WEBVTT00:00:06.840 --> 00:00:08.880大家好今天我要分享的内容00:00:08.880 --> 00:00:11.460是关于社区获得性肺炎00:00:17.080 --> 00:00:18.400首先我们来看一下00:00:18.400 --> 00:00:19.740关于社区性00:00:19.840 --> 00:00:21.940社区获得性肺炎的一个定义00:00:22.600 --> 00:00:24.520那么社区获得性肺炎呢00:00:24.520 --> 00:00:26.060是指在医院外00:00:26.600 --> 00:00:30.260罹患的感染性肺实质炎症00:00:30.920 --> 00:00:31.320包括00:00:31.320 --> 00:00:35.060具有明显明确潜伏期的病原体感染00:00:35.200 --> 00:00:36.500而在入院后00:00:36.720 --> 00:00:40.340平均潜伏期内发病的肺炎00:00:41.120 --> 00:00:42.040那这个定义呢00:00:42.040 --> 00:00:45.020明确了发病的地点是社区环境00:00:45.680 --> 00:00:46.620区别在00:00:46.720 --> 00:00:49.420区别于在医院内感染引发的肺炎00:00:49.880 --> 00:00:52.900例如一位居民在日常生活中00:00:52.960 --> 00:00:55.340没有接触医院内的感染源00:00:55.960 --> 00:00:58.460却出现了肺部炎症症状00:00:59.120 --> 00:01:02.420经过诊断符合CP的一个标准00:01:03.200 --> 00:01:06.420它就可以被确诊为社区获得性肺炎00:01:09.880 --> 00:01:10.680我们来看一下00:01:10.680 --> 00:01:13.540关于社区获得性肺炎的一个定义00:01:15.200 --> 00:01:16.380简单来说00:01:16.520 --> 00:01:18.100社区获得性肺炎00:01:18.200 --> 00:01:21.120就是人们在日常生活的社区环境里00:01:21.120 --> 00:01:22.060得的肺炎00:01:22.640 --> 00:01:23.860不是因为住院00:01:23.960 --> 00:01:26.840或者在医疗机构长时间停留00:01:26.840 --> 00:01:27.940而感染的00:01:28.320 --> 00:01:30.860比如孩子在学校里00:01:30.880 --> 00:01:33.060因为同学间的交叉感染00:01:33.200 --> 00:01:35.660出现发热咳嗽等症状00:01:35.960 --> 00:01:37.660最后被诊断为肺炎00:01:38.160 --> 00:01:39.080这种情况00:01:39.080 --> 00:01:41.820就很可能是社区获得性肺炎00:01:43.040 --> 00:01:45.460它涵盖了各种年龄段人群00:01:45.560 --> 00:01:47.100在社区环境下00:01:47.120 --> 00:01:50.120因多种病原病原体感染肺部00:01:50.120 --> 00:01:51.460所引发的疾病00:01:58.360 --> 00:02:00.620那么按照它的病原区分00:02:02.280 --> 00:02:03.660有多种类型00:02:04.120 --> 00:02:05.500按病原体分类00:02:06.680 --> 00:02:09.380肺炎可以分为细菌性肺炎00:02:09.440 --> 00:02:13.220病毒性肺炎支原体肺炎衣原体肺炎00:02:13.240 --> 00:02:14.820真菌性肺炎等等00:02:15.320 --> 00:02:18.220其中细菌性肺炎最为常见00:02:18.520 --> 00:02:22.140约展社区获得性肺炎的40%-60%00:02:22.920 --> 00:02:25.940常见的致病菌有肺炎尿球菌00:02:26.360 --> 00:02:28.180金黄色葡萄球菌等等00:02:29.000 --> 00:02:31.820病毒性肺炎在冬春季节高发00:02:32.080 --> 00:02:36.760像流感病毒腺病毒等都可能引发尤00:02:36.760 --> 00:02:39.020其是在流感大流行期间00:02:39.400 --> 00:02:42.340病毒性肺炎的发病率会明显上升00:02:43.400 --> 00:02:46.940支原体肺炎则好发于儿童和青少年00:02:47.320 --> 00:02:50.180约占儿童肺炎的20%-50%00:02:50.640 --> 00:02:52.300病程相对较长00:02:59.920 --> 00:03:04.700那么按照嗯患病环境分类00:03:07.600 --> 00:03:10.320主要分为社区获得性肺炎00:03:10.320 --> 00:03:12.220和医院获得性肺炎00:03:13.760 --> 00:03:15.340社区获得性肺炎00:03:15.600 --> 00:03:18.540是在社区环境中感染发病00:03:19.080 --> 00:03:21.180前面我们进行详细介绍了00:03:21.880 --> 00:03:23.400而医院获得性肺炎00:03:23.400 --> 00:03:26.380是指患者入院时不存在00:03:26.560 --> 00:03:28.140也不属于潜伏期00:03:28.640 --> 00:03:31.500而于入院48小时后在医院00:03:32.000 --> 00:03:34.420包括在老年护理院康复院等等00:03:34.800 --> 00:03:36.460嗯发生的一个肺炎00:03:37.400 --> 00:03:39.440医院获得性肺炎的病原体00:03:39.440 --> 00:03:40.900往往更为复杂00:03:41.560 --> 00:03:43.780耐药菌感染的几率较高00:03:44.320 --> 00:03:45.900治疗相对棘手00:03:46.360 --> 00:03:49.700比如一些长期住院的老年患者00:03:50.120 --> 00:03:52.460由于身抗身体抵抗力差00:03:52.840 --> 00:03:54.180在住院期间00:03:54.200 --> 00:03:56.860更容易感染医院获得性肺炎00:04:03.960 --> 00:04:06.240我们来看一下社区获得性呃00:04:06.240 --> 00:04:07.420获得性肺炎00:04:07.560 --> 00:04:09.940在呼吸系统疾病中的占比00:04:11.000 --> 00:04:12.800那么社区获得性肺炎00:04:12.800 --> 00:04:16.140在呼吸系统疾病中占据重要地位00:04:16.840 --> 00:04:18.580在全球范围内00:04:18.800 --> 00:04:20.540它是导致人类发病00:04:20.560 --> 00:04:22.940和死亡的重要原因之一00:04:24.000 --> 00:04:24.980据统计00:04:25.680 --> 00:04:27.300社区获得性肺炎00:04:27.480 --> 00:04:31.780在成人社区获得性感染性疾病中00:04:32.000 --> 00:04:34.220发病率位居前列00:04:35.080 --> 00:04:39.940约占所有社区获得性感染的15%-20%00:04:41.160 --> 00:04:42.940在一些发展中国家00:04:43.520 --> 00:04:45.020由于卫生条件00:04:45.080 --> 00:04:47.580和医疗资源等因素的影响00:04:48.160 --> 00:04:51.220社区获得性肺炎的发病率可能更高00:04:52.440 --> 00:04:55.420例如在非洲的一些地区00:04:55.720 --> 00:04:58.420因为基础设施相对薄弱00:04:59.160 --> 00:05:01.300社区获得性肺炎的发病率00:05:01.360 --> 00:05:04.140可以高达25%左右00:05:09.920 --> 00:05:10.880我们来看一下00:05:10.880 --> 00:05:12.500社区获得性肺炎00:05:12.600 --> 00:05:14.460对于公共卫生的影响00:05:16.240 --> 00:05:17.660社区获得性肺炎00:05:17.720 --> 00:05:20.260对公共卫生有着广泛的影响00:05:20.720 --> 00:05:22.620它具有较高的传染性00:05:23.000 --> 00:05:25.460容易在社区人群中传播00:05:26.160 --> 00:05:29.820尤其是在人口密集通风不良的场所00:05:30.120 --> 00:05:32.420比如学校工厂等等00:05:33.440 --> 00:05:34.900一旦发生疫情00:05:35.000 --> 00:05:37.220可能会导致大量人员患病00:05:37.880 --> 00:05:41.340影响正影响正常的生活和工作秩序00:05:42.320 --> 00:05:45.180此外社区获得性肺炎的治疗00:05:45.280 --> 00:05:47.540需要消耗一定的医疗资源00:05:48.280 --> 00:05:50.620包括床位药品等等00:05:51.720 --> 00:05:54.060给医疗系统带来一定压力00:05:55.160 --> 00:05:56.860例如在流感季节00:05:57.160 --> 00:05:58.880因社区获得性肺炎00:05:58.880 --> 00:06:01.380就诊的患者数量大幅增加00:06:02.160 --> 00:06:05.940常常导致医院门诊和病房人满为患00:06:10.760 --> 00:06:11.600我们来看一下00:06:11.600 --> 00:06:14.900关于社区获得性肺炎常见的病原体00:06:16.520 --> 00:06:19.020首先来看一下细菌类的病原体00:06:20.840 --> 00:06:21.940肺炎链球菌00:06:22.000 --> 00:06:23.760是社区获得性肺炎中00:06:23.760 --> 00:06:25.940极为常见的细菌病原体00:06:26.760 --> 00:06:29.260它广泛存在于健康人的鼻咽部00:06:30.240 --> 00:06:32.260当人体免疫力下降时00:06:32.440 --> 00:06:35.140就容易侵入肺部引发感染00:06:35.960 --> 00:06:36.900据研究00:06:37.160 --> 00:06:39.980在所有社区获得性肺炎病例中00:06:40.600 --> 00:06:45.220肺炎链球菌感染导致的约占30%到50%00:06:46.080 --> 00:06:46.840例如00:06:46.840 --> 00:06:50.740老年人儿童等免疫力较弱的人群00:06:51.120 --> 00:06:52.700在季节交替时00:06:52.800 --> 00:06:55.220很容易受到肺炎链球菌的侵袭00:06:55.600 --> 00:06:58.860出现高热咳嗽咳痰等症状00:06:59.800 --> 00:07:02.100此外金黄色葡萄球菌00:07:02.120 --> 00:07:04.900也是一种不容忽视的细菌病原体00:07:05.520 --> 00:07:07.300它能产生多种毒素00:07:07.600 --> 00:07:09.940感染后病情往往较为严重00:07:10.640 --> 00:07:12.540尤其是在有基础疾病00:07:12.600 --> 00:07:14.520或者免疫力低下的人群中00:07:14.520 --> 00:07:15.540更易发病00:07:20.640 --> 00:07:22.780我们来看一下病毒类的病原体00:07:23.880 --> 00:07:24.980流感病毒00:07:25.000 --> 00:07:25.720是引发00:07:25.720 --> 00:07:28.380社区获得性肺炎的重要病毒之一00:07:29.440 --> 00:07:31.060每年的流感季节00:07:31.600 --> 00:07:33.700流感病毒传播迅速00:07:34.560 --> 00:07:38.060感染后不仅会引起上呼吸道症状00:07:38.720 --> 00:07:41.540还常常累积肺部引发肺炎00:07:42.680 --> 00:07:43.820根据统计00:07:44.480 --> 00:07:46.300在流感流行期间00:07:46.600 --> 00:07:50.300大约有10%到20%的流感患者00:07:50.320 --> 00:07:51.580会并发肺炎00:07:52.880 --> 00:07:55.280像h 3 n 200:07:55.280 --> 00:07:59.100h n h 1 n 1 等不同亚型的流感病毒00:07:59.640 --> 00:08:01.820都具有较强的致病性00:08:03.280 --> 00:08:04.580除了流感病毒00:08:04.800 --> 00:08:06.780腺病毒也较为常见00:08:07.640 --> 00:08:08.880它在儿童中00:08:08.880 --> 00:08:11.580引起肺炎的比例相对较高00:08:12.640 --> 00:08:16.620可以导致发热咳嗽喘息等症状00:08:17.280 --> 00:08:19.420严重影响儿童的健康00:08:23.880 --> 00:08:25.620我们再来看一下支原体00:08:26.360 --> 00:08:27.160支原体呢00:08:27.160 --> 00:08:30.020是一类没有细胞壁的原核微生物00:08:30.600 --> 00:08:31.780肺炎支原体00:08:31.880 --> 00:08:32.080是00:08:32.080 --> 00:08:35.200引起社区获得性肺炎的常见病原体00:08:35.200 --> 00:08:36.000之一00:08:36.600 --> 00:08:39.460尤其是在儿童和青少年群体中00:08:39.520 --> 00:08:40.740发病率较高00:08:41.800 --> 00:08:43.700它主要通过飞沫传播00:08:44.040 --> 00:08:46.140感染后病程相对较长00:08:46.400 --> 00:08:48.940可以持续两到三周甚至更久00:08:49.840 --> 00:08:52.620在一些学校等集体生活场所00:08:53.120 --> 00:08:54.500由于人员密集00:08:54.720 --> 00:08:56.780一旦有支原体肺炎患者00:08:57.000 --> 00:08:59.020很容易造成局部传播00:08:59.880 --> 00:09:00.860据调查00:09:01.120 --> 00:09:03.900在某些学校爆发的肺炎疫情中00:09:04.200 --> 00:09:08.220支原体肺炎占比可达30%到40%00:09:08.960 --> 00:09:12.460给学生的学习和生活带来诸多不便00:09:18.360 --> 00:09:20.740我们来看一下环境因素的影响00:09:22.840 --> 00:09:25.020首先呢是季节变化的作用00:09:25.840 --> 00:09:26.940季节变化00:09:26.960 --> 00:09:29.080对社区获得性肺炎的发病00:09:29.080 --> 00:09:30.580有着显著影响00:09:31.400 --> 00:09:35.020在寒冷的冬季和气温多变的春季00:09:35.600 --> 00:09:37.820肺炎的发病率往往较高00:09:39.040 --> 00:09:40.900冬季气温较低00:09:41.480 --> 00:09:43.600人体呼吸道黏膜的抵抗力00:09:43.600 --> 00:09:44.860会有所下降00:09:45.760 --> 00:09:49.180同时人们在室内活动时间增多00:09:49.680 --> 00:09:51.260空气流通不畅00:09:51.760 --> 00:09:53.700病原体更容易传播00:09:55.040 --> 00:09:57.100例如在北方的冬季00:09:57.520 --> 00:09:58.980室内外温差大00:09:59.280 --> 00:10:01.140人们进出室内外时00:10:01.320 --> 00:10:03.380呼吸道受到冷热刺激00:10:04.080 --> 00:10:05.460容易引发感染00:10:06.560 --> 00:10:07.460据统计00:10:08.240 --> 00:10:11.020冬季社区获得性肺炎的发病率00:10:11.120 --> 00:10:14.820比夏季高出约30%到40%00:10:16.120 --> 00:10:18.020春季气温不稳定00:10:18.440 --> 00:10:19.540乍暖还寒00:10:20.040 --> 00:10:22.460也是各种病原体活跃的时期00:10:23.160 --> 00:10:25.860肺炎发病风险也相对较高00:10:32.920 --> 00:10:35.260其次是空气污染的影响00:10:36.200 --> 00:10:37.300空气污染00:10:37.320 --> 00:10:39.920是导致社区获得性肺炎发病的00:10:39.920 --> 00:10:41.580重要环境因素之一00:10:42.560 --> 00:10:44.740空气中的有害颗粒物00:10:45.040 --> 00:10:48.020如PM2.5 PM10等00:10:48.720 --> 00:10:53.540及有害气体如二氧化硫氮氧化物等00:10:54.000 --> 00:10:56.780会损害呼吸道黏膜的防御功能00:10:57.840 --> 00:11:00.780使人体更容易受到病原体的侵袭00:11:01.960 --> 00:11:03.020研究表明00:11:03.240 --> 00:11:03.640长期00:11:03.640 --> 00:11:06.540生活在空气污染严重地区的人群00:11:06.880 --> 00:11:08.980患社区获得性肺炎的几率00:11:09.080 --> 00:11:12.060比生活在空气质量良好地区的人群00:11:12.080 --> 00:11:13.820高出约2到3倍00:11:14.600 --> 00:11:16.820例如一些工业城市00:11:17.040 --> 00:11:19.500由于工厂排放大量废气00:11:19.760 --> 00:11:21.220空气质量较差00:11:21.560 --> 00:11:23.700社区获得性肺炎的发病率00:11:23.760 --> 00:11:26.620明显高于周边环境较好的地区00:11:32.520 --> 00:11:35.140我们再来看一下居住环境的关联00:11:36.120 --> 00:11:37.240居住环境00:11:37.240 --> 00:11:40.460与社区获得性肺炎的发病密切相关00:11:41.720 --> 00:11:45.340居住空间狭小人口密集的环境00:11:45.800 --> 00:11:47.700病原体更容易传播00:11:48.480 --> 00:11:49.080比如00:11:49.080 --> 00:11:53.100一些老旧小区的出租屋多户合租00:11:53.320 --> 00:11:55.660而且房间通风条件不佳00:11:56.160 --> 00:11:58.220一旦有一个人感染肺炎00:11:58.440 --> 00:12:00.300很容易传染给其他人00:12:01.440 --> 00:12:04.100此外居住环境潮湿00:12:04.280 --> 00:12:07.220也有利于霉菌等病原体的滋生00:12:07.800 --> 00:12:09.260增加感染风险00:12:10.920 --> 00:12:12.260有调查显示00:12:12.680 --> 00:12:15.020居住在潮湿环境中的人群00:12:15.280 --> 00:12:17.260患真菌性肺炎的几率00:12:17.400 --> 00:12:19.980比居住在干燥环境中的人群00:12:20.080 --> 00:12:22.980高出约15%到20%00:12:28.640 --> 00:12:31.340我们再来看一下个人易感因素00:12:32.160 --> 00:12:33.980首先是年龄的因素00:12:34.960 --> 00:12:35.720年龄呢是00:12:35.720 --> 00:12:38.200影响社区获得性肺炎易感性00:12:38.200 --> 00:12:39.420的重要因素00:12:40.040 --> 00:12:42.900儿童的免疫系统尚未发育完全00:12:43.400 --> 00:12:44.900尤其是婴幼儿00:12:45.360 --> 00:12:47.660他们的呼吸道粘膜比较娇嫩00:12:48.120 --> 00:12:49.500免疫功能较弱00:12:50.280 --> 00:12:52.300对病原体的抵抗力较差00:12:52.360 --> 00:12:53.620容易感染肺炎00:12:54.440 --> 00:12:56.600据统计 5岁以下儿童00:12:56.600 --> 00:12:59.140社社区获得性肺炎的高发人群00:12:59.480 --> 00:13:01.800发病率约为其他年龄段人群00:13:01.800 --> 00:13:03.220的2到3倍00:13:04.200 --> 00:13:07.260而老年人则由于身体机能衰退00:13:08.320 --> 00:13:10.340呼吸道防御功能下降00:13:10.960 --> 00:13:12.940肺部组织弹性降低00:13:13.480 --> 00:13:16.100也容易受到肺炎病原体的侵袭00:13:17.360 --> 00:13:19.32065岁以上老年人00:13:19.320 --> 00:13:22.900患社区获得性肺炎的风险明显增加00:13:23.520 --> 00:13:26.340而且感染后病情往往较重00:13:26.960 --> 00:13:28.460恢复时间较长00:13:35.080 --> 00:13:37.460我们再来看一下基础疾病的作用00:13:38.280 --> 00:13:40.140患有基础疾病的人群00:13:40.160 --> 00:13:42.780更容易患上社区获得性肺炎00:13:43.200 --> 00:13:45.940例如慢性阻塞性肺疾病00:13:47.080 --> 00:13:50.300由于他呼吸道存在慢性炎症00:13:50.760 --> 00:13:51.900气道狭窄00:13:52.160 --> 00:13:53.460肺功能受损00:13:53.920 --> 00:13:56.940呼吸道的自净能力和防御功能下降00:13:57.720 --> 00:13:59.160感染肺炎的几率00:13:59.160 --> 00:14:01.700比正常人高出约3-4倍00:14:02.960 --> 00:14:04.660而在糖尿病患者中00:14:04.760 --> 00:14:06.780如果血糖控制不佳时00:14:07.160 --> 00:14:11.300高血糖环境有利于细菌生长繁殖00:14:11.680 --> 00:14:14.940同时患者的免疫力也会受到影响00:14:15.080 --> 00:14:16.380容易并发肺炎00:14:17.360 --> 00:14:19.820此外心血管疾病患者00:14:20.000 --> 00:14:22.940癌症患者等免疫力低下的人群00:14:23.160 --> 00:14:26.060都是社区获得性肺炎的高危人群00:14:31.280 --> 00:14:33.620我们再来看一下生活方式的影响00:14:34.600 --> 00:14:36.200不良的生活方式00:14:36.200 --> 00:14:39.740也会增加患社区获得性肺炎的风险00:14:40.160 --> 00:14:41.500长期吸烟的人00:14:41.640 --> 00:14:43.160烟草中的有害物质00:14:43.160 --> 00:14:44.980会损害呼吸道黏膜00:14:45.200 --> 00:14:47.180降低呼吸道的防御功能00:14:47.440 --> 00:14:49.860使人体更容易受到病原体感染00:14:50.560 --> 00:14:51.580研究表明00:14:51.760 --> 00:14:54.500吸烟者患社区获得性肺炎的几率00:14:54.560 --> 00:14:57.460比不吸烟者高出约1.5到2倍00:14:58.240 --> 00:15:00.940缺乏运动过度劳累的群体00:15:01.120 --> 00:15:02.900身体免疫力会下降00:15:03.160 --> 00:15:06.060也容易成为肺炎病原体的侵袭对象00:15:07.080 --> 00:15:09.580例如一些经常熬夜加班00:15:09.680 --> 00:15:11.580不注重锻炼的上班族00:15:11.760 --> 00:15:13.560在季节交替时00:15:13.560 --> 00:15:16.060更容易患上社区获得性肺炎00:15:20.400 --> 00:15:21.280嗯以上呢00:15:21.280 --> 00:15:23.960就是今天我要和大家分享的内容00:15:23.960 --> 00:15:25.300感谢大家的收听