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--> 00:03.426\n已经开始了，\n\n00:04.026 --> 00:04.375\n嗯，\n\n00:04.375 --> 00:06.926\n首先我们讲一下那个慢阻肺啊。\n\n00:08.539 --> 00:09.465\n我国慢阻肺呢，\n\n00:09.465 --> 00:12.489\n呈现一个高发病高死亡的态势，\n\n00:13.039 --> 00:13.390\n嗯，\n\n00:13.390 --> 00:14.689\n整体的患病率呢，\n\n00:14.689 --> 00:16.840\n是为8.6%，\n\n00:16.840 --> 00:17.514\n人口呢，\n\n00:17.514 --> 00:18.340\n估算人口呢，\n\n00:18.340 --> 00:18.639\n是。\n\n00:19.947 --> 00:20.172\n嗯，\n\n00:20.172 --> 00:21.072\n一个亿左右，\n\n00:21.072 --> 00:21.922\n从其中呢，\n\n00:21.922 --> 00:24.947\n是男性发病率明显的是高于女性，\n\n00:25.447 --> 00:25.847\n嗯，\n\n00:25.847 --> 00:27.547\n大于四十岁以上的呢，\n\n00:27.547 --> 00:30.347\n是高于20到三十九岁以上的。\n\n00:30.347 --> 00:31.047\n然后呢，\n\n00:31.047 --> 00:32.597\n是农村是高于城市。\n\n00:33.347 --> 00:33.696\n嗯，\n\n00:33.696 --> 00:34.771\n主要存在因素呢，\n\n00:34.771 --> 00:37.071\n是我国的慢阻肺的那个患者呢，\n\n00:37.071 --> 00:38.747\n对疾病的认知不足，\n\n00:39.297 --> 00:41.396\n肺功能的检测率是比较低。\n\n00:42.597 --> 00:42.997\n嗯，\n\n00:43.247 --> 00:43.946\n这个呢，\n\n00:43.946 --> 00:46.172\n可以看一下我国的慢阻肺的患者呢，\n\n00:46.172 --> 00:47.821\n自我意识到病情的比例呢，\n\n00:47.821 --> 00:49.297\n仅占2.6%，\n\n00:49.696 --> 00:50.297\n其中。\n\n00:50.511 --> 00:54.410\n是接受过肺功能检查的成人比例仅为9.7%，\n\n00:55.210 --> 00:56.011\n然后呢，\n\n00:56.160 --> 01:00.361\n接受过肺功能检查的慢阻肺的患者比例是12%。\n\n01:01.011 --> 01:01.410\n嗯，\n\n01:01.410 --> 01:06.810\n自述有慢阻肺病史且接受过肺功能检查的患者比例呢，\n\n01:06.810 --> 01:08.460\n是55.8%。\n\n01:09.210 --> 01:09.560\n嗯，\n\n01:09.560 --> 01:10.861\n慢阻肺的管理呢，\n\n01:10.861 --> 01:12.036\n是基层是关键。\n\n01:12.036 --> 01:15.861\n基层是慢阻肺管理的第一线以及是主战场。\n\n01:16.411 --> 01:17.486\n首先第一线呢，\n\n01:17.486 --> 01:20.310\n是慢阻肺的早期症状是不明显的患者。\n\n01:20.497 --> 01:22.972\n是基本上都是在基层就诊，\n\n01:23.522 --> 01:24.647\n而组装厂呢，\n\n01:24.647 --> 01:30.647\n是因为涉及到了处防诊控治康多方面需要呢，\n\n01:30.647 --> 01:32.022\n强化分级诊疗，\n\n01:32.222 --> 01:32.546\n嗯，\n\n01:32.546 --> 01:35.347\n将基层医生纳入管理队伍中，\n\n01:35.347 --> 01:37.972\n让更多的患者得到良好的管理。\n\n01:39.587 --> 01:40.237\n因此呢，\n\n01:40.237 --> 01:41.763\n是慢阻肺呢，\n\n01:41.763 --> 01:44.087\n被纳入了国家分级诊疗政策，\n\n01:44.087 --> 01:48.388\n防治慢病中长期规划，\n\n01:48.388 --> 01:49.188\n2017.2025计划呢，\n\n01:49.188 --> 01:54.288\n是在基层逐步提供促进慢病早期发现服务，\n\n01:54.288 --> 01:55.638\n落实分级诊疗。\n\n01:56.842 --> 02:01.666\n国务院呢关于健康中国行动的意见提示呢，\n\n02:01.666 --> 02:03.692\n是普及肺功能检查，\n\n02:03.791 --> 02:07.291\n提高基层肺功能检查能力。\n\n02:07.291 --> 02:10.516\n健康中国行动2019.2030提示呢，\n\n02:10.516 --> 02:13.216\n是提高基层防治能力和水平，\n\n02:13.216 --> 02:14.492\n落实分级诊疗。\n\n02:16.272 --> 02:16.572\n嗯，\n\n02:16.871 --> 02:20.546\n筑牢慢阻肺管理的第一条道防线，\n\n02:20.546 --> 02:23.772\n应该是把握慢阻肺集中管理的三个关节，\n\n02:23.772 --> 02:28.796\n一个是主动筛查诊断慢阻肺高危的人群。\n\n02:28.796 --> 02:30.647\n慢阻肺的定义呢，\n\n02:30.647 --> 02:35.822\n是指一种常见的可预防和治疗的慢性气道疾病，\n\n02:35.822 --> 02:37.621\n存在明显的抑制性，\n\n02:37.972 --> 02:43.322\n其特征是持续存在的气道受限和相应的呼吸系统症状。\n\n02:43.772 --> 02:46.572\n其病理学的改变主要是气道和。\n\n02:46.712 --> 02:52.188\n肺泡的异常通常与显著暴露于有害颗粒或气体相关，\n\n02:52.188 --> 02:58.313\n遗传易感性异常的炎症反应以及是肺异常发育等。\n\n02:59.164 --> 03:00.063\n众多的宿主，\n\n03:00.063 --> 03:02.113\n差异的发病过程。\n\n03:03.188 --> 03:03.587\n然后呢，\n\n03:03.587 --> 03:05.188\n是2023 GID呢，\n\n03:05.188 --> 03:05.712\n提示呢，\n\n03:05.712 --> 03:08.587\n是强调慢阻肺是一种抑制性的肺部疾病，\n\n03:08.587 --> 03:10.938\n其特征是由于气道异常，\n\n03:11.888 --> 03:14.787\n嗯肺泡引起的慢性呼吸道症状，\n\n03:15.188 --> 03:18.587\n导致持续的反复恶化的气流阻塞。\n\n03:20.315 --> 03:20.466\n嗯，\n\n03:20.466 --> 03:22.716\n慢阻肺和慢性支气管炎呢，\n\n03:22.766 --> 03:23.341\n以及呢，\n\n03:23.341 --> 03:24.615\n肺气肿的概念呢，\n\n03:24.615 --> 03:26.190\n澄清一个呢，\n\n03:26.190 --> 03:27.740\n是慢性支气管炎呢，\n\n03:27.740 --> 03:31.466\n是在除慢性咳嗽的其他已知。\n\n03:32.251 --> 03:37.026\n病因后每年咳嗽、咳痰超过累计3个月内以上，\n\n03:37.026 --> 03:38.751\n并持续两年以上。\n\n03:40.384 --> 03:41.108\n而肺气肿呢，\n\n03:41.108 --> 03:47.983\n是肺中末细支气管远端气管气腔出现异常持久的扩张，\n\n03:47.983 --> 03:53.783\n并伴有肺泡壁以及血支气管破坏而无明显的肺纤维化。\n\n03:54.684 --> 03:55.684\n而慢阻肺呢，\n\n03:55.684 --> 04:02.134\n当慢性支气管炎和肺气肿的肺功能检测出现持续性的气流受阻，\n\n04:02.533 --> 04:04.158\n则可诊断为慢阻肺。\n\n04:04.158 --> 04:10.583\n如今有慢性支气管炎以及是肺气肿而无持续的气流。\n\n04:10.639 --> 04:11.089\n受阻呢，\n\n04:11.089 --> 04:12.889\n是不能诊断为慢阻肺。\n\n04:14.770 --> 04:17.019\n识别慢阻肺高危人群呢，\n\n04:17.019 --> 04:20.695\n应该符合以下一一个及以上的特征，\n\n04:20.695 --> 04:21.144\n一个呢，\n\n04:21.144 --> 04:22.445\n是有烟草的接触。\n\n04:22.545 --> 04:23.095\n第二呢，\n\n04:23.095 --> 04:24.045\n是环境因素，\n\n04:24.144 --> 04:26.445\n比如说空气污染严重的地区啊，\n\n04:26.445 --> 04:29.144\n二氧化硫等有害气体污染的地区啊。\n\n04:29.924 --> 04:30.299\n年龄呢，\n\n04:30.299 --> 04:31.600\n是要大于等于四四岁。\n\n04:31.600 --> 04:32.350\n疾病时呢，\n\n04:32.350 --> 04:35.174\n有患有某些特异性的疾病，\n\n04:35.174 --> 04:36.924\n比如说支气管哮喘啊，\n\n04:37.225 --> 04:40.375\n过敏性鼻炎、慢性支气管炎、肺气肿等。\n\n04:40.424 --> 04:42.075\n婴儿时期的哮喘呢，\n\n04:42.524 --> 04:45.200\n那也是有价值的。\n\n04:45.200 --> 04:45.850\n遗传呢，\n\n04:45.850 --> 04:48.024\n是直系家属中的有慢阻肺的。\n\n04:48.841 --> 04:49.341\n家族史。\n\n04:50.957 --> 04:51.756\n营养因素呢，\n\n04:51.756 --> 04:52.981\n是维生素A缺乏，\n\n04:52.981 --> 04:55.157\n或者胎儿时期的肺功能发育不全，\n\n04:55.207 --> 04:56.557\n营养状况比较差，\n\n04:56.557 --> 04:58.481\n体重基数较低的人呢，\n\n04:58.481 --> 05:00.657\n也是相关性。\n\n05:01.928 --> 05:02.303\n嗯，\n\n05:02.303 --> 05:05.729\n主动筛查推动慢阻肺早诊早治，\n\n05:06.579 --> 05:11.204\n围绕不同人群阐述了那个肺功能筛查病例，\n\n05:11.204 --> 05:13.878\n发现工具对慢阻肺诊断的影响，\n\n05:14.479 --> 05:16.378\n主要是改善易漏诊的现状，\n\n05:16.678 --> 05:19.628\n推动早诊早治健康。\n\n05:19.628 --> 05:20.553\n中国提出呢，\n\n05:20.553 --> 05:26.479\n是建议40岁以上人群或慢性呼吸系统疾病高危人群呢，\n\n05:26.479 --> 05:27.928\n每年检查肺功能一次。\n\n05:28.278 --> 05:29.354\n主动病例呢，\n\n05:29.354 --> 05:31.979\n发现对应的是慢阻肺高危人群的诊。\n\n05:32.032 --> 05:33.183\n诊断和干预呢，\n\n05:33.183 --> 05:35.583\n是有重要的意义啊。\n\n05:35.583 --> 05:36.483\n已经在各国，\n\n05:36.483 --> 05:38.058\n尤其是在基层中呢，\n\n05:38.058 --> 05:41.183\n是践行英国一项研究显示呢，\n\n05:41.183 --> 05:43.782\n是针对40.79岁的人群，\n\n05:43.782 --> 05:50.833\n通过全科人群人医生主动病例发现方式诊断的慢阻肺病，\n\n05:50.933 --> 05:53.808\n那是高于常规机会性发现的病例，\n\n05:53.808 --> 05:54.308\n而且呢，\n\n05:54.308 --> 05:55.882\n是成本效益比较高。\n\n05:58.161 --> 05:58.562\n这个呢，\n\n05:58.562 --> 05:59.812\n是慢阻肺的筛查，\n\n05:59.812 --> 06:03.736\n以及是早筛问卷及分流术仪。\n\n06:03.986 --> 06:04.636\n这个呢，\n\n06:05.486 --> 06:06.462\n早筛问卷呢，\n\n06:06.462 --> 06:07.486\n是全科医生呢，\n\n06:07.486 --> 06:10.587\n通过慢阻肺早筛问卷来筛查高危人群。\n\n06:11.236 --> 06:16.587\n对疑诊患者可能选择向上一级医院转诊进一步确诊。\n\n06:17.286 --> 06:17.687\n嗯，\n\n06:17.736 --> 06:19.611\n这个慢阻肺调查问卷呢，\n\n06:19.611 --> 06:21.486\n是总分大于等于16分，\n\n06:21.486 --> 06:24.136\n需要进一步检查明确是否存在慢阻肺。\n\n06:25.932 --> 06:30.032\n风流术应是一种可以发现部分的慢阻肺患者，\n\n06:30.032 --> 06:32.432\n对于气流受限程度高，\n\n06:32.782 --> 06:34.282\n急性加重风险高，\n\n06:34.282 --> 06:38.207\n需考虑药物治疗以缓解症状的患者呢，\n\n06:38.207 --> 06:39.182\n是尤为敏感。\n\n06:39.682 --> 06:40.557\n嗯，\n\n06:40.557 --> 06:44.407\nPEF占正常预计值的80%.100%呢，\n\n06:44.407 --> 06:46.381\n则处于那个。\n\n06:47.277 --> 06:47.976\n安全值，\n\n06:48.326 --> 06:49.677\n然后呢，\n\n06:49.677 --> 06:52.515\nPEF是小于80，\n\n06:52.515 --> 06:54.552\n80%以上可能存在慢阻肺，\n\n06:54.552 --> 06:56.826\n也需要做进一步的筛查。\n\n06:58.213 --> 06:58.539\n这个呢，\n\n06:58.539 --> 07:05.914\n是英国基于社区的寻找病理计划主动筛查慢阻肺高危人群。\n\n07:06.313 --> 07:06.664\n嗯，\n\n07:06.664 --> 07:10.614\n是可以减少基层对于慢阻肺的筛查工作。\n\n07:11.264 --> 07:11.914\n然后呢，\n\n07:11.914 --> 07:12.563\n通过呢，\n\n07:12.563 --> 07:16.088\n慢阻肺的电子评分筛查出慢阻肺风险者，\n\n07:16.088 --> 07:19.164\n由全科医生外联专家组啊，\n\n07:19.164 --> 07:23.063\n在社区医院提供综合性的服务。\n\n07:25.369 --> 07:26.970\n脉阻肺的那个诊断呢，\n\n07:27.119 --> 07:28.920\n肺功能检查是关键。\n\n07:28.970 --> 07:31.869\n主要症状表现为咳嗽、咳痰、呼吸困难。\n\n07:32.369 --> 07:32.720\n嗯，\n\n07:32.720 --> 07:34.019\n暴露的危险因素呢，\n\n07:34.019 --> 07:36.519\n是包括是烟草烟草暴露啊，\n\n07:36.519 --> 07:37.795\n职业暴露啊，\n\n07:37.795 --> 07:38.244\n以及呢，\n\n07:38.244 --> 07:39.519\n室内外的污染。\n\n07:40.972 --> 07:41.072\n嗯，\n\n07:41.072 --> 07:42.097\n慢阻肺患者呢，\n\n07:42.097 --> 07:48.822\n表现为那个FEV对FVC均明显的下降，\n\n07:49.622 --> 07:49.947\n嗯，\n\n07:49.947 --> 07:52.447\n可以检测出简单的气流受阻啊。\n\n07:52.447 --> 07:54.622\n吸入支气管扩张器以后呢，\n\n07:54.872 --> 07:56.622\n仍旧小于70%，\n\n07:56.972 --> 07:57.747\n表示呢，\n\n07:57.747 --> 07:59.222\n是存在气流的受限。\n\n08:02.122 --> 08:02.671\n这个呢，\n\n08:02.671 --> 08:03.872\n可以分级为四种，\n\n08:03.872 --> 08:06.221\n一个轻度是大于等于80%，\n\n08:06.221 --> 08:07.772\n重度呢，\n\n08:07.772 --> 08:08.272\n50%.80%，\n\n08:08.272 --> 08:10.921\n重度是30.50。\n\n08:11.872 --> 08:12.696\n其重度呢，\n\n08:12.696 --> 08:14.971\n是小于30%。\n\n08:15.421 --> 08:18.147\n鉴别慢阻肺与其他疾病的要点，\n\n08:18.147 --> 08:19.971\n一个是慢阻肺是中年发病，\n\n08:19.971 --> 08:24.221\n长期吸烟或其他烟雾接触史，\n\n08:24.221 --> 08:25.821\n症状缓慢进展，\n\n08:25.821 --> 08:26.471\n然后呢，\n\n08:26.471 --> 08:27.946\n急性加重期症状呢，\n\n08:27.946 --> 08:29.522\n超过日常变异病期呢，\n\n08:29.522 --> 08:30.497\n是持续的恶化。\n\n08:30.497 --> 08:31.171\n哮喘呢，\n\n08:31.171 --> 08:32.372\n指通常儿童期。\n\n08:32.429 --> 08:34.455\n疾病每日症状变化快，\n\n08:34.455 --> 08:35.479\n夜间和。\n\n08:36.523 --> 08:37.773\n清晨症状比较明显，\n\n08:37.773 --> 08:38.547\n可以过敏史，\n\n08:38.547 --> 08:39.572\n鼻炎或者湿疹，\n\n08:39.572 --> 08:40.872\n有哮喘家族史，\n\n08:41.322 --> 08:42.848\n充血性心力衰竭呢，\n\n08:42.848 --> 08:43.697\n是心片呢，\n\n08:43.697 --> 08:45.172\n可以解除心衰的症状。\n\n08:45.273 --> 08:46.047\n肺水肿，\n\n08:46.047 --> 08:47.122\n肺功能提示呢，\n\n08:47.122 --> 08:48.322\n有限制性的通气症，\n\n08:48.322 --> 08:51.223\n而非气流送阻刺控呢，\n\n08:51.223 --> 08:52.572\n一般是大量的咳痰，\n\n08:53.023 --> 08:54.023\n细菌感染。\n\n08:54.223 --> 08:56.122\n初次录用杵状时，\n\n08:56.172 --> 08:59.148\n胸片可以进肌金呢，\n\n08:59.148 --> 09:00.598\n可以见支气管扩张，\n\n09:00.598 --> 09:01.572\n管壁的增合。\n\n09:01.922 --> 09:02.773\n肺结核呢，\n\n09:02.773 --> 09:04.622\n所有年龄和均可发病。\n\n09:04.922 --> 09:06.723\n可以见肺气、人性的病。\n\n09:06.750 --> 09:08.875\n灶或者结节灶空洞性的改变，\n\n09:08.875 --> 09:10.200\n微生物检查呢，\n\n09:10.200 --> 09:12.500\n可以或者抗核客体也可以检查。\n\n09:14.239 --> 09:15.914\n慢阻肺的那个诊断流程呢，\n\n09:15.914 --> 09:17.489\n是年龄大于七四十啊，\n\n09:17.539 --> 09:19.138\n吸烟粉尘接触时啊，\n\n09:19.138 --> 09:20.338\n慢性咳嗽咳痰啊，\n\n09:20.838 --> 09:26.064\n呼吸困难者高危人群的筛查问卷问卷以及分流术语询问病史，\n\n09:26.064 --> 09:26.763\n体格检查。\n\n09:26.763 --> 09:27.364\n然后呢，\n\n09:27.364 --> 09:28.939\n是进入肺功能的检查，\n\n09:29.388 --> 09:32.364\n血常规胸片排除其他疾病检查呢，\n\n09:32.364 --> 09:36.739\n是那个F一V1比FVC小于零点七。\n\n09:36.989 --> 09:37.614\n然后呢，\n\n09:37.614 --> 09:39.263\n是经过支气管扩张器呢，\n\n09:39.263 --> 09:40.739\n仍就没明显的改变。\n\n09:43.133 --> 09:43.283\n嗯，\n\n09:43.283 --> 09:43.809\n然后呢，\n\n09:43.809 --> 09:44.958\n是把握基层呢，\n\n09:44.958 --> 09:46.633\n是要规范。\n\n09:48.171 --> 09:49.171\n稳规划，\n\n09:50.070 --> 09:50.971\n规范化，\n\n09:51.620 --> 09:52.671\n稳定期评估，\n\n09:52.671 --> 09:54.120\n以及是治疗和随访。\n\n09:55.562 --> 09:55.687\n嗯，\n\n09:55.687 --> 09:57.788\n慢阻肺的症状的评估，\n\n09:57.788 --> 09:59.538\n一个是分为四级。\n\n09:59.538 --> 10:04.963\n五级一个是具体活动时才能才能那个感到呼吸困难。\n\n10:05.062 --> 10:05.737\n然后呢，\n\n10:05.737 --> 10:06.288\n第二个呢，\n\n10:06.288 --> 10:10.513\n是平地行走或是爬小山坡时出现气促。\n\n10:10.862 --> 10:11.538\n第四呢，\n\n10:11.538 --> 10:13.713\n是由于气促平地行走时较。\n\n10:14.875 --> 10:15.275\n童年慢，\n\n10:15.275 --> 10:17.825\n或者需要下床下停下来休息。\n\n10:17.924 --> 10:18.650\n第三呢，\n\n10:18.650 --> 10:21.174\n是平地行走100米就感到胸闷气气，\n\n10:21.174 --> 10:22.025\n需要喘气。\n\n10:22.724 --> 10:23.450\n第四呢，\n\n10:23.450 --> 10:25.099\n也是最严重的是呼吸困难，\n\n10:25.099 --> 10:26.375\n以至于不能离开家，\n\n10:26.375 --> 10:29.224\n或者在穿衣服脱衣服的时候就感到呼吸困难。\n\n10:30.547 --> 10:34.197\n简单的口腔是快走气阻、走机气阻和慢走气阻，\n\n10:34.197 --> 10:34.697\n以及呢，\n\n10:34.697 --> 10:36.447\n是稍动气阻、不动气阻。\n\n10:39.010 --> 10:39.109\n嗯，\n\n10:39.109 --> 10:40.984\n中国指南分为ABCD种，\n\n10:40.984 --> 10:41.809\n也就是说，\n\n10:41.809 --> 10:43.385\n一个是气流受限，\n\n10:43.385 --> 10:46.359\n一个中重度急性加重病史。\n\n10:46.659 --> 10:47.335\n第二呢，\n\n10:47.335 --> 10:49.309\n是大于一次或者两次，\n\n10:49.309 --> 10:51.559\n导致住院的急性加重。\n\n10:52.562 --> 10:52.862\n然后，\n\n10:52.862 --> 10:53.288\n最后呢，\n\n10:53.288 --> 10:56.763\n是0或零一次的急性加重慢阻肺，\n\n10:56.763 --> 10:58.187\n可以为IB一，\n\n10:58.288 --> 11:00.138\n也可以分为IB一四种。\n\n11:01.437 --> 11:02.088\n然后呢，\n\n11:02.088 --> 11:03.963\n慢阻肺的主要治疗药物呢，\n\n11:03.963 --> 11:05.237\n是支气管扩张剂，\n\n11:05.838 --> 11:08.713\n可以松解松弛支气管平滑肌，\n\n11:08.713 --> 11:09.638\n扩张支气管，\n\n11:09.638 --> 11:11.138\n缓解气流受限。\n\n11:11.969 --> 11:12.044\n嗯，\n\n11:12.044 --> 11:15.445\n贝塔受体激动剂以及是抗胆碱的药物，\n\n11:15.445 --> 11:17.969\n主要是长效的吸吸吸入制剂。\n\n11:19.020 --> 11:19.770\n短期呢，\n\n11:19.770 --> 11:21.070\n氨需可以缓解症状。\n\n11:21.070 --> 11:23.395\n长期内一经可以预防和缓解症状，\n\n11:23.395 --> 11:24.419\n增加运动耐力。\n\n11:25.254 --> 11:25.578\n嗯，\n\n11:25.578 --> 11:27.828\n这个是短效的特普他林啊，\n\n11:27.828 --> 11:28.604\n沙丁胺醇啊，\n\n11:28.604 --> 11:30.528\n按需使用长效呢，\n\n11:30.528 --> 11:31.804\n包括沙特美罗啊，\n\n11:31.854 --> 11:33.354\n福福莫特罗。\n\n11:33.703 --> 11:34.028\n嗯，\n\n11:34.028 --> 11:35.004\n抗胆碱类呢，\n\n11:35.004 --> 11:38.604\n主要是异丙脱溴胺以及是赛托溴胺等。\n\n11:39.304 --> 11:40.054\n茶碱呢，\n\n11:40.054 --> 11:41.953\n也是可以解除支气管痉挛，\n\n11:42.104 --> 11:42.429\n嗯，\n\n11:42.429 --> 11:48.354\n舒张和全身肺血管改善呼吸肌功能及某些抗炎作用常见的不良反应的，\n\n11:48.354 --> 11:49.179\n这有恶心呕吐，\n\n11:49.179 --> 11:50.953\n腹痛头痛胸痛等。\n\n11:52.351 --> 11:53.651\n慢阻肺的其他的呢？\n\n11:53.651 --> 11:54.452\n抗炎药物呢？\n\n11:54.452 --> 11:56.427\n包括是侵入性的糖皮质激素。\n\n11:57.789 --> 12:00.763\n对于因急性加重而住院治疗呢，\n\n12:00.763 --> 12:03.564\n每年大于两次中中度急性加重呢，\n\n12:03.564 --> 12:05.088\n是强烈推荐使用的。\n\n12:06.039 --> 12:06.439\n嗯，\n\n12:06.439 --> 12:07.088\n还有呢，\n\n12:07.088 --> 12:08.064\n是其他的药物，\n\n12:08.064 --> 12:09.489\n包括是祛痰剂啊，\n\n12:09.588 --> 12:12.164\n包括那个氨溴索，\n\n12:12.164 --> 12:13.414\n乙酰半胱氨酸，\n\n12:13.414 --> 12:15.039\n氟多司坦安宁哌等。\n\n12:15.908 --> 12:16.309\n但是呢，\n\n12:16.309 --> 12:18.758\n是主要是有利于气道的通畅，\n\n12:18.758 --> 12:20.008\n改善通气功能。\n\n12:20.408 --> 12:21.408\n抗氧化剂呢，\n\n12:21.408 --> 12:24.383\n是一酰半氨酸半胱氨酸。\n\n12:24.383 --> 12:25.408\n而中成药呢，\n\n12:25.408 --> 12:26.883\n具有气痰刺激扩张，\n\n12:26.883 --> 12:28.359\n以及是没有调节作用。\n\n12:28.911 --> 12:30.637\n可以有效的缓解临床症状，\n\n12:30.637 --> 12:33.062\n改善肺功能和免疫功能，\n\n12:33.211 --> 12:35.012\n提高生活质量，\n\n12:35.012 --> 12:38.461\n但是仍需要大规模的对对照研究。\n\n12:40.414 --> 12:40.838\n这个呢，\n\n12:40.838 --> 12:42.689\n是慢阻肺的装置的选择呢，\n\n12:42.689 --> 12:44.838\n一个是传统的PNDI，\n\n12:44.838 --> 12:47.963\n以及是新型的DPI，\n\n12:47.963 --> 12:51.689\n以及是SNI慢阻肺稳定期的推荐治疗呢。\n\n12:51.689 --> 12:53.564\n中国指南是，\n\n12:54.364 --> 12:55.564\n可以就是说。\n\n12:56.640 --> 12:56.890\n嗯，\n\n12:57.840 --> 12:59.140\n条件允许的呢，\n\n12:59.440 --> 13:01.239\n使用INA，\n\n13:01.340 --> 13:02.039\n然后呢，\n\n13:02.039 --> 13:02.340\n是，\n\n13:02.989 --> 13:03.289\n嗯，\n\n13:03.289 --> 13:04.715\n稳定剂治疗呢，\n\n13:04.715 --> 13:07.539\n是一般性是推荐使用是。\n\n13:08.742 --> 13:08.817\n嗯，\n\n13:08.817 --> 13:11.343\n一次性的一种支气管扩张剂。\n\n13:12.538 --> 13:14.987\n然后是这个是首选，\n\n13:14.987 --> 13:15.538\n但是呢，\n\n13:15.538 --> 13:19.138\n不推荐使用是ICS+INBA。\n\n13:20.151 --> 13:20.351\n嗯，\n\n13:20.450 --> 13:23.950\n提倡的是慢阻肺的呼吸康复意是呢，\n\n13:23.950 --> 13:28.901\n是在全面评估的基础上为患者提供个体化的综合干预措施。\n\n13:28.950 --> 13:29.351\n嗯，\n\n13:29.750 --> 13:33.351\n包括但不限于运动锻炼、教育和行为改变。\n\n13:34.286 --> 13:39.736\n规律的运动锻炼是呼吸空康复的核心内容。\n\n13:39.736 --> 13:41.736\n这个首先是要健康状态评估啊，\n\n13:41.736 --> 13:44.437\n制定个体化的康复处方，\n\n13:44.687 --> 13:46.586\n以及康复效果的评估，\n\n13:46.637 --> 13:48.387\n康复处方的优化。\n\n13:50.142 --> 13:51.916\n慢阻肺的随访评估呢，\n\n13:51.916 --> 13:56.841\n是基于患者的症状和未来急性加重风险进行评估。\n\n13:56.841 --> 13:58.642\n3.6个月进行一次详细的随访，\n\n13:59.192 --> 13:59.841\n然后呢，\n\n13:59.841 --> 14:01.642\n根据实际的情况进行呢，\n\n14:01.892 --> 14:03.392\n嗯必要的调整。\n\n14:05.185 --> 14:05.385\n嗯，\n\n14:05.385 --> 14:06.585\n辨识和应急呢，\n\n14:06.585 --> 14:08.335\n慢阻肺的急重急性加重。\n\n14:08.335 --> 14:09.161\n急性加重呢，\n\n14:09.161 --> 14:11.335\n一般性是指呼吸困难啊，\n\n14:11.335 --> 14:12.385\n咳嗽咳痰加重啊。\n\n14:12.385 --> 14:14.060\n症状发生在14天以内，\n\n14:14.060 --> 14:16.111\n可能伴有呼吸急促，\n\n14:16.111 --> 14:21.060\n通常为呼吸道感染空气污染造成的局部或者是全身性的炎症加重，\n\n14:21.060 --> 14:23.335\n或者因损伤气道的原因加重。\n\n14:24.796 --> 14:24.971\n嗯，\n\n14:24.971 --> 14:26.846\n诱发因素是呼吸道感染，\n\n14:26.846 --> 14:27.846\n吸入过敏原，\n\n14:27.896 --> 14:30.396\n不规划的稳定性的治疗啊。\n\n14:30.796 --> 14:32.747\n你现在是痰液清除障碍。\n\n14:34.148 --> 14:34.497\n嗯，\n\n14:34.598 --> 14:35.223\n这个呢，\n\n14:35.223 --> 14:39.797\n应该是也要主动询问所有就诊患者的急诊以及住院史，\n\n14:39.997 --> 14:40.697\n然后呢，\n\n14:40.697 --> 14:43.997\n是询问患者的非计划门诊史。\n\n14:45.388 --> 14:46.013\n然后呢，\n\n14:46.013 --> 14:47.539\n也可以做一个问卷啊。\n\n14:48.666 --> 14:49.017\n嗯，\n\n14:49.216 --> 14:51.041\n急性期的家族治疗呢，\n\n14:51.041 --> 14:52.242\n一个是轻度的呢，\n\n14:52.242 --> 14:54.142\n单独使用短效的支气管扩张剂。\n\n14:54.142 --> 14:54.617\n中度呢，\n\n14:54.617 --> 14:58.242\n可以加用或不加用口服糖皮质激素。\n\n14:58.242 --> 14:59.091\n重度的话，\n\n14:59.091 --> 15:02.867\n应该是需要住院或者是急诊ICU治疗。\n\n15:04.307 --> 15:04.456\n嗯，\n\n15:04.456 --> 15:06.882\n转诊的那个指针以及呢，\n\n15:06.882 --> 15:08.132\n转诊前的处置呢，\n\n15:08.132 --> 15:10.456\n这个也是需要根据情况。\n\n15:11.007 --> 15:11.356\n嗯，\n\n15:11.356 --> 15:13.106\n出现重度的慢阻肺啊，\n\n15:13.106 --> 15:14.307\n出现新症状啊，\n\n15:14.307 --> 15:15.757\n有严重的合并症啊，\n\n15:15.956 --> 15:18.507\n促使药物的治疗失败啊，\n\n15:18.507 --> 15:21.757\n高度患者高龄患者诊断不明确等。\n\n15:23.072 --> 15:23.146\n嗯，\n\n15:23.146 --> 15:23.822\n总结一下呢，\n\n15:23.822 --> 15:27.171\n慢阻肺是作为第一线和主战场的基层医生呢，\n\n15:27.171 --> 15:29.521\n在慢阻肺管理中扮演的重要角色。\n\n15:30.072 --> 15:30.421\n嗯，\n\n15:30.421 --> 15:31.721\n第二是筛查呢，\n\n15:31.721 --> 15:33.122\n包括把握三个观点，\n\n15:33.622 --> 15:35.146\n三个观点主动筛查，\n\n15:35.146 --> 15:37.622\n规范化的评估治疗和随访，\n\n15:37.622 --> 15:40.421\n以及识别和应对进行加重，\n\n15:40.921 --> 15:41.721\n谢谢啊。\n\n","v0247cg10004d61eb72ljht5l73fcs4g",942,506,0,"2026-01-25 00:02:04","基层慢阻肺诊疗指南 - 症状识别、诊断与治疗全解析  ","慢阻肺基层诊疗,慢阻肺症状,慢阻肺诊断标准,慢阻肺治疗方案,基层医疗慢阻肺管理  ","本文提供基层医疗机构慢阻肺（COPD）诊疗全流程指南，涵盖早期症状识别、肺功能检查、分级诊断标准及个性化治疗方案，助力基层医生提升慢阻肺规范管理水平。","2026-04-09 12:00:00",[37],{"menuId":38,"menuName":39,"parentId":30,"orderNum":40,"path":41,"component":42,"isFrame":43,"isCache":44,"menuType":45,"visible":21,"status":30,"createDept":6,"remark":24,"createTime":46,"children":47,"columnImage":48,"columnLogo":49,"uncheckedLogo":6,"checkedLogo":6,"isHot":30,"isHome":30,"forceLogin":30,"color":6,"seoTitle":50,"seoKeywords":51,"seoDescription":52,"contentNum":6,"promotionalPoster":53,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":54,"routerPath":41,"componentInfo":42},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 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