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新生儿痛觉不甚敏感，尤其在躯干、眼、腋下部位的痛刺激出现泛化现象。 | [
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哺乳时，当闻到乳的香味时就会积极地寻找乳头，而当闻到不愉快的气味时则转过头去。 | [
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他们喜欢较甜的糖水，吸吮浓度较高的糖水比浓度较低的糖水量多，吸吮力强。 | [
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对于咸的、酸的或苦的液体有不愉快的表情。 | [
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其睡眠生理与年长儿不同，其快速眼动睡眠每天约8～9小时。 | [
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入睡的模式是从醒觉至快速眼动睡眠，新生儿的快速眼动睡眠周期短，约50～60分钟出现1次快速眼动，而成人则为90～100分钟。 | [
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此外，新生儿上半夜的快速眼动与下半夜的一样多。 | [
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新生儿的觉醒和睡眠按不同程度分为6种表现状态，即两种睡眠状态，安静睡眠（深睡）和活动睡眠（浅睡）；三种觉醒状态，安静觉醒、活动觉醒和哭；另一种是介于睡眠和觉醒之间的过渡形式，即瞌睡状态。 | [
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1.安静觉醒状态新生儿在这种状态下很机敏，喜欢看东西，特别是圆形和色彩鲜艳的东西。 | [
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还喜欢注视父母的脸，专心地听他们说话。 | [
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这种安静觉醒的时间很短，刚生下的新生儿约有40分钟的安静觉醒时间。 | [
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2.活动觉醒状态吃奶前或烦躁时，活动增加，眼和脸部活动也增加，并发出声音有时运动很剧烈，甚至出现自发的惊跳。 | [
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有时运动呈阵发性，伴有特殊的节律。 | [
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在这种状态下，如新生儿受到不愉快的刺激，则可使其活动增强或惊跳。 | [
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3.哭的状态新生儿哭时四肢有力地活动，眼可张开或紧闭，脸有时变得很红哭是新生儿表示意愿的一种方式，如饿了、尿布湿了或身体不适时哭，求助于父母能满足他们的要求。 | [
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也可在刚醒时，哭一会儿进入安静觉醒状态。 | [
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4.瞌睡状态通常发生在刚醒后或入睡前。 | [
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眼半睁半闭，眼睑出现闪动，眼闭和前眼球可能向上滚动有时微笑、皱眉或噘嘴唇，目光呆滞，反应迟钝。 | [
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对声音或图形表现茫然。 | [
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常伴有轻度惊跳，这是觉醒和睡眠之间的过渡阶段，持续时间较短。 | [
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5.活动睡眠状态新生儿在活动睡眠时，眼睛通常是闭合的，但偶然短暂地睁一下，眼睑有时颤动，经常可见到眼球在眼睑下快速运动小儿呼吸不规则，比安静睡眠时稍快。 | [
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手臂、腿和整个身体偶然有些活动，且脸上常显出可笑的表情如做出怪相、微笑和皱眉有时出现吸吮动作或咀嚼状态。 | [
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新生儿除了前述的视觉和听觉定向各能力外，能在帮助下竖起头，还有反射性的运动能力，如身体站立，在牵拉新生儿时，新生儿会像拉单杠似的腾空而起。 | [
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在给新生儿做视知觉或行为检查中，如果新生儿处于良好的安静觉醒状态下，当你发出轻柔语声时，新生儿会对你的说话感兴趣，向你凝视，并作出友好的应答，面露笑容，嘴唇嗫嚅犹如与你说话一样，表现十分轻松、惬意颈屈肌和颈伸肌的主动收缩，在帮助下可使头竖立。 | [
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例如，我们用双手在新生儿乳间连线水平固定其身体，自仰卧位慢慢将新生儿扶起，在刚扶起时新生儿头向后垂，当将躯体与床位成垂直时因颈屈肌的主动收缩头会竖立。 | [
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主动肌张力的另一个运动是牵拉反射，即当你取得新生儿的握持反射后，在新生儿紧紧握住你的手指时的刹那立即将双手举起，新生儿靠上肢肌肉的主动收缩会使自己的躯体腾空而起。 | [
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在这阶段中，儿童接受各种感觉刺激，并作出反射性应答，如吸吮、抓握等，在逐渐修正反射的过程中进入第二阶段。 | [
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三、主动脉瓣上狭窄在主动脉窦（乏氏窦）上缘发生的局限性或弥漫性狭窄，少见。 | [
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冠状动脉开口在狭窄之前，所以压力很高，常扩张扭曲，易致动脉硬化，周围动脉和肺动脉也可有狭窄。 | [
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这种疾病可单独发生，也可伴有特发性婴儿高钙血症。 | [
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磁共振成像及超声心动图可显示主动脉瓣上狭窄，多普勒可评估跨狭窄段压差。 | [
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不提倡经导管球囊扩张。 | [
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目前，儿童的疾病谱正在发生变化，既往影响儿童健康最严重的感染性疾病和营养性疾病已经明显下降，而先天性畸形、恶性肿瘤、意外损伤、慢性疾病、心理行为性疾病和环境因素有关的疾病成为儿童健康新的威胁，多数疾病不单纯是生物因素的作用，还受心理和社会诸因素的制约，有许多疾病的生物因素也要通过心理与社会因素起作用。 | [
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参考文献1.洪流，于皆平，沈志祥，等.小儿大肠息肉特点.内镜.1994，11（5）：2902.李铁一.儿科X线诊断学.天津：天津科学技术出版社，1990：1253.林庚金，吴云林主编.内镜临床应用进展.上海：上海科学技术文献出版社，1991：684.尚克中，陈九如.胃肠道造影原理与诊断.上海：上海科学技术文献出版社，1995.3575.童尔昌，季海萍.小儿腹部外科学.北京：人民卫生出版社，19916.吴恩惠.影像诊断学.第3版.北京：人民卫生出版社，1995：1407.许春娣，徐家裕.儿童食管胃静脉曲张的内镜诊断与治疗.见吴云林主编.食管和胃静脉曲张出血的现代治疗.上海：上海科学技术文献出版社，1996：978.许春娣，肖丽萍，张太锦，等.小儿慢性胃炎的临床表现与内镜特点.临床儿科杂志，1994，12（6）：4169.许春娣，吴云林，梅红，等.上消化道出血急诊胃镜检查与止血初步探讨.中华儿科杂志，1995，33（1）：2210.于中麟.反流性食道炎内镜诊断及协作治疗方案（试行）.内镜，1993，10：4811.BeatlieRM，WaikerJA，MurchSH.Indicationforinvestigationofchronicgastrointestinalsymptoms.ArchDisChild，1995，73（4）：35412.ChundiXU，JiayuXU，etal.EndoscopyManagementofgastrointestinalpolypsinchildren.JGastroenterolHepatol，1995，10：28713.GoenkaAS，DAsilvaMS，Cleghon，etal.Thereputicuppergastrointestinalendoscopyinchildren：Auauditof443procedureandliteraturereview.JGastroenterolHepatol，1993，8：44 | [
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四、呼吸性碱中毒呼吸性碱中毒（respiratoryalkalosis）是由于肺泡通气过度增加致血二氧化碳分压降低。 | [
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] |
其原发病因可为心理因素所致的呼吸过度、机械通气时每分通气量太大，也可见于水杨酸中毒所致的呼吸中枢过度刺激、对CO2</sub>的敏感性太高所致的呼吸增加。 | [
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"entity": "呼吸增加",
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低氧、贫血、CO中毒时呼吸加快，也可使PaCO2</sub>降低出现碱中毒。 | [
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急性低碳酸血症可使神经肌肉兴奋性增加低血钙所致的肢体感觉异常。 | [
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"entity": "肢体感觉异常",
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血气分析见pH增加、PaCO2</sub>降低、血浓度降低、尿液常呈酸性。 | [
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四、副流感病毒肺炎副流感病毒肺炎（parainfluenzapneumonia）易感对象为3个月至1岁的婴儿。 | [
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"entity": "parainfluenzapneumonia",
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其发病率仅次于RSV。 | [
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多有3～5日的中等程度发热或高热及呼吸困难、哮吼样咳嗽、三凹征、肺部干湿啰音等，但多数患儿表现较轻，一般无中毒症状，病程较短。 | [
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"entity": "肺部干湿啰音",
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X线检查肺野可有小片状阴影。 | [
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临床上无法与其他病毒性肺炎相区别，根据血清学和病毒学检查结果确定诊断。 | [
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"entity": "血清学和病毒学检查",
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七、先天性膈疝先天性膈疝（congenitaldiaphragmatichernia）是由于胚胎期膈肌发育缺陷，出现较大的裂隙或缺损，致生后一部分腹腔脏器疝入胸腔，压迫胸腔内组织，引起呼吸、循环障碍，或胃肠道梗阻、绞窄、出血甚至坏死。 | [
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{
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"entity": "膈肌",
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{
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"entity": "腹腔脏器",
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{
"id": 5,
"entity": "胸腔",
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{
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"entity": "胸腔内组织",
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{
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"entity": "呼吸、循环障碍",
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] |
按发生部位及临床特点分为三型：①胸腹裂孔疝（即Bochdalek疝），约占90%，症状出现早，多于婴儿期就诊；②胸骨后疝（又称Morgagni疝），较少见，约占3%；③食管裂孔疝，多见于中老年人，儿童偶见。 | [
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{
"id": 1,
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{
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"entity": "胸骨后疝",
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{
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"entity": "Morgagni疝",
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{
"id": 4,
"entity": "食管裂孔疝",
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] |
临床症状的严重程度和出现时间与下列因素有关：①进入胸腔的腹部脏器的种类和容量；②是否有肺发育不全和肺动脉高压；③是否有肠道梗阻或其他先天性畸形。 | [
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{
"id": 1,
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{
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"entity": "肺发育不全",
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多数患儿在生后24小时内出现呼吸困难，喂奶及哭闹时加重，患侧卧位或半坐位时则稍减轻；反复发生肺炎、呕吐及营养不良；体格检查时可发现患侧胸壁呼吸运动减弱，心界向对侧移位，患侧叩诊呈鼓音，肺呼吸音减低或消失，肺部可闻肠鸣音，并呈舟状腹。 | [
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{
"id": 1,
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{
"id": 2,
"entity": "哭闹时加重",
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{
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{
"id": 4,
"entity": "肺炎",
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},
{
"id": 5,
"entity": "呕吐",
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{
"id": 6,
"entity": "营养不良",
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"label": "dis"
},
{
"id": 7,
"entity": "体格检查",
"start_offset": 57,
"end_offset": 61,
"label": "ite"
},
{
"id": 8,
"entity": "患侧胸壁呼吸运动减弱",
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"label": "sym"
},
{
"id": 9,
"entity": "心界向对侧移位",
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"label": "sym"
},
{
"id": 10,
"entity": "患侧叩诊呈鼓音",
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"end_offset": 91,
"label": "sym"
},
{
"id": 11,
"entity": "肺呼吸音减低或消失",
"start_offset": 92,
"end_offset": 101,
"label": "sym"
},
{
"id": 12,
"entity": "肺部可闻肠鸣音",
"start_offset": 102,
"end_offset": 109,
"label": "sym"
},
{
"id": 13,
"entity": "并呈舟状腹",
"start_offset": 110,
"end_offset": 115,
"label": "sym"
}
] |
产前超声波检查多数可做出诊断。 | [
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胸片可发现有疝入侧的胸部出现胃或肠管阴影、或透亮的团块状阴影、纵隔和心脏向对侧移位等。 | [
{
"id": 0,
"entity": "透亮的团块状阴影",
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] |
对于不易确诊的病例，须做钡餐检查以明确其类型和位置，然后决定手术方法。 | [
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{
"id": 1,
"entity": "手术",
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] |
本病均需手术治疗，一旦确诊应尽早手术。 | [
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{
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] |
第六章急性肾衰竭见第十二篇第十一章。 | [
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二、护理要点（一）保温和保湿VLBW出生后，应在远红外暖床上立即擦拭干净其体表的水分，送入暖箱，以防止低体温的出现。 | [
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"entity": "VLBW",
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{
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},
{
"id": 2,
"entity": "暖箱",
"start_offset": 46,
"end_offset": 48,
"label": "equ"
}
] |
在保温的同时应注意保湿，因为其不显性失水相对较多，容易出现脱水。 | [
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"entity": "脱水",
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] |
用塑料布或薄膜覆盖VLBW的全身，可以明显减少不显性失水。 | [
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"id": 0,
"entity": "VLBW",
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] |
通过这些方法，可以将不显性失水的量减少30%～60%，从而减少输液量，这对VLBW而言是有重要意义的。 | [
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"id": 0,
"entity": "VLBW",
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] |
控制液体的供给，是预防动脉导管开放的重要措施之一，并可以减轻肾脏的负担。 | [
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{
"id": 2,
"entity": "肾脏",
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}
] |
但是，也有人提出暖箱内如此高的湿度是否会增加感染的机会，尤其是通过水分传播的铜绿假单胞菌感染。 | [
{
"id": 0,
"entity": "暖箱",
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"end_offset": 10,
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},
{
"id": 1,
"entity": "感染",
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{
"id": 2,
"entity": "铜绿假单胞菌感染",
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] |
高湿度可造成皮肤感染，这种感染对于VLBW而言是致命的。 | [
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"entity": "皮肤感染",
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"end_offset": 10,
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{
"id": 1,
"entity": "感染",
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"label": "dis"
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{
"id": 2,
"entity": "VLBW",
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"label": "dis"
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] |
其实，只要加强医疗行为中预防感染的措施，并将水汽雾化使用的时间控制在生后3～7天内，应当是安全的。 | [
{
"id": 0,
"entity": "感染",
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"end_offset": 16,
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] |
（二）呼吸管理首先应防止胎龄小于32周的早产儿发生因肺表面活性物质的缺乏而出现呼吸窘迫综合征，及时补充肺表面活性物质是有效的措施。 | [
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"id": 0,
"entity": "肺表面活性物质",
"start_offset": 26,
"end_offset": 33,
"label": "bod"
},
{
"id": 1,
"entity": "肺表面活性物质的缺乏",
"start_offset": 26,
"end_offset": 36,
"label": "sym"
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{
"id": 2,
"entity": "呼吸窘迫综合征",
"start_offset": 39,
"end_offset": 46,
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{
"id": 3,
"entity": "及时补充肺表面活性物质",
"start_offset": 47,
"end_offset": 58,
"label": "pro"
}
] |
如果药物治疗效果不佳，并出现严重低氧血症的，可以使用呼吸机进行治疗。 | [
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"id": 0,
"entity": "低氧血症",
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"end_offset": 20,
"label": "dis"
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{
"id": 1,
"entity": "呼吸机",
"start_offset": 26,
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] |
（三）喂养和营养VLBW的喂养不应过迟，尽早喂养可以减轻生理性体重下降的程度，防止低血糖的发生，降低核黄疸的危险性。 | [
{
"id": 0,
"entity": "VLBW",
"start_offset": 8,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "体重",
"start_offset": 31,
"end_offset": 33,
"label": "ite"
},
{
"id": 2,
"entity": "低血糖",
"start_offset": 41,
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"label": "dis"
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{
"id": 3,
"entity": "核黄疸",
"start_offset": 50,
"end_offset": 53,
"label": "dis"
}
] |
喂养应以母乳为最佳，可以减少坏死性小肠结肠炎的发生率，并给予母乳强化剂。 | [
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"entity": "母乳",
"start_offset": 4,
"end_offset": 6,
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"id": 1,
"entity": "坏死性小肠结肠炎",
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{
"id": 2,
"entity": "母乳强化剂",
"start_offset": 30,
"end_offset": 35,
"label": "dru"
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] |
如果没有母乳，可以选用适合早产儿使用的配方奶进行喂养，在用配方奶之前可以先试用糖水，且糖水的浓度不可超过5%，高渗性糖水对VLBW的胃肠道不利，容易引起坏死性小肠结肠炎。 | [
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"id": 0,
"entity": "母乳",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
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{
"id": 1,
"entity": "VLBW",
"start_offset": 61,
"end_offset": 65,
"label": "dis"
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{
"id": 2,
"entity": "胃肠道",
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{
"id": 3,
"entity": "坏死性小肠结肠炎",
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"label": "dis"
}
] |
喂养的方式尽可能选用让小儿自己吸吮的方式，若有困难，可以使用鼻胃管或鼻肠管的方式。 | [
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{
"id": 1,
"entity": "鼻肠管",
"start_offset": 34,
"end_offset": 37,
"label": "equ"
}
] |
需要注意的是，在使用鼻胃管或鼻肠管喂养时，应注意给奶的速度，切忌快速注入，应根据小儿的体重给予喂养的量，开始剂量为2～5ml左右。 | [
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{
"id": 1,
"entity": "鼻肠管",
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"label": "equ"
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{
"id": 2,
"entity": "体重",
"start_offset": 43,
"end_offset": 45,
"label": "ite"
}
] |
事实上，大部分VLBW需经2～3周的全肠外营养（TPN）或部分肠外营养才能防止严重EUGR的发生。 | [
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"entity": "VLBW",
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"end_offset": 11,
"label": "dis"
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{
"id": 1,
"entity": "全肠外营养",
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"id": 2,
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"label": "pro"
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{
"id": 4,
"entity": "EUGR",
"start_offset": 41,
"end_offset": 45,
"label": "dis"
}
] |
在给予TPN时应注意营养素的全面和均衡。 | [
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"entity": "TPN",
"start_offset": 3,
"end_offset": 6,
"label": "pro"
}
] |
（四）预防感染对VLBW的操作过程应严格执行消毒隔离制度，注意其环境和用具的清洁。 | [
{
"id": 0,
"entity": "VLBW",
"start_offset": 8,
"end_offset": 12,
"label": "dis"
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] |
对于使用气管插管、鼻胃管或鼻肠管的小儿，应至少每周换管1次，并对换下的管道进行细菌学检测，以指导抗生素的应用。 | [
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"entity": "细菌学检测",
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{
"id": 6,
"entity": "抗生素",
"start_offset": 48,
"end_offset": 51,
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] |
对VLBW伴有低丙种球蛋白血症的，可以给予静脉输注丙种球蛋白，以提高对感染的抵抗力。 | [
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"entity": "VLBW",
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{
"id": 1,
"entity": "低丙种球蛋白血症",
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{
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},
{
"id": 4,
"entity": "感染",
"start_offset": 35,
"end_offset": 37,
"label": "dis"
}
] |
（五）动脉导管开放（PDA）的处理对存在PDA的VLBW，可以首先控制每天液体的输注量，以降低心脏负荷。 | [
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"end_offset": 9,
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{
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"entity": "PDA",
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"entity": "VLBW",
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{
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"entity": "心脏",
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"label": "bod"
}
] |
其次，可以使用吲哚美辛治疗。 | [
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"entity": "吲哚美辛",
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在使用吲哚美辛后，应注意肾功能的变化和有无坏死性小肠结肠炎的发生。 | [
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"id": 0,
"entity": "吲哚美辛",
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{
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"entity": "坏死性小肠结肠炎",
"start_offset": 21,
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"label": "dis"
}
] |
在使用吲哚美辛关闭动脉导管后24～72小时，可有部分小儿的动脉导管重新开放。 | [
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"entity": "吲哚美辛",
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{
"id": 2,
"entity": "动脉导管重新开放",
"start_offset": 29,
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"label": "dis"
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] |
（六）预防核黄疸对于VLBW，其黄疸的换血胆红素指标应在10～15mg/dl，要及时纠正低蛋白血症，并尽早开始光疗。 | [
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"entity": "核黄疸",
"start_offset": 5,
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"label": "dis"
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{
"id": 1,
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{
"id": 2,
"entity": "黄疸",
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"entity": "换血胆红素",
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{
"id": 4,
"entity": "低蛋白血症",
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"label": "dis"
},
{
"id": 5,
"entity": "光疗",
"start_offset": 55,
"end_offset": 57,
"label": "pro"
}
] |
（七）对于脑室内出血的预防和治疗要防止反复低氧的发生、血压的波动和高渗性补液的输注（VLBW应用的葡萄糖溶液浓度应低于8%），同时应用头颅B超或CT对小儿颅内情况进行连续监测，部分资料显示的应用苯巴比妥或吲哚美辛（消炎痛）及布洛芬都有部分预防脑室内出血的结果，但尚缺乏大样本多中心临床试验结果的支持。 | [
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"entity": "头颅B超或CT",
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"id": 7,
"entity": "颅内",
"start_offset": 77,
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{
"id": 8,
"entity": "苯巴比妥",
"start_offset": 97,
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"label": "dru"
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{
"id": 9,
"entity": "吲哚美辛",
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{
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"entity": "消炎痛",
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{
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"entity": "布洛芬",
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{
"id": 12,
"entity": "脑室内出血",
"start_offset": 121,
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"label": "dis"
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] |
最近的资料显示，目前临床上部分应用的连续腰穿疗法，对治疗由脑室内出血所造成的脑积水其疗效难以肯定，需要进一步的论证。 | [
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{
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] |
第三节细菌性痢疾细菌性痢疾（bacillarydysentery）简称菌痢，系由细菌引起的常见肠道传染病，由四种志贺菌属引起，它们是志贺菌（A群）、福氏菌（B群）、鲍氏菌（C群）、宋内（D群）痢疾杆菌。 | [
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"id": 1,
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{
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"entity": "细菌",
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"id": 5,
"entity": "肠道传染病",
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"label": "dis"
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{
"id": 6,
"entity": "志贺菌",
"start_offset": 56,
"end_offset": 59,
"label": "mic"
},
{
"id": 7,
"entity": "志贺菌（A群）",
"start_offset": 66,
"end_offset": 73,
"label": "mic"
},
{
"id": 8,
"entity": "福氏菌（B群）",
"start_offset": 74,
"end_offset": 81,
"label": "mic"
},
{
"id": 9,
"entity": "鲍氏菌（C群）",
"start_offset": 82,
"end_offset": 89,
"label": "mic"
},
{
"id": 10,
"entity": "宋内（D群）痢疾杆菌",
"start_offset": 90,
"end_offset": 100,
"label": "mic"
}
] |
【临床流行病学】痢疾的发病有明显的季节性，多为夏季或热带地区的雨季，以婴幼儿的发病率最高，多见于2～3岁，小于6个月的婴儿很少发病，这可能是母乳喂养时婴儿从母乳中获得带有抗毒性质粒编码的抗脂多糖抗体。 | [
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"id": 1,
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{
"id": 2,
"entity": "母乳",
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] |
在发达国家，宋内痢疾杆菌引起的感染较常见，福氏菌占第二位；在发展中国家如我国，福氏菌感染占第一位，宋内菌占第二位，志贺菌1型是引起大规模流行的菌型，在亚洲的某些地区，它也是主要的流行菌型。 | [
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"entity": "宋内痢疾杆菌",
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"end_offset": 12,
"label": "mic"
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{
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"entity": "感染",
"start_offset": 15,
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{
"id": 2,
"entity": "福氏菌",
"start_offset": 21,
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"label": "mic"
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{
"id": 3,
"entity": "福氏菌感染",
"start_offset": 39,
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{
"id": 4,
"entity": "宋内菌",
"start_offset": 49,
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},
{
"id": 5,
"entity": "志贺菌1型",
"start_offset": 57,
"end_offset": 62,
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] |
污染的蔬菜、瓜果或粪便管理不当，水源污染是引起痢疾流行或暴发的常见原因，生活的接触也是感染的主要方式。 | [
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"entity": "粪便",
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"label": "bod"
},
{
"id": 1,
"entity": "痢疾",
"start_offset": 23,
"end_offset": 25,
"label": "dis"
}
] |
人类对痢疾有普遍的易感性，感染后的免疫反应不一，亦不长久，所以可多次反复感染。 | [
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{
"id": 2,
"entity": "感染",
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"end_offset": 38,
"label": "dis"
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] |
有报道分泌性IgA和血清抗体在感染的数天或数周内产生，目前已知有抗脂多糖抗体，抗毒力质粒编码的多肽抗体，但它们抗感染的主要保护性决定簇尚不清楚。 | [
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{
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"start_offset": 10,
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},
{
"id": 2,
"entity": "抗脂多糖抗体",
"start_offset": 32,
"end_offset": 38,
"label": "bod"
}
] |
有资料表明这种抗感染作用是血清型特异性的，但也有不同程度的交叉，细胞免疫也可能有一些保护作用，作用不大。 | [
{
"id": 0,
"entity": "血清",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 1,
"entity": "细胞",
"start_offset": 32,
"end_offset": 34,
"label": "bod"
}
] |
【发病机制】所有痢疾杆菌的基本毒力因素是它们能够侵入结肠上皮细胞，这是由一个120～140MDa的大质粒编码的一组多肽造成的侵袭性和杀伤性作用，丢失此质粒的菌株则不再致病。 | [
{
"id": 0,
"entity": "痢疾杆菌",
"start_offset": 8,
"end_offset": 12,
"label": "mic"
},
{
"id": 1,
"entity": "结肠上皮细胞",
"start_offset": 26,
"end_offset": 32,
"label": "bod"
}
] |
此外，染色体编码的因子也具有毒力作用，如编码脂多糖合成的染色体，由1型志贺菌合成的志贺毒素，由福氏菌2a型合成的志贺肠毒素1。 | [
{
"id": 0,
"entity": "1型志贺菌",
"start_offset": 33,
"end_offset": 38,
"label": "mic"
},
{
"id": 1,
"entity": "志贺毒素",
"start_offset": 41,
"end_offset": 45,
"label": "mic"
},
{
"id": 2,
"entity": "福氏菌2a型",
"start_offset": 47,
"end_offset": 53,
"label": "mic"
},
{
"id": 3,
"entity": "志贺肠毒素1",
"start_offset": 56,
"end_offset": 62,
"label": "mic"
}
] |
1型志贺菌可产生大量志贺毒素。 | [
{
"id": 0,
"entity": "1型志贺菌",
"start_offset": 0,
"end_offset": 5,
"label": "mic"
},
{
"id": 1,
"entity": "志贺毒素",
"start_offset": 10,
"end_offset": 14,
"label": "mic"
}
] |
而在痢疾感染的水泻阶段，很可能主要是志贺肠毒素1所致，少量的痢疾杆菌即可致病。 | [
{
"id": 0,
"entity": "痢疾感染",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "水泻",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "志贺肠毒素1",
"start_offset": 18,
"end_offset": 24,
"label": "mic"
},
{
"id": 3,
"entity": "痢疾杆菌",
"start_offset": 30,
"end_offset": 34,
"label": "mic"
}
] |
临床可见下列类型：1.急性菌痢起病急，典型症状为严重的腹痛、高热、呕吐、食欲缺乏、全身中毒症状重，体征有腹胀、压痛、肠鸣音亢进。 | [
{
"id": 0,
"entity": "急性菌痢",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "腹痛",
"start_offset": 27,
"end_offset": 29,
"label": "sym"
},
{
"id": 2,
"entity": "高热",
"start_offset": 30,
"end_offset": 32,
"label": "sym"
},
{
"id": 3,
"entity": "呕吐",
"start_offset": 33,
"end_offset": 35,
"label": "sym"
},
{
"id": 4,
"entity": "食欲缺乏",
"start_offset": 36,
"end_offset": 40,
"label": "sym"
},
{
"id": 5,
"entity": "全身中毒症状重",
"start_offset": 41,
"end_offset": 48,
"label": "sym"
},
{
"id": 6,
"entity": "腹胀",
"start_offset": 52,
"end_offset": 54,
"label": "sym"
},
{
"id": 7,
"entity": "压痛",
"start_offset": 55,
"end_offset": 57,
"label": "sym"
},
{
"id": 8,
"entity": "肠鸣音亢进",
"start_offset": 58,
"end_offset": 63,
"label": "sym"
}
] |
指诊时直肠触痛，大便开始为稀水样，继而见黏冻样、脓冻样或脓血便，便次多，量小，便数不等，年长儿有里急后重，婴幼儿可无脓便及脓血便，易误诊为其他细菌引起的肠炎或病毒性肠炎，病程5～7天。 | [
{
"id": 0,
"entity": "指诊",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "直肠",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 2,
"entity": "指诊时直肠触痛",
"start_offset": 0,
"end_offset": 7,
"label": "sym"
},
{
"id": 3,
"entity": "大便开始为稀水样，继而见黏冻样、脓冻样或脓血便",
"start_offset": 8,
"end_offset": 31,
"label": "sym"
},
{
"id": 4,
"entity": "便次多，量小，便数不等",
"start_offset": 32,
"end_offset": 43,
"label": "sym"
},
{
"id": 5,
"entity": "里急后重",
"start_offset": 48,
"end_offset": 52,
"label": "sym"
},
{
"id": 6,
"entity": "婴幼儿可无脓便及脓血便",
"start_offset": 53,
"end_offset": 64,
"label": "sym"
},
{
"id": 7,
"entity": "细菌",
"start_offset": 71,
"end_offset": 73,
"label": "mic"
},
{
"id": 8,
"entity": "肠炎",
"start_offset": 76,
"end_offset": 78,
"label": "dis"
},
{
"id": 9,
"entity": "病毒性肠炎",
"start_offset": 79,
"end_offset": 84,
"label": "dis"
}
] |
非典型痢疾不发热或只有微热，也无中毒症状，只有粪便培养阳性才能确诊，以被忽视，常为痢疾的传播者。 | [
{
"id": 0,
"entity": "非典型痢疾",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "发热",
"start_offset": 6,
"end_offset": 8,
"label": "sym"
},
{
"id": 2,
"entity": "微热",
"start_offset": 11,
"end_offset": 13,
"label": "sym"
},
{
"id": 3,
"entity": "中毒症状",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
},
{
"id": 4,
"entity": "粪便",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 5,
"entity": "粪便培养阳性",
"start_offset": 23,
"end_offset": 29,
"label": "sym"
},
{
"id": 6,
"entity": "痢疾",
"start_offset": 41,
"end_offset": 43,
"label": "dis"
}
] |
2.中毒性菌痢本病多见于2～7岁小儿，起病急骤，高热甚至超高热，在24小时内出现惊厥、昏迷为主的脑型或以循环衰竭为主的休克型或两者俱存的混合型，有或无脓血便，甚至不出现腹泻。 | [
{
"id": 0,
"entity": "中毒性菌痢",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "高热",
"start_offset": 24,
"end_offset": 26,
"label": "sym"
},
{
"id": 2,
"entity": "超高热",
"start_offset": 28,
"end_offset": 31,
"label": "sym"
},
{
"id": 3,
"entity": "惊厥",
"start_offset": 40,
"end_offset": 42,
"label": "sym"
},
{
"id": 4,
"entity": "昏迷",
"start_offset": 43,
"end_offset": 45,
"label": "sym"
},
{
"id": 5,
"entity": "循环衰竭",
"start_offset": 52,
"end_offset": 56,
"label": "sym"
},
{
"id": 6,
"entity": "脓血便",
"start_offset": 75,
"end_offset": 78,
"label": "sym"
},
{
"id": 7,
"entity": "腹泻",
"start_offset": 84,
"end_offset": 86,
"label": "sym"
}
] |
（1）脑型：以惊厥、头痛、反复呕吐、昏迷、血压增高为主，引起这种颅内高压的原因尚不清楚。 | [
{
"id": 0,
"entity": "惊厥",
"start_offset": 7,
"end_offset": 9,
"label": "sym"
},
{
"id": 1,
"entity": "头痛",
"start_offset": 10,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "反复呕吐",
"start_offset": 13,
"end_offset": 17,
"label": "sym"
},
{
"id": 3,
"entity": "昏迷",
"start_offset": 18,
"end_offset": 20,
"label": "sym"
},
{
"id": 4,
"entity": "血压",
"start_offset": 21,
"end_offset": 23,
"label": "ite"
},
{
"id": 5,
"entity": "血压增高",
"start_offset": 21,
"end_offset": 25,
"label": "sym"
},
{
"id": 6,
"entity": "颅内",
"start_offset": 32,
"end_offset": 34,
"label": "bod"
},
{
"id": 7,
"entity": "颅内高压",
"start_offset": 32,
"end_offset": 36,
"label": "sym"
}
] |
严重者可发生脑水肿、脑疝而发生呼吸衰竭、反复惊厥。 | [
{
"id": 0,
"entity": "脑水肿",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "脑疝",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 15,
"end_offset": 19,
"label": "sym"
},
{
"id": 3,
"entity": "反复惊厥",
"start_offset": 20,
"end_offset": 24,
"label": "sym"
}
] |
（2）休克型：以循环衰竭为主，常发生在年幼儿、体弱儿，也是毒血症和弥漫血管内凝血过程，表现为面色灰、肢端发凉、皮肤有花纹、血压下降、脉细、心率快。 | [
{
"id": 0,
"entity": "循环衰竭",
"start_offset": 8,
"end_offset": 12,
"label": "sym"
},
{
"id": 1,
"entity": "毒血症",
"start_offset": 29,
"end_offset": 32,
"label": "dis"
},
{
"id": 2,
"entity": "面色灰",
"start_offset": 46,
"end_offset": 49,
"label": "sym"
},
{
"id": 3,
"entity": "肢端发凉",
"start_offset": 50,
"end_offset": 54,
"label": "sym"
},
{
"id": 4,
"entity": "皮肤有花纹",
"start_offset": 55,
"end_offset": 60,
"label": "sym"
},
{
"id": 5,
"entity": "血压",
"start_offset": 61,
"end_offset": 63,
"label": "ite"
},
{
"id": 6,
"entity": "血压下降",
"start_offset": 61,
"end_offset": 65,
"label": "sym"
},
{
"id": 7,
"entity": "脉细",
"start_offset": 66,
"end_offset": 68,
"label": "sym"
},
{
"id": 8,
"entity": "心率",
"start_offset": 69,
"end_offset": 71,
"label": "ite"
},
{
"id": 9,
"entity": "心率快",
"start_offset": 69,
"end_offset": 72,
"label": "sym"
}
] |
病程中尚可出现多脏器衰竭、休克肺、休克心、休克肾、休克脑、休克肝等。 | [
{
"id": 0,
"entity": "多脏器衰竭",
"start_offset": 7,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "休克肺",
"start_offset": 13,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "休克心",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "休克肾",
"start_offset": 21,
"end_offset": 24,
"label": "dis"
},
{
"id": 4,
"entity": "休克脑",
"start_offset": 25,
"end_offset": 28,
"label": "dis"
},
{
"id": 5,
"entity": "休克肝",
"start_offset": 29,
"end_offset": 32,
"label": "dis"
}
] |
3.慢性菌痢病程超过2个月以上者诊断为慢性菌痢。 | [
{
"id": 0,
"entity": "慢性菌痢",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "慢性菌痢",
"start_offset": 19,
"end_offset": 23,
"label": "dis"
}
] |
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