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--> 00:01.975\n大家好，\n\n00:01.975 --> 00:05.324\n我是上海市第一人民医院宋凡医生啊，\n\n00:05.324 --> 00:08.175\n那今天我们来看一下这个慢性鼻窦炎的治疗。\n\n00:09.347 --> 00:09.597\n嗯，\n\n00:09.796 --> 00:15.597\n那我将从下面五个方面来简单介绍一下这个慢性鼻窦炎啊。\n\n00:15.597 --> 00:18.047\n先看一下这个就是慢性鼻窦炎的概述，\n\n00:18.246 --> 00:20.097\n再看一下它的发病机制。\n\n00:20.895 --> 00:24.070\n然后再讲一下这个治疗方法的介绍，\n\n00:24.070 --> 00:28.371\n以及这个患者日常管理和生活调整建议啊。\n\n00:28.371 --> 00:29.045\n最后呢，\n\n00:29.346 --> 00:29.721\n嗯，\n\n00:29.721 --> 00:33.145\n再看一下这个预后的评估和随访计划制定。\n\n00:34.672 --> 00:34.972\n嗯，\n\n00:35.172 --> 00:37.372\n那什么是这个慢性鼻窦炎呢？\n\n00:39.227 --> 00:41.926\n慢性鼻窦炎是指鼻窦粘膜的炎症，\n\n00:41.926 --> 00:44.227\n病程超过12周。\n\n00:44.277 --> 00:45.551\n它发病原因呢，\n\n00:45.551 --> 00:51.626\n主要是感染、鼻腔结构异常、过敏反应和环境因素等等。\n\n00:52.027 --> 00:53.676\n那它的主要病理生理呢，\n\n00:53.676 --> 00:55.626\n是鼻窦粘膜充血啊，\n\n00:55.626 --> 00:58.027\n水肿肥厚，\n\n00:58.027 --> 01:00.676\n这个鼻窦口阻塞及分泌物的储留。\n\n01:02.442 --> 01:04.092\n那这临床表现和分型，\n\n01:04.442 --> 01:06.041\n那它主要的临床表现呢，\n\n01:06.041 --> 01:10.192\n主要是鼻塞、流脓鼻涕、头痛、嗅觉减退，\n\n01:10.241 --> 01:13.141\n还有一些就是在门诊会碰到一些患者的主诉呢，\n\n01:13.141 --> 01:14.442\n是这个眶周疼痛，\n\n01:14.641 --> 01:15.241\n对吧？\n\n01:15.241 --> 01:18.342\n特别是有些像，\n\n01:18.342 --> 01:21.291\n筛窦有筛窦炎比较厉害的话，\n\n01:21.791 --> 01:23.141\n是会有眶周疼痛，\n\n01:23.141 --> 01:25.092\n还有上颌窦炎也是。\n\n01:26.013 --> 01:26.613\n它的分型，\n\n01:26.914 --> 01:29.564\n那根据这个症状和鼻窦CT的表现呢，\n\n01:29.564 --> 01:33.164\n可以分为单纯型和脓肿型以及鼻息肉型。\n\n01:33.564 --> 01:35.113\n那它主要伴随症状呢，\n\n01:35.113 --> 01:36.513\n可伴有慢性咽炎啊，\n\n01:36.513 --> 01:39.064\n中耳炎和支气管哮喘等等。\n\n01:41.263 --> 01:43.988\n那这个鼻窦炎的主要诊断呢，\n\n01:43.988 --> 01:50.314\n是根据是根据他的病史、症状和鼻窦CT或者是磁共振等影像学检查，\n\n01:50.613 --> 01:51.013\n对吧，\n\n01:51.013 --> 01:53.564\n那这个影像学检查是非常重要的。\n\n01:54.128 --> 01:54.329\n嗯，\n\n01:54.429 --> 01:54.903\n这个呢，\n\n01:54.903 --> 02:00.329\n需要与急性鼻窦炎和过敏性鼻炎鼻息肉等疾病来，\n\n02:00.329 --> 02:01.554\n就是来进行鉴别。\n\n02:01.554 --> 02:04.429\n它的诊断标准主要呢，\n\n02:04.429 --> 02:06.378\n是根据症状的持续时间，\n\n02:06.378 --> 02:09.328\n还有鼻窦CT的表现以及鼻内镜的检查。\n\n02:10.819 --> 02:13.093\n那我们再看一下这个发病机制的情况，\n\n02:13.093 --> 02:14.869\n就鼻窦炎的发病机制啊，\n\n02:15.119 --> 02:18.593\n鼻窦的先看一下这个鼻窦的解剖结构的特点啊。\n\n02:18.593 --> 02:19.494\n鼻窦的位置呢，\n\n02:19.494 --> 02:22.169\n它是位于鼻腔周围啊，\n\n02:22.169 --> 02:23.044\n共有四对，\n\n02:23.044 --> 02:26.069\n包括上颌窦、额窦、筛窦和蝶窦，\n\n02:26.069 --> 02:29.968\n它其实是是四对骨腔。\n\n02:30.218 --> 02:31.169\n很多患者呢，\n\n02:31.169 --> 02:31.919\n就在门诊啊，\n\n02:31.919 --> 02:36.218\n就是他们觉得就是做做鼻内镜也能看到鼻窦的情况。\n\n02:36.619 --> 02:37.018\n嗯，\n\n02:38.018 --> 02:38.794\n那这个呢，\n\n02:38.794 --> 02:40.819\n就是做鼻内镜是指。\n\n02:40.895 --> 02:42.046\n能看到鼻腔的情况，\n\n02:42.145 --> 02:44.746\n其实是看不到它这个周围这个。\n\n02:45.757 --> 02:48.658\n腹腔那就是鼻窦的情况的啊，\n\n02:48.658 --> 02:49.932\n那鼻窦的情况呢，\n\n02:49.932 --> 02:55.307\n主要还是要通过一些影像学检查才能就就是比较直观的看啊，\n\n02:55.307 --> 02:56.358\n看清楚啊，\n\n02:56.408 --> 02:57.658\n鼻窦的结构啊。\n\n02:57.658 --> 02:58.733\n那每一个鼻窦呢，\n\n02:58.733 --> 03:01.457\n都有一个开口与鼻腔相通称为窦口，\n\n03:01.658 --> 03:03.158\n其内衬有粘膜，\n\n03:03.158 --> 03:04.358\n可分泌粘液，\n\n03:04.507 --> 03:07.257\n具有湿润和过滤空气的作用。\n\n03:08.259 --> 03:09.634\n那鼻窦的生理功能，\n\n03:09.634 --> 03:09.983\n嗯，\n\n03:09.983 --> 03:10.783\n它是什么呢？\n\n03:10.783 --> 03:13.083\n它主要能够减轻头部的重量，\n\n03:13.083 --> 03:14.059\n增加共鸣，\n\n03:14.059 --> 03:15.358\n保护脑组织。\n\n03:15.509 --> 03:16.184\n同时呢，\n\n03:16.184 --> 03:18.708\n也可通过粘膜纤毛运动，\n\n03:18.809 --> 03:20.509\n清除鼻腔内的病，\n\n03:20.509 --> 03:24.509\n清除鼻腔内的细菌、病毒和过敏原等等。\n\n03:26.440 --> 03:26.839\n嗯，\n\n03:27.539 --> 03:31.839\n那来看一下这个就是在慢性鼻窦炎这个发病过程中啊，\n\n03:31.839 --> 03:33.740\n这个炎症反应的这样一个过程。\n\n03:34.632 --> 03:34.832\n嗯，\n\n03:35.031 --> 03:35.807\n那首先呢，\n\n03:35.807 --> 03:39.156\n是这个炎症细胞的浸润在这个慢性鼻窦炎发病时啊，\n\n03:39.156 --> 03:41.481\n鼻鼻腔粘膜有大量的炎症。\n\n03:41.832 --> 03:45.582\n炎症细胞浸润包括嗜酸性粒细胞、中性粒细胞、淋巴细胞等等。\n\n03:45.781 --> 03:48.882\n炎症介质释放炎症细胞呢，\n\n03:48.882 --> 03:52.207\n会释放的炎症介质如组胺、白三烯等等，\n\n03:52.207 --> 03:57.031\n导致血管的扩张、通透性增加、腺体分泌增加等等，\n\n03:57.031 --> 03:58.731\n从而引发鼻腔的一些症状。\n\n03:58.932 --> 03:59.281\n嗯，\n\n03:59.281 --> 04:01.731\n那比如说就是流鼻涕啊。\n\n04:01.981 --> 04:02.632\n其次呢，\n\n04:02.632 --> 04:03.807\n就是粘膜组织重塑，\n\n04:03.807 --> 04:04.832\n长期的炎症啊。\n\n04:04.919 --> 04:06.970\n会导致鼻腔粘膜组织发生重塑，\n\n04:06.970 --> 04:10.669\n包括纤毛脱落、腺体肥大、血管增生等等，\n\n04:10.869 --> 04:14.970\n来进一步影响鼻腔的功能。\n\n04:15.070 --> 04:16.295\n那它的发病原因呢，\n\n04:16.295 --> 04:19.320\n主要有一些遗传因素和这个环境的影响。\n\n04:19.320 --> 04:20.670\n那这个遗传因素呢，\n\n04:20.670 --> 04:24.994\n主要包括基因变异导致鼻腔鼻窦解剖结构的异常，\n\n04:24.994 --> 04:26.095\n增加感染的风险。\n\n04:26.095 --> 04:27.670\n比如有些人就是先天的小，\n\n04:28.269 --> 04:29.769\n就鼻窦就比较小，\n\n04:30.119 --> 04:30.595\n对吧，\n\n04:30.595 --> 04:33.920\n按照窦口可能就就开放的不那么好，\n\n04:34.470 --> 04:34.869\n还。\n\n04:34.915 --> 04:35.115\n第二呢，\n\n04:35.115 --> 04:35.890\n就是环境因素，\n\n04:35.890 --> 04:37.091\n比如空气污染呀，\n\n04:37.091 --> 04:42.015\n过敏原、吸烟等等外部的刺激会加重鼻腔鼻窦的炎症反应。\n\n04:42.265 --> 04:43.890\n还有这个气候的因素，\n\n04:43.890 --> 04:47.915\n比如干燥寒冷等气候条件可以刺激鼻腔粘膜，\n\n04:48.066 --> 04:50.865\n从而诱发或者加重这个鼻窦炎。\n\n04:52.216 --> 04:52.740\n那其实，\n\n04:52.740 --> 04:55.466\n特别是这个上呼吸道感染，\n\n04:55.466 --> 05:01.966\n上呼吸道感染其实也是这个增加是会是会使慢性鼻窦炎，\n\n05:01.966 --> 05:04.865\n就是发病和这个加重。\n\n05:06.932 --> 05:10.381\n那再看一下这个鼻窦炎的治疗方法啊，\n\n05:10.631 --> 05:14.207\n再看一下药物治疗方案的选择以及注意以及注意事项。\n\n05:14.207 --> 05:16.506\n比如局部使用糖皮质激素，\n\n05:16.506 --> 05:19.631\n比如就是布丁奈德或者丙酸氟卡松啊，\n\n05:19.631 --> 05:22.532\n这些那个激素喷剂就鼻用激素喷剂啊，\n\n05:22.532 --> 05:24.131\n可以减轻鼻腔黏膜的水肿，\n\n05:24.131 --> 05:26.332\n缓解鼻塞等症状。\n\n05:26.682 --> 05:27.307\n其次呢，\n\n05:27.307 --> 05:28.631\n对于严重感染的患者，\n\n05:28.631 --> 05:30.557\n可以选用敏感的抗生素进行治疗，\n\n05:30.557 --> 05:33.907\n那需要注意用药时间的和剂量啊。\n\n05:33.907 --> 05:34.432\n还有呢，\n\n05:34.432 --> 05:34.782\n就是。\n\n05:34.940 --> 05:36.015\n液溶解促排剂，\n\n05:36.015 --> 05:37.089\n比如氨溴索啊，\n\n05:37.089 --> 05:38.440\n淘金粮油等等，\n\n05:38.489 --> 05:40.214\n可以稀释鼻腔分泌物，\n\n05:40.214 --> 05:41.440\n促进纤毛运动，\n\n05:41.440 --> 05:45.239\n帮助分泌物的排出等等。\n\n05:45.239 --> 05:48.290\n那手术治疗的适应症和术式的选择，\n\n05:48.489 --> 05:51.239\n那就是有哪些就是说。\n\n05:52.234 --> 05:52.410\n嗯，\n\n05:52.410 --> 05:55.010\n那有哪些患者适合手术治疗呢？\n\n05:55.010 --> 05:55.334\n嗯，\n\n05:55.484 --> 05:57.410\n来看一下这个手术治疗适应症啊。\n\n05:57.410 --> 06:00.484\n比如这个慢性鼻窦炎伴鼻息肉很多情况下呢，\n\n06:00.484 --> 06:01.434\n就是这个鼻息肉啊，\n\n06:01.434 --> 06:02.684\n它堵塞了这个窦口，\n\n06:02.684 --> 06:06.635\n导致了这个鼻窦就鼻窦腔里面的这个分泌物啊，\n\n06:07.035 --> 06:08.184\n排不出来啊，\n\n06:08.184 --> 06:09.035\n久而久之呢，\n\n06:09.035 --> 06:11.084\n就会就会形成鼻窦炎。\n\n06:11.834 --> 06:12.934\n那我们在书中呢，\n\n06:12.934 --> 06:14.584\n也经常能看到这个鼻窦里面，\n\n06:14.684 --> 06:15.984\n特别是上颌窦里面。\n\n06:16.743 --> 06:18.243\n积了很多脓，\n\n06:19.243 --> 06:19.843\n然后呢，\n\n06:19.843 --> 06:20.919\n那个里面的粘膜啊，\n\n06:20.919 --> 06:22.194\n经过这种脓液的浸泡，\n\n06:22.194 --> 06:24.669\n都都都很就是啊，\n\n06:24.669 --> 06:27.794\n就是水肿的很厉害啊。\n\n06:28.194 --> 06:29.894\n这个慢性鼻窦炎伴鼻息肉啊，\n\n06:29.894 --> 06:33.993\n经过药物治疗无效或者伴有明显解剖结构的异常。\n\n06:34.394 --> 06:34.794\n嗯，\n\n06:35.194 --> 06:37.044\n那比如说有些就是患者么，\n\n06:37.044 --> 06:38.444\n他那个鼻中隔偏曲，\n\n06:38.644 --> 06:39.044\n嗯，\n\n06:40.544 --> 06:42.019\n这个偏的比较厉害啊，\n\n06:42.019 --> 06:45.394\n比如说他压迫了就是明显压迫了中鼻甲或者下鼻甲。\n\n06:45.894 --> 06:46.244\n就比如说，\n\n06:46.244 --> 06:47.119\n压迫了中鼻甲吧，\n\n06:47.119 --> 06:49.095\n就是导致了那个窦口鼻道复合体，\n\n06:49.095 --> 06:50.494\n就窦口都比较窄。\n\n06:50.494 --> 06:51.420\n那这样的话呢，\n\n06:51.420 --> 06:57.095\n就是也是会影响这个鼻窦内体内分泌物的排出的啊，\n\n06:57.095 --> 06:58.144\n也会引起鼻窦炎。\n\n07:00.059 --> 07:00.584\n还有呢，\n\n07:00.584 --> 07:02.510\n鼻窦就是鼻腔鼻窦的肿瘤，\n\n07:02.510 --> 07:05.135\n或者疑似疑似是恶性肿瘤。\n\n07:05.135 --> 07:05.760\n那比如说，\n\n07:05.760 --> 07:10.359\n那个叫什么叫什么内翻性乳头状瘤是吧，\n\n07:10.359 --> 07:10.684\n这个呢，\n\n07:10.684 --> 07:11.885\n是一个交界性的肿瘤，\n\n07:11.885 --> 07:12.234\n嗯，\n\n07:12.535 --> 07:15.184\n也是也是比较高发的吧。\n\n07:16.334 --> 07:16.934\n还有呢，\n\n07:16.934 --> 07:21.084\n就是颅面外伤后鼻窦骨折或或者是脑脊液鼻漏等等。\n\n07:21.285 --> 07:21.684\n嗯，\n\n07:21.684 --> 07:22.359\n那这些呢，\n\n07:22.359 --> 07:25.109\n是需要做手术的那术式选择现在呢，\n\n07:25.109 --> 07:29.584\n通常会选择鼻内镜下这个鼻窦手术是目前的的一个。\n\n07:29.656 --> 07:30.506\n这样的首选的方案，\n\n07:30.506 --> 07:31.906\n因为内镜技术的成熟呢，\n\n07:31.906 --> 07:37.055\n就是也嗯也使这个手术技术就是得到了很大的发展和改进。\n\n07:38.355 --> 07:39.406\n但是比内镜呢，\n\n07:39.406 --> 07:40.830\n具有这个视野清晰啊，\n\n07:40.830 --> 07:45.430\n这个操作精确和创伤小等优点。\n\n07:45.430 --> 07:46.006\n其次呢，\n\n07:46.006 --> 07:49.055\n上颌窦根治术这适用于上颌窦病变比较严重，\n\n07:49.205 --> 07:51.406\n窦口引流不畅等等。\n\n07:51.955 --> 07:53.080\n那这个手术呢，\n\n07:53.080 --> 07:55.756\n其实现在在临床上感觉已经做的比较少了，\n\n07:55.756 --> 07:56.156\n嗯，\n\n07:56.756 --> 07:59.455\n可能口腔颌面外科会因为牙的一些问题。\n\n07:59.808 --> 08:01.282\n会做这个手术的之前，\n\n08:01.282 --> 08:04.083\n因为之前就碰到过有有一个患者，\n\n08:04.083 --> 08:05.333\n他是因为阻生牙，\n\n08:05.333 --> 08:07.608\n然后就做了这个手术。\n\n08:08.108 --> 08:11.282\n上颌窦进去的估计对对对他的，\n\n08:11.282 --> 08:11.858\n那个左肾，\n\n08:11.858 --> 08:15.407\n你要进行一些处理。\n\n08:16.917 --> 08:17.967\n其他的术式，\n\n08:17.967 --> 08:20.417\n那那比如这个前额镜手术，\n\n08:20.417 --> 08:24.317\n颅面联合进入手术等等啊，\n\n08:24.317 --> 08:30.342\n这个需要根据具体的病情来选择合适的手术术前准备和术后处理。\n\n08:30.342 --> 08:31.192\n术前呢，\n\n08:31.192 --> 08:34.418\n需要进行全面检查评估病情及手术风险。\n\n08:34.567 --> 08:36.918\n术后需定期随访清理鼻腔，\n\n08:36.918 --> 08:38.218\n使用抗生素等等，\n\n08:38.317 --> 08:41.168\n以促进恢复及预防并发症，\n\n08:41.168 --> 08:41.492\n对吧？\n\n08:41.492 --> 08:42.117\n术后呢，\n\n08:42.117 --> 08:42.518\n嗯，\n\n08:42.968 --> 08:44.067\n需要定期随访，\n\n08:44.067 --> 08:46.418\n就是看一下这个鼻腔就有没有粘连，\n\n08:46.718 --> 08:47.117\n对吧？\n\n08:47.184 --> 08:48.833\n以及术后这个鼻腔粘膜，\n\n08:48.833 --> 08:53.033\n鼻腔粘膜就是恢复的情况，\n\n08:53.234 --> 08:54.908\n还有就是辅助治疗，\n\n08:54.908 --> 08:56.633\n如冲洗的鼻腔冲洗，\n\n08:56.783 --> 08:59.809\n利用生理盐水等液体对鼻腔进行冲洗，\n\n08:59.809 --> 09:01.833\n有助于清除鼻腔内的分泌物，\n\n09:01.934 --> 09:03.484\n从而改善鼻腔通气。\n\n09:03.783 --> 09:05.633\n那其实对于这个鼻腔冲洗啊，\n\n09:05.633 --> 09:08.734\n也有我也跟很多同行就是交流过，\n\n09:08.734 --> 09:10.809\n有些就是有些老师呢，\n\n09:10.809 --> 09:11.984\n他们就是也反。\n\n09:12.567 --> 09:14.091\n也就并不支持这个鼻腔冲洗，\n\n09:14.091 --> 09:15.517\n那比如说在鼻窦炎的时候，\n\n09:15.767 --> 09:17.291\n这鼻窦里面可能都是脓。\n\n09:17.291 --> 09:19.142\n你进行一个鼻腔冲洗，\n\n09:19.142 --> 09:24.492\n可能会导致这个就是就这个感染扩散，\n\n09:24.492 --> 09:24.817\n对吧，\n\n09:24.817 --> 09:30.166\n可能会把这个脓液就感染灶冲洗到别的鼻窦啊，\n\n09:30.166 --> 09:31.966\n或者鼻腔的其他地方啊，\n\n09:31.966 --> 09:34.617\n从而这个加重感染可使这个感染扩散，\n\n09:35.166 --> 09:37.341\n那也是有这方面的因素的对吧？\n\n09:37.341 --> 09:38.117\n那有些老师呢，\n\n09:38.117 --> 09:41.317\n也是那个是比较支持这个鼻腔冲洗的，\n\n09:41.317 --> 09:42.767\n觉得这个鼻腔冲洗可以把。\n\n09:42.823 --> 09:47.723\n把这个鼻窦里面的或者鼻腔里面的这个脓性分泌物都排出去是吧？\n\n09:48.924 --> 09:49.499\n还有呢，\n\n09:49.499 --> 09:51.648\n就是鼻窦负压置换疗法。\n\n09:51.648 --> 09:53.299\n通过负压吸引的原理，\n\n09:53.299 --> 09:54.874\n将药物滴入鼻窦内，\n\n09:54.874 --> 09:56.723\n促进鼻窦内分泌物的排出。\n\n09:57.023 --> 09:58.223\n按照雾化治疗，\n\n09:58.223 --> 10:00.773\n利用雾化器将药物变成微小的颗粒，\n\n10:00.773 --> 10:02.723\n通过呼吸进入鼻腔鼻窦，\n\n10:02.773 --> 10:05.223\n从而达到治疗的目的。\n\n10:06.044 --> 10:06.294\n好，\n\n10:06.395 --> 10:12.195\n那我们再来看一下患者日常管理与生活与生活调整方面的建议啊，\n\n10:12.195 --> 10:13.320\n避免诱发因素，\n\n10:13.320 --> 10:14.969\n减少急性发作的风险。\n\n10:14.969 --> 10:15.544\n比如，\n\n10:15.594 --> 10:17.145\n那有过敏性鼻炎的患者呢，\n\n10:17.145 --> 10:19.119\n要这个避免接触过敏源，\n\n10:19.119 --> 10:21.544\n比如花粉、尘螨、动物的皮毛等等。\n\n10:21.744 --> 10:22.320\n其次呢，\n\n10:22.320 --> 10:24.969\n要保持室内的空室内空气清新，\n\n10:24.969 --> 10:26.094\n定期开窗通风，\n\n10:26.094 --> 10:27.244\n避免空气污染。\n\n10:27.395 --> 10:27.895\n还有呢，\n\n10:27.895 --> 10:28.770\n就是增强体质，\n\n10:28.770 --> 10:29.544\n适当锻炼，\n\n10:29.544 --> 10:30.369\n提高身体，\n\n10:30.369 --> 10:33.744\n免疫力预防感冒等等这个上呼吸道感染疾病啊，\n\n10:33.744 --> 10:34.794\n那我前面也说过，\n\n10:34.794 --> 10:36.294\n这个上呼吸道感染是会。\n\n10:36.356 --> 10:38.505\n可以导致这个鼻窦炎的加重和急性发作，\n\n10:38.556 --> 10:40.481\n从而引起这个一系列的症状，\n\n10:40.481 --> 10:46.080\n比如流脓鼻涕、头痛、眶周疼痛等等。\n\n10:46.080 --> 10:46.556\n还有呢，\n\n10:46.556 --> 10:48.481\n就是合理的饮食啊，\n\n10:48.481 --> 10:49.806\n就是增强免疫力，\n\n10:49.806 --> 10:51.281\n均衡饮食，\n\n10:51.281 --> 10:55.505\n增加蔬菜水果和全谷类食物的摄入，\n\n10:55.505 --> 11:00.306\n以获足以以以获取这个充足的维生素和矿物质。\n\n11:00.505 --> 11:01.056\n还有呢，\n\n11:01.056 --> 11:01.931\n就是高蛋白饮食，\n\n11:01.931 --> 11:05.830\n适当增加鱼、肉、蛋、豆类等富含优质蛋白的食物。\n\n11:05.830 --> 11:06.306\n有助于。\n\n11:06.340 --> 11:07.715\n可以提高免疫力，\n\n11:07.715 --> 11:08.989\n避免刺激性食物，\n\n11:08.989 --> 11:12.465\n减少辛辣、油腻、烟酒等刺激性食物的摄入，\n\n11:12.465 --> 11:14.190\n避免加重鼻窦炎的症状。\n\n11:16.359 --> 11:17.984\n还能保持良好的心态，\n\n11:17.984 --> 11:19.210\n积极面对疾病。\n\n11:19.210 --> 11:20.210\n对，\n\n11:20.309 --> 11:21.135\n那首先呢，\n\n11:21.135 --> 11:22.859\n就要正确认识疾病，\n\n11:22.859 --> 11:25.734\n就了解慢性鼻窦炎的性质和治疗过程，\n\n11:25.734 --> 11:28.210\n避免过度焦焦虑和急躁。\n\n11:28.309 --> 11:29.385\n那有些患者呢，\n\n11:29.385 --> 11:31.460\n他可能知道自己有有鼻窦炎，\n\n11:31.460 --> 11:34.010\n他就担心这个鼻窦炎会不会引起恶变，\n\n11:34.159 --> 11:34.609\n对吧，\n\n11:34.609 --> 11:35.085\n那这个呢，\n\n11:35.085 --> 11:36.460\n一般是不会的啊。\n\n11:38.140 --> 11:38.690\n其次呢，\n\n11:38.690 --> 11:39.440\n就，\n\n11:39.539 --> 11:40.715\n就是树立信心啊，\n\n11:40.715 --> 11:42.239\n相信自己能够战胜疾病，\n\n11:42.239 --> 11:43.965\n积极配合医生的建议，\n\n11:43.965 --> 11:46.015\n医生的治疗和建议，\n\n11:46.015 --> 11:46.914\n寻求支持，\n\n11:46.914 --> 11:50.440\n就是与家人朋友或者病友交流分享治病心得，\n\n11:50.440 --> 11:51.739\n然后相互鼓励。\n\n11:54.216 --> 11:54.440\n嗯，\n\n11:54.440 --> 11:54.741\n好。\n\n11:54.741 --> 11:58.690\n那这个预后的评估和随访计划制定对吧？\n\n11:58.690 --> 11:59.491\n那这鼻窦炎，\n\n11:59.491 --> 12:02.515\n它这个治疗预后就是该怎么评估的吧？\n\n12:02.565 --> 12:05.991\n就是我们要怎么就是来评估这个需不需要手术，\n\n12:05.991 --> 12:08.716\n和这个就治疗后的效果怎么怎么怎么样？\n\n12:08.866 --> 12:09.291\n对吧？\n\n12:09.291 --> 12:11.515\n那先看一下预后评估指标和方法。\n\n12:13.306 --> 12:13.656\n嗯。\n\n12:15.267 --> 12:15.841\n那首先呢，\n\n12:15.841 --> 12:20.117\n就是肯定要根据这个症状改善的情况来评估一下，\n\n12:20.117 --> 12:20.567\n对吧？\n\n12:20.767 --> 12:27.817\n通过对患者鼻塞、流涕、头痛等慢性鼻窦炎相关症状改善程度进行评估来判断治疗效果，\n\n12:27.817 --> 12:28.117\n对吧？\n\n12:28.117 --> 12:28.867\n有些患者呢，\n\n12:28.867 --> 12:29.817\n就用药之后呢，\n\n12:29.817 --> 12:32.492\n这个流脓鼻涕还有呢，\n\n12:32.492 --> 12:34.317\n头痛的症状明显好转的。\n\n12:34.617 --> 12:35.017\n嗯，\n\n12:35.216 --> 12:35.867\n其次呢，\n\n12:35.867 --> 12:37.541\n可以通过这个鼻窦CT的检查，\n\n12:37.541 --> 12:40.166\n通过鼻窦CT检查来观察鼻窦内炎症病，\n\n12:40.166 --> 12:42.142\n就炎症病变的情况啊，\n\n12:42.142 --> 12:43.317\n来评估治疗效果，\n\n12:43.317 --> 12:45.466\n那有些患者确实就是用完药之后。\n\n12:45.539 --> 12:45.815\n然后呢，\n\n12:45.815 --> 12:46.789\n就用了药之后呢，\n\n12:46.789 --> 12:51.565\n它这个鼻窦里面的脓这种分泌物明显要少了很多。\n\n12:51.565 --> 12:51.864\n对，\n\n12:51.864 --> 12:53.890\n但是就是也有很多患者呢，\n\n12:53.890 --> 12:54.565\n用了之后呢，\n\n12:54.565 --> 12:57.164\n鼻窦里面的情况也也也不大好。\n\n12:57.164 --> 13:01.364\n那那通常可能就需要手术了。\n\n13:01.364 --> 13:02.039\n其次呢，\n\n13:02.039 --> 13:05.414\n可以根据患者的这个这个生活质量进行评估，\n\n13:05.414 --> 13:09.065\n利用生活质量评估量表对患者的生活质量来进行评估，\n\n13:09.065 --> 13:12.690\n判断疾病对患者生活的影响，\n\n13:12.690 --> 13:14.364\n定期随访，\n\n13:14.364 --> 13:15.340\n时间安排。\n\n13:15.536 --> 13:16.310\n和检查的内容，\n\n13:16.310 --> 13:17.960\n那这个随访时间安排呢，\n\n13:17.960 --> 13:19.960\n就是随访时间啊，\n\n13:19.960 --> 13:23.435\n可以根据患者病情和治疗方案来进行调整。\n\n13:23.536 --> 13:24.210\n通常呢，\n\n13:24.210 --> 13:27.935\n是建议在治疗后初期每月随访一次，\n\n13:28.135 --> 13:28.986\n之后呢，\n\n13:29.236 --> 13:32.435\n逐渐延长至每两到3个月随访一次。\n\n13:33.935 --> 13:34.335\n嗯，\n\n13:34.435 --> 13:36.161\n那主要检查的内容呢，\n\n13:36.161 --> 13:42.536\n就是是包括主要包括这个症状的评估和鼻窦CT的检查，\n\n13:42.536 --> 13:44.210\n以及鼻内镜的检查等等，\n\n13:44.210 --> 13:45.185\n以全面。\n\n13:45.578 --> 13:47.502\n就是了解患者的病情啊，\n\n13:47.502 --> 13:50.252\n主要还是要根据这个患者需要啊，\n\n13:50.252 --> 13:52.752\n来来制定定期随访计划，\n\n13:52.752 --> 13:55.978\n以监测这个病情的变化和这个治疗效果，\n\n13:56.228 --> 13:56.627\n对吧，\n\n13:56.627 --> 13:57.603\n那有些患者呢，\n\n13:57.603 --> 13:59.578\n也就是也比较那个就是。\n\n14:00.508 --> 14:01.559\n就比较心大吧，\n\n14:01.559 --> 14:04.458\n他们可能就是用一点药之后就觉得好了，\n\n14:04.809 --> 14:06.609\n然后可能就自己把药停了。\n\n14:06.609 --> 14:08.059\n那很多，\n\n14:08.809 --> 14:10.658\n那可能过了一两周对吧，\n\n14:10.658 --> 14:11.833\n或者过了一两个月呢，\n\n14:11.833 --> 14:12.934\n症状又发作了，\n\n14:12.934 --> 14:13.734\n对就是这样，\n\n14:13.734 --> 14:14.958\n就反反复复的发作。\n\n14:15.309 --> 14:15.708\n嗯，\n\n14:17.208 --> 14:17.609\n好，\n\n14:18.809 --> 14:19.184\n嗯，\n\n14:19.184 --> 14:23.283\n那再看一下这个复发的风险预测及干预措施，\n\n14:23.283 --> 14:25.208\n通过评估患者的病史啊，\n\n14:25.208 --> 14:27.309\n生活习惯环境因素等等，\n\n14:27.309 --> 14:29.359\n预测慢性鼻窦炎的复发风险。\n\n14:29.508 --> 14:30.708\n借助鼻窦CT等。\n\n14:30.744 --> 14:33.343\n等检查结果来分析鼻窦内病变的情况，\n\n14:33.544 --> 14:35.193\n判断复发的可能性。\n\n14:35.494 --> 14:36.044\n然后呢，\n\n14:36.044 --> 14:37.593\n就再来看一下干预的措施。\n\n14:37.593 --> 14:38.468\n药物治疗，\n\n14:38.468 --> 14:43.169\n首先根据患者病情给予可以给予局部或者全身药物治疗，\n\n14:43.169 --> 14:45.544\n以控制炎症缓解症状。\n\n14:45.544 --> 14:46.768\n手术治疗，\n\n14:46.768 --> 14:49.718\n对于药物治疗效果不佳或者病情严重的患者，\n\n14:49.718 --> 14:51.044\n可以考虑手术治疗，\n\n14:51.044 --> 14:52.994\n如比如鼻内镜手术啊，\n\n14:52.994 --> 14:55.943\n这是现在最最常最常见的一个手术。\n\n14:56.997 --> 14:57.447\n其次呢，\n\n14:57.447 --> 14:58.497\n就是生活的调理。\n\n14:58.546 --> 14:59.546\n建议患者呢，\n\n14:59.546 --> 15:00.997\n保持良好的生活习惯，\n\n15:01.747 --> 15:03.296\n比如戒烟戒酒。\n\n15:04.307 --> 15:05.333\n加强锻炼等等，\n\n15:05.333 --> 15:07.757\n以降低这个复发的风险。\n\n15:07.757 --> 15:08.357\n好了，\n\n15:08.507 --> 15:09.482\n嗯，\n\n15:09.482 --> 15:10.658\n感谢大家的聆听。\n\n","v0d47cg10004d61b65aljht5lfeamnr0",912,589,"2026-01-24 23:51:04","慢性鼻窦炎怎么治疗？专业治疗方案及日常护理指南  ","慢性鼻窦炎治疗,鼻窦炎症状缓解,药物治疗鼻窦炎,鼻窦炎手术,中医治疗鼻窦炎  ","本文详细介绍慢性鼻窦炎的综合治疗方案，包括药物、手术及中医调理方法，并提供日常护理建议，帮助缓解鼻塞、头痛等症状，预防复发。","2026-04-03 10:30:00",[37],{"menuId":38,"menuName":39,"parentId":17,"orderNum":22,"path":40,"component":41,"isFrame":42,"isCache":43,"menuType":44,"visible":26,"status":17,"createDept":6,"remark":24,"createTime":45,"children":46,"columnImage":47,"columnLogo":48,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":49,"seoKeywords":50,"seoDescription":51,"contentNum":6,"promotionalPoster":52,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":53,"routerPath":40,"componentInfo":41},"1986622624134549505","科普视频","video","/video.html","1","0","T","2025-11-07 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