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对持续缓慢进展的脑室扩张，应该进行干预，治疗措施包括连续腰穿和应用药物减少脑脊液产生。
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可用碳酸酐酶抑制剂乙酰唑胺（diamox）或渗透性药物甘油，乙酰唑胺剂量每天100mg/kg可使脑脊液产生减少50%，与呋塞米（每天1mg/kg）联合应用疗效更好，但碳酸酐酶抑制剂在神经胶质发育过程中可能有不良反应，不宜长期大剂量应用。
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参考文献1.李毅.儿科疾病诊断标准.北京：科学出版社，2001：386-3862.夏经，陈文静.癫痫持续状态的综合治疗.中国实用儿科杂志，1999，14（1）：8-83.NishiyamaI，OhtsukaY，TsudaT，etal.AepidemiologicalstudyofchildrenwithstatusepilepticusinOkayama，JChildNeurol，2007，22（1）：21-214.MinicucciF，BelliniA，FanelliG，etal.Statusepilepticus.NeurolSci，2006，27（Suppl1）：S52-S545.ToniaSabo-Graham，AlanR.Managementofstatusepilepticusinchildren.PediatricsinReview.1998，19（9）：306-3066.DanielH，Lowenstein，BrianK，etal.Statusepilepticus（currentconcepts）.TheNewEnglandJournalofMedicine.1998，（2）：970-9707.NinaGraves，PharmD.PharmacoeconomicConsiderationsinTreatmentOptionsforAcuteSeizures.JournalofChildNeurology.1998，13（1）：S27-S298.GaryR，WilliamR，Stevenlelyveld，etal.Pediatricemergencymedicine.Secondedition.USA.TheMcGraw-HillCompanies.2002
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第七节化脓性脑膜炎细菌性脑膜炎（bacterialmeningitis），简称化脑，是儿童期最严重的感染之一，具有高发病率、高病死率、临床症状多不典型和严重并发症的特点。
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【病因学】化脑在0～2月龄内婴儿，其致病病原常反映母亲的带菌情况和婴儿的生活环境，常见病原有B族链球菌和革兰阴性肠杆菌等，偶尔也有流感嗜血杆菌b型（Hib）或不定型菌株。
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"entity": "革兰阴性肠杆菌",
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"label": "mic"
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"entity": "流感嗜血杆菌b型",
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"label": "mic"
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"entity": "Hib",
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在2月龄至12岁的儿童组中，其致病菌常是肺炎链球菌、脑膜炎双球菌或Hib。
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在美国，没有应用Hib疫苗之前，约70%小于5岁儿童的化脑是由Hib引起。
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另外，在一些有解剖结构缺陷或免疫功能缺陷的人群，少见病原引起脑膜炎的病例增加，如铜绿假单胞菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、沙门菌属和李斯特菌等。
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【流行病学及病原学】细菌性脑膜炎的重要危险因素：其一为年幼儿对感染的病原缺乏免疫力；其二为近期有致病细菌的携带。
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（一）肺炎链球菌肺炎链球菌脑膜炎的发病率约为1/10万～3/10万，一生都可以感染此菌，2岁以下婴幼儿和老年人中的发病率最高。
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其危险性同感染的肺炎链球菌血清型有关，血清型分布在不同国家和地区也不相同。
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（二）流感嗜血杆菌流感嗜血杆菌是广泛寄居在正常人上呼吸道的微生物，在健康儿童中，约30%～80%都带有Hi，绝大多数是无荚膜不定型（NTHI），无致病性的，仅少数为有荚膜菌株，而侵袭性疾病大多数为Hib菌株引起。
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b型流感嗜血杆菌（Hib）带菌的高峰年龄主要在6个月～2岁半，然后很快下降，4岁后很少带菌。
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Hib的传播方式主要由呼吸道经空气、飞沫或经手传染，主要感染5岁以下的儿童，引起多器官、组织的侵袭性感染，其中占第一位而且危害最大的是脑膜炎。
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在美国未用此菌苗前，5岁以下儿童Hi脑膜炎发病率60/10万，死亡率为5%～10%，而由于中枢神经损伤所造成的后遗症发生率为30%～50%。
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近年来人们发现，由于耐药菌株的出现，尽管使用了有效的抗生素，仍有5%的患者死亡，30%的患者有中枢神经系统后遗症。
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在我国，1943年樊培禄首次在成都报告了2例Hi脑膜炎，虽经磺胺治疗，但均未免于死亡。
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1955年黄达枢报告浙江省儿童保健院2年中24例Hi脑膜炎，占该院（1952～1953年）收治化脓性脑膜炎149例的16.1%。
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同年，上海儿科医院100例化脑Hi占11%。
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值得注意的是，此时报道的小儿细菌性脑膜炎中，原因不明者高达24%～38%。
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由于各种原因，以后的近30年国内几乎无Hi脑膜炎的文献可寻。
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1988年11月至1989年年底，北京儿童医院应用CIE荚膜多糖抗原检测方法，结合细菌培养，对北京儿童医院128例化脑患儿进行了病原学研究。
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临床诊断为化脑的患儿只有4例培养出Hib，而抗原检测有37例Hib阳性，占全部小儿化脓性脑膜炎的28.9%。
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在此基础上，采用相同的试验方法，我们于1990～1992年在合肥市（100万人口）组织13家医院15个科室进行了小儿化脑的病因学和流行病学监测。
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所有患儿标本，细菌培养的阳性率仅13.3%，3种细菌抗原CIE监测的阳性率为90%。
|
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抗原检测发现，Hib占所有化脑的51.3%，其中58.8%为1岁以下，80.5%为5岁以下，5岁以下儿童Hib脑膜炎的发病率为10.4/10万。
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这一结果表明，尽管我国小儿Hib脑膜炎的发病率低于欧美国家菌苗使用前的发病率，它仍是我国小儿化脓性脑膜炎重要致病菌。
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（三）脑膜炎球菌性脑膜炎至今仍是全球性疾病，世界各地都有发病。
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在非洲脑脊髓膜炎的流行，A群脑膜炎球菌仍是最常见的病原菌。
|
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此外，在巴西、马里、尼日利亚等地，C群脑膜炎球菌引起过大暴发。
|
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在智利、古巴、挪威等地，B群脑膜炎球菌也和一些暴发有联系，而且由这种血清群引起的病例最近几年在北美已明显增多了。
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【发病机制】细菌抵达脑膜可通过多种途径，如外伤或手术直接接种、淋巴或血流播散等。
|
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},
{
"id": 4,
"entity": "血流",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
}
] |
通常脑膜炎是由菌血症发展而来。
|
[
{
"id": 0,
"entity": "脑膜炎",
"start_offset": 2,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "菌血症",
"start_offset": 7,
"end_offset": 10,
"label": "dis"
}
] |
细菌多由上呼吸道侵入，先在鼻咽部隐匿、繁殖，继而进入血流，直接抵达营养中枢神经系统的血管，或在该处形成局部血栓，并释放出细菌栓子到血液循环中。
|
[
{
"id": 0,
"entity": "上呼吸道",
"start_offset": 4,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "鼻咽部",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "血流",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "中枢神经系统的血管",
"start_offset": 35,
"end_offset": 44,
"label": "bod"
},
{
"id": 4,
"entity": "局部血栓",
"start_offset": 51,
"end_offset": 55,
"label": "sym"
},
{
"id": 5,
"entity": "血液",
"start_offset": 65,
"end_offset": 67,
"label": "bod"
}
] |
由于小儿防御、免疫功能均较成人弱，病原菌容易通过血-脑屏障到达脑膜引起化脑。
|
[
{
"id": 0,
"entity": "血",
"start_offset": 24,
"end_offset": 25,
"label": "bod"
},
{
"id": 1,
"entity": "脑",
"start_offset": 26,
"end_offset": 27,
"label": "bod"
},
{
"id": 2,
"entity": "脑膜",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 3,
"entity": "化脑",
"start_offset": 35,
"end_offset": 37,
"label": "dis"
}
] |
婴幼儿的皮肤、黏膜、肠胃道以及新生儿的脐部也常是感染侵入门户。
|
[
{
"id": 0,
"entity": "皮肤",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "黏膜",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "肠胃道",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 3,
"entity": "脐部",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
}
] |
鼻窦炎、中耳炎、乳突炎既可作为病灶窝藏细菌，也可因病变扩展直接波及脑膜。
|
[
{
"id": 0,
"entity": "鼻窦炎",
"start_offset": 0,
"end_offset": 3,
"label": "dis"
},
{
"id": 1,
"entity": "中耳炎",
"start_offset": 4,
"end_offset": 7,
"label": "dis"
},
{
"id": 2,
"entity": "乳突炎",
"start_offset": 8,
"end_offset": 11,
"label": "dis"
},
{
"id": 3,
"entity": "脑膜",
"start_offset": 33,
"end_offset": 35,
"label": "bod"
}
] |
颅骨外伤、骨折的并发症，特别是那些涉及鼻窦的骨折，更可形成颅内与外界的直接通道，成为细菌侵入的门户。
|
[
{
"id": 0,
"entity": "颅骨外伤",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "骨折",
"start_offset": 5,
"end_offset": 7,
"label": "dis"
},
{
"id": 2,
"entity": "鼻窦的骨折",
"start_offset": 19,
"end_offset": 24,
"label": "dis"
},
{
"id": 3,
"entity": "颅内",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
}
] |
先天性免疫球蛋白缺陷，细胞免疫缺陷或联合免疫缺陷，均影响婴儿预防感染的能力，容易发生严重感染乃至脑膜炎。
|
[
{
"id": 0,
"entity": "先天性免疫球蛋白缺陷",
"start_offset": 0,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "细胞免疫缺陷",
"start_offset": 11,
"end_offset": 17,
"label": "sym"
},
{
"id": 2,
"entity": "联合免疫缺陷",
"start_offset": 18,
"end_offset": 24,
"label": "sym"
},
{
"id": 3,
"entity": "严重感染",
"start_offset": 42,
"end_offset": 46,
"label": "sym"
},
{
"id": 4,
"entity": "脑膜炎",
"start_offset": 48,
"end_offset": 51,
"label": "dis"
}
] |
具有大量荚膜的细菌在血流中生存力加强，在缺乏免疫力的年幼儿中，血清低浓度的抗荚膜IgM与IgG抗体、血清备解素、血清补体成分如C19、C3和C5缺乏或减少，都影响对细菌有效的调理吞噬作用，使其容易发生脑膜炎。
|
[
{
"id": 0,
"entity": "血流",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "脑膜炎",
"start_offset": 100,
"end_offset": 103,
"label": "dis"
}
] |
细菌通过血-脑屏障进入脑脊液循环，因为脑脊液中的补体、抗体浓度明显低于血液循环，细菌可迅速繁殖，而化学趋化因子、肿瘤坏死因子、白细胞介素-1、前列腺素E和其他细胞因子或炎性介质的局部产生引起了局部炎症，细菌的细胞壁成分也可引起强烈的炎症反应。
|
[
{
"id": 0,
"entity": "血",
"start_offset": 4,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "脑",
"start_offset": 6,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 11,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "脑脊液",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
},
{
"id": 4,
"entity": "补体",
"start_offset": 24,
"end_offset": 26,
"label": "bod"
},
{
"id": 5,
"entity": "抗体",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
},
{
"id": 6,
"entity": "血液",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
},
{
"id": 7,
"entity": "局部炎症",
"start_offset": 96,
"end_offset": 100,
"label": "sym"
},
{
"id": 8,
"entity": "强烈的炎症",
"start_offset": 113,
"end_offset": 118,
"label": "sym"
}
] |
继而，炎症造成白细胞浸润、血管通透性增加、血管闭塞，破坏了血-脑屏障。
|
[
{
"id": 0,
"entity": "炎症",
"start_offset": 3,
"end_offset": 5,
"label": "sym"
},
{
"id": 1,
"entity": "白细胞",
"start_offset": 7,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "白细胞浸润",
"start_offset": 7,
"end_offset": 12,
"label": "sym"
},
{
"id": 3,
"entity": "血管",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 4,
"entity": "血管通透性增加",
"start_offset": 13,
"end_offset": 20,
"label": "sym"
},
{
"id": 5,
"entity": "血管",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 6,
"entity": "血管闭塞",
"start_offset": 21,
"end_offset": 25,
"label": "sym"
},
{
"id": 7,
"entity": "血",
"start_offset": 29,
"end_offset": 30,
"label": "bod"
},
{
"id": 8,
"entity": "脑",
"start_offset": 31,
"end_offset": 32,
"label": "bod"
},
{
"id": 9,
"entity": "破坏了血-脑屏障",
"start_offset": 26,
"end_offset": 34,
"label": "sym"
}
] |
在脑脊液中已无菌生长时，细胞因子引起的炎症还在继续，这也就造成了慢性炎症后遗症。
|
[
{
"id": 0,
"entity": "脑脊液",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "炎症",
"start_offset": 19,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "慢性炎症后遗症",
"start_offset": 32,
"end_offset": 39,
"label": "sym"
}
] |
【临床表现】各种细菌所致化脑的临床表现大致相仿，可归纳为感染、颅压增高及脑膜刺激症状。
|
[
{
"id": 0,
"entity": "化脑",
"start_offset": 12,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "感染",
"start_offset": 28,
"end_offset": 30,
"label": "sym"
},
{
"id": 2,
"entity": "颅压增高",
"start_offset": 31,
"end_offset": 35,
"label": "sym"
},
{
"id": 3,
"entity": "脑膜刺激",
"start_offset": 36,
"end_offset": 40,
"label": "sym"
}
] |
近年来，化脑的症状越来越不典型，可能与抗生素的滥用有关。
|
[
{
"id": 0,
"entity": "化脑",
"start_offset": 4,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "抗生素",
"start_offset": 19,
"end_offset": 22,
"label": "dru"
}
] |
严重者在24小时内即出现惊厥、昏迷。
|
[
{
"id": 0,
"entity": "惊厥",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
},
{
"id": 1,
"entity": "昏迷",
"start_offset": 15,
"end_offset": 17,
"label": "sym"
}
] |
由于前囟尚未闭合，骨缝可以裂开，而使颅内压增高及脑膜刺激症状出现较晚，临床表现不典型。
|
[
{
"id": 0,
"entity": "前囟",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "前囟尚未闭合",
"start_offset": 2,
"end_offset": 8,
"label": "sym"
},
{
"id": 2,
"entity": "骨缝",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 3,
"entity": "骨缝可以裂开",
"start_offset": 9,
"end_offset": 15,
"label": "sym"
},
{
"id": 4,
"entity": "颅内压增高",
"start_offset": 18,
"end_offset": 23,
"label": "sym"
},
{
"id": 5,
"entity": "脑膜",
"start_offset": 24,
"end_offset": 26,
"label": "bod"
},
{
"id": 6,
"entity": "脑膜刺激症状",
"start_offset": 24,
"end_offset": 30,
"label": "sym"
}
] |
前囟饱满、布氏征阳性是重要体征，有时皮肤划痕试验阳性。
|
[
{
"id": 0,
"entity": "前囟",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "前囟饱满",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 2,
"entity": "布氏征阳性",
"start_offset": 5,
"end_offset": 10,
"label": "sym"
},
{
"id": 3,
"entity": "皮肤划痕",
"start_offset": 18,
"end_offset": 22,
"label": "pro"
},
{
"id": 4,
"entity": "皮肤划痕试验阳性",
"start_offset": 18,
"end_offset": 26,
"label": "sym"
}
] |
由于宫内感染引起的，可表现为出生时即呈不可逆性休克或呼吸暂停，很快死亡。
|
[
{
"id": 0,
"entity": "宫内感染",
"start_offset": 2,
"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "休克",
"start_offset": 23,
"end_offset": 25,
"label": "dis"
},
{
"id": 2,
"entity": "不可逆性休克",
"start_offset": 19,
"end_offset": 25,
"label": "sym"
},
{
"id": 3,
"entity": "呼吸暂停",
"start_offset": 26,
"end_offset": 30,
"label": "sym"
},
{
"id": 4,
"entity": "死亡",
"start_offset": 33,
"end_offset": 35,
"label": "sym"
}
] |
发热或有或无，甚至体温不升。
|
[
{
"id": 0,
"entity": "发热",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "体温不升",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
}
] |
体格检查仅见前囟张力增高,脑膜刺激征。
|
[
{
"id": 0,
"entity": "前囟",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "前囟张力增高",
"start_offset": 6,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "脑膜",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 3,
"entity": "脑膜刺激征",
"start_offset": 13,
"end_offset": 18,
"label": "sym"
}
] |
前囟隆起亦出现较晚，极易误诊。
|
[
{
"id": 0,
"entity": "前囟",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "前囟隆起",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
}
] |
唯有腰穿检查脑脊液才能确诊。
|
[
{
"id": 0,
"entity": "腰穿检查",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "脑脊液",
"start_offset": 6,
"end_offset": 9,
"label": "bod"
}
] |
【实验室检查】（一）血象白细胞总数及中性粒细胞明显增加，感染严重者有核左移，胞质中可见中毒颗粒。
|
[
{
"id": 0,
"entity": "白细胞总数",
"start_offset": 12,
"end_offset": 17,
"label": "ite"
},
{
"id": 1,
"entity": "中性粒细胞",
"start_offset": 18,
"end_offset": 23,
"label": "ite"
},
{
"id": 2,
"entity": "白细胞总数及中性粒细胞明显增加",
"start_offset": 12,
"end_offset": 27,
"label": "sym"
},
{
"id": 3,
"entity": "核",
"start_offset": 34,
"end_offset": 35,
"label": "bod"
},
{
"id": 4,
"entity": "核左移",
"start_offset": 34,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "胞质中可见中毒颗粒",
"start_offset": 38,
"end_offset": 47,
"label": "sym"
}
] |
小儿血清中CPR对急性化脑的诊断、治疗和判断预后转归均具有重要的帮助作用，CPR可以作为小儿急性化脑病情发展的重要标志物。
|
[
{
"id": 0,
"entity": "血清",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "急性化脑",
"start_offset": 9,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "小儿急性化脑",
"start_offset": 44,
"end_offset": 50,
"label": "dis"
}
] |
贫血常见于流感嗜血杆菌脑膜炎。
|
[
{
"id": 0,
"entity": "贫血",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "流感嗜血杆菌脑膜炎",
"start_offset": 5,
"end_offset": 14,
"label": "dis"
}
] |
（二）血培养早期、未用抗生素治疗者可得阳性结果，能帮助确定病原菌。
|
[
{
"id": 0,
"entity": "抗生素治疗",
"start_offset": 11,
"end_offset": 16,
"label": "pro"
}
] |
（四）瘀点涂片流脑患儿皮肤瘀点涂片并革兰染色找革兰阴性双球菌，阳性率可高达80%以上。
|
[
{
"id": 0,
"entity": "瘀点涂片",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "流脑",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "皮肤瘀点涂片",
"start_offset": 11,
"end_offset": 17,
"label": "pro"
},
{
"id": 3,
"entity": "革兰染色",
"start_offset": 18,
"end_offset": 22,
"label": "pro"
},
{
"id": 4,
"entity": "革兰阴性双球菌",
"start_offset": 23,
"end_offset": 30,
"label": "mic"
}
] |
（五）脑脊液常规、涂片、培养脑脊液检查是诊断化脑的必需手段，可见典型化脓性改变。
|
[
{
"id": 0,
"entity": "脑脊液",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "涂片",
"start_offset": 9,
"end_offset": 11,
"label": "pro"
},
{
"id": 2,
"entity": "脑脊液检查",
"start_offset": 14,
"end_offset": 19,
"label": "pro"
},
{
"id": 3,
"entity": "化脑",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
},
{
"id": 4,
"entity": "化脓",
"start_offset": 34,
"end_offset": 36,
"label": "sym"
}
] |
其外观混浊或稀米汤样，压力增高（当脓液黏稠、流出困难时，无法测量压力）。
|
[
{
"id": 0,
"entity": "外观混浊或稀米汤样",
"start_offset": 1,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "压力增高",
"start_offset": 11,
"end_offset": 15,
"label": "sym"
},
{
"id": 2,
"entity": "脓液",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 3,
"entity": "脓液黏稠、流出困难",
"start_offset": 17,
"end_offset": 26,
"label": "sym"
}
] |
显微镜下检查白细胞计数甚多，每立方毫米自数百至数万，每升可达数亿个，其中以多核白细胞为主。
|
[
{
"id": 0,
"entity": "显微镜",
"start_offset": 0,
"end_offset": 3,
"label": "equ"
},
{
"id": 1,
"entity": "白细胞",
"start_offset": 6,
"end_offset": 9,
"label": "ite"
},
{
"id": 2,
"entity": "白细胞计数甚多",
"start_offset": 6,
"end_offset": 13,
"label": "sym"
},
{
"id": 3,
"entity": "多核白细胞",
"start_offset": 37,
"end_offset": 42,
"label": "bod"
}
] |
糖定量试验，含量常在150mg/L以下。
|
[
{
"id": 0,
"entity": "糖定量试验",
"start_offset": 0,
"end_offset": 5,
"label": "pro"
}
] |
糖定量不但可协助鉴别细菌或病毒感染，还能反映治疗效果。
|
[
{
"id": 0,
"entity": "病毒感染",
"start_offset": 13,
"end_offset": 17,
"label": "dis"
}
] |
蛋白定性试验多为强阳性，定量试验明显增高。
|
[
{
"id": 0,
"entity": "蛋白定性试验",
"start_offset": 0,
"end_offset": 6,
"label": "pro"
}
] |
将脑脊液离心沉淀，作涂片染色，常能查见病原菌，可作为早期选用抗生素治疗的依据。
|
[
{
"id": 0,
"entity": "脑脊液离心沉淀",
"start_offset": 1,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "涂片染色",
"start_offset": 10,
"end_offset": 14,
"label": "pro"
},
{
"id": 2,
"entity": "抗生素治疗",
"start_offset": 30,
"end_offset": 35,
"label": "pro"
}
] |
涂片检查用革兰染色，必要时加用亚甲蓝染色协助观察细菌形态。
|
[
{
"id": 0,
"entity": "涂片检查",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "革兰染色",
"start_offset": 5,
"end_offset": 9,
"label": "pro"
},
{
"id": 2,
"entity": "亚甲蓝染色",
"start_offset": 15,
"end_offset": 20,
"label": "pro"
}
] |
（六）特异性细菌抗原测定利用免疫学技术检查患儿脑脊液、血、尿中细菌抗原为快速确定病原菌的特异方法。
|
[
{
"id": 0,
"entity": "特异性细菌抗原测定",
"start_offset": 3,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "脑脊液",
"start_offset": 23,
"end_offset": 26,
"label": "bod"
},
{
"id": 2,
"entity": "血",
"start_offset": 27,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "尿",
"start_offset": 29,
"end_offset": 30,
"label": "bod"
}
] |
特别是脑脊液抗原检测最重要。
|
[
{
"id": 0,
"entity": "脑脊液抗原检测",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
}
] |
血、尿抗原阳性亦有参考价值。
|
[
{
"id": 0,
"entity": "血",
"start_offset": 0,
"end_offset": 1,
"label": "bod"
},
{
"id": 1,
"entity": "尿",
"start_offset": 2,
"end_offset": 3,
"label": "bod"
}
] |
国外在十余年前即已广泛开展此项工作，由于缺乏优质抗血清，我国尚未普及使用。
|
[
{
"id": 0,
"entity": "血清",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
}
] |
常用的方法有：1.对流免疫电泳（CIE）此法系以已知抗体（特定的抗血清）检测脑脊液中的抗原如可溶性荚膜多糖，特异性高，1小时内即能获得结果，常用做流脑快速诊断，也用以检查嗜血流感杆菌、肺炎链球菌等，阳性率可达70%～80%。
|
[
{
"id": 0,
"entity": "对流免疫电泳",
"start_offset": 9,
"end_offset": 15,
"label": "pro"
},
{
"id": 1,
"entity": "CIE",
"start_offset": 16,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "抗体",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "脑脊液",
"start_offset": 38,
"end_offset": 41,
"label": "bod"
},
{
"id": 4,
"entity": "嗜血流感杆菌",
"start_offset": 85,
"end_offset": 91,
"label": "mic"
},
{
"id": 5,
"entity": "肺炎链球菌",
"start_offset": 92,
"end_offset": 97,
"label": "mic"
}
] |
北京儿童医院128例化脑抗原检测阳性率为86.7%。
|
[
{
"id": 0,
"entity": "化脑抗原检测",
"start_offset": 10,
"end_offset": 16,
"label": "pro"
}
] |
2.乳胶凝集试验（LA）系用已知抗体检测未知抗原（或用已知抗原检测抗体）。
|
[
{
"id": 0,
"entity": "乳胶凝集试验",
"start_offset": 2,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "LA",
"start_offset": 9,
"end_offset": 11,
"label": "pro"
}
] |
对脑膜炎双球菌与流感杆菌检测结果与用CIE方法所测结果相似，但对肺炎链球菌敏感性较差。
|
[
{
"id": 0,
"entity": "脑膜炎双球菌",
"start_offset": 1,
"end_offset": 7,
"label": "mic"
},
{
"id": 1,
"entity": "流感杆菌",
"start_offset": 8,
"end_offset": 12,
"label": "mic"
},
{
"id": 2,
"entity": "CIE",
"start_offset": 18,
"end_offset": 21,
"label": "pro"
},
{
"id": 3,
"entity": "肺炎链球菌",
"start_offset": 32,
"end_offset": 37,
"label": "mic"
}
] |
此法较CIE敏感，但有假阳性可能。
|
[
{
"id": 0,
"entity": "CIE",
"start_offset": 3,
"end_offset": 6,
"label": "pro"
}
] |
所用标本量较CIE多，试剂盒亦较昂贵。
|
[
{
"id": 0,
"entity": "CIE",
"start_offset": 6,
"end_offset": 9,
"label": "pro"
}
] |
3.免疫荧光试验用荧光素标记已知抗体，再加入待检抗原（如脑脊液、血液标本），然后用荧光显微镜观察抗原抗体反应。
|
[
{
"id": 0,
"entity": "免疫荧光试验",
"start_offset": 2,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "脑脊液",
"start_offset": 28,
"end_offset": 31,
"label": "bod"
},
{
"id": 2,
"entity": "血液",
"start_offset": 32,
"end_offset": 34,
"label": "bod"
},
{
"id": 3,
"entity": "荧光显微镜",
"start_offset": 41,
"end_offset": 46,
"label": "equ"
}
] |
4.酶联免疫吸附试验（enzymelinkedimmunosorbentassay，ELISA）用酶标记已知抗体（或抗原）测定相应抗原（或抗体）。
|
[
{
"id": 0,
"entity": "酶联免疫吸附试验",
"start_offset": 2,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "enzymelinkedimmunosorbentassay",
"start_offset": 11,
"end_offset": 41,
"label": "pro"
},
{
"id": 2,
"entity": "ELISA",
"start_offset": 42,
"end_offset": 47,
"label": "pro"
}
] |
（七）头颅CT或MRI检查用于化脑的目的不是直接提供诊断性的依据，其实用价值在于疾病早期用于鉴别诊断，疾病后期特别是出现视神经乳头水肿和神经局限性体征等并发症时协助确定原因。
|
[
{
"id": 0,
"entity": "头颅CT",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "MRI检查",
"start_offset": 8,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "化脑",
"start_offset": 15,
"end_offset": 17,
"label": "dis"
},
{
"id": 3,
"entity": "视神经乳头",
"start_offset": 60,
"end_offset": 65,
"label": "bod"
},
{
"id": 4,
"entity": "视神经乳头水肿",
"start_offset": 60,
"end_offset": 67,
"label": "sym"
},
{
"id": 5,
"entity": "神经局限性体征",
"start_offset": 68,
"end_offset": 75,
"label": "sym"
}
] |
【诊断】遇有以下情况应考虑有化脑可能：①患儿有呼吸道或其他感染如上呼吸道感染、肺炎、中耳炎、乳突炎、骨髓炎、蜂窝织炎或败血症，同时伴有神经系统症状；②有头皮、脊背中线的孔窦畸形、头颅创伤，同时伴有神经系统症状；③婴儿不明原因的持续发热，经一般治疗无效；④婴幼儿初次高热伴惊厥，而不能用一般高热惊厥解释者。
|
[
{
"id": 0,
"entity": "化脑",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸道",
"start_offset": 23,
"end_offset": 26,
"label": "bod"
},
{
"id": 2,
"entity": "上呼吸道感染",
"start_offset": 32,
"end_offset": 38,
"label": "dis"
},
{
"id": 3,
"entity": "肺炎",
"start_offset": 39,
"end_offset": 41,
"label": "dis"
},
{
"id": 4,
"entity": "中耳炎",
"start_offset": 42,
"end_offset": 45,
"label": "dis"
},
{
"id": 5,
"entity": "乳突炎",
"start_offset": 46,
"end_offset": 49,
"label": "dis"
},
{
"id": 6,
"entity": "骨髓炎",
"start_offset": 50,
"end_offset": 53,
"label": "dis"
},
{
"id": 7,
"entity": "蜂窝织炎",
"start_offset": 54,
"end_offset": 58,
"label": "dis"
},
{
"id": 8,
"entity": "败血症",
"start_offset": 59,
"end_offset": 62,
"label": "dis"
},
{
"id": 9,
"entity": "神经系统",
"start_offset": 67,
"end_offset": 71,
"label": "bod"
},
{
"id": 10,
"entity": "神经系统症状",
"start_offset": 67,
"end_offset": 73,
"label": "sym"
},
{
"id": 11,
"entity": "头皮、脊背中线的孔窦畸形",
"start_offset": 76,
"end_offset": 88,
"label": "dis"
},
{
"id": 12,
"entity": "头颅创伤",
"start_offset": 89,
"end_offset": 93,
"label": "dis"
},
{
"id": 13,
"entity": "神经系统",
"start_offset": 98,
"end_offset": 102,
"label": "bod"
},
{
"id": 14,
"entity": "神经系统症状",
"start_offset": 98,
"end_offset": 104,
"label": "sym"
},
{
"id": 15,
"entity": "发热",
"start_offset": 115,
"end_offset": 117,
"label": "sym"
},
{
"id": 16,
"entity": "高热",
"start_offset": 132,
"end_offset": 134,
"label": "sym"
},
{
"id": 17,
"entity": "惊厥",
"start_offset": 135,
"end_offset": 137,
"label": "sym"
},
{
"id": 18,
"entity": "高热惊厥",
"start_offset": 144,
"end_offset": 148,
"label": "sym"
}
] |
新生儿早期脑膜炎病原菌刚刚开始侵入脑膜，脑脊液变化可能不明显，高度怀疑时应隔1、2日后重复检查。
|
[
{
"id": 0,
"entity": "脑膜炎病原菌",
"start_offset": 5,
"end_offset": 11,
"label": "mic"
},
{
"id": 1,
"entity": "脑膜",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 20,
"end_offset": 23,
"label": "bod"
}
] |
通过年龄、季节等流行病学资料与临床经过虽能对致病菌作出初步推测，但迄今仍无明显的症状和体征（流脑患者的典型瘀斑除外）可作为病原菌特异性诊断的根据。
|
[
{
"id": 0,
"entity": "流脑",
"start_offset": 46,
"end_offset": 48,
"label": "dis"
},
{
"id": 1,
"entity": "瘀斑",
"start_offset": 53,
"end_offset": 55,
"label": "sym"
}
] |
进一步确诊必须依靠脑脊液涂片、细菌培养、对流免疫电泳等抗原检查法。
|
[
{
"id": 0,
"entity": "脑脊液涂片",
"start_offset": 9,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "细菌培养",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "对流免疫电泳",
"start_offset": 20,
"end_offset": 26,
"label": "pro"
}
] |
约15%～20%患者其脑脊液呈典型化脑改变，但始终未能找到细菌的患儿应按病原未明的化脑治疗。
|
[
{
"id": 0,
"entity": "脑脊液",
"start_offset": 11,
"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "化脑",
"start_offset": 17,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "化脑",
"start_offset": 41,
"end_offset": 43,
"label": "dis"
}
] |
【鉴别诊断】患儿早期脑脊液未发生典型改变，或由于曾接受抗生素治疗，致脑脊液改变不典型时，常须与以下几种疾病鉴别。
|
[
{
"id": 0,
"entity": "脑脊液",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 1,
"entity": "抗生素治疗",
"start_offset": 27,
"end_offset": 32,
"label": "pro"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 34,
"end_offset": 37,
"label": "bod"
}
] |
（一）病毒性脑膜脑炎病毒性脑膜脑炎（viralmeningitis）起病一般较急，脑脊液外观微毛或轻度浑浊，白细胞计数10×106</sup>～1000×106</sup>/L，早期多核细胞稍增多但以后即以单核细胞为主，蛋白轻度增高，糖、氯化物正常。
|
[
{
"id": 0,
"entity": "病毒性脑膜脑炎",
"start_offset": 3,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "病毒性脑膜脑炎",
"start_offset": 10,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "viralmeningitis",
"start_offset": 18,
"end_offset": 33,
"label": "dis"
},
{
"id": 3,
"entity": "脑脊液",
"start_offset": 41,
"end_offset": 44,
"label": "bod"
},
{
"id": 4,
"entity": "微毛",
"start_offset": 46,
"end_offset": 48,
"label": "bod"
},
{
"id": 5,
"entity": "脑脊液外观微毛或轻度浑浊",
"start_offset": 41,
"end_offset": 53,
"label": "sym"
},
{
"id": 6,
"entity": "白细胞计数",
"start_offset": 54,
"end_offset": 59,
"label": "ite"
},
{
"id": 7,
"entity": "多核细胞",
"start_offset": 91,
"end_offset": 95,
"label": "bod"
},
{
"id": 8,
"entity": "多核细胞稍增多",
"start_offset": 91,
"end_offset": 98,
"label": "sym"
},
{
"id": 9,
"entity": "单核细胞",
"start_offset": 103,
"end_offset": 107,
"label": "bod"
},
{
"id": 10,
"entity": "蛋白",
"start_offset": 110,
"end_offset": 112,
"label": "bod"
},
{
"id": 11,
"entity": "蛋白轻度增高",
"start_offset": 110,
"end_offset": 116,
"label": "sym"
},
{
"id": 12,
"entity": "糖",
"start_offset": 117,
"end_offset": 118,
"label": "bod"
},
{
"id": 13,
"entity": "氯化物",
"start_offset": 119,
"end_offset": 122,
"label": "bod"
},
{
"id": 14,
"entity": "糖、氯化物正常",
"start_offset": 117,
"end_offset": 124,
"label": "sym"
}
] |
（二）结核性脑膜炎结核性脑膜炎（tuberculousmeningitis）起病多较缓慢，常有1～2周全身不适的前驱症状。
|
[
{
"id": 0,
"entity": "结核性脑膜炎",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "结核性脑膜炎",
"start_offset": 9,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "tuberculousmeningitis",
"start_offset": 16,
"end_offset": 37,
"label": "dis"
}
] |
也有急骤起病者，尤其是粟粒性结核的婴儿。
|
[
{
"id": 0,
"entity": "粟粒性结核",
"start_offset": 11,
"end_offset": 16,
"label": "dis"
}
] |
典型结核性脑膜炎脑脊液外观毛玻璃样，有时因蛋白含量过高而呈黄色。
|
[
{
"id": 0,
"entity": "结核性脑膜炎",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "脑脊液",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液外观毛玻璃样",
"start_offset": 8,
"end_offset": 17,
"label": "sym"
},
{
"id": 3,
"entity": "蛋白",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 4,
"entity": "蛋白含量过高而呈黄色",
"start_offset": 21,
"end_offset": 31,
"label": "sym"
}
] |
白细胞计数为数百至千，偶尔超过1000×10<sup>6</sup>/L，单核细胞70%～80%。
|
[
{
"id": 0,
"entity": "白细胞计数",
"start_offset": 0,
"end_offset": 5,
"label": "ite"
},
{
"id": 1,
"entity": "白细胞计数为数百至千",
"start_offset": 0,
"end_offset": 10,
"label": "sym"
},
{
"id": 2,
"entity": "单核细胞",
"start_offset": 37,
"end_offset": 41,
"label": "bod"
}
] |
当脑脊液改变不典型时，常易引起误诊。
|
[
{
"id": 0,
"entity": "脑脊液",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "脑脊液改变",
"start_offset": 1,
"end_offset": 6,
"label": "sym"
}
] |
应仔细询问患者有无结核接触史，检查身体其他部位是否存在结核病灶，进行结核菌素试验，在痰及胃液中寻找结核菌等以协助诊断。
|
[
{
"id": 0,
"entity": "结核",
"start_offset": 9,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "结核病灶",
"start_offset": 27,
"end_offset": 31,
"label": "sym"
},
{
"id": 2,
"entity": "结核菌素试验",
"start_offset": 34,
"end_offset": 40,
"label": "pro"
},
{
"id": 3,
"entity": "痰",
"start_offset": 42,
"end_offset": 43,
"label": "bod"
},
{
"id": 4,
"entity": "胃液",
"start_offset": 44,
"end_offset": 46,
"label": "bod"
},
{
"id": 5,
"entity": "结核菌",
"start_offset": 49,
"end_offset": 52,
"label": "mic"
}
] |
必要时用脑脊液作结核菌培养及动物接种，但这两种方法都不能做到早期诊断。
|
[
{
"id": 0,
"entity": "脑脊液",
"start_offset": 4,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "动物接种",
"start_offset": 14,
"end_offset": 18,
"label": "pro"
}
] |
对高度怀疑而一时不易确诊的患者，应给予抗结核药物以观察治疗反应。
|
[
{
"id": 0,
"entity": "抗结核药物",
"start_offset": 19,
"end_offset": 24,
"label": "dru"
}
] |
（三）真菌性（新型隐球菌）脑膜炎其临床表现、病程及脑脊液改变与结核性脑膜炎相似，起病缓慢症状更为隐匿，病程更长，病情可起伏加重，颅压增高，脑膜刺激症状可不十分明显。
|
[
{
"id": 0,
"entity": "真菌性（新型隐球菌）脑膜炎",
"start_offset": 3,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "脑脊液",
"start_offset": 25,
"end_offset": 28,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液改变",
"start_offset": 25,
"end_offset": 30,
"label": "sym"
},
{
"id": 3,
"entity": "结核性脑膜炎",
"start_offset": 31,
"end_offset": 37,
"label": "dis"
},
{
"id": 4,
"entity": "颅压增高",
"start_offset": 64,
"end_offset": 68,
"label": "sym"
},
{
"id": 5,
"entity": "脑膜",
"start_offset": 69,
"end_offset": 71,
"label": "bod"
},
{
"id": 6,
"entity": "脑膜刺激症状",
"start_offset": 69,
"end_offset": 75,
"label": "sym"
}
] |
确诊靠脑脊液印度墨汁染色见到厚荚膜的发亮圆形菌体，在沙门培养基上有新型隐球菌生长。
|
[
{
"id": 0,
"entity": "脑脊液印度墨汁染色",
"start_offset": 3,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "厚荚膜的发亮圆形菌体",
"start_offset": 14,
"end_offset": 24,
"label": "sym"
},
{
"id": 2,
"entity": "隐球菌",
"start_offset": 35,
"end_offset": 38,
"label": "mic"
}
] |
【治疗原则】（一）抗菌治疗化脑预后好坏与是否早期明确病原菌，选择恰当的抗生素进行治疗密切相关。
|
[
{
"id": 0,
"entity": "化脑",
"start_offset": 13,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "抗生素",
"start_offset": 35,
"end_offset": 38,
"label": "dru"
}
] |
经脑脊液确诊后，应尽快由静脉给予适当、足量的抗生素，以杀菌药物为佳，并根据病情按计划完成全部疗程。
|
[
{
"id": 0,
"entity": "脑脊",
"start_offset": 1,
"end_offset": 3,
"label": "ite"
},
{
"id": 1,
"entity": "脑脊",
"start_offset": 1,
"end_offset": 3,
"label": "bod"
},
{
"id": 2,
"entity": "应尽",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 3,
"entity": "、足量",
"start_offset": 18,
"end_offset": 21,
"label": "dru"
}
] |
治疗效果满意时，体温多于3天左右下降，症状减轻，脑脊液细菌消失，细胞数明显减少，其他生化指标亦有相应好转，此时可继用原来药物治疗，2周后再复查脑脊液。
|
[
{
"id": 0,
"entity": "脑脊液",
"start_offset": 24,
"end_offset": 27,
"label": "bod"
},
{
"id": 1,
"entity": "脑脊液细菌消失",
"start_offset": 24,
"end_offset": 31,
"label": "sym"
},
{
"id": 2,
"entity": "细胞数明显减少",
"start_offset": 32,
"end_offset": 39,
"label": "sym"
},
{
"id": 3,
"entity": "脑脊液",
"start_offset": 71,
"end_offset": 74,
"label": "bod"
}
] |
关于抗生素选择、使用方法应注意以下几点：①患儿年龄对抗生素选择有一定的指导意义：如年长儿童患流感杆菌脑膜炎较少；新生儿化脑大多数是肠道革兰阴性杆菌或链球菌所致，故应选择对这些细菌有效的药物；②保证药物在脑脊液中达到有效浓度：首先应选用易于透过血-脑屏障的药物，使脑脊液中抗生素浓度超过抑菌浓度10倍以上；③鞘内注射：如果选用的药物能很好通过血-脑屏障，原则上不需鞘内注射，以免出现不良反应及增加病儿痛苦；④脑室内注药：由于存在血-脑屏障及脑脊液单向循环，对并发脑室膜炎患儿，有人主张脑室注药以提高疗效。
|
[
{
"id": 0,
"entity": "抗生素",
"start_offset": 2,
"end_offset": 5,
"label": "dru"
},
{
"id": 1,
"entity": "抗生素",
"start_offset": 26,
"end_offset": 29,
"label": "dru"
},
{
"id": 2,
"entity": "流感杆菌脑膜炎",
"start_offset": 46,
"end_offset": 53,
"label": "dis"
},
{
"id": 3,
"entity": "肠道革兰阴性杆菌",
"start_offset": 65,
"end_offset": 73,
"label": "mic"
},
{
"id": 4,
"entity": "链球菌",
"start_offset": 74,
"end_offset": 77,
"label": "mic"
},
{
"id": 5,
"entity": "脑脊液",
"start_offset": 101,
"end_offset": 104,
"label": "bod"
},
{
"id": 6,
"entity": "血",
"start_offset": 121,
"end_offset": 122,
"label": "bod"
},
{
"id": 7,
"entity": "脑",
"start_offset": 123,
"end_offset": 124,
"label": "bod"
},
{
"id": 8,
"entity": "脑脊液",
"start_offset": 131,
"end_offset": 134,
"label": "bod"
},
{
"id": 9,
"entity": "抗生素",
"start_offset": 135,
"end_offset": 138,
"label": "dru"
},
{
"id": 10,
"entity": "鞘内注射",
"start_offset": 153,
"end_offset": 157,
"label": "pro"
},
{
"id": 11,
"entity": "血",
"start_offset": 170,
"end_offset": 171,
"label": "bod"
},
{
"id": 12,
"entity": "脑",
"start_offset": 172,
"end_offset": 173,
"label": "bod"
},
{
"id": 13,
"entity": "鞘内注射",
"start_offset": 181,
"end_offset": 185,
"label": "pro"
},
{
"id": 14,
"entity": "脑室内注药",
"start_offset": 203,
"end_offset": 208,
"label": "pro"
},
{
"id": 15,
"entity": "血",
"start_offset": 213,
"end_offset": 214,
"label": "bod"
},
{
"id": 16,
"entity": "脑",
"start_offset": 215,
"end_offset": 216,
"label": "bod"
},
{
"id": 17,
"entity": "脑脊液",
"start_offset": 219,
"end_offset": 222,
"label": "bod"
},
{
"id": 18,
"entity": "脑室膜炎",
"start_offset": 230,
"end_offset": 234,
"label": "dis"
},
{
"id": 19,
"entity": "脑室注药",
"start_offset": 241,
"end_offset": 245,
"label": "pro"
}
] |
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