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--> 00:04.147\n筑牢慢阻肺管理的第一道防线，\n\n00:04.547 --> 00:07.047\n把握慢阻肺基层管理的三个关键，\n\n00:07.147 --> 00:09.897\n包括主动筛查诊断慢阻肺高危人群，\n\n00:09.947 --> 00:16.122\n规范化稳定期治疗、治评估、随访辨识和应对慢阻肺急性加重，\n\n00:16.122 --> 00:19.298\n我国慢阻肺呈现高发病、高死亡的态势。\n\n00:20.114 --> 00:20.413\n嗯。\n\n00:21.457 --> 00:23.531\n我国慢阻肺患者对疾病的认知不足，\n\n00:23.531 --> 00:25.107\n肺功能检查率低。\n\n00:25.556 --> 00:28.457\n慢阻肺自我意识到病情的比例是2.6%，\n\n00:28.506 --> 00:32.056\n接受过肺功能检查的成人比例约在9.7%，\n\n00:32.306 --> 00:36.657\n接过接受过肺功能检查的慢阻肺患者比例在12%，\n\n00:36.757 --> 00:38.207\n自述有慢阻肺病史，\n\n00:38.207 --> 00:41.957\n且接受过肺功能检测的患者比例在55.8%。\n\n00:42.679 --> 00:42.979\n嗯。\n\n00:43.770 --> 00:46.220\n慢阻肺管理基层是关键，\n\n00:46.220 --> 00:48.919\n基层是慢阻肺管理的第一线和主战场。\n\n00:49.720 --> 00:51.645\n慢阻肺早期症状不明显，\n\n00:51.645 --> 00:53.520\n患者多在基层就诊。\n\n00:54.481 --> 00:58.582\n慢阻肺管理涉及促防、诊、治、康多方面，\n\n00:58.931 --> 01:01.181\n需加强分级诊疗，\n\n01:01.431 --> 01:04.457\n将基层医生的纳入管理队伍中，\n\n01:04.457 --> 01:07.232\n让更多患者得到良好管管理。\n\n01:08.736 --> 01:11.236\n慢阻肺被纳入国家分级诊疗政策，\n\n01:11.486 --> 01:13.986\n防治慢病中长期规划中，\n\n01:13.986 --> 01:20.861\n在基层逐步提提供促进慢病发现早发现治疗落实分级诊疗。\n\n01:20.861 --> 01:25.585\n国务院关于实施健康中国行动的意见中提出普及肺功能检查，\n\n01:25.835 --> 01:27.986\n提高基层肺功能检查能力。\n\n01:28.185 --> 01:32.761\n健康中国行为中也提出提高基层防治能力和水平，\n\n01:32.761 --> 01:33.935\n落实分级诊疗。\n\n01:36.700 --> 01:42.350\n慢性阻塞性肺病的定义在2021年的中国慢阻肺指南中指出，\n\n01:42.801 --> 01:47.051\n慢阻肺是一种常见的可预防和治疗的慢性气道疾病，\n\n01:47.051 --> 01:48.651\n存在明显的特异性，\n\n01:49.051 --> 01:53.950\n其特质是持续存在的气流受限和相应的呼吸道症状。\n\n01:54.100 --> 01:58.051\n其病理学改变主要是气道和或肺泡异常，\n\n01:58.250 --> 02:02.350\n通常与显著暴露于有害颗粒或气体有关。\n\n02:02.551 --> 02:06.901\n遗传易感性异常的炎症反应以及与肺异常发。\n\n02:06.929 --> 02:10.479\n发育等众多的宿主因素参与发病过程。\n\n02:11.582 --> 02:13.132\n2023年的gold强调，\n\n02:13.132 --> 02:16.432\n慢阻肺是一种特异抑制性的肺部疾病，\n\n02:16.481 --> 02:24.832\n其特征是由于呼吸道异常、支气管炎、毛细支气管炎和或肺泡肺气肿引起的慢性呼吸道症状，\n\n02:24.932 --> 02:26.957\n包括呼吸困难、咳嗽、咳痰，\n\n02:26.957 --> 02:30.382\n导致持续的反复恶化的气流阻塞。\n\n02:32.270 --> 02:35.270\n慢阻肺和慢性支气管炎肺气肿的概念澄清，\n\n02:35.520 --> 02:40.044\n慢性支气管炎是在除慢性咳嗽的其他已知病因后，\n\n02:40.044 --> 02:42.044\n每年咳嗽咳痰3个月以上，\n\n02:42.044 --> 02:43.619\n并连续两年以上者。\n\n02:44.169 --> 02:50.645\n肺气肿病理诊断是肺部终末细支气管远端气腔出现异常持久的扩张，\n\n02:50.645 --> 02:55.070\n并伴有肺泡壁和细支气管壁破坏而无明显的肺纤维化。\n\n02:55.470 --> 02:57.970\n而慢阻肺的功能诊断是，\n\n02:57.970 --> 03:02.369\n当慢性支气管炎和肺气肿患者的肺功能检查出现。\n\n03:02.522 --> 03:05.522\n持续气流受限的时候则可诊断为慢阻肺，\n\n03:05.671 --> 03:09.947\n如仅有慢性支气管炎和或肺气肿而无持续性气流受限，\n\n03:09.947 --> 03:11.472\n则不能诊断为慢阻肺。\n\n03:13.406 --> 03:18.305\n识别慢阻肺高危人群符合以下一个及以上的特征，\n\n03:18.356 --> 03:20.880\n包括烟草接触环境因素。\n\n03:20.880 --> 03:23.830\n环境因素主要是居住在空气污染严重地区，\n\n03:23.830 --> 03:26.755\n尤其是二氧化硫等有害气体污染的地区，\n\n03:27.005 --> 03:32.656\n长期从事接触粉尘有害有有毒有害化学气体、重金属颗粒等工作，\n\n03:32.955 --> 03:35.005\n居住在气候寒冷潮湿地区，\n\n03:35.005 --> 03:37.055\n以及使用燃煤木材取暖等。\n\n03:37.587 --> 03:39.361\n年龄大于等于40岁。\n\n03:39.361 --> 03:40.186\n疾病史，\n\n03:40.287 --> 03:42.962\n患有某些特定疾病，\n\n03:42.962 --> 03:46.837\n如支气管哮喘、过敏性鼻炎、慢性支气管炎、肺气肿等，\n\n03:47.037 --> 03:49.736\n婴儿时期反复患的下呼吸道感染，\n\n03:49.986 --> 03:53.561\n遗传直系亲属中有慢阻肺家族史的营养因素，\n\n03:53.561 --> 03:56.436\n包括维生素A缺乏或胎儿时期肺发育不良，\n\n03:56.537 --> 03:57.636\n营养状况较差，\n\n03:57.636 --> 03:58.936\n体重指数较低等。\n\n04:00.057 --> 04:00.832\n主动筛查，\n\n04:00.832 --> 04:01.807\n推动慢阻肺，\n\n04:01.807 --> 04:02.807\n早诊早治，\n\n04:03.358 --> 04:03.707\n嗯，\n\n04:03.707 --> 04:04.707\nGo 2023,\n\n04:04.707 --> 04:06.007\n围绕不同人群。\n\n04:06.938 --> 04:11.539\n阐述了肺功能的筛查病例发现工具对慢阻肺诊断的影响，\n\n04:11.688 --> 04:13.889\n旨在改善易漏诊现状，\n\n04:13.889 --> 04:17.389\n推动早诊早治健康中国2030提出建议，\n\n04:17.389 --> 04:22.989\n40岁及以上的人群或慢性呼吸道疾病高危人群每年检查肺功能一次。\n\n04:23.489 --> 04:28.588\n主动病例发现对于慢阻肺高危人群的诊断和干预有重要的意义，\n\n04:28.588 --> 04:31.088\n已在各国尤其是基层中践行。\n\n04:31.239 --> 04:32.688\n英国一项研究显示，\n\n04:32.688 --> 04:34.789\n针对40.79岁人群，\n\n04:35.039 --> 04:37.088\n通过全科医生主动病例。\n\n04:37.162 --> 04:37.838\n发现方式，\n\n04:37.838 --> 04:42.113\n所诊断的慢阻肺病例高于常规机会性发现病例，\n\n04:42.463 --> 04:44.213\n且更具成本效益。\n\n04:45.710 --> 04:49.735\n慢阻肺筛查有早筛问卷和风流速仪两种。\n\n04:49.735 --> 04:51.635\n早筛问卷是全科，\n\n04:51.635 --> 04:55.010\n医生可以通过慢阻肺早筛问卷来筛查高危人群，\n\n04:55.311 --> 04:58.561\n对疑诊患者可选择向上级医院就诊，\n\n04:58.760 --> 04:59.911\n进一步确诊。\n\n05:01.321 --> 05:02.821\n总分大于等于16分时，\n\n05:02.821 --> 05:05.420\n需要进一步检查明确是否患有慢阻肺。\n\n05:05.670 --> 05:12.270\n风流速仪可发现部分早期慢阻肺患者对气流受限程度重、急性加重风险高，\n\n05:12.270 --> 05:15.770\n需考虑药物治疗以缓解症状的患者尤为敏感，\n\n05:16.071 --> 05:18.971\n以80%为慢阻肺筛查的切点，\n\n05:19.020 --> 05:21.321\n具有最佳的敏感性和特异性。\n\n05:27.027 --> 05:29.451\n英国基于社区的寻找病例计划，\n\n05:29.451 --> 05:31.277\n主动筛查慢阻肺高危人群，\n\n05:31.527 --> 05:35.902\n寻找病例是计划是为减轻基层对于慢阻肺的筛查工作，\n\n05:35.902 --> 05:40.002\n使用target慢阻肺电子评分筛选出慢阻肺风险者，\n\n05:40.002 --> 05:44.226\n由外联专家组在医院和社区之间提供综合服务。\n\n05:47.032 --> 05:50.231\n慢阻肺的诊断肺功、肺功能检查是关键。\n\n05:50.282 --> 05:55.731\n慢阻肺患者的典型表现为EEF1和FVC均出现下降，\n\n05:55.731 --> 05:59.657\nFV1比上FVC可检查出轻流气度、轻度气流受限，\n\n05:59.657 --> 06:03.381\n吸入支气管扩张剂后F 1 V1比上FVC\u003C70%，\n\n06:03.582 --> 06:07.006\n表示存在持续性的气流受限，\n\n06:07.006 --> 06:09.782\nF 1:1占预计值百分比在评价中。\n\n06:10.484 --> 06:13.184\n重度气流受限的良好指标，\n\n06:13.184 --> 06:15.785\n可作为患者的肺功能分级诊断。\n\n06:19.403 --> 06:24.828\n鉴别慢阻肺与其他疾病的要点慢阻肺主要的特征在中年发病，\n\n06:24.828 --> 06:27.428\n长期吸烟史或其他烟雾接触史，\n\n06:27.428 --> 06:28.703\n症状缓慢进展，\n\n06:28.953 --> 06:31.653\n急性加重期症状超过日常变异，\n\n06:31.703 --> 06:32.903\n并持续恶化。\n\n06:33.153 --> 06:35.078\n哮喘是通常儿童期发病，\n\n06:35.078 --> 06:36.278\n每日症状变化快，\n\n06:36.278 --> 06:38.053\n夜间和清晨症状明显，\n\n06:38.203 --> 06:39.227\n可有过敏史，\n\n06:39.227 --> 06:40.602\n鼻炎和或湿疹，\n\n06:40.602 --> 06:41.953\n有哮喘家族史，\n\n06:42.053 --> 06:43.703\n充血性心衰，\n\n06:43.703 --> 06:45.852\nX线胸片表示心脏扩大，\n\n06:45.953 --> 06:46.803\n肺气肿，\n\n06:46.953 --> 06:49.453\n肺水肿肺功能检查提示有。\n\n06:49.877 --> 06:50.752\n制性通气障碍，\n\n06:50.752 --> 06:51.927\n而非气流受限。\n\n06:52.177 --> 06:55.677\n支气管扩张肾主要表现是大量脓痰，\n\n06:55.677 --> 06:56.976\n常伴有细菌感染，\n\n06:57.076 --> 06:58.127\n湿粗罗音，\n\n06:58.127 --> 06:58.902\n杵状指。\n\n06:58.902 --> 07:01.527\nX线胸片或CT提示支气管扩张，\n\n07:01.527 --> 07:02.427\n管壁增厚，\n\n07:02.726 --> 07:03.527\n肺结核。\n\n07:03.576 --> 07:05.277\n所有年龄均可发病，\n\n07:05.277 --> 07:09.777\nX线胸片是肺浸润性病灶或结节灶空洞样改变。\n\n07:09.777 --> 07:12.777\n微生物检查可确诊流行地区高发病。\n\n07:15.005 --> 07:23.804\n基层医院慢阻肺诊断流程首先有年龄大于等于40岁、吸烟、粉尘接触史、慢性咳嗽、咳痰、呼吸等困难症状，\n\n07:23.804 --> 07:26.005\n进入高人群、高危人群筛查。\n\n07:26.773 --> 07:28.199\n包括问卷和风流素仪，\n\n07:28.199 --> 07:30.324\n然后进一步询问病史和体格检查。\n\n07:30.723 --> 07:31.123\n嗯，\n\n07:31.273 --> 07:37.373\n符合的做肺功能检查和血常规胸片来排除其他诊断。\n\n07:37.473 --> 07:39.049\n临床与肺功能不相符的，\n\n07:39.049 --> 07:40.373\n转至上级医院确诊。\n\n07:40.523 --> 07:43.824\nF 1 V1比上FVC\u003C0.7的确诊慢阻肺，\n\n07:43.824 --> 07:44.623\n评估病情，\n\n07:44.924 --> 07:46.824\n制定治疗方案并随访。\n\n07:47.123 --> 07:50.523\n而F 1 V1比上FVC≥0.7的考虑其他诊断，\n\n07:50.523 --> 07:51.373\n定期随访。\n\n07:53.882 --> 07:55.083\n慢阻肺的症状评估，\n\n07:55.433 --> 07:55.833\n嗯，\n\n07:55.933 --> 07:56.858\n四字口诀，\n\n07:56.858 --> 07:57.833\n快走气促，\n\n07:57.833 --> 07:59.208\n走急气促，\n\n07:59.208 --> 08:00.257\n慢走气促，\n\n08:00.257 --> 08:01.108\n稍动气促，\n\n08:01.108 --> 08:02.032\n不动气促。\n\n08:04.049 --> 08:07.725\nNMRC问卷用于评估呼吸困难严重的程度，\n\n08:07.725 --> 08:08.424\n0.1分为症状，\n\n08:08.424 --> 08:09.850\n少两分以上症状多。\n\n08:13.067 --> 08:15.143\nCAT问卷用于评估综合症状，\n\n08:15.143 --> 08:16.792\n0.10分是轻微影响，\n\n08:16.792 --> 08:18.243\n11.20分是中等影响，\n\n08:18.243 --> 08:19.993\n21.30分是严重影响，\n\n08:19.993 --> 08:23.018\n31.40分非常严重影响10分以上为症状多。\n\n08:27.098 --> 08:35.648\n慢阻肺的综合评估和分组go的2023的A、B、e分组2023 go的修改为ABCD评估工具为A、B、e评估工具，\n\n08:35.799 --> 08:39.549\n以明确急性加重的临床相关性、临床意义。\n\n08:40.474 --> 08:42.174\n独立于症状严重程度。\n\n08:43.520 --> 08:46.520\n慢阻肺治疗药物包括支气管扩张剂，\n\n08:46.669 --> 08:48.270\n可松弛支气管平滑肌，\n\n08:48.270 --> 08:49.195\n扩张支气管，\n\n08:49.195 --> 08:50.320\n缓解气流受限。\n\n08:50.419 --> 08:54.320\n临床应用的贝塔受体激动剂以及抗胆碱能药物，\n\n08:54.320 --> 08:57.919\n主要用主要是长期长效的吸入制剂，\n\n08:58.270 --> 09:00.945\n短期按需应用可缓解症状，\n\n09:00.945 --> 09:03.520\n长期规律应用可预防和减轻症状，\n\n09:03.520 --> 09:04.619\n增加运动耐力。\n\n09:04.919 --> 09:06.270\n贝塔2受体激动剂，\n\n09:06.369 --> 09:09.219\n通过激动贝塔2受体实现支气管扩张，\n\n09:09.270 --> 09:13.570\n常见的不良反应有窦性心动过速、肌肉震颤、头晕和头疼等。\n\n09:13.937 --> 09:16.637\n主要包括短效的沙巴和长效的拉巴。\n\n09:17.187 --> 09:21.312\n抗胆碱能药物是通过阻断M受体扩张支气管平滑肌。\n\n09:21.312 --> 09:23.036\n常见的不良反应有口干，\n\n09:23.036 --> 09:23.637\n咳嗽，\n\n09:23.637 --> 09:26.262\n局部刺激吸入相关的支气管痉挛，\n\n09:26.262 --> 09:26.861\n头痛，\n\n09:26.861 --> 09:27.437\n头晕。\n\n09:27.786 --> 09:31.137\n包括短效的S马和长效的拉玛茶碱，\n\n09:31.137 --> 09:33.086\n是解除气道平滑痉挛，\n\n09:33.137 --> 09:35.086\n舒张全身和肺血管，\n\n09:35.187 --> 09:38.086\n改善呼吸肌功能及某些抗炎作用。\n\n09:38.086 --> 09:39.887\n常见的不良反应有恶心，\n\n09:40.187 --> 09:40.836\n呕吐，\n\n09:40.937 --> 09:42.687\n腹痛、头痛、胸痛等。\n\n09:43.963 --> 09:46.013\n缓释型或控释性茶碱，\n\n09:46.013 --> 09:47.564\n每日口服1.2次，\n\n09:47.564 --> 09:49.414\n对治疗慢阻肺有一定的疗效。\n\n09:51.018 --> 09:53.794\n第二个慢阻肺治疗药物是抗炎药物，\n\n09:53.794 --> 09:56.068\n是吸入性的糖皮质激素，\n\n09:56.169 --> 09:57.744\n可减少气道的炎症，\n\n09:57.744 --> 09:58.794\n改善气道重塑。\n\n09:58.794 --> 10:00.669\n不推荐单用ICS治疗，\n\n10:00.669 --> 10:04.218\n在一种或两种长效支气管舒张剂使用的基础上，\n\n10:04.218 --> 10:05.768\n考虑联合ICS治疗。\n\n10:06.169 --> 10:09.294\n与ICS加拉巴或拉玛的单药相比，\n\n10:09.294 --> 10:11.994\nICS加拉玛加拉巴改善肺功能症状，\n\n10:11.994 --> 10:16.193\n健康状况及减少急性加重效果更佳。\n\n10:16.193 --> 10:18.268\nICS有增加肺炎发病率的风险，\n\n10:18.268 --> 10:20.268\n总体不良反应发生率比较低。\n\n10:21.344 --> 10:22.445\n慢阻肺治疗药物，\n\n10:22.445 --> 10:27.695\n其他的药物主要包括祛痰药、抗氧化剂及中药等。\n\n10:29.604 --> 10:34.155\n慢阻肺吸入装置选择有传统的PMDI主动喷雾装置，\n\n10:34.155 --> 10:37.630\n对手口协调性和吸气流速有要求。\n\n10:37.630 --> 10:39.380\nDPI是新一代的DPI易纳器，\n\n10:39.380 --> 10:41.304\n可高控可高效排空，\n\n10:41.304 --> 10:43.354\n实现多组分药递送，\n\n10:43.455 --> 10:44.354\n易学易用，\n\n10:44.354 --> 10:46.554\n关键错误率较低。\n\n10:46.554 --> 10:47.755\nSMI是主动喷雾装置，\n\n10:47.755 --> 10:49.804\n释放微细雾滴，\n\n10:49.804 --> 10:51.854\n对手口协调有一定的要求。\n\n10:54.130 --> 10:57.179\n慢阻肺稳定期治疗推荐中国指南，\n\n10:57.429 --> 11:02.280\n大于等于两次中度急性加重或一次治疗入院的急性加重期。\n\n11:02.679 --> 11:03.005\n嗯，\n\n11:03.005 --> 11:04.530\n根据ABCD分组，\n\n11:04.679 --> 11:07.330\nA组患者条件允许可推荐使用拉玛。\n\n11:07.330 --> 11:13.030\nB组患者若CTACAT大于二十分的推荐其实使用拉玛加拉玛联合治疗。\n\n11:13.280 --> 11:18.729\nD组患者根据患者情况和药物可及性选择拉玛或者拉玛加拉巴。\n\n11:19.343 --> 11:20.443\n或ICS加拉，\n\n11:20.544 --> 11:22.643\n或ICS加拉马加拉巴治疗。\n\n11:23.599 --> 11:25.200\n若CTA大于二十分，\n\n11:25.500 --> 11:29.400\n推荐首选双支气管舒张剂联合治疗。\n\n11:30.702 --> 11:35.552\n对于血EOS大于等于三百个每微升的或合并哮喘的患者，\n\n11:35.552 --> 11:38.202\n首选首先推荐ICS的联合治疗。\n\n11:38.252 --> 11:43.577\n若CAT>20分且和血EOS≥300个每微升的，\n\n11:43.577 --> 11:46.202\n可考虑ICS加拉加拉玛的三联治疗，\n\n11:46.202 --> 11:49.252\n尤其是重度或以上的气流受限者。\n\n11:54.382 --> 12:01.932\n慢阻肺稳定期初始治疗推荐go的2023年的指南是ICS加拉巴加拉玛。\n\n12:01.981 --> 12:07.981\n加拉巴加拉玛成为急性加重高风险人群初始治疗的首选方案之一。\n\n12:08.182 --> 12:13.781\n不再推荐ICS加拉巴及单拉玛用于B组和E组的初始治疗。\n\n12:15.086 --> 12:19.461\n慢阻肺的呼吸康复呼吸康复的定义在全面评估基础上，\n\n12:19.461 --> 12:22.086\n为患者提供个体化的综合干预措施，\n\n12:22.086 --> 12:25.036\n包括但不限于运动锻炼、教育和行动。\n\n12:25.036 --> 12:29.086\n改变规律的运动训练是呼吸康复的核心内容。\n\n12:35.362 --> 12:37.788\n呼吸康复实施措施包括，\n\n12:37.788 --> 12:43.862\n健康平状健康状态评估、制定个体化的康复处方、康复效果的评估以及康复处方的优化。\n\n12:44.312 --> 12:46.612\n慢阻的随访评估，\n\n12:46.612 --> 12:52.788\n随访的频率及内容主要基于对患者症状和未来急性加重风险的评估。\n\n12:52.788 --> 12:54.737\n3.6个月进行一次详细随访，\n\n12:54.737 --> 12:57.562\n根据患者实际情况及需要来进行调整。\n\n12:57.913 --> 13:04.713\n随访评估的内容包括吸烟状况、肺功能、药物及非药物治疗情况、吸入装置使用和掌握情况。\n\n13:04.913 --> 13:05.513\n患者。\n\n13:05.594 --> 13:07.544\n了解其疾病以及自我管理的能力。\n\n13:07.544 --> 13:08.844\n急性加重频率，\n\n13:08.895 --> 13:10.469\n运动耐量，\n\n13:10.469 --> 13:13.895\nBMI s a o二疾病的心理影响，\n\n13:13.895 --> 13:15.270\n合并症和并发症，\n\n13:15.270 --> 13:16.770\n口唇颜色、呼吸频率，\n\n13:16.770 --> 13:19.645\n心肺等重点部位体格检查，\n\n13:19.844 --> 13:20.945\n国内实践案例，\n\n13:20.945 --> 13:22.044\n借助信息化管理，\n\n13:22.044 --> 13:24.494\n慢阻肺患者表现出良好的依从性，\n\n13:24.494 --> 13:27.895\n且慢阻肺症状和焦虑、抑郁得到显著改善。\n\n13:31.255 --> 13:33.255\n慢阻肺急性加重的定义更新，\n\n13:33.604 --> 13:34.005\n嗯。\n\n13:36.390 --> 13:38.591\nGo 2023的定义指出，\n\n13:38.991 --> 13:40.565\n一种急性事件，\n\n13:40.565 --> 13:44.216\n慢阻肺患者呼吸困难和或咳嗽咳痰症状加重，\n\n13:44.216 --> 13:46.278\n症状恶化发生在14天内，\n\n13:46.278 --> 13:48.991\n可能伴有呼吸急促和或心动过速。\n\n13:49.241 --> 13:54.041\n通常是因为呼吸道感染、空气污染造成局部或全身炎症反应加重，\n\n13:54.190 --> 13:56.991\n或者因损伤气道等其他原因所致。\n\n13:57.241 --> 13:58.666\n新增了14天，\n\n13:58.666 --> 14:00.166\n导致了删除了，\n\n14:00.166 --> 14:01.591\n导致需要额外治疗。\n\n14:03.125 --> 14:05.526\n慢阻肺急性加重的常见诱发因素，\n\n14:05.776 --> 14:06.125\n嗯，\n\n14:06.125 --> 14:08.676\n最重要的一条是不规范稳定期的。\n\n14:09.340 --> 14:11.440\n不规范的稳定期的维持治疗。\n\n14:13.903 --> 14:17.103\n慢阻肺急性加重高风险患者的常见特征，\n\n14:17.353 --> 14:17.677\n嗯，\n\n14:17.677 --> 14:19.228\n既往有急性加重病史，\n\n14:19.228 --> 14:19.752\n多症状，\n\n14:19.752 --> 14:20.653\n活动耐量差，\n\n14:20.802 --> 14:21.778\n肺功能异常，\n\n14:21.778 --> 14:24.353\n合并其他慢性疾病以及生物标志物异常。\n\n14:25.203 --> 14:27.752\n慢阻肺急性加重期的评估目的。\n\n14:29.273 --> 14:31.973\n作为选择稳定期初始治疗方案的依据之一，\n\n14:32.073 --> 14:35.023\n作为调整和维持治疗方案的依据之一。\n\n14:36.624 --> 14:38.874\n慢阻肺急性加重病史的回顾啊，\n\n14:38.874 --> 14:42.723\n评估一个是主动询问所有就诊患者的急诊住院史。\n\n14:43.806 --> 14:47.455\n二二是主动询问所有就诊患者的非计划门诊史。\n\n14:49.742 --> 14:54.718\n对慢阻肺急性加重的识别为CERT的文件，\n\n14:54.718 --> 14:57.418\nCERT的开发过程完全由中国患者参与，\n\n14:57.418 --> 14:59.593\n反映了中国患者急性加重的症状。\n\n14:59.992 --> 15:02.442\n慢阻肺急性加重的严重程度分级。\n\n15:03.434 --> 15:04.585\n分为一、二、三级。\n\n15:04.984 --> 15:09.635\n其治疗针对轻度单独使用短效支气管扩张剂治疗，\n\n15:09.635 --> 15:12.460\n中度的使用短效支气管舒张剂和抗菌治疗，\n\n15:12.460 --> 15:14.684\n加用或不加用口服糖皮质激素，\n\n15:14.835 --> 15:17.835\n重度的需要住院或急诊ICU治疗。\n\n15:19.747 --> 15:24.297\n慢阻肺急性加重的紧急转诊指针及转诊前处置。\n\n15:26.226 --> 15:29.401\n诊前抗感染治疗并保持呼吸道通畅，\n\n15:29.401 --> 15:31.625\n控制性氧疗和必要的呼吸支持。\n\n15:33.281 --> 15:38.931\n慢阻肺急性加重的预防包括戒烟、疫苗接种、痰液引流、吸入治疗和呼吸康复。\n\n15:40.614 --> 15:41.065\n总结，\n\n15:41.065 --> 15:43.114\n我国慢阻肺的管理现状有待改善，\n\n15:43.114 --> 15:44.340\n作为第一线和主战场，\n\n15:44.340 --> 15:48.239\n基层医生在慢性阻肺慢阻肺管理中扮演重要角色。\n\n15:48.239 --> 15:50.789\n基层医生在慢阻肺管理中需要把握三个关键，\n\n15:50.789 --> 15:55.864\n主动筛查、规范化稳定期评估、治疗和随访、识别和应对急性加重。\n\n15:57.736 --> 15:58.137\n结束。\n\n","v0347cg10004d61aocqljht2ed18aso0",959,634,"2026-01-24 23:34:03"," 基层慢阻肺诊疗规范解读 | 最新指南与临床实践  \n"," 慢阻肺诊疗规范, 基层医疗指南, COPD管理, 慢阻肺诊断标准, 慢阻肺治疗建议, 基层医生培训  \n"," 本文深入解读基层慢阻肺（COPD）诊疗规范，涵盖最新诊断标准、分级治疗策略及患者管理要点，助力基层医疗机构规范慢阻肺防治流程，提升临床诊疗水平。","2026-04-14 16:00:00",[38],{"menuId":39,"menuName":40,"parentId":17,"orderNum":41,"path":42,"component":43,"isFrame":44,"isCache":45,"menuType":46,"visible":27,"status":17,"createDept":6,"remark":25,"createTime":47,"children":48,"columnImage":49,"columnLogo":50,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":51,"seoKeywords":52,"seoDescription":53,"contentNum":6,"promotionalPoster":54,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":55,"routerPath":42,"componentInfo":43},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 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