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人乳中矿物质的总量比牛乳低，对于肾功能尚未发育完善的初生婴儿是有利的。 | [
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初乳含微量元素锌和铜较高，但人乳中维生素D和维生素K的含量较少，故应及时补充。 | [
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另外，人乳中含有大量免疫物质，能增进婴儿的抗感染能力。 | [
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人乳含有IgA、IgG、IgM及IgE等免疫球蛋白，尤以初乳中SIgA量最多，它具有抗肠道微生物的作用以及抗呼吸道病毒病毒的作用。 | [
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人乳含有各类免疫细胞，其中大多数为巨噬细胞，约占90%；其余是中性粒细胞、T和B淋巴细胞、浆细胞。 | [
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母乳喂哺不易污染，温度适宜，方便经济，不易引起婴儿过敏；可增进母婴感情，使婴儿获得满足感及安全感，也有利于教养，促进婴儿的心理发育。 | [
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大量的研究资料证明母乳喂养的婴儿患病率、死亡率低于非母乳喂养的婴儿。 | [
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表4-2各期人乳的成分（g/L）母乳喂养对早产儿来说更重要，早产儿母乳中的成分与足月母乳又有不同，其营养价值和生物学功能更适合早产儿的需求（表4-4）。 | [
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如蛋白质含量高，利于早产儿的快速生长；乳清蛋白与酪蛋白的比例为70∶30，脂肪和乳糖含量偏低，易于吸收；钠盐较高，利于补充早产儿钠的丢失；长链多不饱和脂肪酸，如二十二碳六烯酸（DHA）、花生四烯酸（AA）和牛磺酸，是足月成熟乳含量的1.5～2倍，对促进早产儿中枢神经系统和视网膜的发育有着积极的意义。 | [
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但由于极低出生体重儿的特点，纯母乳喂养不能满足其对蛋白质及多种营养素的需求，单纯喂养时生长速度较慢；母乳内钙磷含量较低，这些矿物质的不足会刺激骨的重吸收以保证血清钙浓度的正常，具有造成早产儿骨发育不良和代谢性骨病的危险。 | [
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目前，国际上推荐母乳喂养的低出生体重早产儿添加含蛋白质、矿物质和维生素的母乳强化剂（HMF）以确保满足预期的营养和生长需求。 | [
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表4-3早产母乳与足月母乳的主要成分（U/L）（2）哺乳技术：正常新生儿生后0.5～1小时可开始哺乳。 | [
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两侧乳房喂哺先后应相互交替，利于乳汁充分吸空，保持下次乳汁的分泌。 | [
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正确的哺乳姿势首先要在母亲体位舒适的前提下，确保婴儿口腔与母亲乳头的正确含接。 | [
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正确的乳头含接姿应该让婴儿含入乳晕的大部分，将乳晕下的乳房组织（包括储存乳汁的乳窦部位）也含入口内，此时婴儿的舌头向前伸出盖住牙龈，两侧向上卷曲裹住乳窦部位，这样婴儿吸吮的是母亲部分乳房而不是乳头（图4-4甲），如果婴儿吸吮乳头而没有含住乳晕，此时婴儿的舌头挤压不到储存乳汁的乳窦部位，吸不到乳汁，常常表现为哭闹，实际上是乳头含接不良（图4-4乙）。 | [
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从外观上判断正确的含接姿势：婴儿的下颌接触乳房，口张大，下唇外翻，婴儿口上方露出的乳晕比口下方多（图4-4丙）。 | [
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含接不良的姿势：下颌不接触乳房，口张得不大而向前噘，下唇不向外翻，口上下方露出的乳晕一样多（图4-4丁）。 | [
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哺乳期母亲应少吃刺激性食物，不饮酒、不抽烟，忌服或慎服能从乳汁排出的药物，如红霉素、氯霉素、链霉素、溴化物、碘化物、水杨酸盐、抗甲状腺药、抗凝血药、阿托品等，以免婴儿发生药物中毒或不良反应。 | [
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图4-1婴儿与母乳头的含接（3）哺乳禁忌证：有活动性结核、急性传染病、艾滋病、严重心肾疾病、恶性肿瘤及精神病者以及接受放射性核素治疗或服用前述药物的母亲，不宜给婴儿哺乳。 | [
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急性呼吸道感染时，乳母宜戴口罩。 | [
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一侧患乳腺炎，应暂停患侧直接哺乳，但仍应按时挤出或吸出乳汁，以免病愈后无奶。 | [
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由于夏季时婴儿特别容易发生消化不良和腹泻，因而，如断奶时间正好遇到夏季，建议推迟至秋季再断奶。 | [
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婴儿配方奶粉在制造时参照母乳的营养成分，在普通奶粉中增加、减少或置换某些营养素的含量，使其更适合婴儿的生理功能和营养需要特点，这种经过改良后的奶粉比普通奶粉和鲜奶更符合婴儿生长的需要，但与母乳相比还是逊色得多。 | [
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总而言之，人工喂养不如母乳喂养质优、经济、方便，又易污染。 | [
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足月婴儿可选择普通婴儿奶粉，而对于早产儿来说，由于其生长要求更高，消化道功能不成熟，需要更多易消化吸收的营养素，故需要喂养早产儿配方奶。 | [
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必需脂肪酸（包括亚油酸和亚麻酸）的含量和比例适宜，并强化了长链多不饱和脂肪酸，使其达到母乳含量，利于早产儿神经系统的发育。 | [
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这种配方奶中各种营养素和能量介于早产儿配方奶和标准婴儿配方奶之间，以帮助早产儿实现追赶性生长，适用于人工喂养的早产/低出生体重儿或作为母乳的补充（表4-4）。 | [
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"entity": "母乳",
"start_offset": 67,
"end_offset": 69,
"label": "bod"
}
] |
6个月以内的婴儿混合喂养时，母乳喂哺次数一般不变，可先哺母乳，将乳房吸空，再补授人工乳品，这样可维持母乳一定的分泌量。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "母乳",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
},
{
"id": 2,
"entity": "乳房",
"start_offset": 32,
"end_offset": 34,
"label": "bod"
}
] |
（二）及时添加辅食无论是接受母乳喂养，还是人工喂养的婴儿，从第4～6个月起就需要及时添加辅食。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
}
] |
此时，母乳分泌量往往也相对不足，随着婴儿月龄的增长，单纯乳类喂养已不能满足婴儿的生长需求；而且，小儿体内的储备铁已消耗完，而乳类中所含维生素及铁的量均不能满足生长发育的需要，如不及时补充，易患缺铁性贫血，还会造成以后喂养的困难。 | [
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"id": 0,
"entity": "母乳",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "乳类",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
},
{
"id": 2,
"entity": "缺铁性贫血",
"start_offset": 96,
"end_offset": 101,
"label": "dis"
}
] |
第二节过敏性紫癜【概述】过敏性紫癜（anaphylactoidpurpura）也称亨-舒综合征（Henöch-Schöhleinsyndrome，Henoöch-Schönleinpurpura，HSP），是一种以小血管炎为主要病变的系统性血管炎，临床表现为皮肤紫癜，常伴关节炎、腹痛、便血和肾小球肾炎；多发于学龄前和学龄期儿童，男孩多于女孩，一年四季均有发病，以春秋两季居多，国内报告HSP患病率有逐年增高趋势。 | [
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"id": 0,
"entity": "过敏性紫癜",
"start_offset": 3,
"end_offset": 8,
"label": "dis"
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{
"id": 1,
"entity": "过敏性紫癜",
"start_offset": 12,
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"label": "dis"
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{
"id": 2,
"entity": "anaphylactoidpurpura",
"start_offset": 18,
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"label": "dis"
},
{
"id": 3,
"entity": "亨-舒综合征",
"start_offset": 41,
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"label": "dis"
},
{
"id": 4,
"entity": "Henöch-Schöhleinsyndrome",
"start_offset": 48,
"end_offset": 72,
"label": "dis"
},
{
"id": 5,
"entity": "Henoöch-Schönleinpurpura",
"start_offset": 73,
"end_offset": 97,
"label": "dis"
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{
"id": 6,
"entity": "HSP",
"start_offset": 98,
"end_offset": 101,
"label": "dis"
},
{
"id": 7,
"entity": "小血管炎",
"start_offset": 107,
"end_offset": 111,
"label": "dis"
},
{
"id": 8,
"entity": "系统性血管炎",
"start_offset": 117,
"end_offset": 123,
"label": "dis"
},
{
"id": 9,
"entity": "皮肤紫癜",
"start_offset": 129,
"end_offset": 133,
"label": "sym"
},
{
"id": 10,
"entity": "关节炎",
"start_offset": 136,
"end_offset": 139,
"label": "dis"
},
{
"id": 11,
"entity": "腹痛",
"start_offset": 140,
"end_offset": 142,
"label": "sym"
},
{
"id": 12,
"entity": "便血",
"start_offset": 143,
"end_offset": 145,
"label": "sym"
},
{
"id": 13,
"entity": "肾小球肾炎",
"start_offset": 146,
"end_offset": 151,
"label": "dis"
},
{
"id": 14,
"entity": "HSP",
"start_offset": 193,
"end_offset": 196,
"label": "dis"
}
] |
【病因和发病机制】HSP发病机制尚未明确，下列情况可能为诱因如食物过敏（蛋类、乳类和豆类等）、药物（阿司匹林和抗生素等）、微生物（细菌、病毒和寄生虫等）、疫苗接种、麻醉以及恶性病变等。 | [
{
"id": 0,
"entity": "HSP",
"start_offset": 9,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "阿司匹林",
"start_offset": 50,
"end_offset": 54,
"label": "dru"
},
{
"id": 2,
"entity": "抗生素",
"start_offset": 55,
"end_offset": 58,
"label": "dru"
},
{
"id": 3,
"entity": "细菌",
"start_offset": 65,
"end_offset": 67,
"label": "mic"
},
{
"id": 4,
"entity": "病毒",
"start_offset": 68,
"end_offset": 70,
"label": "mic"
},
{
"id": 5,
"entity": "寄生虫",
"start_offset": 71,
"end_offset": 74,
"label": "mic"
}
] |
有报告HSP患儿中，50%以上有链球菌感染史，提示链球菌起触发作用，但随后研究发现链球菌感染史在HSP和健康儿童对照间并无差别。 | [
{
"id": 0,
"entity": "HSP",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "链球菌感染",
"start_offset": 16,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "链球菌",
"start_offset": 25,
"end_offset": 28,
"label": "mic"
},
{
"id": 3,
"entity": "HSP",
"start_offset": 48,
"end_offset": 51,
"label": "dis"
}
] |
30%～50%患儿血清IgA浓度升高；HSP急性期血循环中表面IgA阳性的B淋巴细胞数、IgA类免疫复合物或冷球蛋白均增高；HSP患儿的淋巴细胞可自发合成大量的IgA；IgA、补体C3</sub>和纤维蛋白沉积于肾小球系膜、皮肤和肠道毛细血管而导致相应症状。 | [
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"id": 0,
"entity": "血清IgA",
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"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "HSP",
"start_offset": 19,
"end_offset": 22,
"label": "dis"
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{
"id": 2,
"entity": "IgA阳性的B淋巴细胞",
"start_offset": 31,
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"label": "bod"
},
{
"id": 3,
"entity": "冷球蛋白",
"start_offset": 54,
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"label": "bod"
},
{
"id": 4,
"entity": "HSP",
"start_offset": 62,
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"label": "dis"
},
{
"id": 5,
"entity": "淋巴细胞",
"start_offset": 68,
"end_offset": 72,
"label": "bod"
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{
"id": 6,
"entity": "IgA",
"start_offset": 80,
"end_offset": 83,
"label": "bod"
},
{
"id": 7,
"entity": "IgA",
"start_offset": 84,
"end_offset": 87,
"label": "bod"
},
{
"id": 8,
"entity": "补体C",
"start_offset": 88,
"end_offset": 91,
"label": "bod"
},
{
"id": 9,
"entity": "纤维蛋白",
"start_offset": 99,
"end_offset": 103,
"label": "bod"
},
{
"id": 10,
"entity": "皮肤",
"start_offset": 112,
"end_offset": 114,
"label": "bod"
},
{
"id": 11,
"entity": "肠道毛细血管",
"start_offset": 115,
"end_offset": 121,
"label": "bod"
}
] |
本病有一定遗传倾向，但肯定的HLA连锁尚未确定，有人认为HLA-DW35者易患本病，部分患儿伴有C2补体成分缺乏。 | [
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"id": 0,
"entity": "HLA",
"start_offset": 14,
"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "HLA-DW35",
"start_offset": 28,
"end_offset": 36,
"label": "dis"
}
] |
【病理】HSP病理变化为广泛的白细胞碎裂性小血管炎，以毛细血管炎为主，亦可波及静脉和小动脉；血管壁可见胶原纤维肿胀和坏死，中性粒细胞浸润，周围有散在核碎片；间质水肿，有浆液性渗出，同时可见渗出的红细胞；内皮细胞肿胀，可有血栓形成。 | [
{
"id": 0,
"entity": "HSP",
"start_offset": 4,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "毛细血管炎",
"start_offset": 27,
"end_offset": 32,
"label": "dis"
},
{
"id": 2,
"entity": "静脉",
"start_offset": 39,
"end_offset": 41,
"label": "dis"
},
{
"id": 3,
"entity": "小动脉",
"start_offset": 42,
"end_offset": 45,
"label": "dis"
},
{
"id": 4,
"entity": "血管壁",
"start_offset": 46,
"end_offset": 49,
"label": "dis"
},
{
"id": 5,
"entity": "胶原纤维",
"start_offset": 51,
"end_offset": 55,
"label": "dis"
},
{
"id": 6,
"entity": "中性粒细胞",
"start_offset": 61,
"end_offset": 66,
"label": "dis"
},
{
"id": 7,
"entity": "间质水肿，有浆液性渗出，同时可见渗出的红细胞",
"start_offset": 78,
"end_offset": 100,
"label": "sym"
},
{
"id": 8,
"entity": "内皮细胞肿胀，可有血栓形成",
"start_offset": 101,
"end_offset": 114,
"label": "sym"
}
] |
病变累及皮肤、肾脏、关节及胃肠道，少数涉及心、肺等脏器。 | [
{
"id": 0,
"entity": "皮肤",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
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{
"id": 1,
"entity": "肾脏",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
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{
"id": 2,
"entity": "关节",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
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{
"id": 3,
"entity": "胃肠道",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
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{
"id": 4,
"entity": "心",
"start_offset": 21,
"end_offset": 22,
"label": "bod"
},
{
"id": 5,
"entity": "肺",
"start_offset": 23,
"end_offset": 24,
"label": "bod"
}
] |
在皮肤和肾脏，荧光显微镜下可见IgA为主的免疫复合物沉积。 | [
{
"id": 0,
"entity": "皮肤",
"start_offset": 1,
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"label": "bod"
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{
"id": 1,
"entity": "肾脏",
"start_offset": 4,
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"label": "bod"
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{
"id": 2,
"entity": "荧光显微镜",
"start_offset": 7,
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"label": "equ"
},
{
"id": 3,
"entity": "IgA",
"start_offset": 15,
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"label": "bod"
}
] |
【临床表现】多为急性起病，首发症状以皮肤紫癜为主，部分病例腹痛、关节炎或肾脏症状上呼吸道感染史。 | [
{
"id": 0,
"entity": "皮肤紫癜",
"start_offset": 18,
"end_offset": 22,
"label": "sym"
},
{
"id": 1,
"entity": "关节炎",
"start_offset": 32,
"end_offset": 35,
"label": "dis"
},
{
"id": 2,
"entity": "肾脏",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 3,
"entity": "腹痛、关节炎或肾脏症状",
"start_offset": 29,
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"label": "sym"
},
{
"id": 4,
"entity": "上呼吸道感染",
"start_offset": 40,
"end_offset": 46,
"label": "dis"
}
] |
（一）皮肤紫癜病程中反复出现皮肤紫癜为本病特征，多见于四肢及臀部及躯干较少；初起呈紫红色斑丘疹，高出皮面，继而呈棕褐色而消退，可伴有荨麻疹和血管神经性水肿，重症患儿紫癜可融合成大疱伴出血性坏死。 | [
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"id": 0,
"entity": "皮肤紫癜",
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"label": "sym"
},
{
"id": 1,
"entity": "皮肤紫癜",
"start_offset": 14,
"end_offset": 18,
"label": "sym"
},
{
"id": 2,
"entity": "四肢",
"start_offset": 27,
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"label": "bod"
},
{
"id": 3,
"entity": "臀部",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "躯干",
"start_offset": 33,
"end_offset": 35,
"label": "bod"
},
{
"id": 5,
"entity": "多见于四肢及臀部及躯干较少",
"start_offset": 24,
"end_offset": 37,
"label": "sym"
},
{
"id": 6,
"entity": "紫红色斑丘疹，高出皮面，继而呈棕褐色而消退",
"start_offset": 41,
"end_offset": 62,
"label": "sym"
},
{
"id": 7,
"entity": "荨麻疹",
"start_offset": 66,
"end_offset": 69,
"label": "dis"
},
{
"id": 8,
"entity": "血管神经性水肿",
"start_offset": 70,
"end_offset": 77,
"label": "dis"
},
{
"id": 9,
"entity": "紫癜",
"start_offset": 82,
"end_offset": 84,
"label": "sym"
},
{
"id": 10,
"entity": "大疱伴出血性坏死",
"start_offset": 88,
"end_offset": 96,
"label": "sym"
}
] |
（二）消化道症状半数以上患儿出现反复的阵发性腹痛，位于脐周或下腹部，疼痛剧烈，可伴呕吐，但呕血少见；部分患儿有黑便或血便、腹泻或便秘，偶见并发肠套叠、肠梗阻或肠穿孔。 | [
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"id": 0,
"entity": "消化道",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "阵发性腹痛",
"start_offset": 19,
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"label": "sym"
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{
"id": 2,
"entity": "脐周",
"start_offset": 27,
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{
"id": 3,
"entity": "下腹部",
"start_offset": 30,
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"label": "bod"
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{
"id": 4,
"entity": "疼痛剧烈",
"start_offset": 34,
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"label": "sym"
},
{
"id": 5,
"entity": "呕吐",
"start_offset": 41,
"end_offset": 43,
"label": "sym"
},
{
"id": 6,
"entity": "呕血",
"start_offset": 45,
"end_offset": 47,
"label": "sym"
},
{
"id": 7,
"entity": "腹泻",
"start_offset": 61,
"end_offset": 63,
"label": "sym"
},
{
"id": 8,
"entity": "便秘",
"start_offset": 64,
"end_offset": 66,
"label": "sym"
},
{
"id": 9,
"entity": "并发肠套叠、肠梗阻或肠穿孔",
"start_offset": 69,
"end_offset": 82,
"label": "sym"
}
] |
（三）关节症状出现膝、踝、肘、腕等大关节肿痛，活动受限，呈单发或多发，关节腔有积液，可在数月内消失，不留后遗症。 | [
{
"id": 0,
"entity": "关节",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "膝",
"start_offset": 9,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "踝",
"start_offset": 11,
"end_offset": 12,
"label": "bod"
},
{
"id": 3,
"entity": "肘",
"start_offset": 13,
"end_offset": 14,
"label": "bod"
},
{
"id": 4,
"entity": "腕",
"start_offset": 15,
"end_offset": 16,
"label": "bod"
},
{
"id": 5,
"entity": "大关节",
"start_offset": 17,
"end_offset": 20,
"label": "bod"
},
{
"id": 6,
"entity": "大关节肿痛",
"start_offset": 17,
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},
{
"id": 7,
"entity": "关节腔",
"start_offset": 35,
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"label": "bod"
},
{
"id": 8,
"entity": "积液",
"start_offset": 39,
"end_offset": 41,
"label": "sym"
}
] |
（四）肾脏症状本病引起的肾脏病变是小儿期最常见的继发性肾小球疾患。 | [
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{
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"entity": "肾脏",
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{
"id": 2,
"entity": "继发性肾小球",
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] |
肾脏症状轻重不一，多数患儿出现血尿、蛋白尿和管型，伴血压增高及水肿，称为紫癜性肾炎，少数呈肾病综合征表现；肾脏症状绝大多数在起病1个月内出现，亦可在病程更晚期发生，大多数能完全恢复，少数发展为慢性肾炎，死于慢性肾衰竭。 | [
{
"id": 0,
"entity": "肾脏",
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},
{
"id": 1,
"entity": "血尿",
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"label": "sym"
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{
"id": 2,
"entity": "蛋白尿",
"start_offset": 18,
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"label": "sym"
},
{
"id": 3,
"entity": "管型",
"start_offset": 22,
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"label": "sym"
},
{
"id": 4,
"entity": "血压",
"start_offset": 26,
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"label": "ite"
},
{
"id": 5,
"entity": "血压增高及水肿",
"start_offset": 26,
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"label": "sym"
},
{
"id": 6,
"entity": "紫癜性肾炎",
"start_offset": 36,
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"label": "dis"
},
{
"id": 7,
"entity": "肾病综合征",
"start_offset": 45,
"end_offset": 50,
"label": "dis"
},
{
"id": 8,
"entity": "肾脏",
"start_offset": 53,
"end_offset": 55,
"label": "bod"
},
{
"id": 9,
"entity": "慢性肾炎",
"start_offset": 96,
"end_offset": 100,
"label": "dis"
},
{
"id": 10,
"entity": "慢性肾衰竭",
"start_offset": 103,
"end_offset": 108,
"label": "dis"
}
] |
（五）其他偶可发生颅内出血，导致惊厥、昏迷及失语，还可有鼻、牙龈出血循环系统发生心肌炎、心包炎，或累及呼吸系统发生喉头水肿、哮喘和肺出血。 | [
{
"id": 0,
"entity": "颅内出血",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
},
{
"id": 1,
"entity": "惊厥",
"start_offset": 16,
"end_offset": 18,
"label": "sym"
},
{
"id": 2,
"entity": "昏迷",
"start_offset": 19,
"end_offset": 21,
"label": "sym"
},
{
"id": 3,
"entity": "失语",
"start_offset": 22,
"end_offset": 24,
"label": "sym"
},
{
"id": 4,
"entity": "鼻",
"start_offset": 28,
"end_offset": 29,
"label": "bod"
},
{
"id": 5,
"entity": "牙龈",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 6,
"entity": "鼻、牙龈出血",
"start_offset": 28,
"end_offset": 34,
"label": "sym"
},
{
"id": 7,
"entity": "循环系统",
"start_offset": 34,
"end_offset": 38,
"label": "bod"
},
{
"id": 8,
"entity": "心肌炎",
"start_offset": 40,
"end_offset": 43,
"label": "dis"
},
{
"id": 9,
"entity": "心包炎",
"start_offset": 44,
"end_offset": 47,
"label": "dis"
},
{
"id": 10,
"entity": "呼吸系统",
"start_offset": 51,
"end_offset": 55,
"label": "bod"
},
{
"id": 11,
"entity": "喉头水肿、哮喘和肺出血",
"start_offset": 57,
"end_offset": 68,
"label": "sym"
}
] |
【实验室检查】（一）血象白细胞正常或增加，中性或嗜酸性粒细胞可增高；除非严重出血，一般无贫血；血小板计数正常甚至升高，出血和凝血时间正常，血块退缩试验正常，部分患儿毛细血管脆性试验阳性。 | [
{
"id": 0,
"entity": "血象白细胞",
"start_offset": 10,
"end_offset": 15,
"label": "bod"
},
{
"id": 1,
"entity": "中性或嗜酸性粒细胞",
"start_offset": 21,
"end_offset": 30,
"label": "bod"
},
{
"id": 2,
"entity": "严重出血",
"start_offset": 36,
"end_offset": 40,
"label": "sym"
},
{
"id": 3,
"entity": "血小板",
"start_offset": 47,
"end_offset": 50,
"label": "bod"
},
{
"id": 4,
"entity": "出血",
"start_offset": 59,
"end_offset": 61,
"label": "sym"
},
{
"id": 5,
"entity": "凝血",
"start_offset": 62,
"end_offset": 64,
"label": "sym"
},
{
"id": 6,
"entity": "毛细血管",
"start_offset": 82,
"end_offset": 86,
"label": "bod"
}
] |
（二）尿常规可有红细胞、蛋白及管型，少数有肉眼血尿。 | [
{
"id": 0,
"entity": "尿常规",
"start_offset": 3,
"end_offset": 6,
"label": "ite"
},
{
"id": 1,
"entity": "红细胞",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "蛋白",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "管型",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 4,
"entity": "血尿",
"start_offset": 23,
"end_offset": 25,
"label": "sym"
}
] |
（三）有消化道症状者大便隐血试验多阳性。 | [
{
"id": 0,
"entity": "消化道",
"start_offset": 4,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "大便隐血",
"start_offset": 10,
"end_offset": 14,
"label": "sym"
}
] |
（四）血沉正常或增快血清IgA可升高，IgG、IgM正常亦可轻度升高；C3</sub>、C4</sub>正常或升高；抗核抗体及RF阴性；重症血浆黏度增高。 | [
{
"id": 0,
"entity": "血沉",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "血清IgA",
"start_offset": 10,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "IgG",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "IgM",
"start_offset": 23,
"end_offset": 26,
"label": "bod"
},
{
"id": 4,
"entity": "C3",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
},
{
"id": 5,
"entity": "C4",
"start_offset": 44,
"end_offset": 46,
"label": "bod"
},
{
"id": 6,
"entity": "重症血浆",
"start_offset": 68,
"end_offset": 72,
"label": "bod"
}
] |
（五）腹部超声波检查有利于早期诊断肠套叠等外科急腹症；有中枢神经系统症状患儿可予头颅MRI助诊；肾脏症状较重和迁延患儿可行肾穿刺以了解病情给予相应治疗。 | [
{
"id": 0,
"entity": "腹部超声波检查",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "肠套叠",
"start_offset": 17,
"end_offset": 20,
"label": "sym"
},
{
"id": 2,
"entity": "外科急腹症",
"start_offset": 21,
"end_offset": 26,
"label": "dis"
},
{
"id": 3,
"entity": "中枢神经系统",
"start_offset": 28,
"end_offset": 34,
"label": "bod"
},
{
"id": 4,
"entity": "头颅",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
},
{
"id": 5,
"entity": "MRI",
"start_offset": 42,
"end_offset": 45,
"label": "pro"
},
{
"id": 6,
"entity": "肾脏",
"start_offset": 48,
"end_offset": 50,
"label": "bod"
},
{
"id": 7,
"entity": "肾穿刺",
"start_offset": 61,
"end_offset": 64,
"label": "pro"
}
] |
【诊断和鉴别诊断】典型病例诊断不难，若临床表现不典型，皮肤紫癜未出现时，容易误诊为其他疾病，需与原发性血小板减少性紫癜、风湿性关节炎及外科急腹症等鉴别。 | [
{
"id": 0,
"entity": "皮肤紫癜",
"start_offset": 27,
"end_offset": 31,
"label": "sym"
},
{
"id": 1,
"entity": "原发性血小板减少性紫癜",
"start_offset": 48,
"end_offset": 59,
"label": "dis"
},
{
"id": 2,
"entity": "风湿性关节炎",
"start_offset": 60,
"end_offset": 66,
"label": "dis"
},
{
"id": 3,
"entity": "外科急腹症",
"start_offset": 67,
"end_offset": 72,
"label": "dis"
}
] |
【治疗】（一）一般治疗卧床休息，积极寻找和去除致病因素，控制感染，补充维生素。 | [
{
"id": 0,
"entity": "卧床休息",
"start_offset": 11,
"end_offset": 15,
"label": "pro"
},
{
"id": 1,
"entity": "控制感染",
"start_offset": 28,
"end_offset": 32,
"label": "pro"
},
{
"id": 2,
"entity": "补充维生素",
"start_offset": 33,
"end_offset": 38,
"label": "pro"
}
] |
（二）对症治疗有荨麻疹或血管神经性水肿时，应用抗组胺药物和钙剂；腹痛时应用解痉剂，消化道出血时应禁食，可静脉注射西咪替丁20～40mg/（kg•d），必要时输血。 | [
{
"id": 0,
"entity": "荨麻疹",
"start_offset": 8,
"end_offset": 11,
"label": "sym"
},
{
"id": 1,
"entity": "血管神经性水肿",
"start_offset": 12,
"end_offset": 19,
"label": "sym"
},
{
"id": 2,
"entity": "抗组胺药物",
"start_offset": 23,
"end_offset": 28,
"label": "dru"
},
{
"id": 3,
"entity": "钙剂",
"start_offset": 29,
"end_offset": 31,
"label": "dru"
},
{
"id": 4,
"entity": "腹痛",
"start_offset": 32,
"end_offset": 34,
"label": "sym"
},
{
"id": 5,
"entity": "解痉剂",
"start_offset": 37,
"end_offset": 40,
"label": "dru"
},
{
"id": 6,
"entity": "消化道",
"start_offset": 41,
"end_offset": 44,
"label": "bod"
},
{
"id": 7,
"entity": "静脉注射",
"start_offset": 52,
"end_offset": 56,
"label": "pro"
},
{
"id": 8,
"entity": "西咪替丁",
"start_offset": 56,
"end_offset": 60,
"label": "dru"
},
{
"id": 9,
"entity": "输血",
"start_offset": 78,
"end_offset": 80,
"label": "pro"
}
] |
（三）肾上腺皮质激素急性期对腹痛和关节痛可予缓解，但不能预防肾脏损害的发生，亦不能影响预后。 | [
{
"id": 0,
"entity": "肾上腺皮质激素",
"start_offset": 3,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "腹痛",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "关节痛",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "肾脏",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
}
] |
（四）抗血小板聚集药物阿司匹林3～5mg/kg，或25～50mg/d，每天1次服用；双嘧达莫（潘生丁）3～5mg/（kg•d），分次服用。 | [
{
"id": 0,
"entity": "抗血小板聚集药物",
"start_offset": 3,
"end_offset": 11,
"label": "dru"
},
{
"id": 1,
"entity": "阿司匹林",
"start_offset": 11,
"end_offset": 15,
"label": "dru"
},
{
"id": 2,
"entity": "双嘧达莫",
"start_offset": 42,
"end_offset": 46,
"label": "dru"
},
{
"id": 3,
"entity": "潘生丁",
"start_offset": 47,
"end_offset": 50,
"label": "dru"
}
] |
（五）其他中成药如复方丹参片和银杏叶片，口服3～6个月，可补肾益气和活血化瘀。 | [
{
"id": 0,
"entity": "复方丹参片",
"start_offset": 9,
"end_offset": 14,
"label": "dru"
},
{
"id": 1,
"entity": "银杏叶片",
"start_offset": 15,
"end_offset": 19,
"label": "dru"
},
{
"id": 2,
"entity": "肾",
"start_offset": 30,
"end_offset": 31,
"label": "bod"
}
] |
【预后】本病预后一般良好，除少数重症患儿可死于肠出血、肠套叠、肠坏死或急性肾衰竭外，大多痊愈。 | [
{
"id": 0,
"entity": "肠出血",
"start_offset": 23,
"end_offset": 26,
"label": "sym"
},
{
"id": 1,
"entity": "肠套叠",
"start_offset": 27,
"end_offset": 30,
"label": "sym"
},
{
"id": 2,
"entity": "肠坏死",
"start_offset": 31,
"end_offset": 34,
"label": "sym"
},
{
"id": 3,
"entity": "肾衰竭",
"start_offset": 37,
"end_offset": 40,
"label": "dis"
}
] |
病程一般约1～2周至1～2个月，少数可长达数月或一年以上；肾脏病变常较迁延，可持续数月或数年，大多自行缓解，部分病例有复发倾向。 | [
{
"id": 0,
"entity": "肾脏",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
}
] |
葡萄球菌肺炎@三、葡萄球菌肺炎葡萄球菌肺炎（staphylococcalpneumonia）多发生于新生儿和婴儿。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 9,
"end_offset": 15,
"label": "dis"
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{
"id": 1,
"entity": "葡萄球菌肺炎",
"start_offset": 15,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "staphylococcalpneumonia",
"start_offset": 22,
"end_offset": 45,
"label": "dis"
}
] |
葡萄球菌肺炎@Goel等报道100例患儿中，1岁以内占78%，平均年龄5个月。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
}
] |
葡萄球菌肺炎@金黄色葡萄球（金葡菌）和表皮葡萄球菌均可致病，但以前者致病最强。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "金黄色葡萄球",
"start_offset": 7,
"end_offset": 13,
"label": "mic"
},
{
"id": 2,
"entity": "表皮葡萄球菌",
"start_offset": 19,
"end_offset": 25,
"label": "mic"
}
] |
葡萄球菌肺炎@由于金葡菌可产生多种毒素和酶，具有高度组织破坏性和化脓趋势，因而金葡菌肺炎以广泛出血性坏死、多发性小脓疡形成为特点。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "金葡菌",
"start_offset": 9,
"end_offset": 12,
"label": "mic"
},
{
"id": 2,
"entity": "金葡菌肺炎",
"start_offset": 39,
"end_offset": 44,
"label": "dis"
},
{
"id": 3,
"entity": "出血性坏死",
"start_offset": 47,
"end_offset": 52,
"label": "sym"
},
{
"id": 4,
"entity": "多发性小脓疡",
"start_offset": 53,
"end_offset": 59,
"label": "sym"
}
] |
葡萄球菌肺炎@临床上以起病急、发展快、变化大、化脓性并发症多为特征。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "起病急",
"start_offset": 11,
"end_offset": 14,
"label": "sym"
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{
"id": 2,
"entity": "发展快",
"start_offset": 15,
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"label": "sym"
},
{
"id": 3,
"entity": "变化大",
"start_offset": 19,
"end_offset": 22,
"label": "sym"
},
{
"id": 4,
"entity": "化脓性并发症",
"start_offset": 23,
"end_offset": 29,
"label": "sym"
}
] |
葡萄球菌肺炎@一开始可有1～2天的上呼吸道感染症状，或皮肤疖肿史，病情迅速恶化，出现高热、咳嗽、呻吟、喘憋、气急、发绀，肺部体征出现较早。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "上呼吸道感染",
"start_offset": 17,
"end_offset": 23,
"label": "sym"
},
{
"id": 2,
"entity": "皮肤疖肿",
"start_offset": 27,
"end_offset": 31,
"label": "sym"
},
{
"id": 3,
"entity": "高热",
"start_offset": 42,
"end_offset": 44,
"label": "sym"
},
{
"id": 4,
"entity": "咳嗽",
"start_offset": 45,
"end_offset": 47,
"label": "sym"
},
{
"id": 5,
"entity": "呻吟",
"start_offset": 48,
"end_offset": 50,
"label": "sym"
},
{
"id": 6,
"entity": "喘憋",
"start_offset": 51,
"end_offset": 53,
"label": "sym"
},
{
"id": 7,
"entity": "气急",
"start_offset": 54,
"end_offset": 56,
"label": "sym"
},
{
"id": 8,
"entity": "发绀",
"start_offset": 57,
"end_offset": 59,
"label": "sym"
},
{
"id": 9,
"entity": "肺部",
"start_offset": 60,
"end_offset": 62,
"label": "bod"
}
] |
葡萄球菌肺炎@易出现脓胸、脓气胸、肺大疱等并发症。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "脓胸",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "脓气胸",
"start_offset": 13,
"end_offset": 16,
"label": "dis"
},
{
"id": 3,
"entity": "肺大疱",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
}
] |
葡萄球菌肺炎@外周血白细胞计数常明显升高，以中性粒细胞为主。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "外周血白细胞计数",
"start_offset": 7,
"end_offset": 15,
"label": "ite"
},
{
"id": 2,
"entity": "中性粒细胞",
"start_offset": 22,
"end_offset": 27,
"label": "mic"
}
] |
葡萄球菌肺炎@可伴轻至中度贫血。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "中度贫血",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
}
] |
葡萄球菌肺炎@胸片改变特点：发展快、变化多、吸收慢。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "胸片",
"start_offset": 7,
"end_offset": 9,
"label": "pro"
}
] |
葡萄球菌肺炎@肺部病灶可在数小时内发展成为多发性小脓疡或肺大疱，并出现脓胸、脓气胸等并发症。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "肺部",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "多发性小脓疡",
"start_offset": 21,
"end_offset": 27,
"label": "dis"
},
{
"id": 3,
"entity": "肺大疱",
"start_offset": 28,
"end_offset": 31,
"label": "dis"
},
{
"id": 4,
"entity": "脓胸",
"start_offset": 35,
"end_offset": 37,
"label": "dis"
},
{
"id": 5,
"entity": "脓气胸",
"start_offset": 38,
"end_offset": 41,
"label": "dis"
}
] |
葡萄球菌肺炎@X线改变吸收缓慢，可持续2个月或更久。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "X线",
"start_offset": 7,
"end_offset": 9,
"label": "pro"
}
] |
葡萄球菌肺炎@1岁以下、尤其是3月龄以内的小婴儿，如肺炎病情发展迅速，伴肺大疱、脓胸或肺脓疡形成者应高度怀疑本病。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "肺炎",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
},
{
"id": 2,
"entity": "肺大疱",
"start_offset": 36,
"end_offset": 39,
"label": "dis"
},
{
"id": 3,
"entity": "脓胸",
"start_offset": 40,
"end_offset": 42,
"label": "dis"
},
{
"id": 4,
"entity": "肺脓疡",
"start_offset": 43,
"end_offset": 46,
"label": "dis"
}
] |
葡萄球菌肺炎@在抗生素使用前必须进行痰、鼻咽拭子、浆膜腔液、血液或肺穿刺物的培养。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "抗生素",
"start_offset": 8,
"end_offset": 11,
"label": "pro"
},
{
"id": 2,
"entity": "痰",
"start_offset": 18,
"end_offset": 19,
"label": "pro"
},
{
"id": 3,
"entity": "鼻咽拭子",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
},
{
"id": 4,
"entity": "浆膜腔液",
"start_offset": 25,
"end_offset": 29,
"label": "pro"
},
{
"id": 5,
"entity": "血液",
"start_offset": 30,
"end_offset": 32,
"label": "pro"
},
{
"id": 6,
"entity": "肺穿刺物",
"start_offset": 33,
"end_offset": 37,
"label": "pro"
}
] |
葡萄球菌肺炎@痰或胸水涂片染色可发现中性粒细胞和革兰阳性球菌呈葡萄串链状排列。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "痰",
"start_offset": 7,
"end_offset": 8,
"label": "bod"
},
{
"id": 2,
"entity": "胸水",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 3,
"entity": "中性粒细胞",
"start_offset": 18,
"end_offset": 23,
"label": "mic"
},
{
"id": 4,
"entity": "革兰阳性球菌",
"start_offset": 24,
"end_offset": 30,
"label": "mic"
}
] |
葡萄球菌肺炎@血清中磷壁酸抗体测定可作为病原学诊断的补充。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "血清",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "磷壁酸抗体测定",
"start_offset": 10,
"end_offset": 17,
"label": "ite"
}
] |
葡萄球菌肺炎@合适的抗生素治疗和脓液的引流是治疗的关键。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "抗生素治疗",
"start_offset": 10,
"end_offset": 15,
"label": "pro"
},
{
"id": 2,
"entity": "脓液的引流",
"start_offset": 16,
"end_offset": 21,
"label": "pro"
}
] |
葡萄球菌肺炎@在获取培养标本后应立即给予敏感的杀菌药物，并足量、联合、静脉用药。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "足量、联合、静脉用药",
"start_offset": 29,
"end_offset": 39,
"label": "pro"
}
] |
葡萄球菌肺炎@宜首选耐青霉素酶窄谱青霉素类，如苯唑西林等，可联合头孢霉素类使用。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "耐青霉素",
"start_offset": 10,
"end_offset": 14,
"label": "dru"
},
{
"id": 2,
"entity": "窄谱青霉素",
"start_offset": 15,
"end_offset": 20,
"label": "dru"
},
{
"id": 3,
"entity": "苯唑西林",
"start_offset": 23,
"end_offset": 27,
"label": "dru"
},
{
"id": 4,
"entity": "头孢霉素",
"start_offset": 32,
"end_offset": 36,
"label": "dru"
}
] |
葡萄球菌肺炎@如为耐甲氧西林金葡菌（MRSA）引起，应选用万古霉素治疗。 | [
{
"id": 0,
"entity": "葡萄球菌肺炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "耐甲氧西林金葡菌",
"start_offset": 9,
"end_offset": 17,
"label": "mic"
},
{
"id": 2,
"entity": "MRSA",
"start_offset": 18,
"end_offset": 22,
"label": "mic"
},
{
"id": 3,
"entity": "万古霉素",
"start_offset": 29,
"end_offset": 33,
"label": "dru"
}
] |
三、临床特点（一）原发部位恶性肿瘤一般均有原发部位，但多种儿童恶性肿瘤如淋巴瘤、神经母细胞瘤、尤因肉瘤等在疾病早期就可转移。 | [
{
"id": 0,
"entity": "恶性肿瘤",
"start_offset": 13,
"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "儿童恶性肿瘤",
"start_offset": 29,
"end_offset": 35,
"label": "dis"
},
{
"id": 2,
"entity": "淋巴瘤",
"start_offset": 36,
"end_offset": 39,
"label": "dis"
},
{
"id": 3,
"entity": "神经母细胞瘤",
"start_offset": 40,
"end_offset": 46,
"label": "dis"
},
{
"id": 4,
"entity": "尤因肉瘤",
"start_offset": 47,
"end_offset": 51,
"label": "dis"
}
] |
常见儿童肿瘤的原发灶和转移部位（表11-11），不同原发部位常见的肿瘤（表11-4）。 | [
{
"id": 0,
"entity": "儿童肿瘤",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "肿瘤",
"start_offset": 33,
"end_offset": 35,
"label": "dis"
}
] |
（二）转移特点儿童肿瘤在就诊时已有远处转移者较多见，原因有以下两点：①疾病早期即可发生远处转移是儿童恶性肿瘤的特点之一；②当肿瘤原发于非体表部位，未形成压迫症状或有全身症状时不易发现，在出现症状而就诊时已存在转移灶。 | [
{
"id": 0,
"entity": "儿童肿瘤",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "儿童恶性肿瘤",
"start_offset": 48,
"end_offset": 54,
"label": "dis"
},
{
"id": 2,
"entity": "肿瘤",
"start_offset": 62,
"end_offset": 64,
"label": "dis"
}
] |
即使影像学检查未发现明显转移灶，也有可能已有微小的亚临床转移。 | [
{
"id": 0,
"entity": "影像学检查",
"start_offset": 2,
"end_offset": 7,
"label": "pro"
}
] |
非霍奇金淋巴瘤、神经母细胞瘤、横纹肌肉瘤、尤因肉瘤、骨肉瘤就诊时就存在转移的机会较多，除局部扩散外，易发生淋巴、血行远处转移。 | [
{
"id": 0,
"entity": "非霍奇金淋巴瘤",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "神经母细胞瘤",
"start_offset": 8,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "横纹肌肉瘤",
"start_offset": 15,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "尤因肉瘤",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
},
{
"id": 4,
"entity": "骨肉瘤",
"start_offset": 26,
"end_offset": 29,
"label": "dis"
},
{
"id": 5,
"entity": "淋巴",
"start_offset": 53,
"end_offset": 55,
"label": "bod"
}
] |
常见的远处转移部位是肝、脾、淋巴结、骨髓、骨、肺和颅内（见表11-11）。 | [
{
"id": 0,
"entity": "肝",
"start_offset": 10,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "脾",
"start_offset": 12,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "淋巴结",
"start_offset": 14,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "骨髓",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
},
{
"id": 4,
"entity": "骨",
"start_offset": 21,
"end_offset": 22,
"label": "bod"
},
{
"id": 5,
"entity": "肺",
"start_offset": 23,
"end_offset": 24,
"label": "bod"
},
{
"id": 6,
"entity": "颅内",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
}
] |
表11-3常见儿童肿瘤的原发灶和转移部位表11-4不同原发部位常见的肿瘤（三）临床症状及体征儿童血液系统恶性肿瘤全身症状突出，主要有贫血、出血、发热和肝、脾、淋巴结肿大。 | [
{
"id": 0,
"entity": "儿童肿瘤",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "肿瘤",
"start_offset": 34,
"end_offset": 36,
"label": "dis"
},
{
"id": 2,
"entity": "儿童血液系统恶性肿瘤",
"start_offset": 46,
"end_offset": 56,
"label": "dis"
},
{
"id": 3,
"entity": "贫血",
"start_offset": 66,
"end_offset": 68,
"label": "sym"
},
{
"id": 4,
"entity": "出血",
"start_offset": 69,
"end_offset": 71,
"label": "sym"
},
{
"id": 5,
"entity": "发热",
"start_offset": 72,
"end_offset": 74,
"label": "sym"
},
{
"id": 6,
"entity": "肝",
"start_offset": 75,
"end_offset": 76,
"label": "bod"
},
{
"id": 7,
"entity": "脾",
"start_offset": 77,
"end_offset": 78,
"label": "bod"
},
{
"id": 8,
"entity": "淋巴结",
"start_offset": 79,
"end_offset": 82,
"label": "bod"
},
{
"id": 9,
"entity": "肝、脾、淋巴结肿大",
"start_offset": 75,
"end_offset": 84,
"label": "sym"
}
] |
表11-5常见部位的肿瘤压迫症状（四）实验室检查1.具特殊意义的血、尿生化学检查（1）尿VMA、HVA、HVA检查：80%～90%神经母细胞瘤患儿尿VMA、HVA明显增高，具特异性，可作为诊断及疾病随访指标。 | [
{
"id": 0,
"entity": "肿瘤",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "血、尿生化学检查",
"start_offset": 32,
"end_offset": 40,
"label": "pro"
},
{
"id": 2,
"entity": "尿VMA、HVA",
"start_offset": 43,
"end_offset": 51,
"label": "ite"
},
{
"id": 3,
"entity": "HVA检查",
"start_offset": 52,
"end_offset": 57,
"label": "pro"
},
{
"id": 4,
"entity": "神经母细胞瘤",
"start_offset": 65,
"end_offset": 71,
"label": "dis"
},
{
"id": 5,
"entity": "尿VMA、HVA",
"start_offset": 73,
"end_offset": 81,
"label": "ite"
}
] |
（2）血αFP：肝母细胞瘤、生殖细胞瘤时升高，可作为诊断及疾病随访指标。 | [
{
"id": 0,
"entity": "血αFP",
"start_offset": 3,
"end_offset": 7,
"label": "ite"
},
{
"id": 1,
"entity": "肝母细胞瘤",
"start_offset": 8,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "生殖细胞瘤",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
}
] |
（3）血LDH：多种肿瘤有非特异性增高，在淋巴系恶性肿瘤、神经母细胞瘤中较为突出。 | [
{
"id": 0,
"entity": "血LDH",
"start_offset": 3,
"end_offset": 7,
"label": "ite"
},
{
"id": 1,
"entity": "肿瘤",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "淋巴系恶性肿瘤",
"start_offset": 21,
"end_offset": 28,
"label": "dis"
},
{
"id": 3,
"entity": "神经母细胞瘤",
"start_offset": 29,
"end_offset": 35,
"label": "dis"
}
] |
增高水平与肿瘤负荷相平行，缓解时降至正常，复发时再次增高。 | [
{
"id": 0,
"entity": "肿瘤",
"start_offset": 5,
"end_offset": 7,
"label": "dis"
}
] |
2.影像学检查影像学检查是肿瘤诊断的基础手段，主要包括X线平片、B型超声检查、CT、MRI、骨扫描。 | [
{
"id": 0,
"entity": "影像学检查",
"start_offset": 2,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "影像学检查",
"start_offset": 7,
"end_offset": 12,
"label": "pro"
},
{
"id": 2,
"entity": "肿瘤",
"start_offset": 13,
"end_offset": 15,
"label": "dis"
},
{
"id": 3,
"entity": "X线平片",
"start_offset": 27,
"end_offset": 31,
"label": "pro"
},
{
"id": 4,
"entity": "B型超声检查",
"start_offset": 32,
"end_offset": 38,
"label": "pro"
},
{
"id": 5,
"entity": "CT",
"start_offset": 39,
"end_offset": 41,
"label": "pro"
},
{
"id": 6,
"entity": "MRI",
"start_offset": 42,
"end_offset": 45,
"label": "pro"
},
{
"id": 7,
"entity": "骨扫描",
"start_offset": 46,
"end_offset": 49,
"label": "pro"
}
] |
影像学检查可确定肿块部位、大小、与邻近组织和血管的关系、包膜的完整性、瘤内钙化灶、出血坏死灶、囊性变等，可据此作出初步诊断及手术方案。 | [
{
"id": 0,
"entity": "影像学检查",
"start_offset": 0,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "血管",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 2,
"entity": "包膜",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
},
{
"id": 3,
"entity": "瘤内钙化灶",
"start_offset": 35,
"end_offset": 40,
"label": "bod"
},
{
"id": 4,
"entity": "出血坏死灶",
"start_offset": 41,
"end_offset": 46,
"label": "bod"
}
] |
腹腔常见肿瘤的影像学特征（表11-6）。 | [
{
"id": 0,
"entity": "腹腔",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "肿瘤",
"start_offset": 4,
"end_offset": 6,
"label": "dis"
}
] |
表11-6腹腔常见肿瘤的影像学特征3.骨髓涂片急性白血病时骨髓中幼稚细胞比例明显升高，超过骨髓有核细胞的30%，为诊断白血病的主要依据。 | [
{
"id": 0,
"entity": "肿瘤",
"start_offset": 9,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "骨髓涂片",
"start_offset": 19,
"end_offset": 23,
"label": "ite"
},
{
"id": 2,
"entity": "急性白血病",
"start_offset": 23,
"end_offset": 28,
"label": "dis"
},
{
"id": 3,
"entity": "骨髓中幼稚细胞比例明显升高，超过骨髓有核细胞的30%",
"start_offset": 29,
"end_offset": 55,
"label": "sym"
},
{
"id": 4,
"entity": "白血病",
"start_offset": 59,
"end_offset": 62,
"label": "dis"
}
] |
多种儿童恶性肿瘤易发生骨髓转移，如非霍奇金淋巴瘤、神经母细胞瘤、尤因肉瘤等，因此这些肿瘤应常规作骨髓涂片，检查有无肿瘤细胞浸润。 | [
{
"id": 0,
"entity": "儿童恶性肿瘤",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "骨髓",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "非霍奇金淋巴瘤",
"start_offset": 17,
"end_offset": 24,
"label": "dis"
},
{
"id": 3,
"entity": "神经母细胞瘤",
"start_offset": 25,
"end_offset": 31,
"label": "dis"
},
{
"id": 4,
"entity": "尤因肉瘤",
"start_offset": 32,
"end_offset": 36,
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{
"id": 5,
"entity": "肿瘤",
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"label": "dis"
},
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"entity": "骨髓涂片",
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参考文献1.张皓，任慈芳，王立波，等.单阻断法测135例婴幼儿肺炎患者呼吸道阻力和顺应性的变化.临床儿科杂志，2001，19（6）：330-3302.BeydonN，DavisSD，LombardiE，etal.AnofficialAmericanThoracicSociety/EuropeanRespiratorySocietystatement：pulmonaryfunctiontestinginpreschoolchildren.AmJRespirCritCareMed，2007，175（12）：1304-13043.HiroyukiMochizuki.Bronchialsensitivityandbronchialreactivityinchildrenwithcoughvariantasthma.Chest，2005，128（4）：2427-24274.MillerMR，HankinsonJ，Brusasco.Standardisationofspirometry.EurRespirJ，2005，26：319-3195.OostveenE，MacleodD，LorinoH，etal.Theforcedoscillationtechniqueinclinicalpractice：methodology，recommendationsandfuturedevelopments.EurRespirJ，2003，22（6）：1026-10266.SlyPD，MorganW.Respiratoryfunctiontestingininfantsandpreschool-agedchildren.In：TaussigLMandLandauLIeds.PediatricRespiratorymedicine.2nded.Philadelphia：Mosby，2008：163-1637.TurnerDJ，LanteriCJ，LeSouefKL，etal.Improveddetectionofabnormalrespiratoryfunctionusingforcedexpirationfromrausedlungvolumeininfantswithcysticfibrosis.EurRespirJ，1994，7（11）：1995-19958.TurnerDJ，StickSM，LeSouefKL，etal.Anewtechniquetogenerateandassessforcedexpirationfromraisedlungvolumeininfants.AmJRespirCritCareMed，1995，151（5）：1441-14419.WangerJ，ClausenJL，CoatesA，etal.Standardisationofthemeasurementoflungvolumes.EurRespirJ，2005，26（3）：511-511 | [
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"entity": "肺炎",
"start_offset": 31,
"end_offset": 33,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸道",
"start_offset": 35,
"end_offset": 38,
"label": "bod"
},
{
"id": 2,
"entity": "顺应性",
"start_offset": 41,
"end_offset": 44,
"label": "ite"
},
{
"id": 3,
"entity": "临床儿科",
"start_offset": 48,
"end_offset": 52,
"label": "dep"
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] |
第二节新生儿辅助机械通气辅助机械通气是治疗呼吸衰竭的重要手段。 | [
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"id": 1,
"entity": "辅助机械通气",
"start_offset": 12,
"end_offset": 18,
"label": "pro"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
}
] |
新生儿呼吸系统代偿能力低下，当患呼吸系统疾病时极易发生呼吸衰竭，故在NICU中使用机械通气的频率较高。 | [
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"end_offset": 22,
"label": "dis"
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"entity": "呼吸衰竭",
"start_offset": 27,
"end_offset": 31,
"label": "dis"
},
{
"id": 3,
"entity": "NICU",
"start_offset": 34,
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"label": "dep"
},
{
"id": 4,
"entity": "机械通气",
"start_offset": 41,
"end_offset": 45,
"label": "pro"
}
] |
因此，新生儿急救医生应熟练、全面、准确地掌握机械通气相关的肺力学知识、气体交换方式、主要参数的作用、常用的通气模式及其临床应用。 | [
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"entity": "急救",
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"label": "dep"
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{
"id": 1,
"entity": "机械通气",
"start_offset": 22,
"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "肺",
"start_offset": 29,
"end_offset": 30,
"label": "bod"
}
] |
目前，有很多新类型呼吸机供新生儿选用，但持续气流、压力限定-时间转换型呼吸机（continuousflow，pressurelimitedandtime-cycledventilator）仍是新生儿基本而常用的呼吸机类型。 | [
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"id": 2,
"entity": "continuousflow，pressurelimitedandtime-cycledventilator",
"start_offset": 39,
"end_offset": 93,
"label": "equ"
},
{
"id": 3,
"entity": "呼吸机",
"start_offset": 105,
"end_offset": 108,
"label": "equ"
}
] |
持续气流是指呼吸机在吸气相和呼气相均持续向其管道内送气，在吸气相，呼气阀关闭气体送入肺内，过多气体通过泄压阀排入大气；在呼气相，呼气阀开放，气体排入大气。 | [
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"id": 0,
"entity": "呼吸机",
"start_offset": 6,
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"id": 1,
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"label": "equ"
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"id": 2,
"entity": "呼气阀",
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"label": "equ"
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{
"id": 3,
"entity": "肺",
"start_offset": 42,
"end_offset": 43,
"label": "bod"
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{
"id": 4,
"entity": "泄压阀",
"start_offset": 51,
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"label": "equ"
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"entity": "呼气相",
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{
"id": 6,
"entity": "呼气阀",
"start_offset": 64,
"end_offset": 67,
"label": "equ"
}
] |
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