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--> 00:04.057\n各位老师、各位同学，\n\n00:04.057 --> 00:04.882\n大家中午好。\n\n00:05.739 --> 00:08.640\n今天我给大家讲一个支气管哮喘的一个基础认知。\n\n00:14.309 --> 00:14.484\n嗯，\n\n00:14.484 --> 00:16.708\n众所周知心这个哮喘呢，\n\n00:16.708 --> 00:18.559\n它的一些先讲一下它的定义啊，\n\n00:18.759 --> 00:21.409\n我说它从医学角度来讲啊。\n\n00:22.160 --> 00:22.986\n支气管哮喘呢，\n\n00:22.986 --> 00:25.611\n是一种以慢性气道炎症。\n\n00:26.648 --> 00:29.947\n而气道高反应性为特征性、抑制性疾病。\n\n00:31.670 --> 00:32.194\n这种炎症呢，\n\n00:32.194 --> 00:34.869\n它涉及到一个多种细胞和细胞组成，\n\n00:35.619 --> 00:38.720\n比方说嗜酸性粒细胞、肥大细胞。\n\n00:39.460 --> 00:40.511\nT淋巴细胞的。\n\n00:41.986 --> 00:43.986\n全球大概有3亿人受其影响。\n\n00:45.862 --> 00:49.838\n我们说通俗理解就是说支气管哮喘。\n\n00:50.893 --> 00:52.993\n就是器官变得很敏感。\n\n00:54.387 --> 00:55.486\n在一些因素刺激下，\n\n00:55.486 --> 00:56.837\n会出现一个收缩。\n\n00:57.728 --> 00:58.127\n变窄。\n\n00:59.015 --> 01:01.116\n导致患者的呼吸不顺畅。\n\n01:02.027 --> 01:05.678\n从而引发一个喘息咳嗽症状。\n\n01:06.516 --> 01:08.967\n比方说有的患者在闻到花粉以后，\n\n01:08.967 --> 01:10.116\n就会一个突然发病。\n\n01:12.389 --> 01:14.639\n我们讲支气管哮喘些发病机制啊。\n\n01:16.295 --> 01:17.496\n一个是免疫失衡机制。\n\n01:19.149 --> 01:20.124\n人体的免疫系统啊，\n\n01:20.124 --> 01:21.499\n在哮喘发病中啊，\n\n01:21.499 --> 01:22.698\n起一个关键作用。\n\n01:24.206 --> 01:25.956\n当免疫系统失衡时啊。\n\n01:26.720 --> 01:27.919\n出现T细胞2，\n\n01:28.269 --> 01:30.019\n它这个细胞就会过度活化。\n\n01:30.761 --> 01:35.060\n分泌如白介素四、白介素五等多种细胞因子。\n\n01:36.307 --> 01:37.383\n而这种细胞因子呢，\n\n01:37.383 --> 01:40.657\n会促使B细胞产生大量一个免疫球蛋白I基因。\n\n01:41.532 --> 01:42.833\n进而诱发过敏反应。\n\n01:44.507 --> 01:44.707\n而。\n\n01:45.587 --> 01:46.487\n举个例子来说啊，\n\n01:46.487 --> 01:49.188\n对尘螨过敏的患者接触尘螨后啊，\n\n01:49.188 --> 01:51.337\n就会迅速启动这一个免疫失衡的过程。\n\n01:53.394 --> 01:55.394\n第二个是我们说一个神经调节的异常。\n\n01:57.261 --> 02:00.761\n气道的神经调节出现异常也是哮喘发病的一个主要原因之一。\n\n02:02.764 --> 02:03.290\n这里面呢，\n\n02:03.290 --> 02:04.864\n存在多种神经纤维，\n\n02:04.864 --> 02:06.565\n比方说胆碱的神经啊，\n\n02:06.565 --> 02:09.115\n肾上腺的素能神经等等。\n\n02:10.044 --> 02:12.294\n当这些神经调节功能紊乱的时候啊。\n\n02:12.960 --> 02:14.610\n胆碱的神经张力增加，\n\n02:14.960 --> 02:16.960\n会导致一个气道平滑肌收缩。\n\n02:18.242 --> 02:19.542\n同时气道口径变小。\n\n02:20.764 --> 02:22.289\n说有些患者在情绪激动，\n\n02:22.289 --> 02:23.339\n什么哮喘发生，\n\n02:23.339 --> 02:25.565\n就可能和他的神经调节有相关。\n\n02:28.826 --> 02:32.876\n说支气管哮喘它的一些这个发病机制啊。\n\n02:33.550 --> 02:33.875\n第一个呢，\n\n02:33.875 --> 02:35.649\n我们说遗传因素影响。\n\n02:37.345 --> 02:37.869\n遗传啊，\n\n02:37.869 --> 02:40.020\n在支气管哮喘的发病史中啊，\n\n02:40.020 --> 02:41.020\n它占的地位啊，\n\n02:41.020 --> 02:41.695\n比较重。\n\n02:43.227 --> 02:43.878\n研究表明。\n\n02:44.645 --> 02:46.095\n如果父母双方都有哮喘。\n\n02:46.949 --> 02:49.024\n那么他子女患哮喘几率啊，\n\n02:49.024 --> 02:50.348\n可以高达70%。\n\n02:52.194 --> 02:53.794\n如果说只有一方有哮喘。\n\n02:54.690 --> 02:56.839\n那么子女患病几率也有30%.50%啊。\n\n02:58.421 --> 03:01.072\n某些特定基因的突变或多态性啊，\n\n03:01.322 --> 03:03.921\n与哮喘的易感性是密切相关的。\n\n03:06.419 --> 03:09.020\n下面我们讲讲支气管哮喘病理生理改变。\n\n03:10.776 --> 03:11.925\n括以下几个方面。\n\n03:13.167 --> 03:14.867\n第一个是气道的炎症变化。\n\n03:17.152 --> 03:18.602\n在哮喘发作时候。\n\n03:19.688 --> 03:22.389\n气道粘膜会出现一个明显的炎症反应。\n\n03:23.927 --> 03:25.227\n大量的炎症细胞前，\n\n03:25.677 --> 03:28.826\n包括嗜酸性粒细胞、中性粒细胞系列。\n\n03:30.477 --> 03:33.326\n这些炎症细胞释放多种的炎症介质。\n\n03:34.248 --> 03:35.048\n比方说组胺，\n\n03:35.647 --> 03:36.947\n白三烯等等。\n\n03:37.796 --> 03:39.296\n导致气道的粘膜水肿。\n\n03:40.233 --> 03:41.134\n粘液分泌增加。\n\n03:42.643 --> 03:44.843\n我们可以说通过支气管镜检查发现。\n\n03:45.682 --> 03:46.557\n哮喘患者，\n\n03:46.557 --> 03:48.682\n这个气道经常有粘膜红肿。\n\n03:49.488 --> 03:49.889\n同时呢，\n\n03:49.889 --> 03:52.188\n合并有大量的粘稠的分泌物。\n\n03:54.192 --> 03:54.466\n第二个，\n\n03:54.466 --> 03:57.292\n我说哮喘发作的时候会有一个气道冲出的表现。\n\n03:59.291 --> 04:03.440\n长期反复发作哮喘会引起一个气道重生。\n\n04:05.304 --> 04:07.054\n气道壁的结构会发生一些改变。\n\n04:08.070 --> 04:10.020\n包括平滑肌增生啊。\n\n04:11.125 --> 04:12.225\n具体么称号啊？\n\n04:13.014 --> 04:14.664\n细胞外基质沉淀着的。\n\n04:16.201 --> 04:16.752\n这些变化呢，\n\n04:16.752 --> 04:19.502\n会导致一个气道永久性的狭窄。\n\n04:20.437 --> 04:22.786\n同时他的肺功能有间歇性的下降。\n\n04:24.587 --> 04:26.736\n有研究追踪患者表明。\n\n04:27.644 --> 04:28.595\n对病程延长，\n\n04:28.845 --> 04:30.545\n气道重塑程度增加。\n\n04:31.540 --> 04:33.739\n患者呼吸困难症状也会更加明显。\n\n04:35.929 --> 04:38.179\n我们说还有一个是气流受限的机制。\n\n04:40.201 --> 04:41.201\n由于气道的炎症。\n\n04:42.441 --> 04:43.242\n粘膜的水肿。\n\n04:44.490 --> 04:47.441\n粘液酸的形成及气道平滑肌收缩啊，\n\n04:47.441 --> 04:48.441\n多种因素啊。\n\n04:49.312 --> 04:50.962\n到的内径变窄。\n\n04:52.549 --> 04:53.399\n就通过做助。\n\n04:55.032 --> 04:56.183\n在肺功能检查中，\n\n04:56.233 --> 05:01.032\n我们说它可以表现为第一秒用力呼气容积。\n\n05:02.188 --> 05:07.739\n与以一秒用力呼气容积与用力肺活量的比值降低。\n\n05:09.847 --> 05:10.048\n嗯，\n\n05:10.048 --> 05:11.423\n在哮喘性发作的时候呢，\n\n05:11.423 --> 05:13.898\n患者的第一秒用力呼吸中气啊，\n\n05:14.148 --> 05:16.798\n可能比正常水平要下降50%啊，\n\n05:16.798 --> 05:17.648\n甚至更多。\n\n05:21.846 --> 05:24.196\n这个叫这种哮喘有哪些临床表现呢？\n\n05:24.446 --> 05:26.147\n我说有以下几个啊。\n\n05:27.062 --> 05:30.911\n第一个它典型症状会出现一个反急性的症状。\n\n05:33.364 --> 05:33.764\n喘息，\n\n05:34.664 --> 05:37.664\n支气管哮喘最为常见的一个典型症状之一。\n\n05:39.024 --> 05:39.274\n患者，\n\n05:39.274 --> 05:41.674\n在呼吸的时候会出现一个高调的哮鸣。\n\n05:42.671 --> 05:43.571\n这是吹哨型。\n\n05:45.127 --> 05:45.877\n什么原因引起的？\n\n05:46.227 --> 05:48.278\n这是由于一个气道狭窄以后。\n\n05:49.079 --> 05:51.429\n气流通过受阻产生一个高调音。\n\n05:52.235 --> 05:52.536\n嗯。\n\n05:53.674 --> 05:56.075\n比方说我们在在一个哮喘进行发的时候。\n\n05:56.843 --> 05:58.894\n患者喘息的症状极其明显。\n\n06:00.027 --> 06:00.777\n严重时候啊，\n\n06:00.777 --> 06:02.177\n甚至不用听诊器。\n\n06:03.192 --> 06:04.942\n在距离患者的一定距离里面，\n\n06:04.942 --> 06:06.192\n就可以听到一个消音。\n\n06:08.838 --> 06:10.739\n接下来我们说一个有一个咳嗽表现。\n\n06:12.579 --> 06:13.003\n咳嗽呢，\n\n06:13.003 --> 06:15.178\n在支气管哮喘患者当中啊，\n\n06:15.178 --> 06:16.378\n表现很突出。\n\n06:18.045 --> 06:19.121\n一般性这个咳嗽啊，\n\n06:19.121 --> 06:21.946\n表现为一个自性的干咳。\n\n06:23.346 --> 06:23.747\n有时候呢，\n\n06:23.747 --> 06:25.596\n也会伴有一些少量的白色粘液痰。\n\n06:27.736 --> 06:29.986\n咳嗽这个情况在夜间或者清晨，\n\n06:29.986 --> 06:31.386\n清晨可能会加重。\n\n06:32.563 --> 06:33.338\n部分患者呢，\n\n06:33.338 --> 06:35.213\n可能仅仅以咳嗽为主要症状。\n\n06:36.069 --> 06:38.368\n我们说被称为一个叫咳嗽变异的哮喘。\n\n06:40.212 --> 06:42.161\n有些患者在入睡后不久啊，\n\n06:42.462 --> 06:44.161\n就可能会因为咳嗽而醒来。\n\n06:44.953 --> 06:46.203\n不影响他的睡眠质量。\n\n06:49.078 --> 06:49.403\n可是啊，\n\n06:49.403 --> 06:51.727\n患者典型还会表现为一个呼吸困难。\n\n06:53.760 --> 06:56.959\n我们说呼吸困难是哮喘发作时的重要症状。\n\n06:59.295 --> 06:59.920\n一般的患者呢，\n\n06:59.920 --> 07:02.045\n在这个发作的时候会感觉到空气不用。\n\n07:02.730 --> 07:03.480\n呼吸费力。\n\n07:04.513 --> 07:06.562\n甚至严重时的话会出现一个端坐性呼吸。\n\n07:07.759 --> 07:08.058\n也就是说，\n\n07:08.058 --> 07:12.959\n我们说被迫采取了坐位或半卧位来减轻呼吸困难症状。\n\n07:15.105 --> 07:15.680\n有统计啊，\n\n07:15.680 --> 07:20.205\n80%的哮喘患者在发作时候都会出现一个不同程度的呼吸困难。\n\n07:23.540 --> 07:26.915\n而在不同阶段的哮喘发作，\n\n07:26.915 --> 07:28.441\n症状会有不同的特点。\n\n07:30.053 --> 07:32.854\n我们说在先兆期的症状呢？\n\n07:33.665 --> 07:35.915\n大部分患者在发作时候会出现一个。\n\n07:37.049 --> 07:37.549\n鼻痒啊。\n\n07:38.563 --> 07:39.414\n喷嚏啊。\n\n07:40.192 --> 07:40.942\n眼睛痒啊，\n\n07:40.942 --> 07:42.292\n流泪这些症状。\n\n07:43.859 --> 07:44.459\n而这症状呢，\n\n07:44.459 --> 07:47.259\n通常是由一个气道的过敏反应所引起的。\n\n07:48.562 --> 07:51.062\n比方说一个典型的对花粉过敏患者。\n\n07:51.915 --> 07:53.765\n他首先是在接触花色以后啊，\n\n07:53.915 --> 07:55.515\n先出现一个鼻痒。\n\n07:56.416 --> 07:57.717\n连续打喷嚏症状。\n\n07:59.095 --> 07:59.420\n然后呢，\n\n07:59.420 --> 08:03.744\n再逐渐出现一个喘息、咳嗽等哮喘典型症状。\n\n08:05.609 --> 08:05.859\n然后呢，\n\n08:05.859 --> 08:08.709\n我们说还分为还分为一个急性发作期症状。\n\n08:10.286 --> 08:10.436\n患者，\n\n08:10.436 --> 08:12.210\n先发症状较为严重啊，\n\n08:12.210 --> 08:12.885\n就比较明显，\n\n08:12.885 --> 08:16.985\n就说就所谓的一个患者喘息咳嗽加剧。\n\n08:17.875 --> 08:18.875\n呼吸困难加重。\n\n08:19.782 --> 08:22.433\n甚至可以伴有一个胸闷、胸痛症状。\n\n08:24.045 --> 08:24.494\n这时候呢，\n\n08:24.494 --> 08:25.894\n患者的呼吸频率也会加快。\n\n08:26.695 --> 08:27.170\n达到百分，\n\n08:27.170 --> 08:29.144\n可以达到每分钟30次以上。\n\n08:29.858 --> 08:30.858\n心率会加快。\n\n08:31.751 --> 08:34.651\n甚至于严重时候影响患者生活质量和身体健康。\n\n08:36.473 --> 08:38.174\n而一些患者在急性发作的时候，\n\n08:38.174 --> 08:40.773\n甚至无法正常的行走、说话。\n\n08:44.088 --> 08:45.338\n你说在缓解期呢，\n\n08:45.338 --> 08:46.789\n它会出现哪些症状呢？\n\n08:47.659 --> 08:48.385\n放些症状呢，\n\n08:48.385 --> 08:50.159\n它的相对患者比较轻，\n\n08:50.309 --> 08:51.559\n或者说基本消失。\n\n08:52.484 --> 08:52.934\n但是呢，\n\n08:52.934 --> 08:54.283\n他气道炎症还存在。\n\n08:55.760 --> 08:58.510\n部分患者可能会仍然有一些轻微的咳嗽啊，\n\n08:58.510 --> 08:59.510\n气短等症状。\n\n09:00.263 --> 09:02.763\n波动耐力也可能较正常人要比较差一点。\n\n09:03.953 --> 09:04.203\n比方说，\n\n09:04.203 --> 09:06.552\n有些患者在缓解期进行轻度活动的话，\n\n09:06.953 --> 09:08.153\n会感觉呼吸啊，\n\n09:08.153 --> 09:09.403\n比正常的急促一些。\n\n09:11.645 --> 09:14.395\n我后面讲一下一个特殊的一个哮喘的差异。\n\n09:15.619 --> 09:17.869\n第一个是一个咳嗽变异性哮喘。\n\n09:19.914 --> 09:20.340\n咳嗽变性，\n\n09:20.340 --> 09:20.765\n哮喘呢，\n\n09:20.765 --> 09:23.914\n它经常是以咳嗽作为一个唯一或主要症状。\n\n09:24.906 --> 09:26.106\n没有明显的喘息啊，\n\n09:26.106 --> 09:28.206\n气促等典型哮喘症状。\n\n09:30.361 --> 09:32.411\n他咳嗽经常会表现为一个刺性干咳。\n\n09:33.304 --> 09:34.729\n在夜间或清晨啊，\n\n09:34.729 --> 09:35.604\n发作和加重。\n\n09:36.578 --> 09:39.328\n运动冷空气过敏原呢，\n\n09:39.328 --> 09:40.828\n我们说可以诱发一个咳嗽。\n\n09:42.578 --> 09:43.403\n有研究表明啊，\n\n09:43.403 --> 09:46.427\n大概30%的咳嗽变异性哮喘患者，\n\n09:46.728 --> 09:47.403\n最终啊，\n\n09:47.403 --> 09:48.877\n会发展成为一个典型哮喘。\n\n09:51.111 --> 09:51.361\n第二个呢，\n\n09:51.361 --> 09:52.562\n我们说一个运动型哮喘。\n\n09:54.565 --> 09:55.190\n热性哮喘呢，\n\n09:55.190 --> 09:58.789\n它经常是在运动的过程中或运动后的，\n\n09:58.789 --> 10:00.215\n运动后几分钟内发作。\n\n10:01.385 --> 10:04.935\n症状主要表现包括有喘息、咳嗽、呼吸困难。\n\n10:06.111 --> 10:07.060\n运动强度越大，\n\n10:07.260 --> 10:08.310\n持续时间越长，\n\n10:08.510 --> 10:10.361\n越容易诱发一个哮喘发作。\n\n10:12.072 --> 10:12.447\n比方说，\n\n10:12.447 --> 10:15.322\n新运动员在进行一个高强度训练和比赛时，\n\n10:15.771 --> 10:17.271\n可能会突然出现哮喘症状，\n\n10:17.271 --> 10:18.771\n影响他的运动表现。\n\n10:21.210 --> 10:23.060\n同时我们说还有一个叫职业性的哮喘。\n\n10:24.882 --> 10:29.081\n间性哮喘与患者的工作环境中的过敏预后刺激为好。\n\n10:31.151 --> 10:33.801\n一些患者在接触特定职业性以后。\n\n10:34.736 --> 10:35.937\n会出现一个哮喘症状。\n\n10:36.687 --> 10:38.536\n破坏他工作环境以后这种好环境。\n\n10:39.903 --> 10:43.054\n比如说常见的职业性自强物染有一些化学物质。\n\n10:44.002 --> 10:44.601\n有粉尘，\n\n10:44.952 --> 10:46.202\n有动物皮毛的。\n\n10:47.715 --> 10:49.289\n比方说在面粉厂工作后呢，\n\n10:49.289 --> 10:52.465\n长期接触面粉的粉尘也有可能就会引发，\n\n10:52.515 --> 10:53.715\n还有直接性哮喘。\n\n10:56.288 --> 10:57.987\n那么自用哮喘有哪些诊断方法呢？\n\n10:58.921 --> 11:00.120\n一没错，\n\n11:00.120 --> 11:00.870\n还是一个。\n\n11:01.820 --> 11:03.020\n症状发作特点。\n\n11:04.776 --> 11:05.250\n反复发作，\n\n11:05.250 --> 11:08.575\n喘息、气急、胸闷或咳嗽。\n\n11:09.367 --> 11:09.841\n而且呢，\n\n11:09.841 --> 11:17.117\n与接触病源、冷空气、物理发炎刺激、病毒性上呼吸道感染、运动等有关。\n\n11:18.768 --> 11:19.117\n第二。\n\n11:19.789 --> 11:20.789\n他的体征表现。\n\n11:22.182 --> 11:22.833\n我们说发作时啊，\n\n11:22.833 --> 11:23.908\n在患者的双肺啊，\n\n11:23.908 --> 11:25.533\n可以闻及一个散在的。\n\n11:26.129 --> 11:28.528\n或者说是弥漫性的以呼气相为主的哮鸣。\n\n11:29.492 --> 11:30.591\n呼吸相对延长，\n\n11:31.591 --> 11:32.216\n医生啊，\n\n11:32.216 --> 11:33.017\n通过听诊进行，\n\n11:33.017 --> 11:35.041\n听诊时候就不要这种特征性消音。\n\n11:36.431 --> 11:38.080\n我从你做一个辅助诊断。\n\n11:39.997 --> 11:40.297\n同时呢，\n\n11:40.297 --> 11:41.922\n我们说临床诊断标准的话，\n\n11:41.922 --> 11:43.797\n包括一个症状的缓解情况。\n\n11:45.804 --> 11:49.505\n上面说两个症状实际上可以经过治疗缓解或自行缓解。\n\n11:51.002 --> 11:52.427\n部分轻度的哮喘患者，\n\n11:52.427 --> 11:53.927\n我们说在脱离过敏原后，\n\n11:53.927 --> 11:56.101\n症状可以在几个小时内自行减轻。\n\n11:57.135 --> 11:57.284\n而且，\n\n11:57.284 --> 11:58.010\n大多数患者呢，\n\n11:58.010 --> 12:00.885\n可以通过使用支气管扩张剂等药物治疗以后，\n\n12:01.085 --> 12:02.534\n症状可以得到明显缓解。\n\n12:04.544 --> 12:04.744\n同时，\n\n12:04.744 --> 12:09.594\n我们还要排除其他疾病引起的喘息、气急、胸闷和咳嗽。\n\n12:11.086 --> 12:13.137\n我们需要进行一个病史的详细的询问，\n\n12:13.536 --> 12:16.236\n而且要进行一个全面的体格检查及相关辅助检查，\n\n12:16.637 --> 12:18.937\n排除慢阻肺先于哮喘疾病，\n\n12:19.137 --> 12:20.937\n那明确诊断为一个支气管哮喘。\n\n12:21.815 --> 12:22.065\n嗯。\n\n12:23.383 --> 12:26.484\n说有哪些常见的一些诊断理财手段呢？\n\n12:27.275 --> 12:28.275\n一个是肺功能。\n\n12:29.229 --> 12:32.030\n肺功能是诊断哮喘一个最重要的手段。\n\n12:32.986 --> 12:35.211\n其中的一个通气通气检测。\n\n12:36.096 --> 12:39.497\n我们说测可以测定一个第一秒用气用力呼气的容积。\n\n12:40.409 --> 12:43.159\n用力、肺活量以及它们之间的比值等指标。\n\n12:44.560 --> 12:45.560\n哮喘患者在发射期间呢，\n\n12:45.560 --> 12:46.111\n这些指标呢，\n\n12:46.111 --> 12:46.960\n通常会降低。\n\n12:47.765 --> 12:49.614\n我们说第一秒用力呼气，\n\n12:49.715 --> 12:52.940\n容积可以低于百分之预计，\n\n12:52.940 --> 12:54.414\n估计至80%以上。\n\n12:55.312 --> 12:58.812\n而支气管的激发实际上可以用于测定气道高敏感性。\n\n12:59.723 --> 13:03.924\n如果吸入激发剂以后第一秒用力呼气容积下降大于等于20%，\n\n13:03.924 --> 13:04.573\n则为阳性。\n\n13:05.445 --> 13:07.094\n提示气道高反应性，\n\n13:07.195 --> 13:08.195\n有助于小喘。\n\n13:09.562 --> 13:11.012\n而支气管舒张实验就是指啊，\n\n13:11.012 --> 13:12.961\n我们说吸入支气管舒张剂后。\n\n13:13.705 --> 13:15.854\n如果他的第一秒用力呼起重机，\n\n13:16.354 --> 13:19.255\n较用药前增加百分之大于等于12%，\n\n13:19.655 --> 13:21.280\n也绝对值大于等于20%。\n\n13:21.280 --> 13:24.005\n我们知道气道阻阻塞具有可逆性。\n\n13:24.744 --> 13:27.244\n那么对此哮喘诊断更有重要意义。\n\n13:29.559 --> 13:30.508\n说肠炎呢，\n\n13:30.508 --> 13:31.559\n还有过敏的测试。\n\n13:32.883 --> 13:33.559\n睡眠测试呢，\n\n13:33.559 --> 13:36.633\n它有利于明确哮喘的诱发病因。\n\n13:36.934 --> 13:40.484\n常点的办法有皮肤点刺实验和血清特异性IG检查。\n\n13:42.033 --> 13:43.609\n那皮肤这样一些比较简单，\n\n13:43.609 --> 13:46.708\n他们将少量高度纯化的致命原液体啊，\n\n13:46.708 --> 13:47.734\n低于患者的前臂。\n\n13:48.606 --> 13:49.406\n这样点丝针呢，\n\n13:49.406 --> 13:50.706\n轻轻刺入皮肤表层。\n\n13:52.171 --> 13:53.646\n如果说对某种过敏原过敏呢，\n\n13:53.646 --> 13:54.721\n在15.20分钟以后，\n\n13:54.721 --> 13:57.322\n点刺部位会出现类似于蚊虫叮咬的红肿块。\n\n13:58.557 --> 14:00.156\n表现我们肺的透亮度增加，\n\n14:00.456 --> 14:01.856\n成为过度通气障碍。\n\n14:02.744 --> 14:03.994\n但通常没有明显异常。\n\n14:05.323 --> 14:07.598\nFCT呢对于检查对于这个界面呢，\n\n14:07.598 --> 14:08.573\n更有重要价值。\n\n14:09.280 --> 14:10.929\n就可以排除其他的肺部疾病。\n\n14:11.658 --> 14:12.383\n比方说肺炎啊，\n\n14:12.383 --> 14:13.508\n资源扩张等等。\n\n14:14.291 --> 14:14.591\n若能，\n\n14:14.591 --> 14:17.491\n当患有其他肺部病变导致类似哮喘症状时候，\n\n14:17.491 --> 14:19.341\nC检查可以明确显示肺部，\n\n14:19.690 --> 14:21.541\n帮助人明确判断病情。\n\n14:23.184 --> 14:24.258\n做界面诊断一些要点啊，\n\n14:24.258 --> 14:25.434\n一些一个是慢阻肺。\n\n14:26.078 --> 14:28.127\n慢阻肺大多上都有一个长期吸烟时，\n\n14:28.127 --> 14:30.578\n后期阻塞机体颗粒物致癌的危险因素。\n\n14:31.294 --> 14:34.119\n以慢性、急性加重呼吸困难为主要表现反应，\n\n14:34.119 --> 14:34.945\n症状相对较轻。\n\n14:36.211 --> 14:37.836\n肺功能检查提示气流受限，\n\n14:37.836 --> 14:38.611\n呈持平。\n\n14:39.333 --> 14:41.484\n气管、支气管舒张显多为阴性。\n\n14:42.479 --> 14:43.755\n而哮喘患者气流受损，\n\n14:43.755 --> 14:45.655\n具有可逆性扩张，\n\n14:45.655 --> 14:46.830\n实现肠胃阳性。\n\n14:48.479 --> 14:48.655\n第二，\n\n14:48.655 --> 14:50.280\n与心源性一个哮喘鉴别。\n\n14:51.127 --> 14:53.127\n心源性哮哮喘常见左心衰，\n\n14:53.177 --> 14:54.978\n有高血压、冠心病、心脏病史。\n\n14:55.478 --> 14:57.153\n患者表现为突发的呼吸困难，\n\n14:57.153 --> 14:57.927\n不纯呼吸，\n\n14:58.377 --> 15:00.328\n同时要咳粉红色泡沫样痰。\n\n15:01.099 --> 15:02.950\n当飞抵克隆一个十多音机效应。\n\n15:03.726 --> 15:05.077\n现在可以问到有奔马率，\n\n15:05.476 --> 15:06.502\n动X片检查，\n\n15:06.502 --> 15:07.252\n可他心脏增大，\n\n15:07.252 --> 15:07.827\n肺淤血。\n\n15:08.770 --> 15:09.820\n而希望下降患者呢，\n\n15:09.820 --> 15:11.020\n一般没有心脏病史。\n\n15:11.370 --> 15:13.570\n他以咳白色粘液痰为主，\n\n15:13.770 --> 15:15.671\n胸口现的心脏大小比较正常。\n\n15:18.206 --> 15:18.481\n今天啊，\n\n15:18.481 --> 15:19.606\n我给大家讲这些东西，\n\n15:19.606 --> 15:20.507\n谢谢大家啊。\n\n","v0347cg10004d61git2ljhtcctf85fu0",925,974,"2026-01-25 01:07:04"," 支气管哮喘基础认知 - 症状、病因与治疗方法全解析  "," 支气管哮喘,哮喘症状,哮喘病因,哮喘治疗,哮喘预防,哮喘管理,呼吸系统疾病  "," 本文全面介绍支气管哮喘的基础知识，包括常见症状、主要病因、诊断方法和有效治疗方案，帮助您更好地理解和应对这一慢性呼吸系统疾病，提升生活质量。","2026-04-05 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