,
"end_offset": 60,
"label": "dis"
}
] |
【临床表现】1.颅内出血颅内出血（详见颅内出血章节）是新生儿期常见的临床问题，出血部位包括硬膜下出血蛛网膜下腔出血脑室周围-脑室内出血小脑出血和脑实质出血蛛网膜下腔出血脑室周围-脑室内出血惊厥、两眼凝视、呼吸暂停、四肢肌张力增高或降低、前囟隆起贫血等。
|
[
{
"id": 0,
"entity": "颅内出血",
"start_offset": 8,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "颅内出血",
"start_offset": 12,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "颅内出血",
"start_offset": 19,
"end_offset": 23,
"label": "dis"
},
{
"id": 3,
"entity": "硬膜",
"start_offset": 45,
"end_offset": 47,
"label": "bod"
},
{
"id": 4,
"entity": "硬膜下出血",
"start_offset": 45,
"end_offset": 50,
"label": "sym"
},
{
"id": 5,
"entity": "蛛网膜",
"start_offset": 50,
"end_offset": 53,
"label": "bod"
},
{
"id": 6,
"entity": "蛛网膜下腔出血",
"start_offset": 50,
"end_offset": 57,
"label": "sym"
},
{
"id": 7,
"entity": "脑室",
"start_offset": 57,
"end_offset": 59,
"label": "bod"
},
{
"id": 8,
"entity": "周围-脑室",
"start_offset": 59,
"end_offset": 64,
"label": "bod"
},
{
"id": 9,
"entity": "脑室周围-脑室内出血",
"start_offset": 57,
"end_offset": 67,
"label": "sym"
},
{
"id": 10,
"entity": "小脑",
"start_offset": 67,
"end_offset": 69,
"label": "bod"
},
{
"id": 11,
"entity": "脑实质",
"start_offset": 72,
"end_offset": 75,
"label": "bod"
},
{
"id": 12,
"entity": "小脑出血和脑实质出血",
"start_offset": 67,
"end_offset": 77,
"label": "sym"
},
{
"id": 13,
"entity": "蛛网膜",
"start_offset": 77,
"end_offset": 80,
"label": "bod"
},
{
"id": 14,
"entity": "蛛网膜下腔出血",
"start_offset": 77,
"end_offset": 84,
"label": "sym"
},
{
"id": 15,
"entity": "脑室",
"start_offset": 84,
"end_offset": 86,
"label": "bod"
},
{
"id": 16,
"entity": "周围-脑室",
"start_offset": 86,
"end_offset": 91,
"label": "bod"
},
{
"id": 17,
"entity": "脑室周围-脑室内出血",
"start_offset": 84,
"end_offset": 94,
"label": "sym"
},
{
"id": 18,
"entity": "惊厥",
"start_offset": 94,
"end_offset": 96,
"label": "sym"
},
{
"id": 19,
"entity": "两眼凝视",
"start_offset": 97,
"end_offset": 101,
"label": "sym"
},
{
"id": 20,
"entity": "呼吸暂停",
"start_offset": 102,
"end_offset": 106,
"label": "sym"
},
{
"id": 21,
"entity": "四肢肌张力增高或降低",
"start_offset": 107,
"end_offset": 117,
"label": "sym"
},
{
"id": 22,
"entity": "前囟",
"start_offset": 118,
"end_offset": 120,
"label": "bod"
},
{
"id": 23,
"entity": "前囟隆起",
"start_offset": 118,
"end_offset": 122,
"label": "sym"
},
{
"id": 24,
"entity": "贫血",
"start_offset": 122,
"end_offset": 124,
"label": "dis"
}
] |
2.肝脾破裂贫血、面色苍白，病情呈进行性加重，严重者出现失血性休克。
|
[
{
"id": 0,
"entity": "肝脾",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "肝脾破裂",
"start_offset": 2,
"end_offset": 6,
"label": "sym"
},
{
"id": 2,
"entity": "贫血",
"start_offset": 6,
"end_offset": 8,
"label": "dis"
},
{
"id": 3,
"entity": "面色苍白",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
},
{
"id": 4,
"entity": "失血性休克",
"start_offset": 28,
"end_offset": 33,
"label": "sym"
}
] |
肝脏出血包膜破裂腹腔出血腹胀、腹部叩诊有移动性浊音。
|
[
{
"id": 0,
"entity": "肝脏",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "肝脏出血",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 2,
"entity": "包膜",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
},
{
"id": 3,
"entity": "包膜破裂",
"start_offset": 4,
"end_offset": 8,
"label": "sym"
},
{
"id": 4,
"entity": "腹腔",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 5,
"entity": "腹腔出血",
"start_offset": 8,
"end_offset": 12,
"label": "sym"
},
{
"id": 6,
"entity": "腹胀",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
},
{
"id": 7,
"entity": "腹部叩诊有移动性浊音",
"start_offset": 15,
"end_offset": 25,
"label": "sym"
}
] |
3.肾上腺出血患儿突然出现贫血、面色苍白、循环衰竭、青紫、呼吸不规则、黄疸、四肢肌张力降低，侧腹部触及包块。
|
[
{
"id": 0,
"entity": "肾上腺",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "贫血",
"start_offset": 13,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "面色苍白",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
},
{
"id": 3,
"entity": "循环衰竭",
"start_offset": 21,
"end_offset": 25,
"label": "sym"
},
{
"id": 4,
"entity": "青紫",
"start_offset": 26,
"end_offset": 28,
"label": "sym"
},
{
"id": 5,
"entity": "呼吸不规则",
"start_offset": 29,
"end_offset": 34,
"label": "sym"
},
{
"id": 6,
"entity": "黄疸",
"start_offset": 35,
"end_offset": 37,
"label": "sym"
},
{
"id": 7,
"entity": "四肢肌张力降低",
"start_offset": 38,
"end_offset": 45,
"label": "sym"
},
{
"id": 8,
"entity": "侧腹部触及包块",
"start_offset": 46,
"end_offset": 53,
"label": "sym"
}
] |
【诊断】1.病史多有异常分娩史，出生后要严密观察面色、四肢循环、心率、呼吸及腹部体征。
|
[
{
"id": 0,
"entity": "四肢循环",
"start_offset": 27,
"end_offset": 31,
"label": "ite"
},
{
"id": 1,
"entity": "心率",
"start_offset": 32,
"end_offset": 34,
"label": "ite"
},
{
"id": 2,
"entity": "呼吸及腹部体征",
"start_offset": 35,
"end_offset": 42,
"label": "ite"
}
] |
2.影像学检查怀疑内脏出血者应及时做影像学检查。
|
[
{
"id": 0,
"entity": "内脏",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "内脏出血",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
}
] |
怀疑肝、脾破裂或肾上腺出血腹部B超或腹部X线平片。
|
[
{
"id": 0,
"entity": "肝",
"start_offset": 2,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "脾",
"start_offset": 4,
"end_offset": 5,
"label": "bod"
},
{
"id": 2,
"entity": "肾上腺",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 3,
"entity": "肾上腺出血",
"start_offset": 8,
"end_offset": 13,
"label": "sym"
},
{
"id": 4,
"entity": "腹部",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 5,
"entity": "B超",
"start_offset": 15,
"end_offset": 17,
"label": "pro"
},
{
"id": 6,
"entity": "腹部",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
},
{
"id": 7,
"entity": "X线平片",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
}
] |
3.判断出血部位对出生后发生严重贫血者，要根据临床表现判断是否发生内脏出血出血量及是否发生失血性休克根据生命体征、血压、血红蛋白动态变化，及时作出判断。
|
[
{
"id": 0,
"entity": "严重贫血",
"start_offset": 14,
"end_offset": 18,
"label": "dis"
},
{
"id": 1,
"entity": "内脏",
"start_offset": 33,
"end_offset": 35,
"label": "bod"
},
{
"id": 2,
"entity": "内脏出血",
"start_offset": 33,
"end_offset": 37,
"label": "sym"
},
{
"id": 3,
"entity": "出血量",
"start_offset": 37,
"end_offset": 40,
"label": "ite"
},
{
"id": 4,
"entity": "失血性休克",
"start_offset": 45,
"end_offset": 50,
"label": "sym"
},
{
"id": 5,
"entity": "生命体征",
"start_offset": 52,
"end_offset": 56,
"label": "ite"
},
{
"id": 6,
"entity": "血压",
"start_offset": 57,
"end_offset": 59,
"label": "ite"
},
{
"id": 7,
"entity": "血红蛋白动态变化",
"start_offset": 60,
"end_offset": 68,
"label": "ite"
}
] |
【治疗】1.止血可用维生素K1</sub>、酚磺乙胺、氨甲苯酸（PAMBA）等。
|
[
{
"id": 0,
"entity": "维生素K1</sub>",
"start_offset": 10,
"end_offset": 21,
"label": "dru"
},
{
"id": 1,
"entity": "酚磺乙胺",
"start_offset": 22,
"end_offset": 26,
"label": "dru"
},
{
"id": 2,
"entity": "氨甲苯酸",
"start_offset": 27,
"end_offset": 31,
"label": "dru"
},
{
"id": 3,
"entity": "PAMBA",
"start_offset": 32,
"end_offset": 37,
"label": "dru"
}
] |
2.纠正低血容量如发生失血性休克，应立即给生理盐水，先快速静脉滴注10～20ml/kg，然后根据病情继续维持。
|
[
{
"id": 0,
"entity": "血容量",
"start_offset": 5,
"end_offset": 8,
"label": "ite"
},
{
"id": 1,
"entity": "失血性休克",
"start_offset": 11,
"end_offset": 16,
"label": "sym"
},
{
"id": 2,
"entity": "生理盐水",
"start_offset": 21,
"end_offset": 25,
"label": "dru"
},
{
"id": 3,
"entity": "静脉滴注",
"start_offset": 29,
"end_offset": 33,
"label": "pro"
}
] |
3.输血出现严重贫血或失血性休克，应及时输血，每次10～20ml/kg，病情严重者需多次输血。
|
[
{
"id": 0,
"entity": "贫血",
"start_offset": 8,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "失血性休克",
"start_offset": 11,
"end_offset": 16,
"label": "sym"
},
{
"id": 2,
"entity": "输血",
"start_offset": 20,
"end_offset": 22,
"label": "pro"
},
{
"id": 3,
"entity": "输血",
"start_offset": 44,
"end_offset": 46,
"label": "pro"
}
] |
4.手术对肝脾破裂肾上腺出血糖皮质激素治疗，用氢化可的松，每天5～10mg/kg，静脉滴注。
|
[
{
"id": 0,
"entity": "肝脾",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "肝脾破裂",
"start_offset": 5,
"end_offset": 9,
"label": "sym"
},
{
"id": 2,
"entity": "肾上腺",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 3,
"entity": "肾上腺出血",
"start_offset": 9,
"end_offset": 14,
"label": "sym"
},
{
"id": 4,
"entity": "糖皮质激素",
"start_offset": 14,
"end_offset": 19,
"label": "dru"
},
{
"id": 5,
"entity": "氢化可的松",
"start_offset": 23,
"end_offset": 28,
"label": "dru"
},
{
"id": 6,
"entity": "静脉滴注",
"start_offset": 41,
"end_offset": 45,
"label": "pro"
}
] |
第二章心肺脑复苏【概述】心肺复苏始于1958年，kouwenhoven于1960年将其标准化并广泛用于临床，80年代将脑复苏推向复苏前沿，即目前所称的心肺脑复苏（cardiopulmonarycerebralresuscitation，CPCR）。
|
[
{
"id": 0,
"entity": "心肺脑复苏",
"start_offset": 3,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "心肺复苏",
"start_offset": 12,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "脑复苏",
"start_offset": 59,
"end_offset": 62,
"label": "pro"
},
{
"id": 3,
"entity": "心肺脑复苏",
"start_offset": 75,
"end_offset": 80,
"label": "pro"
},
{
"id": 4,
"entity": "cardiopulmonarycerebralresuscitation",
"start_offset": 81,
"end_offset": 117,
"label": "pro"
},
{
"id": 5,
"entity": "CPCR",
"start_offset": 118,
"end_offset": 122,
"label": "pro"
}
] |
90年代，基础研究已深入到细胞分子水平，复苏操作上出现了一些新方法和新概念，复苏学已成为一门新学科。
|
[
{
"id": 0,
"entity": "复苏操作",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
}
] |
现今认为机体从有生命到死亡经历了临终状态（terminalstate）、心脏骤停（cardiacarrest）、临床死亡（clinicaldeath）、生物死亡（biologicdeath）。
|
[
{
"id": 0,
"entity": "死亡",
"start_offset": 11,
"end_offset": 13,
"label": "sym"
},
{
"id": 1,
"entity": "临终状态",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
},
{
"id": 2,
"entity": "terminalstate",
"start_offset": 21,
"end_offset": 34,
"label": "sym"
},
{
"id": 3,
"entity": "心脏",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 4,
"entity": "心脏骤停",
"start_offset": 36,
"end_offset": 40,
"label": "sym"
},
{
"id": 5,
"entity": "cardiacarrest",
"start_offset": 41,
"end_offset": 54,
"label": "sym"
},
{
"id": 6,
"entity": "临床死亡",
"start_offset": 56,
"end_offset": 60,
"label": "sym"
},
{
"id": 7,
"entity": "clinicaldeath",
"start_offset": 61,
"end_offset": 74,
"label": "sym"
},
{
"id": 8,
"entity": "生物死亡",
"start_offset": 76,
"end_offset": 80,
"label": "sym"
},
{
"id": 9,
"entity": "biologicdeath",
"start_offset": 81,
"end_offset": 94,
"label": "sym"
}
] |
CPCR是对临床死亡及前期采取的心、肺、脑功能抢救措施。
|
[
{
"id": 0,
"entity": "CPCR",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "死亡",
"start_offset": 8,
"end_offset": 10,
"label": "sym"
},
{
"id": 2,
"entity": "心",
"start_offset": 16,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "肺",
"start_offset": 18,
"end_offset": 19,
"label": "bod"
},
{
"id": 4,
"entity": "脑",
"start_offset": 20,
"end_offset": 21,
"label": "bod"
}
] |
【呼吸心脏骤停的病因】心肺脑复苏的对象是各种原因引起的呼吸心脏骤停。
|
[
{
"id": 0,
"entity": "呼吸心脏骤停",
"start_offset": 1,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "心肺脑复苏",
"start_offset": 11,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "呼吸心脏骤停",
"start_offset": 27,
"end_offset": 33,
"label": "dis"
}
] |
引起小儿呼吸、心搏骤停的病因如下：（一）呼吸系统疾病如上气道阻塞（如异物、反流、喉痉挛、喉水肿等）、下气道疾病（如继发于呼吸衰竭或呼吸停止的疾病）。
|
[
{
"id": 0,
"entity": "呼吸、心搏骤停",
"start_offset": 4,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸系统疾病",
"start_offset": 20,
"end_offset": 26,
"label": "dis"
},
{
"id": 2,
"entity": "上气道阻塞",
"start_offset": 27,
"end_offset": 32,
"label": "dis"
},
{
"id": 3,
"entity": "异物",
"start_offset": 34,
"end_offset": 36,
"label": "dis"
},
{
"id": 4,
"entity": "反流",
"start_offset": 37,
"end_offset": 39,
"label": "dis"
},
{
"id": 5,
"entity": "喉痉挛",
"start_offset": 40,
"end_offset": 43,
"label": "dis"
},
{
"id": 6,
"entity": "喉水肿",
"start_offset": 44,
"end_offset": 47,
"label": "dis"
},
{
"id": 7,
"entity": "下气道疾病",
"start_offset": 50,
"end_offset": 55,
"label": "dis"
},
{
"id": 8,
"entity": "呼吸衰竭或呼吸停止的疾病",
"start_offset": 60,
"end_offset": 72,
"label": "dis"
}
] |
（二）感染如败血症、脑膜炎等。
|
[
{
"id": 0,
"entity": "败血症",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "脑膜炎",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
}
] |
（三）中毒与药物过敏如药品（麻醉性抑制剂、镇静剂、抗节律不齐药物药物中毒）、农药、有害气体中毒、青霉素过敏等。
|
[
{
"id": 0,
"entity": "中毒",
"start_offset": 3,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "药物过敏",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
},
{
"id": 2,
"entity": "麻醉性抑制剂、镇静剂、抗节律不齐药物药物中毒",
"start_offset": 14,
"end_offset": 36,
"label": "dis"
},
{
"id": 3,
"entity": "有害气体中毒",
"start_offset": 41,
"end_offset": 47,
"label": "dis"
},
{
"id": 4,
"entity": "青霉素过敏",
"start_offset": 48,
"end_offset": 53,
"label": "dis"
}
] |
（四）循环系统疾病如休克、先天性心脏病、心肌炎、心包炎、心律失常等。
|
[
{
"id": 0,
"entity": "循环系统疾病",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "休克",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "先天性心脏病",
"start_offset": 13,
"end_offset": 19,
"label": "dis"
},
{
"id": 3,
"entity": "心肌炎",
"start_offset": 20,
"end_offset": 23,
"label": "dis"
},
{
"id": 4,
"entity": "心包炎",
"start_offset": 24,
"end_offset": 27,
"label": "dis"
},
{
"id": 5,
"entity": "心律失常",
"start_offset": 28,
"end_offset": 32,
"label": "dis"
}
] |
（五）中枢神经系统疾病如颅脑外伤、颅内感染、颅内出血、颅内肿瘤、脑疝等。
|
[
{
"id": 0,
"entity": "中枢神经系统疾病",
"start_offset": 3,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "颅脑外伤",
"start_offset": 12,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "颅内感染",
"start_offset": 17,
"end_offset": 21,
"label": "dis"
},
{
"id": 3,
"entity": "颅内出血",
"start_offset": 22,
"end_offset": 26,
"label": "dis"
},
{
"id": 4,
"entity": "颅内肿瘤",
"start_offset": 27,
"end_offset": 31,
"label": "dis"
},
{
"id": 5,
"entity": "脑疝",
"start_offset": 32,
"end_offset": 34,
"label": "dis"
}
] |
（六）创伤和意外如窒息、溺水、婴儿猝死综合征等。
|
[
{
"id": 0,
"entity": "窒息",
"start_offset": 9,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "溺水",
"start_offset": 12,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "婴儿猝死综合征",
"start_offset": 15,
"end_offset": 22,
"label": "dis"
}
] |
（七）代谢性疾病如酸碱和电解质紊乱等。
|
[
{
"id": 0,
"entity": "代谢性疾病",
"start_offset": 3,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "酸碱和电解质紊乱",
"start_offset": 9,
"end_offset": 17,
"label": "dis"
}
] |
【临床表现和诊断】心搏骤停常有如下临床表现：①突然出现昏迷，部分患儿有一过性抽搐；②瞳孔扩大；③大动脉搏动消失；④心音消失及心动过缓；⑤呼吸停止或严重呼吸困难；⑥心电图显示等电位和极缓慢心律。
|
[
{
"id": 0,
"entity": "心搏骤停",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
},
{
"id": 1,
"entity": "突然出现昏迷",
"start_offset": 23,
"end_offset": 29,
"label": "sym"
},
{
"id": 2,
"entity": "一过性抽搐",
"start_offset": 35,
"end_offset": 40,
"label": "sym"
},
{
"id": 3,
"entity": "瞳孔",
"start_offset": 42,
"end_offset": 44,
"label": "bod"
},
{
"id": 4,
"entity": "瞳孔扩大",
"start_offset": 42,
"end_offset": 46,
"label": "sym"
},
{
"id": 5,
"entity": "大动脉",
"start_offset": 48,
"end_offset": 51,
"label": "bod"
},
{
"id": 6,
"entity": "大动脉搏动消失",
"start_offset": 48,
"end_offset": 55,
"label": "sym"
},
{
"id": 7,
"entity": "心音消失及心动过缓",
"start_offset": 57,
"end_offset": 66,
"label": "sym"
},
{
"id": 8,
"entity": "呼吸停止",
"start_offset": 68,
"end_offset": 72,
"label": "sym"
},
{
"id": 9,
"entity": "严重呼吸困难",
"start_offset": 73,
"end_offset": 79,
"label": "sym"
},
{
"id": 10,
"entity": "心电图",
"start_offset": 81,
"end_offset": 84,
"label": "ite"
},
{
"id": 11,
"entity": "心电图显示等电位",
"start_offset": 81,
"end_offset": 89,
"label": "sym"
},
{
"id": 12,
"entity": "极缓慢心律",
"start_offset": 90,
"end_offset": 95,
"label": "sym"
}
] |
但切不可等待出现上述临床表现时才考虑实施心肺脑复苏术。
|
[
{
"id": 0,
"entity": "心肺脑复苏术",
"start_offset": 20,
"end_offset": 26,
"label": "pro"
}
] |
如能早期发现心搏骤停的先兆，及时判断并尽早实施心肺脑复苏术常可提高患儿存活率；心肺脑复苏术开始越早，复苏成功率越高。
|
[
{
"id": 0,
"entity": "心搏骤停",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "心肺脑复苏术",
"start_offset": 23,
"end_offset": 29,
"label": "pro"
},
{
"id": 2,
"entity": "心肺脑复苏术",
"start_offset": 39,
"end_offset": 45,
"label": "pro"
}
] |
要避免如下操作而延误时间，丧失抢救良机：①不断地试听患儿心音有无；②等待心电图显示结果；③反复检查患儿瞳孔和扪摸动脉。
|
[
{
"id": 0,
"entity": "不断地试听患儿心音有无",
"start_offset": 21,
"end_offset": 32,
"label": "pro"
},
{
"id": 1,
"entity": "等待心电图显示结果",
"start_offset": 34,
"end_offset": 43,
"label": "pro"
},
{
"id": 2,
"entity": "反复检查患儿瞳孔和扪摸动脉",
"start_offset": 45,
"end_offset": 58,
"label": "pro"
}
] |
临床上迅速而准确的诊断依据是：①突然出现昏迷；②大动脉搏动消失；③呼吸停止。
|
[
{
"id": 0,
"entity": "突然出现昏迷",
"start_offset": 16,
"end_offset": 22,
"label": "sym"
},
{
"id": 1,
"entity": "大动脉",
"start_offset": 24,
"end_offset": 27,
"label": "bod"
},
{
"id": 2,
"entity": "大动脉搏动消失",
"start_offset": 24,
"end_offset": 31,
"label": "sym"
},
{
"id": 3,
"entity": "呼吸停止",
"start_offset": 33,
"end_offset": 37,
"label": "sym"
}
] |
【小儿呼吸心搏骤停的特点】1.心搏骤停在心电图上的常见三种表现形式为心室纤颤、心脏停搏和电机械分离。
|
[
{
"id": 0,
"entity": "小儿呼吸心搏骤停",
"start_offset": 1,
"end_offset": 9,
"label": "sym"
},
{
"id": 1,
"entity": "心搏骤停",
"start_offset": 15,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "心电图",
"start_offset": 20,
"end_offset": 23,
"label": "ite"
},
{
"id": 3,
"entity": "心室",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
},
{
"id": 4,
"entity": "心室纤颤",
"start_offset": 34,
"end_offset": 38,
"label": "sym"
},
{
"id": 5,
"entity": "心脏",
"start_offset": 39,
"end_offset": 41,
"label": "bod"
},
{
"id": 6,
"entity": "心脏停搏",
"start_offset": 39,
"end_offset": 43,
"label": "sym"
},
{
"id": 7,
"entity": "电机械分离",
"start_offset": 44,
"end_offset": 49,
"label": "sym"
}
] |
与成人相比，儿童很少由心室纤颤引起，而主要是极缓慢心律，其中多数是心室自主心律，小部分为极缓慢的窦性心动过缓。
|
[
{
"id": 0,
"entity": "心室纤颤",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "极缓慢心律",
"start_offset": 22,
"end_offset": 27,
"label": "sym"
},
{
"id": 2,
"entity": "心室自主心律",
"start_offset": 33,
"end_offset": 39,
"label": "sym"
},
{
"id": 3,
"entity": "心",
"start_offset": 50,
"end_offset": 51,
"label": "bod"
},
{
"id": 4,
"entity": "极缓慢的窦性心动过缓",
"start_offset": 44,
"end_offset": 54,
"label": "sym"
}
] |
了解小儿心脏停搏的心电图特点，成人复苏时采用心前区捶击捶击的方法原则上不适用于小儿。
|
[
{
"id": 0,
"entity": "心电图",
"start_offset": 9,
"end_offset": 12,
"label": "ite"
},
{
"id": 1,
"entity": "复苏",
"start_offset": 17,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "心前区捶击",
"start_offset": 22,
"end_offset": 27,
"label": "pro"
}
] |
2.与成人相比，小儿心搏骤停较少原发于心脏疾病，而多为严重疾病的终末结果，在儿科多因呼吸停止造成的严重低氧血症和高碳酸血症所致，先引起呼吸骤停，继而心搏骤停。
|
[
{
"id": 0,
"entity": "小儿心搏骤停",
"start_offset": 8,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "心脏疾病",
"start_offset": 19,
"end_offset": 23,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸停止",
"start_offset": 42,
"end_offset": 46,
"label": "sym"
},
{
"id": 3,
"entity": "严重低氧血症",
"start_offset": 49,
"end_offset": 55,
"label": "dis"
},
{
"id": 4,
"entity": "高碳酸血症",
"start_offset": 56,
"end_offset": 61,
"label": "dis"
},
{
"id": 5,
"entity": "呼吸骤停",
"start_offset": 67,
"end_offset": 71,
"label": "dis"
},
{
"id": 6,
"entity": "心搏骤停",
"start_offset": 74,
"end_offset": 78,
"label": "dis"
}
] |
所以，保持呼吸道通畅是复苏成败的关键措施之一。
|
[
{
"id": 0,
"entity": "保持呼吸道通畅",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "复苏",
"start_offset": 11,
"end_offset": 13,
"label": "pro"
}
] |
上气道阻塞是复苏时需最先处理的问题。
|
[
{
"id": 0,
"entity": "上气道",
"start_offset": 0,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "上气道阻塞",
"start_offset": 0,
"end_offset": 5,
"label": "sym"
},
{
"id": 2,
"entity": "复苏",
"start_offset": 6,
"end_offset": 8,
"label": "pro"
}
] |
3.儿童心、肺、脑各个器官发育尚不成熟，易受体内外环境的影响，年龄愈小，呼吸心搏骤停发生率愈高。
|
[
{
"id": 0,
"entity": "心",
"start_offset": 4,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "肺",
"start_offset": 6,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "脑",
"start_offset": 8,
"end_offset": 9,
"label": "bod"
},
{
"id": 3,
"entity": "呼吸心搏骤停",
"start_offset": 36,
"end_offset": 42,
"label": "dis"
}
] |
但小儿脑组织对缺氧耐受性比成人强，多器官衰竭的慢性病较少，故复苏成功率较成人高。
|
[
{
"id": 0,
"entity": "脑组织",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "多器官衰竭",
"start_offset": 17,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "复苏",
"start_offset": 30,
"end_offset": 32,
"label": "pro"
}
] |
复苏成功的患儿遗留的后遗症相对比成人少。
|
[
{
"id": 0,
"entity": "复苏",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
}
] |
4.呼吸道感染是儿童最常见疾病，由呼吸道分泌物堵塞而致的窒息成为小儿呼吸心搏骤停的主要直接因素，恢复肺有效通气的简单、有效、最易于施行的措施是清理呼吸道和口对口人工呼吸。
|
[
{
"id": 0,
"entity": "呼吸道感染",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸道分泌物",
"start_offset": 17,
"end_offset": 23,
"label": "bod"
},
{
"id": 2,
"entity": "窒息",
"start_offset": 28,
"end_offset": 30,
"label": "dis"
},
{
"id": 3,
"entity": "小儿呼吸心搏骤停",
"start_offset": 32,
"end_offset": 40,
"label": "dis"
},
{
"id": 4,
"entity": "肺",
"start_offset": 50,
"end_offset": 51,
"label": "bod"
},
{
"id": 5,
"entity": "清理呼吸道",
"start_offset": 71,
"end_offset": 76,
"label": "pro"
},
{
"id": 6,
"entity": "口对口人工呼吸",
"start_offset": 77,
"end_offset": 84,
"label": "pro"
}
] |
若有简易复苏器和人工呼吸机行气管内插管予以辅助通气是首选方法，有条件应尽早使用，只是单纯鼻导管给氧是最错误的方法。
|
[
{
"id": 0,
"entity": "复苏器",
"start_offset": 4,
"end_offset": 7,
"label": "equ"
},
{
"id": 1,
"entity": "人工呼吸机",
"start_offset": 8,
"end_offset": 13,
"label": "equ"
},
{
"id": 2,
"entity": "气管内插管",
"start_offset": 14,
"end_offset": 19,
"label": "pro"
},
{
"id": 3,
"entity": "辅助通气",
"start_offset": 21,
"end_offset": 25,
"label": "pro"
},
{
"id": 4,
"entity": "鼻导管给氧",
"start_offset": 44,
"end_offset": 49,
"label": "pro"
}
] |
此外，在呼吸停止时，不管心脏是否停搏，均应立即实施心肺脑复苏术。
|
[
{
"id": 0,
"entity": "呼吸停止",
"start_offset": 4,
"end_offset": 8,
"label": "sym"
},
{
"id": 1,
"entity": "心脏",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "停搏",
"start_offset": 16,
"end_offset": 18,
"label": "sym"
},
{
"id": 3,
"entity": "心肺脑复苏术",
"start_offset": 25,
"end_offset": 31,
"label": "pro"
}
] |
【标准心肺复苏程序】1973年，美国心脏病学会在美国医学杂志（JAMA）发表了心肺复苏指南和抢救规范条例，后几次修订，内容包括：①基本生命支持（basiclifesupport，BLS）；②进一步生命支持（advancedlifesupport，ALS）；③延续生命支持延续生命支持（prolongedlifesupport，PLS）。
|
[
{
"id": 0,
"entity": "心肺复苏",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "心脏病",
"start_offset": 18,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "心肺复苏",
"start_offset": 39,
"end_offset": 43,
"label": "pro"
},
{
"id": 3,
"entity": "基本生命支持",
"start_offset": 65,
"end_offset": 71,
"label": "pro"
},
{
"id": 4,
"entity": "basiclifesupport",
"start_offset": 72,
"end_offset": 88,
"label": "pro"
},
{
"id": 5,
"entity": "BLS",
"start_offset": 89,
"end_offset": 92,
"label": "pro"
},
{
"id": 6,
"entity": "进一步生命支持",
"start_offset": 95,
"end_offset": 102,
"label": "pro"
},
{
"id": 7,
"entity": "advancedlifesupport",
"start_offset": 103,
"end_offset": 122,
"label": "pro"
},
{
"id": 8,
"entity": "ALS",
"start_offset": 123,
"end_offset": 126,
"label": "pro"
},
{
"id": 9,
"entity": "延续生命支持",
"start_offset": 129,
"end_offset": 135,
"label": "pro"
},
{
"id": 10,
"entity": "prolongedlifesupport",
"start_offset": 142,
"end_offset": 162,
"label": "pro"
},
{
"id": 11,
"entity": "PLS",
"start_offset": 163,
"end_offset": 166,
"label": "pro"
}
] |
标准心肺复苏程序见表6-4。
|
[
{
"id": 0,
"entity": "心肺复苏",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
}
] |
（一）基本生命支持（BLS）由现场人员立即对患者进行抢救，是心、肺、脑复苏的第一阶段，主要目的是保持呼吸道通畅，建立人工呼吸和人工循环，保证供给重要生命器官的血液和氧气，给患者提供最基本的生命支持，即心肺复苏ABC。
|
[
{
"id": 0,
"entity": "基本生命支持",
"start_offset": 3,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "BLS",
"start_offset": 10,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "心、肺、脑复苏",
"start_offset": 30,
"end_offset": 37,
"label": "pro"
},
{
"id": 3,
"entity": "保持呼吸道通畅",
"start_offset": 48,
"end_offset": 55,
"label": "pro"
},
{
"id": 4,
"entity": "建立人工呼吸和人工循环",
"start_offset": 56,
"end_offset": 67,
"label": "pro"
},
{
"id": 5,
"entity": "重要生命器官",
"start_offset": 72,
"end_offset": 78,
"label": "bod"
},
{
"id": 6,
"entity": "血液",
"start_offset": 79,
"end_offset": 81,
"label": "bod"
},
{
"id": 7,
"entity": "提供最基本的生命支持",
"start_offset": 88,
"end_offset": 98,
"label": "pro"
},
{
"id": 8,
"entity": "心肺复苏ABC",
"start_offset": 100,
"end_offset": 107,
"label": "pro"
}
] |
其中包括A（呼吸道通畅）、B（辅助呼吸）、C（辅助循环）。
|
[
{
"id": 0,
"entity": "呼吸道通畅",
"start_offset": 6,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "辅助呼吸",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "辅助循环",
"start_offset": 23,
"end_offset": 27,
"label": "pro"
}
] |
1.保持呼吸道通畅保持呼吸道通畅是复苏成败的关键措施之一，只有呼吸道通畅复苏程序才能发挥作用。
|
[
{
"id": 0,
"entity": "保持呼吸道通畅",
"start_offset": 2,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "保持呼吸道通畅",
"start_offset": 9,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "复苏",
"start_offset": 17,
"end_offset": 19,
"label": "pro"
},
{
"id": 3,
"entity": "呼吸道",
"start_offset": 31,
"end_offset": 34,
"label": "bod"
},
{
"id": 4,
"entity": "呼吸道通畅",
"start_offset": 31,
"end_offset": 36,
"label": "sym"
},
{
"id": 5,
"entity": "复苏",
"start_offset": 36,
"end_offset": 38,
"label": "pro"
}
] |
方法有：表6-4心肺复苏程序（1）背部叩打加胸部压迫法（图6-6）：医务人员取坐位，保持婴儿俯卧于救者前臂上，前臂可放于大腿上，用手指张开托住患儿的嘴并固定患儿的头，保持头低位。
|
[
{
"id": 0,
"entity": "心肺复苏",
"start_offset": 8,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "背部叩打加胸部压迫法",
"start_offset": 17,
"end_offset": 27,
"label": "pro"
},
{
"id": 2,
"entity": "医务人员取坐位",
"start_offset": 34,
"end_offset": 41,
"label": "pro"
},
{
"id": 3,
"entity": "保持婴儿俯卧于救者前臂上",
"start_offset": 42,
"end_offset": 54,
"label": "pro"
},
{
"id": 4,
"entity": "前臂可放于大腿上",
"start_offset": 55,
"end_offset": 63,
"label": "pro"
},
{
"id": 5,
"entity": "用手指张开托住患儿的嘴并固定患儿的头",
"start_offset": 64,
"end_offset": 82,
"label": "pro"
},
{
"id": 6,
"entity": "保持头低位",
"start_offset": 83,
"end_offset": 88,
"label": "pro"
}
] |
用手掌根部在婴儿肩胛之间进行5次有力的拍打。
|
[
{
"id": 0,
"entity": "用手掌根部在婴儿肩胛之间进行5次有力的拍打",
"start_offset": 0,
"end_offset": 21,
"label": "pro"
}
] |
拍背后将空闲的手放于婴儿背部，手指托住其头颈部，此时患儿处于两手之间，一手支持其头、颈、嘴、胸，一手支持其背部。
|
[
{
"id": 0,
"entity": "拍背后将空闲的手放于婴儿背部",
"start_offset": 0,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "手指托住其头颈部",
"start_offset": 15,
"end_offset": 23,
"label": "pro"
},
{
"id": 2,
"entity": "此时患儿处于两手之间",
"start_offset": 24,
"end_offset": 34,
"label": "pro"
},
{
"id": 3,
"entity": "一手支持其头、颈、嘴、胸",
"start_offset": 35,
"end_offset": 47,
"label": "pro"
},
{
"id": 4,
"entity": "一手支持其背部",
"start_offset": 48,
"end_offset": 55,
"label": "pro"
}
] |
当头、颈很好地托住后，小心地将婴儿反转过来，使其仰卧于另一手的前臂上，手臂置于大腿上，继续维持头低位。
|
[
{
"id": 0,
"entity": "头",
"start_offset": 1,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "颈",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 2,
"entity": "小心地将婴儿反转过来",
"start_offset": 11,
"end_offset": 21,
"label": "pro"
},
{
"id": 3,
"entity": "使其仰卧于另一手的前臂上",
"start_offset": 22,
"end_offset": 34,
"label": "pro"
},
{
"id": 4,
"entity": "手臂置于大腿上",
"start_offset": 35,
"end_offset": 42,
"label": "pro"
},
{
"id": 5,
"entity": "继续维持头低位",
"start_offset": 43,
"end_offset": 50,
"label": "pro"
}
] |
施行5次快速的胸部冲压，位置与胸部按压相同。
|
[
{
"id": 0,
"entity": "施行5次快速的胸部冲压",
"start_offset": 0,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "胸部按压",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
}
] |
若婴儿较大，可将婴儿置于救者大腿上，头置于膝部，用手可靠地固定住头部并保持头低位，在行5次拍背后，翻转过来进行5次胸部冲压，若能见到患儿口或鼻中有异物，应迅速用手指或器械除去异物。
|
[
{
"id": 0,
"entity": "将婴儿置于救者大腿上",
"start_offset": 7,
"end_offset": 17,
"label": "pro"
},
{
"id": 1,
"entity": "头置于膝部",
"start_offset": 18,
"end_offset": 23,
"label": "pro"
},
{
"id": 2,
"entity": "用手可靠地固定住头部并保持头低位",
"start_offset": 24,
"end_offset": 40,
"label": "pro"
},
{
"id": 3,
"entity": "在行5次拍背后",
"start_offset": 41,
"end_offset": 48,
"label": "pro"
},
{
"id": 4,
"entity": "翻转过来进行5次胸部冲压",
"start_offset": 49,
"end_offset": 61,
"label": "pro"
},
{
"id": 5,
"entity": "口",
"start_offset": 68,
"end_offset": 69,
"label": "bod"
},
{
"id": 6,
"entity": "鼻",
"start_offset": 70,
"end_offset": 71,
"label": "bod"
},
{
"id": 7,
"entity": "异物",
"start_offset": 73,
"end_offset": 75,
"label": "dis"
},
{
"id": 8,
"entity": "口或鼻中有异物",
"start_offset": 68,
"end_offset": 75,
"label": "sym"
},
{
"id": 9,
"entity": "用手指或器械除去异物",
"start_offset": 79,
"end_offset": 89,
"label": "pro"
}
] |
在急救现场如无适当的器械，保持呼吸道通畅的首要措施是用手或其他方法将上呼吸道异物清除，同时将患者放平，复苏者用一手托起患者下颌并使头轻度后仰，以减轻舌后坠导致的气道阻塞。
|
[
{
"id": 0,
"entity": "器械",
"start_offset": 10,
"end_offset": 12,
"label": "equ"
},
{
"id": 1,
"entity": "呼吸道",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "用手或其他方法将上呼吸道异物清除",
"start_offset": 26,
"end_offset": 42,
"label": "pro"
},
{
"id": 3,
"entity": "同时将患者放平",
"start_offset": 43,
"end_offset": 50,
"label": "pro"
},
{
"id": 4,
"entity": "复苏者用一手托起患者下颌并使头轻度后仰",
"start_offset": 51,
"end_offset": 70,
"label": "pro"
},
{
"id": 5,
"entity": "舌",
"start_offset": 74,
"end_offset": 75,
"label": "bod"
},
{
"id": 6,
"entity": "气道阻塞",
"start_offset": 80,
"end_offset": 84,
"label": "dis"
}
] |
图6-1背部叩打加胸部压迫法（引自：JAMA，1992，268（16）：2251-2251）（2）口咽和鼻咽通气管的插入（图6-6）：最简单的开放气道的器械是口咽和鼻咽通气导管。
|
[
{
"id": 0,
"entity": "背部叩打加胸部压迫法",
"start_offset": 4,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "口咽和鼻咽通气管",
"start_offset": 49,
"end_offset": 57,
"label": "equ"
},
{
"id": 2,
"entity": "插入",
"start_offset": 58,
"end_offset": 60,
"label": "pro"
},
{
"id": 3,
"entity": "气道",
"start_offset": 73,
"end_offset": 75,
"label": "bod"
},
{
"id": 4,
"entity": "口咽和鼻咽通气导管",
"start_offset": 79,
"end_offset": 88,
"label": "equ"
}
] |
口咽和鼻咽通气导管的作用在于防止舌根后坠所致的上气道阻塞，适用于有意识障碍、舌根后坠，呼吸尚平稳、血气分析及血氧饱和度正常的患儿。
|
[
{
"id": 0,
"entity": "口咽和鼻咽通气导管",
"start_offset": 0,
"end_offset": 9,
"label": "equ"
},
{
"id": 1,
"entity": "舌根",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "舌根后坠",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
},
{
"id": 3,
"entity": "上气道阻塞",
"start_offset": 23,
"end_offset": 28,
"label": "dis"
},
{
"id": 4,
"entity": "有意识障碍",
"start_offset": 32,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "舌根",
"start_offset": 38,
"end_offset": 40,
"label": "bod"
},
{
"id": 6,
"entity": "舌根后坠",
"start_offset": 38,
"end_offset": 42,
"label": "sym"
},
{
"id": 7,
"entity": "呼吸尚平稳",
"start_offset": 43,
"end_offset": 48,
"label": "sym"
},
{
"id": 8,
"entity": "血气分析",
"start_offset": 49,
"end_offset": 53,
"label": "ite"
},
{
"id": 9,
"entity": "血氧饱和度",
"start_offset": 54,
"end_offset": 59,
"label": "ite"
},
{
"id": 10,
"entity": "血气分析及血氧饱和度正常",
"start_offset": 49,
"end_offset": 61,
"label": "sym"
}
] |
（3）气管切开法：紧急状态下，可行环甲膜穿刺法或环甲膜造口术。
|
[
{
"id": 0,
"entity": "气管切开法",
"start_offset": 3,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "环甲膜穿刺法",
"start_offset": 17,
"end_offset": 23,
"label": "pro"
},
{
"id": 2,
"entity": "环甲膜造口术",
"start_offset": 24,
"end_offset": 30,
"label": "pro"
}
] |
环甲膜穿刺法采用16或18号粗针与注射器相连，当注射器内有空气时表明已进入气管。
|
[
{
"id": 0,
"entity": "环甲膜穿刺法",
"start_offset": 0,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "16或18号粗针",
"start_offset": 8,
"end_offset": 16,
"label": "equ"
},
{
"id": 2,
"entity": "注射器",
"start_offset": 17,
"end_offset": 20,
"label": "equ"
},
{
"id": 3,
"entity": "注射器",
"start_offset": 24,
"end_offset": 27,
"label": "equ"
},
{
"id": 4,
"entity": "气管",
"start_offset": 37,
"end_offset": 39,
"label": "bod"
}
] |
环甲膜造口术可由内科医生和五官科医生共同完成，只需气管切开包和气管切开导管等简单器械即可。
|
[
{
"id": 0,
"entity": "环甲膜造口术",
"start_offset": 0,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "内科",
"start_offset": 8,
"end_offset": 10,
"label": "dep"
},
{
"id": 2,
"entity": "五官科",
"start_offset": 13,
"end_offset": 16,
"label": "dep"
},
{
"id": 3,
"entity": "气管切开包",
"start_offset": 25,
"end_offset": 30,
"label": "equ"
},
{
"id": 4,
"entity": "气管切开导管",
"start_offset": 31,
"end_offset": 37,
"label": "equ"
}
] |
环甲膜穿刺法或环甲膜造口术是上气道堵塞时开放气道最简单、最迅速的方法。
|
[
{
"id": 0,
"entity": "环甲膜穿刺法",
"start_offset": 0,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "环甲膜造口术",
"start_offset": 7,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "上气道堵塞",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
},
{
"id": 3,
"entity": "气道",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
}
] |
2.辅助呼吸在保持呼吸道通畅后，仍无自主呼吸的患儿要积极做辅助呼吸，保证供给重要生命器官的氧气。
|
[
{
"id": 0,
"entity": "辅助呼吸",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "呼吸道",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "无自主呼吸",
"start_offset": 17,
"end_offset": 22,
"label": "sym"
},
{
"id": 3,
"entity": "辅助呼吸",
"start_offset": 29,
"end_offset": 33,
"label": "pro"
},
{
"id": 4,
"entity": "重要生命器官",
"start_offset": 38,
"end_offset": 44,
"label": "bod"
}
] |
辅助呼吸的方法有：（1）口对口辅助呼吸法（图6-6）：口对口辅助呼吸法是最简单、有效且易于施行的现场急救措施。
|
[
{
"id": 0,
"entity": "辅助呼吸",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "口对口辅助呼吸法",
"start_offset": 12,
"end_offset": 20,
"label": "pro"
},
{
"id": 2,
"entity": "口对口辅助呼吸法",
"start_offset": 27,
"end_offset": 35,
"label": "pro"
}
] |
如果复苏者吸气后再进行口对口辅助呼吸，患儿可吸入高达18%氧，而二氧化碳浓度可低至2%。
|
[
{
"id": 0,
"entity": "口对口辅助呼吸",
"start_offset": 11,
"end_offset": 18,
"label": "pro"
}
] |
实施者首先通过看胸腹部的起伏，听有无呼气音，用面颊部感受由口呼出的气流来评价有无呼吸，这个过程不要超过10秒，一旦患儿无反应、无呼吸，立即做2次有效呼吸，口对口辅助呼吸法的具体操作是，复苏者站或跪在患儿一侧，将患者的头轻轻后仰使颈项平直，用一手抬起患儿下颌并打开口腔，同时另一手捏住患儿鼻孔，在吸一口气之后，用口将患儿口腔紧紧盖住，然后用力向患儿呼吸道吹气，直吹到其胸部相应抬起为止，若患儿较小，可不必捏住患儿鼻孔，而实行口对口鼻辅助呼吸，吹气后、复苏者移开自己的口腔，并放开患儿之鼻孔借患儿的胸廓与肺的弹性回缩自然呼气。
|
[
{
"id": 0,
"entity": "胸腹部",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "听有无呼气音",
"start_offset": 15,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "用面颊部感受由口呼出的气流来评价有无呼吸",
"start_offset": 22,
"end_offset": 42,
"label": "pro"
},
{
"id": 3,
"entity": "无反应",
"start_offset": 59,
"end_offset": 62,
"label": "sym"
},
{
"id": 4,
"entity": "无呼吸",
"start_offset": 63,
"end_offset": 66,
"label": "sym"
},
{
"id": 5,
"entity": "做2次有效呼吸",
"start_offset": 69,
"end_offset": 76,
"label": "pro"
},
{
"id": 6,
"entity": "口对口辅助呼吸法",
"start_offset": 77,
"end_offset": 85,
"label": "pro"
},
{
"id": 7,
"entity": "复苏者站或跪在患儿一侧",
"start_offset": 92,
"end_offset": 103,
"label": "pro"
},
{
"id": 8,
"entity": "将患者的头轻轻后仰使颈项平直",
"start_offset": 104,
"end_offset": 118,
"label": "pro"
},
{
"id": 9,
"entity": "用一手抬起患儿下颌并打开口腔",
"start_offset": 119,
"end_offset": 133,
"label": "pro"
},
{
"id": 10,
"entity": "同时另一手捏住患儿鼻孔",
"start_offset": 134,
"end_offset": 145,
"label": "pro"
},
{
"id": 11,
"entity": "在吸一口气之后",
"start_offset": 146,
"end_offset": 153,
"label": "pro"
},
{
"id": 12,
"entity": "用口将患儿口腔紧紧盖住",
"start_offset": 154,
"end_offset": 165,
"label": "pro"
},
{
"id": 13,
"entity": "然后用力向患儿呼吸道吹气",
"start_offset": 166,
"end_offset": 178,
"label": "pro"
},
{
"id": 14,
"entity": "直吹到其胸部相应抬起为止",
"start_offset": 179,
"end_offset": 191,
"label": "pro"
},
{
"id": 15,
"entity": "鼻孔",
"start_offset": 205,
"end_offset": 207,
"label": "bod"
},
{
"id": 16,
"entity": "口对口鼻辅助呼吸",
"start_offset": 211,
"end_offset": 219,
"label": "pro"
},
{
"id": 17,
"entity": "口腔",
"start_offset": 232,
"end_offset": 234,
"label": "bod"
},
{
"id": 18,
"entity": "鼻孔",
"start_offset": 241,
"end_offset": 243,
"label": "bod"
},
{
"id": 19,
"entity": "胸廓",
"start_offset": 247,
"end_offset": 249,
"label": "bod"
},
{
"id": 20,
"entity": "肺",
"start_offset": 250,
"end_offset": 251,
"label": "bod"
}
] |
操作要点是：①保持气道开放位；②每次送气时间1～1.5秒；③胸部抬起。
|
[
{
"id": 0,
"entity": "保持气道开放位",
"start_offset": 7,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "送气",
"start_offset": 18,
"end_offset": 20,
"label": "pro"
},
{
"id": 2,
"entity": "胸部抬起",
"start_offset": 30,
"end_offset": 34,
"label": "pro"
}
] |
对存在脉搏但呼吸停止的无反应患儿仅行人工呼吸，无需胸外按压，成人10～12次/分、儿童12～20次/分。
|
[
{
"id": 0,
"entity": "存在脉搏",
"start_offset": 1,
"end_offset": 5,
"label": "sym"
},
{
"id": 1,
"entity": "呼吸停止",
"start_offset": 6,
"end_offset": 10,
"label": "sym"
},
{
"id": 2,
"entity": "无反应",
"start_offset": 11,
"end_offset": 14,
"label": "sym"
},
{
"id": 3,
"entity": "人工呼吸",
"start_offset": 18,
"end_offset": 22,
"label": "pro"
},
{
"id": 4,
"entity": "胸外按压",
"start_offset": 25,
"end_offset": 29,
"label": "pro"
}
] |
图6-2简易通气道A.鼻咽通气道；B.口咽通气道（引自：樊寻梅.实用急救与危重症抢救技术图解.北京：人民卫生出版社，2000：110-110）图6-3口对口辅助呼吸（引自：JAMA，1992，268（16）：2251-2251）图6-4面罩呼吸气囊辅助呼吸法（引自：樊寻梅.实用急救与危重症抢救技术图解.北京：人民卫生出版社，2000：13）（2）面罩或呼吸气囊辅助呼吸法（图6-4）：面罩或呼吸气囊辅助呼吸，如给氧流量10L/min，FiO2</sub>可达30%～40%，使用时将呼吸气囊的面罩盖紧患儿的口鼻，同时用呼吸气囊的皮球的皮球给患儿送气。
|
[
{
"id": 0,
"entity": "对口辅助呼吸",
"start_offset": 76,
"end_offset": 82,
"label": "pro"
},
{
"id": 1,
"entity": "面罩呼吸气囊辅助呼吸法",
"start_offset": 118,
"end_offset": 129,
"label": "pro"
},
{
"id": 2,
"entity": "面罩或呼吸气囊辅助呼吸法",
"start_offset": 174,
"end_offset": 186,
"label": "pro"
},
{
"id": 3,
"entity": "面罩或呼吸气囊辅助呼吸",
"start_offset": 193,
"end_offset": 204,
"label": "pro"
},
{
"id": 4,
"entity": "呼吸气囊的面罩",
"start_offset": 242,
"end_offset": 249,
"label": "equ"
},
{
"id": 5,
"entity": "口鼻",
"start_offset": 254,
"end_offset": 256,
"label": "bod"
},
{
"id": 6,
"entity": "呼吸气囊的皮球",
"start_offset": 260,
"end_offset": 267,
"label": "equ"
},
{
"id": 7,
"entity": "送气",
"start_offset": 273,
"end_offset": 275,
"label": "pro"
}
] |
但应注意引起胃胀气。
|
[
{
"id": 0,
"entity": "胃胀气",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
}
] |
（3）气管内插管和人工机械通气法：气管内插管是首选方法，有条件应尽早使用，并应做好充分的插管前准备，确保插管顺利完成。
|
[
{
"id": 0,
"entity": "气管内插管和人工机械通气法",
"start_offset": 3,
"end_offset": 16,
"label": "pro"
},
{
"id": 1,
"entity": "气管内插管",
"start_offset": 17,
"end_offset": 22,
"label": "pro"
},
{
"id": 2,
"entity": "插管",
"start_offset": 44,
"end_offset": 46,
"label": "pro"
},
{
"id": 3,
"entity": "插管",
"start_offset": 52,
"end_offset": 54,
"label": "pro"
}
] |
1）器械准备：①直接喉镜：注意检查喉镜柄和叶片的接头、喉镜光源，确保其性能良好；②气管导管：气管导管分为有囊导管和无囊导管，有囊导管主要用于年长儿，无囊导管主要用于新生儿和婴幼儿。
|
[
{
"id": 0,
"entity": "直接喉镜",
"start_offset": 8,
"end_offset": 12,
"label": "equ"
},
{
"id": 1,
"entity": "喉镜柄",
"start_offset": 17,
"end_offset": 20,
"label": "equ"
},
{
"id": 2,
"entity": "叶片的接头",
"start_offset": 21,
"end_offset": 26,
"label": "equ"
},
{
"id": 3,
"entity": "喉镜",
"start_offset": 27,
"end_offset": 29,
"label": "equ"
},
{
"id": 4,
"entity": "气管导管",
"start_offset": 41,
"end_offset": 45,
"label": "equ"
},
{
"id": 5,
"entity": "气管导管",
"start_offset": 46,
"end_offset": 50,
"label": "equ"
},
{
"id": 6,
"entity": "有囊导管",
"start_offset": 52,
"end_offset": 56,
"label": "equ"
},
{
"id": 7,
"entity": "无囊导管",
"start_offset": 57,
"end_offset": 61,
"label": "equ"
},
{
"id": 8,
"entity": "有囊导管",
"start_offset": 62,
"end_offset": 66,
"label": "equ"
},
{
"id": 9,
"entity": "无囊导管",
"start_offset": 74,
"end_offset": 78,
"label": "equ"
}
] |
常用气管导管型号如表6-6；2岁以上儿童还可以按以下公式计算：管腔内径=4+年龄/4。
|
[
{
"id": 0,
"entity": "气管导管",
"start_offset": 2,
"end_offset": 6,
"label": "equ"
}
] |
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