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关闭4毫米及以上的大的动脉导管有较高的技术要求，须植入多个弹簧圈。 | [
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弹簧圈封堵术的并发症不多见，包括弹簧圈导致的肺动脉分支栓塞、堵塞不全所致的血管内溶血及植入多个弹簧圈导致的左肺动脉狭窄。 | [
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对于大的动脉导管未闭，纽式装置和近来备受推崇的Amplatzer导管封堵器已取得良好疗效（图9-9C）。 | [
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新近的多中心研究表明，纽扣式堵闭器用纽式装置是可行的和十分安全的。 | [
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在284例年龄在3个月至92岁之间，动脉导管直径在1～15mm间的患者中，278例（98%）患者术后1年、2年、5年的残余分流检出率分别为21%、14%和0%。 | [
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同时，在婴儿和年长儿中采用Amplatzer导管封堵器堵塞中到大型动脉导管亦已积累了大量经验。 | [
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Bilkis等近来报道了209例年龄在2个月至50岁，动脉导管在1.8～12.5mm之间，Amplatzer导管封堵器对98%患者有效，术后24小时内和1月内关闭率分别为66%和97%。 | [
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术后并发症较少，包括堵塞装置引起栓塞、轻度主动脉狭窄，血管内溶血更少见。 | [
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（四）手术治疗手术结扎导管临床上有0.4%到3.1%的残余分流率。 | [
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使用较敏感的彩色多普勒超声探查，残余分流率可能会更高，因此，对于一些再通和管径超过7～10毫米的患者需手术时应切断动脉导管。 | [
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近来，对新生儿、婴儿经腋下小切口胸廓切开术已经开展，取得了广为认可的效果。 | [
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手术步骤包括胸腔镜直视下放置血管夹。 | [
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该新技术扩展应用于早产儿和婴儿，并发症包括气胸、喉返神经损伤。 | [
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（五）无症状动脉导管未闭随着彩色多普勒技术的应用，一些无临床症状的细小的动脉导管引起的微弱的湍流亦可被探及。 | [
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据报道，因发现与动脉导管未闭血流无关的杂音而行彩超检查的儿童中约0.5%发现有无症状性动脉导管未闭。 | [
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曾有报道示1例无症状性导管未闭患者患有动脉内膜炎，是否需常规关闭无症状性导管尚需进一步探讨。 | [
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【预后】未经治疗的动脉导管未闭患者的完整自然病程尚不清楚。 | [
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预期寿命的数据多是在常规使用抗生素之前收集的，由于感染性心内膜炎是患儿死亡的重要原因，预防性使用抗生素使情况与以往有明显不同。 | [
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并发症包括感染性动脉内膜炎、进行性肺血管疾病和动脉瘤形成。 | [
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目前感染性动脉内膜炎的危险性已较前大大降低。 | [
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近期来自瑞典的研究表明，270例动脉导管未闭患者的随访研究中，无一例患感染性动脉内膜炎。 | [
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经导管动脉导管堵塞术很少引起动脉内膜炎，使用Rashkind双伞封堵术的发病率为0.1%。 | [
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但术后通常应用了抗生素进行预防性治疗。 | [
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常规的方法是在彩色多普勒证实导管完全堵闭后，继续连续应用抗生素6～12个月进行预防。 | [
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由于早期发现和治疗，进行性肺血管病变并不常见，偶有病人发展为肺血管病变和不可逆性肺动脉高压，此时为关闭动脉导管的禁忌证，这些病人常考虑行肺移植。 | [
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动脉导管瘤较少见，一旦出现，导管可能增大并压迫肺动脉，损伤喉返神经或出现瘤破裂。 | [
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【导管依赖性循环】动脉导管未闭在许多先天性心脏病中具有重要作用。 | [
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未闭的动脉导管保证了充足的肺血流、体循环血流及体肺循环间血液的混合，此称为“导管依赖性循环”。 | [
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导管依赖性肺循环见于肺动脉瓣闭锁、肺动脉狭窄及严重的法洛四联征；导管依赖性体循环见于严重水肿或离断、严重的主动脉瓣狭窄、左心发育不良综合征。 | [
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对于完全性大动脉转位的患者，必须通过动脉导管使体肺循环血液得到充分混合。 | [
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【维持动脉导管开放】（一）前列腺素E1和E2前列腺素E具有保持动脉导管开放的作用。 | [
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持续静脉点滴前列腺素E1或E2可用于导管依赖性循环的婴儿。 | [
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在特殊情况下，如早产儿，延长前列腺素E的使用时间仍很安全，且耐受量无变化。 | [
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前列腺素E2也可口服，但次数多且吸收不稳定。 | [
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前列腺素E的副作用有发热、呼吸暂停、心动过缓、低血压和癫痫样运动。 | [
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（二）动脉导管支架在实施手术困难的患儿，可植入自体扩张支架或球囊扩张支架以防止动脉导管关闭。 | [
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这种血管内支架的姑息植入适用于左心发育不良综合征、肺动脉环缩和复杂型肺动脉闭锁的患儿。 | [
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{
"id": 5,
"entity": "复杂型肺动脉闭锁",
"start_offset": 31,
"end_offset": 39,
"label": "dis"
}
] |
姑息手术的效果只是暂时的，术后仍需重复通过球囊成形术来减少血管内膜肥厚所带来的影响。 | [
{
"id": 0,
"entity": "姑息手术",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "球囊成形术",
"start_offset": 21,
"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "血管内膜肥厚",
"start_offset": 29,
"end_offset": 35,
"label": "dis"
}
] |
而且，在导管依赖性心脏畸形婴儿中，导管内支架的作用仍需进一步研究。 | [
{
"id": 0,
"entity": "导管依赖性心脏畸形",
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{
"id": 1,
"entity": "导管内支架",
"start_offset": 17,
"end_offset": 22,
"label": "equ"
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] |
第三节神经电生理技术一、脑电图脑电图（electroencephalogram，EEG）描记法是应用电子放大技术将脑部自发的生物电流活动放大100万倍，通过头皮上两点间的电位差，或者头皮和无关电极值的电位差描记出脑波图线，临床上称为脑电图。 | [
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"id": 0,
"entity": "脑电图",
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{
"id": 1,
"entity": "脑电图",
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{
"id": 2,
"entity": "electroencephalogram",
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"entity": "EEG",
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"entity": "脑部",
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{
"id": 5,
"entity": "头皮",
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{
"id": 6,
"entity": "头皮",
"start_offset": 91,
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"label": "bod"
},
{
"id": 7,
"entity": "脑电图",
"start_offset": 116,
"end_offset": 119,
"label": "pro"
}
] |
（一）原理脑电图所见的节律性电活动是发生于大脑皮质锥体细胞，经过突触后传送，它实际是代表着突触后电位，而不是从轴突传出的电位。 | [
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"id": 0,
"entity": "脑电图",
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{
"id": 1,
"entity": "大脑皮质锥体细胞",
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{
"id": 2,
"entity": "突触",
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{
"id": 3,
"entity": "突触",
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{
"id": 4,
"entity": "轴突",
"start_offset": 55,
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"label": "bod"
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] |
脑电图上的曲线并不代表几个神经细胞所发放的电流，而是大脑某一区域内许多神经元在一定生理生化代谢情况下的同步化电位。 | [
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"id": 0,
"entity": "脑电图",
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{
"id": 1,
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{
"id": 2,
"entity": "神经元",
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由于大脑各区情况不同，同步的神经元数目也有差别，所以作为脑电活动信号的波率及波幅等也就不一致。 | [
{
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"entity": "神经元",
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] |
主要见于枕顶区，为年长儿及正常成人的基本节律。 | [
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"entity": "枕顶区",
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] |
α波在清醒安静闭目时即出现，睁眼、注意及思考问题时消失。 | [
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"entity": "α波在清醒安静闭目时即出现，睁眼、注意及思考问题时消失",
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"label": "sym"
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] |
注意、情绪紧张或服用安眠药时可增多。 | [
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"entity": "安眠药",
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{
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"entity": "注意、情绪紧张或服用安眠药时可增多",
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] |
3.θ波频率在4～7Hz，波幅20～40μV，见于顶区及额颞区。 | [
{
"id": 0,
"entity": "额颞区",
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"label": "bod"
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] |
在病理状态下，局限性慢波出现于局限性癫痫、脑肿瘤、脑脓肿、脑外伤性血肿和伴有软化灶的脑血管病等，有定位诊断价值。 | [
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"id": 0,
"entity": "局限性癫痫",
"start_offset": 15,
"end_offset": 20,
"label": "dis"
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{
"id": 1,
"entity": "脑肿瘤",
"start_offset": 21,
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"label": "dis"
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{
"id": 2,
"entity": "脑脓肿",
"start_offset": 25,
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"label": "dis"
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{
"id": 3,
"entity": "脑外伤性血肿",
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"label": "dis"
},
{
"id": 4,
"entity": "伴有软化灶的脑血管病",
"start_offset": 36,
"end_offset": 46,
"label": "dis"
}
] |
弥漫性慢活动见于某些感染、中毒、低血糖、颅内压增高和各种原因引起的昏迷等。 | [
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"id": 0,
"entity": "感染",
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{
"id": 1,
"entity": "中毒",
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{
"id": 2,
"entity": "低血糖",
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"label": "sym"
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{
"id": 3,
"entity": "颅内压增高",
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"label": "sym"
},
{
"id": 4,
"entity": "昏迷",
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"label": "sym"
}
] |
5.κ节律在进行思维活动时，有时于额颞部出现一种6～12Hz，10～40μV的节律，开眼一般不抑制。 | [
{
"id": 0,
"entity": "额颞部",
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"end_offset": 20,
"label": "bod"
}
] |
6.λ波在枕区出现的3～5Hz，10～40μV正相尖波，常为注视所诱发。 | [
{
"id": 0,
"entity": "枕区",
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] |
7.μ节律在中央区出现的7～11Hz的节律，常为弧形，与希腊字母的μ相似，见于3%～13%正常人，常被握拳所抑制，开眼时不消失。 | [
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"entity": "常被握拳所抑制，开眼时不消失",
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] |
8.顶尖波主要是负相尖波，在顶区最明显，常见于浅睡期。 | [
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"entity": "在顶区最明显，常见于浅睡期",
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] |
9.σ节律又称睡梭或睡波，为约14Hz的节律，常发生于中睡期。 | [
{
"id": 0,
"entity": "常发生于中睡期",
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"label": "sym"
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] |
10.κ复合波是由顶尖波和σ节律组成的复合波，可在睡眠中自发性出现或被突然的声音刺激诱发出现。 | [
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"id": 0,
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"label": "sym"
}
] |
棘波是大脑皮层神经细胞过度兴奋癫痫，多棘波见于肌阵挛性发作。 | [
{
"id": 0,
"entity": "大脑皮层神经细胞",
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{
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{
"id": 2,
"entity": "癫痫",
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{
"id": 3,
"entity": "肌阵挛性发作",
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"label": "sym"
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] |
12.尖波是周期为70～200ms的三角形波，与背景脑电图有区别，出现于各种类型癫痫，三相尖波见于肝性昏迷。 | [
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"id": 0,
"entity": "脑电图",
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"label": "pro"
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{
"id": 1,
"entity": "癫痫",
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"label": "dis"
},
{
"id": 2,
"entity": "肝性昏迷",
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"label": "sym"
}
] |
13.棘慢综合波是由1个棘波和1个慢波组成的复合波，棘波周期短于770ms，慢波的周期在200～500ms之间，出现于局限性癫痫。 | [
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"entity": "局限性癫痫",
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"label": "dis"
}
] |
两侧对称同步3Hz持续的有规律的棘慢节律见于失神发作。 | [
{
"id": 0,
"entity": "失神发作",
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] |
14.多棘慢波由2个/2个以上的棘波和1个慢波组成的复合波，见于肌阵挛性发作。 | [
{
"id": 0,
"entity": "见于肌阵挛性发作",
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"label": "sym"
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] |
15.尖慢综合波由1个尖波和1个慢波组成，尖波的周期在70～200ms之间，慢波周期在500～1000ms之间，出现于各种类型癫痫。 | [
{
"id": 0,
"entity": "癫痫",
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"end_offset": 65,
"label": "dis"
}
] |
16.高度失律为不规则的高波幅慢活动，杂以棘波和尖波，一般不会形成典型的复合波，呈发作性或游走性，见于婴儿痉挛。 | [
{
"id": 0,
"entity": "痉挛",
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"label": "sym"
}
] |
17.懒波一侧大脑半球有病变时，在病侧可出现α波减弱或消失，以及β波和睡眠波的减弱或消失。 | [
{
"id": 0,
"entity": "大脑半球",
"start_offset": 7,
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"label": "bod"
},
{
"id": 1,
"entity": "在病侧可出现α波减弱或消失，以及β波和睡眠波的减弱或消失",
"start_offset": 16,
"end_offset": 44,
"label": "sym"
}
] |
18.平坦活动各种频率的电活动有不同程度的抑制，为大脑严重损害或各种原因引起的极度昏迷病人的脑波。 | [
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"entity": "大脑",
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},
{
"id": 1,
"entity": "极度昏迷",
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"label": "sym"
}
] |
19.爆发性抑制活动即在平坦活动背景上，突然出现高波幅慢活动，可合并尖波，是大脑皮层和皮层下广泛损害的表现，见于婴儿痉挛、恶性胶质瘤、脑炎极期或麻醉过深脑电图的参数包括频率、波幅、波形、位相及调节与调幅。 | [
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{
"id": 1,
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{
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{
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"entity": "恶性胶质瘤",
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{
"id": 4,
"entity": "脑炎",
"start_offset": 67,
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"label": "dis"
},
{
"id": 5,
"entity": "麻醉",
"start_offset": 72,
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"label": "pro"
},
{
"id": 6,
"entity": "麻醉过深",
"start_offset": 72,
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"label": "sym"
},
{
"id": 7,
"entity": "脑电图",
"start_offset": 76,
"end_offset": 79,
"label": "pro"
}
] |
脑电图的波幅，常以枕部描记出来的那些基本节律的波高度为标准。 | [
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{
"id": 1,
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] |
（四）儿童正常脑电图1.安静时脑电图（1）新生儿期：以低波幅δ活动和20～50μV的θ活动及散在性低波幅的α波和β波为特征。 | [
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{
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{
"id": 2,
"entity": "低波幅δ活动和20～50μV的θ活动及散在性低波幅的α波和β波",
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] |
（2）婴儿期：特征为频率2～6Hz，波幅20～50μV的慢活动。 | [
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"entity": "特征为频率2～6Hz，波幅20～50μV的慢活动",
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] |
背景活动表现为基线不稳。 | [
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"entity": "背景活动表现为基线不稳",
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] |
6个月以前以δ活动占优势，半岁以后θ活动为主。 | [
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] |
此期α波和β波很少，常散在性或短程出现。 | [
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"entity": "此期α波和β波很少，常散在性或短程出现",
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] |
（3）幼儿期：特点是30～60μV的θ活动，背景活动表现为基线不稳。 | [
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"entity": "背景活动表现为基线不稳",
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] |
1岁半以前以θ活动占优势，1岁半岁以后有13%以α活动占主导。 | [
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] |
此期β活动仍很少。 | [
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"entity": "此期β活动仍很少",
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] |
（4）学龄前期：特征为7～10Hz波幅40～120μV的θ活动，背景活动表现为基线不稳。 | [
{
"id": 0,
"entity": "特征为7～10Hz波幅40～120μV的θ活动，背景活动表现为基线不稳",
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] |
多数（88%）以α活动占优势，少数（12%）以7～8Hzθ活动为主。 | [
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] |
（5）儿童期：以8～11Hz，40～120μV的α活动占优势，背景活动表现为基线不稳或欠稳各占一半左右。 | [
{
"id": 0,
"entity": "以8～11Hz，40～120μV的α活动占优势，背景活动表现为基线不稳或欠稳各占一半左右",
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"label": "sym"
}
] |
（6）青少年期：以9～12Hz，20～100μV的α节律占优势，2/3表现为背景活动基线欠稳。 | [
{
"id": 0,
"entity": "以9～12Hz，20～100μV的α节律占优势，2/3表现为背景活动基线欠稳",
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] |
2.睡眠脑电图睡眠时脑电图改变很大，但有一定规律性，一般把睡眠过程分为下列四期：（1）思睡期：开始α节律波幅增高，区域扩大，然后α节律减少，频率变慢，波幅减低，常短阵或成对出现。 | [
{
"id": 0,
"entity": "开始α节律波幅增高，区域扩大，然后α节律减少，频率变慢，波幅减低，常短阵或成对出现",
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"label": "sym"
}
] |
低波幅β活动和θ活动增多。 | [
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（2）浅睡期：α节律逐渐消失，出现低波幅4～7Hzθ活动和高波幅尖波，后者通常在顶区明显，称顶尖波，为此期特点。 | [
{
"id": 0,
"entity": "α节律逐渐消失，出现低波幅4～7Hzθ活动和高波幅尖波，后者通常在顶区明显",
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"label": "sym"
}
] |
（3）中睡期：慢活动增多，波幅增高而频率进一步减低，自1～6Hz不等，常出现约14Hz的δ节律，为此期特点。 | [
{
"id": 0,
"entity": "慢活动增多，波幅增高而频率进一步减低，自1～6Hz不等，常出现约14Hz的δ节律",
"start_offset": 7,
"end_offset": 47,
"label": "sym"
}
] |
（4）深睡期：δ节律和κ复合波减少至消失。 | [
{
"id": 0,
"entity": "δ节律和κ复合波减少至消失",
"start_offset": 7,
"end_offset": 20,
"label": "sym"
}
] |
1～2Hz高波幅δ活动逐渐增加而占优势。 | [
{
"id": 0,
"entity": "1～2Hz高波幅δ活动逐渐增加而占优势",
"start_offset": 0,
"end_offset": 19,
"label": "sym"
}
] |
极度深睡时持续出现弥漫性0.5～1Hz的高波幅δ活动。 | [
{
"id": 0,
"entity": "极度深睡时持续出现弥漫性0.5～1Hz的高波幅δ活动",
"start_offset": 0,
"end_offset": 26,
"label": "sym"
}
] |
在儿童思睡期或被叫醒时，可呈现持续性或阵发性高波幅慢活动。 | [
{
"id": 0,
"entity": "呈现持续性或阵发性高波幅慢活动",
"start_offset": 13,
"end_offset": 28,
"label": "sym"
}
] |
大脑半球有病变时，在病变部位睡眠波（顶尖波、δ节律或κ复合波）可减弱或消失。 | [
{
"id": 0,
"entity": "大脑半球",
"start_offset": 0,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "在病变部位睡眠波（顶尖波、δ节律或κ复合波）可减弱或消失",
"start_offset": 9,
"end_offset": 37,
"label": "sym"
}
] |
在药物睡眠时，除慢活动外，还重叠有很多快活动。 | [
{
"id": 0,
"entity": "在药物睡眠时，除慢活动外，还重叠有很多快活动",
"start_offset": 0,
"end_offset": 22,
"label": "sym"
}
] |
在昏迷时只有不同程度的慢活动，而不出现睡眠波。 | [
{
"id": 0,
"entity": "昏迷",
"start_offset": 1,
"end_offset": 3,
"label": "sym"
}
] |
（五）儿童异常脑电图对儿童脑电图异常的判断较成人困难，需要熟悉儿童各年龄期的脑电图特点。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 7,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "脑电图",
"start_offset": 13,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "脑电图",
"start_offset": 38,
"end_offset": 41,
"label": "pro"
}
] |
如果某一儿童的脑电图不符合或有异于该年龄组别的脑电图式样，为异常脑电图，提示该儿童的大脑发育出现障碍，或大脑受到某些疾病的损害。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 7,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "脑电图",
"start_offset": 23,
"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "脑电图",
"start_offset": 32,
"end_offset": 35,
"label": "pro"
},
{
"id": 3,
"entity": "大脑",
"start_offset": 42,
"end_offset": 44,
"label": "bod"
},
{
"id": 4,
"entity": "大脑",
"start_offset": 52,
"end_offset": 54,
"label": "bod"
}
] |
2岁以后很多每秒4～6周波慢波，6岁以后有中量每秒4～7周波慢活动均属不正常。 | [
{
"id": 0,
"entity": "2岁以后很多每秒4～6周波慢波，6岁以后有中量每秒4～7周波慢活动",
"start_offset": 0,
"end_offset": 33,
"label": "sym"
}
] |
出现棘波、尖波、病理复合波或高度失律，以及爆发性抑制活动或平坦活动，局限性高幅快波或慢波以及经常不对称，则不论任何年龄组均应视为异常。 | [
{
"id": 0,
"entity": "出现棘波、尖波、病理复合波或高度失律，以及爆发性抑制活动或平坦活动，局限性高幅快波或慢波以及经常不对称",
"start_offset": 0,
"end_offset": 51,
"label": "sym"
}
] |
（六）临床应用脑电图检查对癫痫、颅内占位性病变以及中枢神经系统感染性疾病等阳性率高达80%～90%。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 7,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "癫痫",
"start_offset": 13,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "颅内占位性病变",
"start_offset": 16,
"end_offset": 23,
"label": "dis"
},
{
"id": 3,
"entity": "中枢神经系统感染性疾病",
"start_offset": 25,
"end_offset": 36,
"label": "dis"
}
] |
脑电图也常用于脑外伤、脑血管疾病或躯体性疾病引起中枢神经系统功能失调或损害的检查。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 0,
"end_offset": 3,
"label": "pro"
},
{
"id": 1,
"entity": "脑外伤",
"start_offset": 7,
"end_offset": 10,
"label": "dis"
},
{
"id": 2,
"entity": "脑血管疾病",
"start_offset": 11,
"end_offset": 16,
"label": "dis"
},
{
"id": 3,
"entity": "躯体性疾病",
"start_offset": 17,
"end_offset": 22,
"label": "dis"
},
{
"id": 4,
"entity": "中枢神经系统功能失调或损害",
"start_offset": 24,
"end_offset": 37,
"label": "sym"
}
] |
根据异常脑电波出现是弥漫性还是局限性，可判断病变的范围，如系局限性的异常则有定位诊断的作用。 | [
{
"id": 0,
"entity": "脑电波",
"start_offset": 4,
"end_offset": 7,
"label": "pro"
}
] |
病变部位可出现局灶性δ波。 | [
{
"id": 0,
"entity": "病变部位可出现局灶性δ波",
"start_offset": 0,
"end_offset": 12,
"label": "sym"
}
] |
脑电图检查时常规使用一些诱发方法，使不明显的异常电活动诱发出来，如视反应、过度换气以及闪光刺激等，还可做睡眠诱发及药物诱发试验等。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 0,
"end_offset": 3,
"label": "pro"
}
] |
另外，还可加用特殊电极引导出某部位的异常脑波，如鼻咽电极、蝶骨电极、枕下电极、皮层电极以及深部电极等。 | [
{
"id": 0,
"entity": "鼻咽电极",
"start_offset": 24,
"end_offset": 28,
"label": "equ"
},
{
"id": 1,
"entity": "蝶骨电极",
"start_offset": 29,
"end_offset": 33,
"label": "equ"
},
{
"id": 2,
"entity": "枕下电极",
"start_offset": 34,
"end_offset": 38,
"label": "equ"
},
{
"id": 3,
"entity": "皮层电极",
"start_offset": 39,
"end_offset": 43,
"label": "equ"
},
{
"id": 4,
"entity": "深部电极",
"start_offset": 45,
"end_offset": 49,
"label": "equ"
}
] |
近年还开展了24小时动态监测脑电图和视屏同步监测脑电图，使异常脑电波发现率明显增高。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 14,
"end_offset": 17,
"label": "pro"
},
{
"id": 1,
"entity": "脑电图",
"start_offset": 24,
"end_offset": 27,
"label": "pro"
},
{
"id": 2,
"entity": "脑电波",
"start_offset": 31,
"end_offset": 34,
"label": "pro"
}
] |
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