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易并发急性心力衰竭。 | [
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初期听诊呼吸音减弱、哮鸣音为主，而后可闻细湿啰音。 | [
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"entity": "细湿啰音",
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X线检查见肺纹理增粗或点片状阴影，部分见肺不张或以肺气肿为主要表现。 | [
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鼻咽部脱落细胞病毒免疫荧光或免疫酶检查，均可在数小时内获得结果。 | [
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"entity": "鼻咽部脱落细胞病毒",
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"entity": "免疫酶",
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急性期可有RSV特异IgM升高。 | [
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年龄小、喘憋出现早是本病的特点，但确诊要靠血清学和病毒学检查。 | [
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"entity": "血清学",
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"entity": "病毒学检查",
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六、胶囊内镜全称为“智能胶囊消化道内镜系统”，又称“医用无线内镜”。 | [
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原理是受检者通过口服内置摄像与信号传输装置的智能胶囊，借助消化道蠕动使之在消化道内运动并拍摄图像，医生利用体外的图像记录仪和影像工作站，了解受检者的整个消化道情况，从而对其病情做出诊断。 | [
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"entity": "消化道",
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胶囊内镜具有检查方便、无创伤、无导线、无痛苦、无交叉感染以及不影响患者的正常工作等优点，扩展了消化道检查的视野，克服了传统的插入式内镜所具有的耐受性差、不适用于年老体弱和病情危重等缺陷，可作为消化道疾病尤其是小肠疾病诊断的首选方法。 | [
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"entity": "小肠疾病",
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二、免疫调节治疗通过增强和调节机体免疫功能，达到清除体内病毒的目的。 | [
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"entity": "病毒",
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如胸腺素α1，能促进T细胞分化和成熟、使IL-2和IL-2受体表达增加、增加Th细胞功能等，使机体能有效发挥免疫防护功能。 | [
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"entity": "Th细胞",
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已证实，其单用或联合应用治疗慢性丙型肝炎效佳；并可用于重型丙型和乙型肝炎的治疗。 | [
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"entity": "重型丙型和乙型肝炎",
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再如，聚肌胞（人工合成的双链RNA）是高效干扰素诱生剂，具广谱抗病毒作用。 | [
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"entity": "人工合成的双链RNA",
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"entity": "干扰素诱生剂",
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下述治疗性疫苗实际上都是通过调节和提高特异性免疫功能而发挥其抗病毒效应。 | [
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参考文献1.韩玉昆，等.儿科实用诊断治疗学.合肥：安徽科技出版社，19992.杨锡强，等.儿童免疫学.北京：人民卫生出版社，20013.杨锡强.原发性免疫缺陷病.中国实用儿科杂志，2000，15（8）：5044.OchsHD，SmithCIE，PuckJM.PrimaryImmunodeficiencyDiseases：AMolecularandApproach.OxfordUniversityPress.NewYork，Oxford，19995.RosenFS，WedgwoodRJP，EiblM.Primaryimmunodeficiencydisease：ReportofaWHOScientificGroup，ClinExpImmunol，1997，109（Supl）：1-16.StiehmER.ImmunologicDisorderinInfantsandChildren.3rded，W.B.SaundersCo，19967.GrezM，BeckerS，SaulnierS，etal.Genetherapyofchronicgranulomatousdisease.BoneMarrowTransplant，2000，25：S99 | [
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参考文献1.罗学荣，苏林雁，万国斌，等.品行障碍儿童家庭环境的logistic回归分析.中国心理卫生杂志，1994，（8）：2612.沈晓明.儿童铅中毒.北京：人民卫生出版社，1996；53-533.陶国泰.儿童少年精神医学.南京：江苏科学技术出版社，1999：438-4424.叶广俊.现代儿童少年卫生学.北京：人民卫生出版社，1999：332-3325.AmericanAcademyofPediatrics.Committeeonpsychosocialaspectsofchildandfamilyhealth：thepediatrician’sroleinhelpingchildrenandfamiliesdealwithseparationanddivorce.Pediatrics，1994，（1）：1196.BischofGP，StithSM，WhitneyML.Familyenvironmentsofadolescent，sexoffendersandotherjuveniledelinquents.Adolescence，1995，（117）：1577.BrentDA.Depressionandsuicideinchildrenandadolescents.PediatrRev，1993，（10）：3808.DuRrantRH，GettsA，CadenheadC，etal.Exposuretoviolenceandvictimizationanddepression，hopelessnessandpurposeinlifeamongadolescentslivinginandaroundpublichousing.JDevelBehavPediatr，1995，（4）：2339.HofmannAD，GreydanusDE.Adolescentmedicine.3<sup>rd</sup>ed.Appleton＆Lange：Stanford，1997：835-83510.HindelangRL，DwyerWO.Adolescentrisk-takingbehavior：Areviewoftheroleofparentalinvolvement.CurrentproblemsinPediatrics，2001，（3）：6311.SmetanaJG.Parentingstylesandconceptionsofparentalauthorityduringadolescence.ChildDevel，1995，（2）：29912.WenderEH.Attention-deficithyperactivitydisordersinadolescence.JDevelBehavPediatr，1995，（3）：192 | [
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第六节主动脉狭窄有几种类型的先天性心血管畸形可阻挡血液自左室喷射出。 | [
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"entity": "左室",
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最常见为主动脉瓣本身的异常，其他的原因可包括：二尖瓣或乳头肌的位置异常、室间隔肌性肥厚、主动脉瓣下纤维环、主动脉瓣下薄膜样结构仅留一小孔、主动脉瓣上狭窄。 | [
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"entity": "主动脉瓣上狭窄",
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由于主动脉瓣狭窄（aorticstenosis）是最常见的主动脉狭窄类型，本节将作一详述。 | [
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一、主动脉瓣狭窄大约85%的先天性主动脉瓣狭窄为二瓣畸形，这二个主动脉瓣一大一小，其间有一偏心的鱼嘴样开口。 | [
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梗阻部分是由于瓣叶交界融合所形成的小孔，部分是由于瓣叶增厚、活动缺乏。 | [
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如在宫内时狭窄已严重，可发生左室血液转移，因而可出现左心室及升主动脉发育不良。 | [
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约20%伴其他畸形，如主动脉瓣关闭不全、水肿、升主动脉发育不良、动脉导管未闭，以及二尖瓣关闭不全及狭窄。 | [
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"entity": "二尖瓣关闭不全及狭窄",
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【病理生理】如左心室收缩压高、左心室肥厚、且主动脉舒张压低、舒张期短，心内膜下血流可不足，心内膜下缺血因此发生。 | [
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这解释了为什么严重主动脉瓣狭窄时会发生心内膜下坏死及纤维化。 | [
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轻型患者只有杂音而无左室肥厚。 | [
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反之，如卵圆孔未闭，心房水平存在明显的左向右分流，左心房压升高不多，此时肺水肿可不明显，但心输出量降低。 | [
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"entity": "心输出量降低",
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在上述任一情况，左心室均可显著扩大，并发生左心功能不全。 | [
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在较轻型病例左心室肥厚足以克服梗阻，因而心输出量可维持。 | [
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先天性主动脉瓣狭窄的自然病程往往有日趋恶化的趋势。 | [
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当患儿生长时，心排量必需增长，但狭窄瓣口并不能相应扩大，所以左心室与主动脉的压差愈益扩大，尤其在患儿生长较快的年龄阶段狭窄程度可较快变化。 | [
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"label": "bod"
},
{
"id": 3,
"entity": "主动脉",
"start_offset": 34,
"end_offset": 37,
"label": "bod"
}
] |
【临床表现】症状集中在幼婴和少儿两个年龄阶段；严重的狭窄在新生儿期即有表现，呼吸急速，心率增快，面色苍白，肺有水泡音，肝可肿大，患儿这些心力衰竭的表现可急剧恶化而夭折。 | [
{
"id": 0,
"entity": "呼吸急速",
"start_offset": 38,
"end_offset": 42,
"label": "sym"
},
{
"id": 1,
"entity": "心率",
"start_offset": 43,
"end_offset": 45,
"label": "ite"
},
{
"id": 2,
"entity": "心率增快",
"start_offset": 43,
"end_offset": 47,
"label": "sym"
},
{
"id": 3,
"entity": "面色苍白",
"start_offset": 48,
"end_offset": 52,
"label": "sym"
},
{
"id": 4,
"entity": "肺",
"start_offset": 53,
"end_offset": 54,
"label": "bod"
},
{
"id": 5,
"entity": "肺有水泡音",
"start_offset": 53,
"end_offset": 58,
"label": "sym"
},
{
"id": 6,
"entity": "肝",
"start_offset": 59,
"end_offset": 60,
"label": "bod"
},
{
"id": 7,
"entity": "肝可肿大",
"start_offset": 59,
"end_offset": 63,
"label": "sym"
},
{
"id": 8,
"entity": "心力衰竭",
"start_offset": 68,
"end_offset": 72,
"label": "dis"
}
] |
左心房的压力增高即可撑开未闭的卵圆孔向右心房分流，所以右心室可有容量的超负荷。 | [
{
"id": 0,
"entity": "左心房",
"start_offset": 0,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "卵圆孔",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "右心房",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "右心室",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
}
] |
X线示心脏增大，肺有充血及淤血；心电图示右心室占优势，患婴有典型的左心室肥厚者少。 | [
{
"id": 0,
"entity": "X线",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "心脏",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 2,
"entity": "心脏增大",
"start_offset": 3,
"end_offset": 7,
"label": "sym"
},
{
"id": 3,
"entity": "肺",
"start_offset": 8,
"end_offset": 9,
"label": "bod"
},
{
"id": 4,
"entity": "肺有充血及淤血",
"start_offset": 8,
"end_offset": 15,
"label": "sym"
},
{
"id": 5,
"entity": "心电图",
"start_offset": 16,
"end_offset": 19,
"label": "pro"
},
{
"id": 6,
"entity": "右心室",
"start_offset": 20,
"end_offset": 23,
"label": "bod"
},
{
"id": 7,
"entity": "右心室占优势",
"start_offset": 20,
"end_offset": 26,
"label": "sym"
},
{
"id": 8,
"entity": "左心室肥厚",
"start_offset": 33,
"end_offset": 38,
"label": "dis"
}
] |
杂音往往为诊断本病的线索，少数患儿诉易疲劳、腹痛或胸痛；典型的心绞痛在小儿很少见。 | [
{
"id": 0,
"entity": "杂音",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "疲劳",
"start_offset": 19,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "腹痛",
"start_offset": 22,
"end_offset": 24,
"label": "sym"
},
{
"id": 3,
"entity": "胸痛",
"start_offset": 25,
"end_offset": 27,
"label": "sym"
},
{
"id": 4,
"entity": "心绞痛",
"start_offset": 31,
"end_offset": 34,
"label": "dis"
}
] |
如有劳力型气急和昏厥，往往为严重狭窄的表现；但患儿因对症状无知，家长亦可并不介意，所以必须详细询问病史。 | [
{
"id": 0,
"entity": "劳力型气急",
"start_offset": 2,
"end_offset": 7,
"label": "sym"
},
{
"id": 1,
"entity": "昏厥",
"start_offset": 8,
"end_offset": 10,
"label": "sym"
},
{
"id": 2,
"entity": "严重狭窄",
"start_offset": 14,
"end_offset": 18,
"label": "dis"
}
] |
脉搏往往正常。 | [
{
"id": 0,
"entity": "脉搏",
"start_offset": 0,
"end_offset": 2,
"label": "ite"
}
] |
典型的脉压缩小，脉跳的起落缓渐需至成年方明显。 | [
{
"id": 0,
"entity": "脉压",
"start_offset": 3,
"end_offset": 5,
"label": "ite"
}
] |
心尖搏动持重有力；常可触到震颤，多位于胸骨右缘第二肋间，亦可在胸骨左缘下部或心尖部最清楚，且可向胸骨柄上窝及颈动脉传导。 | [
{
"id": 0,
"entity": "可触到震颤",
"start_offset": 10,
"end_offset": 15,
"label": "sym"
},
{
"id": 1,
"entity": "胸骨右缘第二肋间",
"start_offset": 19,
"end_offset": 27,
"label": "bod"
},
{
"id": 2,
"entity": "胸骨左缘下部",
"start_offset": 31,
"end_offset": 37,
"label": "bod"
},
{
"id": 3,
"entity": "心尖部",
"start_offset": 38,
"end_offset": 41,
"label": "bod"
},
{
"id": 4,
"entity": "胸骨柄上窝",
"start_offset": 48,
"end_offset": 53,
"label": "bod"
},
{
"id": 5,
"entity": "颈动脉",
"start_offset": 54,
"end_offset": 57,
"label": "bod"
}
] |
如无震颤，心尖搏动亦属正常，则狭窄往往很轻，压差常不超过30mmHg。 | [
{
"id": 0,
"entity": "心尖",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "狭窄",
"start_offset": 15,
"end_offset": 17,
"label": "dis"
}
] |
第一心音正常，胸骨左缘可听到收缩早期喀喇音，系由于瓣膜突然绷紧所致。 | [
{
"id": 0,
"entity": "胸骨左缘",
"start_offset": 7,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "第一心音正常，胸骨左缘可听到收缩早期喀喇音",
"start_offset": 0,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "瓣膜",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
}
] |
洪亮而粗糙的收缩期杂音为本病最重要体征，在胸骨右缘上部最响，并向胸骨柄上窝，背面及颈部传导，也可在左缘最响，甚至在心尖部也可很响；杂音自第一音后开始，以后渐强，其高峰视狭窄的程度而异，狭窄愈重，高峰出现愈迟，至收缩晚期又渐弱或听不到，至主动脉瓣关闭前完全消失。 | [
{
"id": 0,
"entity": "胸骨右缘上部",
"start_offset": 21,
"end_offset": 27,
"label": "bod"
},
{
"id": 1,
"entity": "背面",
"start_offset": 38,
"end_offset": 40,
"label": "bod"
},
{
"id": 2,
"entity": "心尖部",
"start_offset": 57,
"end_offset": 60,
"label": "bod"
},
{
"id": 3,
"entity": "狭窄",
"start_offset": 84,
"end_offset": 86,
"label": "dis"
},
{
"id": 4,
"entity": "狭窄",
"start_offset": 92,
"end_offset": 94,
"label": "dis"
},
{
"id": 5,
"entity": "主动脉瓣",
"start_offset": 118,
"end_offset": 122,
"label": "bod"
}
] |
响度为4～5/6级，有时可通过骨传导在右肘部亦能听到，使凭听诊量血压完全失真。 | [
{
"id": 0,
"entity": "骨",
"start_offset": 15,
"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "右肘部",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "血压",
"start_offset": 32,
"end_offset": 34,
"label": "ite"
}
] |
在胸骨左缘中部有时可听到2/6～3/6级渐弱的吹风样舒张期杂音，为主动脉瓣关闭不全所致。 | [
{
"id": 0,
"entity": "胸骨左缘",
"start_offset": 1,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "主动脉瓣关闭不全",
"start_offset": 33,
"end_offset": 41,
"label": "dis"
}
] |
由于左心室收缩射血费时较长，所以第二心音中主动脉瓣关闭音推迟，与肺动脉瓣关闭音接近，使正常所有的第二音分裂时距缩短；狭窄重者左心室射血时间更形延长，使主动脉瓣与肺动脉瓣关闭音相重叠；如极度狭窄，主动脉瓣关闭音甚至落后于肺动脉瓣关闭音，而且呼吸的影响与正常相反，吸气时分裂较短，而呼气分裂扩大，形成所谓“矛盾分裂”。 | [
{
"id": 0,
"entity": "左心室",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "主动脉瓣",
"start_offset": 21,
"end_offset": 25,
"label": "bod"
},
{
"id": 2,
"entity": "肺动脉瓣",
"start_offset": 32,
"end_offset": 36,
"label": "bod"
},
{
"id": 3,
"entity": "狭窄",
"start_offset": 58,
"end_offset": 60,
"label": "dis"
},
{
"id": 4,
"entity": "左心室",
"start_offset": 62,
"end_offset": 65,
"label": "bod"
},
{
"id": 5,
"entity": "主动脉瓣",
"start_offset": 75,
"end_offset": 79,
"label": "bod"
},
{
"id": 6,
"entity": "肺动脉瓣",
"start_offset": 80,
"end_offset": 84,
"label": "bod"
},
{
"id": 7,
"entity": "主动脉瓣",
"start_offset": 97,
"end_offset": 101,
"label": "bod"
},
{
"id": 8,
"entity": "肺动脉瓣",
"start_offset": 109,
"end_offset": 113,
"label": "bod"
}
] |
心尖部常可听到第三心音，严重狭窄甚至可听到左房使劲收缩充盈左室的第四心音。 | [
{
"id": 0,
"entity": "左房",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 1,
"entity": "左室",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
},
{
"id": 2,
"entity": "严重狭窄甚至可听到左房使劲收缩充盈左室的第四心音",
"start_offset": 12,
"end_offset": 36,
"label": "sym"
}
] |
【实验室检查】心电图示左心室肥大，但其程度不一定能反映狭窄的轻重。 | [
{
"id": 0,
"entity": "心电图",
"start_offset": 7,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "左心室",
"start_offset": 11,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "左心室肥大",
"start_offset": 11,
"end_offset": 16,
"label": "sym"
}
] |
严重者右心亦有增大，肺野充血。 | [
{
"id": 0,
"entity": "右心",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "严重者右心亦有增大，肺野充血",
"start_offset": 0,
"end_offset": 14,
"label": "sym"
}
] |
Doppler超声可估算压差和反流量。 | [
{
"id": 0,
"entity": "Doppler超声",
"start_offset": 0,
"end_offset": 9,
"label": "pro"
}
] |
由于超声检查的完善使心导管检查渐少用，逆行主动脉插管可通过狭窄的主动脉瓣口进入左心室，左心室压和由左心室拉回主动脉时压力连续曲线可显示狭窄的部位和左心室与主动脉之间的压差峰值。 | [
{
"id": 0,
"entity": "超声检查",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "心导管检查",
"start_offset": 10,
"end_offset": 15,
"label": "pro"
},
{
"id": 2,
"entity": "主动脉插管",
"start_offset": 21,
"end_offset": 26,
"label": "pro"
},
{
"id": 3,
"entity": "主动脉瓣口",
"start_offset": 32,
"end_offset": 37,
"label": "bod"
},
{
"id": 4,
"entity": "左心室",
"start_offset": 39,
"end_offset": 42,
"label": "bod"
},
{
"id": 5,
"entity": "左心室",
"start_offset": 43,
"end_offset": 46,
"label": "bod"
},
{
"id": 6,
"entity": "左心室",
"start_offset": 49,
"end_offset": 52,
"label": "bod"
},
{
"id": 7,
"entity": "主动脉",
"start_offset": 54,
"end_offset": 57,
"label": "bod"
},
{
"id": 8,
"entity": "左心室",
"start_offset": 73,
"end_offset": 76,
"label": "bod"
},
{
"id": 9,
"entity": "主动脉",
"start_offset": 77,
"end_offset": 80,
"label": "bod"
}
] |
左心室造影可显示左心室流出道的梗阻解剖，室壁厚度和二尖瓣有否反流。 | [
{
"id": 0,
"entity": "左心室造影",
"start_offset": 0,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "左心室流出道",
"start_offset": 8,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "室壁",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "二尖瓣",
"start_offset": 25,
"end_offset": 28,
"label": "bod"
}
] |
婴儿期主动脉逆行插管不易成功，可由右心导管穿过卵圆孔至左心房，再顺流入左心室，可测得左心室压力和行左心室造影。 | [
{
"id": 0,
"entity": "主动脉逆行插管",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "右心导管",
"start_offset": 17,
"end_offset": 21,
"label": "equ"
},
{
"id": 2,
"entity": "卵圆孔",
"start_offset": 23,
"end_offset": 26,
"label": "bod"
},
{
"id": 3,
"entity": "左心房",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "左心室",
"start_offset": 35,
"end_offset": 38,
"label": "bod"
},
{
"id": 5,
"entity": "左心室压力",
"start_offset": 42,
"end_offset": 47,
"label": "ite"
},
{
"id": 6,
"entity": "左心室造影",
"start_offset": 49,
"end_offset": 54,
"label": "pro"
}
] |
【治疗】当有心肌缺血或主动脉瓣口很小时应予手术。 | [
{
"id": 0,
"entity": "心肌缺血",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "主动脉瓣口",
"start_offset": 11,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "手术",
"start_offset": 21,
"end_offset": 23,
"label": "pro"
}
] |
如瓣口面积少于0.65cm<sub>2</sup>/M<sub>2</sup>而心排量正常，则左心室与主动脉的收缩期峰值压差已达到或超过70mmHg，这在大多数中心是行瓣膜切开术的指征。 | [
{
"id": 0,
"entity": "瓣口",
"start_offset": 1,
"end_offset": 3,
"label": "dis"
},
{
"id": 1,
"entity": "心",
"start_offset": 40,
"end_offset": 41,
"label": "dis"
},
{
"id": 2,
"entity": "左心室",
"start_offset": 47,
"end_offset": 50,
"label": "dis"
},
{
"id": 3,
"entity": "主动脉",
"start_offset": 51,
"end_offset": 54,
"label": "dis"
},
{
"id": 4,
"entity": "瓣膜切开术",
"start_offset": 84,
"end_offset": 89,
"label": "pro"
}
] |
瓣膜切开术只是姑息性的，术中切开瓣膜连合处以减少梗阻，但瓣膜连合处切开不能过大，因为这样的话可引起主动脉瓣明显反流。 | [
{
"id": 0,
"entity": "瓣膜切开术",
"start_offset": 0,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "瓣膜",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "梗阻",
"start_offset": 24,
"end_offset": 26,
"label": "dis"
},
{
"id": 3,
"entity": "瓣膜",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "主动脉瓣",
"start_offset": 49,
"end_offset": 53,
"label": "bod"
}
] |
这种姑息术可挽救生命，并维持良好功能状态数年，但术后再狭窄的发生率很高，常与钙化有关。 | [
{
"id": 0,
"entity": "姑息术",
"start_offset": 2,
"end_offset": 5,
"label": "pro"
}
] |
最终，大多数严重主动脉瓣狭窄的患儿可能需要换瓣。 | [
{
"id": 0,
"entity": "严重主动脉瓣狭窄",
"start_offset": 6,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "换瓣",
"start_offset": 21,
"end_offset": 23,
"label": "pro"
}
] |
换瓣如可能应尽量推迟至成人，这样可避免因成长问题而需再次换瓣。 | [
{
"id": 0,
"entity": "换瓣",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "换瓣",
"start_offset": 28,
"end_offset": 30,
"label": "pro"
}
] |
在某些患儿可施行Ross手术，术后由于主动脉位置是自己的肺动脉瓣，因而无需抗凝，瓣膜的寿命也会延长。 | [
{
"id": 0,
"entity": "Ross手术",
"start_offset": 8,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "主动脉",
"start_offset": 19,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "肺动脉瓣",
"start_offset": 28,
"end_offset": 32,
"label": "bod"
},
{
"id": 3,
"entity": "瓣膜",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
}
] |
1984年，Lababidi等首先报道应用经皮球囊主动脉瓣成形术（PBAV）成功地治疗先天性或后天性主动脉瓣狭窄，引起广泛的重视。 | [
{
"id": 0,
"entity": "经皮球囊主动脉瓣成形术",
"start_offset": 21,
"end_offset": 32,
"label": "pro"
},
{
"id": 1,
"entity": "PBAV",
"start_offset": 33,
"end_offset": 37,
"label": "pro"
},
{
"id": 2,
"entity": "先天性或后天性主动脉瓣狭窄",
"start_offset": 43,
"end_offset": 56,
"label": "dis"
}
] |
由于我国发病率较欧美国家为少，另外PBAV在技术上有别于PBPV，且有严重并发症发生，因此国内除上海新华医院一组报告外，尚无系统开展该技术的报道。 | [
{
"id": 0,
"entity": "PBAV",
"start_offset": 17,
"end_offset": 21,
"label": "pro"
},
{
"id": 1,
"entity": "PBPV",
"start_offset": 28,
"end_offset": 32,
"label": "pro"
}
] |
根据1982～1986年204例小儿经皮球囊主动脉瓣形成术总结，95.1%获得即期成功。 | [
{
"id": 0,
"entity": "经皮球囊主动脉瓣形成术",
"start_offset": 18,
"end_offset": 29,
"label": "pro"
}
] |
随后对PBAV方法学上进行较多的研究，包括单球囊与双球囊扩张术及采用长的球囊进行扩张术，以后把球囊瓣膜成形术应用到新生儿病例，甚至进行胎儿主动脉瓣球囊成形术。 | [
{
"id": 0,
"entity": "PBAV",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "单球囊与双球囊扩张术",
"start_offset": 21,
"end_offset": 31,
"label": "pro"
},
{
"id": 2,
"entity": "长的球囊进行扩张术",
"start_offset": 34,
"end_offset": 43,
"label": "pro"
},
{
"id": 3,
"entity": "球囊瓣膜成形术",
"start_offset": 47,
"end_offset": 54,
"label": "pro"
},
{
"id": 4,
"entity": "胎儿主动脉瓣球囊成形术",
"start_offset": 67,
"end_offset": 78,
"label": "pro"
}
] |
目前，正在对PBAV病人进行中、长期随访，以观察其疗效与心功能的改变。 | [
{
"id": 0,
"entity": "PBAV",
"start_offset": 6,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "心",
"start_offset": 28,
"end_offset": 29,
"label": "bod"
}
] |
第四节鼻窦炎儿童鼻窦炎（sinusitis）较为常见，但不易识别。 | [
{
"id": 0,
"entity": "鼻窦炎",
"start_offset": 4,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "儿童鼻窦炎",
"start_offset": 7,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "sinusitis",
"start_offset": 13,
"end_offset": 22,
"label": "dis"
}
] |
急性鼻窦炎常继发于急性鼻炎，以肺炎链球菌、卡他莫拉菌和不定型流感嗜血杆菌引起者居多。 | [
{
"id": 0,
"entity": "急性鼻窦炎",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "急性鼻炎",
"start_offset": 9,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "肺炎链球菌",
"start_offset": 15,
"end_offset": 20,
"label": "mic"
},
{
"id": 3,
"entity": "卡他莫拉菌",
"start_offset": 21,
"end_offset": 26,
"label": "mic"
},
{
"id": 4,
"entity": "不定型流感嗜血杆菌",
"start_offset": 27,
"end_offset": 36,
"label": "mic"
}
] |
慢性鼻窦炎大多由于急性鼻窦炎反复发作所致，营养不良、免疫功能低下、过敏性体质、腺样体肥大等亦为常见致病因素。 | [
{
"id": 0,
"entity": "慢性鼻窦炎",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "急性鼻窦炎",
"start_offset": 9,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "腺样体",
"start_offset": 39,
"end_offset": 42,
"label": "bod"
}
] |
常见病原包括A组溶血性链球菌、金黄色葡萄球菌和厌氧菌，且常为混合感染。 | [
{
"id": 0,
"entity": "A组溶血性链球菌",
"start_offset": 6,
"end_offset": 14,
"label": "mic"
},
{
"id": 1,
"entity": "金黄色葡萄球菌",
"start_offset": 15,
"end_offset": 22,
"label": "mic"
},
{
"id": 2,
"entity": "厌氧菌",
"start_offset": 23,
"end_offset": 26,
"label": "mic"
},
{
"id": 3,
"entity": "混合感染",
"start_offset": 30,
"end_offset": 34,
"label": "dis"
}
] |
儿童鼻窦炎常缺乏头痛、面部疼痛、水肿、触痛。 | [
{
"id": 0,
"entity": "儿童鼻窦炎",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "面部",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "缺乏头痛、面部疼痛、水肿、触痛",
"start_offset": 6,
"end_offset": 21,
"label": "sym"
}
] |
咳嗽于平卧时加剧。 | [
{
"id": 0,
"entity": "咳嗽于平卧时加剧",
"start_offset": 0,
"end_offset": 8,
"label": "sym"
}
] |
分泌物引流不畅可致持久发热、头痛，相应的鼻窦部位压痛，鼻黏膜充血、水肿，中、下鼻道有黏稠脓液。 | [
{
"id": 0,
"entity": "持久发热",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
},
{
"id": 1,
"entity": "头",
"start_offset": 14,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "头痛",
"start_offset": 14,
"end_offset": 16,
"label": "sym"
},
{
"id": 3,
"entity": "鼻窦",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 4,
"entity": "相应的鼻窦部位压痛",
"start_offset": 17,
"end_offset": 26,
"label": "sym"
},
{
"id": 5,
"entity": "鼻黏膜",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 6,
"entity": "鼻黏膜充血、水肿",
"start_offset": 27,
"end_offset": 35,
"label": "sym"
},
{
"id": 7,
"entity": "中、下鼻道",
"start_offset": 36,
"end_offset": 41,
"label": "bod"
},
{
"id": 8,
"entity": "中、下鼻道有黏稠脓液",
"start_offset": 36,
"end_offset": 46,
"label": "sym"
}
] |
可合并中耳炎、眼眶蜂窝织炎、眼眶脓肿等。 | [
{
"id": 0,
"entity": "中耳炎",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "眼眶蜂窝织炎",
"start_offset": 7,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "眼眶脓肿",
"start_offset": 14,
"end_offset": 18,
"label": "dis"
}
] |
慢性鼻窦炎主要症状为鼻塞、流脓涕及张口呼吸。 | [
{
"id": 0,
"entity": "慢性鼻窦炎",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "鼻塞",
"start_offset": 10,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "流脓涕",
"start_offset": 13,
"end_offset": 16,
"label": "sym"
},
{
"id": 3,
"entity": "张口呼吸",
"start_offset": 17,
"end_offset": 21,
"label": "sym"
}
] |
可有疲乏、体重不增、食欲缺乏、贫血等。 | [
{
"id": 0,
"entity": "疲乏",
"start_offset": 2,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "体重",
"start_offset": 5,
"end_offset": 7,
"label": "ite"
},
{
"id": 2,
"entity": "体重不增",
"start_offset": 5,
"end_offset": 9,
"label": "sym"
},
{
"id": 3,
"entity": "食欲缺乏",
"start_offset": 10,
"end_offset": 14,
"label": "sym"
},
{
"id": 4,
"entity": "贫血",
"start_offset": 15,
"end_offset": 17,
"label": "sym"
}
] |
多数上呼吸道感染症状在7～10天内缓解，如症状持续10天未见缓解，应怀疑急性鼻窦炎。 | [
{
"id": 0,
"entity": "上呼吸道感染",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "急性鼻窦炎",
"start_offset": 36,
"end_offset": 41,
"label": "dis"
}
] |
如患儿病程虽在10天以内，但高热不退、伴流脓涕、头痛、眼眶肿胀，亦应考虑到本病可能。 | [
{
"id": 0,
"entity": "高热不退",
"start_offset": 14,
"end_offset": 18,
"label": "sym"
},
{
"id": 1,
"entity": "伴流脓涕",
"start_offset": 19,
"end_offset": 23,
"label": "sym"
},
{
"id": 2,
"entity": "头痛",
"start_offset": 24,
"end_offset": 26,
"label": "sym"
},
{
"id": 3,
"entity": "眼眶肿胀",
"start_offset": 27,
"end_offset": 31,
"label": "sym"
}
] |
病程超过90天者为慢性鼻窦炎。 | [
{
"id": 0,
"entity": "慢性鼻窦炎",
"start_offset": 9,
"end_offset": 14,
"label": "dis"
}
] |
根据鼻咽部分泌物细菌培养和药物敏感试验结果选用适当的抗生素。 | [
{
"id": 0,
"entity": "鼻咽部分泌物",
"start_offset": 2,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "细菌培养",
"start_offset": 8,
"end_offset": 12,
"label": "ite"
},
{
"id": 2,
"entity": "药物敏感试验",
"start_offset": 13,
"end_offset": 19,
"label": "ite"
},
{
"id": 3,
"entity": "抗生素",
"start_offset": 26,
"end_offset": 29,
"label": "dru"
}
] |
可首选羟氨苄青霉素，如为产β-内酰胺酶的卡他莫拉菌或流感嗜血杆菌感染，或上述治疗失败，应选用含β-内酰胺酶抑制剂的复合青霉素类、大环内酯类、第二或第三代头孢霉素。 | [
{
"id": 0,
"entity": "羟氨苄青霉素",
"start_offset": 3,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "卡他莫拉菌",
"start_offset": 20,
"end_offset": 25,
"label": "mic"
},
{
"id": 2,
"entity": "流感嗜血杆菌",
"start_offset": 26,
"end_offset": 32,
"label": "mic"
},
{
"id": 3,
"entity": "β-内酰胺酶抑制剂",
"start_offset": 47,
"end_offset": 56,
"label": "dru"
},
{
"id": 4,
"entity": "复合青霉素类",
"start_offset": 57,
"end_offset": 63,
"label": "dru"
},
{
"id": 5,
"entity": "大环内酯类",
"start_offset": 64,
"end_offset": 69,
"label": "dru"
},
{
"id": 6,
"entity": "第二或第三代头孢霉素",
"start_offset": 70,
"end_offset": 80,
"label": "dru"
}
] |
局部可短期使用麻黄素等滴鼻，以保证引流通畅。 | [
{
"id": 0,
"entity": "麻黄素",
"start_offset": 7,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "滴鼻",
"start_offset": 11,
"end_offset": 13,
"label": "pro"
}
] |
对有过敏性鼻炎基础的患儿可考虑加用抗组胺药物、抗白三烯药物或鼻吸糖皮质激素治疗。 | [
{
"id": 0,
"entity": "过敏性鼻炎",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "抗组胺",
"start_offset": 17,
"end_offset": 20,
"label": "dru"
},
{
"id": 2,
"entity": "抗白三烯",
"start_offset": 23,
"end_offset": 27,
"label": "dru"
},
{
"id": 3,
"entity": "鼻吸",
"start_offset": 30,
"end_offset": 32,
"label": "pro"
},
{
"id": 4,
"entity": "糖皮质激素",
"start_offset": 32,
"end_offset": 37,
"label": "dru"
}
] |
但抗组胺药可使分泌物黏稠而影响鼻窦引流，无过敏背景患儿应避免使用。 | [
{
"id": 0,
"entity": "抗组胺药",
"start_offset": 1,
"end_offset": 5,
"label": "dru"
},
{
"id": 1,
"entity": "分泌物黏稠",
"start_offset": 7,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "鼻窦",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "过敏",
"start_offset": 21,
"end_offset": 23,
"label": "dis"
}
] |
流感嗜血杆菌肺炎@二、流感嗜血杆菌肺炎流感嗜血杆菌（Hi）肺炎（hemophilusinfluenzaepneumonia）常见于5岁以下婴儿和年幼儿童。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 11,
"end_offset": 19,
"label": "dis"
},
{
"id": 1,
"entity": "流感嗜血杆菌",
"start_offset": 19,
"end_offset": 25,
"label": "dis"
},
{
"id": 2,
"entity": "Hi",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
},
{
"id": 3,
"entity": "肺炎",
"start_offset": 29,
"end_offset": 31,
"label": "dis"
},
{
"id": 4,
"entity": "hemophilusinfluenzaepneumonia",
"start_offset": 32,
"end_offset": 61,
"label": "dis"
}
] |
流感嗜血杆菌肺炎疾病@应用特异性免疫血清可将Hi分为a～f6型，其中以b型（Hib）致病力最强。 | [
{
"id": 0,
"entity": "b型（Hib）",
"start_offset": 35,
"end_offset": 42,
"label": "dis"
}
] |
流感嗜血杆菌肺炎@由于Hib疫苗的接种，20世纪90年代以后美国等发达国家Hib所致肺炎下降了95%。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "Hib疫苗",
"start_offset": 11,
"end_offset": 16,
"label": "mic"
},
{
"id": 2,
"entity": "肺炎",
"start_offset": 42,
"end_offset": 44,
"label": "dis"
}
] |
流感嗜血杆菌肺炎@近年来也有较多非b型Hi感染的报道。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
}
] |
流感嗜血杆菌肺炎@本病临床表现无特异性。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
}
] |
流感嗜血杆菌肺炎@但起病多较缓慢，病程可长达数周之久。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
}
] |
流感嗜血杆菌肺炎@幼婴常伴有菌血症，易出现脓胸、心包炎等化脓性并发症。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "菌血症",
"start_offset": 14,
"end_offset": 17,
"label": "sym"
},
{
"id": 2,
"entity": "脓胸",
"start_offset": 21,
"end_offset": 23,
"label": "sym"
},
{
"id": 3,
"entity": "心包炎",
"start_offset": 24,
"end_offset": 27,
"label": "sym"
}
] |
流感嗜血杆菌肺炎@外周血白细胞计数常中度升高。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "血白细胞",
"start_offset": 11,
"end_offset": 15,
"label": "ite"
}
] |
流感嗜血杆菌肺炎@多数患儿X线表现为大叶性或节段性病灶，下叶多受累。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "X线",
"start_offset": 13,
"end_offset": 15,
"label": "pro"
}
] |
流感嗜血杆菌肺炎@幼婴常伴胸膜受累。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "胸膜受累",
"start_offset": 13,
"end_offset": 17,
"label": "sym"
}
] |
流感嗜血杆菌肺炎@本病诊断有赖于从血、胸水或肺穿刺液中分离到病菌。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "血、胸水或肺穿刺液",
"start_offset": 17,
"end_offset": 26,
"label": "bod"
}
] |
流感嗜血杆菌肺炎@由于Hi在正常人群的咽部中有一定的携带率，托幼机构中更高，因而呼吸道标本诊断价值不大。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "咽部",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
}
] |
流感嗜血杆菌肺炎@治疗时必须注意Hi的耐药问题。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
}
] |
流感嗜血杆菌肺炎@目前分离的Hi主要耐药机制是产生β-内酰胺酶，美国、我国香港等地Hi菌株产酶率已高达30%以上。 | [
{
"id": 0,
"entity": "β-内酰胺酶",
"start_offset": 25,
"end_offset": 31,
"label": "mic"
}
] |
流感嗜血杆菌肺炎@国内各地关于氨苄西林耐药率和产酶率差异较大。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "氨苄西林",
"start_offset": 15,
"end_offset": 19,
"label": "dru"
}
] |
流感嗜血杆菌肺炎@如对病菌不产酶，可使用氨苄西林，如不能明确其是否产酶，首选头孢噻肟、头孢曲松等。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "氨苄西林",
"start_offset": 20,
"end_offset": 24,
"label": "dru"
},
{
"id": 2,
"entity": "头孢噻肟",
"start_offset": 38,
"end_offset": 42,
"label": "dru"
},
{
"id": 3,
"entity": "头孢曲松",
"start_offset": 43,
"end_offset": 47,
"label": "dru"
}
] |
流感嗜血杆菌肺炎@如最初反应良好，可改为口服，疗程为10～14天。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "口服",
"start_offset": 20,
"end_offset": 22,
"label": "pro"
}
] |
流感嗜血杆菌肺炎@在大环内酯类中，阿奇霉素、克拉霉素对Hi有较好的敏感性。 | [
{
"id": 0,
"entity": "流感嗜血杆菌肺炎",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "阿奇霉素",
"start_offset": 17,
"end_offset": 21,
"label": "dru"
},
{
"id": 2,
"entity": "克拉霉素",
"start_offset": 22,
"end_offset": 26,
"label": "dru"
}
] |
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