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对革兰阴性杆菌和金黄色葡萄球菌至少用抗生素治疗3周。
|
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"id": 0,
"entity": "革兰阴性杆菌",
"start_offset": 1,
"end_offset": 7,
"label": "mic"
},
{
"id": 1,
"entity": "金黄色葡萄球菌",
"start_offset": 8,
"end_offset": 15,
"label": "mic"
},
{
"id": 2,
"entity": "抗生素",
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"end_offset": 21,
"label": "dru"
}
] |
【并发症】（一）硬脑膜下积液常见于1岁以下的肺炎链球菌及流感杆菌脑膜炎患儿，但亦可见于流脑和其他细菌引起的化脑。
|
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"entity": "硬脑膜下积液",
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"id": 1,
"entity": "肺炎链球菌",
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"label": "mic"
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"id": 2,
"entity": "流感杆菌脑膜炎",
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"end_offset": 35,
"label": "mic"
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{
"id": 3,
"entity": "流脑",
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"label": "dis"
},
{
"id": 4,
"entity": "化脑",
"start_offset": 53,
"end_offset": 55,
"label": "dis"
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] |
它可发生在化脑同时或症状出现数小时或数日之后，多发生在病后7～10天。
|
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当化脑患儿经恰当治疗不见好转，或在治疗过程中临床和脑脊液已逐渐好转，但忽又出现发热或烦躁、意识障碍、喷射性呕吐、惊厥等颅内压增高症状。
|
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"id": 1,
"entity": "发热",
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{
"id": 2,
"entity": "烦躁",
"start_offset": 42,
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"label": "sym"
},
{
"id": 3,
"entity": "意识障碍",
"start_offset": 45,
"end_offset": 49,
"label": "sym"
},
{
"id": 4,
"entity": "喷射性呕吐",
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},
{
"id": 5,
"entity": "惊厥",
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"label": "sym"
},
{
"id": 6,
"entity": "颅内压增高",
"start_offset": 59,
"end_offset": 64,
"label": "sym"
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] |
进一步做颅骨透照试验、头颅B超和CT证实。
|
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"entity": "头颅B超",
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{
"id": 2,
"entity": "CT证实",
"start_offset": 16,
"end_offset": 20,
"label": "pro"
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] |
病情较重者可有硬脑膜下积脓，有时涂片或培养发现病原菌。
|
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{
"id": 0,
"entity": "硬脑膜下积脓",
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] |
与脑积水相反硬脑膜下积液可发生于及时得到正确治疗的患者。
|
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"id": 0,
"entity": "脑积水",
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"id": 1,
"entity": "硬脑膜下积液",
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] |
硬脑膜下积液的处理：若积液量不多，大多能在1～2个月自行吸收，若积液量多，同时有颅内压增高症状或硬脑膜下积脓时，均应穿刺放液。
|
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"id": 2,
"entity": "硬脑膜下积脓",
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"label": "sym"
},
{
"id": 3,
"entity": "穿刺放液",
"start_offset": 58,
"end_offset": 62,
"label": "pro"
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] |
（二）颅内压增高症急性弥漫性脑水肿导致颅内压增高为常见并发症，如程度严重，进展急速，则可发生颞叶钩回疝或枕骨大孔疝。
|
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"id": 1,
"entity": "急性弥漫性脑水肿",
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"entity": "颅内压增高",
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"entity": "颞叶钩回疝",
"start_offset": 46,
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"label": "sym"
},
{
"id": 4,
"entity": "枕骨大孔疝",
"start_offset": 52,
"end_offset": 57,
"label": "sym"
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] |
对此认识不足，未及早采用脱水疗法及时抢救，可以危及生命。
|
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"entity": "脱水疗法",
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"end_offset": 16,
"label": "pro"
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] |
（三）脑室膜炎脑室膜炎亦是比较常见的并发症，是造成预后不良和严重后遗症的重要原因。
|
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"entity": "脑室膜炎",
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"id": 1,
"entity": "脑室膜炎",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
}
] |
革兰阴性杆菌所致者尤其多。
|
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"id": 0,
"entity": "革兰阴性杆菌",
"start_offset": 0,
"end_offset": 6,
"label": "mic"
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] |
感染途径系经过血行播散，脉络膜裂隙蔓延或经脑脊液逆行扩散。
|
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"id": 0,
"entity": "脑脊液",
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"end_offset": 24,
"label": "bod"
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] |
治疗脑室膜炎除全身用药外，需向脑室内注入相应抗生素。
|
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"id": 0,
"entity": "脑室膜炎",
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"entity": "脑室",
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"label": "bod"
},
{
"id": 2,
"entity": "抗生素",
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"end_offset": 25,
"label": "dru"
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] |
（四）脑积水患脑膜炎时，脓性渗出物易堵塞狭小孔道或发生粘连而引起脑脊液循环障碍，产生脑积水。
|
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"entity": "脑积水",
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"entity": "脓性渗出物",
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"id": 3,
"entity": "脑脊液",
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"id": 4,
"entity": "脓性渗出物易堵塞狭小孔道或发生粘连而引起脑脊液循环障碍",
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{
"id": 5,
"entity": "脑积水",
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}
] |
最突出的症状是头颅迅速扩大，骨缝分离，前囟扩大、饱满，头皮静脉扩张，颅部叩诊有破壶音。
|
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{
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"entity": "骨缝分离",
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{
"id": 3,
"entity": "前囟",
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},
{
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"entity": "前囟扩大、饱满",
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{
"id": 5,
"entity": "头皮",
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{
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"entity": "头皮静脉扩张",
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{
"id": 7,
"entity": "颅部",
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{
"id": 8,
"entity": "颅部叩诊有破壶音",
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] |
脑积液治疗分内科和外科两种。
|
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（五）脑性低钠血症化脑患儿除因呕吐不进饮食等原因可引起水、电解质紊乱外，还可见脑性低钠血症，出现昏睡、惊厥、昏迷、全身软弱无力、四肢肌张力低下、尿少症状。
|
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"entity": "脑性低钠血症",
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"entity": "化脑",
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{
"id": 2,
"entity": "呕吐",
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},
{
"id": 3,
"entity": "水、电解质紊乱",
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{
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"entity": "脑性低钠血症",
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"entity": "昏睡",
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{
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"entity": "惊厥",
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{
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"entity": "昏迷",
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{
"id": 8,
"entity": "全身软弱无力",
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{
"id": 9,
"entity": "四肢",
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{
"id": 10,
"entity": "四肢肌张力低下",
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},
{
"id": 11,
"entity": "尿",
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"label": "bod"
},
{
"id": 12,
"entity": "尿少",
"start_offset": 72,
"end_offset": 74,
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}
] |
其发生原理与感染影响脑神经垂体，抗利尿激素分泌过多导致水潴留有关。
|
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"entity": "抗利尿激素",
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},
{
"id": 2,
"entity": "抗利尿激素分泌过多",
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},
{
"id": 3,
"entity": "水潴留",
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"label": "sym"
}
] |
（六）其他由于脑实质损害及粘连可使脑神经受累或出现肢体瘫痪，亦可发生脑脓肿、颅内动脉炎及继发性癫痫发作。
|
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"entity": "脑神经",
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{
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"entity": "脑神经受累",
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},
{
"id": 3,
"entity": "肢体",
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},
{
"id": 4,
"entity": "肢体瘫痪",
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},
{
"id": 5,
"entity": "脑脓肿",
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},
{
"id": 6,
"entity": "颅内动脉炎",
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},
{
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"entity": "继发性癫痫",
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] |
此外，中耳炎、肺炎和关节炎也偶可发生。
|
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【预后】与化脑预后有关的因素是：患儿年龄、感染细菌种类、病情轻重，治疗早晚，有无并发症及细菌对抗生素的敏感性等。
|
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新生儿化脑病死率可达65%～75%，特别是宫内感染肠道细菌预后极差。
|
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"entity": "肠道细菌",
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"entity": "宫内感染肠道细菌",
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] |
金黄色葡萄球菌及肠道细菌引起者由于细菌耐药，治疗困难，病死率亦高。
|
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流感嗜血杆菌脑膜炎的病死率约10%～15%。
|
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如多动性障碍、轻或重度精神发育迟缓、反复抽搐发作、语言发育障碍、脑积水、运动功能障碍、视力障碍和偏瘫等。
|
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"entity": "反复抽搐",
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"entity": "语言发育障碍",
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"label": "sym"
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{
"id": 4,
"entity": "脑积水",
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"id": 5,
"entity": "运动功能障碍",
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},
{
"id": 6,
"entity": "视力障碍和偏瘫",
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"end_offset": 50,
"label": "sym"
}
] |
听力障碍发生率高，脑膜炎球菌、流感嗜血杆菌、肺炎链球菌所致后遗症分别占5.4%、2.7%、7.8%。
|
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{
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"entity": "肺炎链球菌",
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] |
二、儿童肿瘤的发病率世界各地各类肿瘤的发病率不完全相同，有些肿瘤有明显的地域差异，（表11-11）。
|
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{
"id": 2,
"entity": "肿瘤",
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] |
据报告尼日利亚的伊巴丹，儿童肿瘤年发病率最高为155.6/百万，斐济的印第安人发病率仅为39.7/百万。
|
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我国上海市有较完整的肿瘤登记系统，上海市儿童肿瘤的发病率（表11-11）。
|
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表11-1常见儿童肿瘤在不同国家地区的发病率差异如下表11-2上海市1972～1978年和1986～1992年0～15岁儿童肿瘤新病例数和标化发病率（1/百万）续表
|
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"id": 1,
"entity": "儿童肿瘤",
"start_offset": 60,
"end_offset": 64,
"label": "dis"
}
] |
第二章泌尿系统疾病的诊治技术第一节尿液检查血液经肾小球滤过膜滤过后形成的原尿，再经过肾小管选择性的吸收与排泌，最终通过输尿管、膀胱以及尿道而排出体外即成为尿液。
|
[
{
"id": 0,
"entity": "泌尿系统疾病",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "尿液检查",
"start_offset": 17,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "血液",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 3,
"entity": "肾小球滤过膜",
"start_offset": 24,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "原尿",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 5,
"entity": "肾小管",
"start_offset": 42,
"end_offset": 45,
"label": "bod"
},
{
"id": 6,
"entity": "输尿管",
"start_offset": 59,
"end_offset": 62,
"label": "bod"
},
{
"id": 7,
"entity": "膀胱",
"start_offset": 63,
"end_offset": 65,
"label": "bod"
},
{
"id": 8,
"entity": "尿道",
"start_offset": 67,
"end_offset": 69,
"label": "bod"
},
{
"id": 9,
"entity": "尿液",
"start_offset": 77,
"end_offset": 79,
"label": "bod"
}
] |
因此，尿液中除含有大量的水分外，还含有蛋白质和核酸代谢的中间和终末产物（尿素、尿酸、肌酐和氨基酸）、各种有机酸盐类和无机盐类、激素以及酶等。
|
[
{
"id": 0,
"entity": "尿液",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "蛋白质",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "核酸",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "尿素",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 4,
"entity": "尿酸",
"start_offset": 39,
"end_offset": 41,
"label": "bod"
},
{
"id": 5,
"entity": "肌酐",
"start_offset": 42,
"end_offset": 44,
"label": "bod"
},
{
"id": 6,
"entity": "氨基酸",
"start_offset": 45,
"end_offset": 48,
"label": "bod"
},
{
"id": 7,
"entity": "有机酸盐类",
"start_offset": 52,
"end_offset": 57,
"label": "bod"
},
{
"id": 8,
"entity": "无机盐类",
"start_offset": 58,
"end_offset": 62,
"label": "bod"
},
{
"id": 9,
"entity": "激素",
"start_offset": 63,
"end_offset": 65,
"label": "bod"
},
{
"id": 10,
"entity": "酶",
"start_offset": 67,
"end_offset": 68,
"label": "bod"
}
] |
还有一些正常或病理的有形成分，如细胞、细菌、寄生虫以及结晶等。
|
[
{
"id": 0,
"entity": "细胞",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 1,
"entity": "细菌",
"start_offset": 19,
"end_offset": 21,
"label": "mic"
},
{
"id": 2,
"entity": "寄生虫",
"start_offset": 22,
"end_offset": 25,
"label": "mic"
}
] |
因此，尿液是反映整个泌尿系统病变和功能状态的窗口，检查分析尿液可为相应的疾病提供诊断依据。
|
[
{
"id": 0,
"entity": "尿液",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "泌尿系统病变",
"start_offset": 10,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "检查分析尿液",
"start_offset": 25,
"end_offset": 31,
"label": "pro"
}
] |
尿液检查分析的内容包括：尿液的一般性状检查、尿生化分析、尿沉渣分析和尿细菌学检查。
|
[
{
"id": 0,
"entity": "尿液检查分析",
"start_offset": 0,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "尿液的一般性状检查",
"start_offset": 12,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "尿生化分析",
"start_offset": 22,
"end_offset": 27,
"label": "pro"
},
{
"id": 3,
"entity": "尿沉渣分析",
"start_offset": 28,
"end_offset": 33,
"label": "pro"
},
{
"id": 4,
"entity": "尿细菌学检查",
"start_offset": 34,
"end_offset": 40,
"label": "pro"
}
] |
一、尿液的一般性状检查（一）尿量小儿24小时尿量变化较大，不仅与肾血流量、肾小球滤过率以及肾小管回吸收率相关，还受摄入液体量、活动量、出汗以及环境温度的影响。
|
[
{
"id": 0,
"entity": "尿液的一般性状检查",
"start_offset": 2,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "尿量",
"start_offset": 14,
"end_offset": 16,
"label": "ite"
},
{
"id": 2,
"entity": "尿量",
"start_offset": 22,
"end_offset": 24,
"label": "ite"
},
{
"id": 3,
"entity": "肾血流量",
"start_offset": 32,
"end_offset": 36,
"label": "ite"
},
{
"id": 4,
"entity": "肾小球滤过率",
"start_offset": 37,
"end_offset": 43,
"label": "ite"
},
{
"id": 5,
"entity": "肾小管回吸收率",
"start_offset": 45,
"end_offset": 52,
"label": "ite"
},
{
"id": 6,
"entity": "汗",
"start_offset": 68,
"end_offset": 69,
"label": "bod"
}
] |
新生儿每小时尿量约1～3ml/kg，每日尿量婴儿为400～500ml，幼儿500～600ml，学龄前期600～800ml，学龄期800～1400ml。
|
[
{
"id": 0,
"entity": "尿量",
"start_offset": 6,
"end_offset": 8,
"label": "ite"
},
{
"id": 1,
"entity": "尿量",
"start_offset": 20,
"end_offset": 22,
"label": "ite"
}
] |
（二）颜色正常尿液透明，呈淡黄色或黄色，主要是由于含有代谢产物尿色素（urochrome）、尿胆素（urobilin）和尿红质（uroerythrin）等有色物质。
|
[
{
"id": 0,
"entity": "尿液",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "尿色素",
"start_offset": 31,
"end_offset": 34,
"label": "bod"
},
{
"id": 2,
"entity": "urochrome",
"start_offset": 35,
"end_offset": 44,
"label": "bod"
},
{
"id": 3,
"entity": "尿胆素",
"start_offset": 46,
"end_offset": 49,
"label": "bod"
},
{
"id": 4,
"entity": "urobilin",
"start_offset": 50,
"end_offset": 58,
"label": "bod"
},
{
"id": 5,
"entity": "尿红质",
"start_offset": 60,
"end_offset": 63,
"label": "bod"
},
{
"id": 6,
"entity": "uroerythrin",
"start_offset": 64,
"end_offset": 75,
"label": "bod"
}
] |
在疾病状态或特殊生理状态下，可出现尿液颜色的改变。
|
[
{
"id": 0,
"entity": "尿液颜色的改变",
"start_offset": 17,
"end_offset": 24,
"label": "sym"
}
] |
红色尿最常见的是血尿，其次为血红蛋白尿和肌红蛋白尿，卟啉尿（porphyrinuria）外观如红葡萄酒样，见于先天性卟啉代谢异常。
|
[
{
"id": 0,
"entity": "红色尿",
"start_offset": 0,
"end_offset": 3,
"label": "sym"
},
{
"id": 1,
"entity": "血尿",
"start_offset": 8,
"end_offset": 10,
"label": "sym"
},
{
"id": 2,
"entity": "血红蛋白尿",
"start_offset": 14,
"end_offset": 19,
"label": "sym"
},
{
"id": 3,
"entity": "肌红蛋白尿",
"start_offset": 20,
"end_offset": 25,
"label": "sym"
},
{
"id": 4,
"entity": "卟啉尿",
"start_offset": 26,
"end_offset": 29,
"label": "sym"
},
{
"id": 5,
"entity": "porphyrinuria",
"start_offset": 30,
"end_offset": 43,
"label": "sym"
},
{
"id": 6,
"entity": "外观如红葡萄酒样",
"start_offset": 44,
"end_offset": 52,
"label": "sym"
},
{
"id": 7,
"entity": "先天性卟啉代谢异常",
"start_offset": 55,
"end_offset": 64,
"label": "dis"
}
] |
黄褐色尿见于黄疸病人以及服用含动物胆红素的药物后如牛黄解毒丸和熊胆粉等。
|
[
{
"id": 0,
"entity": "黄褐色尿",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "黄疸",
"start_offset": 6,
"end_offset": 8,
"label": "dis"
},
{
"id": 2,
"entity": "牛黄解毒丸",
"start_offset": 25,
"end_offset": 30,
"label": "dru"
},
{
"id": 3,
"entity": "熊胆粉",
"start_offset": 31,
"end_offset": 34,
"label": "dru"
}
] |
淡绿色尿见于铜绿假单孢菌感染或使用亚甲蓝和阿米替林等药物后。
|
[
{
"id": 0,
"entity": "淡绿色尿",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "铜绿假单孢菌感染",
"start_offset": 6,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "亚甲蓝",
"start_offset": 17,
"end_offset": 20,
"label": "dru"
},
{
"id": 3,
"entity": "阿米替林",
"start_offset": 21,
"end_offset": 25,
"label": "dru"
}
] |
乳白色尿常是由于脓尿、乳糜尿（chyluria）、磷酸盐或碳酸盐结晶所致。
|
[
{
"id": 0,
"entity": "乳白色尿",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "脓尿",
"start_offset": 8,
"end_offset": 10,
"label": "sym"
},
{
"id": 2,
"entity": "乳糜尿",
"start_offset": 11,
"end_offset": 14,
"label": "sym"
},
{
"id": 3,
"entity": "chyluria",
"start_offset": 15,
"end_offset": 23,
"label": "sym"
}
] |
蓝色尿常见于由于色氨基吸收障碍，尿中排出大量尿蓝母的蓝尿布综合征。
|
[
{
"id": 0,
"entity": "蓝色尿",
"start_offset": 0,
"end_offset": 3,
"label": "sym"
},
{
"id": 1,
"entity": "色氨基吸收障碍",
"start_offset": 8,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "尿",
"start_offset": 16,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "尿蓝母",
"start_offset": 22,
"end_offset": 25,
"label": "bod"
},
{
"id": 4,
"entity": "蓝尿布综合征",
"start_offset": 26,
"end_offset": 32,
"label": "dis"
}
] |
黑褐色尿除见于重症血尿和变性血红蛋白尿外，还见于胱氨酸病、酚中毒以及黑尿酸症等。
|
[
{
"id": 0,
"entity": "黑褐色尿",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "重症血尿",
"start_offset": 7,
"end_offset": 11,
"label": "sym"
},
{
"id": 2,
"entity": "变性血红蛋白尿",
"start_offset": 12,
"end_offset": 19,
"label": "sym"
},
{
"id": 3,
"entity": "胱氨酸病",
"start_offset": 24,
"end_offset": 28,
"label": "dis"
},
{
"id": 4,
"entity": "酚中毒",
"start_offset": 29,
"end_offset": 32,
"label": "dis"
},
{
"id": 5,
"entity": "黑尿酸症",
"start_offset": 34,
"end_offset": 38,
"label": "dis"
}
] |
（三）气味正常尿一般无味，但可受食物及代谢排泄物的影响而改变，如大蒜味。
|
[
{
"id": 0,
"entity": "尿",
"start_offset": 7,
"end_offset": 8,
"label": "bod"
}
] |
细菌感染常使尿素转变为氨的气味。
|
[
{
"id": 0,
"entity": "细菌感染",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "尿素",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
}
] |
某些代谢病可产生特殊气味，如苯丙酮酸尿时尿有鼠尿样臭味，枫糖尿症时尿有甜味，糖尿病酮症酸中毒时，尿液呈烂苹果味。
|
[
{
"id": 0,
"entity": "代谢病",
"start_offset": 2,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "苯丙酮酸尿",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "尿有鼠尿样臭味",
"start_offset": 20,
"end_offset": 27,
"label": "sym"
},
{
"id": 3,
"entity": "枫糖尿症",
"start_offset": 28,
"end_offset": 32,
"label": "dis"
},
{
"id": 4,
"entity": "尿有甜味",
"start_offset": 33,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "糖尿病酮症酸中毒",
"start_offset": 38,
"end_offset": 46,
"label": "dis"
},
{
"id": 6,
"entity": "尿液呈烂苹果味",
"start_offset": 48,
"end_offset": 55,
"label": "sym"
}
] |
服用某些特别的食物或药物后尿液也可出现特殊气味。
|
[
{
"id": 0,
"entity": "尿液",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
}
] |
（四）尿比重和尿渗透压尿比重表示尿中全部粒子的重量总和，是简单测定肾浓缩功能的指标。
|
[
{
"id": 0,
"entity": "尿比重",
"start_offset": 3,
"end_offset": 6,
"label": "ite"
},
{
"id": 1,
"entity": "尿渗透压",
"start_offset": 7,
"end_offset": 11,
"label": "ite"
},
{
"id": 2,
"entity": "尿比重",
"start_offset": 11,
"end_offset": 14,
"label": "ite"
},
{
"id": 3,
"entity": "尿",
"start_offset": 16,
"end_offset": 17,
"label": "bod"
},
{
"id": 4,
"entity": "测定肾浓缩功能",
"start_offset": 31,
"end_offset": 38,
"label": "pro"
}
] |
大多数情况下渗透压可根据尿比重以下列公式推算：尿渗透浓度（压）=［（尿比重-1000）×4000］mOsm/（kg•H2</sub>O）新生儿尿比重为1.006～1.008，尿渗透压为240mOsm/（kg•H2</sub>O），儿童尿比重范围为1.003～1.030间，渗透压在40～1400mOsm/（kg•H2</sub>O）范围内波动。
|
[
{
"id": 0,
"entity": "渗透压",
"start_offset": 6,
"end_offset": 9,
"label": "ite"
},
{
"id": 1,
"entity": "尿比重",
"start_offset": 12,
"end_offset": 15,
"label": "ite"
},
{
"id": 2,
"entity": "尿渗透浓度",
"start_offset": 23,
"end_offset": 28,
"label": "ite"
},
{
"id": 3,
"entity": "尿比重",
"start_offset": 34,
"end_offset": 37,
"label": "ite"
},
{
"id": 4,
"entity": "尿比重",
"start_offset": 71,
"end_offset": 74,
"label": "ite"
},
{
"id": 5,
"entity": "尿渗透压",
"start_offset": 87,
"end_offset": 91,
"label": "ite"
},
{
"id": 6,
"entity": "尿比重",
"start_offset": 117,
"end_offset": 120,
"label": "ite"
},
{
"id": 7,
"entity": "渗透压",
"start_offset": 136,
"end_offset": 139,
"label": "ite"
}
] |
当有大量的高分子量的粒子存在，如尿糖、尿蛋白及造影剂时尿比重明显升高，应予以矫正。
|
[
{
"id": 0,
"entity": "尿糖",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 1,
"entity": "尿蛋白",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "造影剂",
"start_offset": 23,
"end_offset": 26,
"label": "dru"
},
{
"id": 3,
"entity": "尿比重",
"start_offset": 27,
"end_offset": 30,
"label": "ite"
}
] |
尿液每100ml中含1g糖或蛋白时，可将所测得的比重减去0.003。
|
[
{
"id": 0,
"entity": "尿液",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "糖",
"start_offset": 12,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "蛋白",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
}
] |
低张尿比重＜1.010，尿渗透压小于血浆渗透压，常≤200mOsm/（kg•H2</sub>O）；高张尿比重＞1.020，尿渗透压常＞800mOsm/（kg•H2</sub>O）；等张尿比重为1.010左右，尿渗透压等于血浆渗透透压［400mOsm/（kg•H2</sub>O）］。
|
[
{
"id": 0,
"entity": "低张尿比重",
"start_offset": 0,
"end_offset": 5,
"label": "ite"
},
{
"id": 1,
"entity": "尿渗透压",
"start_offset": 12,
"end_offset": 16,
"label": "ite"
},
{
"id": 2,
"entity": "血浆渗透压",
"start_offset": 18,
"end_offset": 23,
"label": "ite"
},
{
"id": 3,
"entity": "高张尿比重",
"start_offset": 49,
"end_offset": 54,
"label": "ite"
},
{
"id": 4,
"entity": "尿渗透压",
"start_offset": 61,
"end_offset": 65,
"label": "ite"
},
{
"id": 5,
"entity": "等张尿比重",
"start_offset": 90,
"end_offset": 95,
"label": "ite"
},
{
"id": 6,
"entity": "尿渗透压",
"start_offset": 104,
"end_offset": 108,
"label": "ite"
},
{
"id": 7,
"entity": "血浆渗透透压",
"start_offset": 110,
"end_offset": 116,
"label": "ite"
}
] |
固定低张尿见于肾小管浓缩功能障碍、尿崩症、低钾血症及高钙血症所致肾小管功能受损等。
|
[
{
"id": 0,
"entity": "固定低张尿",
"start_offset": 0,
"end_offset": 5,
"label": "sym"
},
{
"id": 1,
"entity": "肾小管浓缩功能障碍",
"start_offset": 7,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "尿崩症",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "低钾血症",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
},
{
"id": 4,
"entity": "高钙血症",
"start_offset": 26,
"end_offset": 30,
"label": "dis"
},
{
"id": 5,
"entity": "肾小管功能受损",
"start_offset": 32,
"end_offset": 39,
"label": "sym"
}
] |
等张尿见于急、慢性肾衰竭。
|
[
{
"id": 0,
"entity": "等张尿",
"start_offset": 0,
"end_offset": 3,
"label": "sym"
},
{
"id": 1,
"entity": "急、慢性肾衰竭",
"start_offset": 5,
"end_offset": 12,
"label": "dis"
}
] |
高张尿见于脱水和糖尿病等。
|
[
{
"id": 0,
"entity": "高张尿",
"start_offset": 0,
"end_offset": 3,
"label": "sym"
},
{
"id": 1,
"entity": "脱水",
"start_offset": 5,
"end_offset": 7,
"label": "sym"
},
{
"id": 2,
"entity": "糖尿病",
"start_offset": 8,
"end_offset": 11,
"label": "dis"
}
] |
（五）酸碱度（pH）尿pH反映尿酸化的程度，随全身酸碱平衡而变化。
|
[
{
"id": 0,
"entity": "酸碱度（pH）",
"start_offset": 3,
"end_offset": 10,
"label": "ite"
},
{
"id": 1,
"entity": "尿pH",
"start_offset": 10,
"end_offset": 13,
"label": "ite"
},
{
"id": 2,
"entity": "尿",
"start_offset": 15,
"end_offset": 16,
"label": "bod"
}
] |
正常尿一般为弱酸性（5.0～6.5），变动范围为4.5～7.5。
|
[
{
"id": 0,
"entity": "尿",
"start_offset": 2,
"end_offset": 3,
"label": "bod"
}
] |
常用试纸法测定。
|
[
{
"id": 0,
"entity": "试纸法",
"start_offset": 2,
"end_offset": 5,
"label": "pro"
}
] |
需准确测定pH时必须用pH计。
|
[
{
"id": 0,
"entity": "pH",
"start_offset": 5,
"end_offset": 7,
"label": "ite"
},
{
"id": 1,
"entity": "pH计",
"start_offset": 11,
"end_offset": 14,
"label": "equ"
}
] |
pH＞7.0～7.5提示产生尿素酶的奇异变形杆菌引起的泌尿系感染，因其可产生氨而使尿pH升高。
|
[
{
"id": 0,
"entity": "pH",
"start_offset": 0,
"end_offset": 2,
"label": "ite"
},
{
"id": 1,
"entity": "尿素酶",
"start_offset": 14,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "奇异变形杆菌引起的泌尿系感染",
"start_offset": 18,
"end_offset": 32,
"label": "dis"
},
{
"id": 3,
"entity": "尿pH",
"start_offset": 41,
"end_offset": 44,
"label": "ite"
}
] |
远端肾小管酸中毒时因尿酸化障碍，尿pH不能下降至6.0以下。
|
[
{
"id": 0,
"entity": "远端肾小管酸中毒",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "尿酸化障碍",
"start_offset": 10,
"end_offset": 15,
"label": "sym"
},
{
"id": 2,
"entity": "尿pH",
"start_offset": 16,
"end_offset": 19,
"label": "ite"
}
] |
参考文献1.殷雷，盛芳芸，曾纪骅，等.99mTc-DMSA肾静态显像对上尿路感染诊断的评价.中华儿科杂志，1999，36（10）：610-6132.葛琳娟.小儿膀胱输尿管返流的诊治进展.中华小儿外科杂志，1998，19（5）：307-3073.黄澄如，梁若馨，白继武，等.小儿原发性膀胱输尿管反流的诊断与手术治疗.中华泌尿外科杂志，2001，22（11）：674-6774.MajdM，RushtonHG.RenalCorticalScintigraphyinthediagnosisofacutepyelonephritis.SeminNuclMed.1992，22（2）：98-985.StanleyH.Urinarytractinfection’soldandnewconcepts.PediatrNephrol，1995，42（5）：1433-14336.CormuC，CochatP.ColletJP，etal.Surveyoftheattituesmanagementofacutepyelonephritisinchildren.PediatrNephrol，1994，8（3）：275-2757.BiggiA，DardanelliL，PomeroGetal.Acuterenalscintigraphyinchildrenwithafirsturinarytractinfection.PediatrNephrol，2001，16（9）：733-7338.FunfstuekR，StraubeE，SchildbachO，etal.PreventionofreinfectionbyL-methionineinpatientswithrecurrenturinarytractinfection.MedKlin，1997，92（10）：574-5749.NayirA，EmreS，SirinA，etal.Vaccinationwithinactivateduropathogenicbacteriainchildhoodrecurrenturinarytractinfection.KidneyInt，1995，48（3）：1677-1677
|
[
{
"id": 0,
"entity": "尿路感染",
"start_offset": 36,
"end_offset": 40,
"label": "dis"
},
{
"id": 1,
"entity": "儿科",
"start_offset": 48,
"end_offset": 50,
"label": "dep"
},
{
"id": 2,
"entity": "小儿膀胱输尿管返流",
"start_offset": 78,
"end_offset": 87,
"label": "dis"
},
{
"id": 3,
"entity": "小儿外科",
"start_offset": 95,
"end_offset": 99,
"label": "dep"
},
{
"id": 4,
"entity": "小儿原发性膀胱输尿管反流",
"start_offset": 136,
"end_offset": 148,
"label": "dis"
},
{
"id": 5,
"entity": "泌尿外科",
"start_offset": 159,
"end_offset": 163,
"label": "dep"
}
] |
第五节支气管扩张症支气管扩张症（bronchiectasis）以亚段支气管持续扩张为特征，伴支气管壁及支气管周围组织的炎症性破坏和管腔内渗出物积聚。
|
[
{
"id": 0,
"entity": "支气管扩张症",
"start_offset": 4,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "支气管扩张症",
"start_offset": 10,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "bronchiectasis",
"start_offset": 17,
"end_offset": 31,
"label": "dis"
},
{
"id": 3,
"entity": "亚段支气管持续扩张",
"start_offset": 33,
"end_offset": 42,
"label": "sym"
},
{
"id": 4,
"entity": "支气管壁",
"start_offset": 47,
"end_offset": 51,
"label": "bod"
},
{
"id": 5,
"entity": "支气管周围组织",
"start_offset": 52,
"end_offset": 59,
"label": "bod"
},
{
"id": 6,
"entity": "管腔内渗出物积聚",
"start_offset": 66,
"end_offset": 74,
"label": "sym"
}
] |
百日咳患儿可伴支气管扩张，但数个月后常可恢复正常。
|
[
{
"id": 0,
"entity": "百日咳",
"start_offset": 0,
"end_offset": 3,
"label": "dis"
},
{
"id": 1,
"entity": "支气管扩张",
"start_offset": 7,
"end_offset": 12,
"label": "dis"
}
] |
国外报道囊性纤维化和HIV感染是儿童支气管扩张的重要原因。
|
[
{
"id": 0,
"entity": "囊性纤维化",
"start_offset": 4,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "HIV感染",
"start_offset": 10,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "支气管扩张",
"start_offset": 18,
"end_offset": 23,
"label": "dis"
}
] |
其他因素包括异物吸入、支气管淋巴结结核、哮喘、肿瘤、各种原因引起的慢性肺炎等。
|
[
{
"id": 0,
"entity": "异物吸入",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "支气管淋巴结结核",
"start_offset": 11,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "哮喘",
"start_offset": 20,
"end_offset": 22,
"label": "dis"
},
{
"id": 3,
"entity": "肿瘤",
"start_offset": 23,
"end_offset": 25,
"label": "dis"
},
{
"id": 4,
"entity": "慢性肺炎",
"start_offset": 33,
"end_offset": 37,
"label": "dis"
}
] |
易患反复下呼吸道感染，尤其在同一部位反复发生肺炎，甚至肺脓疡。
|
[
{
"id": 0,
"entity": "下呼吸道感染",
"start_offset": 4,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "肺炎",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "肺脓疡",
"start_offset": 27,
"end_offset": 30,
"label": "dis"
}
] |
病程久者多有不同程度咯血、贫血、营养不良等。
|
[
{
"id": 0,
"entity": "咯血",
"start_offset": 10,
"end_offset": 12,
"label": "sym"
},
{
"id": 1,
"entity": "贫血",
"start_offset": 13,
"end_offset": 15,
"label": "sym"
},
{
"id": 2,
"entity": "营养不良",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
}
] |
肺部检查可在肺底部闻及水泡音或哮鸣音。
|
[
{
"id": 0,
"entity": "肺部检查",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "肺底部",
"start_offset": 6,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "肺底部闻及水泡音或哮鸣音",
"start_offset": 6,
"end_offset": 18,
"label": "sym"
}
] |
如病变广泛，常因肺不张或纤维性病变致纵隔移向患侧。
|
[
{
"id": 0,
"entity": "肺不张",
"start_offset": 8,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "纤维性病变",
"start_offset": 12,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "纵隔",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
}
] |
支气管造影显示支气管呈柱状、梭状或囊状扩张。
|
[
{
"id": 0,
"entity": "支气管造影",
"start_offset": 0,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "支气管呈柱状、梭状或囊状扩张",
"start_offset": 7,
"end_offset": 21,
"label": "sym"
}
] |
当扩大的支气管走行与CT扫描层面平行时，即表现为“轨道征”；相垂直时，即构成“印戒征”。
|
[
{
"id": 0,
"entity": "支气管",
"start_offset": 4,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "CT",
"start_offset": 10,
"end_offset": 12,
"label": "pro"
},
{
"id": 2,
"entity": "轨道征",
"start_offset": 25,
"end_offset": 28,
"label": "sym"
},
{
"id": 3,
"entity": "印戒征",
"start_offset": 39,
"end_offset": 42,
"label": "sym"
}
] |
清除分泌物后雾化吸入抗生素可能有益，但过长疗程也会增加耐药性。
|
[
{
"id": 0,
"entity": "雾化吸入",
"start_offset": 6,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "抗生素",
"start_offset": 10,
"end_offset": 13,
"label": "dru"
}
] |
应每年接种流感疫苗。
|
[
{
"id": 0,
"entity": "接种",
"start_offset": 3,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "流感疫苗",
"start_offset": 5,
"end_offset": 9,
"label": "dru"
}
] |
如病变限于一肺段或肺叶，经上述治疗病情无改善甚至恶化者，可考虑肺段或肺叶切除。
|
[
{
"id": 0,
"entity": "肺段",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "肺叶",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "肺段",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 3,
"entity": "肺叶",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
}
] |
三、内镜下逆行胰胆管造影术（ERCP）利用内镜操作技术，进行X线造影是检查胰腺及胆道疾病的重要手段。
|
[
{
"id": 0,
"entity": "内镜下逆行胰胆管造影术",
"start_offset": 2,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "ERCP",
"start_offset": 14,
"end_offset": 18,
"label": "pro"
},
{
"id": 2,
"entity": "内镜",
"start_offset": 21,
"end_offset": 23,
"label": "equ"
},
{
"id": 3,
"entity": "X线造影",
"start_offset": 30,
"end_offset": 34,
"label": "pro"
},
{
"id": 4,
"entity": "胰腺",
"start_offset": 37,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "胆道疾病",
"start_offset": 40,
"end_offset": 44,
"label": "dis"
}
] |
ERCP是在电子十二指肠镜下由口腔经十二指肠乳头插管注入照影剂，从而逆行显示胰胆管的造影技术，是目前国际公认的胰胆管疾病诊断金标准，是确诊胆管结石的最佳方法。
|
[
{
"id": 0,
"entity": "ERCP",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "电子十二指肠镜",
"start_offset": 6,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "口腔",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "十二指肠乳头",
"start_offset": 18,
"end_offset": 24,
"label": "bod"
},
{
"id": 4,
"entity": "照影剂",
"start_offset": 28,
"end_offset": 31,
"label": "dru"
},
{
"id": 5,
"entity": "胰胆管",
"start_offset": 38,
"end_offset": 41,
"label": "bod"
},
{
"id": 6,
"entity": "胰胆管疾病",
"start_offset": 55,
"end_offset": 60,
"label": "dis"
},
{
"id": 7,
"entity": "胆管结石",
"start_offset": 69,
"end_offset": 73,
"label": "dis"
}
] |
在ERCP基础上，可以同时进行Oddis括约肌切开术、胆管结石碎石取石术、胆总管支架植入术、内镜下鼻胆汁引流术以及内镜下碎石取石术等微创手术，对胆管结石等疾病能进行快速、安全、有效的治疗，是一种典型的、成功率极高的微创手术，代表了现代微创手术理念的发展趋向，已成为众多胆胰疾病首选的诊疗方法。
|
[
{
"id": 0,
"entity": "ERCP",
"start_offset": 1,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "Oddis括约肌切开术",
"start_offset": 15,
"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "胆管结石碎石取石术",
"start_offset": 27,
"end_offset": 36,
"label": "pro"
},
{
"id": 3,
"entity": "胆总管支架植入术",
"start_offset": 37,
"end_offset": 45,
"label": "pro"
},
{
"id": 4,
"entity": "内镜下鼻胆汁引流术",
"start_offset": 46,
"end_offset": 55,
"label": "pro"
},
{
"id": 5,
"entity": "内镜下碎石取石术",
"start_offset": 57,
"end_offset": 65,
"label": "pro"
},
{
"id": 6,
"entity": "微创手术",
"start_offset": 66,
"end_offset": 70,
"label": "pro"
},
{
"id": 7,
"entity": "胆管结石",
"start_offset": 72,
"end_offset": 76,
"label": "dis"
},
{
"id": 8,
"entity": "胆胰疾病",
"start_offset": 134,
"end_offset": 138,
"label": "dis"
}
] |
目前用于先天性与后天性胆道及胰腺疾患的诊断。
|
[
{
"id": 0,
"entity": "先天性与后天性胆道及胰腺疾患",
"start_offset": 4,
"end_offset": 18,
"label": "dis"
}
] |
适应证：凡疑似胰、胆疾病或属于胰、胆疾病皆为适应证，一般多在B超后进行，尤其对胆道疾病诊断价值最高。
|
[
{
"id": 0,
"entity": "胰",
"start_offset": 7,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "胆疾病",
"start_offset": 9,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "胰",
"start_offset": 15,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "胆疾病",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
},
{
"id": 4,
"entity": "B超",
"start_offset": 30,
"end_offset": 32,
"label": "pro"
},
{
"id": 5,
"entity": "胆道疾病",
"start_offset": 39,
"end_offset": 43,
"label": "dis"
}
] |
禁忌证：除同胃镜检查禁忌证外，上消化道梗阻、胰腺炎急性发作期及胆道感染伴发热者均为禁忌。
|
[
{
"id": 0,
"entity": "胃镜检查",
"start_offset": 6,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "上消化道梗阻",
"start_offset": 15,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "胰腺炎",
"start_offset": 22,
"end_offset": 25,
"label": "dis"
},
{
"id": 3,
"entity": "胆道感染伴发热",
"start_offset": 31,
"end_offset": 38,
"label": "dis"
}
] |
碘过敏者慎用。
|
[
{
"id": 0,
"entity": "碘过敏",
"start_offset": 0,
"end_offset": 3,
"label": "dis"
}
] |
ERCP的并发症：急性药物性胰腺炎，急性胆管炎，造影剂后腹膜炎，其发生率国内报道0.57%～3.11%。
|
[
{
"id": 0,
"entity": "急性药物性胰腺炎",
"start_offset": 9,
"end_offset": 17,
"label": "sym"
},
{
"id": 1,
"entity": "急性胆管炎",
"start_offset": 18,
"end_offset": 23,
"label": "sym"
},
{
"id": 2,
"entity": "造影剂后腹膜炎",
"start_offset": 24,
"end_offset": 31,
"label": "sym"
}
] |
儿童发生率高于成人。
|
[
{
"id": 0,
"entity": "儿童发生率高于成人",
"start_offset": 0,
"end_offset": 9,
"label": "sym"
}
] |
二、经皮球囊瓣膜成形术经皮球囊瓣膜成形术20世纪80年代起应用于临床，最常应用的为肺动脉瓣狭窄扩张术（PBPV）。
|
[
{
"id": 0,
"entity": "经皮球囊瓣膜成形术",
"start_offset": 2,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "经皮球囊瓣膜成形术",
"start_offset": 11,
"end_offset": 20,
"label": "pro"
},
{
"id": 2,
"entity": "肺动脉瓣狭窄扩张术",
"start_offset": 41,
"end_offset": 50,
"label": "pro"
},
{
"id": 3,
"entity": "PBPV",
"start_offset": 51,
"end_offset": 55,
"label": "pro"
}
] |
目前已对PBPV术进行了系统研究，包括应用指征、方法学、效果及存在的问题。
|
[
{
"id": 0,
"entity": "PBPV术",
"start_offset": 4,
"end_offset": 9,
"label": "pro"
}
] |
主动脉瓣狭窄球囊扩张术（PBAV）国内仅少数心血管中心开展，这一技术的开展，有助于与外科根治手术（Ross）内外科联合治疗。
|
[
{
"id": 0,
"entity": "主动脉瓣狭窄球囊扩张术",
"start_offset": 0,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "PBAV",
"start_offset": 12,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "心血管",
"start_offset": 22,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "外科根治手术",
"start_offset": 42,
"end_offset": 48,
"label": "pro"
},
{
"id": 4,
"entity": "Ross",
"start_offset": 49,
"end_offset": 53,
"label": "pro"
},
{
"id": 5,
"entity": "内外科",
"start_offset": 54,
"end_offset": 57,
"label": "dep"
}
] |
（一）经皮球囊肺动脉瓣成形术近30年来，通过对PBPV的适应证、方法学、术前后血流动力学、作用机制及随访等进行深入综合研究，表明PBPV为简便、有效、安全、经济的治疗典型肺动脉瓣狭窄的首选方法，在大部分病例PBPV可替代外科开胸手术。
|
[
{
"id": 0,
"entity": "经皮球囊肺动脉瓣成形术",
"start_offset": 3,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "PBPV",
"start_offset": 23,
"end_offset": 27,
"label": "pro"
},
{
"id": 2,
"entity": "PBPV",
"start_offset": 64,
"end_offset": 68,
"label": "pro"
},
{
"id": 3,
"entity": "典型肺动脉瓣狭窄",
"start_offset": 83,
"end_offset": 91,
"label": "dis"
},
{
"id": 4,
"entity": "PBPV",
"start_offset": 103,
"end_offset": 107,
"label": "pro"
},
{
"id": 5,
"entity": "外科开胸手术",
"start_offset": 110,
"end_offset": 116,
"label": "pro"
}
] |
另外对发育不良型、心房水平右向左分流重症肺动脉瓣狭窄、法洛四联症及复合畸形、室间隔完整的肺动脉瓣闭锁等进行PBPV术正在临床研究中。
|
[
{
"id": 0,
"entity": "发育不良型、心房水平右向左分流重症肺动脉瓣狭窄",
"start_offset": 3,
"end_offset": 26,
"label": "dis"
},
{
"id": 1,
"entity": "法洛四联症",
"start_offset": 27,
"end_offset": 32,
"label": "dis"
},
{
"id": 2,
"entity": "复合畸形",
"start_offset": 33,
"end_offset": 37,
"label": "dis"
},
{
"id": 3,
"entity": "室间隔完整的肺动脉瓣闭锁",
"start_offset": 38,
"end_offset": 50,
"label": "dis"
},
{
"id": 4,
"entity": "PBPV术",
"start_offset": 53,
"end_offset": 58,
"label": "pro"
}
] |
1.适应证由于方法学改进，大量PBPV术临床应用经验的积累，目前应用的指征更加明确且应用范围较前广泛，主要的指征为：（1）典型肺动脉瓣狭窄：肺动脉与右心室压差≥50mmHg。
|
[
{
"id": 0,
"entity": "PBPV",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
},
{
"id": 1,
"entity": "典型肺动脉瓣狭窄",
"start_offset": 61,
"end_offset": 69,
"label": "dis"
},
{
"id": 2,
"entity": "肺动脉",
"start_offset": 70,
"end_offset": 73,
"label": "bod"
},
{
"id": 3,
"entity": "右心室",
"start_offset": 74,
"end_offset": 77,
"label": "bod"
}
] |
对于新生儿重症肺动脉瓣狭窄亦可进行急诊球囊扩张术。
|
[
{
"id": 0,
"entity": "新生儿重症肺动脉瓣狭窄",
"start_offset": 2,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "急诊球囊扩张术",
"start_offset": 17,
"end_offset": 24,
"label": "pro"
}
] |
（2）重症肺动脉瓣狭窄伴心房水平右向左分流：目前在有经验的心血管中心，大部分病例仍为适应证。
|
[
{
"id": 0,
"entity": "重症肺动脉瓣狭窄伴心房水平右向左分流",
"start_offset": 3,
"end_offset": 21,
"label": "dis"
},
{
"id": 1,
"entity": "心血管",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
}
] |
（3）发育不良型肺动脉瓣狭窄：早期报道效果不良，目前约2/3病例仍可获得满意效果，但重症病例效果不满意。
|
[
{
"id": 0,
"entity": "发育不良型肺动脉瓣狭窄",
"start_offset": 3,
"end_offset": 14,
"label": "dis"
}
] |
（4）其他：包括复杂型先心病的姑息疗法以缓解发绀和换瓣后引起再狭窄，室间隔完整的肺动脉瓣闭锁等。
|
[
{
"id": 0,
"entity": "复杂型先心病",
"start_offset": 8,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "姑息疗法",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "发绀和换瓣后引起再狭窄",
"start_offset": 22,
"end_offset": 33,
"label": "sym"
},
{
"id": 3,
"entity": "室间隔完整的肺动脉瓣闭锁",
"start_offset": 34,
"end_offset": 46,
"label": "dis"
}
] |
以上选择指征需要根据每一心血管中心介入性心导管术的经验、条件及人员设备等而定。
|
[
{
"id": 0,
"entity": "心血管",
"start_offset": 12,
"end_offset": 15,
"label": "bod"
},
{
"id": 1,
"entity": "介入性心导管术",
"start_offset": 17,
"end_offset": 24,
"label": "pro"
}
] |
开始PBPV时，应选择典型的PS为宜。
|
[
{
"id": 0,
"entity": "PBPV",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
}
] |
2.方法学在进行PBPV前，首先行右心导管术及右心室造影，以确定肺动脉瓣狭窄的类型及严重程度，然后按规范方法进行。
|
[
{
"id": 0,
"entity": "PBPV",
"start_offset": 8,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "右心导管术",
"start_offset": 17,
"end_offset": 22,
"label": "pro"
},
{
"id": 2,
"entity": "右心室造影",
"start_offset": 23,
"end_offset": 28,
"label": "pro"
},
{
"id": 3,
"entity": "肺动脉瓣狭窄",
"start_offset": 32,
"end_offset": 38,
"label": "dis"
}
] |
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