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对于重危患儿，为了能够尽快控制病情，在没有得到明确的病原学诊断以前，就可以开始用广谱的静脉抗生素治疗。 | [
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"entity": "静脉抗生素治疗",
"start_offset": 43,
"end_offset": 50,
"label": "pro"
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常用的抗生素分类及使用剂量（表8-8～表8-8）。 | [
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表8-8药效动力学因素对剂量方案和体内效能相关参数的影响注：MIC，最低抑菌浓度；AUC，曲线下面积；MBC，最低杀菌浓度表8-9常用抗生素分类续表续表表8-10呼吸道感染常用抗生素剂量与方法续表<sup>*</sup>氨基糖苷类抗生素在6岁以下小儿原则不用，6岁以上慎用。 | [
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"entity": "抗生素",
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{
"id": 1,
"entity": "呼吸道感染",
"start_offset": 81,
"end_offset": 86,
"label": "dis"
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"id": 2,
"entity": "抗生素",
"start_offset": 88,
"end_offset": 91,
"label": "dru"
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{
"id": 3,
"entity": "氨基糖苷类抗生素",
"start_offset": 110,
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im，肌内注射；ivgtt，静脉滴注；po，口服肺炎链球菌：青霉素敏感者首选青霉素，或羟氨苄青霉素；青霉素低度耐药者仍可首选青霉素，但剂量要加大，也可选用第1代或第2代头孢菌素，备选头孢曲松或头孢噻肟或万古霉素。 | [
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"entity": "im",
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"id": 1,
"entity": "肌内注射",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
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"id": 2,
"entity": "ivgtt",
"start_offset": 8,
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"label": "pro"
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"entity": "静脉滴注",
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"label": "pro"
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"label": "pro"
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"entity": "口服",
"start_offset": 22,
"end_offset": 24,
"label": "pro"
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{
"id": 6,
"entity": "肺炎链球菌",
"start_offset": 24,
"end_offset": 29,
"label": "mic"
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{
"id": 7,
"entity": "青霉素",
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"end_offset": 33,
"label": "dru"
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{
"id": 8,
"entity": "青霉素敏感",
"start_offset": 30,
"end_offset": 35,
"label": "sym"
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{
"id": 9,
"entity": "青霉素",
"start_offset": 38,
"end_offset": 41,
"label": "dru"
},
{
"id": 10,
"entity": "羟氨苄青霉素",
"start_offset": 43,
"end_offset": 49,
"label": "dru"
},
{
"id": 11,
"entity": "青霉素",
"start_offset": 50,
"end_offset": 53,
"label": "dru"
},
{
"id": 12,
"entity": "青霉素低度耐药",
"start_offset": 50,
"end_offset": 57,
"label": "sym"
},
{
"id": 13,
"entity": "青霉素",
"start_offset": 62,
"end_offset": 65,
"label": "dru"
},
{
"id": 14,
"entity": "第1代或第2代头孢菌素",
"start_offset": 77,
"end_offset": 88,
"label": "dru"
},
{
"id": 15,
"entity": "头孢曲松",
"start_offset": 91,
"end_offset": 95,
"label": "dru"
},
{
"id": 16,
"entity": "头孢噻肟",
"start_offset": 96,
"end_offset": 100,
"label": "dru"
},
{
"id": 17,
"entity": "万古霉素",
"start_offset": 101,
"end_offset": 105,
"label": "dru"
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青霉素高度耐药或存在危险因素者首选万古霉素或头孢曲松或头孢噻肟。 | [
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"start_offset": 17,
"end_offset": 21,
"label": "dru"
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"id": 2,
"entity": "头孢曲松",
"start_offset": 22,
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"label": "dru"
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{
"id": 3,
"entity": "头孢噻肟",
"start_offset": 27,
"end_offset": 31,
"label": "dru"
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] |
流感嗜血杆菌：首选羟氨苄青霉素/克拉维酸或氨苄西林/舒巴坦，备选第2～3代头孢菌素或新大环内酯类（罗红霉素、阿奇霉素、克拉霉素）。 | [
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"entity": "流感嗜血杆菌",
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"entity": "羟氨苄青霉素/克拉维酸",
"start_offset": 9,
"end_offset": 20,
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"id": 2,
"entity": "氨苄西林/舒巴坦",
"start_offset": 21,
"end_offset": 29,
"label": "dru"
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{
"id": 3,
"entity": "第2～3代头孢菌素",
"start_offset": 32,
"end_offset": 41,
"label": "dru"
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{
"id": 4,
"entity": "新大环内酯类",
"start_offset": 42,
"end_offset": 48,
"label": "dru"
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{
"id": 5,
"entity": "罗红霉素",
"start_offset": 49,
"end_offset": 53,
"label": "dru"
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{
"id": 6,
"entity": "阿奇霉素",
"start_offset": 54,
"end_offset": 58,
"label": "dru"
},
{
"id": 7,
"entity": "克拉霉素",
"start_offset": 59,
"end_offset": 63,
"label": "dru"
}
] |
葡萄球菌：MSSA、MSSE，首选苯唑西林或氯唑青霉素，备选第1代、第2代头孢菌素。 | [
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"entity": "葡萄球菌",
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"entity": "MSSA",
"start_offset": 5,
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"entity": "MSSE",
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"entity": "第1代、第2代头孢菌素",
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MRSA、MRSE，首选万古霉素或联用利福平。 | [
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"id": 3,
"entity": "利福平",
"start_offset": 19,
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卡他莫拉菌：首选羟氨苄青霉素/克拉维酸，备选第2代或第3代头孢菌素或新大环内酯类。 | [
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"entity": "第2代或第3代头孢菌素",
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"label": "dru"
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{
"id": 3,
"entity": "新大环内酯类",
"start_offset": 34,
"end_offset": 40,
"label": "dru"
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肠杆菌科（大肠杆菌、克雷伯杆菌、变形杆菌等）：首选头孢曲松或头孢噻肟，单用或联用丁胺卡那霉素，备选有替卡西林/克拉维酸或氨曲南或亚胺培南或第3代头孢菌素如头孢吡肟等或庆大霉素。 | [
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"entity": "肠杆菌科",
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"id": 1,
"entity": "大肠杆菌",
"start_offset": 5,
"end_offset": 9,
"label": "mic"
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{
"id": 2,
"entity": "克雷伯杆菌",
"start_offset": 10,
"end_offset": 15,
"label": "mic"
},
{
"id": 3,
"entity": "变形杆菌",
"start_offset": 16,
"end_offset": 20,
"label": "mic"
},
{
"id": 4,
"entity": "头孢曲松",
"start_offset": 25,
"end_offset": 29,
"label": "dru"
},
{
"id": 5,
"entity": "头孢噻肟",
"start_offset": 30,
"end_offset": 34,
"label": "dru"
},
{
"id": 6,
"entity": "丁胺卡那霉素",
"start_offset": 40,
"end_offset": 46,
"label": "dru"
},
{
"id": 7,
"entity": "替卡西林/克拉维酸",
"start_offset": 50,
"end_offset": 59,
"label": "dru"
},
{
"id": 8,
"entity": "氨曲南",
"start_offset": 60,
"end_offset": 63,
"label": "dru"
},
{
"id": 9,
"entity": "亚胺培南",
"start_offset": 64,
"end_offset": 68,
"label": "dru"
},
{
"id": 10,
"entity": "第3代头孢菌素",
"start_offset": 69,
"end_offset": 76,
"label": "dru"
},
{
"id": 11,
"entity": "头孢吡肟",
"start_offset": 77,
"end_offset": 81,
"label": "dru"
},
{
"id": 12,
"entity": "庆大霉素",
"start_offset": 83,
"end_offset": 87,
"label": "dru"
}
] |
铜绿假单胞杆菌：首选替卡西林/克拉维酸或哌拉西林/他唑巴坦，或美洛西林或头孢他啶或头孢哌酮/舒巴坦或头孢吡肟，单用或联用氨基糖苷类抗生素（丁胺卡那霉素或庆大霉素，应注意使用指征：6岁以下小儿原则不用，6岁以上慎用），备选有氨基糖苷类联用氨曲南或亚胺培南。 | [
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"id": 2,
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"start_offset": 20,
"end_offset": 29,
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{
"id": 3,
"entity": "美洛西林",
"start_offset": 31,
"end_offset": 35,
"label": "dru"
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{
"id": 4,
"entity": "头孢他啶",
"start_offset": 36,
"end_offset": 40,
"label": "dru"
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{
"id": 5,
"entity": "头孢哌酮/舒巴坦",
"start_offset": 41,
"end_offset": 49,
"label": "dru"
},
{
"id": 6,
"entity": "头孢吡肟",
"start_offset": 50,
"end_offset": 54,
"label": "dru"
},
{
"id": 7,
"entity": "氨基糖苷类抗生素",
"start_offset": 60,
"end_offset": 68,
"label": "dru"
},
{
"id": 8,
"entity": "丁胺卡那霉素",
"start_offset": 69,
"end_offset": 75,
"label": "dru"
},
{
"id": 9,
"entity": "庆大霉素",
"start_offset": 76,
"end_offset": 80,
"label": "dru"
},
{
"id": 10,
"entity": "氨基糖苷类",
"start_offset": 111,
"end_offset": 116,
"label": "dru"
},
{
"id": 11,
"entity": "氨曲南",
"start_offset": 118,
"end_offset": 121,
"label": "dru"
},
{
"id": 12,
"entity": "亚胺培南",
"start_offset": 122,
"end_offset": 126,
"label": "dru"
}
] |
B族链球菌：首选青霉素，或羟氨苄青霉素或氨苄西林，青霉素剂量要加大。 | [
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"label": "dru"
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"label": "dru"
},
{
"id": 4,
"entity": "青霉素",
"start_offset": 25,
"end_offset": 28,
"label": "dru"
}
] |
厌氧菌：首选青霉素，联用克林霉素或甲硝唑，或羟氨苄青霉素/克拉维酸或氨苄西林/舒巴坦。 | [
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"start_offset": 6,
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{
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"entity": "克林霉素",
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"id": 3,
"entity": "甲硝唑",
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{
"id": 4,
"entity": "羟氨苄青霉素/克拉维酸",
"start_offset": 22,
"end_offset": 33,
"label": "dru"
},
{
"id": 5,
"entity": "氨苄西林/舒巴坦",
"start_offset": 34,
"end_offset": 42,
"label": "dru"
}
] |
单核细胞增多性李斯特菌：首选羟氨苄青霉素或氨苄西林。 | [
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"entity": "单核细胞增多性李斯特菌",
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"entity": "羟氨苄青霉素",
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"entity": "氨苄西林",
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百日咳杆菌、支原体、衣原体：选用大环内酯类抗生素。 | [
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"entity": "衣原体",
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"entity": "大环内酯类抗生素",
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参考文献1.全国人体重要寄生虫病现状调查办公室.全国人体重要寄生虫病现状调查报告.中国寄生虫学与寄生虫病杂志，2005，23（5）：332-3322.王战胜.小儿鼻蛲虫病16例分析.临床儿科杂志，2000，18：3193.詹斌，肖树华，李铁华，等.钩虫流行现状及疫苗研制进展.中华寄生虫学及寄生虫病杂志，2000，18：182-1824.陈应文，揭盛华.预防日本血吸虫病口服药物研究进展.湖北预防医学杂志，1999，10（5）：16-165.苏正明，胡敏，徐兴建，等.微波酶联免疫吸附试验诊断日本血吸虫病.中国血吸虫病防治杂志，2004，16（3）：178-1786.谢闻悦.血吸虫致弱疫苗的发展现状及展望.中国寄生虫病防治杂志，2000，13（3）：221-2217.娄培安.重组抗原在诊断疟疾上的应用.国外医学寄生虫分册，2000，27（6）：248-2488.周家莲，杨恒林.抗疟药研究现状与发展趋势.中国病原生物学杂志，2008，3（11）：865-8679.张述义.先天性弓形虫感染的产前研究的国内、外进展.中国优生与遗传杂志，2000，8（4）：124-12410.张历浊.儿童棘阿米巴角膜炎1例.中国斜视与小儿眼科杂志，2001，9（1）：311.黄德珉，叶鸿瑁，罗风珍，译.儿科感染性疾病（下）.沈阳：辽宁教育出版社，200012.BehrmanR，KliegmanRM，JensonH.NelsonTextbookofPediatrics.16thedition.London：W.B.Saunderscompany，2000 | [
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"end_offset": 16,
"label": "dis"
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"id": 1,
"entity": "寄生虫病",
"start_offset": 30,
"end_offset": 34,
"label": "dis"
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"id": 2,
"entity": "寄生虫",
"start_offset": 43,
"end_offset": 46,
"label": "mic"
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"id": 3,
"entity": "寄生虫病",
"start_offset": 48,
"end_offset": 52,
"label": "dis"
},
{
"id": 4,
"entity": "小儿鼻蛲虫病",
"start_offset": 79,
"end_offset": 85,
"label": "dis"
},
{
"id": 5,
"entity": "儿科",
"start_offset": 93,
"end_offset": 95,
"label": "dep"
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"id": 6,
"entity": "钩虫",
"start_offset": 124,
"end_offset": 126,
"label": "mic"
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{
"id": 7,
"entity": "疫苗",
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"end_offset": 133,
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"entity": "寄生虫病",
"start_offset": 145,
"end_offset": 149,
"label": "dis"
},
{
"id": 10,
"entity": "日本血吸虫病",
"start_offset": 179,
"end_offset": 185,
"label": "dis"
},
{
"id": 11,
"entity": "口服",
"start_offset": 185,
"end_offset": 187,
"label": "pro"
},
{
"id": 12,
"entity": "微波酶联免疫吸附试验",
"start_offset": 234,
"end_offset": 244,
"label": "pro"
},
{
"id": 13,
"entity": "日本血吸虫病",
"start_offset": 246,
"end_offset": 252,
"label": "dis"
},
{
"id": 14,
"entity": "血吸虫病",
"start_offset": 255,
"end_offset": 259,
"label": "dis"
},
{
"id": 15,
"entity": "血吸虫致弱疫苗",
"start_offset": 288,
"end_offset": 295,
"label": "dru"
},
{
"id": 16,
"entity": "寄生虫病",
"start_offset": 306,
"end_offset": 310,
"label": "dis"
},
{
"id": 17,
"entity": "疟疾",
"start_offset": 346,
"end_offset": 348,
"label": "dis"
},
{
"id": 18,
"entity": "寄生虫",
"start_offset": 357,
"end_offset": 360,
"label": "mic"
},
{
"id": 19,
"entity": "抗疟药",
"start_offset": 391,
"end_offset": 394,
"label": "dru"
},
{
"id": 20,
"entity": "先天性弓形虫感染",
"start_offset": 438,
"end_offset": 446,
"label": "dis"
},
{
"id": 21,
"entity": "儿童棘阿米巴角膜炎",
"start_offset": 493,
"end_offset": 502,
"label": "dis"
},
{
"id": 22,
"entity": "斜视",
"start_offset": 507,
"end_offset": 509,
"label": "dis"
},
{
"id": 23,
"entity": "眼科",
"start_offset": 512,
"end_offset": 514,
"label": "dep"
},
{
"id": 24,
"entity": "感染性疾病",
"start_offset": 547,
"end_offset": 552,
"label": "dis"
}
] |
二、肺动脉瓣下狭窄孤立性弥漫性肺动脉瓣下狭窄而肺动脉瓣正常极其罕见。 | [
{
"id": 0,
"entity": "肺动脉瓣下狭窄",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "孤立性弥漫性肺动脉瓣下狭窄",
"start_offset": 9,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "肺动脉瓣",
"start_offset": 23,
"end_offset": 27,
"label": "bod"
}
] |
纤维或纤维肌性环可出现在瓣下右心室流出道的任何水平，并造成梗阻。 | [
{
"id": 0,
"entity": "纤维",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "纤维肌性环",
"start_offset": 3,
"end_offset": 8,
"label": "bod"
},
{
"id": 2,
"entity": "瓣下右心室流出道",
"start_offset": 12,
"end_offset": 20,
"label": "bod"
},
{
"id": 3,
"entity": "梗阻",
"start_offset": 29,
"end_offset": 31,
"label": "dis"
}
] |
大的异常肌束还可将右室腔分成两个单独腔（右室双腔），并造成梗阻，常伴有室间隔缺损，也可单独存在。 | [
{
"id": 0,
"entity": "肌束",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "右室腔",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "单独腔",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 3,
"entity": "梗阻",
"start_offset": 29,
"end_offset": 31,
"label": "dis"
},
{
"id": 4,
"entity": "室间隔缺损",
"start_offset": 35,
"end_offset": 40,
"label": "dis"
}
] |
心肌肿瘤，特别是涉及室间隔的肿瘤，也可引起右心室流出道梗阻。 | [
{
"id": 0,
"entity": "心肌肿瘤",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "室间隔",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "肿瘤",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "右心室流出道梗阻",
"start_offset": 21,
"end_offset": 29,
"label": "dis"
}
] |
纠正性大动脉转位伴心房通常位患儿的30%～50%存在肺动脉瓣下形态学左室流出道的梗阻。 | [
{
"id": 0,
"entity": "纠正性大动脉转位",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "心房通常位",
"start_offset": 9,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "肺动脉瓣下形态学左室流出道的梗阻",
"start_offset": 26,
"end_offset": 42,
"label": "dis"
}
] |
这种情况通常伴有室间隔缺损，也可室间隔完整。 | [
{
"id": 0,
"entity": "室间隔缺损",
"start_offset": 8,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "室间隔",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
}
] |
上述病损的临床表现类似于肺动脉瓣狭窄，但喀喇音可听不到，瓣后肺动脉瓣扩张也可不明显或缺乏。 | [
{
"id": 0,
"entity": "肺动脉瓣狭窄",
"start_offset": 12,
"end_offset": 18,
"label": "dis"
},
{
"id": 1,
"entity": "喀喇音可听不到",
"start_offset": 20,
"end_offset": 27,
"label": "sym"
},
{
"id": 2,
"entity": "瓣后肺动脉瓣",
"start_offset": 28,
"end_offset": 34,
"label": "bod"
},
{
"id": 3,
"entity": "瓣后肺动脉瓣扩张也可不明显或缺乏",
"start_offset": 28,
"end_offset": 44,
"label": "sym"
}
] |
收缩期杂音在胸骨左缘第三、第四肋间最响。 | [
{
"id": 0,
"entity": "收缩期杂音",
"start_offset": 0,
"end_offset": 5,
"label": "sym"
},
{
"id": 1,
"entity": "胸骨左缘",
"start_offset": 6,
"end_offset": 10,
"label": "bod"
}
] |
三、蛛网膜下腔出血原发性蛛网膜下腔出血（primarysubarachnoidhemorrhage）是新生儿常见的颅内出血类型，多见于早产儿，也可见于足月儿，前者主要与缺氧有关，后者则多由产伤所致。 | [
{
"id": 0,
"entity": "蛛网膜下腔出血",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "原发性蛛网膜下腔出血",
"start_offset": 9,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "primarysubarachnoidhemorrhage",
"start_offset": 20,
"end_offset": 49,
"label": "dis"
},
{
"id": 3,
"entity": "颅内出血",
"start_offset": 57,
"end_offset": 61,
"label": "dis"
},
{
"id": 4,
"entity": "缺氧",
"start_offset": 84,
"end_offset": 86,
"label": "sym"
}
] |
新生儿蛛网膜下腔出血起源于软脑膜丛的小静脉或蛛网膜下腔的桥静脉。 | [
{
"id": 0,
"entity": "新生儿蛛网膜下腔出血",
"start_offset": 0,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "软脑膜丛的小静脉",
"start_offset": 13,
"end_offset": 21,
"label": "bod"
},
{
"id": 2,
"entity": "蛛网膜下腔的桥静脉",
"start_offset": 22,
"end_offset": 31,
"label": "bod"
}
] |
【临床表现】轻度蛛网膜下腔出血可无症状或症状轻微。 | [
{
"id": 0,
"entity": "蛛网膜下腔出血",
"start_offset": 8,
"end_offset": 15,
"label": "dis"
}
] |
中度出血可引起惊厥，常开始于生后第2天，惊厥发作间期患儿情况良好。 | [
{
"id": 0,
"entity": "中度出血",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "惊厥",
"start_offset": 7,
"end_offset": 9,
"label": "sym"
},
{
"id": 2,
"entity": "惊厥",
"start_offset": 20,
"end_offset": 22,
"label": "sym"
}
] |
大量蛛网膜下腔出血可致患儿病情迅速恶化和死亡。 | [
{
"id": 0,
"entity": "蛛网膜下腔出血",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
}
] |
蛛网膜下腔出血的诊断常因其他原因腰穿发现均匀一致的血性脑脊液而提示，确诊需通过CT检查，头颅超声对蛛网膜下腔出血不够敏感。 | [
{
"id": 0,
"entity": "蛛网膜下腔出血",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "血性脑脊液",
"start_offset": 25,
"end_offset": 30,
"label": "sym"
},
{
"id": 2,
"entity": "CT检查",
"start_offset": 39,
"end_offset": 43,
"label": "pro"
},
{
"id": 3,
"entity": "头颅超声",
"start_offset": 44,
"end_offset": 48,
"label": "pro"
},
{
"id": 4,
"entity": "蛛网膜下腔出血",
"start_offset": 49,
"end_offset": 56,
"label": "dis"
}
] |
血性脑脊液是提示蛛网膜下腔或脑室内出血的一个线索，但需与腰椎穿刺损伤鉴别。 | [
{
"id": 0,
"entity": "血性脑脊液",
"start_offset": 0,
"end_offset": 5,
"label": "sym"
},
{
"id": 1,
"entity": "蛛网膜下腔或脑室内出血",
"start_offset": 8,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "腰椎穿刺",
"start_offset": 28,
"end_offset": 32,
"label": "pro"
}
] |
非急性期颅内出血的脑脊液特征为脑脊液黄色、红细胞数量增多和蛋白含量增高，脑脊液中糖常常降低（＜30mg/dl），甚至可低达10mg/dl，并可持续数周甚至数月。 | [
{
"id": 0,
"entity": "非急性期颅内出血",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "脑脊液",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 3,
"entity": "红细胞",
"start_offset": 21,
"end_offset": 24,
"label": "bod"
},
{
"id": 4,
"entity": "脑脊液黄色、红细胞数量增多和蛋白含量增高",
"start_offset": 15,
"end_offset": 35,
"label": "sym"
},
{
"id": 5,
"entity": "脑脊液",
"start_offset": 36,
"end_offset": 39,
"label": "bod"
}
] |
脑脊液中糖的降低可能系出血损伤葡萄糖向脑脊液转运的机制。 | [
{
"id": 0,
"entity": "脑脊液",
"start_offset": 0,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "葡萄糖",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
}
] |
当脑脊液糖降低，伴淋巴细胞增多和蛋白含量增高时，很难与细菌性脑膜炎鉴别。 | [
{
"id": 0,
"entity": "脑脊液",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "淋巴细胞",
"start_offset": 9,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "蛋白",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 3,
"entity": "细菌性脑膜炎",
"start_offset": 27,
"end_offset": 33,
"label": "dis"
}
] |
【治疗】新生儿原发性蛛网膜下腔出血预后较好，90%随访正常，治疗以对症为主，如有惊厥可用地西泮类药物抗惊厥。 | [
{
"id": 0,
"entity": "新生儿原发性蛛网膜下腔出血",
"start_offset": 4,
"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "惊厥",
"start_offset": 40,
"end_offset": 42,
"label": "sym"
},
{
"id": 2,
"entity": "地西泮类药物",
"start_offset": 44,
"end_offset": 50,
"label": "dru"
},
{
"id": 3,
"entity": "惊厥",
"start_offset": 51,
"end_offset": 53,
"label": "sym"
}
] |
大量蛛网膜下腔出血的主要后遗症是出血后脑积水，但其发展过程比脑室内出血后脑积水缓慢，预后比脑室内出血好。 | [
{
"id": 0,
"entity": "蛛网膜下腔出血",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "出血",
"start_offset": 16,
"end_offset": 18,
"label": "sym"
},
{
"id": 2,
"entity": "脑积水",
"start_offset": 19,
"end_offset": 22,
"label": "dis"
},
{
"id": 3,
"entity": "脑积水",
"start_offset": 36,
"end_offset": 39,
"label": "dis"
},
{
"id": 4,
"entity": "脑室内出血",
"start_offset": 45,
"end_offset": 50,
"label": "dis"
}
] |
蛛网膜下腔出血后脑积水的处理同脑室内出血。 | [
{
"id": 0,
"entity": "蛛网膜下腔出血",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "脑积水",
"start_offset": 8,
"end_offset": 11,
"label": "dis"
},
{
"id": 2,
"entity": "脑室内出血",
"start_offset": 15,
"end_offset": 20,
"label": "dis"
}
] |
二、海绵状淋巴管瘤海绵状淋巴管瘤（cavernouslymphangioma）系由许多小的多房性腔隙组成，内含淋巴或血液混合的液体，腔隙脏壁衬有内皮细胞层，因有时混有血管瘤，又称淋巴血管瘤。 | [
{
"id": 0,
"entity": "海绵状淋巴管瘤",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "海绵状淋巴管瘤",
"start_offset": 9,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "cavernouslymphangioma",
"start_offset": 17,
"end_offset": 38,
"label": "dis"
},
{
"id": 3,
"entity": "淋巴",
"start_offset": 55,
"end_offset": 57,
"label": "bod"
},
{
"id": 4,
"entity": "血液",
"start_offset": 58,
"end_offset": 60,
"label": "bod"
},
{
"id": 5,
"entity": "内皮细胞层",
"start_offset": 72,
"end_offset": 77,
"label": "bod"
},
{
"id": 6,
"entity": "血管瘤",
"start_offset": 83,
"end_offset": 86,
"label": "dis"
},
{
"id": 7,
"entity": "淋巴血管瘤",
"start_offset": 89,
"end_offset": 94,
"label": "dis"
}
] |
多见于上肢、颈、腋窝、肩胛、口腔和舌等处。 | [
{
"id": 0,
"entity": "上肢",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "颈",
"start_offset": 6,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "腋窝",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 3,
"entity": "肩胛",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 4,
"entity": "口腔",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 5,
"entity": "舌",
"start_offset": 17,
"end_offset": 18,
"label": "bod"
}
] |
肿瘤的体积一般很大，侵入舌部的可引起巨舌，侵犯口腔则吞咽、呼吸甚至说话困难，肿瘤的表面有增厚的皮肤，易感染，与周围的组织、器官发生粘连。 | [
{
"id": 0,
"entity": "肿瘤",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "舌部",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "巨舌",
"start_offset": 18,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "口腔",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 4,
"entity": "吞咽、呼吸甚至说话困难",
"start_offset": 26,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "肿瘤",
"start_offset": 38,
"end_offset": 40,
"label": "dis"
},
{
"id": 6,
"entity": "皮肤",
"start_offset": 47,
"end_offset": 49,
"label": "bod"
},
{
"id": 7,
"entity": "感染",
"start_offset": 51,
"end_offset": 53,
"label": "sym"
},
{
"id": 8,
"entity": "组织",
"start_offset": 58,
"end_offset": 60,
"label": "bod"
},
{
"id": 9,
"entity": "器官",
"start_offset": 61,
"end_offset": 63,
"label": "bod"
}
] |
切除是主要的治疗方法，对有扩张趋势，或影响呼吸和进食的颈部、口底的巨大淋巴管瘤有绝对的手术指征。 | [
{
"id": 0,
"entity": "切除",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "颈部",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
},
{
"id": 2,
"entity": "口底",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 3,
"entity": "巨大淋巴管",
"start_offset": 33,
"end_offset": 38,
"label": "dis"
},
{
"id": 4,
"entity": "手术",
"start_offset": 43,
"end_offset": 45,
"label": "pro"
}
] |
术中要注意出血和休克的应对措施。 | [
{
"id": 0,
"entity": "休克",
"start_offset": 8,
"end_offset": 10,
"label": "dis"
}
] |
尽量避免损伤血管和神经。 | [
{
"id": 0,
"entity": "血管",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "神经",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
}
] |
第十四章急性中毒【概述】毒物是指在一定条件下，以各种形式和剂量作用于人体，产生对人体有害的生物学反应和病理变化，导致机体功能严重损害甚至危及生命的物质，包括化学品、药物、植物和气体等。 | [
{
"id": 0,
"entity": "急性中毒",
"start_offset": 5,
"end_offset": 9,
"label": "dis"
}
] |
毒物进入人体后，在体内与体液、组织相互作用后可引起一系列中毒症状表现，组织代谢和器官功能障碍，严重者可导致患儿终身残疾或死亡。 | [
{
"id": 0,
"entity": "人体",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "体液",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "组织",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "中毒",
"start_offset": 28,
"end_offset": 30,
"label": "dis"
},
{
"id": 4,
"entity": "中毒症状",
"start_offset": 28,
"end_offset": 32,
"label": "sym"
},
{
"id": 5,
"entity": "组织",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
},
{
"id": 6,
"entity": "器官",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
},
{
"id": 7,
"entity": "组织代谢和器官功能障碍",
"start_offset": 35,
"end_offset": 46,
"label": "sym"
},
{
"id": 8,
"entity": "残疾",
"start_offset": 57,
"end_offset": 59,
"label": "dis"
}
] |
因摄入毒物而产生的一系列危及生命的病理生理改变和相应症状称为中毒。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 30,
"end_offset": 32,
"label": "dis"
}
] |
摄入毒物后数小时至数天内出现中毒表现者称为急性中毒。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "急性中毒",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
}
] |
凡能引起中毒的物质均被视为毒物。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 4,
"end_offset": 6,
"label": "dis"
}
] |
由于年幼儿有一定的活动能力，但认知能力和生活经验不足，对某些毒物和药物的危害缺乏认识，因此中毒发生率在此年龄组较高。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 45,
"end_offset": 47,
"label": "dis"
}
] |
文献报道中，年龄小于5岁的中毒群体虽发病率较高，但大多属于无意中毒，其摄入的中毒物质剂量不大、毒物种类单一，其病死率低于青少年患者，而青少年患者有相当部分在存在精神抑郁或心理障碍情况下自伤性服毒，其服毒剂量通常较大，病死率相对较高。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 13,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "中毒",
"start_offset": 31,
"end_offset": 33,
"label": "dis"
},
{
"id": 2,
"entity": "中毒",
"start_offset": 38,
"end_offset": 40,
"label": "dis"
},
{
"id": 3,
"entity": "精神抑郁",
"start_offset": 80,
"end_offset": 84,
"label": "dis"
},
{
"id": 4,
"entity": "心理障碍",
"start_offset": 85,
"end_offset": 89,
"label": "dis"
}
] |
小儿发生中毒后被送至医院时，经常会遇到患儿家长不能准确提供毒物种类及毒物摄入量的病史，以致无法实施有针对性的解毒措施，可在短时间内导致病孩死亡。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 4,
"end_offset": 6,
"label": "dis"
}
] |
3.药物过量中毒许多药物（包括中药）过量均可导致中毒，如地高辛、抗癫痫药、退热药、麻醉镇静药、抗心律失常药等。 | [
{
"id": 0,
"entity": "中药",
"start_offset": 15,
"end_offset": 17,
"label": "dru"
},
{
"id": 1,
"entity": "中毒",
"start_offset": 24,
"end_offset": 26,
"label": "dis"
},
{
"id": 2,
"entity": "地高辛",
"start_offset": 28,
"end_offset": 31,
"label": "dru"
},
{
"id": 3,
"entity": "抗癫痫药",
"start_offset": 32,
"end_offset": 36,
"label": "dru"
},
{
"id": 4,
"entity": "退热药",
"start_offset": 37,
"end_offset": 40,
"label": "dru"
},
{
"id": 5,
"entity": "麻醉镇静药",
"start_offset": 41,
"end_offset": 46,
"label": "dru"
},
{
"id": 6,
"entity": "抗心律失常药",
"start_offset": 47,
"end_offset": 53,
"label": "dru"
}
] |
此外，根据毒物的物理状态还可分为挥发性与非挥发性毒物，根据毒物吸收方式分为食入、吸入、皮肤接触吸收性毒物等。 | [
{
"id": 0,
"entity": "皮肤",
"start_offset": 43,
"end_offset": 45,
"label": "bod"
}
] |
进入途径以胃肠道最多，其他还有呼吸道、皮肤、五官、创口、注射等。 | [
{
"id": 0,
"entity": "胃肠道",
"start_offset": 5,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "呼吸道",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "皮肤",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "五官",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
}
] |
毒物的作用部位直接影响中毒程度，当毒物作用于氧代谢、神经系统、心脏等代谢关键环节或重要脏器时，可使患者很快出现严重症状甚至死亡。 | [
{
"id": 0,
"entity": "神经系统",
"start_offset": 26,
"end_offset": 30,
"label": "bod"
},
{
"id": 1,
"entity": "心脏",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 2,
"entity": "脏器",
"start_offset": 43,
"end_offset": 45,
"label": "bod"
},
{
"id": 3,
"entity": "严重症状",
"start_offset": 55,
"end_offset": 59,
"label": "sym"
}
] |
大多数毒物进入体内经肝脏代谢转化后毒性减弱或消失，并由肾脏排泄，一些毒物亦可为原形经肾脏排泄。 | [
{
"id": 0,
"entity": "肝脏",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "肾脏",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
},
{
"id": 2,
"entity": "肾脏",
"start_offset": 42,
"end_offset": 44,
"label": "bod"
}
] |
少数毒物可由皮肤汗腺、乳腺、泪液、呼吸道、胆道或肠道排泄。 | [
{
"id": 0,
"entity": "皮肤汗腺",
"start_offset": 6,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "乳腺",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "泪液",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "呼吸道",
"start_offset": 17,
"end_offset": 20,
"label": "bod"
},
{
"id": 4,
"entity": "胆道",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 5,
"entity": "肠道",
"start_offset": 24,
"end_offset": 26,
"label": "bod"
}
] |
各毒物间的排泄速度差异很大，主要取决于毒物本身特性和患者肾脏功能，毒物排泄时间最长可达数周甚至数月。 | [
{
"id": 0,
"entity": "肾脏",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
}
] |
治疗中的促进毒物排泄方法对于中毒早期毒物大部分积聚于血流中的患者效果较好，当毒物的分布在体内达到平衡时，大多数毒物仅有5%左右存在于血液中，此时仅采用排泄治疗效果较差。 | [
{
"id": 0,
"entity": "血液",
"start_offset": 66,
"end_offset": 68,
"label": "bod"
}
] |
此外，毒物脂溶性高或血浆蛋白结合率高、中毒时毒物剂量较大、休克等因素亦会导致毒物排泄速度减慢。 | [
{
"id": 0,
"entity": "血浆蛋白",
"start_offset": 10,
"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "中毒",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "休克",
"start_offset": 29,
"end_offset": 31,
"label": "sym"
}
] |
但对毒物一时不能明确者，临床表现也有助于鉴别中毒的毒物种类和病情程度。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
}
] |
生命体征及心、脑、肾等主要器官功能受损常提示中毒病情严重，以下是中毒时各系统常见的症状和表现。 | [
{
"id": 0,
"entity": "心",
"start_offset": 5,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "脑",
"start_offset": 7,
"end_offset": 8,
"label": "bod"
},
{
"id": 2,
"entity": "肾",
"start_offset": 9,
"end_offset": 10,
"label": "bod"
},
{
"id": 3,
"entity": "心、脑、肾等主要器官功能受损",
"start_offset": 5,
"end_offset": 19,
"label": "sym"
},
{
"id": 4,
"entity": "中毒",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
},
{
"id": 5,
"entity": "中毒",
"start_offset": 32,
"end_offset": 34,
"label": "dis"
}
] |
表6-20常见中毒症状体征与可能毒物（一）消化系统在急性中毒时，胃肠道症状通常最为显著。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "中毒症状",
"start_offset": 7,
"end_offset": 11,
"label": "sym"
},
{
"id": 2,
"entity": "消化系统",
"start_offset": 21,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "急性中毒",
"start_offset": 26,
"end_offset": 30,
"label": "dis"
},
{
"id": 4,
"entity": "胃肠道",
"start_offset": 32,
"end_offset": 35,
"label": "bod"
},
{
"id": 5,
"entity": "胃肠道症状",
"start_offset": 32,
"end_offset": 37,
"label": "sym"
}
] |
毒物大多数均为食入中毒，少数为非食入中毒。 | [
{
"id": 0,
"entity": "食入中毒",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "非食入中毒",
"start_offset": 15,
"end_offset": 20,
"label": "dis"
}
] |
因此，对于小儿不明原因下突然出现急性消化道症状，应注意鉴别是否存在中毒。 | [
{
"id": 0,
"entity": "消化道",
"start_offset": 18,
"end_offset": 21,
"label": "bod"
},
{
"id": 1,
"entity": "急性消化道症状",
"start_offset": 16,
"end_offset": 23,
"label": "sym"
},
{
"id": 2,
"entity": "中毒",
"start_offset": 33,
"end_offset": 35,
"label": "dis"
}
] |
肝脏是毒物代谢转化的主要场所，由消化道进入的毒物，大多经肝脏代谢后毒性下降或失去毒性。 | [
{
"id": 0,
"entity": "肝脏",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "消化道",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "肝脏",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
}
] |
肝脏受到毒物侵犯后可发生不同程度的损害，出现黄疸、肝炎症状。 | [
{
"id": 0,
"entity": "肝脏",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "黄疸",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "肝炎",
"start_offset": 25,
"end_offset": 27,
"label": "dis"
},
{
"id": 3,
"entity": "黄疸、肝炎症状",
"start_offset": 22,
"end_offset": 29,
"label": "sym"
}
] |
原先有肝功能障碍者可因解毒功能下降而使中毒症状加重。 | [
{
"id": 0,
"entity": "肝功能障碍",
"start_offset": 3,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "中毒",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "中毒症状",
"start_offset": 19,
"end_offset": 23,
"label": "sym"
}
] |
（二）循环系统大部分中毒患儿均会出现循环系统症状，如心动过速、周围循环灌注变差等。 | [
{
"id": 0,
"entity": "循环系统",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "中毒",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "循环系统",
"start_offset": 18,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "循环系统症状",
"start_offset": 18,
"end_offset": 24,
"label": "sym"
},
{
"id": 4,
"entity": "心动过速",
"start_offset": 26,
"end_offset": 30,
"label": "sym"
},
{
"id": 5,
"entity": "周围循环灌注变差",
"start_offset": 31,
"end_offset": 39,
"label": "sym"
}
] |
自主神经对心血管系统影响较大，具有交感神经激动作用的毒物可使血压升高、心率快速和心律失常，而拟副交感神经毒物则会引起心动过缓。 | [
{
"id": 0,
"entity": "自主神经",
"start_offset": 0,
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"label": "bod"
},
{
"id": 1,
"entity": "心血管系统",
"start_offset": 5,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "交感神经",
"start_offset": 17,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "血压升高",
"start_offset": 30,
"end_offset": 34,
"label": "sym"
},
{
"id": 4,
"entity": "心率快速",
"start_offset": 35,
"end_offset": 39,
"label": "sym"
},
{
"id": 5,
"entity": "心律失常",
"start_offset": 40,
"end_offset": 44,
"label": "sym"
},
{
"id": 6,
"entity": "交感神经",
"start_offset": 48,
"end_offset": 52,
"label": "bod"
},
{
"id": 7,
"entity": "心动过缓",
"start_offset": 58,
"end_offset": 62,
"label": "sym"
}
] |
（三）呼吸系统许多毒物（包括吸入有毒气体）会损害呼吸系统功能。 | [
{
"id": 0,
"entity": "呼吸系统",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "呼吸系统",
"start_offset": 24,
"end_offset": 28,
"label": "bod"
}
] |
（四）泌尿系统肾脏是毒物和毒物代谢产物排泄的主要器官，中毒后循环、呼吸障碍导致的肾脏缺血缺氧，可引起不同程度的肾脏损害症状，表现为血尿、蛋白尿、水肿、尿量减少等。 | [
{
"id": 0,
"entity": "泌尿系统",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "肾脏",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "中毒",
"start_offset": 27,
"end_offset": 29,
"label": "dis"
},
{
"id": 3,
"entity": "呼吸障碍",
"start_offset": 33,
"end_offset": 37,
"label": "dis"
},
{
"id": 4,
"entity": "肾脏缺血缺氧",
"start_offset": 40,
"end_offset": 46,
"label": "sym"
},
{
"id": 5,
"entity": "肾脏损害",
"start_offset": 55,
"end_offset": 59,
"label": "dis"
},
{
"id": 6,
"entity": "肾脏损害症状",
"start_offset": 55,
"end_offset": 61,
"label": "sym"
},
{
"id": 7,
"entity": "血尿",
"start_offset": 65,
"end_offset": 67,
"label": "sym"
},
{
"id": 8,
"entity": "蛋白尿",
"start_offset": 68,
"end_offset": 71,
"label": "sym"
},
{
"id": 9,
"entity": "水肿",
"start_offset": 72,
"end_offset": 74,
"label": "sym"
},
{
"id": 10,
"entity": "尿量",
"start_offset": 75,
"end_offset": 77,
"label": "ite"
},
{
"id": 11,
"entity": "尿量减少",
"start_offset": 75,
"end_offset": 79,
"label": "sym"
}
] |
部分毒物还具有选择性的肾脏毒性，直接损害肾脏。 | [
{
"id": 0,
"entity": "肾脏",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 1,
"entity": "肾脏",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
}
] |
肾脏损害中以急性肾衰竭最为严重。 | [
{
"id": 0,
"entity": "肾脏损害",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "急性肾衰竭",
"start_offset": 6,
"end_offset": 11,
"label": "dis"
}
] |
后者通常表现为短期内出现尿闭、高血压、氮质血症，重者还可出现意识改变、抽搐和急性肺水肿。 | [
{
"id": 0,
"entity": "尿闭",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
},
{
"id": 1,
"entity": "高血压",
"start_offset": 15,
"end_offset": 18,
"label": "sym"
},
{
"id": 2,
"entity": "氮质血症",
"start_offset": 19,
"end_offset": 23,
"label": "sym"
},
{
"id": 3,
"entity": "意识改变",
"start_offset": 30,
"end_offset": 34,
"label": "sym"
},
{
"id": 4,
"entity": "抽搐",
"start_offset": 35,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "肺",
"start_offset": 40,
"end_offset": 41,
"label": "bod"
},
{
"id": 6,
"entity": "急性肺水肿",
"start_offset": 38,
"end_offset": 43,
"label": "sym"
}
] |
（五）神经系统中枢神经系统是人体高级生命活动器官和调节机体生理功能的重要器官。 | [
{
"id": 0,
"entity": "神经系统",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "中枢神经系统",
"start_offset": 7,
"end_offset": 13,
"label": "bod"
}
] |
瞳孔是脑功能观察的重要体征，并可在一定程度上鉴别毒物种类和脑功能状况。 | [
{
"id": 0,
"entity": "瞳孔",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "脑",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 2,
"entity": "脑",
"start_offset": 29,
"end_offset": 30,
"label": "bod"
}
] |
吗啡、乙醇、有机磷等中毒时，瞳孔通常显著缩小；而曼陀罗类、镇静剂中毒时，则瞳孔扩大。 | [
{
"id": 0,
"entity": "瞳孔",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "瞳孔通常显著缩小",
"start_offset": 14,
"end_offset": 22,
"label": "sym"
},
{
"id": 2,
"entity": "瞳孔扩大",
"start_offset": 37,
"end_offset": 41,
"label": "sym"
}
] |
瞳孔扩大伴对光反应消失提示脑功能损害严重。 | [
{
"id": 0,
"entity": "瞳孔",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "瞳孔扩大伴对光反应消失",
"start_offset": 0,
"end_offset": 11,
"label": "sym"
},
{
"id": 2,
"entity": "脑功能损害",
"start_offset": 13,
"end_offset": 18,
"label": "dis"
},
{
"id": 3,
"entity": "脑功能损害严重",
"start_offset": 13,
"end_offset": 20,
"label": "sym"
}
] |
（六）其他有些毒物能抑制骨髓造血功能，破坏红细胞，引起贫血、溶血等。 | [
{
"id": 0,
"entity": "骨髓",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "红细胞",
"start_offset": 21,
"end_offset": 24,
"label": "bod"
},
{
"id": 2,
"entity": "贫血",
"start_offset": 27,
"end_offset": 29,
"label": "sym"
},
{
"id": 3,
"entity": "溶血",
"start_offset": 30,
"end_offset": 32,
"label": "sym"
}
] |
应激、休克和缺氧还可诱发DIC，引起皮肤、消化道等部位广泛出血。 | [
{
"id": 0,
"entity": "应激",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "休克",
"start_offset": 3,
"end_offset": 5,
"label": "sym"
},
{
"id": 2,
"entity": "DIC",
"start_offset": 12,
"end_offset": 15,
"label": "dis"
},
{
"id": 3,
"entity": "皮肤",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
},
{
"id": 4,
"entity": "消化道",
"start_offset": 21,
"end_offset": 24,
"label": "bod"
},
{
"id": 5,
"entity": "皮肤、消化道等部位广泛出血",
"start_offset": 18,
"end_offset": 31,
"label": "sym"
}
] |
细胞呼吸抑制剂可引起细胞能量代谢障碍而死亡（如氰化物）。 | [
{
"id": 0,
"entity": "细胞能量代谢障碍",
"start_offset": 10,
"end_offset": 18,
"label": "sym"
}
] |
临床医师可以根据中毒患者的面容、呼出气味、症状、其他体征、排泄物的性状等，结合病史，综合分析，得出初步诊断；此外，还可根据所在地域流行病学发病率较高的中毒毒物进行筛选和鉴别。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 8,
"end_offset": 10,
"label": "dis"
}
] |
各种毒物引起的急性中毒常具有各自的特征，这些特征是中毒诊断的重要线索和依据。 | [
{
"id": 0,
"entity": "急性中毒",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
}
] |
采集标本应及早进行，包括原毒物样品、胃液或呕吐物、血液、尿液等。 | [
{
"id": 0,
"entity": "胃液",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
},
{
"id": 1,
"entity": "血液",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
},
{
"id": 2,
"entity": "尿液",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
}
] |
毒物确定后，还必须了解毒物服用剂量、发病时间和脏器受累表现以及就诊前处理等，以便确定相应的处理方案。 | [
{
"id": 0,
"entity": "脏器",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 1,
"entity": "脏器受累",
"start_offset": 23,
"end_offset": 27,
"label": "sym"
}
] |
对于这些患儿，应常规监测肝、肾等各脏器功能，为病情判断和支持处理提供依据。 | [
{
"id": 0,
"entity": "肝",
"start_offset": 12,
"end_offset": 13,
"label": "bod"
},
{
"id": 1,
"entity": "肾",
"start_offset": 14,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "脏器",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
}
] |
【治疗】（一）对于存在呼吸、心搏骤停、休克、惊厥的患儿应首先现场进行抢救，保持良好的氧供和循环，严密监护并维持生命体征稳定，纠正内环境紊乱。 | [
{
"id": 0,
"entity": "呼吸、心搏骤停",
"start_offset": 11,
"end_offset": 18,
"label": "sym"
},
{
"id": 1,
"entity": "休克",
"start_offset": 19,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "惊厥",
"start_offset": 22,
"end_offset": 24,
"label": "sym"
}
] |
对存在呼吸衰竭者应及早给予呼吸支持。 | [
{
"id": 0,
"entity": "呼吸衰竭",
"start_offset": 3,
"end_offset": 7,
"label": "sym"
},
{
"id": 1,
"entity": "呼吸支持",
"start_offset": 13,
"end_offset": 17,
"label": "pro"
}
] |
血压不稳者给予多巴胺5～10μg/（kg•min）静脉维持。 | [
{
"id": 0,
"entity": "血压",
"start_offset": 0,
"end_offset": 2,
"label": "ite"
},
{
"id": 1,
"entity": "血压不稳",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 2,
"entity": "多巴胺",
"start_offset": 7,
"end_offset": 10,
"label": "dru"
},
{
"id": 3,
"entity": "静脉维持",
"start_offset": 25,
"end_offset": 29,
"label": "pro"
}
] |
（二）清除毒物1.清除尚未吸收的毒物其目的为防止已与体表、体腔接触，但尚未进入体内的毒物，以最大限度降低毒物进入体内的量和减轻病情。 | [
{
"id": 0,
"entity": "体表",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 1,
"entity": "体腔",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
}
] |
洗胃一般于食入毒物后4～6小时内进行，操作时动作要轻巧迅速，危重患者取平卧位，头偏向一侧，胃内容物要尽量抽净，反复灌洗，直至洗出胃液清晰为止。 | [
{
"id": 0,
"entity": "胃",
"start_offset": 45,
"end_offset": 46,
"label": "bod"
},
{
"id": 1,
"entity": "胃液",
"start_offset": 64,
"end_offset": 66,
"label": "bod"
}
] |
洗胃过程中应注意观察患者的反应和呕吐情况，防止胃内容物反流入肺内引起窒息。 | [
{
"id": 0,
"entity": "洗胃",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "呕吐",
"start_offset": 16,
"end_offset": 18,
"label": "sym"
},
{
"id": 2,
"entity": "胃",
"start_offset": 23,
"end_offset": 24,
"label": "bod"
},
{
"id": 3,
"entity": "肺",
"start_offset": 30,
"end_offset": 31,
"label": "bod"
},
{
"id": 4,
"entity": "窒息",
"start_offset": 34,
"end_offset": 36,
"label": "sym"
}
] |
洗胃后可随即给患者50%硫酸镁0.5ml/kg导泻，加速毒物从肠道排出，或胃内注入活性炭0.5～1g/kg吸附毒物。 | [
{
"id": 0,
"entity": "洗胃",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "硫酸镁",
"start_offset": 12,
"end_offset": 15,
"label": "dru"
},
{
"id": 2,
"entity": "导泻",
"start_offset": 23,
"end_offset": 25,
"label": "pro"
},
{
"id": 3,
"entity": "胃",
"start_offset": 37,
"end_offset": 38,
"label": "bod"
},
{
"id": 4,
"entity": "注入活性炭",
"start_offset": 39,
"end_offset": 44,
"label": "pro"
}
] |
对强酸、强碱中毒或惊厥者不宜用洗胃、催吐及导泻法，以免发生消化道穿孔。 | [
{
"id": 0,
"entity": "中毒",
"start_offset": 6,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "洗胃",
"start_offset": 15,
"end_offset": 17,
"label": "pro"
},
{
"id": 2,
"entity": "催吐",
"start_offset": 18,
"end_offset": 20,
"label": "pro"
},
{
"id": 3,
"entity": "导泻法",
"start_offset": 21,
"end_offset": 24,
"label": "pro"
},
{
"id": 4,
"entity": "消化道穿孔",
"start_offset": 29,
"end_offset": 34,
"label": "sym"
}
] |
近来国外文献报道胃肠道脱毒并不能显著改变患者的症状、病程和预后。 | [
{
"id": 0,
"entity": "胃肠道",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
}
] |
许多学者不主张采用催吐法治疗小儿急性中毒。 | [
{
"id": 0,
"entity": "催吐法",
"start_offset": 9,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "小儿急性中毒",
"start_offset": 14,
"end_offset": 20,
"label": "dis"
}
] |
但也有人认为食入毒物一小时内洗胃才有效。 | [
{
"id": 0,
"entity": "洗胃",
"start_offset": 14,
"end_offset": 16,
"label": "pro"
}
] |
如遇皮肤接触毒物者（如有机磷农药中毒）应立即脱去全部衣裤，以微温清水冲洗全身，并注意五官、毛发、指甲部位的清洗，一般洗5～15分钟左右。 | [
{
"id": 0,
"entity": "皮肤",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "中毒",
"start_offset": 16,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "五官",
"start_offset": 42,
"end_offset": 44,
"label": "bod"
},
{
"id": 3,
"entity": "毛发",
"start_offset": 45,
"end_offset": 47,
"label": "bod"
},
{
"id": 4,
"entity": "指甲",
"start_offset": 48,
"end_offset": 50,
"label": "bod"
}
] |
对体表不溶于水的毒物，可用适当溶剂，例如用10%乙醇或植物油冲洗酚类毒物，也可用适当的解毒剂加入水中冲洗。 | [
{
"id": 0,
"entity": "解毒剂",
"start_offset": 43,
"end_offset": 46,
"label": "dru"
}
] |
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