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1.可逆性细胞损伤细胞所需能量主要由线粒体生成的ATP供给。 | [
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缺氧首先是细胞有氧代谢即线粒体内氧化磷酸化发生障碍，使ATP产生减少甚至停止。 | [
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由于能源缺乏，加之缺氧，导致细胞代谢及功能异常：①葡萄糖无氧酵解增强：无氧酵解使葡萄糖和糖原消耗增加，易出现低血糖；同时也使乳酸增多，引起代谢性酸中毒。 | [
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②细胞水肿：由于ATP缺乏，钠泵主动转运障碍，使钠、水潴留。 | [
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③钙离子内流增加：由于钙泵主动转运的障碍，使钙向细胞内流动增多。 | [
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④核蛋白脱落：由于核蛋白从粗面内质网脱落，使蛋白和酶等物质的合成减少。 | [
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本阶段如能恢复血流灌注和供氧，上述变化可恢复，一般不留后遗症。 | [
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2.不可逆性细胞损伤若窒息持续存在或严重缺氧，将导致不可逆性细胞损伤：①严重的线粒体形态和功能异常：不能进行氧化磷酸化、ATP产生障碍，线粒体产能过程中断；②细胞膜严重损伤：丧失其屏障和转运功能；③溶酶体破裂：由于溶酶体膜损伤，溶酶体酶扩散到细胞质中，消化细胞内各种成分（自溶）。 | [
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此阶段即使恢复血流灌注和供氧，上述变化亦不可完全恢复。 | [
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3.血流再灌注损伤复苏后，由于血流再灌注可导致细胞内钙超载和氧自由基增加，从而引起细胞的进一步损伤。 | [
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（二）窒息发展过程1.原发性呼吸暂停（primaryapnea）当胎儿或新生儿发生低氧血症、高碳酸血症和代谢性酸中毒时，由于儿茶酚胺分泌增加，呼吸和心率增快，机体血流重新分布即选择性血管收缩，使次要的组织和器官（如肺、肠、肾、肌肉、皮肤等）血流量减少，而主要的生命器官（如脑、心肌、肾上腺）的血流量增多，血压增高，心输出量增加。 | [
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如低氧血症和酸中毒持续存在则出现呼吸停止，称为原发性呼吸暂停。 | [
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此时肌张力存在，血压仍高，循环尚好，但发绀加重，伴有心率减慢。 | [
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在此阶段若病因解除，经过清理呼吸道和物理刺激即可恢复自主呼吸。 | [
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2.继发性呼吸暂停（secondaryapnea）若病因未解除，低氧血症持续存在，肺、肠、肾、肌肉和皮肤等血流量严重减少，脑、心肌和肾上腺的血流量也减少，可导致机体各器官功能和形态损伤，如脑和心肌损伤、休克、应激性溃疡等。 | [
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在原发性呼吸暂停后出现几次喘息样呼吸，继而出现呼吸停止，即所谓的继发性呼吸暂停。 | [
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此时肌张力消失，苍白，心率和血压持续下降，出现心力衰竭及休克等。 | [
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此阶段对清理呼吸道和物理刺激无反应，需正压通气方可恢复自主呼吸。 | [
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否则将死亡，存活者可留有后遗症。 | [
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窒息是从原发性呼吸暂停到继发性呼吸暂停的发展过程，但两种呼吸暂停的表现均为无呼吸和心率低于100次/分，故临床上难以鉴别，为了不延误抢救时机，对生后无呼吸者都应按继发性呼吸暂停进行处理。 | [
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（三）窒息后血液生化和代谢改变在窒息应激状态时，儿茶酚胺及胰高血糖素释放增加，使早期血糖正常或增高；当缺氧持续，动用糖增加、糖原贮存空虚，出现低血糖症。 | [
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此外，酸中毒抑制胆红素与清蛋白结合，降低肝内酶的活力而致高间接胆红素血症；由于左心房心钠素分泌增加，造成低钠血症等。 | [
{
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"entity": "酸中毒",
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{
"id": 1,
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"start_offset": 20,
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{
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【临床表现】（一）胎儿缺氧表现先出现胎动增加、胎心增快，胎心率≥160次/分；晚期则胎动减少（＜20次/12小时），甚至消失，胎心减慢，胎心率＜100次/分，严重时甚至心脏停搏；窒息可导致肛门括约肌松弛，排出胎便，使羊水呈黄绿色。 | [
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"id": 0,
"entity": "胎儿缺氧表现",
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{
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"id": 6,
"entity": "胎心率",
"start_offset": 68,
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"label": "ite"
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{
"id": 7,
"entity": "心脏",
"start_offset": 84,
"end_offset": 86,
"label": "bod"
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{
"id": 8,
"entity": "心脏停搏",
"start_offset": 84,
"end_offset": 88,
"label": "sym"
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{
"id": 9,
"entity": "窒息",
"start_offset": 89,
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"label": "dis"
},
{
"id": 10,
"entity": "肛门括约肌",
"start_offset": 94,
"end_offset": 99,
"label": "bod"
},
{
"id": 11,
"entity": "肛门括约肌松弛",
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{
"id": 12,
"entity": "羊水呈黄绿色",
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"end_offset": 114,
"label": "sym"
}
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（二）窒息判定Apgar评分是临床评价出生窒息的经典而简易的方法。 | [
{
"id": 0,
"entity": "窒",
"start_offset": 3,
"end_offset": 4,
"label": "dis"
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{
"id": 1,
"entity": "窒",
"start_offset": 3,
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"label": "pro"
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{
"id": 2,
"entity": "评",
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"label": "dis"
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{
"id": 3,
"entity": "评",
"start_offset": 17,
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] |
1分钟评分与动脉血pH相关，但不完全一致，如母亲分娩时用麻醉药或止痛药使新生儿生后呼吸抑制，Apgar评分虽低，但无宫内缺氧，血气改变相对较轻。 | [
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"id": 0,
"entity": "麻醉药",
"start_offset": 28,
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"label": "dru"
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{
"id": 1,
"entity": "止痛药",
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"label": "dru"
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{
"id": 2,
"entity": "呼吸抑制",
"start_offset": 41,
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{
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"entity": "宫内缺氧",
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"label": "sym"
},
{
"id": 4,
"entity": "血气",
"start_offset": 63,
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"label": "ite"
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] |
2.Apgar评分内容包括皮肤颜色（appearance）、心率（pulse）、对刺激的反应（grimace）、肌张力（activity）和呼吸（respiration）。 | [
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{
"id": 1,
"entity": "pulse",
"start_offset": 33,
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"label": "ite"
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1分钟Apgar评分8～10为正常，4～7分应密切注意窒息的可能性，0～3分为窒息。 | [
{
"id": 0,
"entity": "窒息",
"start_offset": 39,
"end_offset": 41,
"label": "dis"
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4.评估的意义1分钟评分反映窒息严重程度；5分钟及10分钟评分除反映窒息的严重程度外，还可反映复苏抢救的效果。 | [
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"entity": "窒息",
"start_offset": 14,
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"label": "dis"
},
{
"id": 1,
"entity": "窒息",
"start_offset": 34,
"end_offset": 36,
"label": "dis"
}
] |
5.注意事项应客观、快速及准确地进行评估；胎龄小的早产儿成熟度低，虽无窒息，但评分较低；单凭Apgar评分不应作为评估低氧或产时窒息以及神经系统预后的唯一指标。 | [
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"entity": "窒息",
"start_offset": 35,
"end_offset": 37,
"label": "dis"
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{
"id": 1,
"entity": "窒息",
"start_offset": 64,
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"label": "dis"
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{
"id": 2,
"entity": "神经系统",
"start_offset": 68,
"end_offset": 72,
"label": "bod"
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] |
（三）并发症由于窒息不同，发生器官损害的种类及严重程度各异。 | [
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"entity": "窒",
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{
"id": 1,
"entity": "窒",
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【辅助检查】对宫内缺氧胎儿，可通过羊膜镜了解胎粪污染羊水的程度，或在胎头露出宫口时取胎儿头皮血进行血气分析，以估计宫内缺氧程度；生后应检测动脉血气、血糖、电解质、血尿素氮和肌酐等生化指标。 | [
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"start_offset": 44,
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"entity": "缺氧",
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"id": 4,
"entity": "动脉血气",
"start_offset": 69,
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{
"id": 5,
"entity": "血糖",
"start_offset": 74,
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"entity": "电解质",
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"entity": "血尿素氮",
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"label": "ite"
},
{
"id": 8,
"entity": "肌酐",
"start_offset": 86,
"end_offset": 88,
"label": "ite"
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] |
【诊断】目前，我国新生儿窒息的诊断及程度判定仍依赖单独Apgar评分，但由于Apgar评分受多种因素的影响，单凭Apgar评分并不能准确诊断窒息及预测神经发育结局。 | [
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因此，1996年，美国儿科学会（AAP）和妇产科学会（ACOG）将围生期窒息定义为：①严重的代谢性酸中毒（pH＜7）；②5分钟后Apgar评分仍≤3分；③有新生儿脑病表现；④伴有多器官功能障碍。 | [
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"entity": "儿科",
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"id": 1,
"entity": "围生期窒息",
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"entity": "新生儿脑病",
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【治疗与预防】复苏（resuscitation）必须分秒必争，由儿科医生和助产士（师）合作进行。 | [
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（一）复苏方案采用国际公认的ABCDE复苏方案：①A（airway）：清理呼吸道；②B（breathing）：建立呼吸；③C（circulation）：恢复循环；④D（drugs）：药物治疗；⑤E（evaluationandenvironment）：评估和环境（保温）。 | [
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"id": 4,
"entity": "评估和环境（保温）",
"start_offset": 125,
"end_offset": 134,
"label": "pro"
}
] |
其中评估和保温（E）贯穿于整个复苏过程中。 | [
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执行ABCD每一步骤的前后，应对评价指标即呼吸、心率（计数6秒钟心率然后乘10）和皮肤颜色进行评估。 | [
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"id": 0,
"entity": "呼吸",
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{
"id": 1,
"entity": "心率",
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"label": "ite"
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{
"id": 2,
"entity": "心率",
"start_offset": 32,
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] |
复苏初期建议用纯氧（目前证据尚不足以证明空气复苏的有效性），以后通过监测动脉血气值或经皮血氧饱和度，逐步调整吸入气的氧浓度。 | [
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"entity": "纯氧",
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{
"id": 1,
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随着复苏理论和实践的进步，已证实一些复苏方法存在很多弊端，临床复苏时应予注意：①气道未清理干净前（尤其是胎粪污染儿），切忌刺激新生儿使其大哭，以免将气道内吸入物进一步吸入肺内。 | [
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"entity": "肺",
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"end_offset": 86,
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] |
清理呼吸道和触觉刺激后30秒钟仍无自主呼吸，应视为继发性呼吸暂停，即刻改用正压通气。 | [
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"id": 0,
"entity": "呼吸道",
"start_offset": 2,
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"label": "bod"
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{
"id": 1,
"entity": "继发性呼吸暂停",
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{
"id": 2,
"entity": "正压通气",
"start_offset": 37,
"end_offset": 41,
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] |
②复苏过程中禁用呼吸兴奋剂。 | [
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"entity": "呼吸兴奋剂",
"start_offset": 8,
"end_offset": 13,
"label": "dru"
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] |
③复苏过程中禁用高张葡萄糖，因为应激时血糖已升高，给予高张葡萄糖可增加颅内出血发生的机会，同时糖的无氧酵解增加，加重代谢性酸中毒。 | [
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"id": 0,
"entity": "高张葡萄糖",
"start_offset": 8,
"end_offset": 13,
"label": "dru"
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{
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{
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{
"id": 4,
"entity": "代谢性酸中毒",
"start_offset": 58,
"end_offset": 64,
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] |
用温热毛巾揩干头部及全身，以减少散热；摆好体位，肩部以布卷垫高2～3cm，使颈部轻微伸仰，然后进行复苏。 | [
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1.清理呼吸道（A）新生儿娩出后，应立即吸净口和鼻腔的黏液，因鼻腔较敏感，受刺激后易触发呼吸，故应先吸口腔，后吸鼻腔（图5-5）；如羊水混有胎粪，无论胎粪是稠是稀，胎儿一经娩出后，立刻进行有无活力评估，有活力的新生儿继续初步复苏，无活力者应立即气管插管，吸净气道内的胎粪，然后再建立呼吸（有活力的定义是呼吸规则、肌张力好及心率＞100次/分，以上三项中有一项不好即为无活力）。 | [
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{
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"entity": "心率",
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2.建立呼吸（B）包括触觉刺激和正压通气：①触觉刺激：清理呼吸道后拍打或弹足底1～2次或沿长轴快速摩擦腰背皮肤1～2次（图5-5、5-5）（切忌不要超过2次或粗暴拍打），如出现正常呼吸，心率＞100次/分，肤色红润可继续观察。 | [
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"entity": "建立呼吸",
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②正压通气：触觉刺激后仍呼吸暂停或抽泣样呼吸，或心率＜100次/分，或持续的中心性发绀，需用面罩正压通气（图5-4）。 | [
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"entity": "正压通气",
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"id": 2,
"entity": "持续的中心性发绀",
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通气频率40～60次/分，吸呼比1∶2，压力20～40cmH2</sub>O，即可见胸廓扩张和听诊呼吸音正常为宜。 | [
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气囊面罩正压通气30秒后，如自主呼吸不充分或心率＜100次/分，需继续气囊面罩或气管插管正压通气。 | [
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"entity": "气囊面罩",
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"id": 1,
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{
"id": 3,
"entity": "气囊面罩",
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图5-1吸引先口腔后鼻腔图5-2拍打足底及弹足底图5-3摩擦后背图5-4面罩正压通气3.恢复循环（C）即胸外心脏按压。 | [
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"entity": "摩擦后背",
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{
"id": 3,
"entity": "面罩",
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{
"id": 6,
"entity": "胸外心脏按压",
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}
] |
如气管插管正压通气30秒后，心率＜60次/分或心率在60～80次/分不再增加，应在继续正压通气的同时，进行胸外心脏按压。 | [
{
"id": 0,
"entity": "正压通气",
"start_offset": 5,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
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"end_offset": 16,
"label": "ite"
},
{
"id": 2,
"entity": "心率",
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"end_offset": 25,
"label": "ite"
},
{
"id": 3,
"entity": "正压通气",
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"end_offset": 47,
"label": "pro"
},
{
"id": 4,
"entity": "胸外心脏按压",
"start_offset": 53,
"end_offset": 59,
"label": "pro"
}
] |
方法是：采用双拇指或中食指按压胸骨体下1/3处，频率为90次/分，胸外按压和正压通气的比例为3∶1（每按压3次，正压通气1次），按压深度为胸廓前后径的1/3（图5-5）。 | [
{
"id": 0,
"entity": "双拇指",
"start_offset": 6,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "中食指",
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"label": "bod"
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{
"id": 2,
"entity": "胸骨",
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"label": "bod"
},
{
"id": 3,
"entity": "胸外按压",
"start_offset": 33,
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"label": "pro"
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{
"id": 4,
"entity": "正压通气",
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"label": "pro"
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{
"id": 5,
"entity": "正压通气",
"start_offset": 56,
"end_offset": 60,
"label": "pro"
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] |
按压或抬起过程中，双拇指或中食指指端不能离开胸骨按压部位，也不宜用力过大以免损伤。 | [
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"label": "bod"
},
{
"id": 1,
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"label": "bod"
},
{
"id": 2,
"entity": "胸骨",
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"end_offset": 24,
"label": "bod"
}
] |
4.药物治疗（D）目的是改善心脏功能、增加组织灌流和恢复酸碱平衡。 | [
{
"id": 0,
"entity": "心脏",
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"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "组织",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
}
] |
（1）肾上腺素：①作用：可直接兴奋心肌起搏组织和传导系统的β受体，使心率加快，心输出量增加，同时兴奋血管α受体，使血管收缩，血压增高；②指征：心率为0或胸外心脏按压30秒后，心率仍持续＜60次/分；③方法：给予1∶10000肾上腺素，0.1～0.3ml/kg静脉注入，或0.3～1ml/kg气管内注入，3～5分钟重复一次；④疗效评价：给药30秒后，有效者心率≥100次/分；无效者应考虑是否存在代谢性酸中毒和有效血容量减少等。 | [
{
"id": 0,
"entity": "肾上腺素",
"start_offset": 3,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "心率",
"start_offset": 34,
"end_offset": 36,
"label": "ite"
},
{
"id": 2,
"entity": "血压增高",
"start_offset": 62,
"end_offset": 66,
"label": "sym"
},
{
"id": 3,
"entity": "心率",
"start_offset": 71,
"end_offset": 73,
"label": "ite"
},
{
"id": 4,
"entity": "胸外心脏按压",
"start_offset": 76,
"end_offset": 82,
"label": "pro"
},
{
"id": 5,
"entity": "心率",
"start_offset": 87,
"end_offset": 89,
"label": "ite"
},
{
"id": 6,
"entity": "肾上腺素",
"start_offset": 112,
"end_offset": 116,
"label": "dru"
},
{
"id": 7,
"entity": "静脉注入",
"start_offset": 129,
"end_offset": 133,
"label": "pro"
},
{
"id": 8,
"entity": "心率",
"start_offset": 177,
"end_offset": 179,
"label": "ite"
},
{
"id": 9,
"entity": "代谢性酸中毒",
"start_offset": 197,
"end_offset": 203,
"label": "dis"
}
] |
（2）扩容剂：①作用：增加血容量，改善循环。 | [
{
"id": 0,
"entity": "扩容剂",
"start_offset": 3,
"end_offset": 6,
"label": "dru"
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] |
②指征：有急性失血的病史，疑似失血或休克（伴有血容量减少表现）。 | [
{
"id": 0,
"entity": "失血",
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"end_offset": 17,
"label": "sym"
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{
"id": 1,
"entity": "休克",
"start_offset": 18,
"end_offset": 20,
"label": "sym"
},
{
"id": 2,
"entity": "血容量减少",
"start_offset": 23,
"end_offset": 28,
"label": "sym"
}
] |
③方法：可给予等渗透晶体液，如生理盐水，对大量失血者可选择红细胞悬液。 | [
{
"id": 0,
"entity": "生理盐水",
"start_offset": 15,
"end_offset": 19,
"label": "dru"
},
{
"id": 1,
"entity": "红细胞悬液",
"start_offset": 29,
"end_offset": 34,
"label": "dru"
}
] |
④疗效：有效者脉搏有力、血压上升、皮肤转红及代谢性酸中毒减轻。 | [
{
"id": 0,
"entity": "脉搏",
"start_offset": 7,
"end_offset": 9,
"label": "ite"
},
{
"id": 1,
"entity": "血压",
"start_offset": 12,
"end_offset": 14,
"label": "ite"
},
{
"id": 2,
"entity": "代谢性酸中毒",
"start_offset": 22,
"end_offset": 28,
"label": "dis"
}
] |
（3）纳洛酮（naloxone）：①作用：是半合成吗啡拮抗剂，阻断吗啡样物质与其受体结合，从而拮抗所有吗啡类镇痛药的呼吸抑制、缩瞳、胆总管痉挛及致幻作用，并降低镇痛效应。 | [
{
"id": 0,
"entity": "纳洛酮",
"start_offset": 3,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "半合成吗啡拮抗剂",
"start_offset": 22,
"end_offset": 30,
"label": "dru"
},
{
"id": 2,
"entity": "吗啡类镇痛药",
"start_offset": 51,
"end_offset": 57,
"label": "dru"
},
{
"id": 3,
"entity": "呼吸抑制",
"start_offset": 58,
"end_offset": 62,
"label": "sym"
},
{
"id": 4,
"entity": "缩瞳",
"start_offset": 63,
"end_offset": 65,
"label": "sym"
},
{
"id": 5,
"entity": "胆总管痉挛",
"start_offset": 66,
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"label": "sym"
},
{
"id": 6,
"entity": "致幻",
"start_offset": 72,
"end_offset": 74,
"label": "sym"
}
] |
②指征：生后有呼吸抑制表现，其母亲产前4小时内用过吗啡类麻醉镇痛药者。 | [
{
"id": 0,
"entity": "吗啡类麻醉镇痛药",
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"end_offset": 33,
"label": "dru"
}
] |
③方法：应给予纳洛酮，每次0.1mg/kg，静脉或肌肉注射或气管内注入，均应快速输入。 | [
{
"id": 0,
"entity": "纳洛酮",
"start_offset": 7,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "静脉或肌肉注射",
"start_offset": 22,
"end_offset": 29,
"label": "pro"
}
] |
但应注意，纳洛酮不选择作为产房有呼吸抑制新生儿开始复苏的措施，应在保证通气情况下，使用该药物。 | [
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"id": 0,
"entity": "纳洛酮",
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"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "呼吸抑制",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
}
] |
图5-5胸外心脏按压（三）复苏后的监护与转运复苏后需监测肤色、体温、呼吸、心率、血压、尿量、血气、血糖和电解质等。 | [
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"id": 0,
"entity": "胸外心脏按压",
"start_offset": 4,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "体温",
"start_offset": 31,
"end_offset": 33,
"label": "ite"
},
{
"id": 2,
"entity": "呼吸",
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"end_offset": 36,
"label": "ite"
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{
"id": 3,
"entity": "心率",
"start_offset": 37,
"end_offset": 39,
"label": "ite"
},
{
"id": 4,
"entity": "血压",
"start_offset": 40,
"end_offset": 42,
"label": "ite"
},
{
"id": 5,
"entity": "尿量",
"start_offset": 43,
"end_offset": 45,
"label": "ite"
},
{
"id": 6,
"entity": "血气",
"start_offset": 46,
"end_offset": 48,
"label": "ite"
},
{
"id": 7,
"entity": "血糖",
"start_offset": 49,
"end_offset": 51,
"label": "ite"
},
{
"id": 8,
"entity": "电解质",
"start_offset": 52,
"end_offset": 55,
"label": "ite"
}
] |
如并发症严重，需转运到NICU治疗，转运中需注意保温、监护生命指标和予以必要的治疗。 | [
{
"id": 0,
"entity": "NICU",
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"label": "dep"
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] |
【预防】①加强围生期保健，及时处理高危妊娠；②加强胎儿监护，避免和及时纠正宫内缺氧；③密切监测临产孕妇，避免难产；④培训接产人员熟练掌握复苏技术；⑤医院产房内需配备复苏设备，高危妊娠分娩时必须有掌握复苏技术的人员在场。 | [
{
"id": 0,
"entity": "复苏设备",
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"label": "equ"
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] |
第三节呼吸的控制和肺部气体交换多种原因要求理解和掌握小儿呼吸控制系统的原理。 | [
{
"id": 0,
"entity": "肺部",
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"label": "bod"
}
] |
在小儿出生后的呼吸适应涉及肺、心脏和中枢神经系统功能和结构上的调节；临床生理和病理生理变化使呼吸控制问题居于首位，比如气道阻塞、重症哮喘、心力衰竭、通气不足、低氧血症等；神经系统在调节呼吸上的重要作用显得尤为重要，比如新生儿缺氧缺血性脑损害、超低出生体重新生儿脑发育和呼吸暂停、小儿颅内感染和损伤等。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 13,
"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "心脏",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "中枢神经系统",
"start_offset": 18,
"end_offset": 24,
"label": "bod"
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{
"id": 3,
"entity": "气道阻塞",
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"label": "sym"
},
{
"id": 4,
"entity": "哮喘",
"start_offset": 66,
"end_offset": 68,
"label": "dis"
},
{
"id": 5,
"entity": "心力衰竭",
"start_offset": 69,
"end_offset": 73,
"label": "dis"
},
{
"id": 6,
"entity": "通气不足",
"start_offset": 74,
"end_offset": 78,
"label": "sym"
},
{
"id": 7,
"entity": "低氧血症",
"start_offset": 79,
"end_offset": 83,
"label": "dis"
},
{
"id": 8,
"entity": "神经系统",
"start_offset": 85,
"end_offset": 89,
"label": "bod"
},
{
"id": 9,
"entity": "新生儿缺氧缺血性脑损害",
"start_offset": 109,
"end_offset": 120,
"label": "dis"
},
{
"id": 10,
"entity": "出生体重",
"start_offset": 123,
"end_offset": 127,
"label": "ite"
},
{
"id": 11,
"entity": "脑",
"start_offset": 130,
"end_offset": 131,
"label": "bod"
},
{
"id": 12,
"entity": "超低出生体重新生儿脑发育和呼吸暂停",
"start_offset": 121,
"end_offset": 138,
"label": "sym"
},
{
"id": 13,
"entity": "小儿颅内感染和损伤",
"start_offset": 139,
"end_offset": 148,
"label": "sym"
}
] |
（一）呼吸中枢呼吸中枢为中枢神经系统内产生和调节呼吸运动的神经细胞群。 | [
{
"id": 0,
"entity": "呼吸中枢",
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"label": "bod"
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{
"id": 1,
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{
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"entity": "中枢神经系统",
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{
"id": 3,
"entity": "神经细胞群",
"start_offset": 29,
"end_offset": 34,
"label": "bod"
}
] |
呼吸的节律性来自呼吸中枢的节律性活动，由产生和调节呼吸运动的神经细胞群组成。 | [
{
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"entity": "呼吸中枢",
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"label": "bod"
},
{
"id": 1,
"entity": "神经细胞群",
"start_offset": 30,
"end_offset": 35,
"label": "bod"
}
] |
这些细胞群广泛分布在大脑皮层、间脑、脑桥、延髓和脊髓部位，并在产生和调节呼吸运动时发挥不同的作用，并彼此协调和制约，对于传入的冲动加以整合。 | [
{
"id": 0,
"entity": "大脑皮层",
"start_offset": 10,
"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "间脑",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "脑桥",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
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{
"id": 3,
"entity": "延髓",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 4,
"entity": "脊髓",
"start_offset": 24,
"end_offset": 26,
"label": "bod"
}
] |
1.脊髓脊髓中支配呼吸肌的运动神经元位于颈3～5（支配膈肌）和胸段（支配肋间肌和腹肌）前角。 | [
{
"id": 0,
"entity": "脊髓",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "脊髓中",
"start_offset": 4,
"end_offset": 7,
"label": "bod"
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{
"id": 2,
"entity": "呼吸肌",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 3,
"entity": "运动神经元",
"start_offset": 13,
"end_offset": 18,
"label": "bod"
},
{
"id": 4,
"entity": "颈",
"start_offset": 20,
"end_offset": 21,
"label": "bod"
},
{
"id": 5,
"entity": "膈肌",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
},
{
"id": 6,
"entity": "胸",
"start_offset": 31,
"end_offset": 32,
"label": "bod"
},
{
"id": 7,
"entity": "肋间肌",
"start_offset": 36,
"end_offset": 39,
"label": "bod"
},
{
"id": 8,
"entity": "腹肌",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
}
] |
脊髓不产生节律性呼吸，主要为联系高位脑和呼吸肌的中继站，但也作为整合某些呼吸反射的初级中枢。 | [
{
"id": 0,
"entity": "脊髓",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "高位脑",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "呼吸肌",
"start_offset": 20,
"end_offset": 23,
"label": "bod"
}
] |
2.低位脑干脑桥和延髓组成低位脑干，是产生呼吸节律的部位。 | [
{
"id": 0,
"entity": "低位脑干",
"start_offset": 2,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "脑桥",
"start_offset": 6,
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"label": "bod"
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{
"id": 2,
"entity": "延髓",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 3,
"entity": "低位脑干",
"start_offset": 13,
"end_offset": 17,
"label": "bod"
}
] |
脑桥上部为抑制呼吸的结构，脑桥中下部有长吸气中枢，为呼吸调整中枢。 | [
{
"id": 0,
"entity": "脑桥",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "脑桥",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "长吸气中枢",
"start_offset": 19,
"end_offset": 24,
"label": "bod"
}
] |
延髓中有呼吸神经元，包括吸气神经元、呼气神经元、吸气-呼气神经元、呼气-吸气神经元。 | [
{
"id": 0,
"entity": "延髓",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "呼吸神经元",
"start_offset": 4,
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"label": "bod"
},
{
"id": 2,
"entity": "吸气神经元",
"start_offset": 12,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "呼气神经元",
"start_offset": 18,
"end_offset": 23,
"label": "bod"
},
{
"id": 4,
"entity": "吸气-呼气神经元",
"start_offset": 24,
"end_offset": 32,
"label": "bod"
},
{
"id": 5,
"entity": "呼气-吸气神经元",
"start_offset": 33,
"end_offset": 41,
"label": "bod"
}
] |
这些神经元在延髓中主要集中在背侧和腹侧，其轴突交叉到对侧并下行至脊髓颈段，支配膈神经运动神经元，或支配脊髓肋间呼吸内、外肌和腹肌的运动神经元。 | [
{
"id": 0,
"entity": "神经元",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "延髓",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
},
{
"id": 2,
"entity": "背侧",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "腹侧",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 4,
"entity": "脊髓颈段",
"start_offset": 32,
"end_offset": 36,
"label": "bod"
},
{
"id": 5,
"entity": "膈神经运动神经元",
"start_offset": 39,
"end_offset": 47,
"label": "bod"
},
{
"id": 6,
"entity": "脊髓",
"start_offset": 51,
"end_offset": 53,
"label": "bod"
},
{
"id": 7,
"entity": "肋间呼吸内、外肌",
"start_offset": 53,
"end_offset": 61,
"label": "bod"
},
{
"id": 8,
"entity": "腹肌",
"start_offset": 62,
"end_offset": 64,
"label": "bod"
},
{
"id": 9,
"entity": "运动神经元",
"start_offset": 65,
"end_offset": 70,
"label": "bod"
}
] |
但也可经同侧作为舌咽神经和迷走神经传出，支配咽喉部呼吸辅助肌。 | [
{
"id": 0,
"entity": "舌咽神经",
"start_offset": 8,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "迷走神经",
"start_offset": 13,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "咽喉部呼吸辅助肌",
"start_offset": 22,
"end_offset": 30,
"label": "bod"
}
] |
产生呼吸节律的神经结构较广泛，使呼吸节律发源于多部位，不易因局灶性损害而丧失呼吸节律。 | [
{
"id": 0,
"entity": "不易因局灶性损害而丧失呼吸节律",
"start_offset": 27,
"end_offset": 42,
"label": "sym"
}
] |
3.高位脑大脑皮层、边缘系统、下丘脑等作为高位脑，可以随意控制呼吸、屏气、加强加快呼吸，是随意呼吸调节系统，而低位脑干对呼吸调节系统是不随意的自主节律呼吸调节系统。 | [
{
"id": 0,
"entity": "高位脑",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "大脑皮层",
"start_offset": 5,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "边缘系统",
"start_offset": 10,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "下丘脑",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 4,
"entity": "高位脑",
"start_offset": 21,
"end_offset": 24,
"label": "bod"
},
{
"id": 5,
"entity": "呼吸调节系统",
"start_offset": 47,
"end_offset": 53,
"label": "bod"
},
{
"id": 6,
"entity": "低位脑干",
"start_offset": 55,
"end_offset": 59,
"label": "bod"
},
{
"id": 7,
"entity": "呼吸调节系统",
"start_offset": 60,
"end_offset": 66,
"label": "bod"
},
{
"id": 8,
"entity": "自主节律呼吸调节系统",
"start_offset": 71,
"end_offset": 81,
"label": "bod"
}
] |
新生儿和婴幼儿的自主呼吸节律自出生后一直处于发育中，不断通过呼吸肌运动和肺扩张运动，并经反射刺激呼吸中枢的发育、调节和整合功能，并在儿童早期基本完成随意呼吸运动及调节的发育成熟。 | [
{
"id": 0,
"entity": "呼吸肌",
"start_offset": 30,
"end_offset": 33,
"label": "bod"
},
{
"id": 1,
"entity": "肺",
"start_offset": 36,
"end_offset": 37,
"label": "bod"
},
{
"id": 2,
"entity": "呼吸中枢",
"start_offset": 48,
"end_offset": 52,
"label": "bod"
}
] |
此外，呼吸和吞咽的运动协调，呼吸对心血管功能的调节，呼吸和全身运动等，均随小儿生理发育而成熟。 | [
{
"id": 0,
"entity": "心血管",
"start_offset": 17,
"end_offset": 20,
"label": "bod"
}
] |
（二）中枢对呼吸的调节作用呼吸中枢通过反馈机制控制呼吸活动，以保持全身性氧和二氧化碳代谢平衡。 | [
{
"id": 0,
"entity": "中枢",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "呼吸中枢",
"start_offset": 13,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "氧和二氧化碳",
"start_offset": 36,
"end_offset": 42,
"label": "mic"
}
] |
其作用依靠中枢和外周化学感受器、外周牵张感受器。 | [
{
"id": 0,
"entity": "中枢",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "外周化学感受器",
"start_offset": 8,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "外周牵张感受器",
"start_offset": 16,
"end_offset": 23,
"label": "bod"
}
] |
呼吸肌与胸廓依靠中枢发放的冲动保持呼吸运动，但容易因过度疲劳而衰竭。 | [
{
"id": 0,
"entity": "呼吸肌",
"start_offset": 0,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "胸廓",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
}
] |
1.化学感受器位于颈动脉和主动脉的化学感受器对外周动脉血氧、二氧化碳分压和pH水平敏感，冲动经窦神经和迷走神经传入延髓。 | [
{
"id": 0,
"entity": "化学感受器",
"start_offset": 2,
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"label": "bod"
},
{
"id": 1,
"entity": "颈动脉",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "主动脉",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "化学感受器",
"start_offset": 17,
"end_offset": 22,
"label": "bod"
},
{
"id": 4,
"entity": "冲动经窦神经",
"start_offset": 44,
"end_offset": 50,
"label": "bod"
},
{
"id": 5,
"entity": "迷走神经",
"start_offset": 51,
"end_offset": 55,
"label": "bod"
},
{
"id": 6,
"entity": "延髓",
"start_offset": 57,
"end_offset": 59,
"label": "bod"
}
] |
低氧、二氧化碳增高、pH增高可以刺激呼吸加深加快，并主要经主动脉体带来血液循环变化。 | [
{
"id": 0,
"entity": "主动脉体",
"start_offset": 29,
"end_offset": 33,
"label": "bod"
},
{
"id": 1,
"entity": "血液",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
}
] |
延髓中枢化学感受器主要对二氧化碳变化敏感，而不感受氧水平的变化。 | [
{
"id": 0,
"entity": "延髓中枢化学感受器",
"start_offset": 0,
"end_offset": 9,
"label": "bod"
}
] |
血液中的二氧化碳能够迅速通过血脑屏障，导致延髓化学感受区周围液体中［H<sup>+</sup>］升高，引起中枢呼吸兴奋。 | [
{
"id": 0,
"entity": "血液",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "血脑屏障",
"start_offset": 14,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "延髓化学感受区",
"start_offset": 21,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "中枢呼吸兴奋",
"start_offset": 53,
"end_offset": 59,
"label": "sym"
}
] |
在一定范围内，二氧化碳水平升高可以刺激呼吸兴奋，超过一定范围，则表现为呼吸抑制。 | [
{
"id": 0,
"entity": "呼吸兴奋",
"start_offset": 19,
"end_offset": 23,
"label": "sym"
},
{
"id": 1,
"entity": "呼吸抑制",
"start_offset": 35,
"end_offset": 39,
"label": "sym"
}
] |
二氧化碳刺激呼吸兴奋的作用主要依靠中枢化学感受器（80%），其次为外周化学感受器（20%）。 | [
{
"id": 0,
"entity": "呼吸兴奋",
"start_offset": 6,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "中枢化学感受器",
"start_offset": 17,
"end_offset": 24,
"label": "bod"
},
{
"id": 2,
"entity": "外周化学感受器",
"start_offset": 33,
"end_offset": 40,
"label": "bod"
}
] |
低氧则主要通过外周化学感受器使呼吸兴奋，而对于中枢则是呼吸抑制。 | [
{
"id": 0,
"entity": "外周化学感受器",
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"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "呼吸兴奋",
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},
{
"id": 2,
"entity": "中枢",
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"label": "bod"
},
{
"id": 3,
"entity": "呼吸抑制",
"start_offset": 27,
"end_offset": 31,
"label": "sym"
}
] |
如果持续低氧，对外周化学感受器刺激的反射作用不能抵消对中枢化学感受器呼吸抑制的刺激，则出现呼吸抑制。 | [
{
"id": 0,
"entity": "外周化学感受器",
"start_offset": 8,
"end_offset": 15,
"label": "bod"
},
{
"id": 1,
"entity": "中枢化学感受器",
"start_offset": 27,
"end_offset": 34,
"label": "bod"
},
{
"id": 2,
"entity": "呼吸抑制",
"start_offset": 45,
"end_offset": 49,
"label": "sym"
}
] |
2.外周牵张感受器肺牵张反射又称为赫-布反射（Hering-Breuerreflex），为吸气相限制反射。 | [
{
"id": 0,
"entity": "外周牵张感受器",
"start_offset": 2,
"end_offset": 9,
"label": "bod"
}
] |
当肺扩张时，气道牵张作用于气管至细支气管平滑肌内的感受器，经迷走神经传入中枢延髓，可以出现抑制性吸气神经元冲动，避免肺过度扩张，也称为迷走反射。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 1,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "气道",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
},
{
"id": 2,
"entity": "气管",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 3,
"entity": "细支气管平滑肌",
"start_offset": 16,
"end_offset": 23,
"label": "bod"
},
{
"id": 4,
"entity": "感受器",
"start_offset": 25,
"end_offset": 28,
"label": "bod"
},
{
"id": 5,
"entity": "迷走神经",
"start_offset": 30,
"end_offset": 34,
"label": "bod"
},
{
"id": 6,
"entity": "中枢延髓",
"start_offset": 36,
"end_offset": 40,
"label": "bod"
},
{
"id": 7,
"entity": "吸气神经元",
"start_offset": 48,
"end_offset": 53,
"label": "bod"
},
{
"id": 8,
"entity": "肺",
"start_offset": 58,
"end_offset": 59,
"label": "bod"
}
] |
亥氏反射（Head’sreflex）为深吸气反射，当肺扩张时出现的加强性吸气。 | [
{
"id": 0,
"entity": "肺",
"start_offset": 26,
"end_offset": 27,
"label": "bod"
},
{
"id": 1,
"entity": "加强性吸气",
"start_offset": 33,
"end_offset": 38,
"label": "sym"
}
] |
3.防御性呼吸反射分布在呼吸道黏膜上皮的感受器对机械或化学刺激敏感，经迷走神经传入延髓，触发一系列协调的反射效应，为咳嗽反射。 | [
{
"id": 0,
"entity": "防御性呼吸反射",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸道黏膜",
"start_offset": 12,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "感受器",
"start_offset": 20,
"end_offset": 23,
"label": "bod"
},
{
"id": 3,
"entity": "迷走神经",
"start_offset": 35,
"end_offset": 39,
"label": "bod"
},
{
"id": 4,
"entity": "延髓",
"start_offset": 41,
"end_offset": 43,
"label": "bod"
}
] |
咳嗽反射包括深吸气、声门紧闭、呼气肌强烈收缩、肺内压和胸腔内压骤然上升、声门突然打开等序列过程，气流以极高的速度从肺内冲出，并将气道内异物和分泌物带出。 | [
{
"id": 0,
"entity": "深吸气",
"start_offset": 6,
"end_offset": 9,
"label": "sym"
},
{
"id": 1,
"entity": "声门紧闭",
"start_offset": 10,
"end_offset": 14,
"label": "sym"
},
{
"id": 2,
"entity": "呼气肌强烈收缩",
"start_offset": 15,
"end_offset": 22,
"label": "sym"
},
{
"id": 3,
"entity": "肺内压",
"start_offset": 23,
"end_offset": 26,
"label": "ite"
},
{
"id": 4,
"entity": "胸腔内压",
"start_offset": 27,
"end_offset": 31,
"label": "ite"
},
{
"id": 5,
"entity": "肺内压和胸腔内压骤然上升",
"start_offset": 23,
"end_offset": 35,
"label": "sym"
},
{
"id": 6,
"entity": "声门突然打开",
"start_offset": 36,
"end_offset": 42,
"label": "sym"
},
{
"id": 7,
"entity": "肺",
"start_offset": 57,
"end_offset": 58,
"label": "bod"
},
{
"id": 8,
"entity": "气道",
"start_offset": 64,
"end_offset": 66,
"label": "bod"
}
] |
剧烈咳嗽可以导致胸腔内压急剧升高，使静脉压和脑脊液压升高。 | [
{
"id": 0,
"entity": "胸腔内压",
"start_offset": 8,
"end_offset": 12,
"label": "ite"
},
{
"id": 1,
"entity": "静脉压",
"start_offset": 18,
"end_offset": 21,
"label": "ite"
},
{
"id": 2,
"entity": "脑脊液压",
"start_offset": 22,
"end_offset": 26,
"label": "ite"
}
] |
如果刺激主要作用在鼻腔黏膜，则出现喷嚏反射，感受器经三叉神经传入冲动，带来软腭下垂，呼出气主要从鼻腔喷出，达到清除鼻腔中的刺激物。 | [
{
"id": 0,
"entity": "鼻腔黏膜",
"start_offset": 9,
"end_offset": 13,
"label": "bod"
},
{
"id": 1,
"entity": "感受器",
"start_offset": 22,
"end_offset": 25,
"label": "bod"
},
{
"id": 2,
"entity": "三叉神经",
"start_offset": 26,
"end_offset": 30,
"label": "bod"
},
{
"id": 3,
"entity": "软腭",
"start_offset": 37,
"end_offset": 39,
"label": "bod"
},
{
"id": 4,
"entity": "鼻腔",
"start_offset": 48,
"end_offset": 50,
"label": "bod"
},
{
"id": 5,
"entity": "鼻腔",
"start_offset": 57,
"end_offset": 59,
"label": "bod"
}
] |
（三）呼吸肌和呼吸功能肺通气动力为呼吸肌运动，分为吸气（进气）和呼气（排气）过程。 | [
{
"id": 0,
"entity": "呼吸肌",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "肺",
"start_offset": 11,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "呼吸肌",
"start_offset": 17,
"end_offset": 20,
"label": "bod"
}
] |
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