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自然呼吸时收缩呼吸肌作用使胸腔内负压增大，胸廓增大同时使肺扩张，即肺泡的膨胀。 | [
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肺内压力低于外界大气压力，气流经气道进入肺泡，在吸气末肺泡内压与外界大气压相同时，气流流动停止，进气结束。 | [
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呼气时收缩呼吸肌舒张（或伴有呼气肌收缩），胸廓缩小，或者在肺组织弹性回缩作用下，使肺泡内压力高于外界大气压力，肺内气体向肺外流动，在呼气末肺内压与外界大气压相等时，气流流动停止，呼气结束。 | [
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新生儿和小婴儿肋间呼吸肌发育不全，呼吸运动主要依赖膈肌，为腹式呼吸。 | [
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到幼儿和儿童期，随着肋间肌发育逐渐完善，可以同时有胸式和腹式呼吸，且中枢意识控制的随意呼吸功能完善。 | [
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（四）肺的气体交换功能1.呼吸频率和节律呼吸频率指每分钟呼吸次数，呼吸节律指呼吸活动的时间规律性。 | [
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新生儿多表现为呼吸节律不齐。 | [
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周期性呼吸（periodicrespiration）指呼吸时短暂性停止20秒以下，然后又恢复。 | [
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呼吸暂停指呼吸停止＞20秒。 | [
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主要因为随着肺发育长大，气道至外周肺泡距离增加，气流充盈肺泡及排出气体所需要时间相应延长，使呼吸周期延长，但也因为肺泡总表面积显著增加，满足了机体代谢需要。 | [
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小儿肺部病变时，如果出现气道通气障碍，或肺部炎症使有效气体交换面积和效率下降时，主要依靠加快呼吸频率来保持气体交换，以满足机体代谢需要。 | [
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2.肺通气量基本肺容积包括潮气量、吸气储备量（补吸气量）、呼气储备量（补呼气量）、残余气量。 | [
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潮气量指一次呼吸时进入或排出肺部的气量。 | [
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小儿潮气量一般以体重修正，为6～8ml/kg。 | [
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肺容量为基本肺容积中任两项或两项以上的联合气量。 | [
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其中深吸气量（inspiratorycapacity）为平静呼气末做最大吸气时所能吸入的气体量，相当于潮气量与补吸气量之和。 | [
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功能残气量（functionalresidualcapacity，FRC）为平静呼气末尚存留于肺内的气量，相当于残气量和补呼气量之和。 | [
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新生儿出生早期肺液排出后，获得FRC约20～25ml/kg，至儿童期保持为25～30ml/kg水平，至成年可以达到30～35ml/kg。 | [
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FRC的生理意义为缓冲呼吸过程中肺泡气中氧和二氧化碳分压的过度变化，使肺泡气和动脉血的PaO<sub>2</sub>和PaCO<sub>2</sub>不会随呼吸而发生大幅度波动，以利于气体交换。 | [
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在病理情况下，弥漫性肺泡损伤使FRC下降，哮喘、肺气肿、老年肺弹性回缩力减退时，FRC增高。 | [
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对于没有随意呼吸控制的小婴儿和幼儿，不能测定补吸气量和补呼气量，也不能直接测定出残余气量。 | [
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3.换气功能进入肺部的气体约1/3在大小气道管腔，不参与气体交换，为解剖无效腔；2/3达到呼吸性细支气管和肺泡，参与气体交换。 | [
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在由呼吸性细支气管、肺泡导管、肺泡囊和肺泡组成的呼吸性功能单位中，通过成千上万个微小肺泡，吸入气体的氧气弥散通过肺泡隔进入肺泡毛细血管并进入循环血液，血液中二氧化碳气体进入肺泡，随呼出气排出体外。 | [
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动脉血液将氧气带到外周组织并释放，使组织获得氧供，并将组织代谢产生的二氧化碳带回到肺部，从而保证机体的氧和二氧化碳代谢平衡。 | [
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在肺部气体交换保持合适的通气和血液灌流比例，在新生儿期，通气-灌流比接近1，儿童期与成人相似，为0.8。 | [
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如果因肺外分流（动脉导管、卵圆孔未闭，房、室间隔缺损）肺部血流显著减少，或肺内动静脉分流，参与气体交换的毛细血管网减少，则使通气-灌流比例增大。 | [
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没有参加气体交换的肺泡部分成为生理无效腔。 | [
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二、胃肠测压法目前低顺应性的关注导管系统和腔内微型传感器导管系统已成为定型的测压技术设备。 | [
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利用连续灌注导管测压系统工作原理，用微泵向导管内注水，水流速度恒定，导管末端测孔逸水时克服的阻力即为胃肠腔内压力。 | [
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常用PCPolygrafHR型胃肠动力监测系统，有4通道和8通道的。 | [
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（一）食管测压常用4通道测压导管，可测不同部位及不同方向的压力。 | [
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"label": "pro"
},
{
"id": 1,
"entity": "4通道测压导管",
"start_offset": 9,
"end_offset": 16,
"label": "equ"
}
] |
液压毛细管灌注系统内的水流速度0.5cm/min。 | [
{
"id": 0,
"entity": "液压毛细管灌注系统",
"start_offset": 0,
"end_offset": 9,
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}
] |
检查前禁食4～6小时，小婴儿适当用镇静剂，将测压导管经鼻腔或口插入，直至4个通道的测孔都到达胃内，采用定点牵拉法测定胃内压、上下食管括约肌压力、长度及松弛情况、食管体部蠕动情况等。 | [
{
"id": 0,
"entity": "镇静剂",
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"label": "dru"
},
{
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{
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"entity": "鼻腔",
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{
"id": 3,
"entity": "口",
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{
"id": 4,
"entity": "胃",
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"end_offset": 47,
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{
"id": 5,
"entity": "胃内压",
"start_offset": 58,
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{
"id": 6,
"entity": "上下食管括约肌压力",
"start_offset": 62,
"end_offset": 71,
"label": "ite"
},
{
"id": 7,
"entity": "食管体部蠕动情况",
"start_offset": 80,
"end_offset": 88,
"label": "ite"
}
] |
食管测压是研究和诊断食管动力障碍性疾病的基本方法，对食管裂孔疝可作出诊断，并可用于评价贲门失弛缓症、弥漫性食管痉挛的药物和手术治疗效果及胃底折叠术抗反流的疗效，筛选、评价作用于食管的药物，如促动力药等。 | [
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"id": 0,
"entity": "食管测压",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
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"start_offset": 10,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "食管裂孔疝",
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{
"id": 3,
"entity": "贲门失弛缓症",
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"label": "dis"
},
{
"id": 4,
"entity": "弥漫性食管痉挛",
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{
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{
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{
"id": 7,
"entity": "促动力药",
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"label": "dru"
}
] |
（二）直肠肛门测压直肠肛门紧闭与舒张存在着一定的压力变化。 | [
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肛门内外括约肌的压力变化与直肠内压力变化有密切关系，并且是连续性反射性活动。 | [
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"entity": "直肠内压力",
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1967年，SchnauferheLawson等先后报道用直肠肛门测压法发现了先天性巨结肠患儿直肠肛门反射消失的报告，使直肠肛门测压法首先在小儿外科得到广泛应用。 | [
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{
"id": 4,
"entity": "小儿外科",
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"label": "dep"
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] |
作为一种研究直肠肛门生理、病理及诊断疾病和判定直肠肛门功能的方法，直肠肛门测压法得到了越来越多的应用。 | [
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测压导管带有气囊，在测定腔内压力的同时，可观察不同气囊内压时直肠和括约肌压力的变化及反射情况。 | [
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{
"id": 3,
"entity": "括约肌",
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] |
小儿常用4通道导管，每通道测孔相隔1cm。 | [
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"entity": "4通道导管",
"start_offset": 4,
"end_offset": 9,
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] |
检查前排空大、小便，检查时取左侧卧位，将测压管插入直肠内，采用定点牵拉法测定压力，并向气囊内注气以观察松弛反射及直肠收缩反射，检测内外括约肌协调功能。 | [
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"entity": "测压管",
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"label": "equ"
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{
"id": 1,
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{
"id": 2,
"entity": "定点牵拉法",
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{
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{
"id": 5,
"entity": "括约肌",
"start_offset": 67,
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"label": "bod"
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] |
检测指标：压力（包括直肠静息压，肛门内、外括约肌压力）；反射（直肠收缩反射、内括约肌松弛反射、外括约肌松弛反射）；直肠耐受性；括约肌长度。 | [
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"entity": "直肠静息压",
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{
"id": 1,
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{
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"entity": "直肠收缩反射",
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{
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"entity": "内括约肌松弛反射",
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{
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"entity": "外括约肌松弛反射",
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{
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"entity": "直肠耐受性",
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},
{
"id": 6,
"entity": "括约肌长度",
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"end_offset": 68,
"label": "ite"
}
] |
临床上用于先天性巨结肠的诊断，评估慢性便秘、特发性大便失禁患儿的直肠、肛门功能以及肛门部手术后的疗效评价。 | [
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{
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{
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"entity": "特发性大便失禁",
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{
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{
"id": 5,
"entity": "肛门",
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] |
（三）其他胃内压测定以及Oddi括约肌压力测定等。 | [
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"entity": "胃内压测定",
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第六节青春期的生长发育青春（adolescence）期开始于生长突增，终止于骨骺完全愈合、躯体停止生长、性发育成熟。 | [
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{
"id": 1,
"entity": "躯体",
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在这个时期，生长突增，性腺、生殖器官及第二性征迅速发育，内分泌及心理发生明显的变化，它是人体生长发育的最后阶段。 | [
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{
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"entity": "生殖器官",
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{
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"entity": "内分泌",
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] |
（一）体格生长青春早期出现身高的突增，突增的幅度女孩为每年增加8～10cm，整个青春期可增加25cm，男孩每年增加9～12cm，整个青春期可增加28cm。 | [
{
"id": 0,
"entity": "身高",
"start_offset": 13,
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] |
由于男孩的身高突增比女性晚2年，骨骼停止时间亦晚2年，且突增的幅度较大，因此在青春期结束时男性的平均身高比女性高10cm。 | [
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{
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生长加速从远端开始，最早是手和足增大，随后是臂和腿增长，最后才是躯干。 | [
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"id": 0,
"entity": "手",
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{
"id": 1,
"entity": "足",
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{
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"entity": "臂",
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"label": "bod"
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{
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"entity": "腿",
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"label": "bod"
},
{
"id": 4,
"entity": "躯干",
"start_offset": 32,
"end_offset": 34,
"label": "bod"
}
] |
四肢长度增长快于躯干，使坐高与身高之比缩小，当长骨的生长速度减慢时脊柱的生长相对较快，使坐高与身高的比例达到成人正常比例。 | [
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"entity": "四肢",
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{
"id": 1,
"entity": "躯干",
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{
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{
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"entity": "脊柱",
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"label": "bod"
},
{
"id": 5,
"entity": "身高",
"start_offset": 47,
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] |
体重的变化规律与身高相似，但生长突增不如身高显著，增长持续的时间较长，在青春期后仍可继续增长。 | [
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{
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{
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青春期男、女儿童的各种身体成分总量都在增加，但各种成分的比例有所不同，男性的瘦体重（leanbodymass）增加迅速，尤其是骨骼肌的增加明显。 | [
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"entity": "瘦体重",
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{
"id": 1,
"entity": "骨骼肌",
"start_offset": 63,
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"label": "bod"
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] |
而女性的体脂量在整个青春期持续增长，尤以青春后期更为明显。 | [
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"entity": "体脂量",
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各种围长和宽度如胸围、大腿围、小腿围、臀围、骨盆宽都有增长，但有性别差异，男孩的肩宽、胸围增幅大，女孩则骨盆宽增加明显，最终形成男性身材高大、肌肉发达、上体宽的体格特征，而女性显示身材较矮、体脂丰满、下体宽的体型。 | [
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{
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{
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{
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{
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"entity": "肩宽",
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{
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{
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{
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"entity": "肌肉",
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{
"id": 9,
"entity": "上体",
"start_offset": 76,
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"label": "bod"
},
{
"id": 10,
"entity": "体脂",
"start_offset": 95,
"end_offset": 97,
"label": "ite"
}
] |
（二）骨骼发育青春期各骨化中心相继钙化，并与骨干的骨骺端愈合。 | [
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"entity": "骨骼",
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{
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{
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] |
长骨骨干与骨骺约15、16岁（女性）、17、18岁（男性）愈合，椎骨体与骨骺到20岁以后才能完全愈合。 | [
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{
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{
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{
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] |
判断骨骼发育程度可应用骨骼年龄（骨龄boneage）。 | [
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{
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{
"id": 2,
"entity": "骨龄",
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] |
测定骨龄的理想部位为手腕部，通过骨骼X线摄片观察儿童手腕部骨骼钙化程度，并与骨龄标准比较，从而确定儿童的骨龄，反映儿童体格生长情况。 | [
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{
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{
"id": 3,
"entity": "X线摄片",
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{
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"entity": "手腕部",
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{
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{
"id": 7,
"entity": "骨龄",
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"label": "ite"
}
] |
1.性器官和性功能卵巢一般在8～10岁开始发育增快，重量增加，外形由纺锤形变为扁圆形，功能也逐渐完善，出现周期性排卵和分泌雌激素，月经初潮是女性青春期发育过程中的重要标志和评定指标。 | [
{
"id": 0,
"entity": "性器官",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "卵巢",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "雌激素",
"start_offset": 61,
"end_offset": 64,
"label": "bod"
}
] |
睾丸增大是男性青春期发育的第一个信号，睾丸开始增大的年龄最早为9.5岁，阴茎增大迟于睾丸增大的半年至1年后，睾丸的作用是产生精子和分泌雄激素，男性遗精的年龄平均为15、16岁。 | [
{
"id": 0,
"entity": "睾丸",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "睾丸",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
},
{
"id": 2,
"entity": "阴茎",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 3,
"entity": "睾丸",
"start_offset": 42,
"end_offset": 44,
"label": "bod"
},
{
"id": 4,
"entity": "睾丸",
"start_offset": 54,
"end_offset": 56,
"label": "bod"
},
{
"id": 5,
"entity": "精子",
"start_offset": 62,
"end_offset": 64,
"label": "bod"
},
{
"id": 6,
"entity": "雄激素",
"start_offset": 67,
"end_offset": 70,
"label": "bod"
}
] |
2.第二性征发育乳房大约在8～13岁开始发育，阴毛在乳房开始发育后的6个月到1年出现，腋毛则在阴毛出现后的半年至1年后出现。 | [
{
"id": 0,
"entity": "乳房",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "阴毛",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 2,
"entity": "乳房",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "腋毛",
"start_offset": 43,
"end_offset": 45,
"label": "bod"
},
{
"id": 4,
"entity": "阴毛",
"start_offset": 47,
"end_offset": 49,
"label": "bod"
}
] |
身高生长突增的开始是青春期最早的征象，多数女孩乳房增大和身高突增同时出现。 | [
{
"id": 0,
"entity": "乳房",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
}
] |
男性的第二性征表现在阴毛、腋毛、胡须、变声、喉结等方面。 | [
{
"id": 0,
"entity": "阴毛",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "腋毛",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "胡须",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 3,
"entity": "变声",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
},
{
"id": 4,
"entity": "喉结",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
}
] |
阴毛出现的年龄个体差异很大，在阴毛出现后1～2年出现腋毛，在腋毛出现后一年才出现胡须。 | [
{
"id": 0,
"entity": "阴毛",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "阴毛",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "腋毛",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "腋毛",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "胡须",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
}
] |
喉节从12岁开始出现，13岁声音变粗，18岁时喉节和变声完成。 | [
{
"id": 0,
"entity": "喉节",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
}
] |
表3-3青春期性发育顺序（四）功能发育青春期的功能发育常以心肺功能、肌肉力量及运动能力反映之。 | [
{
"id": 0,
"entity": "肌肉",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
}
] |
2.肌肉力量青春期时男性的握力（表示手及臂部肌肉力量）可增长25～35kg，女性增长15～20kg，年增长值男性4～10kg，女性2～5kg，男性握力值始终高于女性，随年龄增长，这种性别差异增大。 | [
{
"id": 0,
"entity": "肌肉",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "肌肉",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
}
] |
3.运动能力青春期的运动能力有较明显的增强，肌肉活动中所表现出一定的力量、速度、灵敏及柔韧性。 | [
{
"id": 0,
"entity": "肌肉",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
}
] |
第十二章小儿呼吸衰竭第一节呼吸衰竭的病因及病理生理呼吸衰竭（respiratoryfailure）是指由于各种原因导致中枢和（或）外周性呼吸生理功能障碍，使动脉血氧分压（PaO<sub>2</sub>）＜8kPa（60mmHg）和动脉二氧化碳分压（PaCO<sub>2</sub>）＞6.67kPa（50mmHg），并存在呼吸困难症状的临床综合征。 | [
{
"id": 0,
"entity": "呼吸衰竭",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸衰竭",
"start_offset": 13,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 25,
"end_offset": 29,
"label": "dis"
},
{
"id": 3,
"entity": "respiratoryfailure",
"start_offset": 30,
"end_offset": 48,
"label": "dis"
},
{
"id": 4,
"entity": "中枢和（或）外周性呼吸生理功能障碍",
"start_offset": 59,
"end_offset": 76,
"label": "dis"
},
{
"id": 5,
"entity": "动脉血氧分压",
"start_offset": 78,
"end_offset": 84,
"label": "ite"
},
{
"id": 6,
"entity": "动脉二氧化碳分压",
"start_offset": 115,
"end_offset": 123,
"label": "ite"
},
{
"id": 7,
"entity": "呼吸困难",
"start_offset": 161,
"end_offset": 165,
"label": "sym"
}
] |
小儿多见急性呼吸衰竭。 | [
{
"id": 0,
"entity": "急性呼吸衰竭",
"start_offset": 4,
"end_offset": 10,
"label": "dis"
}
] |
目前随着小儿危重病救治技术的完善和提高，尤其在急诊室和重症监护救治手段的应用，对于传统意义上的呼吸衰竭定义和认识有待进一步的发展。 | [
{
"id": 0,
"entity": "急诊室",
"start_offset": 23,
"end_offset": 26,
"label": "dep"
},
{
"id": 1,
"entity": "重症监护",
"start_offset": 27,
"end_offset": 31,
"label": "dep"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 47,
"end_offset": 51,
"label": "dis"
}
] |
一、病因和分类（一）根据年龄分类1.新生儿阶段一般指出生后28天内出现的呼吸系统或其他系统疾病导致的呼吸衰竭。 | [
{
"id": 0,
"entity": "呼吸系统",
"start_offset": 36,
"end_offset": 40,
"label": "bod"
},
{
"id": 1,
"entity": "呼吸衰竭",
"start_offset": 50,
"end_offset": 54,
"label": "dis"
}
] |
多因窒息、缺氧、肺发育不成熟、吸入羊水胎粪、肺部或全身感染导致。 | [
{
"id": 0,
"entity": "窒息",
"start_offset": 2,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "缺氧",
"start_offset": 5,
"end_offset": 7,
"label": "dis"
},
{
"id": 2,
"entity": "肺",
"start_offset": 8,
"end_offset": 9,
"label": "bod"
},
{
"id": 3,
"entity": "肺部",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 4,
"entity": "全身",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
}
] |
此外，先天性畸形和发育障碍导致上、下呼吸道梗阻，膈疝使肺部受压迫等，也可以导致呼吸衰竭。 | [
{
"id": 0,
"entity": "先天性畸形",
"start_offset": 3,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "发育障碍",
"start_offset": 9,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "上、下呼吸道梗阻",
"start_offset": 15,
"end_offset": 23,
"label": "dis"
},
{
"id": 3,
"entity": "膈疝",
"start_offset": 24,
"end_offset": 26,
"label": "dis"
},
{
"id": 4,
"entity": "肺部",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
},
{
"id": 5,
"entity": "呼吸衰竭",
"start_offset": 39,
"end_offset": 43,
"label": "dis"
}
] |
此阶段气道免疫系统发育尚不完善，容易感染细菌和病毒，导致呼吸衰竭的原因多为支气管肺炎、中枢感染等。 | [
{
"id": 0,
"entity": "气道免疫系统",
"start_offset": 3,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "细菌",
"start_offset": 20,
"end_offset": 22,
"label": "mic"
},
{
"id": 2,
"entity": "病毒",
"start_offset": 23,
"end_offset": 25,
"label": "mic"
},
{
"id": 3,
"entity": "呼吸衰竭",
"start_offset": 28,
"end_offset": 32,
"label": "dis"
},
{
"id": 4,
"entity": "支气管肺炎",
"start_offset": 37,
"end_offset": 42,
"label": "dis"
},
{
"id": 5,
"entity": "中枢感染",
"start_offset": 43,
"end_offset": 47,
"label": "dis"
}
] |
3.儿童阶段多可因肺炎、先天性心脏病、哮喘持续状态、感染性疾病、肺外脏器功能衰竭等发展而来。 | [
{
"id": 0,
"entity": "肺炎",
"start_offset": 9,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "先天性心脏病",
"start_offset": 12,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "哮喘",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
},
{
"id": 3,
"entity": "肺外脏器功能衰竭",
"start_offset": 32,
"end_offset": 40,
"label": "dis"
}
] |
此外，外伤、手术创伤、气道异物、溺水、中毒等也会严重影响到呼吸功能，导致急性呼吸衰竭。 | [
{
"id": 0,
"entity": "外伤",
"start_offset": 3,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "手术创伤",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
},
{
"id": 2,
"entity": "气道",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 3,
"entity": "中毒",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
},
{
"id": 4,
"entity": "急性呼吸衰竭",
"start_offset": 36,
"end_offset": 42,
"label": "dis"
}
] |
（二）根据中枢性和外周性病因的分类1.中枢性原发病对脑部的伤害、脑水肿或颅内高压影响呼吸中枢的正常功能，导致中枢呼吸运动神经元的冲动发放异常，而出现呼吸频率和节律异常，临床主要为通气功能异常。 | [
{
"id": 0,
"entity": "脑部",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 1,
"entity": "脑水肿",
"start_offset": 32,
"end_offset": 35,
"label": "dis"
},
{
"id": 2,
"entity": "颅内高压",
"start_offset": 36,
"end_offset": 40,
"label": "dis"
},
{
"id": 3,
"entity": "呼吸中枢",
"start_offset": 42,
"end_offset": 46,
"label": "bod"
},
{
"id": 4,
"entity": "呼吸频率和节律",
"start_offset": 74,
"end_offset": 81,
"label": "ite"
},
{
"id": 5,
"entity": "通气功能异常",
"start_offset": 89,
"end_offset": 95,
"label": "sym"
}
] |
如颅内感染、出血、头颅创伤，窒息和缺氧等。 | [
{
"id": 0,
"entity": "颅内感染",
"start_offset": 1,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "出血",
"start_offset": 6,
"end_offset": 8,
"label": "dis"
},
{
"id": 2,
"entity": "头颅创伤",
"start_offset": 9,
"end_offset": 13,
"label": "dis"
},
{
"id": 3,
"entity": "窒息",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 4,
"entity": "缺氧",
"start_offset": 17,
"end_offset": 19,
"label": "dis"
}
] |
药物中毒、酸中毒、肝肾功能障碍也可以导致中枢性呼吸衰竭。 | [
{
"id": 0,
"entity": "药物中毒",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "酸中毒",
"start_offset": 5,
"end_offset": 8,
"label": "dis"
},
{
"id": 2,
"entity": "肝肾功能障碍",
"start_offset": 9,
"end_offset": 15,
"label": "dis"
},
{
"id": 3,
"entity": "中枢性呼吸衰竭",
"start_offset": 20,
"end_offset": 27,
"label": "dis"
}
] |
2.外周性原发于呼吸器官，如气道、肺、胸廓和呼吸肌病变，或继发于肺部及胸腔以外脏器系统病变的各种疾病。 | [
{
"id": 0,
"entity": "呼吸器官",
"start_offset": 8,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "气道",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "肺",
"start_offset": 17,
"end_offset": 18,
"label": "bod"
},
{
"id": 3,
"entity": "胸廓",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
},
{
"id": 4,
"entity": "呼吸肌",
"start_offset": 22,
"end_offset": 25,
"label": "bod"
},
{
"id": 5,
"entity": "肺部",
"start_offset": 32,
"end_offset": 34,
"label": "bod"
},
{
"id": 6,
"entity": "胸腔",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
},
{
"id": 7,
"entity": "脏器系统",
"start_offset": 39,
"end_offset": 43,
"label": "bod"
}
] |
（三）根据感染和非感染性病因的分类1.感染性疾病如细菌、病毒、真菌、原虫性肺炎并发呼吸衰竭，或脓毒症等全身性感染导致急性肺部炎症、损伤、水肿、出血等病变。 | [
{
"id": 0,
"entity": "细菌",
"start_offset": 25,
"end_offset": 27,
"label": "mic"
},
{
"id": 1,
"entity": "病毒",
"start_offset": 28,
"end_offset": 30,
"label": "mic"
},
{
"id": 2,
"entity": "真菌",
"start_offset": 31,
"end_offset": 33,
"label": "mic"
},
{
"id": 3,
"entity": "原虫性肺炎",
"start_offset": 34,
"end_offset": 39,
"label": "dis"
},
{
"id": 4,
"entity": "呼吸衰竭",
"start_offset": 41,
"end_offset": 45,
"label": "dis"
},
{
"id": 5,
"entity": "脓毒症",
"start_offset": 47,
"end_offset": 50,
"label": "dis"
},
{
"id": 6,
"entity": "全身",
"start_offset": 51,
"end_offset": 53,
"label": "bod"
},
{
"id": 7,
"entity": "急性肺部炎症",
"start_offset": 58,
"end_offset": 64,
"label": "dis"
},
{
"id": 8,
"entity": "损伤",
"start_offset": 65,
"end_offset": 67,
"label": "dis"
},
{
"id": 9,
"entity": "水肿",
"start_offset": 68,
"end_offset": 70,
"label": "dis"
},
{
"id": 10,
"entity": "出血",
"start_offset": 71,
"end_offset": 73,
"label": "dis"
}
] |
中枢感染也是导致呼吸衰竭的重要原因。 | [
{
"id": 0,
"entity": "中枢感染",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸衰竭",
"start_offset": 8,
"end_offset": 12,
"label": "dis"
}
] |
2.非感染性如手术、创伤、吸入、淹溺、中毒等导致的中枢性和外周性呼吸衰竭。 | [
{
"id": 0,
"entity": "手术",
"start_offset": 7,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "创伤",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "淹溺",
"start_offset": 16,
"end_offset": 18,
"label": "dis"
},
{
"id": 3,
"entity": "中毒",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
},
{
"id": 4,
"entity": "中枢性和外周性呼吸衰竭",
"start_offset": 25,
"end_offset": 36,
"label": "dis"
}
] |
（四）直接根据疾病种类的分类直接根据原发疾病所出现的呼吸衰竭加以分类区别，如肺炎合并呼吸衰竭，脑炎、脑膜炎合并呼吸衰竭，或者多脏器功能衰竭合并呼吸衰竭。 | [
{
"id": 0,
"entity": "呼吸衰竭",
"start_offset": 26,
"end_offset": 30,
"label": "dis"
},
{
"id": 1,
"entity": "肺炎",
"start_offset": 38,
"end_offset": 40,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 42,
"end_offset": 46,
"label": "dis"
},
{
"id": 3,
"entity": "脑炎",
"start_offset": 47,
"end_offset": 49,
"label": "dis"
},
{
"id": 4,
"entity": "脑膜炎",
"start_offset": 50,
"end_offset": 53,
"label": "dis"
},
{
"id": 5,
"entity": "呼吸衰竭",
"start_offset": 55,
"end_offset": 59,
"label": "dis"
},
{
"id": 6,
"entity": "多脏器功能衰竭",
"start_offset": 62,
"end_offset": 69,
"label": "dis"
},
{
"id": 7,
"entity": "呼吸衰竭",
"start_offset": 71,
"end_offset": 75,
"label": "dis"
}
] |
（五）根据病理生理特点的分类1.急性呼吸衰竭多为急性发作并出现持续低氧血症，依赖紧急复苏抢救。 | [
{
"id": 0,
"entity": "急性呼吸衰竭",
"start_offset": 16,
"end_offset": 22,
"label": "dis"
},
{
"id": 1,
"entity": "低氧血症",
"start_offset": 33,
"end_offset": 37,
"label": "dis"
},
{
"id": 2,
"entity": "紧急复苏抢救",
"start_offset": 40,
"end_offset": 46,
"label": "pro"
}
] |
2.慢性呼吸衰竭多表现为肺部基础疾病进行性损害，导致失代偿，出现高碳酸血症和酸中毒。 | [
{
"id": 0,
"entity": "慢性呼吸衰竭",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "肺部",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "高碳酸血症",
"start_offset": 32,
"end_offset": 37,
"label": "dis"
},
{
"id": 3,
"entity": "酸中毒",
"start_offset": 38,
"end_offset": 41,
"label": "dis"
}
] |
偶尔也可见于肺外疾病，如Duchenne型肌营养不良时进行性膈肌无力导致的气体交换不足。 | [
{
"id": 0,
"entity": "Duchenne型肌",
"start_offset": 12,
"end_offset": 22,
"label": "bod"
},
{
"id": 1,
"entity": "营养不良",
"start_offset": 22,
"end_offset": 26,
"label": "dis"
},
{
"id": 2,
"entity": "进行性膈肌无力",
"start_offset": 27,
"end_offset": 34,
"label": "dis"
}
] |
3.血氧和二氧化碳水平根据血气分析临床可诊断呼吸衰竭为Ⅰ型（低氧血症型）和Ⅱ型（低氧血症伴高碳酸血症）。 | [
{
"id": 0,
"entity": "血氧",
"start_offset": 2,
"end_offset": 4,
"label": "ite"
},
{
"id": 1,
"entity": "二氧化碳",
"start_offset": 5,
"end_offset": 9,
"label": "ite"
},
{
"id": 2,
"entity": "血气分析",
"start_offset": 13,
"end_offset": 17,
"label": "pro"
},
{
"id": 3,
"entity": "呼吸衰竭",
"start_offset": 22,
"end_offset": 26,
"label": "dis"
},
{
"id": 4,
"entity": "低氧血症",
"start_offset": 30,
"end_offset": 34,
"label": "dis"
},
{
"id": 5,
"entity": "低氧血症",
"start_offset": 40,
"end_offset": 44,
"label": "dis"
},
{
"id": 6,
"entity": "高碳酸血症",
"start_offset": 45,
"end_offset": 50,
"label": "dis"
}
] |
第四节转移性骨肿瘤原发于身体其他部位的肿瘤，主要是恶性肿瘤，通过各种途径转移至骨骼并在骨内继续生长，形成子肿瘤。 | [
{
"id": 0,
"entity": "转移性骨肿瘤",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "肿瘤",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "恶性肿瘤",
"start_offset": 25,
"end_offset": 29,
"label": "dis"
},
{
"id": 3,
"entity": "骨骼",
"start_offset": 39,
"end_offset": 41,
"label": "bod"
},
{
"id": 4,
"entity": "骨",
"start_offset": 43,
"end_offset": 44,
"label": "bod"
},
{
"id": 5,
"entity": "子肿瘤",
"start_offset": 52,
"end_offset": 55,
"label": "dis"
}
] |
在骨肿瘤中占有一定的比例。 | [
{
"id": 0,
"entity": "骨肿瘤",
"start_offset": 1,
"end_offset": 4,
"label": "dis"
}
] |
【转移】转移性骨肿瘤的产生主要通过淋巴或血液两条途径，原发肿瘤可以来自全身各处。 | [
{
"id": 0,
"entity": "转移性骨肿瘤",
"start_offset": 4,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "淋巴",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "血液",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
}
] |
【临床表现】转移到肢体骨骼的肿瘤主要以局部肿块最先发现，而躯干部的转移性骨肿瘤往往是疼痛为首发表现。 | [
{
"id": 0,
"entity": "肢体骨骼",
"start_offset": 9,
"end_offset": 13,
"label": "bod"
},
{
"id": 1,
"entity": "肿瘤",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "局部肿块",
"start_offset": 19,
"end_offset": 23,
"label": "bod"
},
{
"id": 3,
"entity": "躯干部",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "转移性骨肿瘤",
"start_offset": 33,
"end_offset": 39,
"label": "dis"
}
] |
位于深部的骨骼转移，早期肿块不易发现，只反映出局部的疼痛，靠近关节附近的肿瘤可以引起关节功能的障碍，肿瘤增大在重要的神经附近时可以有或多或少的压迫症状，产生麻木、肌肉无力或萎缩，不少病例的诊断是在病理骨折发生时才发现了骨骼的病变，要特别引起重视。 | [
{
"id": 0,
"entity": "早期肿块不易发现",
"start_offset": 10,
"end_offset": 18,
"label": "sym"
},
{
"id": 1,
"entity": "只反映出局部的疼痛",
"start_offset": 19,
"end_offset": 28,
"label": "sym"
},
{
"id": 2,
"entity": "关节",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 3,
"entity": "肿瘤",
"start_offset": 36,
"end_offset": 38,
"label": "dis"
},
{
"id": 4,
"entity": "肿瘤",
"start_offset": 50,
"end_offset": 52,
"label": "dis"
},
{
"id": 5,
"entity": "神经",
"start_offset": 58,
"end_offset": 60,
"label": "bod"
},
{
"id": 6,
"entity": "压迫症状",
"start_offset": 71,
"end_offset": 75,
"label": "sym"
},
{
"id": 7,
"entity": "产生麻木",
"start_offset": 76,
"end_offset": 80,
"label": "sym"
},
{
"id": 8,
"entity": "肌肉无力或萎缩",
"start_offset": 81,
"end_offset": 88,
"label": "sym"
},
{
"id": 9,
"entity": "病理骨折",
"start_offset": 98,
"end_offset": 102,
"label": "dis"
},
{
"id": 10,
"entity": "骨骼",
"start_offset": 109,
"end_offset": 111,
"label": "bod"
}
] |
【诊断】（一）X线表现转移性骨肿瘤的X线表现多数为肿瘤发生的骨骼产生各种骨骼破坏性改变，病变多局限在骨骼内，边缘不清，有时与原发性骨肿瘤不易鉴别。 | [
{
"id": 0,
"entity": "X线",
"start_offset": 7,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "转移性骨肿瘤",
"start_offset": 11,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "X线",
"start_offset": 18,
"end_offset": 20,
"label": "pro"
},
{
"id": 3,
"entity": "肿瘤",
"start_offset": 25,
"end_offset": 27,
"label": "dis"
},
{
"id": 4,
"entity": "骨骼",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 5,
"entity": "骨骼",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 6,
"entity": "骨骼",
"start_offset": 50,
"end_offset": 52,
"label": "bod"
},
{
"id": 7,
"entity": "原发性骨肿瘤",
"start_offset": 62,
"end_offset": 68,
"label": "dis"
}
] |
转移性骨肿瘤可单发或多发，单发性系发生于某一骨内的转移，局限于一处产生骨质破坏，使邻近骨皮质扩大膨胀，X线上可以为同一的骨质破坏或者形成大小不等的囊性腔隙也可以是广泛的骨质破坏骨内，也可以表现为两种形式，一种是广泛地散在于多数骨内，一种是连续侵犯相邻近的几个骨，如侵犯同侧的髂骨及股骨近端，肩胛骨及肱骨近端。 | [
{
"id": 0,
"entity": "转移性骨肿瘤",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "骨内",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 2,
"entity": "骨质",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
},
{
"id": 3,
"entity": "骨皮质",
"start_offset": 43,
"end_offset": 46,
"label": "bod"
},
{
"id": 4,
"entity": "X线",
"start_offset": 51,
"end_offset": 53,
"label": "pro"
},
{
"id": 5,
"entity": "骨质",
"start_offset": 60,
"end_offset": 62,
"label": "bod"
},
{
"id": 6,
"entity": "X线上可以为同一的骨质破坏",
"start_offset": 51,
"end_offset": 64,
"label": "sym"
},
{
"id": 7,
"entity": "囊性腔隙",
"start_offset": 73,
"end_offset": 77,
"label": "bod"
},
{
"id": 8,
"entity": "或者形成大小不等的囊性腔隙",
"start_offset": 64,
"end_offset": 77,
"label": "sym"
},
{
"id": 9,
"entity": "骨质",
"start_offset": 84,
"end_offset": 86,
"label": "bod"
},
{
"id": 10,
"entity": "也可以是广泛的骨质破坏",
"start_offset": 77,
"end_offset": 88,
"label": "sym"
},
{
"id": 11,
"entity": "骨",
"start_offset": 88,
"end_offset": 89,
"label": "bod"
},
{
"id": 12,
"entity": "骨",
"start_offset": 113,
"end_offset": 114,
"label": "bod"
},
{
"id": 13,
"entity": "骨",
"start_offset": 129,
"end_offset": 130,
"label": "bod"
},
{
"id": 14,
"entity": "髂骨",
"start_offset": 137,
"end_offset": 139,
"label": "bod"
},
{
"id": 15,
"entity": "股骨",
"start_offset": 140,
"end_offset": 142,
"label": "bod"
},
{
"id": 16,
"entity": "肩胛骨",
"start_offset": 145,
"end_offset": 148,
"label": "bod"
},
{
"id": 17,
"entity": "肱骨",
"start_offset": 149,
"end_offset": 151,
"label": "bod"
}
] |
（二）实验室检查转移性骨肿瘤的诊断假如是在原发肿瘤的诊断之后，相对容易。 | [
{
"id": 0,
"entity": "转移性骨肿瘤",
"start_offset": 8,
"end_offset": 14,
"label": "dis"
}
] |
根据儿童常见肿瘤的发病次序，选择性地进行必要的实验室检查，可以帮助作出正确的诊断。 | [
{
"id": 0,
"entity": "肿瘤",
"start_offset": 6,
"end_offset": 8,
"label": "dis"
}
] |
（三）活体组织检查对于骨骼的肿瘤性病变，活体组织检查是明确诊断最直接的方法，应该尽早进行。 | [
{
"id": 0,
"entity": "活体组织检查",
"start_offset": 3,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "骨骼",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "肿瘤性病变",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
},
{
"id": 3,
"entity": "活体组织检查",
"start_offset": 20,
"end_offset": 26,
"label": "pro"
}
] |
单一的病灶，以直接挖取病灶组织为主要方法，多发性病灶则应该考虑从相对较易取得病变组织的部位着手。 | [
{
"id": 0,
"entity": "病变组织",
"start_offset": 38,
"end_offset": 42,
"label": "bod"
}
] |
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