WEBVTT00:00:03.400 --> 00:00:07.420今天来聊一下预防与治疗心血器官00:00:10.800 --> 00:00:15.060啊我都分为四大部分了一是病因分析00:00:15.520 --> 00:00:19.820二症状与检查三诊断与鉴别00:00:20.040 --> 00:00:22.020四治疗与预防00:00:26.200 --> 00:00:27.500因当时00:00:28.040 --> 00:00:30.740一慢性支气管炎的介绍00:00:32.120 --> 00:00:32.920d00:00:33.200 --> 00:00:35.740慢性支气管炎是气管00:00:35.760 --> 00:00:36.920支气管黏膜00:00:36.920 --> 00:00:39.660及其周围组织的慢性非特异性00:00:40.960 --> 00:00:44.020症状以咳嗽咳痰为主00:00:44.800 --> 00:00:49.580伴喘息每年发病持续3个月以上00:00:50.720 --> 00:00:52.460连续2年及以上00:00:54.040 --> 00:00:57.700鉴别需要进一步排除具有咳嗽咳痰00:00:58.040 --> 00:01:00.540分析症状的其他疾病00:01:01.240 --> 00:01:03.060如肺结核00:01:03.680 --> 00:01:05.660成肺肺脓疡00:01:06.480 --> 00:01:08.500心脏病心功能不全00:01:09.560 --> 00:01:11.780支气管扩张支气管哮喘00:01:12.200 --> 00:01:16.540慢性病咽炎血管反流综合征等疾00:01:24.640 --> 00:01:25.740病因分析00:01:26.880 --> 00:01:29.420就诊科室呼吸内科内科00:01:31.400 --> 00:01:32.200呃00:01:32.560 --> 00:01:36.020慢性支气管炎的病因尚未完全明确00:01:36.120 --> 00:01:38.540一般认为是多种环境与00:01:38.640 --> 00:01:41.860机体自身因素长期共同作用00:01:42.440 --> 00:01:45.300导致气管支气管黏膜00:01:45.360 --> 00:01:48.660及周围组织慢性非特异性炎症00:01:49.840 --> 00:01:50.820具体路线00:01:52.080 --> 00:01:54.900吸烟致病吸烟是主因00:01:55.000 --> 00:01:58.420其中化学物质会损伤气道上皮00:02:02.080 --> 00:02:03.780刺激副交感神经00:02:04.440 --> 00:02:06.900增加氧自由基00:02:07.640 --> 00:02:09.500破坏肺弹力纤维00:02:10.600 --> 00:02:15.380吸烟患病率比不吸烟者高2到8倍00:02:16.280 --> 00:02:18.700烟瘾和吸烟量越大00:02:19.360 --> 00:02:20.860患病可能性越高00:02:23.360 --> 00:02:24.260职业暴露00:02:26.120 --> 00:02:28.460长期接触职业粉尘00:02:28.800 --> 00:02:33.500化学物质如烟雾工业废气等00:02:34.160 --> 00:02:36.420浓度高或接触酒00:02:37.080 --> 00:02:39.740会损伤吸道的黏膜00:02:41.200 --> 00:02:43.860引发炎症导致发病00:02:47.080 --> 00:02:48.100空气污染00:02:50.160 --> 00:02:53.660其中有害气体如二氧化硫等00:02:54.000 --> 00:02:55.900会损伤气道上皮00:02:55.960 --> 00:02:58.020增加细菌感染风险00:02:58.880 --> 00:03:02.100室内油烟生物燃料产物等00:03:02.560 --> 00:03:03.980也是许多因素00:03:05.160 --> 00:03:06.220感染因素00:03:07.640 --> 00:03:10.220包括病毒支原体00:03:10.600 --> 00:03:13.860细菌反复感染是重要因素00:03:14.840 --> 00:03:17.420病毒感染形成细道上皮00:03:18.200 --> 00:03:21.260为细菌感染创造条件00:03:22.280 --> 00:03:25.820支原体感染在儿童和青少年中00:03:25.960 --> 00:03:26.940较常见00:03:29.480 --> 00:03:30.580其他因素00:03:32.360 --> 00:03:34.780免疫紊乱起到奥感应00:03:35.240 --> 00:03:36.940自主神经失调00:03:37.560 --> 00:03:38.740年龄增长00:03:40.000 --> 00:03:41.900气候寒冷干燥等00:03:42.120 --> 00:03:45.660都会影响气道功能和抵抗力00:03:46.920 --> 00:03:47.980促使发病00:03:58.960 --> 00:04:02.900症状减长主要症状一是咳嗽00:04:03.200 --> 00:04:05.180一般晨间咳嗽为主00:04:05.560 --> 00:04:08.100睡眠时有镇咳或咳痰00:04:09.040 --> 00:04:13.660课程范围白色黏液或浆液泡沫型00:04:13.840 --> 00:04:17.660无可代取清晨排痰较多00:04:18.400 --> 00:04:21.740起床后会有体微变动和自己排痰00:04:23.960 --> 00:04:25.300反吸气疾00:04:26.560 --> 00:04:30.380反吸明显者可能伴他支气管哮喘00:04:31.400 --> 00:04:35.540或伴肺气重视表现为活动或的气质00:04:40.680 --> 00:04:44.220那检查方法一个呢是体格检查00:04:44.400 --> 00:04:47.200肺部听诊是医生诊断肺部炎症00:04:47.200 --> 00:04:50.300了解呼吸系统生理病理状况00:04:50.560 --> 00:04:52.980最常见最便捷的手段00:04:54.120 --> 00:04:56.740能够为医生诊断提供一定的00:05:00.200 --> 00:05:02.380第二个呢是实验室检查00:05:02.960 --> 00:05:07.060包括实验常规检查中癌细胞的变化00:05:07.120 --> 00:05:10.380对医生诊断及粪便细菌病毒感染00:05:10.640 --> 00:05:12.100提供重要的依据00:05:14.280 --> 00:05:15.980参培养加药名时00:05:16.400 --> 00:05:19.900可以抑制患者感染细菌的种类00:05:20.360 --> 00:05:23.540并为临床用药提供治疗服务00:05:25.800 --> 00:05:26.980x线检查00:05:28.440 --> 00:05:31.160x线检查可以直观的显示00:05:31.160 --> 00:05:33.180患者肺部的感染范围00:05:33.680 --> 00:05:37.180是医生了解患者肺气管00:05:37.400 --> 00:05:38.820支气管的手拉手00:05:41.400 --> 00:05:43.300第四个是呼吸00:05:43.880 --> 00:05:45.300对功能的增强00:05:46.080 --> 00:05:48.300用于提示气道阻塞情况00:05:48.560 --> 00:05:51.380一般一般呢是用于疾病的后期00:06:13.200 --> 00:06:15.940rise诊断与鉴别00:06:16.800 --> 00:06:17.860诊断方法00:06:19.000 --> 00:06:22.440主要是在典型临床表现00:06:22.440 --> 00:06:26.220实验室检查及x线检查的基础上00:06:26.480 --> 00:06:30.980排除其他原因的对即被系统疾病00:06:32.560 --> 00:06:33.820做出的是诊断00:06:34.840 --> 00:06:37.780每年咳嗽咳痰或暗有喘息00:06:38.240 --> 00:06:40.740持续3个月以上或以上00:06:41.040 --> 00:06:43.420且连续2年或2年以上00:06:44.200 --> 00:06:48.260在排除其他具有类似症状的疾病后00:06:48.800 --> 00:06:52.820和初初步考虑慢性支气管炎的诊断00:06:55.080 --> 00:06:57.700二在疾病缓解期00:06:59.160 --> 00:07:03.500患者体格检查可能无明显的异常体征00:07:04.160 --> 00:07:06.420但在急性发作期00:07:06.800 --> 00:07:09.020会出现肺部停诊的异常00:07:09.960 --> 00:07:13.420如两肺可闻及散在的甘露因或湿若因00:07:14.760 --> 00:07:18.940咳嗽或咳嗽或落因可减少或消失00:07:20.800 --> 00:07:24.020喘息型患者可听到哮鸣00:07:24.720 --> 00:07:28.420严重时可出现呼吸增快发干等表现00:07:31.080 --> 00:07:32.620在实验时间上00:07:35.000 --> 00:07:36.180血液检查00:07:37.080 --> 00:07:38.420急性发作期00:07:39.880 --> 00:07:41.400血常会成癌细胞00:07:41.400 --> 00:07:44.820激素和中性粒细胞比例可能升高00:07:45.480 --> 00:07:47.420提示存在细菌感染00:07:48.360 --> 00:07:49.700如果是病毒感染00:07:50.400 --> 00:07:53.220癌细胞激素可正常或偏低00:07:55.320 --> 00:07:57.620impossible be cushional00:08:01.120 --> 00:08:01.920此外00:08:02.200 --> 00:08:05.980c反应蛋白等炎症指标也可能升高00:08:11.040 --> 00:08:14.860痰液简称通过痰液图片和配药00:08:14.920 --> 00:08:17.860可明确痰液中的病原体种类00:08:18.480 --> 00:08:22.140如细菌病毒支原体等00:08:22.880 --> 00:08:25.300有助于指导抗生素的使用00:08:29.840 --> 00:08:31.100影像学检查00:08:32.600 --> 00:08:36.140对于一些不典型病理或与其他疾病00:08:36.840 --> 00:08:39.480难以鉴别是胸部CT检查00:08:39.480 --> 00:08:42.340可提供更详细的对比信息00:08:43.399 --> 00:08:45.480有助于排除其他肺部疾病00:08:45.480 --> 00:08:48.380如支气管扩张肺部肿瘤等00:08:52.160 --> 00:08:53.340肺功能检查00:08:54.880 --> 00:08:56.860肺功能检查是判断00:08:57.680 --> 00:09:00.820气流受限的主要客观指标00:09:02.760 --> 00:09:04.700对慢性支气管炎症00:09:05.240 --> 00:09:06.940慢性支气管炎的诊断00:09:07.520 --> 00:09:08.740严重评估00:09:09.600 --> 00:09:11.220严重程度的评估00:09:11.240 --> 00:09:13.980疾病的进展及预后判断等00:09:14.360 --> 00:09:15.860具有重要的意义00:09:27.880 --> 00:09:30.180啊三相似病症区分00:09:30.800 --> 00:09:32.680那咳嗽病因第一个呢00:09:32.680 --> 00:09:34.540是咳嗽病因系列哮喘00:09:35.040 --> 00:09:37.100以刺激性咳嗽为特征00:09:37.240 --> 00:09:41.500灰尘油烟冷空气等容易诱发咳嗽00:09:41.840 --> 00:09:44.940患有家庭或个人过敏疾病史00:09:46.080 --> 00:09:47.900对抗生素治疗无效00:09:48.360 --> 00:09:51.300支气管激发失炎阳性可鉴别00:09:53.360 --> 00:09:56.42013性理系暴性支气管炎00:09:57.080 --> 00:10:00.580x线检查无明显改变或肺纹理的增加00:10:01.400 --> 00:10:03.700支气管是激发事业阴性00:10:04.040 --> 00:10:05.620正常上容易误诊00:10:07.280 --> 00:10:11.500诱导痰检查时酸性乙细胞比例增加00:10:12.160 --> 00:10:13.300可以诊断00:10:14.840 --> 00:10:16.020三肺结核00:10:16.440 --> 00:10:20.420常有发热乏力盗汗及消瘦等症状00:10:21.120 --> 00:10:24.320痰液找抗酸杆菌及胸部x线检查00:10:24.320 --> 00:10:25.120推荐00:10:26.640 --> 00:10:31.660四支气管肺癌多数有数年的吸烟史00:10:32.280 --> 00:10:34.140顽固性会进行咳嗽00:10:34.240 --> 00:10:35.540或过去有00:10:36.240 --> 00:10:38.060咳嗽时长期00:10:38.520 --> 00:10:41.260而近期咳嗽性质的发生改变00:10:41.680 --> 00:10:45.580常有痰中带血有视力表现为反复00:10:45.760 --> 00:10:48.220同一部位的阻塞性肺炎00:10:48.840 --> 00:10:52.020经抗菌药物治疗未能完全消退00:10:53.280 --> 00:10:54.700看脱落细胞时00:10:55.280 --> 00:10:56.560胸部CT及00:10:56.560 --> 00:10:59.460纤维支气管镜等检查可明确诊断00:11:03.280 --> 00:11:07.020对精制纤维化临床经过缓慢00:11:08.720 --> 00:11:11.740开始进入咳嗽咳痰后有气弹00:11:12.360 --> 00:11:13.820仔细听准在00:11:14.720 --> 00:11:16.620呼下后侧00:11:18.000 --> 00:11:19.620课文报眼影00:11:21.960 --> 00:11:22.980学习分析00:11:25.240 --> 00:11:28.500其实动脉血氧混压降低而二氧化碳00:11:29.400 --> 00:11:30.500可不升高00:11:31.720 --> 00:11:33.100六支气管扩张00:11:33.560 --> 00:11:36.500典型者表现为反复大量咳脓痰00:11:37.360 --> 00:11:40.660或反复的卡形x线胸片00:11:41.120 --> 00:11:43.660该片常见被纹理增出00:11:44.240 --> 00:11:46.180卷成卷发轴00:11:46.880 --> 00:11:49.500高波面CT检查有助于诊断00:11:51.000 --> 00:11:54.240其他疾病也可能出现咳嗽咳痰00:11:54.240 --> 00:11:55.780半乳喘息等症状00:11:56.240 --> 00:11:58.560容易闷滞混淆00:11:58.560 --> 00:12:00.580这些疾病有支气管哮喘00:12:01.200 --> 00:12:04.16013型胰细胞型支气管炎肺结核00:12:04.160 --> 00:12:05.180支气管悲哀00:12:06.520 --> 00:12:09.020特发性肺纤维化支气管扩张00:12:09.560 --> 00:12:12.580慢性咽炎上呼吸道咳嗽症状00:12:13.040 --> 00:12:16.060综合症卵屎官胃食管反流00:12:17.080 --> 00:12:18.900某些心血管疾病00:12:19.520 --> 00:12:21.180乳腺间盘狭窄等00:12:21.520 --> 00:12:23.680如果出现上述类似的症状00:12:23.680 --> 00:12:25.960需要及时去医院就诊00:12:25.960 --> 00:12:28.320请医生进行检查和诊断00:12:28.320 --> 00:12:30.260医生主要通过体格检查00:12:30.600 --> 00:12:32.840实验室检查及XCN检查00:12:32.840 --> 00:12:34.980恢复其他疾病作出诊断00:12:40.040 --> 00:12:44.420治疗预防治疗方法急性加重期的治疗00:12:44.760 --> 00:12:48.260主要是应用药物减轻急性症状00:12:48.400 --> 00:12:51.340意识控制感染根据病原00:12:52.520 --> 00:12:53.320菌00:12:53.680 --> 00:12:55.980种类及药物实验结果00:12:56.440 --> 00:12:57.620选择抗菌药物00:12:58.000 --> 00:13:01.020一般可选用氢霉素类卵磷00:13:01.720 --> 00:13:04.820多宝菌素类如投保复兴投保可00:13:05.200 --> 00:13:07.300恶环内酯类如胺二氢霉素00:13:07.480 --> 00:13:09.840或味道酮类如作用沙星等00:13:09.840 --> 00:13:10.640抗生素00:13:11.640 --> 00:13:14.780轻者口服给药重者可静脉滴注00:13:14.960 --> 00:13:16.980二镇咳止痰00:13:17.760 --> 00:13:20.760对于咳嗽咳痰症状明显者00:13:20.760 --> 00:13:22.860可使用镇咳止痰药00:13:24.120 --> 00:13:28.140常用药物如氨溴素乙酰胺胱氨酚等00:13:28.520 --> 00:13:30.460能起使痰液促进00:13:31.240 --> 00:13:33.700痰液的排出三可为主诊00:13:33.800 --> 00:13:36.420可选用药米沙芬等镇咳药物00:13:37.520 --> 00:13:40.340对于老年体弱无力咳痰者00:13:40.360 --> 00:13:43.980或痰量较多久以湿痰为主00:13:44.600 --> 00:13:46.780避免单纯使用镇咳药00:13:47.400 --> 00:13:49.100一免疫00:13:49.960 --> 00:13:54.040以免一直咳嗽反射导致痰也无法咳出00:13:54.040 --> 00:13:55.180发生病情00:13:56.520 --> 00:13:57.460临床治疗00:13:59.120 --> 00:14:00.740有喘息症状者00:14:00.880 --> 00:14:04.820可使用支气管扩张剂缓解喘息症状00:14:05.240 --> 00:14:08.220如沙丁鹌鹑特普塔林等短效00:14:08.320 --> 00:14:10.060beta受体激动剂00:14:10.240 --> 00:14:12.980通过吸入给药能迅速起效00:14:13.320 --> 00:14:15.980也可使用NX剂boy00:14:16.560 --> 00:14:19.020所插件等插件类药物00:14:19.240 --> 00:14:22.460以及乙丙脱硝胺等抗单碱类药物00:14:22.680 --> 00:14:25.100可口服或无化食00:14:29.040 --> 00:14:31.840缓解期的治疗一是戒烟00:14:31.840 --> 00:14:34.640这是治疗和预防慢性支气管炎00:14:34.640 --> 00:14:36.340进展的关键措施00:14:36.360 --> 00:14:39.820戒烟可减少烟草对呼吸道的刺激00:14:40.400 --> 00:14:42.580减缓肺功能下降速度00:14:43.040 --> 00:14:45.300降低急性发作的频率00:14:47.680 --> 00:14:50.580康复治疗包括呼吸功能00:14:51.560 --> 00:14:54.300缩成呼吸腐蚀呼吸等00:14:54.640 --> 00:14:56.480可增强呼吸机力量00:14:56.480 --> 00:14:59.140提高肺功肺通气功能00:15:00.160 --> 00:15:01.420进行寒短00:15:01.960 --> 00:15:03.420冷水洗脸等00:15:03.760 --> 00:15:06.740可提高机体对寒冷的适应能力00:15:06.800 --> 00:15:08.820减少呼吸道感染的发生00:15:10.280 --> 00:15:12.060三长期家庭饮料00:15:12.480 --> 00:15:15.140对于存在慢性呼吸衰竭的患者00:15:15.800 --> 00:15:20.700长期家庭饮料可提高生活质量生存率00:15:21.360 --> 00:15:23.060一般采用鼻道关系00:15:23.520 --> 00:15:25.700养流量1到2升每分钟00:15:26.240 --> 00:15:28.120吸氧时间每天15小时以00:15:28.120 --> 00:15:31.420上四药物维持治疗00:15:32.000 --> 00:15:34.560部分患者可关于使用成效00:15:34.560 --> 00:15:35.780支气管输送剂00:15:36.680 --> 00:15:38.580乌沙梅特罗替帕松00:15:40.760 --> 00:15:41.780布丁奈德00:15:42.760 --> 00:15:45.840福沃特罗等能有效控制症状00:15:45.840 --> 00:15:47.700减少急性发作次数00:15:47.800 --> 00:15:49.340延缓疾病进展00:15:50.120 --> 00:15:52.920对于反复满足呼吸道感染的患者00:15:52.920 --> 00:15:55.860可使用免疫调节剂乳胸腺肽00:15:56.120 --> 00:15:57.820等增强免疫力00:16:00.440 --> 00:16:01.500呃预防00:16:03.000 --> 00:16:05.420呃一个是戒烟限酒00:16:05.520 --> 00:16:09.460吸烟是慢性支气管炎的主要危险因素00:16:09.480 --> 00:16:12.660戒烟能有效降低患病风险00:16:13.000 --> 00:16:16.800多样的饮酒可能影响机体免疫功能00:16:16.800 --> 00:16:18.620间接增加患病几率00:16:19.600 --> 00:16:20.780适度的锻炼00:16:21.120 --> 00:16:23.700选择适合自己的运动方式00:16:23.720 --> 00:16:26.020增强体质提高机体免疫力00:16:26.320 --> 00:16:29.940改善心肺功能有助于预防慢性支气管00:16:31.400 --> 00:16:34.320规律作息保证充足的睡眠00:16:34.320 --> 00:16:37.580良好的睡眠处于身体恢复和00:16:37.760 --> 00:16:40.020免疫系统的正常运转00:16:40.160 --> 00:16:41.580减少患病的可能00:16:41.680 --> 00:16:42.480四00:16:42.840 --> 00:16:44.260避免职业暴露00:16:45.120 --> 00:16:48.320从事接触苯酮化学物质的多的人群00:16:48.320 --> 00:16:50.140要严格遵守水源00:16:50.400 --> 00:16:52.300防护规定00:16:52.320 --> 00:16:54.220减少有害物质的吸入00:16:54.920 --> 00:16:56.460本身居住环境00:16:57.280 --> 00:17:00.540保持室内空气流通并且分层通风00:17:02.560 --> 00:17:04.660六预防呼吸道感染00:17:05.280 --> 00:17:06.400在流感高发季00:17:06.400 --> 00:17:09.060尽量避免前往人员密集场所00:17:09.520 --> 00:17:11.540医药时可接种流感疫苗00:17:11.800 --> 00:17:13.540对人类雏菌疫苗等00:17:14.720 --> 00:17:16.860七控制基础疾病00:17:17.240 --> 00:17:18.480患有支气管哮喘00:17:18.480 --> 00:17:20.420鼻炎等基础疾病的发展00:17:20.440 --> 00:17:22.560人群积极治疗00:17:22.560 --> 00:17:26.280控制病发病情的发展防止厌倦00:17:26.280 --> 00:17:27.080慢00:17:27.320 --> 00:17:28.120性支气管炎00:17:30.600 --> 00:17:33.320注意饮食均衡保持饮食多样化00:17:33.320 --> 00:17:36.840多吃富含维生素优质蛋白质的食物00:17:36.840 --> 00:17:38.700增加机体的免疫