[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"$f65-g5LTUgHIk8dGZIHhGe2pKpxnfW0g-O4HGxk3yxcs":3,"$fjYPMeDrBRMBBXIP2Wv3KoXUug_-7FHj1nvt_0bKZnSM":8,"$futrA4VPV2dIytqznoKOD9Wl-Tx3MdAbCtPcQtP-fIyk":60,"$feGl5-rA9JYJtKHFJdW835tSThcZp4mksdenov5-YjVs":61,"$fWlLDvbGFFmI1p4mZv4RMfGPG_I6X_mfoFueFfMADHUM":65},{"code":4,"msg":5,"message":6,"data":6,"success":7},401,"认证失败，无法访问系统资源",null,false,{"code":9,"msg":10,"message":6,"data":11,"success":59},200,"操作成功",{"id":12,"specialistId":13,"specialistAssistants":14,"profilePhoto":15,"specialistName":16,"roleType":17,"adept":18,"hospital":19,"department":20,"postsTitle":21,"materialTotal":22,"videoTotal":23,"isConcern":7,"title":24,"coverVertical":25,"coverAcross":26,"directionMarker":22,"description":27,"vid":28,"time":29,"mediaType":22,"views":30,"likes":17,"isThumbsUp":7,"isCollection":7,"collections":17,"createTime":31,"seoTitle":32,"seoKeywords":33,"seoDescription":34,"shelvesTime":35,"menus":36,"menuId":38,"type":55,"quality":56,"commentCount":17,"isComment":22,"deviceType":57,"url":58},10288,864317,[],"https://ystcdn.venuertc.com/medical/ystApp/ZNEfrOECfh5blyVCYIE0fL0yZmTJleEF.png","陆桢兵",0,"急危重症诊治、急诊气道管理、器官功能支持、血流动力学监测、急危重症超声诊断技术、心肺脑复苏等","上海交通大学医学院附属瑞金医院","急诊科","住院医师",1,7,"肺脓肿全方位解析","","https://cdn.yishi-tong.com/console/3/hHu3gBccP3jm77vZnMWBbYNV6ILDjhjm.png","WEBVTT\n\n00:00.230 --> 00:00.630\n看头。\n\n00:11.163 --> 00:11.588\n大家好，\n\n00:11.588 --> 00:14.312\n今天同大家一起分享一下辅助检查。\n\n00:16.922 --> 00:20.822\n我们先来看一下辅助检查当中的影像学检查，\n\n00:21.121 --> 00:23.771\n一个是X线胸片的表现。\n\n00:24.861 --> 00:29.961\nX胸片是诊断肺脓肿的常用初步检查方法。\n\n00:30.757 --> 00:32.106\n在肺脓肿早期，\n\n00:32.407 --> 00:37.506\n胸片可显示大片浓密模糊浸润阴影，\n\n00:38.207 --> 00:41.506\n扩展为团块片状的，\n\n00:41.506 --> 00:45.757\n这种浓密阴影分布在一个或数个肺段。\n\n00:46.407 --> 00:48.106\n随着病情的进展。\n\n00:49.139 --> 00:53.389\n当我们脓肿形成并与支气管相通后呢，\n\n00:53.590 --> 00:58.139\n可出现圆形透亮区及气液平面。\n\n00:58.689 --> 00:59.340\n例如，\n\n00:59.590 --> 01:03.090\n在一个急性肺脓肿患者的胸片上，\n\n01:03.189 --> 01:08.489\n能看到右肺下叶有一较大的圆形透亮区，\n\n01:08.940 --> 01:11.690\n其中有明显的气液平面。\n\n01:12.858 --> 01:15.458\n液平面上方为透亮的气体，\n\n01:15.708 --> 01:20.258\n下方为浓稠的脓液形成的致密，\n\n01:20.958 --> 01:23.858\n这是肺脓肿典型的X线表现。\n\n01:24.972 --> 01:29.272\n不同部位的肺脓肿在胸片上有不同的特征。\n\n01:30.832 --> 01:32.632\n如果是吸入性的肺脓肿，\n\n01:32.832 --> 01:35.931\n多发生在肺部的低垂部位，\n\n01:36.281 --> 01:40.082\n胸片可以显示相应部位的病变。\n\n01:43.195 --> 01:47.646\n我们再看一下CT扫描的优势，\n\n01:47.646 --> 01:54.396\nCT扫描对肺脓肿的诊断具有更高的准确性和敏感性，\n\n01:55.096 --> 02:03.445\n它能够更清晰的显示脓肿的大小、形态、部位以及与周围组织的关系。\n\n02:04.279 --> 02:07.529\n与X线相比，\n\n02:07.529 --> 02:15.229\nCT可以发现一些胸片难以显示的小脓肿或位于隐蔽部位的脓肿。\n\n02:16.175 --> 02:16.526\n例如，\n\n02:16.925 --> 02:22.876\n对于一些位于纵隔旁、心影后等部位的肺脓肿，\n\n02:22.876 --> 02:27.076\nCT能够准确的定位和显示病变细节。\n\n02:28.274 --> 02:29.574\n此外呢，\n\n02:29.574 --> 02:33.975\nCT还可以观察到肺部周围组织的情况，\n\n02:34.375 --> 02:39.675\n判断是否存在胸膜增厚、粘连等并发症。\n\n02:40.817 --> 02:44.167\n在CT增强的扫描当中，\n\n02:44.867 --> 02:47.518\n这个脓肿壁会出现强化，\n\n02:47.817 --> 02:52.167\n有助于其他肺部疾病进行鉴别诊断。\n\n02:56.289 --> 02:59.839\n再看磁共振成像的应用，\n\n02:59.839 --> 03:04.740\nMRI在肺脓肿的诊断中也有一定的应用价值，\n\n03:05.289 --> 03:09.940\n虽然MRI对肺部气体的显示不如CT。\n\n03:10.733 --> 03:13.582\n但它对软组织的分辨能力比较强。\n\n03:14.520 --> 03:21.445\n在判断肺脓肿与周围血管、神经等结构的关系方面，\n\n03:21.445 --> 03:23.220\nMRI具有独特的优势。\n\n03:23.621 --> 03:24.270\n例如，\n\n03:24.520 --> 03:29.421\n当需要明确肺脓肿是否侵犯周围大血管时。\n\n03:30.518 --> 03:37.244\nMRI可以通过多平面成像清晰的显示血管的形态和走形，\n\n03:37.843 --> 03:40.393\n以及与脓肿的位置关系，\n\n03:41.044 --> 03:46.244\n对于一些怀疑有血管受累的复杂肺脓肿病例。\n\n03:47.210 --> 03:52.485\nMi检查能够为制定治疗方案提供重要信息。\n\n03:53.524 --> 03:53.973\n不过呢，\n\n03:54.074 --> 03:56.712\n由于MRI检查费用比较高，\n\n03:56.712 --> 03:58.824\n检查的时间较长，\n\n03:59.223 --> 04:03.123\n且对体内有金属植入物的患者不适用，\n\n04:03.473 --> 04:09.123\n所以在临床上通常不作为肺脓肿的首选检查方法。\n\n04:10.520 --> 04:12.470\n我们再看一下实验室的检查，\n\n04:12.970 --> 04:18.420\n血常规的检查意义是肺脓肿实验室检查的基本项目。\n\n04:18.821 --> 04:20.571\n在肺脓肿患者中，\n\n04:20.920 --> 04:23.420\n白细胞计数通常会升高，\n\n04:23.621 --> 04:27.170\n一般可以超过10×10的9次方每升，\n\n04:27.471 --> 04:31.621\n甚至高达20到三十乘以10的九次方倍数。\n\n04:32.270 --> 04:32.971\n其中，\n\n04:33.121 --> 04:36.221\n中性粒细胞比例也会显著的增加，\n\n04:36.371 --> 04:39.020\n达到80%.90%以上，\n\n04:39.670 --> 04:40.571\n这是因为。\n\n04:40.752 --> 04:43.502\n细菌感染引发了机体的炎症反应。\n\n04:44.574 --> 04:48.373\n白细胞作为免疫系统的重要组成部分，\n\n04:49.123 --> 04:51.574\n会大量聚集到感染部位，\n\n04:51.723 --> 04:53.174\n以对抗病原体。\n\n04:54.493 --> 04:56.919\n一位肺脓肿患者的血常规结果显示，\n\n04:56.919 --> 05:01.019\n白细胞计数为18×10的9次方，\n\n05:01.019 --> 05:03.894\n中性粒细胞比例为85%，\n\n05:03.894 --> 05:07.993\n这就提示患者体内存在较为严重的细菌性感染。\n\n05:08.566 --> 05:09.467\n此外呢，\n\n05:09.467 --> 05:13.066\n红细胞沉降率ESR也会增快，\n\n05:13.367 --> 05:16.117\nC反应蛋白水平也会升高，\n\n05:16.566 --> 05:21.967\n这些指标都有助于判断病情的严重程度和炎症的活动情况。\n\n05:23.640 --> 05:23.940\n另外，\n\n05:23.940 --> 05:25.790\n痰液的检查与方法。\n\n05:27.610 --> 05:31.510\n痰液检查对于明确肺脓肿的病原体重要的意义，\n\n05:31.710 --> 05:35.860\n患者应当在清晨起床后清水漱口，\n\n05:36.061 --> 05:39.360\n然后用力的咳出深部的痰液来送检。\n\n05:39.911 --> 05:44.360\n痰液涂片检查可以初步观察痰液中的细菌性，\n\n05:45.161 --> 05:50.110\n如是否有格兰阳性或者阴性菌球菌杆菌，\n\n05:50.610 --> 05:54.460\n通过痰液的培养可以确定具体的病原菌，\n\n05:54.561 --> 05:56.061\n并进行药敏试验。\n\n05:56.411 --> 05:57.760\n为选择敏感。\n\n05:57.791 --> 05:59.492\n的抗生素提供依据。\n\n06:00.574 --> 06:00.748\n比如，\n\n06:00.748 --> 06:06.023\n一位肺脓肿患者的痰液培养结果中发现了金黄色葡萄球菌，\n\n06:06.373 --> 06:09.523\n且该菌株对苯唑西林敏感，\n\n06:09.773 --> 06:14.574\n这就指导医生选择苯唑西林进行针对性治疗。\n\n06:15.174 --> 06:15.873\n此外，\n\n06:16.074 --> 06:18.924\n对于怀有有厌氧菌感染的患者，\n\n06:18.973 --> 06:21.023\n还需进行厌氧培养，\n\n06:21.223 --> 06:23.674\n以提高厌氧菌的检出率。\n\n06:26.604 --> 06:26.854\n此外，\n\n06:26.854 --> 06:32.454\n血培养的检查作用在肺脓肿诊断中也有一定的作用。\n\n06:33.565 --> 06:39.114\n尤其是对于血源性的肺脓肿和病情较重伴有菌血症的患者，\n\n06:39.214 --> 06:42.565\n通常采集患者的血液进行培养，\n\n06:43.065 --> 06:44.815\n如果培养出病原菌，\n\n06:44.864 --> 06:46.915\n不仅可以明确病原体，\n\n06:47.265 --> 06:49.464\n还能够指导抗生素的选择。\n\n06:50.209 --> 06:50.584\n比如，\n\n06:50.584 --> 06:53.959\n在一些血源性肺脓肿患者当中，\n\n06:54.260 --> 06:58.559\n血培养可能发现与原发灶相同的病原菌，\n\n06:59.309 --> 07:06.059\n如从皮肤这个用处分离出的细菌与血培养结果一致。\n\n07:06.660 --> 07:07.609\n一般来说，\n\n07:07.609 --> 07:12.559\n在患者寒战高热时采集的血液进行培养，\n\n07:12.709 --> 07:14.510\n阳性率相对较高。\n\n07:15.109 --> 07:15.984\n同时呢，\n\n07:15.984 --> 07:20.209\n多次血培养有助于提高病原菌的进出率。\n\n07:20.764 --> 07:25.963\n为准确诊断和有效治疗提供更可靠的依据。\n\n07:27.816 --> 07:29.242\n一些特殊的检查手段，\n\n07:29.242 --> 07:31.217\n包括支气管镜的检查，\n\n07:31.516 --> 07:35.867\n是在肺脓肿的诊断和治疗中都具有重要的作用的。\n\n07:36.598 --> 07:43.898\n它可以包括明确病因、获取标本、进行病原学的检查以及是进行局部的治疗。\n\n07:44.653 --> 07:45.653\n操作的时候呢，\n\n07:45.653 --> 07:51.403\n医生会将支气管镜通过鼻腔或者是口腔插入患者的气道，\n\n07:51.752 --> 07:53.852\n直接观察支气管内的情况，\n\n07:54.102 --> 07:59.252\n查看支气管粘膜有没有充血、水肿、溃疡等病变，\n\n07:59.602 --> 08:03.002\n是否存在异物、肿瘤等阻塞因素。\n\n08:04.144 --> 08:04.444\n例如，\n\n08:04.444 --> 08:10.794\n肺脓肿患者的支气管检查中发现气气管内大量的脓性分泌物。\n\n08:11.044 --> 08:13.694\n通过吸引可以清除分泌物，\n\n08:13.843 --> 08:17.493\n还可以看到粘膜表面有散在的溃疡灶。\n\n08:18.093 --> 08:18.819\n同时呢，\n\n08:18.819 --> 08:26.493\n支气管镜还可以通过活检孔道获取病变组织或者是分泌物，\n\n08:26.493 --> 08:28.843\n进行病理检查和细菌培养，\n\n08:29.093 --> 08:31.993\n有助于我们明确病因和病原菌。\n\n08:33.505 --> 08:37.556\n另外特殊的检查手段包括支气管肺泡的灌洗，\n\n08:37.556 --> 08:40.755\n应用我们支气管肺泡的灌洗术，\n\n08:40.755 --> 08:45.755\n在支气管镜检查的基础上进行一项特殊的检查，\n\n08:45.955 --> 08:51.556\n通过向支气管肺泡内注入生理盐水并回收，\n\n08:52.306 --> 08:55.606\n收集肺泡表面的分泌物进行检查。\n\n08:56.718 --> 09:00.593\nBAL可以获取更准确的病原学诊断信息。\n\n09:00.943 --> 09:06.443\n对于一些常规痰液检查阴性的患者，\n\n09:06.443 --> 09:08.294\nBAL可能会发现病原菌。\n\n09:09.080 --> 09:09.304\n例如，\n\n09:09.304 --> 09:11.280\n在疑难的肺脓肿病例当中，\n\n09:11.380 --> 09:13.429\n痰液多次培养都是阴性。\n\n09:13.580 --> 09:18.580\n但是通过BAL获取的病原体的标本培养出了病原菌，\n\n09:19.080 --> 09:22.630\n就提高了我们治疗的一个关键依据。\n\n09:23.229 --> 09:24.255\n另外呢，\n\n09:24.255 --> 09:28.429\nBAL还可以用于评估肺部炎症的程度和范围，\n\n09:28.729 --> 09:32.979\n对于判断病情和制定治疗方案是有一定的帮助的。\n\n09:33.479 --> 09:34.955\n在治疗方面呢，\n\n09:34.955 --> 09:41.929\nBAL还可以通过冲洗和注入抗生素等药物对肺脓肿进行局部治疗，\n\n09:42.030 --> 09:43.530\n提高治疗的效果。\n\n09:44.630 --> 09:49.580\n特殊检查包括另外经皮穿刺活检的适应症。\n\n09:50.822 --> 09:57.922\n经皮的肺穿刺活检是一种通过皮肤穿刺获取肺部病变组织进行。\n\n09:59.041 --> 10:00.390\n病理检查的方法，\n\n10:00.841 --> 10:07.291\n它的适应症主要是对于肺部占位性病变或难以明确病因的肺脓肿，\n\n10:07.541 --> 10:10.640\n需要通过病理检查来明确诊断。\n\n10:11.643 --> 10:14.744\n比如我们肺脓肿经过常规效果治疗不佳，\n\n10:15.044 --> 10:17.443\n怀疑存在肿瘤的病变时，\n\n10:17.943 --> 10:21.093\n可以进行经皮肺穿刺活检。\n\n10:21.921 --> 10:22.122\n然而，\n\n10:22.122 --> 10:23.971\n该检查也有一定的风险，\n\n10:24.221 --> 10:26.021\n如它会引起气胸，\n\n10:26.671 --> 10:27.771\n引起出血。\n\n10:28.271 --> 10:30.271\n气胸是常见的并发症，\n\n10:30.471 --> 10:31.421\n发生率呢，\n\n10:31.421 --> 10:33.372\n是5%.20%。\n\n10:34.130 --> 10:34.505\n主要呢，\n\n10:34.505 --> 10:39.080\n是由于穿刺过程中损伤的胸膜导致气体进入胸腔，\n\n10:39.731 --> 10:41.531\n出血的发生率比较低，\n\n10:41.880 --> 10:45.531\n但也可能出现少量的咯血和局部的出血。\n\n10:45.981 --> 10:46.806\n因此呢，\n\n10:46.806 --> 10:49.681\n在进行经皮肺穿刺活检前呢，\n\n10:49.781 --> 10:54.380\n需要对患者的病情和身体情况进行全面的评估，\n\n10:54.531 --> 10:56.431\n权衡检查的一个力。\n\n10:58.068 --> 11:01.218\n另外我们再要评估诊断和鉴别诊断，\n\n11:01.518 --> 11:07.718\n肺脓肿的诊断标准是典型的患者会出现高热、咳嗽，\n\n11:07.718 --> 11:09.218\n大量的浓臭痰，\n\n11:09.669 --> 11:11.544\n高热通常持续不退，\n\n11:11.544 --> 11:13.169\n体温39°以上。\n\n11:13.854 --> 11:17.153\n这是由于细菌感染引起的一个强烈炎症反应。\n\n11:17.453 --> 11:19.804\n咳嗽在疾病初期可能比较轻，\n\n11:20.203 --> 11:21.504\n随后会加重，\n\n11:22.054 --> 11:24.153\n咳出的痰液的量也比较多，\n\n11:24.453 --> 11:26.453\n甚至每日可达数百毫升。\n\n11:27.294 --> 11:29.244\n并且并有明显的恶臭味，\n\n11:29.643 --> 11:35.693\n这是肺组织坏死液化形成脓液的特殊成分。\n\n11:36.908 --> 11:38.758\n例如一位肺脓肿的患者，\n\n11:38.758 --> 11:40.359\n通常持续高热一周，\n\n11:40.408 --> 11:42.158\n体温维持在39°，\n\n11:42.208 --> 11:44.158\n在39°8高热时。\n\n11:45.073 --> 11:46.323\n咳嗽的比较剧烈，\n\n11:46.424 --> 11:50.424\n咳出了400ml的黄色脓性恶臭痰液，\n\n11:51.073 --> 11:53.624\n那么这些症状都高度提示是肺癌。\n\n11:55.072 --> 11:56.421\n肺脓肿的诊断标准，\n\n11:56.421 --> 11:59.122\n影像学的诊断是至关重要的。\n\n11:59.471 --> 12:05.921\nX片早期大片浓密模糊浸润阴影或团片状的浓密阴影，\n\n12:06.171 --> 12:07.096\n病情进展，\n\n12:07.096 --> 12:09.146\n脓肿形成与支气管相通后，\n\n12:09.146 --> 12:12.271\n会出现圆形透亮区和气液平。\n\n12:12.271 --> 12:18.171\nCT扫描能够更清晰的显示脓肿的大小、形态、部位和周围组织的关系。\n\n12:18.521 --> 12:23.247\n对于一些胸片难以发现的小脓肿或隐蔽部位的脓肿，\n\n12:23.247 --> 12:24.622\nCT是具有优势的。\n\n12:25.390 --> 12:27.802\n在某些患者的CT图像上，\n\n12:27.802 --> 12:32.090\n图像清晰显示右肺上叶有一不规则脓肿。\n\n12:33.797 --> 12:35.047\n脓肿壁的较厚，\n\n12:35.247 --> 12:36.947\n周围组织有渗出，\n\n12:37.098 --> 12:39.148\n这些都符合肺脓肿的表现。\n\n12:39.947 --> 12:41.697\n肺脓肿的诊断标准，\n\n12:41.898 --> 12:44.747\n一个是实验室检查结果的支持。\n\n12:45.247 --> 12:48.898\n实验室检查结果是肺脓肿诊断有力的支持。\n\n12:49.247 --> 12:52.497\n通常血中白细胞计数明显升高，\n\n12:52.547 --> 12:55.047\n通常都要超过10乘十的九次方，\n\n12:55.297 --> 12:56.697\n周期率显著增高，\n\n12:56.697 --> 12:58.497\n达90%以上，\n\n12:58.848 --> 13:02.348\n反映机体对敏感细菌的一个感染。\n\n13:03.765 --> 13:05.215\n那么都具有重要的意义，\n\n13:05.215 --> 13:06.539\n如果培养出病原菌，\n\n13:06.539 --> 13:09.364\n就有助于明确诊断和指导抗生素治疗。\n\n13:09.664 --> 13:11.690\n一位患者的血常规提示，\n\n13:11.690 --> 13:16.164\n一万六十六乘以19次方每升中性粒细胞百分比88，\n\n13:16.315 --> 13:17.664\n痰液培养肺克，\n\n13:18.015 --> 13:22.739\n这都是临床症状和影像学表现来明确诊断。\n\n13:22.739 --> 13:25.640\n肺脓肿的例子需要鉴别诊断，\n\n13:25.640 --> 13:26.715\n包括细菌性肺炎，\n\n13:26.715 --> 13:29.815\n细菌性肺炎与肺脓肿在早期诊断是有相似的，\n\n13:29.815 --> 13:31.765\n都会出现发热、咳嗽、咳痰，\n\n13:31.914 --> 13:33.965\n但是细菌性肺炎起病更急。\n\n13:34.039 --> 13:36.289\n高热咳痰的症状更为突出，\n\n13:36.539 --> 13:37.940\n痰液是黏的，\n\n13:38.039 --> 13:38.715\n通常呢，\n\n13:38.715 --> 13:39.489\n没有臭味。\n\n13:39.989 --> 13:42.015\n例如细菌性肺炎啊，\n\n13:42.015 --> 13:44.289\n它会伴随着病情的进展。\n\n13:46.937 --> 13:48.487\n出现这种高热寒战，\n\n13:48.638 --> 13:49.737\n而肺脓肿呢，\n\n13:49.737 --> 13:51.538\n相对病情会比较缓慢。\n\n13:51.838 --> 13:54.888\n它会出现大量的脓臭痰啊，\n\n13:54.888 --> 13:57.088\n这是两者在症状上的重要区别。\n\n13:57.187 --> 13:58.138\n影像学上呢，\n\n13:58.138 --> 13:59.838\n细菌性肺炎是大片的实变，\n\n13:59.937 --> 14:01.138\n密度比较均匀。\n\n14:02.143 --> 14:05.593\n肺脓肿的早期是大片浓密的模糊的浸润，\n\n14:05.692 --> 14:06.367\n后期呢，\n\n14:06.367 --> 14:07.793\n出现透亮区和叶片，\n\n14:07.893 --> 14:09.043\n这些都可以鉴别。\n\n14:09.848 --> 14:10.297\n另外呢，\n\n14:10.297 --> 14:12.398\n空洞性的肺结核也需要鉴别。\n\n14:12.447 --> 14:15.297\n空洞性的肺结核会出现咳嗽、咳痰、咯血，\n\n14:15.497 --> 14:17.148\n肺部影像学也是空洞，\n\n14:17.297 --> 14:18.848\n容易与肺脓肿混淆。\n\n14:19.098 --> 14:19.822\n然而呢，\n\n14:19.822 --> 14:24.572\n我们空洞型的肺结核患者通常都是低热盗汗、乏力的症状，\n\n14:24.572 --> 14:25.148\n消瘦，\n\n14:25.547 --> 14:28.148\n这与肺脓肿是重要的鉴别诊断要点。\n\n14:28.247 --> 14:30.648\n有些空洞性的肺结核患者呢，\n\n14:30.697 --> 14:32.398\n通常是午后低热，\n\n14:32.398 --> 14:34.348\n体温都在38°以内，\n\n14:34.547 --> 14:35.973\n夜间盗汗是明显，\n\n14:35.973 --> 14:37.497\n身体是逐渐消瘦的。\n\n14:37.497 --> 14:38.723\n痰液检查方面呢，\n\n14:38.723 --> 14:39.947\n肺结核患者的痰液。\n\n14:40.119 --> 14:41.570\n能够检查到结核杆菌，\n\n14:41.669 --> 14:42.994\n而肺脓肿患者呢，\n\n14:42.994 --> 14:47.719\n通常都是细菌肺结核空洞形态是多样的啊，\n\n14:47.719 --> 14:49.570\n然后肺脓肿的空洞形态呢，\n\n14:49.570 --> 14:52.719\n就是有表现为液片空洞壁的不均匀，\n\n14:52.719 --> 14:54.320\n这些都可以进行区分。\n\n14:54.770 --> 14:57.119\n支气管肺癌也是需要鉴别的，\n\n14:57.219 --> 14:59.344\n它是伴有阻塞性肺炎时呢，\n\n14:59.344 --> 15:00.570\n也会出现发热啊，\n\n15:00.570 --> 15:01.169\n咳嗽啊，\n\n15:01.169 --> 15:03.770\n咳痰与肺脓肿的相似之处呢，\n\n15:04.070 --> 15:07.320\n但是这个患者的支气管肺炎的患者呢，\n\n15:07.320 --> 15:09.020\n具有长期的吸烟史，\n\n15:09.219 --> 15:10.020\n通常是。\n\n15:10.091 --> 15:10.992\n刺激性的干咳。\n\n15:12.577 --> 15:14.202\n影像学的表现上呢，\n\n15:14.202 --> 15:16.026\n会有胸痛啊，\n\n15:16.077 --> 15:19.601\n消瘦这些它的CT检查呢，\n\n15:19.601 --> 15:21.327\n通常是占位性的病变，\n\n15:21.327 --> 15:22.351\n边缘不规则，\n\n15:22.351 --> 15:23.927\n有分叶和毛刺的。\n\n15:24.476 --> 15:25.327\n另外呢，\n\n15:25.377 --> 15:27.276\n是症状的鉴别。\n\n15:27.427 --> 15:29.177\n症状鉴别的关键点呢，\n\n15:29.177 --> 15:31.927\n就是肺脓肿与其他疾病的重要环节上。\n\n15:32.606 --> 15:33.382\n发热的特点，\n\n15:33.382 --> 15:35.156\n肺脓肿是持续性的高热，\n\n15:35.206 --> 15:36.906\n细菌性肺炎也有高热，\n\n15:36.906 --> 15:38.507\n但通常是张弛热，\n\n15:38.807 --> 15:40.956\n咳嗽咳痰的差异也比较明显。\n\n15:41.057 --> 15:42.856\n肺脓肿是大量的脓臭痰，\n\n15:43.007 --> 15:45.656\n细菌性肺炎并没有恶臭味。\n\n15:45.956 --> 15:48.682\n空洞型的肺结核的患者的痰液呢，\n\n15:48.682 --> 15:49.606\n是少量黏痰，\n\n15:49.606 --> 15:51.507\n脓性痰也没有臭味。\n\n15:52.497 --> 15:54.047\n咯血的情况也有所不同，\n\n15:54.247 --> 15:55.898\n肺脓肿的患者咯血呢，\n\n15:55.898 --> 15:57.547\n都在疾病过程当中出现，\n\n15:57.747 --> 15:58.848\n可少可多，\n\n15:58.997 --> 16:01.848\n而空洞性肺结核的咯血就较为常见了。\n\n16:02.047 --> 16:03.497\n支气管肺癌中呢，\n\n16:03.497 --> 16:05.922\n带血丝是比较多见的，\n\n16:05.922 --> 16:07.697\n咯血不是特别多见。\n\n16:08.763 --> 16:12.763\n影像学的鉴别包括X片肺脓肿早期是大片浓密，\n\n16:12.814 --> 16:14.963\n后期是透亮区和气液片。\n\n16:15.414 --> 16:17.263\n细菌性肺炎是大片实变，\n\n16:17.713 --> 16:20.489\n空洞性的肺结核都有空洞灶，\n\n16:20.489 --> 16:21.763\n周围有卫星灶。\n\n16:21.914 --> 16:23.039\n支气管肺炎呢，\n\n16:23.039 --> 16:25.164\n通常是占位性的。\n\n16:25.164 --> 16:29.164\nCT也更能表现为肺脓肿管壁比较厚。\n\n16:30.705 --> 16:30.856\n然后，\n\n16:30.856 --> 16:32.205\n气液平的比较明显，\n\n16:32.356 --> 16:38.806\n细菌性肺炎的实变影、空洞性肺结核的空洞影形态和支气管肺癌的形态啊，\n\n16:38.806 --> 16:40.556\n强化都是有区别的。\n\n16:41.495 --> 16:41.796\n另外呢，\n\n16:41.796 --> 16:43.971\n实验室检查的意义在于，\n\n16:43.971 --> 16:45.695\n实验室检查的鉴别诊断，\n\n16:45.895 --> 16:48.895\n血常规对于炎性判断都有一定的帮助。\n\n16:49.245 --> 16:51.945\n肺脓肿的患者与细菌性肺炎，\n\n16:51.945 --> 16:55.495\n白细胞计数与中性粒细胞计数通常都明显升高，\n\n16:55.695 --> 17:00.046\n但是一些特殊的病原体感染肺炎可能有不同的情况，\n\n17:00.346 --> 17:04.796\n痰液的检查这时候就显得鉴鉴别诊断就至关重要了。\n\n17:04.946 --> 17:07.696\n肺脓肿的痰液可以发现多种病原菌，\n\n17:07.796 --> 17:11.196\n而空洞性的肺结核通常就是找到结核杆菌。\n\n17:11.784 --> 17:13.134\n支气管肺癌的痰液呢，\n\n17:13.134 --> 17:14.833\n可能会找到癌细胞，\n\n17:15.384 --> 17:16.409\n血液培养呢，\n\n17:16.409 --> 17:19.558\n对于血源性的肺脓肿和某些伴有菌血症疾病呢，\n\n17:19.558 --> 17:20.984\n是有鉴别价值的。\n\n17:21.183 --> 17:21.808\n这些呢，\n\n17:21.808 --> 17:24.734\n可以通过实验室检查的结论来综合分析，\n\n17:25.183 --> 17:28.784\n为我们临床的鉴别诊断提供一个有力的支持，\n\n17:28.933 --> 17:29.734\n从而呢，\n\n17:29.734 --> 17:32.583\n对我们临床的治疗进行一个方案的。\n\n17:35.238 --> 17:35.687\n认定，\n\n17:36.588 --> 17:36.937\n嗯，\n\n17:36.937 --> 17:37.338\n好了，\n\n17:37.338 --> 17:38.838\n今天同大家就分享到这里，\n\n17:38.838 --> 17:39.287\n谢谢。\n\n","v0347cg10004d61ejjiljhtbn5qau7kg",1064,558,"2026-01-25 00:25:33","肺脓肿全方位解析：病因、症状、诊断与治疗全指南  ","肺脓肿, 肺脓肿病因, 肺脓肿症状, 肺脓肿诊断, 肺脓肿治疗, 肺部感染, 咳脓痰, 抗生素治疗  ","本文全面解析肺脓肿的病因、典型症状（如高热、咳脓痰）、诊断方法（影像学检查、痰培养）及治疗方案（抗生素、引流手术），帮助您了解这一严重肺部感染的防治要点。","2026-04-04 17:30:00",[37],{"menuId":38,"menuName":39,"parentId":17,"orderNum":40,"path":41,"component":42,"isFrame":43,"isCache":44,"menuType":45,"visible":22,"status":17,"createDept":6,"remark":25,"createTime":46,"children":47,"columnImage":48,"columnLogo":49,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"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 10:31:58",[],"https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:40/0d7fcb56-3dc4-4dcb-99ca-a5d5c438378e.png","https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:43/958efac7-dd02-4681-b8fd-0dd84b1bbf42.png","健康科普视频大全,了解你的健康生活","健康科普视频, 戒烟视频, 饮食健康视频, 胸痛科普, 用药知识, 职业健康视频, 贫血科普, 眼健康视频","精选健康科普视频,涵盖戒烟、胸痛、饮食、用药与职业健康等多个主题,让你轻松获取科学健康知识,提升生活质量。","https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:45/fa8fe113-deaa-4454-8105-d629769963dd.png","Video",2,"重大疾病",4,"https://vod.haohuanjiao.com/huanjiao/specialistVideo/864317/98669cdf-e127-457a-b45b-bc4fbe4755a9.tmp?a=0&auth_key=1789027210-5acc95c196644af88f719fe62b46c992-0-0416e13ee0819e2c8d54b316c2ddb9dd&br=453&bt=453&cd=0%7C0%7C0&ch=0&cr=0&cs=0&dr=0&ds=4&eid=v0347cg10004d61ejjiljhtbn5qau7kg&er=0&l=202608110542230B427E09DAF44004C3B2&lr=&mime_type=video_mp4&net=0&pl=0&qs=13&rc=ajpkOGVrb21oOTczNGY3M0Apbnh0cXdtbG00ZzMzajo2eWdocm5rcWdmZy5hLS1kNDBzc2Q0XjJfZWlnYjMxLS5gMS06Yw%3D%3D&vl=&vr=",true,{"code":9,"msg":58,"message":6,"data":6,"success":59},{"code":9,"msg":10,"message":6,"data":62,"success":59},{"pageNo":22,"pageSize":63,"result":64,"totalSize":17},10,[],{"code":9,"msg":10,"message":6,"data":66,"success":59},{"authors":67,"appraiseDimensionScoresVos":68},[],[]]