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（5）房室结消融和起搏器植入作为反复发作或难治性心房内折返性心动过速的替代疗法。 | [
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"entity": "房室结消融",
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"entity": "起搏器植入",
"start_idx": 9,
"type": "pro"
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"end_idx": 33,
"entity": "反复发作或难治性心房内折返性心动过速",
"start_idx": 16,
"type": "dis"
},
{
"end_idx": 38,
"entity": "替代疗法",
"start_idx": 35,
"type": "pro"
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（6）发作一次伴血流动力学损害的室性心动过速（ventriculartachycardia），可接受导管消融者。 | [
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"entity": "血流动力学损害的室性心动过速",
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"entity": "ventriculartachycardia",
"start_idx": 23,
"type": "dis"
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"end_idx": 53,
"entity": "导管消融",
"start_idx": 50,
"type": "pro"
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4.第三类（1）无症状性WPW综合征患者，年龄小于5岁。 | [
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"entity": "无症状性WPW综合征",
"start_idx": 8,
"type": "dis"
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（2）室上性心动过速可用常规抗心律失常药物控制，年龄小于5岁。 | [
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"entity": "室上性心动过速",
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"entity": "抗心律失常药物",
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（3）非持续性，不考虑为无休止性的阵发性室性心动过速（即一次监视数小时或任何一小时记录的心电图条带几乎均可出现），心室功能正常。 | [
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"type": "dis"
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"entity": "心电图",
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"type": "pro"
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"end_idx": 58,
"entity": "心室",
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（4）非持续性室上性心动过速，不需其他治疗和（或）症状轻微。 | [
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"entity": "非持续性室上性心动过速",
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第十章胸膜疾病小儿胸膜疾病以胸膜炎最为常见，多继发于肺部感染，原发性或其他原因所致者较少见。 | [
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"entity": "胸膜疾病",
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"entity": "小儿胸膜疾病",
"start_idx": 7,
"type": "dis"
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"end_idx": 16,
"entity": "胸膜炎",
"start_idx": 14,
"type": "dis"
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"end_idx": 29,
"entity": "肺部感染",
"start_idx": 26,
"type": "dis"
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] |
第一节胸膜炎胸膜炎（pleurisy）分为三种：干性胸膜炎、浆液性胸膜炎和化脓性胸膜炎。 | [
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"entity": "pleurisy",
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"entity": "干性胸膜炎",
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"entity": "浆液性胸膜炎",
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"type": "dis"
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{
"end_idx": 42,
"entity": "化脓性胸膜炎",
"start_idx": 37,
"type": "dis"
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] |
一、干性胸膜炎干性胸膜炎（dryorplasticpleurisy）又称纤维素性胸膜炎，常与肺部细菌感染有关，亦可发生于急性上呼吸道疾病过程中。 | [
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"entity": "dryorplasticpleurisy",
"start_idx": 13,
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"entity": "纤维素性胸膜炎",
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"entity": "肺部细菌感染",
"start_idx": 46,
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{
"end_idx": 67,
"entity": "急性上呼吸道疾病",
"start_idx": 60,
"type": "dis"
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] |
结缔组织疾病如风湿热患儿亦可发生。 | [
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"entity": "结缔组织疾病",
"start_idx": 0,
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"entity": "风湿热",
"start_idx": 7,
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] |
深呼吸及咳嗽时疼痛加剧。 | [
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"entity": "深呼吸及咳嗽时疼痛加剧",
"start_idx": 0,
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病程早期可闻胸膜摩擦音在全部呼吸期间均可听到。 | [
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"entity": "闻胸膜摩擦音在全部呼吸期间均可听到",
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{
"end_idx": 7,
"entity": "胸膜",
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胸部X线透视和胸片可见患侧膈呼吸运动减弱肋膈角变钝流行性胸痛和带状疱疹前驱期的胸痛及肋骨骨折相鉴别。 | [
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"entity": "胸部X线透视和胸片可见患侧膈呼吸运动减弱",
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"entity": "胸片",
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"entity": "侧膈",
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"entity": "肋膈角变钝",
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"entity": "肋膈角",
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{
"end_idx": 29,
"entity": "流行性胸痛",
"start_idx": 25,
"type": "dis"
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"end_idx": 40,
"entity": "带状疱疹前驱期的胸痛",
"start_idx": 31,
"type": "sym"
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{
"end_idx": 34,
"entity": "带状疱疹",
"start_idx": 31,
"type": "dis"
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"end_idx": 39,
"entity": "胸",
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"type": "bod"
},
{
"end_idx": 45,
"entity": "肋骨骨折",
"start_idx": 42,
"type": "dis"
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] |
同时应分析胸膜炎的原因，注意肺部有无炎症，并进行必要的检查，尤其注意排除结核病。 | [
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"entity": "肺部",
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"entity": "炎症",
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"entity": "结核病",
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如非肺炎病例，宜用宽大胶布条紧缠患部以减少其呼吸动作或给镇咳剂抑制咳嗽。 | [
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"entity": "镇咳剂",
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"entity": "咳嗽",
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] |
肺炎患儿则不宜采用。 | [
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] |
第十三节狂犬病狂犬病（rabies）又称恐水症（hydrophobia），是由狂犬病毒引起的中枢神经系统急性传染病，为人畜共患的自然疫源性疾病。 | [
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"entity": "狂犬病毒",
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"type": "mic"
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"entity": "中枢神经系统急性传染病",
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{
"end_idx": 70,
"entity": "自然疫源性疾病",
"start_idx": 64,
"type": "dis"
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] |
临床上以恐水、怕风、咽肌痉挛、进行性瘫痪为特征，病死率极高。 | [
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"entity": "进行性瘫痪",
"start_idx": 15,
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【病原和流行病学】狂犬病病毒（rabiesvirus）属弹状病毒科狂犬病病毒属。 | [
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"entity": "狂犬病病毒",
"start_idx": 33,
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病毒基因为单负链RNA。 | [
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狂犬病病毒能在多种细胞中生长，但绝大多数毒株不引起细胞病变（长期传代培养适应后才出现），故常采用免疫酶技术或动物接种试验检测病毒增殖。 | [
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{
"end_idx": 10,
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"entity": "毒株",
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"end_idx": 52,
"entity": "免疫酶技术",
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"end_idx": 59,
"entity": "动物接种试验",
"start_idx": 54,
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"end_idx": 63,
"entity": "病毒",
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"type": "mic"
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在狂犬患者和动物神经细胞内存在狂犬病病毒特有的胞质内包涵体，又称内基小体（Negribodies）。 | [
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"entity": "胞质内包涵体",
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"entity": "内基小体",
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病毒对理化因素抵抗力较低，56℃30分钟或100℃2分钟、强酸、强碱、甲醛、升汞、脂溶剂、季铵类化合物都能很快杀灭之；紫外线和直射阳光可迅速降低病毒活力。 | [
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"entity": "病毒",
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] |
狂犬病的传染源主要是犬，其次是猫和狼，其他野生动物如狐、浣熊、吸血蝙蝠也能传播本病。 | [
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患病或带毒动物唾液中有大量病毒，通过咬伤、抓伤和舔伤皮肤黏膜而侵入，偶经食入带毒肉类而感染。 | [
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"entity": "皮肤黏膜",
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"entity": "感染",
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人群普通易感，被病犬咬伤而未预防接种者发病率为10%～70%，病死率近100%。 | [
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狂犬病在全球2/3的国家和地区流行。 | [
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我国在20世纪50年代发病率很低，近几年随着“宠物热”的升温，发病率逐年增高，近5年全国狂犬病年疫报人数由160人（1996年）上升至899人（2001年），年死亡人数由140人（1996年）上升至862人（2001年）。 | [
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【发病机制和病理改变】狂犬病病毒的靶细胞是神经细胞和肌细胞。 | [
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侵入后先在局部神经末梢或在附近肌细胞中增殖后再侵入神经末梢，沿周围传入神经轴索上行至脊髓前背根神经大量增殖，然后侵入脊髓和中枢神经系统，主要侵犯脑干、基底节、海马回及小脑等处神经元，引起弥漫性脑脊髓病变；再沿传出神经侵入各组织器官继续复制。 | [
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{
"end_idx": 73,
"entity": "脑干",
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"entity": "基底节",
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{
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"entity": "海马回",
"start_idx": 79,
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{
"end_idx": 84,
"entity": "小脑",
"start_idx": 83,
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{
"end_idx": 89,
"entity": "神经元",
"start_idx": 87,
"type": "bod"
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{
"end_idx": 100,
"entity": "弥漫性脑脊髓病变",
"start_idx": 93,
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{
"end_idx": 107,
"entity": "传出神经",
"start_idx": 104,
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{
"end_idx": 114,
"entity": "组织器官",
"start_idx": 111,
"type": "bod"
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由于迷走神经、舌咽神经核及舌下神经核受损伤，可发生呼吸肌及吞咽肌痉挛。 | [
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{
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"entity": "舌下神经核",
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"entity": "呼吸肌及吞咽肌痉挛",
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交感神经受累时，可致唾液分泌和出汗增多。 | [
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{
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"entity": "汗",
"start_idx": 16,
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] |
延髓和脊髓受损，则可引起各种类型的瘫痪。 | [
{
"end_idx": 1,
"entity": "延髓",
"start_idx": 0,
"type": "bod"
},
{
"end_idx": 6,
"entity": "延髓和脊髓受损",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 4,
"entity": "脊髓",
"start_idx": 3,
"type": "bod"
},
{
"end_idx": 18,
"entity": "瘫痪",
"start_idx": 17,
"type": "dis"
}
] |
最终因脑实质损伤导致呼吸和循环衰竭而死亡。 | [
{
"end_idx": 7,
"entity": "脑实质损伤",
"start_idx": 3,
"type": "dis"
},
{
"end_idx": 16,
"entity": "呼吸和循环衰竭",
"start_idx": 10,
"type": "dis"
}
] |
病毒侵入靶细胞的机制与病毒结合乙酰胆碱受体或其他受体有关。 | [
{
"end_idx": 1,
"entity": "病毒",
"start_idx": 0,
"type": "mic"
},
{
"end_idx": 6,
"entity": "靶细胞",
"start_idx": 4,
"type": "bod"
},
{
"end_idx": 12,
"entity": "病毒",
"start_idx": 11,
"type": "mic"
},
{
"end_idx": 20,
"entity": "乙酰胆碱受体",
"start_idx": 15,
"type": "bod"
},
{
"end_idx": 25,
"entity": "受体",
"start_idx": 24,
"type": "bod"
}
] |
病毒抗原诱导的特异性中和抗体、特异性细胞免疫及其分泌的细胞因子，特别是干扰素在抗狂犬病病毒免疫中起重要作用。 | [
{
"end_idx": 3,
"entity": "病毒抗原",
"start_idx": 0,
"type": "mic"
},
{
"end_idx": 13,
"entity": "特异性中和抗体",
"start_idx": 7,
"type": "mic"
},
{
"end_idx": 30,
"entity": "特异性细胞免疫及其分泌的细胞因子",
"start_idx": 15,
"type": "mic"
},
{
"end_idx": 37,
"entity": "干扰素",
"start_idx": 35,
"type": "bod"
},
{
"end_idx": 44,
"entity": "狂犬病病毒",
"start_idx": 40,
"type": "mic"
}
] |
主要病理改变为脑实质和脑膜水肿、充血，微小血管出血，尤以大脑海马、延髓、脑桥、小脑和咬伤部位相应的背根节及脊髓段最为严重。 | [
{
"end_idx": 9,
"entity": "脑实质",
"start_idx": 7,
"type": "bod"
},
{
"end_idx": 17,
"entity": "脑实质和脑膜水肿、充血",
"start_idx": 7,
"type": "sym"
},
{
"end_idx": 12,
"entity": "脑膜",
"start_idx": 11,
"type": "bod"
},
{
"end_idx": 24,
"entity": "微小血管出血",
"start_idx": 19,
"type": "dis"
},
{
"end_idx": 31,
"entity": "大脑海马",
"start_idx": 28,
"type": "bod"
},
{
"end_idx": 34,
"entity": "延髓",
"start_idx": 33,
"type": "bod"
},
{
"end_idx": 37,
"entity": "脑桥",
"start_idx": 36,
"type": "bod"
},
{
"end_idx": 40,
"entity": "小脑",
"start_idx": 39,
"type": "bod"
},
{
"end_idx": 51,
"entity": "背根节",
"start_idx": 49,
"type": "bod"
},
{
"end_idx": 55,
"entity": "脊髓段",
"start_idx": 53,
"type": "bod"
}
] |
显微镜下见神经细胞空泡形成，透明变性和染色体分解小神经胶质细胞浸润，血管周围单核细胞及浆细胞浸润。 | [
{
"end_idx": 2,
"entity": "显微镜",
"start_idx": 0,
"type": "equ"
},
{
"end_idx": 8,
"entity": "神经细胞",
"start_idx": 5,
"type": "bod"
},
{
"end_idx": 10,
"entity": "神经细胞空泡",
"start_idx": 5,
"type": "sym"
},
{
"end_idx": 17,
"entity": "透明变性",
"start_idx": 14,
"type": "sym"
},
{
"end_idx": 21,
"entity": "染色体",
"start_idx": 19,
"type": "bod"
},
{
"end_idx": 23,
"entity": "染色体分解",
"start_idx": 19,
"type": "sym"
},
{
"end_idx": 30,
"entity": "小神经胶质细胞",
"start_idx": 24,
"type": "bod"
},
{
"end_idx": 32,
"entity": "小神经胶质细胞浸润",
"start_idx": 24,
"type": "sym"
},
{
"end_idx": 41,
"entity": "血管周围单核细胞",
"start_idx": 34,
"type": "bod"
},
{
"end_idx": 47,
"entity": "血管周围单核细胞及浆细胞浸润",
"start_idx": 34,
"type": "sym"
},
{
"end_idx": 45,
"entity": "浆细胞",
"start_idx": 43,
"type": "bod"
}
] |
70%～80%患者的神经细胞质中可发现内基小体，呈圆形或卵圆形，直径3～10μm，由狂犬病病毒核糖核蛋白聚集而成，有特异性诊断价值。 | [
{
"end_idx": 39,
"entity": "70%～80%患者的神经细胞质中可发现内基小体，呈圆形或卵圆形，直径3～10μm",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 14,
"entity": "神经细胞质",
"start_idx": 10,
"type": "bod"
},
{
"end_idx": 22,
"entity": "内基小体",
"start_idx": 19,
"type": "bod"
},
{
"end_idx": 51,
"entity": "狂犬病病毒核糖核蛋白",
"start_idx": 42,
"type": "mic"
}
] |
影响潜伏期的因素为年龄（儿童较短）、伤口部位（头面部发病早）、伤口性质（深咬伤较短）和入侵病毒的数量、毒力及宿主防御机制等。 | [
{
"end_idx": 25,
"entity": "头面部",
"start_idx": 23,
"type": "bod"
},
{
"end_idx": 46,
"entity": "病毒",
"start_idx": 45,
"type": "mic"
}
] |
（一）前驱期持续1～4天，常有低热、头痛、乏力、咽痛、腹痛、烦躁等。 | [
{
"end_idx": 16,
"entity": "低热",
"start_idx": 15,
"type": "sym"
},
{
"end_idx": 19,
"entity": "头痛",
"start_idx": 18,
"type": "sym"
},
{
"end_idx": 18,
"entity": "头",
"start_idx": 18,
"type": "bod"
},
{
"end_idx": 22,
"entity": "乏力",
"start_idx": 21,
"type": "sym"
},
{
"end_idx": 25,
"entity": "咽痛",
"start_idx": 24,
"type": "sym"
},
{
"end_idx": 24,
"entity": "咽",
"start_idx": 24,
"type": "bod"
},
{
"end_idx": 28,
"entity": "腹痛",
"start_idx": 27,
"type": "sym"
},
{
"end_idx": 27,
"entity": "腹",
"start_idx": 27,
"type": "bod"
},
{
"end_idx": 31,
"entity": "烦躁",
"start_idx": 30,
"type": "sym"
}
] |
继之对强光、高声等刺激敏感而有咽喉紧迫感，进食时咽喉肌轻度痉挛，但尚能吞咽。 | [
{
"end_idx": 19,
"entity": "对强光、高声等刺激敏感而有咽喉紧迫感",
"start_idx": 2,
"type": "sym"
},
{
"end_idx": 16,
"entity": "咽喉",
"start_idx": 15,
"type": "bod"
},
{
"end_idx": 30,
"entity": "进食时咽喉肌轻度痉挛",
"start_idx": 21,
"type": "sym"
},
{
"end_idx": 30,
"entity": "咽喉肌轻度痉挛",
"start_idx": 24,
"type": "sym"
},
{
"end_idx": 26,
"entity": "咽喉肌",
"start_idx": 24,
"type": "bod"
},
{
"end_idx": 36,
"entity": "尚能吞咽",
"start_idx": 33,
"type": "sym"
}
] |
约80%的患者伤口局部及其神经通路上有放射性疼痛、麻木、痒及感觉异常。 | [
{
"end_idx": 23,
"entity": "伤口局部及其神经通路上有放射性疼痛",
"start_idx": 7,
"type": "sym"
},
{
"end_idx": 26,
"entity": "麻木",
"start_idx": 25,
"type": "sym"
},
{
"end_idx": 28,
"entity": "痒",
"start_idx": 28,
"type": "sym"
},
{
"end_idx": 33,
"entity": "感觉异常",
"start_idx": 30,
"type": "sym"
}
] |
（二）兴奋期反射性咽喉痉挛逐渐加重，当饮水，甚至听到讲水、看到水及咽水动作，或风、光、声、烟刺激也会引起咽喉部严重痉挛，出现典型的恐水症。 | [
{
"end_idx": 10,
"entity": "咽喉",
"start_idx": 9,
"type": "bod"
},
{
"end_idx": 16,
"entity": "咽喉痉挛逐渐加重",
"start_idx": 9,
"type": "sym"
},
{
"end_idx": 58,
"entity": "当饮水，甚至听到讲水、看到水及咽水动作，或风、光、声、烟刺激也会引起咽喉部严重痉挛",
"start_idx": 18,
"type": "sym"
},
{
"end_idx": 54,
"entity": "咽喉部",
"start_idx": 52,
"type": "bod"
},
{
"end_idx": 67,
"entity": "恐水症",
"start_idx": 65,
"type": "dis"
}
] |
常伴呼吸肌痉挛而发生呼吸困难，全身肌张力高，颈部强硬。 | [
{
"end_idx": 6,
"entity": "呼吸肌痉挛",
"start_idx": 2,
"type": "dis"
},
{
"end_idx": 13,
"entity": "呼吸困难",
"start_idx": 10,
"type": "sym"
},
{
"end_idx": 20,
"entity": "全身肌张力高",
"start_idx": 15,
"type": "sym"
},
{
"end_idx": 19,
"entity": "肌张力",
"start_idx": 17,
"type": "ite"
},
{
"end_idx": 23,
"entity": "颈部",
"start_idx": 22,
"type": "bod"
},
{
"end_idx": 25,
"entity": "颈部强硬",
"start_idx": 22,
"type": "sym"
}
] |
常出现躁狂与昏睡交替。 | [
{
"end_idx": 4,
"entity": "躁狂",
"start_idx": 3,
"type": "sym"
},
{
"end_idx": 9,
"entity": "昏睡交替",
"start_idx": 6,
"type": "sym"
}
] |
发作时暴躁异常；发作间歇期则较安静，语言清晰。 | [
{
"end_idx": 6,
"entity": "暴躁异常",
"start_idx": 3,
"type": "sym"
},
{
"end_idx": 21,
"entity": "间歇期则较安静，语言清晰",
"start_idx": 10,
"type": "sym"
}
] |
由于交感神经亢进，有大汗、心率增快、血压升高、瞳孔扩大、唾液分泌增加等表现。 | [
{
"end_idx": 5,
"entity": "交感神经",
"start_idx": 2,
"type": "bod"
},
{
"end_idx": 7,
"entity": "交感神经亢进",
"start_idx": 2,
"type": "sym"
},
{
"end_idx": 11,
"entity": "大汗",
"start_idx": 10,
"type": "sym"
},
{
"end_idx": 16,
"entity": "心率增快",
"start_idx": 13,
"type": "sym"
},
{
"end_idx": 14,
"entity": "心率",
"start_idx": 13,
"type": "ite"
},
{
"end_idx": 21,
"entity": "血压升高",
"start_idx": 18,
"type": "sym"
},
{
"end_idx": 19,
"entity": "血压",
"start_idx": 18,
"type": "ite"
},
{
"end_idx": 24,
"entity": "瞳孔",
"start_idx": 23,
"type": "bod"
},
{
"end_idx": 26,
"entity": "瞳孔扩大",
"start_idx": 23,
"type": "sym"
},
{
"end_idx": 29,
"entity": "唾液",
"start_idx": 28,
"type": "bod"
},
{
"end_idx": 33,
"entity": "唾液分泌增加",
"start_idx": 28,
"type": "sym"
}
] |
患者可高热39～40℃，神志大多清晰，部分患者有精神失常，可在发作中死于呼吸衰竭或循环衰竭。 | [
{
"end_idx": 10,
"entity": "高热39～40℃",
"start_idx": 3,
"type": "sym"
},
{
"end_idx": 17,
"entity": "神志大多清晰",
"start_idx": 12,
"type": "sym"
},
{
"end_idx": 27,
"entity": "精神失常",
"start_idx": 24,
"type": "sym"
},
{
"end_idx": 39,
"entity": "呼吸衰竭",
"start_idx": 36,
"type": "dis"
},
{
"end_idx": 44,
"entity": "循环衰竭",
"start_idx": 41,
"type": "dis"
}
] |
（三）麻痹期痉挛减少或停止，患者渐安静，逐步发生全身弛缓性瘫痪，尤以肢体软瘫多见。 | [
{
"end_idx": 4,
"entity": "麻痹",
"start_idx": 3,
"type": "dis"
},
{
"end_idx": 12,
"entity": "痉挛减少或停止",
"start_idx": 6,
"type": "sym"
},
{
"end_idx": 18,
"entity": "渐安静",
"start_idx": 16,
"type": "sym"
},
{
"end_idx": 30,
"entity": "逐步发生全身弛缓性瘫痪",
"start_idx": 20,
"type": "sym"
},
{
"end_idx": 30,
"entity": "弛缓性瘫痪",
"start_idx": 26,
"type": "dis"
},
{
"end_idx": 37,
"entity": "肢体软瘫",
"start_idx": 34,
"type": "sym"
},
{
"end_idx": 35,
"entity": "肢体",
"start_idx": 34,
"type": "bod"
}
] |
感觉减退，反射消失，呼吸变慢而不齐，心搏微弱，血压下降，神志不清，最终因呼吸麻痹和循环衰竭而死亡。 | [
{
"end_idx": 3,
"entity": "感觉减退",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 8,
"entity": "反射消失",
"start_idx": 5,
"type": "sym"
},
{
"end_idx": 16,
"entity": "呼吸变慢而不齐",
"start_idx": 10,
"type": "sym"
},
{
"end_idx": 21,
"entity": "心搏微弱",
"start_idx": 18,
"type": "sym"
},
{
"end_idx": 18,
"entity": "心",
"start_idx": 18,
"type": "bod"
},
{
"end_idx": 26,
"entity": "血压下降",
"start_idx": 23,
"type": "sym"
},
{
"end_idx": 24,
"entity": "血压",
"start_idx": 23,
"type": "ite"
},
{
"end_idx": 31,
"entity": "神志不清",
"start_idx": 28,
"type": "sym"
},
{
"end_idx": 39,
"entity": "呼吸麻痹",
"start_idx": 36,
"type": "dis"
},
{
"end_idx": 44,
"entity": "循环衰竭",
"start_idx": 41,
"type": "dis"
}
] |
狂犬病整个病程3～5天，极少超过10天。 | [
{
"end_idx": 2,
"entity": "狂犬病",
"start_idx": 0,
"type": "dis"
}
] |
极少见“麻痹型”病例，后者以高热、进行性麻痹为主，终至衰竭死亡，全病程约8～9天。 | [
{
"end_idx": 5,
"entity": "麻痹",
"start_idx": 4,
"type": "dis"
},
{
"end_idx": 15,
"entity": "高热",
"start_idx": 14,
"type": "sym"
},
{
"end_idx": 21,
"entity": "进行性麻痹",
"start_idx": 17,
"type": "dis"
},
{
"end_idx": 28,
"entity": "衰竭",
"start_idx": 27,
"type": "dis"
}
] |
【实验室检查】（一）血、尿常规及脑脊液白细胞总数轻至中度升高，亦可高达30×109</sup>/L，以中性粒细胞占优势，可达80%以上。 | [
{
"end_idx": 5,
"entity": "实验室检查",
"start_idx": 1,
"type": "pro"
},
{
"end_idx": 14,
"entity": "血、尿常规",
"start_idx": 10,
"type": "ite"
},
{
"end_idx": 29,
"entity": "脑脊液白细胞总数轻至中度升高",
"start_idx": 16,
"type": "sym"
},
{
"end_idx": 23,
"entity": "脑脊液白细胞总数",
"start_idx": 16,
"type": "ite"
},
{
"end_idx": 55,
"entity": "中性粒细胞",
"start_idx": 51,
"type": "ite"
}
] |
尿常规有轻度蛋白尿，偶有透明管型。 | [
{
"end_idx": 15,
"entity": "尿常规有轻度蛋白尿，偶有透明管型",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 2,
"entity": "尿常规",
"start_idx": 0,
"type": "ite"
},
{
"end_idx": 7,
"entity": "蛋白",
"start_idx": 6,
"type": "bod"
},
{
"end_idx": 8,
"entity": "尿",
"start_idx": 8,
"type": "bod"
}
] |
脑脊液压力在正常范围或稍增高，细胞数及蛋白量稍增多。 | [
{
"end_idx": 13,
"entity": "脑脊液压力在正常范围或稍增高",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 4,
"entity": "脑脊液压力",
"start_idx": 0,
"type": "ite"
},
{
"end_idx": 24,
"entity": "细胞数及蛋白量稍增多",
"start_idx": 15,
"type": "sym"
},
{
"end_idx": 17,
"entity": "细胞数",
"start_idx": 15,
"type": "ite"
},
{
"end_idx": 21,
"entity": "蛋白量",
"start_idx": 19,
"type": "ite"
}
] |
（二）病原学检查1.病毒分离取患者唾液（病后4～24天）、脑脊液和尿沉渣（病后头2周内）或死后脑组织悬液接种敏感细胞，经检测病毒抗原鉴定病毒或脑内接种敏感动物，若接种动物在6～10天出现痉挛和麻痹或脑组织中找到内基小体即可诊断。 | [
{
"end_idx": 7,
"entity": "病原学检查",
"start_idx": 3,
"type": "pro"
},
{
"end_idx": 13,
"entity": "病毒分离",
"start_idx": 10,
"type": "pro"
},
{
"end_idx": 18,
"entity": "唾液",
"start_idx": 17,
"type": "bod"
},
{
"end_idx": 31,
"entity": "脑脊液",
"start_idx": 29,
"type": "bod"
},
{
"end_idx": 35,
"entity": "尿沉渣",
"start_idx": 33,
"type": "bod"
},
{
"end_idx": 51,
"entity": "脑组织悬液",
"start_idx": 47,
"type": "bod"
},
{
"end_idx": 57,
"entity": "接种敏感细胞",
"start_idx": 52,
"type": "pro"
},
{
"end_idx": 65,
"entity": "检测病毒抗原",
"start_idx": 60,
"type": "pro"
},
{
"end_idx": 69,
"entity": "病毒",
"start_idx": 68,
"type": "mic"
},
{
"end_idx": 78,
"entity": "脑内接种敏感动物",
"start_idx": 71,
"type": "pro"
},
{
"end_idx": 82,
"entity": "接种",
"start_idx": 81,
"type": "pro"
},
{
"end_idx": 94,
"entity": "痉挛",
"start_idx": 93,
"type": "sym"
},
{
"end_idx": 97,
"entity": "麻痹",
"start_idx": 96,
"type": "dis"
},
{
"end_idx": 102,
"entity": "脑组织中",
"start_idx": 99,
"type": "bod"
},
{
"end_idx": 108,
"entity": "脑组织中找到内基小体",
"start_idx": 99,
"type": "sym"
},
{
"end_idx": 108,
"entity": "内基小体",
"start_idx": 105,
"type": "bod"
}
] |
2.内基小体检查取死者脑组织或咬人动物脑组织（最好是脑室底部）印压涂片或病理切片，染色直接镜检或免疫荧光法检查内基小体，阳性率为70%～80%。 | [
{
"end_idx": 7,
"entity": "内基小体检查",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 13,
"entity": "脑组织",
"start_idx": 11,
"type": "bod"
},
{
"end_idx": 21,
"entity": "脑组织",
"start_idx": 19,
"type": "bod"
},
{
"end_idx": 29,
"entity": "脑室底部",
"start_idx": 26,
"type": "bod"
},
{
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"entity": "印压涂片",
"start_idx": 31,
"type": "pro"
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{
"end_idx": 39,
"entity": "病理切片",
"start_idx": 36,
"type": "pro"
},
{
"end_idx": 46,
"entity": "染色直接镜检",
"start_idx": 41,
"type": "pro"
},
{
"end_idx": 58,
"entity": "免疫荧光法检查内基小体",
"start_idx": 48,
"type": "pro"
}
] |
3.病毒抗原检测取患者唾液、咽-气管分泌物、尿沉渣、有神经原纤维的皮肤（常取颈部发际处）活检标本，用免疫荧光法或ELISA或ELISA夹心法检测病毒抗原，具有较高敏感性和特异性。 | [
{
"end_idx": 7,
"entity": "病毒抗原检测",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 12,
"entity": "唾液",
"start_idx": 11,
"type": "bod"
},
{
"end_idx": 20,
"entity": "咽-气管分泌物",
"start_idx": 14,
"type": "bod"
},
{
"end_idx": 24,
"entity": "尿沉渣",
"start_idx": 22,
"type": "bod"
},
{
"end_idx": 34,
"entity": "有神经原纤维的皮肤",
"start_idx": 26,
"type": "bod"
},
{
"end_idx": 42,
"entity": "颈部发际处",
"start_idx": 38,
"type": "bod"
},
{
"end_idx": 47,
"entity": "活检标本",
"start_idx": 44,
"type": "pro"
},
{
"end_idx": 54,
"entity": "免疫荧光法",
"start_idx": 50,
"type": "pro"
},
{
"end_idx": 60,
"entity": "ELISA",
"start_idx": 56,
"type": "pro"
},
{
"end_idx": 69,
"entity": "ELISA夹心法",
"start_idx": 62,
"type": "pro"
},
{
"end_idx": 75,
"entity": "病毒抗原",
"start_idx": 72,
"type": "ite"
}
] |
4.中和抗体测定患者存活一周以上可用中和试验或ELISA法检测血清中和抗体，未接种过疫苗的患者抗体水平低；接种过疫苗的患者在出现症状后6～10天中和抗体水平快速增高，滴度可≥1∶5000（疫苗免疫不能达到此水平）。 | [
{
"end_idx": 7,
"entity": "中和抗体测定",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 21,
"entity": "中和试验",
"start_idx": 18,
"type": "pro"
},
{
"end_idx": 28,
"entity": "ELISA法",
"start_idx": 23,
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},
{
"end_idx": 36,
"entity": "血清中和抗体",
"start_idx": 31,
"type": "ite"
},
{
"end_idx": 40,
"entity": "接种",
"start_idx": 39,
"type": "pro"
},
{
"end_idx": 43,
"entity": "疫苗",
"start_idx": 42,
"type": "dis"
},
{
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"entity": "接种",
"start_idx": 53,
"type": "pro"
},
{
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"entity": "疫苗",
"start_idx": 56,
"type": "dis"
},
{
"end_idx": 81,
"entity": "中和抗体水平快速增高",
"start_idx": 72,
"type": "sym"
},
{
"end_idx": 77,
"entity": "中和抗体水平",
"start_idx": 72,
"type": "ite"
},
{
"end_idx": 84,
"entity": "滴度",
"start_idx": 83,
"type": "ite"
},
{
"end_idx": 97,
"entity": "疫苗免疫",
"start_idx": 94,
"type": "pro"
}
] |
病程晚期脑脊液中检出高水平抗体（疫苗不能诱导）亦有诊断意义。 | [
{
"end_idx": 7,
"entity": "脑脊液中",
"start_idx": 4,
"type": "bod"
},
{
"end_idx": 14,
"entity": "抗体",
"start_idx": 13,
"type": "ite"
},
{
"end_idx": 17,
"entity": "疫苗",
"start_idx": 16,
"type": "dru"
}
] |
5.病毒RNA检查用斑点杂交法或RT-PCR法检测狂犬病病毒核衣壳序列，因有非特异性扩增带干扰，PCR产物需用Southern印迹法加以确认。 | [
{
"end_idx": 8,
"entity": "病毒RNA检查",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 14,
"entity": "斑点杂交法",
"start_idx": 10,
"type": "pro"
},
{
"end_idx": 22,
"entity": "RT-PCR法",
"start_idx": 16,
"type": "pro"
},
{
"end_idx": 34,
"entity": "狂犬病病毒核衣壳序列",
"start_idx": 25,
"type": "ite"
},
{
"end_idx": 50,
"entity": "PCR",
"start_idx": 48,
"type": "pro"
},
{
"end_idx": 65,
"entity": "Southern印迹法",
"start_idx": 55,
"type": "pro"
}
] |
确诊有赖于病原学检查或尸检脑组织发现内基小体。 | [
{
"end_idx": 9,
"entity": "病原学检查",
"start_idx": 5,
"type": "pro"
},
{
"end_idx": 12,
"entity": "尸检",
"start_idx": 11,
"type": "pro"
},
{
"end_idx": 21,
"entity": "尸检脑组织发现内基小体",
"start_idx": 11,
"type": "sym"
},
{
"end_idx": 15,
"entity": "脑组织",
"start_idx": 13,
"type": "bod"
},
{
"end_idx": 21,
"entity": "内基小体",
"start_idx": 18,
"type": "mic"
}
] |
（二）鉴别诊断1.破伤风（tetanus）有外伤史，潜伏期短，多为6～14天。 | [
{
"end_idx": 11,
"entity": "破伤风",
"start_idx": 9,
"type": "dis"
},
{
"end_idx": 19,
"entity": "tetanus",
"start_idx": 13,
"type": "dis"
},
{
"end_idx": 23,
"entity": "外伤",
"start_idx": 22,
"type": "dis"
}
] |
有牙关紧闭，角弓反张，全身阵发性强直性肌痉挛，持续时间长；而无高度兴奋和恐水现象，预后也较好。 | [
{
"end_idx": 4,
"entity": "牙关紧闭",
"start_idx": 1,
"type": "sym"
},
{
"end_idx": 2,
"entity": "牙关",
"start_idx": 1,
"type": "bod"
},
{
"end_idx": 9,
"entity": "角弓反张",
"start_idx": 6,
"type": "sym"
},
{
"end_idx": 21,
"entity": "全身阵发性强直性肌痉挛",
"start_idx": 11,
"type": "sym"
},
{
"end_idx": 12,
"entity": "全身",
"start_idx": 11,
"type": "bod"
},
{
"end_idx": 21,
"entity": "肌痉挛",
"start_idx": 19,
"type": "dis"
},
{
"end_idx": 34,
"entity": "高度兴奋",
"start_idx": 31,
"type": "sym"
},
{
"end_idx": 39,
"entity": "恐水现象",
"start_idx": 36,
"type": "sym"
}
] |
但须注意，狂犬患者被咬伤时，也可同时感染破伤风。 | [
{
"end_idx": 6,
"entity": "狂犬",
"start_idx": 5,
"type": "dis"
},
{
"end_idx": 11,
"entity": "被咬伤",
"start_idx": 9,
"type": "dis"
},
{
"end_idx": 22,
"entity": "感染破伤风",
"start_idx": 18,
"type": "dis"
}
] |
2.其他病毒所致脑炎和脑膜炎有神志改变，甚至昏迷，此与狂犬病患者神志清楚、惊恐不安的情况不同。 | [
{
"end_idx": 5,
"entity": "病毒",
"start_idx": 4,
"type": "mic"
},
{
"end_idx": 9,
"entity": "脑炎",
"start_idx": 8,
"type": "dis"
},
{
"end_idx": 13,
"entity": "脑膜炎",
"start_idx": 11,
"type": "dis"
},
{
"end_idx": 18,
"entity": "神志改变",
"start_idx": 15,
"type": "sym"
},
{
"end_idx": 23,
"entity": "昏迷",
"start_idx": 22,
"type": "sym"
},
{
"end_idx": 29,
"entity": "狂犬病",
"start_idx": 27,
"type": "dis"
},
{
"end_idx": 35,
"entity": "神志清楚",
"start_idx": 32,
"type": "sym"
},
{
"end_idx": 40,
"entity": "惊恐不安",
"start_idx": 37,
"type": "sym"
}
] |
可通过脑脊液变化和病原学检查区别。 | [
{
"end_idx": 5,
"entity": "脑脊液",
"start_idx": 3,
"type": "bod"
},
{
"end_idx": 7,
"entity": "脑脊液变化",
"start_idx": 3,
"type": "sym"
},
{
"end_idx": 13,
"entity": "病原学检查",
"start_idx": 9,
"type": "pro"
}
] |
【预防和治疗】（一）控制和消灭传染源加强犬等管理，野犬应尽量捕杀，家犬应登记，注射疫苗。 | [
{
"end_idx": 17,
"entity": "控制和消灭传染源",
"start_idx": 10,
"type": "pro"
},
{
"end_idx": 23,
"entity": "加强犬等管理",
"start_idx": 18,
"type": "pro"
},
{
"end_idx": 40,
"entity": "注射",
"start_idx": 39,
"type": "pro"
},
{
"end_idx": 42,
"entity": "疫苗",
"start_idx": 41,
"type": "dru"
}
] |
狂犬应立即击毙，焚毁或深埋，不可剥皮。 | [] |
一时不能肯定为狂犬者，应隔离观察10天，取击毙或隔离期死亡动物的脑组织作病原学检查。 | [
{
"end_idx": 18,
"entity": "隔离观察10天",
"start_idx": 12,
"type": "pro"
},
{
"end_idx": 40,
"entity": "取击毙或隔离期死亡动物的脑组织作病原学检查",
"start_idx": 20,
"type": "pro"
}
] |
以20%肥皂水或0.1%苯扎溴铵彻底冲洗伤口至少半小时；再用白酒或70%乙醇、碘酊涂擦几次，以清除局部的病毒。 | [
{
"end_idx": 6,
"entity": "20%肥皂水",
"start_idx": 1,
"type": "dru"
},
{
"end_idx": 15,
"entity": "0.1%苯扎溴铵",
"start_idx": 8,
"type": "dru"
},
{
"end_idx": 21,
"entity": "彻底冲洗伤口",
"start_idx": 16,
"type": "pro"
},
{
"end_idx": 31,
"entity": "白酒",
"start_idx": 30,
"type": "dru"
},
{
"end_idx": 37,
"entity": "70%乙醇",
"start_idx": 33,
"type": "dru"
},
{
"end_idx": 40,
"entity": "碘酊",
"start_idx": 39,
"type": "dru"
},
{
"end_idx": 42,
"entity": "涂擦",
"start_idx": 41,
"type": "pro"
},
{
"end_idx": 53,
"entity": "病毒",
"start_idx": 52,
"type": "mic"
}
] |
除非伤及大血管需要紧急止血外，3天内不必包扎或缝合伤口。 | [
{
"end_idx": 6,
"entity": "伤及大血管",
"start_idx": 2,
"type": "sym"
},
{
"end_idx": 6,
"entity": "大血管",
"start_idx": 4,
"type": "bod"
},
{
"end_idx": 12,
"entity": "紧急止血",
"start_idx": 9,
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},
{
"end_idx": 21,
"entity": "包扎",
"start_idx": 20,
"type": "pro"
},
{
"end_idx": 26,
"entity": "缝合伤口",
"start_idx": 23,
"type": "pro"
}
] |
（三）疫苗接种疫苗接种是预防和控制狂犬病的重要措施之一。 | [
{
"end_idx": 6,
"entity": "疫苗接种",
"start_idx": 3,
"type": "pro"
},
{
"end_idx": 10,
"entity": "疫苗接种",
"start_idx": 7,
"type": "pro"
},
{
"end_idx": 19,
"entity": "狂犬病",
"start_idx": 17,
"type": "dis"
}
] |
1.狂犬病病毒疫苗目前主要使用细胞培养疫苗，包括：①人二倍体细胞狂犬疫苗（humandiploidcell，HDCV）：免疫原性强，不良反应很少，注射次数少，但制备困难，价格昂贵；②原代地鼠肾细胞狂犬病疫苗：效力在2.5IU以上，使用安全；③精制Vero狂犬病疫苗：免疫原性和不良反应与①相似，但价格低。 | [
{
"end_idx": 8,
"entity": "狂犬病病毒疫苗",
"start_idx": 2,
"type": "dru"
},
{
"end_idx": 18,
"entity": "细胞培养",
"start_idx": 15,
"type": "pro"
},
{
"end_idx": 20,
"entity": "疫苗",
"start_idx": 19,
"type": "dru"
},
{
"end_idx": 35,
"entity": "人二倍体细胞狂犬疫苗",
"start_idx": 26,
"type": "dru"
},
{
"end_idx": 52,
"entity": "humandiploidcell",
"start_idx": 37,
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},
{
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"entity": "HDCV",
"start_idx": 54,
"type": "dru"
},
{
"end_idx": 102,
"entity": "原代地鼠肾细胞狂犬病疫苗",
"start_idx": 91,
"type": "dru"
},
{
"end_idx": 131,
"entity": "精制Vero狂犬病疫苗",
"start_idx": 121,
"type": "dru"
}
] |
其他有精制鸡胚狂犬病疫苗、精制鸭胚狂犬病疫苗和原代牛肾细胞狂犬病疫苗。 | [
{
"end_idx": 11,
"entity": "精制鸡胚狂犬病疫苗",
"start_idx": 3,
"type": "dru"
},
{
"end_idx": 21,
"entity": "精制鸭胚狂犬病疫苗",
"start_idx": 13,
"type": "dru"
},
{
"end_idx": 33,
"entity": "原代牛肾细胞狂犬病疫苗",
"start_idx": 23,
"type": "dru"
}
] |
2.接触前免疫对象为有职业危险者、接触狂犬病病毒的实验室工作人员及和狂犬患者密切接触者。 | [
{
"end_idx": 6,
"entity": "接触前免疫",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 23,
"entity": "狂犬病病毒",
"start_idx": 19,
"type": "mic"
},
{
"end_idx": 35,
"entity": "狂犬",
"start_idx": 34,
"type": "dis"
}
] |
推荐0、28日二剂和0、7、28或0、28、56日三剂接种方案，每次1.0ml肌内注射或深皮下注射，或0.1ml皮内注射。 | [
{
"end_idx": 30,
"entity": "接种方案",
"start_idx": 27,
"type": "pro"
},
{
"end_idx": 42,
"entity": "肌内注射",
"start_idx": 39,
"type": "pro"
},
{
"end_idx": 48,
"entity": "深皮下注射",
"start_idx": 44,
"type": "pro"
},
{
"end_idx": 59,
"entity": "皮内注射",
"start_idx": 56,
"type": "pro"
}
] |
3.接触后免疫WHO推荐的标准免疫方案（HDCV疫苗）为0、3、7、14和28日各肌内注射1ml，第90日再加强1次。 | [
{
"end_idx": 6,
"entity": "接触后免疫",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 25,
"entity": "HDCV疫苗",
"start_idx": 20,
"type": "dru"
},
{
"end_idx": 44,
"entity": "肌内注射",
"start_idx": 41,
"type": "pro"
}
] |
佐剂地鼠肾细胞疫苗建议采用2-2-1程序，即0日肌内注射2剂（2ml），第7日和第21日各肌内注射1ml。 | [
{
"end_idx": 8,
"entity": "地鼠肾细胞疫苗",
"start_idx": 2,
"type": "dru"
},
{
"end_idx": 27,
"entity": "肌内注射",
"start_idx": 24,
"type": "pro"
},
{
"end_idx": 48,
"entity": "肌内注射",
"start_idx": 45,
"type": "pro"
}
] |
注射部位成人取三角肌，儿童注入腿前外侧。 | [
{
"end_idx": 3,
"entity": "注射部位",
"start_idx": 0,
"type": "bod"
},
{
"end_idx": 9,
"entity": "三角肌",
"start_idx": 7,
"type": "bod"
},
{
"end_idx": 18,
"entity": "注入腿前外侧",
"start_idx": 13,
"type": "pro"
}
] |
不宜接种于臂部。 | [
{
"end_idx": 3,
"entity": "接种",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 6,
"entity": "臂部",
"start_idx": 5,
"type": "bod"
}
] |
（四）注射免疫血清WHO推荐，在接种疫苗同时注射人狂犬病免疫球蛋白（HRIG），剂量为20IU/kg（马狂犬病免疫球蛋白剂量为40IU/kg）。 | [
{
"end_idx": 4,
"entity": "注射",
"start_idx": 3,
"type": "pro"
},
{
"end_idx": 8,
"entity": "免疫血清",
"start_idx": 5,
"type": "dru"
},
{
"end_idx": 19,
"entity": "接种疫苗",
"start_idx": 16,
"type": "pro"
},
{
"end_idx": 23,
"entity": "注射",
"start_idx": 22,
"type": "pro"
},
{
"end_idx": 32,
"entity": "人狂犬病免疫球蛋白",
"start_idx": 24,
"type": "dru"
},
{
"end_idx": 37,
"entity": "HRIG",
"start_idx": 34,
"type": "dru"
},
{
"end_idx": 59,
"entity": "马狂犬病免疫球蛋白",
"start_idx": 51,
"type": "dru"
}
] |
先做皮试，阴性者一次肌内注射或一半剂量在伤口周围浸润注射，另半量肌内注射。 | [
{
"end_idx": 3,
"entity": "皮试",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 13,
"entity": "肌内注射",
"start_idx": 10,
"type": "pro"
},
{
"end_idx": 27,
"entity": "伤口周围浸润注射",
"start_idx": 20,
"type": "pro"
},
{
"end_idx": 35,
"entity": "肌内注射",
"start_idx": 32,
"type": "pro"
}
] |
皮试阳性者需行脱敏处理（0.05ml稀释20倍，0.05ml稀释10倍，0.1ml，0.2ml，0.5ml，不稀释抗血清分别皮下注射，每次观察15分钟）后方可注射。 | [
{
"end_idx": 3,
"entity": "皮试阳性",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 1,
"entity": "皮试",
"start_idx": 0,
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},
{
"end_idx": 10,
"entity": "脱敏处理",
"start_idx": 7,
"type": "pro"
},
{
"end_idx": 65,
"entity": "皮下注射",
"start_idx": 62,
"type": "pro"
},
{
"end_idx": 80,
"entity": "注射",
"start_idx": 79,
"type": "pro"
}
] |
补充水电解质及热量，纠正酸碱平衡失调，维护心血管及呼吸功能。 | [
{
"end_idx": 8,
"entity": "补充水电解质及热量",
"start_idx": 0,
"type": "pro"
},
{
"end_idx": 17,
"entity": "纠正酸碱平衡失调",
"start_idx": 10,
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},
{
"end_idx": 28,
"entity": "维护心血管及呼吸功能",
"start_idx": 19,
"type": "pro"
}
] |
兴奋期狂躁时可交替应用多种镇静剂，甚至应用吗啡或全身麻醉。 | [
{
"end_idx": 4,
"entity": "兴奋期狂躁",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 15,
"entity": "交替应用多种镇静剂",
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{
"end_idx": 22,
"entity": "应用吗啡",
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{
"end_idx": 27,
"entity": "全身麻醉",
"start_idx": 24,
"type": "pro"
}
] |
咽喉痉挛不能控制导致窒息时可气管切开，间歇正压给氧。 | [
{
"end_idx": 1,
"entity": "咽喉",
"start_idx": 0,
"type": "bod"
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{
"end_idx": 7,
"entity": "咽喉痉挛不能控制",
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{
"end_idx": 11,
"entity": "窒息",
"start_idx": 10,
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"entity": "气管切开",
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},
{
"end_idx": 24,
"entity": "间歇正压给氧",
"start_idx": 19,
"type": "pro"
}
] |
脑水肿时给脱水剂。 | [
{
"end_idx": 2,
"entity": "脑水肿",
"start_idx": 0,
"type": "dis"
},
{
"end_idx": 7,
"entity": "脱水剂",
"start_idx": 5,
"type": "dru"
}
] |
麻痹期可用呼吸循环兴奋剂、给氧或人工辅助呼吸。 | [
{
"end_idx": 1,
"entity": "麻痹",
"start_idx": 0,
"type": "dis"
},
{
"end_idx": 11,
"entity": "呼吸循环兴奋剂",
"start_idx": 5,
"type": "dru"
},
{
"end_idx": 14,
"entity": "给氧",
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"type": "pro"
},
{
"end_idx": 21,
"entity": "人工辅助呼吸",
"start_idx": 16,
"type": "pro"
}
] |
三、核素检查放射性核素检查（简称核素检查），是利用放射性核素对疾病进行检查和对脏器功能进行测定的方法，已广泛应用于小儿肾脏疾病的诊断和病理生理研究，有以下常用的方法应用于临床。 | [
{
"end_idx": 5,
"entity": "核素检查",
"start_idx": 2,
"type": "pro"
},
{
"end_idx": 12,
"entity": "放射性核素检查",
"start_idx": 6,
"type": "pro"
},
{
"end_idx": 19,
"entity": "核素检查",
"start_idx": 16,
"type": "pro"
},
{
"end_idx": 36,
"entity": "利用放射性核素对疾病进行检查",
"start_idx": 23,
"type": "pro"
},
{
"end_idx": 46,
"entity": "对脏器功能进行测定",
"start_idx": 38,
"type": "pro"
},
{
"end_idx": 72,
"entity": "小儿肾脏疾病的诊断和病理生理研究",
"start_idx": 57,
"type": "pro"
}
] |
（一）肾动态显像和GRF、ERPF测定静脉注射由肾小球滤过或肾小管上皮细胞分泌而不被回吸收的显像剂（如99mTc-DTPA、131I-邻碘马尿酸和99mTc-EC等）后，用γ相机快速连续采集包括双肾和部分膀胱区域的放射性影像，可以依次观察到显像剂随血流灌注肾动脉和肾血管床的情况，然后是迅速聚集在肾实质，继而逐渐由肾实质流向肾盏、肾盂，最后经输尿管而达膀胱的整个过程，该检查提供两侧肾脏血流、肾功能和尿路是否通畅等多方面的信息，并可定量计算出双肾的GFR和ERPF。 | [
{
"end_idx": 7,
"entity": "肾动态显像",
"start_idx": 3,
"type": "pro"
},
{
"end_idx": 18,
"entity": "GRF、ERPF测定",
"start_idx": 9,
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},
{
"end_idx": 22,
"entity": "静脉注射",
"start_idx": 19,
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},
{
"end_idx": 26,
"entity": "肾小球",
"start_idx": 24,
"type": "bod"
},
{
"end_idx": 36,
"entity": "肾小管上皮细胞",
"start_idx": 30,
"type": "bod"
},
{
"end_idx": 48,
"entity": "显像剂",
"start_idx": 46,
"type": "dru"
},
{
"end_idx": 60,
"entity": "99mTc-DTPA",
"start_idx": 51,
"type": "dru"
},
{
"end_idx": 71,
"entity": "131I-邻碘马尿酸",
"start_idx": 62,
"type": "dru"
},
{
"end_idx": 80,
"entity": "99mTc-EC",
"start_idx": 73,
"type": "dru"
},
{
"end_idx": 88,
"entity": "γ相机",
"start_idx": 86,
"type": "equ"
},
{
"end_idx": 98,
"entity": "双肾",
"start_idx": 97,
"type": "bod"
},
{
"end_idx": 105,
"entity": "部分膀胱区域",
"start_idx": 100,
"type": "bod"
},
{
"end_idx": 111,
"entity": "放射性影像",
"start_idx": 107,
"type": "pro"
},
{
"end_idx": 122,
"entity": "显像剂",
"start_idx": 120,
"type": "dru"
},
{
"end_idx": 125,
"entity": "血流",
"start_idx": 124,
"type": "bod"
},
{
"end_idx": 130,
"entity": "肾动脉",
"start_idx": 128,
"type": "bod"
},
{
"end_idx": 135,
"entity": "肾血管床",
"start_idx": 132,
"type": "bod"
},
{
"end_idx": 150,
"entity": "肾实质",
"start_idx": 148,
"type": "bod"
},
{
"end_idx": 159,
"entity": "肾实质",
"start_idx": 157,
"type": "bod"
},
{
"end_idx": 163,
"entity": "肾盏",
"start_idx": 162,
"type": "bod"
},
{
"end_idx": 166,
"entity": "肾盂",
"start_idx": 165,
"type": "bod"
},
{
"end_idx": 173,
"entity": "输尿管",
"start_idx": 171,
"type": "bod"
},
{
"end_idx": 177,
"entity": "膀胱",
"start_idx": 176,
"type": "bod"
},
{
"end_idx": 194,
"entity": "两侧肾脏血流",
"start_idx": 189,
"type": "bod"
},
{
"end_idx": 196,
"entity": "肾",
"start_idx": 196,
"type": "bod"
},
{
"end_idx": 201,
"entity": "尿路",
"start_idx": 200,
"type": "bod"
},
{
"end_idx": 226,
"entity": "双肾的GFR",
"start_idx": 221,
"type": "ite"
},
{
"end_idx": 231,
"entity": "ERPF",
"start_idx": 228,
"type": "ite"
}
] |
本法十分灵敏，当血浆BUN＞36mmol/L（100mg/dl）和Scr＞800μmol/dl（10mg/dl），仍可使泌尿系显影。 | [
{
"end_idx": 31,
"entity": "血浆BUN＞36mmol/L（100mg/dl）",
"start_idx": 8,
"type": "sym"
},
{
"end_idx": 12,
"entity": "血浆BUN",
"start_idx": 8,
"type": "ite"
},
{
"end_idx": 55,
"entity": "Scr＞800μmol/dl（10mg/dl）",
"start_idx": 33,
"type": "sym"
},
{
"end_idx": 35,
"entity": "Scr",
"start_idx": 33,
"type": "ite"
},
{
"end_idx": 64,
"entity": "泌尿系显影",
"start_idx": 60,
"type": "pro"
}
] |
已成为GFR的“金标准”。 | [
{
"end_idx": 5,
"entity": "GFR",
"start_idx": 3,
"type": "ite"
}
] |
动态肾显影还可作为肾血管性高血压的初筛方法，肾血管性高血压多为单侧肾动脉狭窄，典型表现为患侧肾血流灌注不良肾静态显像静脉注射能够聚集并滞留在肾实质内的显像剂（如99mTc-DMSA和99mTc-GH等），取后位进行肾区静态显像，所得影像即为肾实质影像。 | [
{
"end_idx": 4,
"entity": "动态肾显影",
"start_idx": 0,
"type": "pro"
},
{
"end_idx": 20,
"entity": "肾血管性高血压的初筛方法",
"start_idx": 9,
"type": "pro"
},
{
"end_idx": 28,
"entity": "肾血管性高血压",
"start_idx": 22,
"type": "dis"
},
{
"end_idx": 37,
"entity": "单侧肾动脉狭窄",
"start_idx": 31,
"type": "dis"
},
{
"end_idx": 52,
"entity": "患侧肾血流灌注不良",
"start_idx": 44,
"type": "sym"
},
{
"end_idx": 48,
"entity": "患侧肾血流",
"start_idx": 44,
"type": "bod"
},
{
"end_idx": 57,
"entity": "肾静态显像",
"start_idx": 53,
"type": "pro"
},
{
"end_idx": 61,
"entity": "静脉注射",
"start_idx": 58,
"type": "pro"
},
{
"end_idx": 73,
"entity": "肾实质内",
"start_idx": 70,
"type": "bod"
},
{
"end_idx": 77,
"entity": "显像剂",
"start_idx": 75,
"type": "dru"
},
{
"end_idx": 89,
"entity": "99mTc-DMSA",
"start_idx": 80,
"type": "dru"
},
{
"end_idx": 98,
"entity": "99mTc-GH",
"start_idx": 91,
"type": "dru"
},
{
"end_idx": 112,
"entity": "取后位进行肾区静态显像",
"start_idx": 102,
"type": "pro"
},
{
"end_idx": 122,
"entity": "肾实质",
"start_idx": 120,
"type": "bod"
}
] |
当血浆BUN＞18mmol/L（50mg/dl），Scr＞440μmol/L（5mg/dl）时，本法仍可显示残余的肾组织，较IVP灵敏。 | [
{
"end_idx": 23,
"entity": "血浆BUN＞18mmol/L（50mg/dl）",
"start_idx": 1,
"type": "sym"
},
{
"end_idx": 5,
"entity": "血浆BUN",
"start_idx": 1,
"type": "ite"
},
{
"end_idx": 45,
"entity": "Scr＞440μmol/L（5mg/dl）",
"start_idx": 25,
"type": "sym"
},
{
"end_idx": 27,
"entity": "Scr",
"start_idx": 25,
"type": "ite"
},
{
"end_idx": 59,
"entity": "残余的肾组织",
"start_idx": 54,
"type": "bod"
},
{
"end_idx": 64,
"entity": "IVP",
"start_idx": 62,
"type": "pro"
}
] |
肾静态显像和动态显像是所有显像技术（包括静脉肾盂造影、肾动脉造影、X线计算机体层扫描以及超声检查等）中最直观者，能直接显示肾实质全影，因此十分有利于观察肾脏的位置、形态和大小。 | [
{
"end_idx": 4,
"entity": "肾静态显像",
"start_idx": 0,
"type": "pro"
},
{
"end_idx": 9,
"entity": "动态显像",
"start_idx": 6,
"type": "pro"
},
{
"end_idx": 16,
"entity": "显像技术",
"start_idx": 13,
"type": "pro"
},
{
"end_idx": 25,
"entity": "静脉肾盂造影",
"start_idx": 20,
"type": "pro"
},
{
"end_idx": 31,
"entity": "肾动脉造影",
"start_idx": 27,
"type": "pro"
},
{
"end_idx": 41,
"entity": "X线计算机体层扫描",
"start_idx": 33,
"type": "pro"
},
{
"end_idx": 47,
"entity": "超声检查",
"start_idx": 44,
"type": "pro"
},
{
"end_idx": 63,
"entity": "肾实质",
"start_idx": 61,
"type": "bod"
},
{
"end_idx": 77,
"entity": "肾脏",
"start_idx": 76,
"type": "bod"
}
] |
对先天性肾畸形，如蹄铁形肾（horseshoekidney）、孤立肾（singlekidney）、双肾一侧融合（unilateralfusion）、重复肾（duplicationofthekidney）和先天性肾盂输尿管连接部狭窄（pelviuretericobstruction）等，本法可一目了然，并可了解局部的功能状态。 | [
{
"end_idx": 6,
"entity": "先天性肾畸形",
"start_idx": 1,
"type": "dis"
},
{
"end_idx": 12,
"entity": "蹄铁形肾",
"start_idx": 9,
"type": "dis"
},
{
"end_idx": 28,
"entity": "horseshoekidney",
"start_idx": 14,
"type": "dis"
},
{
"end_idx": 33,
"entity": "孤立肾",
"start_idx": 31,
"type": "dis"
},
{
"end_idx": 46,
"entity": "singlekidney",
"start_idx": 35,
"type": "dis"
},
{
"end_idx": 54,
"entity": "双肾一侧融合",
"start_idx": 49,
"type": "dis"
},
{
"end_idx": 71,
"entity": "unilateralfusion",
"start_idx": 56,
"type": "dis"
},
{
"end_idx": 76,
"entity": "重复肾",
"start_idx": 74,
"type": "dis"
},
{
"end_idx": 99,
"entity": "duplicationofthekidney",
"start_idx": 78,
"type": "dis"
},
{
"end_idx": 114,
"entity": "先天性肾盂输尿管连接部狭窄",
"start_idx": 102,
"type": "dis"
},
{
"end_idx": 139,
"entity": "pelviuretericobstruction",
"start_idx": 116,
"type": "dis"
}
] |
用本法显影受肾功能的影响很小，有人估计，只要残留肾功能在3%以上，本法即可勉强显影。 | [
{
"end_idx": 4,
"entity": "显影",
"start_idx": 3,
"type": "pro"
},
{
"end_idx": 6,
"entity": "肾",
"start_idx": 6,
"type": "bod"
},
{
"end_idx": 24,
"entity": "肾",
"start_idx": 24,
"type": "bod"
},
{
"end_idx": 40,
"entity": "显影",
"start_idx": 39,
"type": "pro"
}
] |
肾静态显像观察到急性肾盂肾炎患儿肾瘢痕的阳性率达50%左右，瘢痕征的表现为肾影中单个或多个局部放射性缺损或减低区，多位于上下极，典型者呈楔形，宽面向外，使整个肾影变形。 | [
{
"end_idx": 4,
"entity": "肾静态显像",
"start_idx": 0,
"type": "pro"
},
{
"end_idx": 21,
"entity": "肾静态显像观察到急性肾盂肾炎患儿肾瘢痕的阳性",
"start_idx": 0,
"type": "sym"
},
{
"end_idx": 13,
"entity": "急性肾盂肾炎",
"start_idx": 8,
"type": "dis"
},
{
"end_idx": 18,
"entity": "肾瘢痕",
"start_idx": 16,
"type": "dis"
},
{
"end_idx": 74,
"entity": "瘢痕征的表现为肾影中单个或多个局部放射性缺损或减低区，多位于上下极，典型者呈楔形，宽面向外",
"start_idx": 30,
"type": "sym"
},
{
"end_idx": 37,
"entity": "肾",
"start_idx": 37,
"type": "bod"
},
{
"end_idx": 79,
"entity": "肾",
"start_idx": 79,
"type": "bod"
},
{
"end_idx": 82,
"entity": "肾影变形",
"start_idx": 79,
"type": "sym"
}
] |
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