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--> 00:03.806\n大家好，\n\n00:04.105 --> 00:04.506\n嗯。\n\n00:05.731 --> 00:05.932\n嗯。\n\n00:08.998 --> 00:12.098\n接下来由我那个带来这个肺脓肿的一个。\n\n00:12.958 --> 00:13.458\n课件。\n\n00:17.665 --> 00:18.114\n接下来，\n\n00:18.114 --> 00:20.165\n我将通过这个概念，\n\n00:20.364 --> 00:22.014\n病因和发病机制，\n\n00:22.315 --> 00:22.715\n嗯，\n\n00:22.764 --> 00:31.940\n临床表现、实验室和其他检查诊断标准和这个鉴别诊断治疗还有治疗啊，\n\n00:31.940 --> 00:33.814\n进行一个简单的介绍。\n\n00:34.756 --> 00:35.756\n首先是概念，\n\n00:36.305 --> 00:36.655\n嗯，\n\n00:36.655 --> 00:42.605\n肺脓肿是一种由多种病原体引起的肺组织化脓性病变，\n\n00:42.956 --> 00:45.780\n早期为肺组织化脓性感染，\n\n00:45.780 --> 00:46.456\n继而。\n\n00:47.765 --> 00:49.215\n坏死液化啊，\n\n00:49.215 --> 00:50.215\n脓肿形成。\n\n00:53.319 --> 00:53.444\n嗯，\n\n00:53.444 --> 00:55.368\n病因和发病机制啊，\n\n00:55.368 --> 00:56.618\n主要是三个啊，\n\n00:56.618 --> 00:59.168\n第一是这个吸入性的肺脓肿，\n\n00:59.469 --> 01:01.319\n第二是血源性肺脓肿，\n\n01:01.469 --> 01:03.469\n第三是继发性肺脓肿。\n\n01:05.245 --> 01:06.694\n吸入性肺脓肿呢，\n\n01:06.894 --> 01:07.294\n嗯，\n\n01:07.294 --> 01:08.769\n发病机制啊，\n\n01:08.769 --> 01:13.245\n主要是口咽鼻腔寄居菌啊，\n\n01:13.245 --> 01:14.919\n经口咽吸入啊，\n\n01:14.919 --> 01:16.620\n扁桃体炎啊，\n\n01:16.620 --> 01:17.544\n鼻窦炎。\n\n01:18.294 --> 01:18.569\n嗯，\n\n01:18.569 --> 01:21.444\n齿槽易脓的脓性分泌物，\n\n01:21.745 --> 01:27.095\n口眼鼻咽部手术后的血块啊，\n\n01:27.095 --> 01:28.470\n齿垢，\n\n01:28.470 --> 01:32.995\n还有这个呕吐物的误吸的原因是包括这个。\n\n01:33.917 --> 01:34.093\n嗯，\n\n01:34.093 --> 01:35.767\n全身麻醉啊，\n\n01:35.818 --> 01:37.267\n脑血管意外，\n\n01:37.267 --> 01:37.917\n然后。\n\n01:38.972 --> 01:42.172\n醉酒、昏迷、癫痫发作等。\n\n01:43.212 --> 01:44.763\n然后受寒。\n\n01:46.809 --> 01:51.809\n极度疲劳引起全身气道局部防御功能下降啊，\n\n01:51.809 --> 01:55.760\n还有这个咳嗽的一个这个反射啊。\n\n02:01.386 --> 02:03.685\n和吞咽和吞咽的障碍，\n\n02:03.886 --> 02:04.236\n嗯，\n\n02:04.236 --> 02:07.060\n特点是这个单发性多见。\n\n02:07.060 --> 02:12.886\n然后部位是与体位和这个支气管解剖有关。\n\n02:15.550 --> 02:15.899\n然后，\n\n02:16.100 --> 02:18.550\n第二是血源性的一个肺脓肿。\n\n02:18.550 --> 02:20.300\n然后发病机制呢，\n\n02:20.750 --> 02:21.149\n嗯，\n\n02:21.149 --> 02:24.899\n第一是是这个肺外感染病灶，\n\n02:24.949 --> 02:27.050\n然后皮肤创伤感染，\n\n02:27.550 --> 02:27.949\n嗯，\n\n02:28.050 --> 02:29.300\n结痈啊，\n\n02:29.350 --> 02:30.350\n骨髓炎，\n\n02:30.699 --> 02:32.600\n静脉毒瘾者，\n\n02:32.600 --> 02:34.925\n右心心内膜炎，\n\n02:34.925 --> 02:38.100\n腹腔盆腔膜器官感染。\n\n02:39.445 --> 02:40.695\n治一个菌血症，\n\n02:40.695 --> 02:44.296\n细菌、脓毒、栓子栓塞肺小血管。\n\n02:45.380 --> 02:49.529\n最后引起的一个肺脓肿特点是多发啊，\n\n02:49.630 --> 02:53.505\n部位是好发于两肺边缘部啊，\n\n02:53.505 --> 02:55.455\n致病菌是啊，\n\n02:55.455 --> 02:57.979\n致病菌多为金黄色葡萄球菌啊，\n\n02:58.029 --> 02:59.179\n有明显的。\n\n03:00.417 --> 03:01.867\n脓毒败血症表现。\n\n03:05.630 --> 03:07.354\n继发性的肺脓肿啊，\n\n03:07.354 --> 03:08.854\n继发性肺脓肿啊，\n\n03:08.854 --> 03:11.479\n继发于其他这个肺部疾病，\n\n03:11.830 --> 03:12.205\n嗯，\n\n03:12.205 --> 03:13.304\n细菌性肺炎，\n\n03:13.304 --> 03:14.654\n支气管扩张啊，\n\n03:14.654 --> 03:15.630\n肺囊肿，\n\n03:15.729 --> 03:17.580\n支气管肺癌，\n\n03:17.729 --> 03:19.380\n肺结核空洞等。\n\n03:19.830 --> 03:20.229\n嗯，\n\n03:20.279 --> 03:22.979\n肺邻近器官的化脓性病变，\n\n03:23.279 --> 03:24.130\n肝脓肿，\n\n03:24.130 --> 03:25.380\n膈下脓肿，\n\n03:25.580 --> 03:26.955\n然后肾周脓肿，\n\n03:26.955 --> 03:28.429\n脊柱旁脓肿。\n\n03:29.132 --> 03:29.382\n嗯，\n\n03:29.481 --> 03:34.807\n食管穿孔等也可以直接蔓延或穿破啊，\n\n03:34.807 --> 03:38.832\n使这个肺致这个肺形成这个脓肿。\n\n03:39.231 --> 03:39.606\n嗯，\n\n03:39.606 --> 03:44.031\n支气管异物构成的这个管腔阻塞，\n\n03:44.031 --> 03:46.481\n其远端也会形成一个脓肿。\n\n03:48.507 --> 03:49.257\n症状方面，\n\n03:49.608 --> 03:50.007\n嗯。\n\n03:51.483 --> 03:53.582\n第一是这个急性起病啊，\n\n03:53.582 --> 03:56.832\n全身中毒症状有胃寒、高热，\n\n03:56.832 --> 03:59.082\n体温是在39.40°，\n\n03:59.533 --> 03:59.932\n嗯，\n\n04:00.033 --> 04:01.307\n乏力纳差等，\n\n04:01.307 --> 04:03.332\n咳嗽咳咳痰，\n\n04:03.733 --> 04:08.182\n胸痛累积这个胸膜和这个，\n\n04:08.682 --> 04:11.358\n累积胸膜会出现一些胸痛症状的，\n\n04:11.358 --> 04:12.483\n还有咯血等。\n\n04:12.783 --> 04:13.557\n嗯，\n\n04:13.557 --> 04:14.332\n10.14天后，\n\n04:14.332 --> 04:16.458\n脓腔与支气管相通，\n\n04:16.458 --> 04:20.183\n大量脓臭痰及坏死。\n\n04:21.088 --> 04:23.289\n组织咳出啊，\n\n04:23.289 --> 04:23.713\n300.500ml,\n\n04:23.713 --> 04:25.264\n每日分成啊，\n\n04:25.264 --> 04:26.389\n症状就减轻。\n\n04:26.389 --> 04:28.639\n第二是这个慢性肺脓肿，\n\n04:28.938 --> 04:29.264\n嗯，\n\n04:29.264 --> 04:31.164\n慢性呼吸道感染症状，\n\n04:31.164 --> 04:33.563\n慢性消耗病态，\n\n04:33.563 --> 04:34.989\n是贫血，\n\n04:34.989 --> 04:36.789\n还有这个消瘦。\n\n04:37.139 --> 04:37.463\n嗯，\n\n04:37.463 --> 04:39.489\n血源性肺脓肿早期的话，\n\n04:39.489 --> 04:41.789\n是全身脓毒血症表现，\n\n04:42.239 --> 04:46.688\n后期是经数日至两周才出现肺部症状。\n\n04:47.703 --> 04:48.303\n且较轻。\n\n04:51.510 --> 04:51.760\n嗯。\n\n04:54.001 --> 04:54.175\n嗯，\n\n04:54.175 --> 04:56.300\n体征，\n\n04:56.550 --> 05:01.050\n与肺脓肿大小这个部位相关啊，\n\n05:01.351 --> 05:04.726\n后浊或实音湿罗音，\n\n05:04.726 --> 05:07.925\n胸膜摩擦音累及胸，\n\n05:07.925 --> 05:10.501\n累及胸膜空问音啊。\n\n05:10.501 --> 05:14.950\n慢性肺脓肿患者这个胸廓略塌陷，\n\n05:14.950 --> 05:16.550\n叩是浊音，\n\n05:16.950 --> 05:18.300\n呼吸音减低，\n\n05:18.351 --> 05:19.751\n可有杵状指。\n\n05:19.950 --> 05:23.001\n血源性肺脓肿多无阳性体征。\n\n05:26.377 --> 05:26.601\n然后，\n\n05:26.601 --> 05:27.951\n实验室检查的话，\n\n05:27.951 --> 05:29.351\n是，\n\n05:29.351 --> 05:31.326\n白细胞总数是增高的，\n\n05:31.326 --> 05:34.076\n然后中性粒细胞是大于90%。\n\n05:34.476 --> 05:34.851\n嗯，\n\n05:34.851 --> 05:35.601\n核左移，\n\n05:35.601 --> 05:38.777\n半中毒颗粒慢性肺脓肿，\n\n05:38.777 --> 05:41.127\n白细胞可无明显改变，\n\n05:41.127 --> 05:42.877\n可轻度贫血。\n\n05:43.326 --> 05:46.826\n细菌学是图片培养和药物。\n\n05:48.339 --> 05:49.489\n流质后分层，\n\n05:49.489 --> 05:51.540\n上层是泡沫样痰，\n\n05:51.589 --> 05:54.015\n中层是粘液样成分，\n\n05:54.015 --> 05:55.239\n下层是坏死。\n\n05:58.851 --> 06:01.451\n影像学我们可以看到这个，\n\n06:01.451 --> 06:03.101\n吸入性的肺脓肿，\n\n06:03.502 --> 06:08.502\n然后和这个早期的这个化脓性炎症阶段。\n\n06:09.861 --> 06:09.986\n嗯，\n\n06:09.986 --> 06:12.812\nX线真相为大片浓密。\n\n06:14.250 --> 06:14.375\n度。\n\n06:14.375 --> 06:18.799\n这个模糊炎性浸润阴影边缘不清，\n\n06:18.799 --> 06:21.700\n分布在一个或数个肺段。\n\n06:26.907 --> 06:27.032\n嗯，\n\n06:27.032 --> 06:29.808\n第二是这个肺脓肿后，\n\n06:30.257 --> 06:31.657\n肺脓肿形成后，\n\n06:32.208 --> 06:39.983\n大片浓密炎性阴影中出现圆形透亮区及液平面消散。\n\n06:39.983 --> 06:43.657\n其脓肿周围炎症渐吸收，\n\n06:43.757 --> 06:45.782\n脓腔缩小而消失，\n\n06:45.782 --> 06:49.358\n最后残留少许纤维条索引。\n\n06:51.582 --> 06:52.532\n然后影像。\n\n06:53.425 --> 06:53.776\n然后，\n\n06:53.776 --> 06:56.675\n这个第二是这个慢性肺脓肿，\n\n06:57.026 --> 06:58.726\n我们可以看到，\n\n06:58.825 --> 07:00.575\n腔壁增厚，\n\n07:01.075 --> 07:02.751\n内壁不规则，\n\n07:02.751 --> 07:06.550\n周围炎症略消略消散。\n\n07:06.550 --> 07:10.825\n然后伴纤维组织显著增生啊，\n\n07:10.825 --> 07:14.626\n还有这个伴有不同程度的肺叶收缩，\n\n07:14.675 --> 07:16.925\n胸膜增厚。\n\n07:18.334 --> 07:18.884\n健肺，\n\n07:18.884 --> 07:20.634\n代偿性的肺气肿。\n\n07:23.220 --> 07:24.970\n那我们看看CT的一个表现啊，\n\n07:25.619 --> 07:27.320\n这个就是，\n\n07:27.320 --> 07:29.670\n一个典型的一个肺窗，\n\n07:29.670 --> 07:31.320\n我们可以看到是一个空洞，\n\n07:31.320 --> 07:33.119\n然后还可以看到一些液瓶。\n\n07:34.070 --> 07:36.570\n然后是纵隔窗。\n\n07:36.570 --> 07:39.545\n我们可以看到这个在这个洞的周围，\n\n07:39.545 --> 07:41.845\n其实它是有一个低密度影，\n\n07:41.845 --> 07:44.670\n其实是就是它这个液化坏死啊，\n\n07:44.670 --> 07:46.420\n就是肺脓肿的一个坏死组织。\n\n07:47.795 --> 07:48.045\n嗯。\n\n07:49.187 --> 07:49.286\n嗯，\n\n07:49.286 --> 07:50.886\n纤维支气管镜啊，\n\n07:50.886 --> 07:53.736\n有无支气管管腔阻塞啊，\n\n07:53.736 --> 07:57.536\n防污染采样寻找病原学依据，\n\n07:57.986 --> 07:59.286\n必要时啊，\n\n07:59.286 --> 08:02.511\n病变部位注射药物进行治疗，\n\n08:02.511 --> 08:05.036\n取活检鉴别肿瘤性疾病。\n\n08:07.649 --> 08:08.950\n诊断啊，\n\n08:08.950 --> 08:09.950\n诱因啊，\n\n08:09.950 --> 08:11.950\n口腔手术啊，\n\n08:11.950 --> 08:13.450\n然后昏迷呕吐，\n\n08:14.000 --> 08:14.399\n嗯，\n\n08:14.399 --> 08:16.575\n异物吸入时症状，\n\n08:16.575 --> 08:17.924\n然后是胃寒，\n\n08:17.924 --> 08:19.725\n高热10到十四天后，\n\n08:19.725 --> 08:21.549\n大量浓臭痰的。\n\n08:22.100 --> 08:23.625\n三是血象啊，\n\n08:23.625 --> 08:26.399\n和这个GX线和CT检查。\n\n08:27.164 --> 08:29.963\n四是病原体的一个检查。\n\n08:32.034 --> 08:32.385\n嗯，\n\n08:32.385 --> 08:35.385\n鉴别诊断是细菌性肺炎啊，\n\n08:35.385 --> 08:38.234\n空洞型肺结核继发感染，\n\n08:38.734 --> 08:39.135\n嗯，\n\n08:39.184 --> 08:42.734\n后肺囊肿继发感染和支气管肺癌。\n\n08:45.216 --> 08:47.616\n首先是细菌性肺炎，\n\n08:47.916 --> 08:50.616\n早期肺脓肿无大量脓臭，\n\n08:50.616 --> 08:50.940\n痰，\n\n08:50.940 --> 08:53.265\n极少有脓腔形成，\n\n08:54.166 --> 08:58.515\n经有效治疗一般两周痊愈。\n\n09:00.085 --> 09:01.760\n冲动型肺结核呢，\n\n09:01.760 --> 09:03.685\n我们可以看到这个，\n\n09:04.185 --> 09:06.435\n慢性结核中毒症状，\n\n09:06.986 --> 09:08.685\n午后低热乏力，\n\n09:08.935 --> 09:09.661\n盗汗，\n\n09:09.661 --> 09:10.960\n长期咳嗽，\n\n09:10.960 --> 09:11.685\n咯血，\n\n09:12.135 --> 09:13.960\n无大量脓痰啊，\n\n09:13.960 --> 09:15.385\n空洞壁较厚，\n\n09:15.385 --> 09:17.236\n然后一般无液片，\n\n09:17.585 --> 09:21.036\n周围可见结核多形性病灶，\n\n09:21.536 --> 09:24.435\n痰中找到抗酸杆菌可诊断。\n\n09:27.138 --> 09:29.312\n肺囊肿继发感染啊，\n\n09:29.312 --> 09:36.588\n感染中毒症状及病灶周围炎症较肺脓肿轻是。\n\n09:37.828 --> 09:39.002\n感染控制后，\n\n09:39.002 --> 09:43.377\n胸片可见边缘光滑的薄壁空洞，\n\n09:43.528 --> 09:47.578\n如有既往胸片相比较啊，\n\n09:47.578 --> 09:49.028\n则更容易鉴别。\n\n09:51.366 --> 09:51.666\n嗯，\n\n09:51.666 --> 09:53.515\n支气管肺癌啊，\n\n09:53.515 --> 09:56.741\n支气管肺癌阻塞支气管远啊，\n\n09:56.741 --> 09:58.515\n导致远端肺，\n\n09:59.166 --> 09:59.565\n嗯，\n\n09:59.666 --> 10:00.616\n肺脓肿，\n\n10:00.616 --> 10:01.265\n然后。\n\n10:02.455 --> 10:06.955\n肺化脓性感染形成脓肿或癌性空洞啊，\n\n10:06.955 --> 10:08.705\n空洞常呈偏心，\n\n10:09.005 --> 10:10.630\n厚壁较厚，\n\n10:10.630 --> 10:12.255\n内壁凹凸不平，\n\n10:12.255 --> 10:14.804\n周围少炎症浸润，\n\n10:14.955 --> 10:17.729\n肺门淋巴结可肿大。\n\n10:17.729 --> 10:20.905\n纤维支气管，\n\n10:21.104 --> 10:22.280\n纤支镜啊，\n\n10:22.280 --> 10:23.330\n肺组织活检，\n\n10:23.330 --> 10:25.405\n痰脱落细胞学可诊断。\n\n10:27.736 --> 10:28.335\n然后，\n\n10:28.585 --> 10:30.385\n抗菌药物治疗呢，\n\n10:30.385 --> 10:32.411\n首先原则是抗生素啊，\n\n10:32.411 --> 10:33.236\n加引流。\n\n10:33.536 --> 10:38.185\n然后抗生素的疗程是8.10周啊，\n\n10:38.185 --> 10:40.411\n直至空洞及炎症消失啊。\n\n10:40.411 --> 10:40.861\n首先，\n\n10:40.861 --> 10:43.236\n我们要覆盖厌氧菌啊，\n\n10:43.385 --> 10:46.635\n可以用青霉素、克林霉素、甲硝唑啊。\n\n10:47.500 --> 10:48.950\n第二是阳性球菌的话，\n\n10:48.950 --> 10:49.875\n是血源性的。\n\n10:49.875 --> 10:53.176\n我们一般是相应的耐酶抗生素。\n\n10:53.176 --> 10:54.551\n如果考虑玛萨的，\n\n10:54.551 --> 10:58.551\n可使用万古霉素替考拉宁、利奈唑胺等。\n\n10:58.851 --> 10:59.250\n嗯，\n\n10:59.500 --> 11:02.401\n对于这格兰氏阴性的杆菌的话，\n\n11:02.401 --> 11:04.250\n我们根据药敏用药，\n\n11:04.500 --> 11:06.700\n您药标准一般的话，\n\n11:06.700 --> 11:09.776\n是临床症状完全消失啊，\n\n11:09.776 --> 11:10.700\n或者是X。\n\n11:10.750 --> 11:16.651\n第二是X线显示脓腔及炎性病变完全消散。\n\n11:17.809 --> 11:20.960\n少量残留条状纤维阴影。\n\n11:23.593 --> 11:25.193\n痰液引流，\n\n11:25.193 --> 11:27.419\n根据脓肿部位，\n\n11:27.419 --> 11:29.268\n病人取相应体位。\n\n11:29.268 --> 11:34.093\n脓肿处于高位患者尽可能配合用力吸气，\n\n11:34.143 --> 11:36.794\n并用力咳出脓性痰液。\n\n11:37.143 --> 11:37.544\n嗯，\n\n11:37.794 --> 11:39.794\n每日至少两次，\n\n11:39.843 --> 11:41.994\n每次10.15分钟。\n\n11:42.294 --> 11:50.193\n早餐前及晚上临睡前进行各种体位至少3坚持3分钟以上。\n\n11:50.393 --> 11:53.294\n引流前配合雾化吸入。\n\n11:53.973 --> 11:55.572\n可增强引流效果，\n\n11:55.622 --> 12:00.023\n如患者体质虚弱或有大咯血时啊，\n\n12:00.023 --> 12:02.822\n则暂不易体位引流啊，\n\n12:02.822 --> 12:04.372\n以免引起窒息，\n\n12:04.672 --> 12:06.697\n有痰液阻塞啊，\n\n12:06.697 --> 12:09.023\n可纤维支气管镜冲洗。\n\n12:10.190 --> 12:11.966\n我可以看到下面这张图，\n\n12:11.966 --> 12:14.041\n就是一个体位引流。\n\n12:14.541 --> 12:18.890\n这个是右左下肺背段的一个体位引流，\n\n12:19.091 --> 12:21.116\n是个俯卧位啊，\n\n12:21.116 --> 12:22.541\n颏朝下啊，\n\n12:22.690 --> 12:23.491\n收腹。\n\n12:24.820 --> 12:25.919\n稍屈背啊，\n\n12:25.969 --> 12:27.844\n不要直接拍打背，\n\n12:27.844 --> 12:29.570\n正背中背啊。\n\n12:30.963 --> 12:31.088\n北，\n\n12:31.088 --> 12:32.013\n北中部啊。\n\n12:33.817 --> 12:37.067\n这是右上肺后段体位啊，\n\n12:37.067 --> 12:38.367\n左侧卧位，\n\n12:38.367 --> 12:40.617\n右侧前倾45°，\n\n12:40.918 --> 12:43.218\n可支撑于左腋窝。\n\n12:43.668 --> 12:47.468\n头端床抬高20.30。\n\n12:48.395 --> 12:48.596\n嗯。\n\n12:49.677 --> 12:50.802\n然后这个公分，\n\n12:50.802 --> 12:54.827\n然后位于下面的左胸上下滑动。\n\n12:58.000 --> 12:58.151\n然后，\n\n12:58.151 --> 12:59.351\n外科指针啊，\n\n12:59.351 --> 13:02.351\n慢性肺脓肿内科治疗3个月，\n\n13:02.450 --> 13:03.976\n脓腔仍不缩小，\n\n13:03.976 --> 13:08.000\n或脓腔大于5cm不易闭合者。\n\n13:08.000 --> 13:09.450\n第二是大咯血，\n\n13:09.450 --> 13:12.801\n内科治疗无效或危及生命安全。\n\n13:13.250 --> 13:19.351\n第三是支气管胸膜瘘或脓胸经抽吸啊。\n\n13:21.226 --> 13:25.476\n经抽吸和这个冲洗疗效不佳者，\n\n13:25.476 --> 13:28.000\n四是支气管阻塞移位，\n\n13:28.000 --> 13:29.325\n支气管肺癌者。\n\n13:32.718 --> 13:35.168\n最后进行一个总结，\n\n13:35.168 --> 13:36.718\n我们就是，\n\n13:36.768 --> 13:38.867\n我们前面也讲到了，\n\n13:39.018 --> 13:44.268\n首先这个肺脓肿我们大概是分三种啊，\n\n13:44.317 --> 13:45.668\n一个是这个。\n\n13:46.546 --> 13:47.645\n吸入性的啊，\n\n13:47.645 --> 13:48.520\n血源性的，\n\n13:48.520 --> 13:49.296\n和这个临近，\n\n13:49.296 --> 13:50.745\n脏器这个。\n\n13:52.151 --> 13:53.601\n继发的一个感染啊，\n\n13:54.101 --> 13:57.000\n但临床上我们其实这个，\n\n13:57.101 --> 13:59.250\n可能对呼吸科的来讲的话，\n\n13:59.250 --> 14:02.200\n可能这个吸入性的更常见啊。\n\n14:03.773 --> 14:04.924\n最常见的原因呢？\n\n14:06.294 --> 14:07.494\n也是因为这个，\n\n14:07.945 --> 14:08.344\n嗯，\n\n14:08.445 --> 14:11.419\n有些病人是因为这个误吸啊，\n\n14:11.419 --> 14:14.844\n就是脑梗脑梗的之后引起来的这个。\n\n14:16.978 --> 14:19.978\n这个吞咽功能有异常引起的五气，\n\n14:20.377 --> 14:21.528\n那这个时候呢，\n\n14:21.528 --> 14:22.978\n我们这个。\n\n14:24.356 --> 14:24.606\n嗯，\n\n14:24.606 --> 14:25.681\n治疗上的话，\n\n14:25.681 --> 14:28.056\n我们选用选选取的抗生素呢，\n\n14:28.306 --> 14:31.156\n可能就是要考虑无吸之后。\n\n14:32.158 --> 14:33.833\n格兰氏阴性杆菌，\n\n14:33.833 --> 14:36.932\n然后最常见的是肺炎克雷伯菌啊，\n\n14:36.932 --> 14:37.507\n同时呢，\n\n14:37.507 --> 14:39.958\n我们要覆盖这个厌氧菌啊，\n\n14:40.158 --> 14:41.682\n所以说这个一般的话，\n\n14:41.682 --> 14:44.158\n临床上选用这个。\n\n14:45.299 --> 14:45.500\n嗯，\n\n14:45.849 --> 14:48.099\n青霉素类加上这个。\n\n14:50.223 --> 14:51.773\n这个酶的抑制剂啊，\n\n14:52.124 --> 14:54.424\n这个我们是最常见的一个方案，\n\n14:54.874 --> 14:56.273\n或者是选用这种。\n\n14:57.635 --> 15:00.234\n呼吸喹诺酮中的这个莫西沙星啊，\n\n15:00.234 --> 15:02.885\n因为它同时也可以覆盖厌氧菌，\n\n15:03.284 --> 15:04.684\n这是比较常见的。\n\n15:04.784 --> 15:06.434\n如果要是治疗效果不好，\n\n15:06.434 --> 15:09.484\n可能用选用这个碳青霉烯类的啊，\n\n15:09.484 --> 15:11.284\n这个罗培南啊，\n\n15:11.284 --> 15:14.184\n或者这个亚培南之类的。\n\n15:15.171 --> 15:16.520\n大部分的病患者呢，\n\n15:16.520 --> 15:18.221\n这个经过治疗啊，\n\n15:18.221 --> 15:20.620\n都是可以治愈的啊。\n\n15:20.620 --> 15:21.570\n少部分的话，\n\n15:21.570 --> 15:23.870\n可能最后需要这个外科治疗。\n\n","v0347cg10004d61abu2ljht3c7geu3d0",927,656,"2026-01-24 23:22:04","肺脓肿症状、病因及治疗方法 - 专业医疗指南  ","肺脓肿, 肺脓肿症状, 肺脓肿病因, 肺脓肿治疗, 肺部感染, 咳脓痰, 抗生素治疗  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