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间歇性清洁导尿方法为：使用一次性消毒或普通的导尿管（后者每次用前开水煮沸20分钟，用后及时洗净置于干净容器内），每次导尿前用肥皂和清水洗净手和阴部，男孩需使用润滑剂，大年龄的女孩如能自行导尿则借助镜子或感觉，一手将阴唇分开，另一手插导尿管。 | [
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（2）留置导尿术：虽然多数情况下间歇性导尿要优于留置导尿，但下列情况应考虑留置导尿：①低压性膀胱输尿管反流；②严重的双侧上尿路积水；③伴有膀胱输尿管反流的急性重症肾盂肾炎；④患儿不合作。 | [
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留置导尿的适应证还包括：①重症和虚弱患儿存在膀胱排空不完全、完全性尿潴留或尿失禁；②可进行间歇性导尿但因某些原因无法实施者。 | [
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留置导尿期间需预防以下并发症：①尿路感染；②膀胱结石；③膀胱挛缩；④血尿；⑤导尿管堵塞等。 | [
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2.药物治疗神经源性膀胱的药物应用完全是以膀胱、尿道神经支配、自主神经受体分布和药物对膀胱尿道平滑肌作用为基础的，基本可分为兴奋或抑制膀胱逼尿肌、兴奋或抑制膀胱颈和后尿道的药物两大类。 | [
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药物可以是在下尿路存在或形成的、可影响膀胱尿道功能的神经递质，也可以是模拟、增强或抑制某一种或数种神经递质功能的物质，包括经典的神经递质如乙酰胆碱酰胆碱、去甲肾上腺素和组胺，以及其他非胆碱能非肾上腺素能递质如前列腺素、5-羟色胺、多巴胺、NO和P物质等神经肽。 | [
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"entity": "多巴胺",
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药物治疗的主要根据是尿流动力学的检查结果，从应用的范围来看，主要是针对膀胱逼尿肌和尿道括约肌的。 | [
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逼尿肌反射亢进是临床碰到的最为常见的情况，可采用抗胆碱能药物以降低膀胱逼尿肌的收缩。 | [
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抗胆碱能药物包括普鲁苯辛及颠茄合剂等；也可使用兼有抗胆碱及松弛平滑肌作用的药物如氯化羟丁宁和双环胺等。 | [
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对伴有尿道平滑肌痉挛的逼尿肌反射亢进，可应用α受体阻滞剂酚苄明（松弛膀胱出口和尿道平滑肌），可单用或与抗胆碱能药物普鲁苯辛或与氯化羟丁宁合用。 | [
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以达到减轻逼尿肌收缩和解除尿道平滑肌痉挛的作用。 | [
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对伴有尿道外括约肌痉挛的逼尿肌反射亢进，为减轻逼尿肌收缩和解除尿道外括约肌痉挛，降低排尿阻力，可使用骨骼肌松弛剂如硝苯呋海因钠，多突触抑制剂如肼双二乙胺三嗪、氯苯氨丁酸和地西泮以及抗胆碱能药物。 | [
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膀胱逼尿肌反射低下或无反射，治疗的目的在于增加逼尿肌收缩，同时降低流出阻力。 | [
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联合应用氨基甲酰甲基胆碱（拟胆碱药）和酚苄明可达此目的。 | [
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前者单用效果不甚满意，因为氨基甲酰甲基胆碱能增强逼尿肌收缩，同时亦增加尿道平滑肌的收缩。 | [
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加用酚苄明后流出阻力有效地降低，而又不改变增强了的逼尿肌收缩力，是一种极好地联合用药方法。 | [
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丙咪嗪（Imipramine）是目前较为常用的药物，临床上主要用于小儿遗尿症，由于其具有抑制逼尿肌异常反射、增加膀胱容量以及增加尿道内压力的作用，也可治疗因无抑制收缩膀胱导致尿失禁的神经源性膀胱患儿。 | [
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其缺点主要为可产生口干等胃肠道症状、易耐受或复发。 | [
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近年来，有关神经肽在下尿路中的生理和病理作用越来越受到重视，有实验证明P物质不但作为痛觉和炎症的调节因子，还可通过特异性受体对下尿路平滑肌产生收缩作用，临床上也据此采用辣椒素（capsaicin）进行膀胱内灌注以耗竭P物质，减少逼尿肌收缩，改善逼尿肌反射亢进和膀胱过敏等症状，取得较好的疗效。 | [
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3.神经阻滞疗法骶神经根或阴部神经阻滞治疗的目的在于减轻或消除膀胱反射亢进以及减轻或消除外括约肌痉挛。 | [
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由于技术要求高，定位难度大，易发生治疗后大便失禁和阳痿等并发症，且小儿难以合作等原因，目前神经阻滞治疗很少被使用，骶神经根阻滞术仅用于预测骶神经根切断的效果。 | [
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4.其他方法排尿训练及生物反馈等方法旨在诱导、强化正确的感觉反馈，以形成反射性排尿，对神经源性膀胱患儿有一定的作用。 | [
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（1）排尿训练1）“扳机点”排尿：通过用手摩擦大腿、轻叩耻骨上区等方法找到最易诱发膀胱收缩、括约肌松弛而引起排尿的刺激部位（扳机点），并配合以一定的姿势或动作增加排尿的强度。 | [
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"start_offset": 9,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "通过用手摩擦大腿、轻叩耻骨上区等方法找到最易诱发膀胱收缩、括约肌松弛而引起排尿的刺激部位（扳机点），并配合以一定的姿势或动作增加排尿的强度",
"start_offset": 17,
"end_offset": 86,
"label": "pro"
}
] |
该方法适用于诱导逼尿肌反射亢进的患儿产生反射性排尿。 | [
{
"id": 0,
"entity": "逼尿肌反射亢进",
"start_offset": 8,
"end_offset": 15,
"label": "dis"
}
] |
2）Crede手法和Valsalva动作：对于因逼尿肌无反射或反射减退而无Crede手法，即嘱患儿取端坐位，以一手或二手四指压迫耻骨上区，持续压迫膀胱，增加膀胱内压使膀胱颈也可同时辅以Valsalva动作（用力吸气后屏住呼吸做呼气的动作），逼尿肌反射亢进为其禁忌证Kegel训练：目的在于增强盆底肌肉尤其是耻骨尾骨肌的功能。 | [
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"id": 0,
"entity": "Crede手法",
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{
"id": 1,
"entity": "逼尿肌",
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"label": "bod"
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{
"id": 2,
"entity": "逼尿肌无反射或反射减退而无",
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{
"id": 3,
"entity": "Crede手法",
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{
"id": 4,
"entity": "耻骨",
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},
{
"id": 5,
"entity": "膀胱",
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"label": "bod"
},
{
"id": 6,
"entity": "膀胱",
"start_offset": 78,
"end_offset": 80,
"label": "bod"
},
{
"id": 7,
"entity": "膀胱颈",
"start_offset": 83,
"end_offset": 86,
"label": "bod"
},
{
"id": 8,
"entity": "逼尿肌",
"start_offset": 120,
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"label": "bod"
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{
"id": 9,
"entity": "Kegel训练",
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"label": "pro"
},
{
"id": 10,
"entity": "盆底肌肉",
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"label": "bod"
},
{
"id": 11,
"entity": "耻骨尾骨肌",
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"end_offset": 158,
"label": "bod"
}
] |
应指导患儿进行会阴部收缩或放松，做类似于抑制排大便（提肛）和中断排尿（收缩尿道外括约肌）的动作。 | [
{
"id": 0,
"entity": "应指导患儿进行会阴部收缩或放松，做类似于抑制排大便（提肛）和中断排尿（收缩尿道外括约肌）的动作",
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] |
在女性压力性尿失禁，还可将手指置于阴道内指导患儿通过收缩阴道肌肉进行挤压来增强耻骨尾骨肌的收缩逼尿肌与括约肌不协调的患儿，也可通过该训练指导他们松弛会阴，在不用劲的情况下维持尿流的连续性。 | [
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"id": 0,
"entity": "压力性尿失禁",
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},
{
"id": 1,
"entity": "将手指置于阴道内指导患儿通过收缩阴道肌肉进行挤压来增强耻骨尾骨肌的收缩",
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"label": "pro"
},
{
"id": 2,
"entity": "逼尿肌",
"start_offset": 47,
"end_offset": 50,
"label": "bod"
},
{
"id": 3,
"entity": "括约肌",
"start_offset": 51,
"end_offset": 54,
"label": "bod"
},
{
"id": 4,
"entity": "通过该训练指导他们松弛会阴，在不用劲的情况下维持尿流的连续性",
"start_offset": 63,
"end_offset": 93,
"label": "pro"
}
] |
（2）生物反馈：生物反馈的定义为应用检测仪器将体内生理过程记录并加以放大，使之成为可被利用的信息。 | [
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"id": 0,
"entity": "生物反馈",
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"label": "pro"
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{
"id": 1,
"entity": "生物反馈",
"start_offset": 8,
"end_offset": 12,
"label": "pro"
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] |
尿流动力学仪器通过膀胱压力容积测定和会阴肌肌电图描计将得到的信息反馈给患者：对于排尿困难者，可训练其增加膀胱内压，克服出口阻力，并同时松弛外括约肌；对于急迫性尿失禁的患儿，可训练其抑制逼尿肌收缩训练以增加膀胱出口阻力手术治疗1.降低膀胱出口阻力的手术（1）神经根切断术：因上运动神经元病变引起逼尿肌反射亢进或痉挛性膀胱，经骶神经阻滞试验、尿流动力学测定证实效果显著且保守治疗无效时，可考虑进行骶神经根切断术，切断骶髓反射弧使上运动神经元病变转变为下运动神经元病变，由此产生一无反射性膀胱，从而增加膀胱容量，降低膀胱内压力以减少对肾脏的威胁骶神经根切断术后，25例转变为有一定容量的无反射性膀胱，23例能满意地排空膀胱，无需再用导尿管。 | [
{
"id": 0,
"entity": "膀胱压力容积测定",
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"label": "pro"
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{
"id": 1,
"entity": "会阴肌肌电图描计",
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"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "膀胱",
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"label": "bod"
},
{
"id": 3,
"entity": "外括约肌",
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{
"id": 4,
"entity": "可训练其抑制逼尿肌收缩",
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"label": "pro"
},
{
"id": 5,
"entity": "训练以增加膀胱出口阻力",
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"label": "pro"
},
{
"id": 6,
"entity": "手术治疗",
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"label": "pro"
},
{
"id": 7,
"entity": "降低膀胱出口阻力的手术",
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"end_offset": 125,
"label": "pro"
},
{
"id": 8,
"entity": "神经根切断术",
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"label": "pro"
},
{
"id": 9,
"entity": "运动神经元病变",
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},
{
"id": 10,
"entity": "逼尿肌反射亢进",
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"end_offset": 153,
"label": "dis"
},
{
"id": 11,
"entity": "痉挛性膀胱",
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"end_offset": 159,
"label": "dis"
},
{
"id": 12,
"entity": "骶神经阻滞试验",
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"end_offset": 168,
"label": "pro"
},
{
"id": 13,
"entity": "尿流动力学测定",
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"end_offset": 176,
"label": "pro"
},
{
"id": 14,
"entity": "骶神经根切断术",
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"end_offset": 203,
"label": "pro"
},
{
"id": 15,
"entity": "上运动神经元病",
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"end_offset": 219,
"label": "dis"
},
{
"id": 16,
"entity": "下运动神经元病变",
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"end_offset": 231,
"label": "dis"
},
{
"id": 17,
"entity": "无反射性膀胱",
"start_offset": 237,
"end_offset": 243,
"label": "dis"
},
{
"id": 18,
"entity": "膀胱",
"start_offset": 248,
"end_offset": 250,
"label": "bod"
},
{
"id": 19,
"entity": "膀胱",
"start_offset": 255,
"end_offset": 257,
"label": "bod"
},
{
"id": 20,
"entity": "骶神经根切断术",
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"end_offset": 276,
"label": "pro"
},
{
"id": 21,
"entity": "无反射性膀胱",
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"end_offset": 296,
"label": "dis"
},
{
"id": 22,
"entity": "膀胱",
"start_offset": 306,
"end_offset": 308,
"label": "bod"
},
{
"id": 23,
"entity": "导尿管",
"start_offset": 313,
"end_offset": 316,
"label": "equ"
}
] |
然而阳痿和大便失禁是骶神经根切断术的常见并发症，上述报道中有85%的病人出现阳痿症状。 | [
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"id": 0,
"entity": "阳痿",
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{
"id": 1,
"entity": "大便失禁",
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{
"id": 2,
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{
"id": 3,
"entity": "阳痿",
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] |
近年采用选择性骶神经根切断术的报告中，结果较为满意且阳痿的发生率较低。 | [
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"id": 0,
"entity": "选择性骶神经根切断术",
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{
"id": 1,
"entity": "阳痿",
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] |
在20世纪50和60年代单侧或双侧性阴部神经切断术也是治疗小儿尿路出口梗阻的一种常规手术，但因阳痿发生率也较高，并可能出现术后会阴和肛门周围皮肤感觉丧失以及大便失禁，目前已少采用。 | [
{
"id": 0,
"entity": "单侧或双侧性阴部神经切断术",
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{
"id": 1,
"entity": "小儿尿路出口梗阻",
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{
"id": 2,
"entity": "阳痿",
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{
"id": 3,
"entity": "术后会阴和肛门周围皮肤感觉丧失以及大便失禁",
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"label": "sym"
}
] |
（2）经尿道膀胱颈、尿道外括约肌切开术：Braasch和Thompson在1953年首次经尿道行膀胱颈切开术，以后这一手术为Emmett所提倡。 | [
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{
"id": 1,
"entity": "经尿道行膀胱颈切开术",
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] |
手术切开部位主要为膀胱截石位5点、7点和/或12点。 | [
{
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"entity": "膀胱截石位5点、7点和/或12点",
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] |
对于无反射性膀胱，膀胱颈部不能适当开放但又无明显外括约肌痉挛者效果较好，可结合腹部用力或Crede法排尿而获得满意的排空效果。 | [
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"id": 0,
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{
"id": 1,
"entity": "膀胱颈部",
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{
"id": 2,
"entity": "外括约肌痉挛",
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"label": "dis"
}
] |
但该方法不适用于外括约肌痉挛或膀胱逼尿肌与尿道括约肌不协调的病人。 | [
{
"id": 0,
"entity": "外括约肌痉挛",
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{
"id": 1,
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"label": "dis"
}
] |
由于目前尚无单纯作用于外括约肌的药物，经尿道外括约肌切开术常应用于因上运动神经元病变造成外括约肌痉挛或膀胱逼尿肌与尿道括约肌不协调的病例。 | [
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"id": 0,
"entity": "上运动神经元病变",
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{
"id": 1,
"entity": "外括约肌痉挛",
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{
"id": 2,
"entity": "膀胱逼尿肌与尿道括约肌不协调",
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"end_offset": 65,
"label": "dis"
}
] |
术前尿流动力学评价十分重要：膀胱有足够容量，逼尿肌收缩较好，尿道压力显示括约肌压力等于或大于逼尿肌压力，或存在膀胱逼尿肌与尿道括约肌不协调时采用经尿道外括约肌切开术效果较好。 | [
{
"id": 0,
"entity": "膀胱有足够容量",
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"label": "sym"
},
{
"id": 1,
"entity": "逼尿肌收缩较好",
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{
"id": 2,
"entity": "尿道压力显示括约肌压力等于或大于逼尿肌压力",
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},
{
"id": 3,
"entity": "或存在膀胱逼尿肌与尿道括约肌不协调时采用经尿道外括约肌切开术效果较好",
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"label": "sym"
}
] |
该手术为一种不可逆的手术方法，如患者膀胱颈部功能不正常（无正常控制排尿能力），尿失禁是其唯一结果，病人常需在术后使用集尿装置。 | [
{
"id": 0,
"entity": "尿失禁",
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"label": "dis"
},
{
"id": 1,
"entity": "集尿装置",
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}
] |
标准切口从近精阜下端起到尿道球部止，长约2.5～3cm，深度为必须切断该处的弹性纤维环、环行平滑肌和外括约肌组织。 | [
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"id": 0,
"entity": "精阜下端",
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{
"id": 1,
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{
"id": 2,
"entity": "弹性纤维环",
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{
"id": 3,
"entity": "环行平滑肌",
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},
{
"id": 4,
"entity": "外括约肌组织",
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"label": "bod"
}
] |
经尿道外括约肌切开术的并发症为切口出血、穿孔、尿外渗及尿路感染、尿道狭窄等，有作者认为12点切口是并发症最少最安全的切口，而3点和9点切口出现阳痿的可能性较大。 | [
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{
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{
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{
"id": 6,
"entity": "阳痿",
"start_offset": 71,
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"label": "dis"
}
] |
（3）Y-V膀胱颈成形术：应用于因慢性炎症或导管慢性刺激造成膀胱颈部纤维狭窄的神经源性膀胱病人，常与其他手术如纠正膀胱输尿管反流等同时进行，或对完全性尿失禁病人于本手术同时植入人工尿道括约肌。 | [
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{
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{
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{
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"entity": "膀胱输尿管反流",
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{
"id": 4,
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{
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"entity": "植入人工尿道括约肌",
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}
] |
Y-V成形术一般能起到在保持尿不失禁的情况下改善膀胱排空的作用，虽可能损害近端括约肌机制，但较轻微。 | [
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{
"id": 1,
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}
] |
2.增加膀胱出口阻力的手术（1）膀胱颈悬吊术：多用于治疗膀胱出口阻力低且不伴逼尿肌不稳定的尿失禁患者。 | [
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{
"id": 1,
"entity": "膀胱颈悬吊术",
"start_offset": 16,
"end_offset": 22,
"label": "pro"
},
{
"id": 2,
"entity": "膀胱出口阻力低且不伴逼尿肌不稳定",
"start_offset": 28,
"end_offset": 44,
"label": "sym"
},
{
"id": 3,
"entity": "尿失禁",
"start_offset": 45,
"end_offset": 48,
"label": "dis"
}
] |
目前主要采用悬吊术（slingprocedures），利用机体各种组织片或合成替代物作膀胱颈悬吊术。 | [
{
"id": 0,
"entity": "悬吊术",
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"end_offset": 9,
"label": "pro"
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{
"id": 1,
"entity": "slingprocedures",
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"label": "pro"
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{
"id": 2,
"entity": "膀胱颈悬吊术",
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"label": "pro"
}
] |
Kurzrock等采用膀胱前壁带蒂肌瓣环绕膀胱颈部并将其悬吊于耻骨及筋膜的方法治疗膀胱出口阻力低且顺应性差的神经源性膀胱患儿，获得较好的治疗效果。 | [
{
"id": 0,
"entity": "采用膀胱前壁带蒂肌瓣环绕膀胱颈部并将其悬吊于耻骨及筋膜的方法",
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{
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{
"id": 2,
"entity": "神经源性膀胱",
"start_offset": 54,
"end_offset": 60,
"label": "dis"
}
] |
（2）特氟隆（teflon）等生物材料注射手术：1973年Politano报道应用特氟隆作为硬化剂，注射于膜部尿道治疗压力性尿失禁，治愈率达76%，引起各界注意。 | [
{
"id": 0,
"entity": "特氟隆（teflon）",
"start_offset": 3,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "生物材料注射手术",
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"end_offset": 23,
"label": "pro"
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{
"id": 2,
"entity": "特氟隆",
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},
{
"id": 3,
"entity": "注射",
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},
{
"id": 4,
"entity": "压力性尿失禁",
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"end_offset": 65,
"label": "dis"
}
] |
如今，尽管美国FDA未批准使用，内镜特氟隆注射疗法已用于漏尿压较低的神经源性尿失禁患儿的初次治疗，或通过手术不能完全控制的失禁病例。 | [
{
"id": 0,
"entity": "内镜特氟隆注射疗法",
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{
"id": 1,
"entity": "神经源性尿失禁",
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"end_offset": 41,
"label": "dis"
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] |
理想的内镜治疗应满足下列标准：内镜检查发现后尿道和膀胱颈可以进行黏膜下注射，而尿道必须容易导尿；如膀胱功能亢进且药物无法控制，逼尿肌不稳定、膀胱顺应性低以及逼尿肌括约肌失协调者不宜作内镜治疗。 | [
{
"id": 0,
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{
"id": 1,
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{
"id": 2,
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{
"id": 3,
"entity": "膀胱颈",
"start_offset": 25,
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{
"id": 4,
"entity": "黏膜",
"start_offset": 32,
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{
"id": 5,
"entity": "膀胱功能亢进",
"start_offset": 49,
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"label": "dis"
},
{
"id": 6,
"entity": "逼尿肌不稳定",
"start_offset": 63,
"end_offset": 69,
"label": "sym"
},
{
"id": 7,
"entity": "膀胱顺应性低以及逼尿肌括约肌失协调",
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"label": "sym"
},
{
"id": 8,
"entity": "内镜治疗",
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"end_offset": 95,
"label": "pro"
}
] |
内镜注射疗法常采用经尿道操作，用Williams针穿过膀胱镜的操作道，女性在膀胱截石位3、6、9、12点，男性在5、7、12点（男性6点处不注射，以免伤及精阜和前列腺组织）位置穿入尿道括约肌段黏膜或括约肌，每一部位注射0.75～2.5ml的特氟隆，以隆起的黏膜完全闭合管腔为度。 | [
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"entity": "内镜注射疗法",
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{
"id": 1,
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"label": "equ"
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{
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"entity": "膀胱",
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{
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"entity": "精阜",
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{
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{
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"entity": "尿道括约肌段黏膜",
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{
"id": 6,
"entity": "括约肌",
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"label": "bod"
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{
"id": 7,
"entity": "特氟隆",
"start_offset": 120,
"end_offset": 123,
"label": "dru"
},
{
"id": 8,
"entity": "黏膜",
"start_offset": 128,
"end_offset": 130,
"label": "bod"
}
] |
患儿术后需留置8～10FrFoley导尿管，后再行数小时的间歇导尿以避免术后暂时性的尿潴留。 | [
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"entity": "FrFoley导尿管",
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{
"id": 1,
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"label": "dis"
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] |
除特氟隆外，戊二醛交联的牛胶原蛋白也是一种常用的生物注射材料，但它们可能引起特氟隆颗粒迁移至肺和脑实质、“特氟隆性肉芽肿”或胶原蛋白导致的急/慢性免疫反应等并发症。 | [
{
"id": 0,
"entity": "特氟隆",
"start_offset": 1,
"end_offset": 4,
"label": "dru"
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{
"id": 1,
"entity": "戊二醛交联的牛胶原蛋白",
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"end_offset": 17,
"label": "dru"
},
{
"id": 2,
"entity": "肺",
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{
"id": 3,
"entity": "脑实质",
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},
{
"id": 4,
"entity": "“特氟隆性肉芽肿”或胶原蛋白导致的急/慢性免疫反应",
"start_offset": 52,
"end_offset": 77,
"label": "dis"
}
] |
（3）人工尿道括约肌：适用于神经源性尿失禁患者。 | [
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"entity": "人工尿道括约肌",
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{
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"entity": "神经源性尿失禁",
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] |
严重逼尿肌反射亢进、膀胱顺应性差、合并严重的膀胱输尿管反流以及尿道梗阻者不宜应用。 | [
{
"id": 0,
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{
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{
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"entity": "膀胱输尿管反流",
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},
{
"id": 3,
"entity": "尿道梗阻",
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"label": "dis"
}
] |
3.增加膀胱容量的手术目前应用的主要为胃（肠）膀胱扩大成形术。 | [
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{
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] |
胃、肠膀胱扩大成形术的目的在于使患者膀胱有足够容量，减少排尿次数，增加尿量，并能使患者随意地进行排尿。 | [
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] |
膀胱容量小，且有尿潴留的患者作膀胱扩大术后，进行间歇性导尿的次数可大为减少。 | [
{
"id": 0,
"entity": "膀胱容量小",
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{
"id": 1,
"entity": "且有尿潴留",
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] |
也可用于逼尿肌反射亢进的病人，但如患有逼尿肌括约肌不协调或膀胱出口梗阻者可能影响膀胱扩大术的效果。 | [
{
"id": 0,
"entity": "逼尿肌反射亢进",
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{
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"entity": "逼尿肌括约肌不协调或膀胱出口梗阻",
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"label": "dis"
},
{
"id": 2,
"entity": "膀胱扩大术",
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"end_offset": 45,
"label": "pro"
}
] |
膀胱扩大术可选用胃、回肠、盲肠或乙状结肠作为材料，并可产生相应的并发症：①残余尿。 | [
{
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"entity": "膀胱扩大术",
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{
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{
"id": 2,
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{
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"entity": "盲肠",
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{
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"entity": "乙状结肠",
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},
{
"id": 5,
"entity": "残余尿",
"start_offset": 37,
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}
] |
②尿路感染。 | [
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"entity": "尿路感染",
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] |
③结石形成。 | [
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] |
④电解质紊乱，多见于尿路梗阻患者。 | [
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"entity": "电解质紊乱",
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] |
⑤尿液酸度升高，产生尿痛等刺激症状，多见于胃膀胱扩大成形术。 | [
{
"id": 0,
"entity": "尿液酸度升高，产生尿痛等刺激症状，多见于胃膀胱扩大成形术",
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"end_offset": 29,
"label": "sym"
}
] |
⑥膀胱出口梗阻导致手术失败。 | [
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"entity": "膀胱出口梗阻导致手术失败",
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] |
上运动神经元病变常引起逼尿肌括约肌收缩不协调，不能产生正常排尿功能，故采用膀胱扩大术的同时，作Y-V成形术或括约肌切开术，以改善术后排尿功能。 | [
{
"id": 0,
"entity": "上运动神经元病变常引起逼尿肌括约肌收缩不协调，不能产生正常排尿功能",
"start_offset": 0,
"end_offset": 33,
"label": "sym"
},
{
"id": 1,
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},
{
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"entity": "Y-V成形术",
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},
{
"id": 3,
"entity": "括约肌切开术",
"start_offset": 54,
"end_offset": 60,
"label": "pro"
}
] |
⑦有黏膜恶变可能。 | [
{
"id": 0,
"entity": "有黏膜恶变可能",
"start_offset": 1,
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"label": "sym"
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] |
自体膀胱扩大术可增加膀胱容量和顺应性，降低膀胱贮尿期压力，从而减少对上尿路的损害，对于因神经源性膀胱引起的膀胱顺应性差、容量小以及膀胱压力高等情况尤为有效，而且与采用胃（肠道）代膀胱手术以扩大膀胱容量相比，该手术具有创伤小，手术、住院时间短，无需进行特别的术前准备，不会出现术后代谢紊乱或尿路结石、感染等并发症，也不影响以后其他膀胱扩大手术方法的应用的优点，但其长期效果有待观察。 | [
{
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{
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"entity": "代谢紊乱",
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{
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{
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{
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"entity": "膀胱扩大手术",
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] |
4.增加膀胱逼尿肌收缩能力的手术（1）电刺激治疗1954年McGuire在截瘫病人中首次试用了可植入性膀胱刺激装置，但效果不理想。 | [
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{
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（2）单层肠浆肌层膀胱加强术：应用带血管神经蒂的肠段，去除肠黏膜，沿系膜对侧缘剪开，形成单层肠浆肌层，包绕缝合于膀胱表面，加强膀胱逼尿肌收缩能力，也可能促进逼尿肌神经的再分布，重新建立排尿反射。 | [
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{
"id": 1,
"entity": "应用带血管神经蒂的肠段，去除肠黏膜，沿系膜对侧缘剪开，形成单层肠浆肌层",
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{
"id": 2,
"entity": "包绕缝合于膀胱表面，加强膀胱逼尿肌收缩能力，也可能促进逼尿肌神经的再分布，重新建立排尿反射",
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] |
该手术的效果可能与膀胱逼尿肌的纤维疤痕化程度有关。 | [
{
"id": 0,
"entity": "膀胱逼尿肌",
"start_offset": 9,
"end_offset": 14,
"label": "bod"
}
] |
5.其他尿流改道常作为最后保护和挽救肾功能的重要措施之一，极少用于神经源性膀胱的最初治疗。 | [
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{
"id": 1,
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] |
主要适用于尿路感染和尿道梗阻持续存在，药物或外科治疗无法解决者；膀胱功能完全丧失，无力排空或出现完全性尿失禁者；膀胱失代偿导致上尿路积水者。 | [
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{
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{
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"entity": "完全性尿失禁",
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{
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"entity": "膀胱失代偿导致上尿路积水",
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"label": "sym"
}
] |
尿流改道方法繁多，以膀胱为界可分成三大类：①膀胱以下：导尿术及会阴尿道造瘘术；②膀胱部位：耻骨上膀胱造瘘术及膀胱皮肤造瘘术；③膀胱以上：输尿管皮肤造瘘术、输尿管乙状结肠吻合术、输尿管肠吻合造瘘术及肾造瘘术等。 | [
{
"id": 0,
"entity": "膀胱",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 1,
"entity": "导尿术",
"start_offset": 27,
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"label": "pro"
},
{
"id": 2,
"entity": "会阴尿道造瘘术",
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"end_offset": 38,
"label": "pro"
},
{
"id": 3,
"entity": "耻骨上膀胱造瘘术",
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},
{
"id": 4,
"entity": "膀胱皮肤造瘘术",
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"label": "pro"
},
{
"id": 5,
"entity": "输尿管皮肤造瘘术",
"start_offset": 68,
"end_offset": 76,
"label": "pro"
},
{
"id": 6,
"entity": "输尿管乙状结肠吻合术",
"start_offset": 77,
"end_offset": 87,
"label": "pro"
},
{
"id": 7,
"entity": "输尿管肠吻合造瘘术",
"start_offset": 88,
"end_offset": 97,
"label": "pro"
},
{
"id": 8,
"entity": "肾造瘘术",
"start_offset": 98,
"end_offset": 102,
"label": "pro"
}
] |
选择合适的尿流改道手术，应首先考虑肾功能情况，其次是手术部位（膀胱、输尿管及肾脏）、转流道（应用导管、肠段及尿路本身器官）、暂时或永久改道等手术方面的选择。 | [
{
"id": 0,
"entity": "膀胱",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 1,
"entity": "输尿管",
"start_offset": 34,
"end_offset": 37,
"label": "bod"
},
{
"id": 2,
"entity": "肾脏",
"start_offset": 38,
"end_offset": 40,
"label": "bod"
}
] |
神经源性膀胱患者采用膀胱以上的尿流改道手术并不多见，并且由于间歇性导尿的广泛应用，永久性尿流改道多用于对尿失禁的控制。 | [
{
"id": 0,
"entity": "神经源性膀胱",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "膀胱",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "尿流改道手术",
"start_offset": 15,
"end_offset": 21,
"label": "pro"
}
] |
（三）并发症的治疗1.尿路感染是神经源性膀胱最常见的并发症，主要由于残余尿积聚或留置导尿造成。 | [
{
"id": 0,
"entity": "尿路感染",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "神经源性膀胱",
"start_offset": 16,
"end_offset": 22,
"label": "dis"
}
] |
间歇性清洁导尿可明显降低尿路感染率，该方法不主张应用抗生素或化学杀菌剂作为预防用药，以防耐药菌产生，仅主张于有明显感染症状时用。 | [
{
"id": 0,
"entity": "抗生素",
"start_offset": 26,
"end_offset": 29,
"label": "dru"
},
{
"id": 1,
"entity": "化学杀菌剂",
"start_offset": 30,
"end_offset": 35,
"label": "dru"
}
] |
2.尿路结石神经源性膀胱患者中尿潴留、尿路感染、组织碎片和上皮细胞脱落等为结石形成创造了有利条件。 | [
{
"id": 0,
"entity": "尿路结石",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "神经源性膀胱",
"start_offset": 6,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "尿潴留",
"start_offset": 15,
"end_offset": 18,
"label": "dis"
},
{
"id": 3,
"entity": "尿路感染",
"start_offset": 19,
"end_offset": 23,
"label": "dis"
},
{
"id": 4,
"entity": "组织碎片",
"start_offset": 24,
"end_offset": 28,
"label": "dis"
},
{
"id": 5,
"entity": "上皮细胞脱落",
"start_offset": 29,
"end_offset": 35,
"label": "dis"
}
] |
多见于膀胱结石，尤其在留置导尿的患者。 | [
{
"id": 0,
"entity": "膀胱结石",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
}
] |
3.膀胱输尿管反流治疗的基本原则是保持膀胱排空和降低膀胱内压，如上述方法不能使反流消失，应考虑进行抗反流手术。 | [
{
"id": 0,
"entity": "膀胱输尿管反流",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "保持膀胱排空和降低膀胱内压",
"start_offset": 17,
"end_offset": 30,
"label": "pro"
}
] |
4.上尿路积水引起输尿管和/或肾盂积水的原因，主要是由于膀胱残余尿量增加，膀胱内压升高，影响膀胱输尿管连接部抗反流的正常机制。 | [
{
"id": 0,
"entity": "上尿路积水",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "膀胱残余尿量增加，膀胱内压升高，影响膀胱输尿管连接部抗反流的正常机制",
"start_offset": 28,
"end_offset": 62,
"label": "sym"
}
] |
治疗上尿路积水的关键在于早期处理，通过导尿术等方法减少残余尿，降低膀胱内压力。 | [
{
"id": 0,
"entity": "治疗上尿路积水的关键在于早期处理，通过导尿术等方法减少残余尿，降低膀胱内压力",
"start_offset": 0,
"end_offset": 38,
"label": "pro"
}
] |
如儿童期的钙摄入充足，可使成人期的骨质疏松和骨折的机会减少。 | [
{
"id": 0,
"entity": "骨质疏松",
"start_offset": 17,
"end_offset": 21,
"label": "sym"
},
{
"id": 1,
"entity": "骨折",
"start_offset": 22,
"end_offset": 24,
"label": "sym"
}
] |
第一节婴儿期（0～1岁）的膳食特点【婴儿期的营养需要】此期的生长发育是一生中最快的，一年内体重增加3倍，身长增加50%，故各种营养素的需求量大，但此时胃肠功能不成熟，存在矛盾；肝脏功能不完善，氨基酸要求高；肾脏功能不全，负担不能过大。 | [
{
"id": 0,
"entity": "胃肠功能不成熟",
"start_offset": 75,
"end_offset": 82,
"label": "sym"
},
{
"id": 1,
"entity": "肝脏功能不完善",
"start_offset": 88,
"end_offset": 95,
"label": "sym"
},
{
"id": 2,
"entity": "肾脏功能不全",
"start_offset": 103,
"end_offset": 109,
"label": "sym"
}
] |
热能需要高于成人3～4倍，1岁以内的婴儿母乳喂养70～85kcal/（kg•d），人工喂养75～90kcal/（kg•d）。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
}
] |
蛋白质2～4g/（kg•d）（母乳2g/kg，牛乳3.5g/kg，大豆蛋白4g/kg）。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
}
] |
由于肝脏不成熟，某些氨基酸（如组氨酸）不能合成，胱氨酸、酪氨酸合成低下；另外，由于支链氨基酸不增加肝脏负担；精氨酸有促进生长的作用，防止高氨血症，提高免疫功能；牛磺酸参与胆汁酸的代谢，且是神经系统及视网膜发育不可缺少的成分。 | [
{
"id": 0,
"entity": "肝脏不成熟",
"start_offset": 2,
"end_offset": 7,
"label": "sym"
},
{
"id": 1,
"entity": "胱氨酸",
"start_offset": 24,
"end_offset": 27,
"label": "bod"
},
{
"id": 2,
"entity": "酪氨酸",
"start_offset": 28,
"end_offset": 31,
"label": "bod"
},
{
"id": 3,
"entity": "胱氨酸、酪氨酸合成低下",
"start_offset": 24,
"end_offset": 35,
"label": "sym"
},
{
"id": 4,
"entity": "支链氨基酸",
"start_offset": 41,
"end_offset": 46,
"label": "bod"
},
{
"id": 5,
"entity": "肝脏",
"start_offset": 49,
"end_offset": 51,
"label": "bod"
},
{
"id": 6,
"entity": "精氨酸",
"start_offset": 54,
"end_offset": 57,
"label": "bod"
},
{
"id": 7,
"entity": "高氨血症",
"start_offset": 68,
"end_offset": 72,
"label": "dis"
},
{
"id": 8,
"entity": "牛磺酸",
"start_offset": 80,
"end_offset": 83,
"label": "bod"
},
{
"id": 9,
"entity": "胆汁酸",
"start_offset": 85,
"end_offset": 88,
"label": "bod"
},
{
"id": 10,
"entity": "神经系统",
"start_offset": 94,
"end_offset": 98,
"label": "bod"
},
{
"id": 11,
"entity": "视网膜",
"start_offset": 99,
"end_offset": 102,
"label": "bod"
}
] |
所以，氨基酸品种需要多，必需氨基酸的需要量明显高于成人。 | [
{
"id": 0,
"entity": "氨基酸",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "必需氨基酸",
"start_offset": 12,
"end_offset": 17,
"label": "bod"
}
] |
脂肪提供的热能占总热能的35%～50%，必需脂肪酸不低于1%～3%。 | [
{
"id": 0,
"entity": "脂肪",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "必需脂肪酸",
"start_offset": 20,
"end_offset": 25,
"label": "bod"
}
] |
婴儿（尤其是早产儿）不能从亚油酸、亚麻酸合成花生四烯酸和二十二碳六烯酸，而这些成分也是神经细胞膜和视网膜发育不可缺少的，所以，必须由食物中补充。 | [
{
"id": 0,
"entity": "亚油酸",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "亚麻酸",
"start_offset": 17,
"end_offset": 20,
"label": "bod"
},
{
"id": 2,
"entity": "花生四烯酸",
"start_offset": 22,
"end_offset": 27,
"label": "bod"
},
{
"id": 3,
"entity": "二十二碳六烯酸",
"start_offset": 28,
"end_offset": 35,
"label": "bod"
},
{
"id": 4,
"entity": "神经细胞膜",
"start_offset": 43,
"end_offset": 48,
"label": "bod"
},
{
"id": 5,
"entity": "视网膜",
"start_offset": 49,
"end_offset": 52,
"label": "bod"
}
] |
乳类包括母乳、牛乳、羊乳和婴儿配方乳。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
}
] |
母乳是婴儿首选的最佳食品，现公认4～6个月内婴儿应采用纯母乳喂养。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "母乳",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
}
] |
1.母乳喂养（1）人乳的优点：人乳的优越性是其他任何乳类所不能比拟的，其所含的营养素一般都能满足婴儿的需求，对婴儿的生长发育最有利。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "人乳",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "人乳",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
}
] |
各期人乳所含营养成分见表4-4。 | [
{
"id": 0,
"entity": "人乳",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
}
] |
人乳中乳清蛋白比酪蛋白多，且以人乳清蛋白为主，在胃中形成的凝块小，易消化，不易引起过敏。 | [
{
"id": 0,
"entity": "人乳",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "乳清蛋白",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "酪蛋白",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 3,
"entity": "乳清蛋白",
"start_offset": 16,
"end_offset": 20,
"label": "bod"
},
{
"id": 4,
"entity": "胃",
"start_offset": 24,
"end_offset": 25,
"label": "bod"
},
{
"id": 5,
"entity": "过敏",
"start_offset": 41,
"end_offset": 43,
"label": "sym"
}
] |
人乳所含的氨基酸比值恰当。 | [
{
"id": 0,
"entity": "氨基酸",
"start_offset": 5,
"end_offset": 8,
"label": "bod"
}
] |
牛磺酸含量是牛乳的10倍，它具有促进大脑发育的作用。 | [
{
"id": 0,
"entity": "牛磺酸",
"start_offset": 0,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "大脑",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
}
] |
此外，还含有乳铁蛋白、分泌型IgA（SIgA）、溶菌酶等抗感染的蛋白质。 | [
{
"id": 0,
"entity": "乳铁蛋白",
"start_offset": 6,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "分泌型IgA",
"start_offset": 11,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "SIgA",
"start_offset": 18,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "溶菌酶",
"start_offset": 24,
"end_offset": 27,
"label": "bod"
},
{
"id": 4,
"entity": "感染",
"start_offset": 29,
"end_offset": 31,
"label": "dis"
},
{
"id": 5,
"entity": "蛋白质",
"start_offset": 32,
"end_offset": 35,
"label": "bod"
}
] |
人乳含不饱和必需脂肪酸较多，还含卵磷脂和鞘磷脂，对婴儿中枢神经系统发育极为重要。 | [
{
"id": 0,
"entity": "人乳",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "必需脂肪酸",
"start_offset": 6,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "卵磷脂",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 3,
"entity": "鞘磷脂",
"start_offset": 20,
"end_offset": 23,
"label": "bod"
},
{
"id": 4,
"entity": "中枢神经系统",
"start_offset": 27,
"end_offset": 33,
"label": "bod"
}
] |
乳糖含量高，且以乙型乳糖为主，有助于类脂物的完全氧化及肝糖原的贮存，可促进乳酸杆菌生长，使pH值降低，有助于钙的吸收和抑制大肠杆菌生长，人乳乳糖较葡萄糖更易合成脑苷脂类，有利于大脑发育。 | [
{
"id": 0,
"entity": "乳糖",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "乙型乳糖",
"start_offset": 8,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "类脂物",
"start_offset": 18,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "肝糖原",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "乳酸杆菌",
"start_offset": 37,
"end_offset": 41,
"label": "bod"
},
{
"id": 5,
"entity": "大肠杆菌",
"start_offset": 61,
"end_offset": 65,
"label": "bod"
},
{
"id": 6,
"entity": "人乳乳糖",
"start_offset": 68,
"end_offset": 72,
"label": "bod"
},
{
"id": 7,
"entity": "脑苷脂类",
"start_offset": 80,
"end_offset": 84,
"label": "bod"
},
{
"id": 8,
"entity": "大脑",
"start_offset": 88,
"end_offset": 90,
"label": "bod"
}
] |
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