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--> 00:05.929\n各位老师、各位同仁，\n\n00:05.929 --> 00:06.630\n大家好，\n\n00:06.780 --> 00:11.229\n今天我们来学习一下有关基层慢阻肺的相关知识。\n\n00:20.170 --> 00:20.545\n那么，\n\n00:20.545 --> 00:22.971\n筑牢慢阻肺管理的第一道防线，\n\n00:23.170 --> 00:25.820\n首先是把握慢阻肺基层管理。\n\n00:26.121 --> 00:29.871\n一、主动筛查诊断慢阻肺高危人群。\n\n00:30.221 --> 00:33.471\n二、规范化稳定期评估治疗随访。\n\n00:33.721 --> 00:34.245\n第三，\n\n00:34.245 --> 00:36.870\n辨识和应对慢阻肺急性加重。\n\n00:37.472 --> 00:41.122\n现在我国慢阻肺呈现高发病高死亡态姿，\n\n00:41.571 --> 00:45.946\n那么在城市中整体患病率达到8.6%啊，\n\n00:45.946 --> 00:49.472\n农村中估算人数也有1亿啊。\n\n00:49.472 --> 00:54.472\n一般男性高于女性大于等于40岁高于20.39岁。\n\n00:55.119 --> 00:56.419\n农村高于城市。\n\n00:58.262 --> 01:01.161\n我国现在慢阻肺患者对疾病的认知不足，\n\n01:01.212 --> 01:03.587\n肺功能检查率比较低啊。\n\n01:03.587 --> 01:08.211\n慢阻肺患者自我意识到病情的比例只有2.6%，\n\n01:08.412 --> 01:12.412\n接受过肺功能检查的成人比例是9.7%，\n\n01:12.662 --> 01:17.662\n那么接受过肺功能检查的慢阻肺患者比例也只有12%，\n\n01:17.811 --> 01:23.762\n自述有慢阻肺病史且接受过肺功能检查的患者比例55.8%。\n\n01:24.568 --> 01:28.617\n那么我国患者这个肺功能检查率还是比较低的。\n\n01:30.335 --> 01:30.835\n那么，\n\n01:30.835 --> 01:33.536\n慢阻肺的管理基层是非常关键的。\n\n01:33.636 --> 01:36.986\n基层是慢阻肺管理的第一线和主战场。\n\n01:37.335 --> 01:38.661\n第一线指的是呢，\n\n01:38.661 --> 01:41.185\n慢阻肺它早期症状并不明显，\n\n01:41.386 --> 01:42.986\n患者多在基层。\n\n01:44.265 --> 01:46.966\n主战场指的是这个慢阻肺管理啊，\n\n01:47.015 --> 01:50.416\n它涉及这个促诊啊，\n\n01:51.015 --> 01:56.166\n促防诊控还有治康多方面需要强化分级诊疗。\n\n01:56.919 --> 01:59.870\n将基层医生也要纳入到管理队伍中，\n\n01:59.970 --> 02:02.720\n让患者到得到更好的管理。\n\n02:07.190 --> 02:08.139\n慢阻肺呢，\n\n02:08.139 --> 02:11.039\n已经被纳入国家分级诊疗政策。\n\n02:11.240 --> 02:14.289\n防治慢阻肺中长期计划中也提到，\n\n02:14.440 --> 02:17.789\n在基层要逐步提供促进慢病。\n\n02:19.054 --> 02:22.003\n早期发现服务落实分级治疗。\n\n02:22.154 --> 02:27.404\n国务院关于实施健康中国行动的意见中也提出要普及肺功能检查，\n\n02:27.604 --> 02:30.203\n提高基层肺功能检查能力。\n\n02:30.404 --> 02:32.203\n健康中国行动中也指出，\n\n02:32.304 --> 02:34.253\n提高基层防治能力和水平，\n\n02:34.253 --> 02:36.054\n落实落实分级治疗。\n\n02:44.606 --> 02:47.180\n那么把握慢阻肺基层管理呢？\n\n02:47.180 --> 02:50.805\n首先是主动去筛查诊断慢阻肺和高危人群。\n\n02:51.106 --> 02:52.955\n那么什么是慢阻肺呢？\n\n02:53.953 --> 02:57.003\n慢阻肺指的就是慢性阻塞性肺疾病，\n\n02:57.104 --> 03:00.453\n在2021年中国慢阻肺指南中指出，\n\n03:00.654 --> 03:05.054\n它是一种常见的可预防和治疗的慢性气道疾病，\n\n03:05.304 --> 03:07.054\n存在明显的抑制性。\n\n03:07.253 --> 03:08.179\n其特征呢，\n\n03:08.179 --> 03:11.953\n是持续存在的气流受限和相应的呼吸系统症状。\n\n03:12.354 --> 03:16.003\n其病理学改变主要是气道或者是肺泡异常，\n\n03:16.203 --> 03:19.804\n通常与显著暴露于有害颗粒或气体相关，\n\n03:20.003 --> 03:24.354\n遗传易感性异常的炎症反应以及肺异常发育等。\n\n03:24.473 --> 03:27.473\n众多的宿主因素参与发病过程。\n\n03:30.669 --> 03:33.869\n在这个慢阻肺2023年中，\n\n03:33.869 --> 03:37.119\n也强调了慢阻肺是一种抑制性的肺部疾病。\n\n03:37.270 --> 03:39.195\n其特征是由于呼吸道异常，\n\n03:39.195 --> 03:40.695\n比如说支气管炎啊，\n\n03:40.695 --> 03:43.945\n毛细支气管炎和或者是肺泡啊，\n\n03:43.945 --> 03:47.419\n肺气肿引起的慢慢性呼吸道症状，\n\n03:47.470 --> 03:49.544\n包括困呼吸困难啊，\n\n03:49.544 --> 03:50.195\n咳嗽啊，\n\n03:50.195 --> 03:50.970\n咳痰啊，\n\n03:51.119 --> 03:54.470\n导致有这个持续的反复恶化的气流阻塞。\n\n03:56.690 --> 03:57.065\n那么，\n\n03:57.065 --> 04:01.589\n慢阻肺和慢性支气管炎肺气肿概念需要来澄清一下。\n\n04:01.940 --> 04:03.414\n慢性支气管炎呢，\n\n04:03.414 --> 04:07.389\n指的是在除慢性咳嗽的其他已知病因后，\n\n04:07.490 --> 04:09.964\n每年咳嗽咳痰是3个月以上，\n\n04:09.964 --> 04:11.289\n并且持续两年。\n\n04:12.162 --> 04:12.962\n肺气肿呢，\n\n04:12.962 --> 04:18.511\n是肺部中中末细支气管远端气腔出现异常持久的扩张，\n\n04:18.611 --> 04:23.011\n并伴有肺泡壁和细支气管破坏而无明显的肺纤维化。\n\n04:23.312 --> 04:23.761\n但是，\n\n04:23.761 --> 04:29.511\n慢阻肺它指的是当慢性支气管炎和肺气肿患者接受肺功能检查时候，\n\n04:29.562 --> 04:31.962\n出现持续气流受限，\n\n04:32.111 --> 04:33.812\n就可以诊断为慢阻肺。\n\n04:34.161 --> 04:34.736\n那么，\n\n04:34.736 --> 04:38.712\n如果仅仅是只有慢性支气管炎和和或肺气肿，\n\n04:38.761 --> 04:40.611\n但是没有持续气流受限，\n\n04:40.661 --> 04:42.261\n就不能诊断为慢阻肺。\n\n04:42.339 --> 04:42.589\n肺，\n\n04:42.589 --> 04:46.589\n所以一直强调慢阻肺的关键是持续气流受限。\n\n04:50.753 --> 04:51.128\n那么，\n\n04:51.128 --> 04:52.753\n什么样是高危人群呢？\n\n04:52.803 --> 04:54.454\n第一个是烟草接触，\n\n04:54.553 --> 04:58.104\n比如说长期吸烟或者接触二手烟患者。\n\n04:58.303 --> 04:59.803\n第二是环境因素，\n\n04:59.954 --> 05:01.903\n居住在空气污染地区，\n\n05:02.053 --> 05:05.153\n尤其是二氧化硫等有害气体污染的地区，\n\n05:05.704 --> 05:12.253\n还有就是长期从事接触粉尘、有害有毒化学物气体重金属颗粒等工作，\n\n05:12.503 --> 05:16.204\n还有是居住在气候寒冷潮湿地区，\n\n05:16.204 --> 05:18.954\n以及使用燃煤木材取暖等。\n\n05:18.954 --> 05:20.303\n第三个就是年龄。\n\n05:20.303 --> 05:20.854\n年龄。\n\n05:21.216 --> 05:22.015\n大于等于四十岁，\n\n05:22.265 --> 05:23.765\n第四个是疾病史，\n\n05:23.966 --> 05:26.066\n比如说患有某些特定疾病，\n\n05:26.615 --> 05:31.466\n如支气管哮喘、过敏性鼻炎、慢性支气管炎、肺气肿等，\n\n05:31.665 --> 05:34.665\n婴儿时期反复患下呼吸道感染，\n\n05:34.915 --> 05:35.515\n还有。\n\n05:36.446 --> 05:40.796\n遗遗传因素就是直系亲属中有慢阻肺家族史，\n\n05:40.796 --> 05:42.471\n还有就是营养因素，\n\n05:42.471 --> 05:43.696\n维生素A缺乏呀，\n\n05:43.696 --> 05:45.997\n或者是胎儿时期肺就发育不良的，\n\n05:46.147 --> 05:47.471\n营养状态比较差，\n\n05:47.471 --> 05:48.747\n体重底数偏低。\n\n05:51.134 --> 05:51.558\n那么，\n\n05:51.558 --> 05:52.584\n慢阻肺呢，\n\n05:52.584 --> 05:54.209\n我们主要是要主动筛查，\n\n05:54.209 --> 05:55.834\n推动慢阻肺，\n\n05:55.884 --> 05:56.933\n早诊早治。\n\n05:58.742 --> 06:00.041\n慢阻肺的筛查呢，\n\n06:00.041 --> 06:02.141\n比如说早期的问卷调查呀，\n\n06:02.191 --> 06:04.941\n或者是采用这个风流速仪呀。\n\n06:11.591 --> 06:14.066\n那慢阻肺将如何诊断呢？\n\n06:14.066 --> 06:14.415\n首先，\n\n06:14.415 --> 06:16.765\n肺功能检查是关键症状，\n\n06:16.765 --> 06:19.615\n一般是这个咳嗽、咳痰、呼吸困难，\n\n06:19.716 --> 06:22.540\n还有就是因素是暴露于危险因素，\n\n06:22.540 --> 06:23.591\n烟草的暴露，\n\n06:23.591 --> 06:24.365\n职业暴露，\n\n06:24.365 --> 06:25.415\n室内外污染。\n\n06:26.252 --> 06:28.852\n接受肺气肺功能检查啊，\n\n06:28.852 --> 06:34.178\n然后看他的气流受限程度来评估这个慢阻肺的严重程度。\n\n06:36.290 --> 06:39.540\n还有慢阻肺和其他疾病鉴别的要点，\n\n06:39.839 --> 06:41.190\n比如说慢阻肺，\n\n06:41.190 --> 06:43.765\n它就是一般中年发病，\n\n06:43.765 --> 06:45.089\n大于等于40岁嘛。\n\n06:45.190 --> 06:49.239\n然后长期吸烟史或者其他烟雾接触史啊，\n\n06:49.239 --> 06:51.690\n症状是缓慢进展的，\n\n06:51.790 --> 06:55.989\n在急性加重期症状超过异常变异并持续恶化。\n\n06:56.515 --> 06:57.091\n哮喘呢，\n\n06:57.091 --> 06:59.265\n一般是通常儿童期发病，\n\n06:59.365 --> 07:00.841\n每日症状变化快，\n\n07:00.841 --> 07:02.716\n夜间和清晨症状明显，\n\n07:02.865 --> 07:04.216\n可有过敏史啊，\n\n07:04.216 --> 07:04.966\n鼻炎啊，\n\n07:04.966 --> 07:05.665\n或湿疹。\n\n07:06.601 --> 07:08.825\n还有就是有哮喘家族史。\n\n07:09.717 --> 07:11.217\n充血性心力衰竭，\n\n07:11.368 --> 07:12.292\n它显示呢，\n\n07:12.292 --> 07:14.467\n是X线胸片，\n\n07:14.567 --> 07:15.542\n心脏扩大，\n\n07:15.542 --> 07:16.243\n肺水肿，\n\n07:16.243 --> 07:19.268\n肺功能检查提示有限制性通气障碍，\n\n07:19.268 --> 07:21.368\n而不是这个气流受限。\n\n07:22.066 --> 07:23.165\n支气管扩张呢，\n\n07:23.165 --> 07:24.466\n是大量的脓痰，\n\n07:24.665 --> 07:26.265\n常伴有细菌感染，\n\n07:26.265 --> 07:28.216\n出湿罗音杵状指。\n\n07:28.415 --> 07:31.966\nX线胸片或者CT显示支气管扩张，\n\n07:32.066 --> 07:33.716\n管壁增厚。\n\n07:33.716 --> 07:35.015\n肺结核的患者呢，\n\n07:35.015 --> 07:37.265\n是所有年龄都可以发病。\n\n07:37.265 --> 07:40.566\nX线胸片显示就是肺浸润灶啊，\n\n07:40.566 --> 07:42.515\n或者是结节状空洞样改变。\n\n07:42.615 --> 07:47.015\n这个SC还胸片还是显示的比较明显的。\n\n07:47.115 --> 07:49.115\n然后微生物检查可以确诊，\n\n07:49.115 --> 07:50.216\n流行地区高发。\n\n07:51.776 --> 07:53.651\n那我们在基层这个慢阻肺，\n\n07:53.651 --> 07:55.626\n它诊断的流程是什么样的呢？\n\n07:55.675 --> 07:58.226\n首先就是一些高危人群，\n\n07:58.226 --> 08:00.675\n他是年龄大于等于40岁呀，\n\n08:00.726 --> 08:02.726\n有这个吸烟粉尘接触史，\n\n08:02.825 --> 08:06.526\n然后伴有慢性咳嗽咳痰呼吸困难等症状，\n\n08:06.726 --> 08:09.425\n就把它列为高危人群啊，\n\n08:09.425 --> 08:12.476\n这样就对其进行问卷调查，\n\n08:12.476 --> 08:14.050\n风流速一啊，\n\n08:14.050 --> 08:15.950\n询问详细的询问病史，\n\n08:15.950 --> 08:17.175\n进行体格检查。\n\n08:17.425 --> 08:18.300\n首先啊，\n\n08:18.300 --> 08:20.075\n最常见的就是肺功能检查。\n\n08:20.276 --> 08:21.776\n那么肺功能检查。\n\n08:22.071 --> 08:26.321\nFEV1比上FVC小于零点七啊，\n\n08:26.321 --> 08:28.946\n就基本可以确诊为慢阻肺了。\n\n08:29.045 --> 08:30.196\n评估病情，\n\n08:30.196 --> 08:33.070\n并且治疗这个方案，\n\n08:33.070 --> 08:33.995\n定期随访。\n\n08:36.060 --> 08:39.210\n如果这个临床与肺功能不不相符啊，\n\n08:39.210 --> 08:42.736\n有诊断不明确的情况就要转至上级医院。\n\n08:42.935 --> 08:43.460\n那么，\n\n08:43.460 --> 08:47.411\n我们还会辅助一些其他的检查诊断啊，\n\n08:47.411 --> 08:49.010\n比如说这个血常规啊，\n\n08:49.010 --> 08:49.736\n胸片啊，\n\n08:49.736 --> 08:51.935\n来排除是不是其他的疾病。\n\n08:52.622 --> 08:55.197\n那么FEV1比上F，\n\n08:55.197 --> 08:57.447\nVC这个比值大于等于0.7，\n\n08:57.447 --> 08:59.721\n我们可能就要考虑其他的这段了。\n\n09:01.854 --> 09:08.304\n第二个猪慢阻肺的关键就是规范化、稳定期评估、治疗和随访。\n\n09:11.426 --> 09:12.200\n慢阻肺，\n\n09:12.200 --> 09:15.625\n它的症状评估主要是根据他的呼吸困难。\n\n09:16.125 --> 09:17.276\n呼吸困难程度，\n\n09:17.276 --> 09:17.651\n比如说，\n\n09:17.651 --> 09:18.401\n零级的时候，\n\n09:18.401 --> 09:21.526\n他是只有在剧烈活动时才感到呼吸困难。\n\n09:21.776 --> 09:22.476\n一级呢，\n\n09:22.476 --> 09:24.075\n就是在平地快走啊，\n\n09:24.075 --> 09:26.375\n或者步行爬小坡时出现气短。\n\n09:26.575 --> 09:27.950\n二级是由于气短，\n\n09:27.950 --> 09:30.026\n平地行走时就比同龄慢，\n\n09:30.026 --> 09:31.575\n或者需要停下来休息。\n\n09:31.825 --> 09:36.926\n三是在平地上步行100米左右或者数分钟就需要停下来喘气，\n\n09:37.075 --> 09:38.851\n那么四级就更加严重了，\n\n09:38.851 --> 09:41.575\n因为严重呼吸困难都不能离开家。\n\n09:41.880 --> 09:44.630\n穿衣服、脱衣服时都会出现呼吸困难。\n\n09:48.950 --> 09:49.450\n那么，\n\n09:49.450 --> 09:51.849\n慢阻肺治疗的药物都有哪些呢？\n\n09:51.849 --> 09:56.799\n主要就是支气管扩张剂可以松弛支支气管平滑肌，\n\n09:56.799 --> 09:59.700\n扩张支气管缓解气流受限。\n\n09:59.849 --> 10:03.750\n临床应用的别的受体集中剂以及抗胆碱能药物，\n\n10:03.750 --> 10:06.599\n主要是长效的吸入制剂啊。\n\n10:06.599 --> 10:07.299\n短期呢，\n\n10:07.299 --> 10:09.650\n可以按需应用缓解症状。\n\n10:09.700 --> 10:12.424\n长期规律应用可以预防和减轻症状，\n\n10:12.424 --> 10:13.549\n增加运动耐力。\n\n10:14.265 --> 10:14.666\n首先，\n\n10:14.666 --> 10:16.166\n贝塔2受体集中剂，\n\n10:16.515 --> 10:21.015\n它是通过激动贝塔二受体实现支气管扩张。\n\n10:21.166 --> 10:24.341\n常见的不良反应有动性、窦性、心动过速啊，\n\n10:24.341 --> 10:26.166\n肌肉震颤、头晕和头疼。\n\n10:26.835 --> 10:29.585\n短效的有特布他林、沙丁胺醇，\n\n10:29.585 --> 10:32.236\n长效的比如沙美特罗、福莫特罗等。\n\n10:32.921 --> 10:34.247\n抗胆碱能药物呢，\n\n10:34.247 --> 10:43.572\n是通过阻断M受体扩张支气管平滑肌常见的不良反应有口干、咳嗽、局部刺激吸入相关的支气管痉痉挛、头痛、头晕。\n\n10:44.072 --> 10:46.096\n短效的比如说异丙托溴铵，\n\n10:46.096 --> 10:49.521\n长效的比如说赛托溴铵或者是格隆溴铵。\n\n10:50.210 --> 10:51.260\n还有茶碱类的，\n\n10:51.260 --> 10:53.359\n它可以解除气道平滑肌痉挛，\n\n10:53.460 --> 10:55.809\n舒张全全身和肺血管，\n\n10:55.859 --> 10:58.609\n改善呼吸肌功能及某些抗炎作用。\n\n10:59.109 --> 11:00.960\n它也有常见的不良反应，\n\n11:00.960 --> 11:01.784\n比如说恶心啊，\n\n11:01.784 --> 11:02.359\n呕吐啊，\n\n11:02.359 --> 11:02.960\n腹痛啊，\n\n11:02.960 --> 11:03.609\n头痛啊，\n\n11:03.609 --> 11:04.409\n胸痛等。\n\n11:05.460 --> 11:08.234\n那么缓释型或者是控释型茶碱，\n\n11:08.234 --> 11:10.909\n每日需需要口服一到两次，\n\n11:11.109 --> 11:14.109\n对这个治疗慢阻肺有一定的效果。\n\n11:15.650 --> 11:16.200\n还有呢，\n\n11:16.200 --> 11:20.099\n慢阻肺治疗的药物要配合一些抗炎药物，\n\n11:20.099 --> 11:22.450\n比如说糖吸入糖皮质激素，\n\n11:22.650 --> 11:24.275\n它可以减少气道炎症，\n\n11:24.275 --> 11:25.900\n改善气道重塑。\n\n11:26.150 --> 11:28.500\n但是不推荐单药使用。\n\n11:30.166 --> 11:30.491\n那么，\n\n11:30.491 --> 11:32.666\n慢阻肺还可以联合一些其他的药物，\n\n11:32.666 --> 11:33.565\n比如说祛痰药。\n\n11:33.716 --> 11:34.140\n那么，\n\n11:34.140 --> 11:37.416\n祛痰药主要是有利于气道引流通畅，\n\n11:37.416 --> 11:38.616\n改善通气功能，\n\n11:38.616 --> 11:42.366\n但是是对于一些有黏痰的患者比较有效。\n\n11:42.515 --> 11:45.966\n常见的比如说盐酸氨溴索呀、乙酰半胱氨酸。\n\n11:46.710 --> 11:47.661\n抗氧化剂呢，\n\n11:47.661 --> 11:50.036\n就是慢阻肺的患者气道炎症，\n\n11:50.036 --> 11:53.236\n炎症导致这个氧化负荷增加，\n\n11:53.685 --> 11:56.185\n促理促使其病理生理变化。\n\n11:56.286 --> 12:01.685\n这样可以用一些抗氧化剂来降低这个病情反复加重的情况。\n\n12:02.721 --> 12:03.822\n还有就是中药，\n\n12:03.872 --> 12:08.171\n那么中药具有祛痰、支气管舒张和免疫调节等作用，\n\n12:08.171 --> 12:10.296\n也可以有效的缓解临床症状，\n\n12:10.296 --> 12:12.421\n改善肺功能和免疫功能，\n\n12:12.421 --> 12:13.721\n提高生活质量。\n\n12:16.921 --> 12:18.021\n那么慢阻肺呢？\n\n12:18.021 --> 12:19.971\n在吸入装置上的选择？\n\n12:21.690 --> 12:23.440\n长期的慢阻肺治疗啊，\n\n12:23.440 --> 12:27.489\n也需要使用这个吸入装置。\n\n12:27.489 --> 12:31.815\n合理的使用吸入装置对于慢阻肺的治疗啊，\n\n12:31.815 --> 12:34.440\n还有急性加重也是非常重要的。\n\n12:38.986 --> 12:39.411\n那么，\n\n12:39.411 --> 12:42.986\n我们慢阻肺在稳定期要进行这个随访评估。\n\n12:43.385 --> 12:44.661\n随访的频率呢，\n\n12:44.661 --> 12:48.111\n一般是3.6个月进行一次详细随访，\n\n12:48.111 --> 12:50.835\n根据实际情况再进行调整。\n\n12:51.463 --> 12:52.489\n随访的内容呢，\n\n12:52.489 --> 12:56.213\n主要属主要是一些比如说吸烟情况啊，\n\n12:56.213 --> 12:59.314\n有没有戒烟肺功能的检查呀，\n\n12:59.463 --> 13:02.013\n还有药物及非药物治疗情况，\n\n13:02.263 --> 13:04.914\n还有吸入装置的使用和掌握能力。\n\n13:06.151 --> 13:06.601\n患者，\n\n13:06.601 --> 13:10.226\n有不有有没有了解自我这个病情啊？\n\n13:10.226 --> 13:11.702\n有没有进行自我管理？\n\n13:11.851 --> 13:14.252\n还有急性加重的频率是多少？\n\n13:16.085 --> 13:17.786\n还有他的运动耐量啊，\n\n13:18.185 --> 13:19.635\n还有是BMI，\n\n13:19.635 --> 13:23.335\n他的体重是不是过高或者是过低呀？\n\n13:23.335 --> 13:27.635\n有没有偏瘦或者是饮食不良的习惯，\n\n13:27.736 --> 13:28.135\n嗯？\n\n13:28.736 --> 13:31.661\n还有就是这个心理的影响啊，\n\n13:31.661 --> 13:32.786\n如果焦虑的话，\n\n13:32.786 --> 13:34.536\n也会加重这个病情。\n\n13:34.786 --> 13:36.585\n还有其他的这个并发症，\n\n13:36.585 --> 13:37.710\n还有合并症，\n\n13:37.710 --> 13:39.435\n一些症状进行随访。\n\n13:40.366 --> 13:44.765\n那么我们还应该辨识和应对慢阻肺急性加重时期。\n\n13:45.166 --> 13:47.666\n什么是指慢阻肺急性加重呢？\n\n13:49.254 --> 13:54.254\n在2023年中已经明确指出它是一种急性事件。\n\n13:54.403 --> 13:58.453\n慢阻肺患者呼吸困难或者是咳嗽咳痰症状加重，\n\n13:58.604 --> 14:01.028\n症状恶化发生在14天内，\n\n14:01.028 --> 14:04.104\n可能伴有呼吸急促或者是心动过速，\n\n14:04.203 --> 14:05.953\n通常是因为呼吸道感染，\n\n14:05.953 --> 14:09.203\n空气污染造成局部或全身炎症反应加重，\n\n14:09.304 --> 14:12.403\n或者因损伤气道的其他原因所致。\n\n14:15.010 --> 14:18.286\n慢阻肺一般常见的诱发因素，\n\n14:18.486 --> 14:18.885\n嗯，\n\n14:18.885 --> 14:20.036\n指的是这个，\n\n14:20.335 --> 14:22.710\n比如说出现这个呼吸道感染，\n\n14:22.710 --> 14:23.060\n嗯，\n\n14:23.060 --> 14:24.085\n病原体呀，\n\n14:24.135 --> 14:26.036\n还有这个病毒啊，\n\n14:26.036 --> 14:26.635\n细菌。\n\n14:27.802 --> 14:29.302\n还有就是不稳定，\n\n14:29.502 --> 14:30.202\n不规范，\n\n14:30.202 --> 14:31.452\n稳定期维持治疗。\n\n14:31.552 --> 14:33.427\n在稳定期的时候啊，\n\n14:33.427 --> 14:35.202\n吸入治疗使用的不规范，\n\n14:35.351 --> 14:36.202\n或者是呢，\n\n14:36.202 --> 14:37.627\n停用吸入治疗，\n\n14:37.627 --> 14:38.452\n误吸等。\n\n14:39.278 --> 14:41.328\n还有就是吸烟和空气污染，\n\n14:41.627 --> 14:42.903\n还有环境因素。\n\n14:42.903 --> 14:44.978\n比如说气温的变化啊，\n\n14:45.478 --> 14:47.052\n还有吸入过敏原啊，\n\n14:47.052 --> 14:49.552\n还有没有及时的清除这个痰液，\n\n14:49.552 --> 14:52.927\n都是急性加重的常见诱发因素。\n\n15:06.794 --> 15:07.244\n那么，\n\n15:07.244 --> 15:11.744\n我们慢阻肺急性加重的严重程序程序等级啊，\n\n15:11.744 --> 15:15.843\n结合这个症状体征动脉血氧分析啊，\n\n15:15.843 --> 15:18.018\n还有这个稳定期肺功能，\n\n15:18.018 --> 15:24.318\n以既往急性加重史的综合评判来建议这个严重程度一级呢，\n\n15:24.318 --> 15:25.718\n就是没有呼吸衰竭，\n\n15:25.718 --> 15:28.643\n呼吸的频率是20到三十三十次。\n\n15:28.794 --> 15:30.843\n然后没有使用这个呼吸机，\n\n15:31.093 --> 15:33.619\n精神状态还是没有改变的啊，\n\n15:33.619 --> 15:36.044\n可以通过这个面罩吸氧改善。\n\n15:36.596 --> 15:36.895\n嗯。\n\n15:39.142 --> 15:39.541\n那么，\n\n15:39.541 --> 15:40.242\n二级呢，\n\n15:40.242 --> 15:41.916\n就是急性呼吸衰竭了，\n\n15:41.916 --> 15:44.791\n呼吸频率会大于30次每分钟啊。\n\n15:44.841 --> 15:46.466\n使用呼吸机啊，\n\n15:46.466 --> 15:48.591\n但是精神状态还是没有改变的，\n\n15:48.591 --> 15:50.591\n也可以通过面罩改善。\n\n15:51.473 --> 15:52.223\n三级呢，\n\n15:52.223 --> 15:55.023\n急性呼吸衰竭可能会危及危及生命，\n\n15:55.023 --> 15:58.598\n呼吸频率还是大于30次每分钟啊。\n\n15:58.598 --> 15:59.848\n也在使用呼吸机，\n\n15:59.848 --> 16:03.424\n但是是精神状态会急剧的下降啊。\n\n16:03.624 --> 16:05.723\n通过面罩吸氧改善不了。\n\n16:08.986 --> 16:09.361\n那么，\n\n16:09.361 --> 16:11.835\n我们慢阻肺急性加重治疗首先，\n\n16:11.835 --> 16:16.486\n轻度的就是单独使用短效支气管舒支气管舒张剂治疗，\n\n16:16.685 --> 16:21.486\n中度的使用短效支气管舒张剂还要配合抗菌药物啊，\n\n16:21.486 --> 16:23.885\n加用或者是不加用糖皮质激素。\n\n16:24.085 --> 16:27.536\n重度的就需要住院或者急诊ICU及治疗。\n\n16:32.226 --> 16:32.552\n那么，\n\n16:32.552 --> 16:38.327\n我们慢阻肺的紧急性加重的紧急转诊指征是什么样的呢？\n\n16:38.377 --> 16:41.276\n就是症状显著加剧，\n\n16:41.276 --> 16:44.101\n突然出现这个呼吸困难啊。\n\n16:44.101 --> 16:48.776\n重度的慢阻肺患者出现身心体征或者是原有体征加重，\n\n16:48.827 --> 16:49.976\n比如说发干，\n\n16:49.976 --> 16:50.976\n神志的改变，\n\n16:51.127 --> 16:53.127\n还有有严重的合并症。\n\n16:53.276 --> 16:56.302\n合并症初始药物治疗没有效果了，\n\n16:56.302 --> 16:59.327\n高龄的患者诊断不明确的啊，\n\n16:59.327 --> 17:02.526\n院外治疗没有条件或者是医疗条件。\n\n17:02.676 --> 17:03.176\n比较差，\n\n17:03.276 --> 17:07.375\n这样就需要转至上级医院进行处置。\n\n17:10.385 --> 17:10.760\n那么，\n\n17:10.760 --> 17:13.936\n我们怎样来预防慢阻肺急性加重呢？\n\n17:14.086 --> 17:15.336\n首先是戒烟，\n\n17:15.385 --> 17:18.735\n要强烈鼓励和支持所有吸烟者戒烟，\n\n17:19.036 --> 17:23.235\n这样对于这个急性加重的预防非常有效。\n\n17:23.485 --> 17:24.985\n第二个就是疫苗接种，\n\n17:24.985 --> 17:28.235\n国内外多个指南推荐慢阻肺患者接种疫苗，\n\n17:28.385 --> 17:29.711\n包括流感疫苗啊，\n\n17:29.711 --> 17:31.010\n肺炎球菌疫苗啊，\n\n17:31.010 --> 17:32.686\n新型冠状病毒疫苗啊，\n\n17:32.686 --> 17:36.436\n百日咳疫苗以及这个疱疹病毒疫苗等，\n\n17:36.635 --> 17:38.336\n还有就是痰液引流，\n\n17:38.336 --> 17:39.885\n要及时的使用这个。\n\n17:40.423 --> 17:41.249\n祛痰剂啊，\n\n17:41.249 --> 17:43.374\n促进这个粘液溶解，\n\n17:43.524 --> 17:45.198\n有利于气道引流通畅，\n\n17:45.198 --> 17:46.323\n改善通气功能。\n\n17:46.624 --> 17:49.173\n还有就是吸入治疗要稳定期，\n\n17:49.274 --> 17:52.073\n长期规范使用支气管舒张剂。\n\n17:52.761 --> 17:53.911\n还有呼吸康复，\n\n17:53.911 --> 17:56.011\n对于有一些呼吸困难的患者，\n\n17:56.062 --> 17:57.187\n呼吸康复呢，\n\n17:57.187 --> 17:59.261\n是作为常规的推荐的。\n\n18:03.865 --> 18:09.465\n那么我们慢阻肺这个急性加重期的管理是非常重要的。\n\n18:11.732 --> 18:13.482\n今天所讲的内容，\n\n18:13.482 --> 18:19.332\n我们主要是指我国慢阻肺现在的这个管理状况还是有待于改善的。\n\n18:19.482 --> 18:23.631\n基层医生在慢阻肺管理中是扮有着重要的角色的。\n\n18:23.832 --> 18:24.232\n那么，\n\n18:24.232 --> 18:27.982\n基层医生在慢阻肺管理中需要把握的三个关键，\n\n18:28.182 --> 18:30.232\n第一个就是主动筛查啊，\n\n18:30.232 --> 18:32.432\n识别这个慢阻肺高危人群，\n\n18:32.631 --> 18:34.281\n对其进行诊断，\n\n18:34.281 --> 18:35.932\n进行肺功能检查，\n\n18:36.432 --> 18:40.906\n还有就是规范化稳定期评估、治疗和随访啊。\n\n18:40.906 --> 18:41.781\n在稳定期。\n\n18:41.848 --> 18:45.147\n的时候要对其进行这个风险评估啊，\n\n18:45.147 --> 18:47.072\n及时的进行治疗啊，\n\n18:47.072 --> 18:49.947\n定期的随访有没有这个病情的变化。\n\n18:50.995 --> 18:53.870\n那么在这个慢阻肺急性加重的时候，\n\n18:53.870 --> 18:57.196\n我们要及时的识别和进行应对啊。\n\n18:58.056 --> 19:03.005\n能够明确的判断出什么是慢阻肺的急性加重，\n\n19:03.056 --> 19:06.281\n那么加重了我们应该如何治疗啊。\n\n19:06.281 --> 19:08.156\n什么情况下可以在畸形。\n\n19:08.911 --> 19:10.312\n基层医院进行治疗，\n\n19:10.362 --> 19:14.312\n什么情况需要紧急转至上上级医院啊？\n\n19:14.312 --> 19:19.087\n对于我们这个慢阻肺患者都是受益非常大的。\n\n19:19.087 --> 19:19.411\n嗯，\n\n19:19.712 --> 19:20.437\n今天呢，\n\n19:20.437 --> 19:25.036\n我们关于这个慢阻肺的相关知识就讲到这里啊，\n\n19:25.036 --> 19:25.962\n谢谢大家。\n\n","v0347cg10004d61i122ljht3tpa4n7qg",1178,880,"2026-01-25 03:01:03"," 基层慢阻肺诊疗规范解读 | 最新指南与临床实践  \n"," 慢阻肺诊疗规范, 基层医疗指南, 慢阻肺管理, COPD治疗, 呼吸系统疾病, 基层医生培训  \n"," 本文深入解读基层慢阻肺诊疗规范，涵盖诊断标准、分级治疗策略、药物选择及患者管理要点，助力基层医生提升慢阻肺规范化诊疗水平，优化患者长期预后。","2026-04-08 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