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--> 00:21.389\n各位老师，\n\n00:21.389 --> 00:22.715\n大家下午好，\n\n00:22.715 --> 00:25.915\n我今天分享的题目是支气管异物的诊断与处理。\n\n00:29.117 --> 00:29.492\n首先，\n\n00:29.492 --> 00:30.642\n支气管异物是。\n\n00:31.864 --> 00:34.264\n我们临床常见的一种。\n\n00:36.576 --> 00:40.550\n一种一种一种急症的大多数呢，\n\n00:40.550 --> 00:42.125\n是发生于儿童的。\n\n00:42.125 --> 00:47.026\n这个这个与儿童的心理发育、家庭看护、意愿性等多种因素有关。\n\n00:47.935 --> 00:48.560\n比如说，\n\n00:48.560 --> 00:50.134\n特别是3岁以下的儿童，\n\n00:50.134 --> 00:52.735\n如果磨牙未有未萌出，\n\n00:52.735 --> 00:54.560\n咀嚼功能不完善，\n\n00:54.560 --> 00:57.509\n吞咽协调功能和保护功能不健全。\n\n00:58.243 --> 00:58.542\n白。\n\n01:00.082 --> 01:00.757\n还没有，\n\n01:00.757 --> 01:02.407\n还没有完全自我保护意识，\n\n01:02.407 --> 01:04.082\n并且喜欢口含玩物。\n\n01:05.005 --> 01:05.755\n可以导致，\n\n01:06.155 --> 01:09.606\n可以导致此此次不良事件的发病率极高。\n\n01:11.882 --> 01:12.082\n嗯，\n\n01:12.681 --> 01:13.556\n严重时呢，\n\n01:13.556 --> 01:14.931\n可以导致患儿的误吸。\n\n01:16.336 --> 01:17.961\n形成窒息，\n\n01:17.961 --> 01:19.287\n甚至死亡，\n\n01:19.336 --> 01:20.461\n轻症轻者呢，\n\n01:20.461 --> 01:20.986\n也可以有，\n\n01:20.986 --> 01:21.512\n也可有，\n\n01:21.512 --> 01:22.936\n也可以有组织性肺炎啊，\n\n01:22.936 --> 01:24.086\n支气管炎等等。\n\n01:28.160 --> 01:29.885\n我我目前在我国呢，\n\n01:29.885 --> 01:32.910\n按照这个异物的种类呢，\n\n01:32.910 --> 01:34.834\n绝大多数人都是外源性异物呢，\n\n01:34.834 --> 01:36.610\n占99%，\n\n01:36.610 --> 01:37.410\n内源性异物呢，\n\n01:37.410 --> 01:38.934\n只占1%，\n\n01:38.934 --> 01:40.184\n按照异物的性质呢，\n\n01:40.184 --> 01:42.410\n最常见的是植物性异物，\n\n01:42.510 --> 01:43.822\n约占92%，\n\n01:43.822 --> 01:46.010\n大多数都是以可视性异物为主。\n\n01:47.088 --> 01:49.789\n比如说花生米、瓜子、豆类等。\n\n01:51.315 --> 01:52.315\n动物性异物呢，\n\n01:52.315 --> 01:53.864\n也比较常见，\n\n01:53.915 --> 01:54.614\n主要以，\n\n01:54.614 --> 01:55.815\n主要是以骨头为主。\n\n02:01.970 --> 02:02.720\n同时呢，\n\n02:02.819 --> 02:03.870\n业务的位置呢，\n\n02:03.870 --> 02:04.870\n主要主要在。\n\n02:07.391 --> 02:08.391\n气管异物呢，\n\n02:08.391 --> 02:11.792\n约占呼吸道异物的10%.18%。\n\n02:13.003 --> 02:14.804\n左左侧支气管异物呢，\n\n02:14.804 --> 02:15.703\n约占40%，\n\n02:15.703 --> 02:16.354\n45。\n\n02:17.339 --> 02:18.639\n右右侧支气管异物呢，\n\n02:18.639 --> 02:19.740\n约占约占45，\n\n02:19.740 --> 02:20.789\n左侧支气管异物呢，\n\n02:20.789 --> 02:21.740\n约占36%。\n\n02:25.242 --> 02:25.492\n嗯。\n\n02:27.985 --> 02:28.311\n然后呢，\n\n02:28.311 --> 02:29.386\n支气管异物呢，\n\n02:29.535 --> 02:31.061\n异物异物异物事件呢，\n\n02:31.061 --> 02:37.285\n主要是主要是我们可以通过详细询问异物吸入的具体时间、地点以及发生的实情情景。\n\n02:37.436 --> 02:38.085\n比如说，\n\n02:38.085 --> 02:42.035\n了解孩子是否在吃饭时、玩耍中还是其他活动时吸入异物，\n\n02:42.235 --> 02:45.186\n这有助于判断异物的种类和可能进入统计。\n\n02:46.287 --> 02:50.136\n因为80%的准确病史能够为后续的诊断提供关键线索。\n\n02:51.311 --> 02:51.787\n同时呢，\n\n02:51.787 --> 02:53.412\n我们在病史的采集过程中呢，\n\n02:53.412 --> 02:53.787\n还要。\n\n02:55.768 --> 02:56.468\n还要关注异物，\n\n02:56.468 --> 02:58.292\n异物的特征性描述，\n\n02:58.292 --> 03:01.718\n尽可能获取异物的大小、形状、材质信息等等。\n\n03:01.768 --> 03:05.518\n比如说我们要知道这个东西是圆形的还是塑料的，\n\n03:05.518 --> 03:07.218\n是比较尖锐的。\n\n03:08.175 --> 03:09.175\n比如说鱼刺啊，\n\n03:09.175 --> 03:10.949\n甚至一些比较坚韧的骨头等等。\n\n03:11.759 --> 03:12.210\n甚至呢，\n\n03:12.210 --> 03:13.309\n还有一些是腐蚀性的，\n\n03:13.309 --> 03:15.934\n比如说我们常见的一些纽扣电池啊。\n\n03:17.781 --> 03:19.906\n不同的形状和材质呢，\n\n03:19.955 --> 03:22.755\n以及对异物处理方式有所不同。\n\n03:22.755 --> 03:23.156\n比如说，\n\n03:23.156 --> 03:24.080\n我们常见的鱼刺啊，\n\n03:24.080 --> 03:26.130\n可鱼刺甚至骨头的话，\n\n03:26.130 --> 03:29.080\n可能除了在窒息的风险以外呢，\n\n03:29.080 --> 03:31.505\n可能还会导致这种支气管出血等等。\n\n03:35.419 --> 03:35.845\n同时呢，\n\n03:35.845 --> 03:38.320\n我们也我们也要详细的询问呢，\n\n03:38.320 --> 03:39.044\n患者呢，\n\n03:39.395 --> 03:43.945\n从异物吸入吸入后到就诊就诊时症状的变化情况，\n\n03:44.044 --> 03:50.195\n包括初期的症状如呛咳、憋憋气的过程及严重严重程度及持续时间，\n\n03:50.195 --> 03:51.494\n是否有缓解期，\n\n03:51.794 --> 03:54.044\n以及后期是否出现新的症状。\n\n03:54.195 --> 03:54.869\n例如呢，\n\n03:54.869 --> 03:55.744\n某些患者呢，\n\n03:55.744 --> 03:57.744\n初期有剧烈的呛咳之后缓解，\n\n03:57.744 --> 03:58.770\n但数天以后呢，\n\n03:58.770 --> 04:00.645\n可能出现发烧咳嗽的症状。\n\n04:01.507 --> 04:02.356\n这可能提示呢，\n\n04:02.356 --> 04:03.156\n出现并发症，\n\n04:03.207 --> 04:04.031\n那早期呢，\n\n04:04.031 --> 04:06.007\n可能是由于这个异物的直接刺激，\n\n04:06.106 --> 04:08.656\n导致了这个患者的咳嗽，\n\n04:08.656 --> 04:12.457\n包括包括这个异物堵塞堵塞这个气道引起的这个呼吸困难，\n\n04:12.507 --> 04:13.707\n但数周后呢。\n\n04:14.748 --> 04:15.149\n嗯。\n\n04:16.209 --> 04:16.434\n患者，\n\n04:16.434 --> 04:17.234\n出现发烧啊，\n\n04:17.234 --> 04:17.934\n咳嗽加重啊，\n\n04:17.934 --> 04:20.309\n可能可能是出现了阻塞性肺炎等等情况。\n\n04:22.420 --> 04:22.871\n那同时呢，\n\n04:22.871 --> 04:25.321\n我们体格检查也是至关重要的。\n\n04:25.371 --> 04:26.371\n通过听诊器呢，\n\n04:26.371 --> 04:28.795\n对于肺部的听诊重点关注呼吸音是否对称，\n\n04:28.795 --> 04:30.020\n有无异常呼吸音。\n\n04:30.071 --> 04:32.871\n当气管支气管内有异物时，\n\n04:33.071 --> 04:35.321\n患者呼吸音可能减弱，\n\n04:35.420 --> 04:37.821\n还可能听到一些哮鸣或者失落音。\n\n04:39.350 --> 04:42.149\n例如在异物阻塞阻塞一侧支气管时，\n\n04:42.149 --> 04:45.350\n可以可以听到该侧的呼吸音明显低于对侧。\n\n04:46.298 --> 04:48.847\n可用于辅助判断支气管异物的位置。\n\n04:51.472 --> 04:52.722\n用于检查呢。\n\n04:53.979 --> 04:55.053\n手触摸患者胸部，\n\n04:55.053 --> 04:56.903\n感受患者双侧胸廓呢，\n\n04:56.903 --> 04:57.979\n活动是否一致，\n\n04:58.128 --> 04:59.079\n有无压痛？\n\n04:59.860 --> 05:01.610\n异物导致肺部疾病病变时，\n\n05:01.710 --> 05:02.260\n患者。\n\n05:03.601 --> 05:06.752\n病病患侧的呼吸胸廓活动可能减弱，\n\n05:06.851 --> 05:08.277\n局部可能出现压痛。\n\n05:08.277 --> 05:09.701\n如出现肺气肿、肺不张时，\n\n05:09.701 --> 05:10.502\n患者胸廓。\n\n05:11.682 --> 05:13.782\n的触感可能与正常侧会有差异。\n\n05:17.071 --> 05:17.897\n体格检查呢，\n\n05:17.897 --> 05:19.296\n那我们要看到患者呢，\n\n05:19.296 --> 05:19.721\n有无。\n\n05:20.532 --> 05:22.282\n咽喉部有红肿破损的情况，\n\n05:22.381 --> 05:26.532\n判断异物是否在咽喉部残留以及对其造成损伤。\n\n05:26.532 --> 05:26.957\n例如，\n\n05:26.957 --> 05:28.832\n如发现咽喉部有明显的划伤，\n\n05:28.981 --> 05:31.182\n可能提示异物经过此处。\n\n05:31.182 --> 05:35.782\n同时也可也也能为判断异物的大小和形状提供一定的依据。\n\n05:38.200 --> 05:39.401\n我们的影像学检查呢，\n\n05:39.401 --> 05:42.276\n主要是包括一个X光和CT。\n\n05:42.376 --> 05:42.751\n嗯，\n\n05:42.751 --> 05:44.200\nX光的正侧位片呢，\n\n05:44.200 --> 05:46.101\n可以帮助发现不透光的异物，\n\n05:46.101 --> 05:49.026\n比如说金属异物、较大的骨质异物。\n\n05:49.881 --> 05:49.955\n嗯，\n\n05:49.955 --> 05:50.805\n还可以观察呢。\n\n05:50.805 --> 05:53.480\n患者肺部有肺气肿、肺不张等间接真相。\n\n05:55.397 --> 05:59.196\n比如在X光可以看到金属啊、硬币等等异物的形状。\n\n06:00.285 --> 06:04.084\n以及因异物导致阻塞所导致肺透亮度改变的情况，\n\n06:04.084 --> 06:06.834\n对判断异物的位置和并发症有重要意义。\n\n06:08.738 --> 06:09.562\n在临床应用中呢，\n\n06:09.562 --> 06:10.388\n我们更多的。\n\n06:11.622 --> 06:12.821\n会使用一个CT扫描。\n\n06:13.894 --> 06:15.070\nCT扫描相比X光呢，\n\n06:15.070 --> 06:17.644\n能够更清晰的显示支气管内的异物的位置。\n\n06:18.872 --> 06:20.671\n具体的形态大小。\n\n06:21.384 --> 06:25.759\n对于一些X线不易发现的低密度异物或者较小的异物呢，\n\n06:25.759 --> 06:27.584\n有较高的诊断价值，\n\n06:27.584 --> 06:28.884\n比如说塑料啊，\n\n06:28.884 --> 06:29.584\n木质啊，\n\n06:29.584 --> 06:34.834\n木质的异物在XX在CT图像上能够更清楚的显现，\n\n06:34.834 --> 06:35.984\n并被准确的识别。\n\n06:39.979 --> 06:41.678\n其他的影像学检查手段呢，\n\n06:41.678 --> 06:43.829\n比如我们比较少用的是支气管造影，\n\n06:43.979 --> 06:45.204\n将支气管造影呢，\n\n06:45.204 --> 06:46.428\n是将造影剂注入支气管，\n\n06:46.428 --> 06:47.278\n通过观察。\n\n06:48.386 --> 06:52.687\n其通行情况以明确异物的异物异物的位置和气道形态。\n\n06:52.837 --> 06:57.161\n这种这种方法对于诊断复杂部位的异物或者微小异物有优势。\n\n06:57.161 --> 07:00.437\n有优势能够清晰的显示异物与气道关系，\n\n07:00.437 --> 07:01.661\n但属于有创检查，\n\n07:01.661 --> 07:05.036\n但可能存在一些存存在一定一定的风险啊。\n\n07:05.036 --> 07:05.812\n这样的检查呢，\n\n07:05.812 --> 07:06.261\n目前呢，\n\n07:06.261 --> 07:08.361\n在临床上也是比较少用的大多数呢，\n\n07:08.361 --> 07:09.486\n有通过CT呢，\n\n07:09.486 --> 07:11.437\n经基本上都可以发现的。\n\n07:15.337 --> 07:16.761\n支气管异物的治疗呢？\n\n07:17.826 --> 07:18.152\n嗯，\n\n07:18.152 --> 07:18.627\n首先呢，\n\n07:18.627 --> 07:19.326\n支气管异物呢，\n\n07:19.326 --> 07:21.552\n是其相关的风险呢，\n\n07:21.552 --> 07:24.627\n是是是比较是比较大的。\n\n07:26.726 --> 07:27.427\n轻者呢？\n\n07:29.567 --> 07:32.868\n严重严重轻轻者可能会出现一些比如说。\n\n07:33.860 --> 07:34.960\n呼吸道刺激的症状，\n\n07:34.960 --> 07:36.385\n比如说一些咳嗽等等。\n\n07:36.385 --> 07:37.585\n通过这些剧的咳嗽啊，\n\n07:37.585 --> 07:39.210\n能够把这些异物异物给清，\n\n07:39.210 --> 07:42.010\n异物给异物给清清理出来。\n\n07:42.110 --> 07:43.661\n严重的严重的情况呢，\n\n07:43.661 --> 07:44.960\n甚至可能会出现窒息。\n\n07:47.933 --> 07:51.609\n猝死等我们现场急救呢，\n\n07:51.609 --> 07:55.134\n这是一个基本上每个每每每个人都应该会掌握的。\n\n07:55.134 --> 07:56.658\n除除除了一个学医，\n\n07:56.658 --> 07:59.884\n除了一个专业专业专业的专业的医学知识，\n\n07:59.933 --> 08:03.058\n医学医医医医务医务人员从业者，\n\n08:03.058 --> 08:04.834\n其他的不一一般的话呢，\n\n08:04.834 --> 08:05.283\n民众呢，\n\n08:05.283 --> 08:08.134\n我们也应该讲究这些紧急的处理措施。\n\n08:09.309 --> 08:10.285\n主要的处理措施呢，\n\n08:10.285 --> 08:11.609\n主要是一个海姆立克急救法，\n\n08:11.609 --> 08:14.160\n主要适用于呢一些就是危急的情况，\n\n08:14.160 --> 08:16.834\n比如说异物、异物、异物引起的气道梗阻。\n\n08:18.282 --> 08:20.282\n主要分为成人和儿童两种。\n\n08:22.289 --> 08:22.789\n成人呢，\n\n08:22.789 --> 08:23.864\n主要是施救者啊，\n\n08:23.864 --> 08:25.838\n站在患者的身后，\n\n08:25.938 --> 08:27.989\n前脚距离患者呢，\n\n08:27.989 --> 08:28.563\n有一脚宽，\n\n08:28.563 --> 08:29.264\n后脚呢，\n\n08:29.264 --> 08:30.789\n脚跟垫起，\n\n08:30.789 --> 08:31.688\n膝盖微弯，\n\n08:31.938 --> 08:33.838\n双臂环绕患者的腹部，\n\n08:33.838 --> 08:34.739\n一手握拳。\n\n08:36.349 --> 08:38.775\n拇指顶顶住患者肚脐上方，\n\n08:38.775 --> 08:40.974\n两横指剑突下方，\n\n08:40.974 --> 08:41.825\n另一手呢，\n\n08:42.325 --> 08:43.375\n抓住拳头，\n\n08:43.474 --> 08:45.625\n急速且有力的向拉动双臂，\n\n08:45.625 --> 08:48.125\n向内向上冲击患者上腹部，\n\n08:48.125 --> 08:49.275\n每次约一秒钟。\n\n08:50.333 --> 08:51.059\n例如呢？\n\n08:51.978 --> 08:55.703\n成人聚餐时不慎将食物被食物噎住，\n\n08:55.853 --> 08:58.203\n旁人可立刻采取这种方法急救。\n\n09:00.015 --> 09:03.341\n很多因异物堵塞导致气道窒息的情况，\n\n09:03.341 --> 09:06.716\n可以通过海姆立克急救法得到缓解，\n\n09:06.716 --> 09:07.241\n同时呢，\n\n09:07.241 --> 09:10.515\n如果说自己一个人一一个给自己，\n\n09:10.515 --> 09:11.466\n自己一个人呢。\n\n09:12.744 --> 09:14.645\n没有没有没有他人辅助的情况下呢，\n\n09:14.645 --> 09:19.719\n也可用也也可也可也可找一个适量适适适当适当高的一个桌角。\n\n09:21.622 --> 09:21.921\n抵，\n\n09:22.021 --> 09:22.572\n抵住，\n\n09:22.671 --> 09:23.671\n抵住这个。\n\n09:24.992 --> 09:28.793\n其其上方和剑突下方的位置，\n\n09:28.843 --> 09:29.242\n嗯，\n\n09:29.942 --> 09:31.293\n以自身的力量呢，\n\n09:31.543 --> 09:32.867\n向向桌脚，\n\n09:32.867 --> 09:33.742\n桌脚用力。\n\n09:34.909 --> 09:35.684\n同样的是，\n\n09:35.684 --> 09:40.534\n向向内向上的进行一个冲冲击自己的腹部，\n\n09:40.534 --> 09:42.309\n有助于这个异物的咳出，\n\n09:42.559 --> 09:44.909\n有助于这个异物的排出。\n\n09:45.510 --> 09:47.034\n1岁以下的婴幼儿呢，\n\n09:47.034 --> 09:49.434\n可以采用一个拍背法。\n\n09:49.434 --> 09:50.734\n主要的操作方法呢，\n\n09:50.734 --> 09:54.210\n是将婴儿的面部朝下放在手臂上，\n\n09:54.210 --> 09:56.559\n用手支撑婴儿患者头部和颈部，\n\n09:56.710 --> 09:58.960\n保持头部略低于身体。\n\n09:59.643 --> 10:00.393\n另一只手呢？\n\n10:02.447 --> 10:03.197\n在掌根，\n\n10:03.447 --> 10:05.171\n在的掌根呢？\n\n10:05.171 --> 10:05.947\n在婴儿的。\n\n10:06.895 --> 10:11.994\n背背背部两侧肩胛骨之间快速有力的拍击5次。\n\n10:12.744 --> 10:16.544\n如婴如婴儿进食辅食时不小心被不小心呛到异物，\n\n10:16.645 --> 10:20.645\n家属可迅速采用拍背法帮助婴儿排出异物。\n\n10:26.005 --> 10:27.030\n现场紧急措施呢，\n\n10:27.030 --> 10:28.705\n还包括咳嗽。\n\n10:28.705 --> 10:29.854\n当异物进入气道时，\n\n10:29.854 --> 10:30.830\n患者清醒，\n\n10:30.830 --> 10:33.080\n患者有意识清醒且有力，\n\n10:33.080 --> 10:34.192\n有咳嗽能力时，\n\n10:34.192 --> 10:35.880\n应当鼓励其用力咳嗽。\n\n10:35.880 --> 10:36.929\n通过咳嗽反射呢，\n\n10:36.929 --> 10:38.229\n将异物咳出。\n\n10:38.580 --> 10:39.155\n比如说，\n\n10:39.155 --> 10:41.479\n儿童吸入小小的小的颗粒物时，\n\n10:41.479 --> 10:42.604\n若能够自主咳嗽，\n\n10:42.604 --> 10:43.880\n可以将其异物咳嗽。\n\n10:43.880 --> 10:45.679\n这是一种简单有效的处理方式。\n\n10:48.148 --> 10:48.973\n到了医院呢，\n\n10:48.973 --> 10:50.197\n我们一般采取的方法呢，\n\n10:50.197 --> 10:53.523\n比如说直直接喉镜下取异物取出。\n\n10:53.523 --> 10:54.297\n利用喉镜呢，\n\n10:54.297 --> 10:56.072\n主要是取出声门附近的异物。\n\n10:56.072 --> 10:57.247\n在直接喉镜下，\n\n10:57.247 --> 10:57.997\n在直视，\n\n10:58.098 --> 11:00.273\n在直接的喉镜直视下，\n\n11:00.273 --> 11:02.497\n使用合适的医疗器械将异物取出，\n\n11:02.497 --> 11:04.997\n例如卡在喉部的鱼刺等等。\n\n11:06.687 --> 11:07.138\n医生呢，\n\n11:07.138 --> 11:09.987\n可以通过这个喉镜的清晰看到异物的位置。\n\n11:11.765 --> 11:13.715\n然后使用喉钳准确的夹，\n\n11:13.715 --> 11:15.065\n准确的夹住并取出。\n\n11:15.114 --> 11:16.515\n该种方法操作简单，\n\n11:16.515 --> 11:19.265\n能够快速解除异物对喉部的梗阻。\n\n11:20.325 --> 11:21.101\n同时呢，\n\n11:21.450 --> 11:24.301\n这这种这种方法也能看到这个异物啊，\n\n11:24.301 --> 11:26.375\n有没有对喉对喉部产生一些损伤，\n\n11:26.375 --> 11:27.601\n比如说出血啊，\n\n11:27.601 --> 11:28.500\n水肿等等，\n\n11:28.551 --> 11:29.401\n那后续呢，\n\n11:29.401 --> 11:31.325\n可能是可能还需要一些其他的治疗，\n\n11:31.325 --> 11:32.950\n如果是如果有类似的情况。\n\n11:34.216 --> 11:34.341\n嗯，\n\n11:34.341 --> 11:36.565\n如果说这个异物比较深，\n\n11:36.966 --> 11:38.265\n到了支气管或者说。\n\n11:39.924 --> 11:40.174\n嗯，\n\n11:40.174 --> 11:40.724\n这个呢，\n\n11:40.724 --> 11:42.724\n可能需要支气管镜下的异物取出，\n\n11:42.924 --> 11:44.025\n这是目前治疗。\n\n11:45.236 --> 11:47.262\n气管支气管异物最常见的使用方法，\n\n11:47.461 --> 11:49.911\n通过支气管镜进入气管和支气管，\n\n11:49.961 --> 11:51.762\n直接观察异物的位置、形态，\n\n11:51.812 --> 11:54.111\n并使用相应的工具将异物取出。\n\n11:54.211 --> 11:55.812\n对于各种类型的异物，\n\n11:55.861 --> 11:59.812\n包括植物、动物性、矿物性都有很好的治疗效果。\n\n11:59.812 --> 12:02.161\n如儿童吸入花生米等异物，\n\n12:02.161 --> 12:06.387\n支气管镜下异物取出术可以提高手术成功率，\n\n12:06.387 --> 12:08.762\n能够有效的避免并发症。\n\n12:12.223 --> 12:12.674\n同时呢，\n\n12:12.674 --> 12:13.624\n对于一些患者呢，\n\n12:13.624 --> 12:14.948\n出现了一些并发症的情况呀，\n\n12:14.948 --> 12:18.773\n比如说因为异因为异物的刺激引起气道黏膜的炎症反应，\n\n12:18.773 --> 12:21.374\n可使用抗生素或抗生素预防预防感染，\n\n12:21.374 --> 12:22.249\n比如头孢菌素。\n\n12:22.348 --> 12:22.999\n同时呢，\n\n12:22.999 --> 12:24.598\n可以使用一些支气管扩张剂，\n\n12:24.698 --> 12:26.624\n能够减轻患者患者气道痉挛，\n\n12:26.624 --> 12:28.049\n减轻患者呼吸困难症状。\n\n12:28.148 --> 12:30.523\n比如说在药物球取出后，\n\n12:30.523 --> 12:32.723\n为了防止食物是肺部感染，\n\n12:32.723 --> 12:34.398\n可以可以适当的给予抗生素。\n\n12:43.309 --> 12:44.383\n手术治疗实际上，\n\n12:44.383 --> 12:48.283\n当异物导致患者出现严重的呼吸困难、窒息等情况时呢，\n\n12:48.283 --> 12:51.359\n通过现场急救和常规治疗方法无解时，\n\n12:51.359 --> 12:52.609\n需要立即进行手术。\n\n12:52.708 --> 12:53.234\n例如，\n\n12:53.234 --> 12:53.734\n患者呢，\n\n12:53.734 --> 12:55.258\n异物完全堵塞气道出现。\n\n12:56.219 --> 12:56.794\n面色青紫，\n\n12:56.794 --> 12:57.770\n意识上升的情况，\n\n12:57.770 --> 12:59.869\n应当应当争分夺秒进行。\n\n13:01.309 --> 13:04.885\n进行易于挽救生命这些手术的时机呢，\n\n13:04.885 --> 13:07.284\n通常是一些患者症状比较轻，\n\n13:07.284 --> 13:10.409\n异物暂时未引起严重的并发症。\n\n13:10.409 --> 13:11.409\n通过保同时呢，\n\n13:11.409 --> 13:12.609\n通过保守治疗方法呢，\n\n13:12.609 --> 13:13.710\n无法将异物排出，\n\n13:14.059 --> 13:15.409\n可以选择择期手术。\n\n13:16.638 --> 13:17.388\n如果异物呢，\n\n13:17.388 --> 13:18.763\n在支气管停留时间比较长，\n\n13:18.763 --> 13:21.088\n虽然未曾造成急性急性的梗阻，\n\n13:21.088 --> 13:22.713\n但存在潜在的感染风险，\n\n13:22.864 --> 13:26.013\n也应当在合适的情况下进行异物的取出。\n\n13:32.077 --> 13:33.127\n还有一些患者呢，\n\n13:33.127 --> 13:34.776\n对于一些位置比较特殊的，\n\n13:34.877 --> 13:37.877\n或者说通过支气管镜的方式难以取出的异物。\n\n13:38.559 --> 13:38.710\n嗯，\n\n13:38.710 --> 13:39.309\n或者呢，\n\n13:39.309 --> 13:39.784\n义务呢，\n\n13:39.784 --> 13:40.210\n导致。\n\n13:42.218 --> 13:44.518\n严重的严重的病变，\n\n13:44.518 --> 13:45.393\n比如说肺不张，\n\n13:45.393 --> 13:46.343\n肺部感染等等，\n\n13:46.343 --> 13:49.768\n或者说这个异物又又又又。\n\n13:50.973 --> 13:53.073\n有比较尖锐的异物扎到了胸腔里面，\n\n13:53.223 --> 13:54.448\n就穿透了支气管壁，\n\n13:54.448 --> 13:57.773\n扎到扎到胸腔里面可能需要进行开胸手术。\n\n13:59.668 --> 14:00.492\n这种手术方法呢，\n\n14:00.492 --> 14:03.192\n患者会直接暴露患者病病变的部位，\n\n14:03.192 --> 14:04.218\n将异物取出，\n\n14:04.468 --> 14:06.817\n并对受损的肺组织进行修复。\n\n14:06.968 --> 14:07.393\n不过，\n\n14:07.393 --> 14:08.968\n开胸手术的创伤比较大。\n\n14:12.770 --> 14:13.145\n一般呢，\n\n14:13.145 --> 14:14.296\n如果通过前两种方式，\n\n14:14.296 --> 14:15.895\n可以可以可以将异物取出，\n\n14:15.895 --> 14:17.421\n一般很少会选择第三种。\n\n14:20.114 --> 14:20.664\n还有一些呢，\n\n14:20.763 --> 14:23.189\n还有一些随着随着目前科学技术的进展呢，\n\n14:23.189 --> 14:25.138\n还有一些胸腔镜下的手术，\n\n14:25.138 --> 14:28.463\n它与它与开传统开胸手术相比呢，\n\n14:28.463 --> 14:29.463\n创伤会更小一点，\n\n14:29.463 --> 14:31.338\n恢复时间会更短一点，\n\n14:31.338 --> 14:31.939\n出血量少，\n\n14:31.939 --> 14:32.513\n恢复快。\n\n14:32.763 --> 14:33.114\n嗯，\n\n14:33.114 --> 14:36.713\n对于一些较小的异物或病或病理范围相对极限的患者，\n\n14:36.713 --> 14:37.864\n局限的情况呢，\n\n14:37.864 --> 14:39.314\n胸腔镜是更好的选择。\n\n14:43.760 --> 14:44.710\n支气管异物呢，\n\n14:44.710 --> 14:46.036\n最重要的一个处理措施呢，\n\n14:46.036 --> 14:48.986\n是预防针对儿童呢，\n\n14:48.986 --> 14:49.411\n首先呢，\n\n14:49.411 --> 14:52.710\n我们要安合理安排饮食，\n\n14:52.710 --> 14:55.036\n要要对不同年龄段的年龄，\n\n14:55.036 --> 14:56.286\n年龄阶段的儿童呢，\n\n14:56.885 --> 14:58.635\n选择其合适的食物。\n\n14:59.309 --> 14:59.583\n比如说，\n\n14:59.583 --> 15:00.934\n如果患者患儿比较小，\n\n15:00.934 --> 15:04.758\n就不应该给予一些花生米啊、瓜子啊、坚果之类的食物。\n\n15:05.864 --> 15:06.114\n嗯。\n\n15:08.929 --> 15:10.130\n防止误吸的风险，\n\n15:10.330 --> 15:13.179\n同时要培养良好的进食习惯。\n\n15:13.530 --> 15:14.905\n进食进食地点呢，\n\n15:14.905 --> 15:15.405\n要安静，\n\n15:15.405 --> 15:19.380\n避免患避免嬉戏哭闹奔跑。\n\n15:19.380 --> 15:21.979\n用固定的用餐地点营造安静的住宿环境，\n\n15:22.080 --> 15:22.479\n嗯。\n\n15:23.913 --> 15:24.437\n尽量让患，\n\n15:24.437 --> 15:25.888\n尽量让儿童呢，\n\n15:25.888 --> 15:26.312\n专注于，\n\n15:26.312 --> 15:28.513\n专注于吃饭，\n\n15:28.513 --> 15:29.213\n不要让。\n\n15:30.997 --> 15:32.898\n还尽量避免让孩子在吃饭的时候，\n\n15:32.898 --> 15:33.372\n同时呢，\n\n15:33.372 --> 15:36.047\n看看看电视或者玩玩具。\n\n15:37.023 --> 15:38.572\n以免分孩子分心，\n\n15:38.572 --> 15:39.747\n导致食物的误吸。\n\n15:42.633 --> 15:43.283\n同时呢，\n\n15:43.283 --> 15:44.633\n也应当保管一些，\n\n15:44.684 --> 15:45.758\n保管好孩子，\n\n15:45.758 --> 15:47.583\n孩子的一些小小的物件。\n\n15:48.304 --> 15:50.580\n放在一些儿童无法触及的地方。\n\n15:51.372 --> 15:51.447\n嗯，\n\n15:51.447 --> 15:52.096\n因为儿童呢，\n\n15:52.096 --> 15:54.622\n无法对这些食这些东西进行一个合理的辨别，\n\n15:54.622 --> 15:57.971\n会会进行一个误误食或者说误吸。\n\n16:00.133 --> 16:00.583\n同时呢，\n\n16:00.783 --> 16:03.484\n给孩子也也应当进行一个安全教育。\n\n16:03.533 --> 16:04.133\n比如说，\n\n16:04.133 --> 16:08.434\n给孩子讲解一些一些物品不能够放到口鼻的道理。\n\n16:08.684 --> 16:10.883\n可以通过一些动画绘本啊，\n\n16:10.883 --> 16:13.833\n让孩子了解支气管的危害，\n\n16:13.833 --> 16:15.633\n提高孩子自我保护意识。\n\n16:17.534 --> 16:18.109\n成人呢，\n\n16:18.109 --> 16:18.710\n主要是。\n\n16:19.976 --> 16:21.452\n主主要主要这种异物，\n\n16:21.452 --> 16:22.226\n异物的吸入呢，\n\n16:22.226 --> 16:22.702\n一个是呢，\n\n16:22.702 --> 16:24.252\n吃饭的时候要保持专注。\n\n16:25.036 --> 16:26.835\n第二个是饮酒要适量控制。\n\n16:27.783 --> 16:28.333\n同时呢，\n\n16:28.333 --> 16:29.434\n注意口腔护理，\n\n16:29.434 --> 16:30.133\n其实成人呢，\n\n16:30.133 --> 16:34.333\n大多数都是都是都是都是都是都是都是饮酒后或者说。\n\n16:35.440 --> 16:36.690\n在睡眠的过程中啊，\n\n16:36.690 --> 16:37.791\n一些假牙掉了。\n\n16:38.380 --> 16:39.981\n掉掉落的一些气管异物。\n\n16:48.116 --> 16:49.416\n今天的分享到此结束，\n\n16:49.416 --> 16:49.916\n谢谢。\n\n","v0247cg10004d61gkkaljht8ne7ddkq0",1013,606,0,"2026-01-25 01:18:33","气管支气管异物诊断方法 - 症状、检查与治疗指南  ","气管支气管异物, 异物诊断方法, 支气管镜检查, 儿童异物吸入, 呼吸道异物症状  ","本文详细介绍气管支气管异物的常见诊断方法，包括临床症状识别、影像学检查和支气管镜操作，帮助您了解儿童及成人呼吸道异物的处理流程和急救措施。","2026-04-06 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