WEBVTT00:00:04.400 --> 00:00:05.200呃00:00:06.080 --> 00:00:08.020今大家呃00:00:08.080 --> 00:00:08.960中午好啊00:00:08.960 --> 00:00:10.600那么非常高兴的话00:00:10.600 --> 00:00:13.240呃今今天跟大家来做一下00:00:13.240 --> 00:00:15.720一个关于慢性阻塞性肺病的00:00:15.720 --> 00:00:17.860一个健康的宣教00:00:18.480 --> 00:00:19.320那么呃00:00:19.320 --> 00:00:22.320我将从以下的六点进行一个展开00:00:22.320 --> 00:00:25.400那么首先就是包括一个疾病的概述00:00:25.400 --> 00:00:27.260还有诊断的方法00:00:27.280 --> 00:00:30.000还有就是对于慢性阻塞性肺病的00:00:30.000 --> 00:00:32.800现在的一个治疗的方案啊00:00:32.800 --> 00:00:34.000以及呃00:00:34.000 --> 00:00:37.260对于慢阻肺的一个日常的一个管理00:00:37.320 --> 00:00:39.680呃以及现在的话啊00:00:39.680 --> 00:00:40.400对于慢阻肺00:00:40.400 --> 00:00:43.600我们要进行一些健康的教育啊00:00:43.600 --> 00:00:46.120和呃对于社会上00:00:46.120 --> 00:00:47.940呃提供的一些00:00:48.000 --> 00:00:50.400对于慢阻肺的一个支持和资源00:00:50.400 --> 00:00:51.540来展开00:00:53.320 --> 00:00:54.200我们首先讲一下00:00:54.200 --> 00:00:56.160一个关于对于慢性阻塞性肺病的00:00:56.160 --> 00:00:57.980一个疾病的一个概述啊00:00:58.040 --> 00:00:59.520那么慢阻肺的一个定义00:00:59.520 --> 00:01:02.180它实际上是一个抑制性的疾病00:01:02.200 --> 00:01:03.580那么呃00:01:04.000 --> 00:01:07.580是气流受限性的一个疾病啊00:01:07.600 --> 00:01:10.440呃主要的病因是一个吸烟00:01:10.440 --> 00:01:12.840以及环境的因素啊00:01:12.840 --> 00:01:16.460因为慢性阻塞性肺病的一个呃00:01:16.520 --> 00:01:17.360抑制性的话00:01:17.360 --> 00:01:20.240他的临床表现也是不相同的00:01:20.240 --> 00:01:23.480有一些就是目前来说研究比较多的00:01:23.480 --> 00:01:26.280可能就是关于一个2型炎症方面的00:01:26.280 --> 00:01:29.180一个慢阻肺的研究比较多啊00:01:29.200 --> 00:01:31.180那么临床的表现的话00:01:31.480 --> 00:01:35.320呃首先就是一个对于呃有慢性咳嗽00:01:35.320 --> 00:01:37.620也就长期的一个反复咳嗽00:01:37.800 --> 00:01:41.180而且多是多为一个晨间的咳嗽00:01:41.480 --> 00:01:44.380明显的那么他还有伴有一个咳痰00:01:44.600 --> 00:01:47.000那么一般为一个白色的粘液00:01:47.000 --> 00:01:49.660或者一个浆液泡沫性痰00:01:50.040 --> 00:01:52.320偶有的带有一些血丝00:01:52.320 --> 00:01:53.080那当然了00:01:53.080 --> 00:01:54.980对于慢性阻塞性肺病00:01:55.000 --> 00:01:56.720存在一个急性感染的00:01:56.720 --> 00:01:57.640这部分患者的话00:01:57.640 --> 00:01:58.760他的痰液性质00:01:58.760 --> 00:02:00.200可能就会转变为00:02:00.200 --> 00:02:03.720成为一个黄黄脓样的痰啊那00:02:03.720 --> 00:02:06.320么除了慢性的咳嗽咳痰之外的话00:02:06.320 --> 00:02:08.080随着肺功能的退步的话00:02:08.080 --> 00:02:09.840慢阻肺的这部分患者00:02:09.840 --> 00:02:12.240可能出现一个呼吸困难的一个00:02:12.240 --> 00:02:15.040也就活动耐力下降的一个临床表现00:02:15.040 --> 00:02:16.040啊啊00:02:16.040 --> 00:02:19.360或随着这个年龄还有肺功能的退化00:02:19.360 --> 00:02:22.120他的一个活动的形就是00:02:22.120 --> 00:02:25.500可能就是走百米就出现一个气喘00:02:25.760 --> 00:02:27.060呼吸困难啊00:02:28.280 --> 00:02:29.240那么目前来说00:02:29.240 --> 00:02:30.200慢阻肺的一个00:02:30.200 --> 00:02:32.080主要的一个影响人群的话00:02:32.080 --> 00:02:34.860还是中老年群体00:02:35.040 --> 00:02:37.960而且尤其的话是一个00:02:37.960 --> 00:02:40.760这部分就是长期有吸烟史00:02:40.760 --> 00:02:43.000或者有职业暴露史的00:02:43.000 --> 00:02:44.380这部分人群00:02:44.840 --> 00:02:48.020更是慢阻肺的一个高发人群啊00:02:48.120 --> 00:02:50.040那么研究呢也发现了00:02:50.040 --> 00:02:51.040那么吸烟的话00:02:51.040 --> 00:02:52.080是慢阻肺病的00:02:52.080 --> 00:02:54.980一个主要的一个风险因素00:02:56.080 --> 00:02:58.080而且长期的吸烟者的话00:02:58.080 --> 00:03:01.020患病的概率的话是显著增加的00:03:01.240 --> 00:03:04.040所以我们在就是筛选这部分患者00:03:04.040 --> 00:03:06.240所以门诊碰到这部分患者的时候00:03:06.240 --> 00:03:08.000有长期的吸烟史00:03:08.000 --> 00:03:10.280或者有一些就是粉尘的接触史00:03:10.280 --> 00:03:12.960这部分患者出现有慢性的咳嗽00:03:12.960 --> 00:03:13.900咳痰的话00:03:14.040 --> 00:03:14.880就要考虑到00:03:14.880 --> 00:03:18.700是否存在有慢阻肺的这个疾病啊00:03:19.560 --> 00:03:22.240那么有考虑到这部分疾病的话00:03:22.240 --> 00:03:25.160我们要进行一些相关的一个检查00:03:25.160 --> 00:03:27.020来进行一个诊断00:03:27.040 --> 00:03:28.360那么对于慢阻肺的话00:03:28.360 --> 00:03:30.240它的诊断方法的话00:03:30.240 --> 00:03:33.100目前就是一些常规的检查项目00:03:33.440 --> 00:03:35.340就是肺功能的检测啊00:03:35.480 --> 00:03:36.880肺功能检测的话00:03:36.880 --> 00:03:39.120评估一个呼吸的流量00:03:39.120 --> 00:03:40.180肺容积00:03:40.560 --> 00:03:44.020判断一个气流受限的一个程度00:03:44.200 --> 00:03:45.240那么同时的话00:03:45.240 --> 00:03:47.600那么对于慢性咳嗽00:03:47.600 --> 00:03:49.360咳痰的这部分患者的话00:03:49.360 --> 00:03:53.020还是要做一些胸部的影像学检查00:03:53.160 --> 00:03:57.120以排除一些其他的肺部的疾病00:03:57.120 --> 00:03:58.440包括肿瘤啊00:03:58.440 --> 00:03:59.700感染等等00:04:02.440 --> 00:04:03.560那么慢就00:04:03.560 --> 00:04:05.560是现在肺功能检测来说的话00:04:05.560 --> 00:04:07.160我们呃推进了00:04:07.160 --> 00:04:10.040因为慢阻肺的一个就是呃00:04:10.040 --> 00:04:12.160下基层的一个项目的话00:04:12.160 --> 00:04:14.080现在的话对于基层医院的话00:04:14.080 --> 00:04:16.660都可以进行一个肺功能的检测00:04:16.959 --> 00:04:18.079肺功能检查的话00:04:18.079 --> 00:04:19.519我们常规测量的是00:04:19.519 --> 00:04:22.340一个FDV温比FVC的值00:04:22.400 --> 00:04:24.760那么它可以评估一个气流的受限00:04:24.760 --> 00:04:25.880那么同时呢00:04:25.880 --> 00:04:27.200测定一个FDV温00:04:27.200 --> 00:04:28.640占预计值的一个比例00:04:28.640 --> 00:04:30.000来分分00:04:30.000 --> 00:04:32.360就是气流受限的一个程度啊00:04:32.360 --> 00:04:33.720那么我们都知道00:04:33.720 --> 00:04:35.400慢性阻塞性肺病的00:04:35.400 --> 00:04:36.840一个诊断的金标准00:04:36.840 --> 00:04:38.880还是通过肺功能检测00:04:38.880 --> 00:04:39.840那么同时00:04:39.840 --> 00:04:42.280它的肺功能检测是有个前提00:04:42.280 --> 00:04:45.820就是在吸入支气管舒张剂之后00:04:46.600 --> 00:04:48.560做测的一个肺功能的检测00:04:48.560 --> 00:04:50.440那么他如果呃00:04:50.440 --> 00:04:52.160使用支气管舒张剂以后00:04:52.160 --> 00:04:56.240他的Fe根比FVC小于70%00:04:56.240 --> 00:04:58.440那么我们就可以明确诊断00:04:58.440 --> 00:04:59.080这个患者00:04:59.080 --> 00:05:02.120是存在有一个慢性阻塞性肺病的00:05:02.120 --> 00:05:04.800啊那么呃同时呢00:05:04.800 --> 00:05:06.640对于支气管舒张实验的话00:05:06.640 --> 00:05:08.840现在也是我们可以呃00:05:08.840 --> 00:05:10.960除了诊断慢阻肺00:05:10.960 --> 00:05:12.760我们还可以来诊断一些00:05:12.760 --> 00:05:14.480鉴别一些支气管哮喘等等00:05:14.480 --> 00:05:18.000那么评估一个气道的一个敏感性00:05:18.000 --> 00:05:20.060来进行一个辅助的诊断00:05:21.080 --> 00:05:23.060呃影像学的检查的话00:05:23.120 --> 00:05:24.200现现在来说00:05:24.200 --> 00:05:27.980可能就是包括胸部的x线检查00:05:28.000 --> 00:05:29.460和CT的扫描00:05:29.640 --> 00:05:31.320那么胸部的x检查的话00:05:31.320 --> 00:05:33.900可以显示一个肺部的一个异常00:05:34.000 --> 00:05:35.680比如说有肺炎啊00:05:35.680 --> 00:05:37.060肺栓塞等等00:05:37.080 --> 00:05:38.200那么CT的扫描00:05:38.200 --> 00:05:41.080目前是就是基本上已经普及了00:05:41.080 --> 00:05:43.700我们建议的话还是40岁以上的00:05:43.720 --> 00:05:44.640有吸烟的患者00:05:44.640 --> 00:05:47.920还是每年要做一些CT的扫描啊00:05:47.920 --> 00:05:51.280那么它可以提供详细的一个呃肺00:05:51.280 --> 00:05:52.840部结构的信息00:05:52.840 --> 00:05:56.800诊断是否患者是否存在一个肺大疱00:05:56.800 --> 00:05:58.540肺纤维化等病变00:06:00.520 --> 00:06:02.520那么针对慢性阻塞性肺病的00:06:02.520 --> 00:06:04.000一个治疗方案来说00:06:04.000 --> 00:06:04.960那么呃00:06:04.960 --> 00:06:08.320实际上有药物治疗和非药物治疗00:06:08.320 --> 00:06:10.600那么药物治疗来说的话00:06:10.600 --> 00:06:12.840现在就是购的指南的话00:06:12.840 --> 00:06:15.380每年都有相应的更新00:06:15.400 --> 00:06:18.020那么选择的药物也各不相同啊00:06:18.240 --> 00:06:20.560那么最近的2025年购的指南的话00:06:20.560 --> 00:06:22.120我们现在第一线的治疗00:06:22.120 --> 00:06:23.080还是00:06:23.080 --> 00:06:26.160对于一个支气管舒张剂的一个使用00:06:26.160 --> 00:06:28.480啊那么常用的支气管舒张剂00:06:28.480 --> 00:06:31.280就分为一个Beta受体的一个激动剂00:06:31.280 --> 00:06:33.620和抗胆碱能的一个药物00:06:33.720 --> 00:06:36.300它可以缓解呼吸困难00:06:36.680 --> 00:06:39.200那么包括还有一个糖皮质激素00:06:39.200 --> 00:06:40.400那么糖皮质激素的话00:06:40.400 --> 00:06:44.020我们还是推荐以西路型为主啊00:06:44.160 --> 00:06:46.400它可以适用于中重度患者00:06:46.400 --> 00:06:47.800减少急性加重00:06:47.800 --> 00:06:50.040那么而且的话吸入型的话00:06:50.040 --> 00:06:51.400它可以减少00:06:51.400 --> 00:06:55.040就是全身就包括口服和静脉使用00:06:55.040 --> 00:06:58.320糖皮质激素引起的一些副作用00:06:58.320 --> 00:07:00.160包括有激发的感染00:07:00.160 --> 00:07:01.760还有就骨质疏松00:07:01.760 --> 00:07:02.600糖尿类固醇00:07:02.600 --> 00:07:04.340糖尿病等等啊00:07:05.040 --> 00:07:07.760现在的话呃支气管舒张剂的话00:07:07.760 --> 00:07:10.480我们有专门的有闭合的三联00:07:10.480 --> 00:07:13.200它含有就是贝塔受体激动剂00:07:13.200 --> 00:07:15.120抗胆碱能药和ICS00:07:15.120 --> 00:07:16.840也就吸入糖皮肌激素00:07:16.840 --> 00:07:18.780三合一的这个选择00:07:18.840 --> 00:07:22.160那么还有就是双支扩的双吃扩剂00:07:22.160 --> 00:07:22.800也就是说00:07:22.800 --> 00:07:25.720Beta受体激动剂和抗胆碱能药物00:07:25.720 --> 00:07:28.040就是双联的一个支气管舒张剂00:07:28.040 --> 00:07:30.640那么包括还有以前的就是啊00:07:30.640 --> 00:07:33.060糖皮质激素和Beta受体激动剂00:07:33.120 --> 00:07:34.880呃联合的呃ICS00:07:34.880 --> 00:07:38.300加拉巴的一个呃制剂型等等00:07:38.840 --> 00:07:39.960那么可以根据00:07:39.960 --> 00:07:43.280患者的一个肺功能的一个情况00:07:43.280 --> 00:07:44.080以及患者00:07:44.080 --> 00:07:45.120的一个呃00:07:45.120 --> 00:07:48.280每年的一个急性加重的一个次数00:07:48.280 --> 00:07:50.120来选择呃00:07:50.120 --> 00:07:53.700对应的选择是这个支气管舒张剂00:07:54.480 --> 00:07:56.400嗯这是非常重要点00:07:56.400 --> 00:07:57.600我们推荐的话00:07:57.600 --> 00:07:59.680只要确诊慢性阻塞性肺病的00:07:59.680 --> 00:08:00.360这部分患者00:08:00.360 --> 00:08:04.160我们还是推荐呃支气管舒张00:08:04.160 --> 00:08:05.040而且的话00:08:05.040 --> 00:08:07.760就像慢阻肺也是一个慢性疾病嘛00:08:07.760 --> 00:08:09.960就像高血压糖尿病一样00:08:09.960 --> 00:08:12.860也是建议他患者要长期的使用00:08:12.960 --> 00:08:15.580而且定期的要随访肺功能检测00:08:16.280 --> 00:08:17.200那么第二个的话00:08:17.200 --> 00:08:19.660就是一个非药物的治疗啊00:08:19.680 --> 00:08:21.240那么非药物的治疗的话00:08:21.240 --> 00:08:24.000我们针对的就是有没有缺氧啊00:08:24.000 --> 00:08:25.040这部分患者啊00:08:25.040 --> 00:08:27.120那么有呼吸衰竭00:08:27.120 --> 00:08:29.960那么呃养饱厚度在90以下的00:08:29.960 --> 00:08:32.080或者有二氧化碳储留的这部分患者00:08:32.080 --> 00:08:35.420我们还是推荐要长期的家庭养疗00:08:35.440 --> 00:08:37.580它可以改善生活质量00:08:38.320 --> 00:08:39.280那么同时的话00:08:39.280 --> 00:08:40.080还有一部分00:08:40.080 --> 00:08:42.160就是一个康肺康复的治疗00:08:42.160 --> 00:08:45.320那么它可以进行一个呼吸训练00:08:45.320 --> 00:08:47.100与肌肉的训练啊00:08:48.360 --> 00:08:49.600康复的训练的话00:08:49.600 --> 00:08:51.180我们呃00:08:51.200 --> 00:08:53.960通过就是专门的一个康复训练师00:08:53.960 --> 00:08:54.640来进行00:08:54.640 --> 00:08:57.520对患者进行一些呃呼吸训练00:08:57.520 --> 00:09:00.040包括一个腹式呼吸00:09:00.040 --> 00:09:01.920多重呼吸的锻炼啊00:09:01.920 --> 00:09:05.340可以增强患者的一个呼吸肌的力量00:09:05.480 --> 00:09:07.400那么还有一些可以借助一些00:09:07.400 --> 00:09:08.200就是散步00:09:08.200 --> 00:09:09.000瑜伽等等00:09:09.000 --> 00:09:10.560甚至的话我们现在的话00:09:10.560 --> 00:09:12.620康复科提供有器械00:09:12.640 --> 00:09:13.960可以增强一些00:09:13.960 --> 00:09:16.720就是孕呃患者的一个体质00:09:16.720 --> 00:09:19.260以改善患者的一个肺功能00:09:21.400 --> 00:09:23.880那么对于呃慢阻肺的话00:09:23.880 --> 00:09:26.720只因为他是一个慢慢性的疾病啊00:09:26.720 --> 00:09:27.900那么呃00:09:28.080 --> 00:09:30.860日常的管理也是非常重要的啊00:09:30.920 --> 00:09:34.700那么强调一个生活方式的调整00:09:35.560 --> 00:09:38.420最主要的就是一个戒烟限酒啊00:09:38.440 --> 00:09:40.800那么戒烟并且限制酒精00:09:40.800 --> 00:09:41.520的摄入呢00:09:41.520 --> 00:09:44.500可以减少一个呼吸道的刺激00:09:44.720 --> 00:09:47.840而且吸烟的话对于肺功能的恶化00:09:47.840 --> 00:09:49.920还有就是急性的加重00:09:49.920 --> 00:09:50.960对慢阻肺00:09:50.960 --> 00:09:53.860可以影响患者的一个急性加重啊00:09:54.080 --> 00:09:55.680同时呢我们建议患者00:09:55.680 --> 00:09:57.780要进行一个健康的饮食00:09:58.040 --> 00:09:59.920均衡的饮食啊00:09:59.920 --> 00:10:01.540多吃蔬菜00:10:01.680 --> 00:10:03.680少吃油腻的一个食物00:10:03.680 --> 00:10:06.860那么来维持一个健康的一个体重00:10:08.400 --> 00:10:09.920对于有呃00:10:09.920 --> 00:10:12.080就是有一些呃患者00:10:12.080 --> 00:10:14.800就是有一个职业的接触暴露史的00:10:14.800 --> 00:10:15.440这部患者00:10:15.440 --> 00:10:18.200我们还是要建议做一些00:10:18.200 --> 00:10:20.820环境与职业的一个防护啊00:10:21.040 --> 00:10:24.100首先就是要避免接触有害的环境00:10:24.560 --> 00:10:27.180呃远离烟草烟雾00:10:27.240 --> 00:10:29.900空气污染等有害的环境00:10:29.960 --> 00:10:32.940同时呢要保持室内的空气清新00:10:33.040 --> 00:10:37.180那么对于有从事高风险的职业时00:10:37.240 --> 00:10:41.220呃需要佩戴一些防护的装备00:10:41.800 --> 00:10:43.720呃像现在来说我们的N9500:10:43.720 --> 00:10:44.840口罩等等00:10:44.840 --> 00:10:46.360呃都是有需要的啊00:10:46.360 --> 00:10:46.600那么00:10:46.600 --> 00:10:50.020它可以减少有害物质的一个吸入00:10:50.440 --> 00:10:52.560那么当然慢性阻塞性肺病的话00:10:52.560 --> 00:10:53.560稳定期的治疗00:10:53.560 --> 00:10:56.500那么还有一些就是针对于急性发作00:10:56.720 --> 00:10:58.600那么对于慢性阻塞性肺病00:10:58.600 --> 00:10:59.440急性发作00:10:59.440 --> 00:11:02.160实际上80%都是由感染引起的00:11:02.160 --> 00:11:05.440那么在家里出现一个急性加重00:11:05.440 --> 00:11:06.600咳痰加重的时候00:11:06.600 --> 00:11:09.120我们首先是要给他做好00:11:09.120 --> 00:11:12.400一个呼吸道通畅的一个作作用啊00:11:12.400 --> 00:11:16.040那么鼓励他患者一个咳痰啊啊00:11:16.040 --> 00:11:17.560辅助拍背排痰00:11:17.560 --> 00:11:18.720那么同时呢00:11:18.720 --> 00:11:20.440如果有低氧的时候呢00:11:20.440 --> 00:11:24.040要给他进行一个吸氧的一个治疗00:11:24.040 --> 00:11:24.840呃00:11:25.400 --> 00:11:27.120呃患者气急明显的时候00:11:27.120 --> 00:11:28.400我们可以使用一些00:11:28.400 --> 00:11:31.020就是速效的支气管舒张剂00:11:31.400 --> 00:11:34.080也就是说呃可以用一些短效的00:11:34.080 --> 00:11:36.480速效的一个贝塔受体的激动剂00:11:36.480 --> 00:11:37.940包括万托林啊00:11:37.960 --> 00:11:39.620沙丁胺醇等等啊00:11:39.640 --> 00:11:40.120那么00:11:40.120 --> 00:11:40.360呃00:11:40.360 --> 00:11:42.840我们同时使用药物之后呢00:11:42.840 --> 00:11:45.820要紧急的联系120救助00:11:45.880 --> 00:11:47.400那么使患者的话00:11:47.400 --> 00:11:48.040呃00:11:48.040 --> 00:11:51.580及早的就是选择有针对性的治疗00:11:53.080 --> 00:11:55.280那么对于慢阻肺的患者的话00:11:55.280 --> 00:11:58.140还要做一些就是健康宣教00:11:58.480 --> 00:12:02.500那么疾病的知识要对于患者来做00:12:02.840 --> 00:12:04.280对于慢性阻塞性肺病00:12:04.280 --> 00:12:06.620要进行一些知识的一个普及00:12:06.920 --> 00:12:08.960首先要介绍一些他患者的一个00:12:08.960 --> 00:12:10.680这个疾病的一个主要的病因00:12:10.680 --> 00:12:13.320那么他的主要病因前面一再的强调00:12:13.320 --> 00:12:15.240也就是吸烟啊00:12:15.240 --> 00:12:16.280空气污染等等00:12:16.280 --> 00:12:19.200所以对于呃有吸烟的这部分患者00:12:19.200 --> 00:12:20.600我们还是要呃00:12:20.600 --> 00:12:22.220要强调他要戒烟00:12:22.480 --> 00:12:23.120那么同时呢00:12:23.120 --> 00:12:24.000还要就是00:12:24.000 --> 00:12:26.320对于慢阻肺的一个典型的症状00:12:26.320 --> 00:12:30.040也要跟患者来解释清楚呢00:12:30.040 --> 00:12:32.760比如说如果出现一些慢性的咳嗽00:12:32.760 --> 00:12:33.960咳痰啊00:12:33.960 --> 00:12:35.440出现呼吸困难等等00:12:35.440 --> 00:12:37.400那么有可能呃00:12:37.400 --> 00:12:39.120就是不是就是有慢阻肺00:12:39.120 --> 00:12:41.920那么可以进相到相对应的科室00:12:41.920 --> 00:12:44.160就呼吸内科来做一些检查00:12:44.160 --> 00:12:45.540治疗等等啊00:12:46.520 --> 00:12:49.120嗯还有就是患者的话00:12:49.120 --> 00:12:51.120要做一些一个自我的00:12:51.120 --> 00:12:54.340要具备自我监测的一个技能00:12:54.480 --> 00:12:56.800那么他可以要平速的话00:12:56.800 --> 00:13:01.340是要学会监测呼吸的一个频率00:13:01.360 --> 00:13:05.100了解正常与异常的一个范围00:13:05.440 --> 00:13:06.160而且的话00:13:06.160 --> 00:13:07.440平常可以做一些00:13:07.440 --> 00:13:09.620就是症状的一个记录啊00:13:09.680 --> 00:13:12.440那么我们可以看看患者的一个咳嗽00:13:12.440 --> 00:13:14.860咳痰的一个症状有没有变化00:13:15.000 --> 00:13:16.420如果有脓痰00:13:16.800 --> 00:13:18.000咳嗽频率增加00:13:18.000 --> 00:13:20.560那么及时患者是否有存在有感染00:13:20.560 --> 00:13:22.480可能有急性加重的风险00:13:22.480 --> 00:13:23.360那么这个时候呢00:13:23.360 --> 00:13:27.180我们要及时的一个调整治疗方案啊00:13:29.400 --> 00:13:31.600那么预防的措施的指导的话00:13:31.600 --> 00:13:35.140就是还是强调一个戒烟限酒00:13:35.160 --> 00:13:37.720那么对于慢阻肺的患者的00:13:37.720 --> 00:13:39.620话我们强调就是戒烟00:13:39.640 --> 00:13:41.300无论什么时候都不晚00:13:41.400 --> 00:13:44.380而且的话也要限制酒精的摄入00:13:44.800 --> 00:13:46.860这是对慢阻肺来说00:13:47.080 --> 00:13:49.560可以改善患者的一个肺功能00:13:49.560 --> 00:13:52.100减少患者的一个急性加重00:13:52.400 --> 00:13:54.820还有就是要改善的环境啊00:13:54.840 --> 00:13:56.520因为慢阻肺的患者的话00:13:56.520 --> 00:13:58.480他对于空气的一个要求00:13:58.480 --> 00:13:59.280还是比较高的00:13:59.280 --> 00:14:00.480那么提倡的00:14:00.480 --> 00:14:03.240保持一个室内的空气清新00:14:03.240 --> 00:14:05.940避免吸入有害气体和颗粒00:14:07.880 --> 00:14:08.440同时的话00:14:08.440 --> 00:14:10.840我们还要对于慢阻肺患者的话00:14:10.840 --> 00:14:13.520我们还是要寻求一些社会的支持00:14:13.520 --> 00:14:15.580和一些资源的保护啊00:14:15.680 --> 00:14:17.840那么社会的支持服务的话00:14:17.840 --> 00:14:18.520现在来说00:14:18.520 --> 00:14:21.500我们可以进行一些健康的讲座00:14:22.320 --> 00:14:24.360可以定期在社区举办00:14:24.360 --> 00:14:26.380慢阻肺的健康讲座00:14:26.480 --> 00:14:28.360提高居民的疾病认知00:14:28.360 --> 00:14:30.500和自我管理的一个能力00:14:30.920 --> 00:14:32.520而且的话呃00:14:32.520 --> 00:14:34.160从事健康讲座之外00:14:34.160 --> 00:14:37.220我们还可以做一些康复的一个指导00:14:37.320 --> 00:14:38.360提供慢阻肺00:14:38.360 --> 00:14:40.640患者的一个康复训练的指导00:14:40.640 --> 00:14:42.940包括一个呼吸操00:14:43.160 --> 00:14:44.960运动的建议等等00:14:44.960 --> 00:14:48.260可以提供一个他的一个运动的耐力00:14:49.040 --> 00:14:51.260促进患者的一个康复啊00:14:51.360 --> 00:14:52.840那么现在来说的话00:14:52.840 --> 00:14:55.860因为互联网的一个发达嘛00:14:56.040 --> 00:14:57.800我们也可以通过一个00:14:57.800 --> 00:14:59.720在线的健康资源00:14:59.720 --> 00:15:02.640来给患者做一些补给啊00:15:02.640 --> 00:15:05.400那么可以有通过一个专业的网站00:15:05.400 --> 00:15:06.840那么可以给患者00:15:06.840 --> 00:15:09.640提供一个权威的医学网站00:15:09.640 --> 00:15:11.640那么来提供啊00:15:11.640 --> 00:15:13.440慢阻肺的一个疾病知识00:15:13.440 --> 00:15:16.180和自我管理的一个技巧00:15:16.400 --> 00:15:18.680而且的话也可以鼓励患者呢00:15:18.680 --> 00:15:21.760加入一些患者的一个交流论坛啊00:15:21.760 --> 00:15:23.600不管是微信还是电脑上面00:15:23.600 --> 00:15:25.280我们都可呃都可以00:15:25.280 --> 00:15:27.540论坛上面都可以分享经验00:15:27.600 --> 00:15:30.740来获取一个情感的一个支持00:15:30.760 --> 00:15:32.400呃增强一个抗00:15:32.400 --> 00:15:33.860病的一个信心00:15:35.360 --> 00:15:37.440那么我们平常的话00:15:37.440 --> 00:15:39.320在临床工作上面的话00:15:39.320 --> 00:15:42.520也可能就是帮助患者来呃做一些00:15:42.520 --> 00:15:43.880就是首先就是一些00:15:43.880 --> 00:15:45.560慢阻肺的一个健康宣教吧00:15:45.560 --> 00:15:49.640介绍一个慢阻肺的一个呃治疗啊00:15:49.640 --> 00:15:50.680还有诊断00:15:50.680 --> 00:15:52.440那么还有呢就是可以呃00:15:52.440 --> 00:15:54.800我们可以给患者来介绍一个00:15:54.800 --> 00:15:56.720互助组织啊00:15:56.720 --> 00:15:57.080啊00:15:57.080 --> 00:15:59.040然后使得患者呢00:15:59.040 --> 00:16:01.360可以通过呃这个组织00:16:01.360 --> 00:16:03.800来分享一个治疗的一个经验00:16:03.800 --> 00:16:05.240和康复的经验00:16:05.240 --> 00:16:08.640来提供一个呃心理的一个支持00:16:08.640 --> 00:16:09.880那么以上的话00:16:09.880 --> 00:16:13.780就是跟大家分享的一个呃00:16:13.920 --> 00:16:15.920就是宣教吧00:16:15.920 --> 00:16:16.720啊谢谢