[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"$f65-g5LTUgHIk8dGZIHhGe2pKpxnfW0g-O4HGxk3yxcs":3,"$fnte72uyEYaTtes7S1tMIqm0UmuHlJFH2JlFWqMV1Xq4":8,"$fp-ixsr10JUkjCqyerY7ZBFfyL8MAhiqI280ILQeJVBE":60,"$fIwll5OF2qkxj9qr0T6k4EYjRu13e21vkh3bviGLecBQ":61,"$fmzrThtP3XNowQMI3Yqm3MRduV1o68ZW86tNpkXfFpQw":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":6,"adept":17,"hospital":18,"department":19,"postsTitle":20,"materialTotal":21,"videoTotal":22,"isConcern":7,"title":23,"coverVertical":24,"coverAcross":25,"directionMarker":26,"description":27,"vid":28,"time":29,"mediaType":26,"views":30,"likes":21,"isThumbsUp":7,"isCollection":7,"collections":21,"createTime":31,"seoTitle":32,"seoKeywords":33,"seoDescription":34,"shelvesTime":35,"menus":36,"menuId":38,"type":55,"quality":56,"commentCount":21,"isComment":26,"deviceType":57,"url":58},10651,825416,[],"https://cdn.yishi-tong.com/console/store-unknown/lBhR9kP_6Hoia8sU0XTdZMGj9xDRd9QN.jpg","徐文蓉","糖尿病、高血压达标治疗。","上海市徐汇区长桥街道社区卫生服务中心","全科医疗","副主任医师",0,14,"肺炎的危害与防治","","https://cdn.yishi-tong.com/console/3/nW-eXEMhE93a4z174OiiFmVA-9cGBA04.png",1,"WEBVTT\n\n00:02.848 --> 00:02.947\n嗯，\n\n00:02.947 --> 00:04.223\n大家好，\n\n00:04.223 --> 00:04.848\n今天呢，\n\n00:04.848 --> 00:08.548\n我们一起学习一下关于肺炎的。\n\n00:09.288 --> 00:10.187\n一些知识，\n\n00:10.637 --> 00:15.687\n然后包括肺炎的危害及其如何防治肺炎。\n\n00:19.392 --> 00:22.892\n首先我们要知道一下什么是肺炎链球菌。\n\n00:24.038 --> 00:25.438\n肺炎链链球菌呢，\n\n00:25.438 --> 00:27.638\n它是上呼吸道的正常菌群，\n\n00:27.788 --> 00:29.089\n它广泛存在，\n\n00:29.288 --> 00:31.188\n易于传播的。\n\n00:32.382 --> 00:38.333\n病原大于30%的健康成人和60%的健康儿童的鼻咽部，\n\n00:38.783 --> 00:41.632\n都会携带肺炎链球菌。\n\n00:44.166 --> 00:45.741\n它的单种血清型呢，\n\n00:45.741 --> 00:48.515\n可在鼻鼻咽部长期存在。\n\n00:49.542 --> 00:54.643\n它也可以通过频繁密切的接触在人与人之间的传播。\n\n00:56.908 --> 00:57.983\n首先要明白，\n\n00:57.983 --> 01:00.158\n它是一个正常的菌群，\n\n01:00.408 --> 01:04.907\n30%的健康成人和60%的健康儿童，\n\n01:04.907 --> 01:06.108\n鼻炎部都会有。\n\n01:06.358 --> 01:07.682\n但它会致病吗？\n\n01:07.682 --> 01:08.458\n当然会，\n\n01:08.557 --> 01:10.282\n那么什么时候会致病呢？\n\n01:10.282 --> 01:12.807\n就当你免疫力低下。\n\n01:14.002 --> 01:14.852\n免疫力降低，\n\n01:15.203 --> 01:17.402\n五病毒感染以后，\n\n01:17.602 --> 01:21.303\n那肺炎肺炎链球菌就可以治病。\n\n01:22.114 --> 01:24.464\n那么它发病的季节呢，\n\n01:24.464 --> 01:26.464\n是在冬季和初春。\n\n01:27.440 --> 01:28.690\n感染比较常见。\n\n01:31.585 --> 01:31.861\n然后，\n\n01:31.861 --> 01:34.935\n根据它的荚膜多糖抗原分类，\n\n01:35.085 --> 01:39.136\n肺炎球菌会有80种以上的血清型。\n\n01:41.452 --> 01:43.501\n那我们看一下肺炎链球菌，\n\n01:43.702 --> 01:46.351\n它可以引起哪些疾病呢？\n\n01:49.722 --> 01:54.123\n那我们根据他的疾病的严重程度呢？\n\n01:54.956 --> 01:55.356\n可以分，\n\n01:55.956 --> 01:58.456\n可以分为一个是脑膜炎。\n\n02:00.508 --> 02:03.758\n肺炎菌血症和中耳炎。\n\n02:06.849 --> 02:08.899\n那么看看它的，\n\n02:08.899 --> 02:12.074\n肺炎链球菌疾病的危害啊，\n\n02:12.074 --> 02:13.600\n首先刚才已经说过了，\n\n02:13.600 --> 02:18.975\n它是上呼吸道的正常菌群广泛存在并易于传播的病原。\n\n02:19.630 --> 02:22.080\n在肺炎链球菌感染病例中呢，\n\n02:22.080 --> 02:23.531\n有5%死亡，\n\n02:23.731 --> 02:26.481\n20%肺炎患者伴菌血症，\n\n02:26.580 --> 02:29.630\n其中10%可以出现脑膜炎。\n\n02:30.240 --> 02:31.240\n所以一旦患病，\n\n02:31.440 --> 02:32.914\n它的致死率也好，\n\n02:32.914 --> 02:34.490\n它的致残率也好，\n\n02:34.740 --> 02:37.889\n它的疾病严重程度还是比较严重，\n\n02:38.240 --> 02:44.039\n所以说每年全球因肺炎链球菌感染致死的病例要超过100万。\n\n02:45.011 --> 02:46.110\n这些病人呢？\n\n02:46.210 --> 02:48.261\n大多数死亡的病例呢？\n\n02:49.509 --> 02:51.110\n发生在发展中国家，\n\n02:51.210 --> 02:53.759\n医疗资源比较贫、匮乏，\n\n02:54.410 --> 02:55.759\n卫生习惯比较差。\n\n02:55.960 --> 02:56.559\n经济。\n\n02:57.473 --> 02:59.824\n比较落后的那些发展中国家，\n\n02:59.923 --> 03:02.923\n那那么在即使在发达国家，\n\n03:03.024 --> 03:10.024\n某些人群的侵袭性肺炎球菌性疾病的死亡率也很高，\n\n03:10.024 --> 03:13.173\n尤其是老年人和慢性病患者，\n\n03:13.423 --> 03:15.824\n因为还是因为老年人的呼吸道的。\n\n03:16.686 --> 03:17.662\n抵抗力下降，\n\n03:17.662 --> 03:20.486\n慢慢性病患者全身的抵抗力下降，\n\n03:20.486 --> 03:22.087\n免疫力低下而引起。\n\n03:24.589 --> 03:25.815\n我们具体说一下，\n\n03:25.815 --> 03:28.889\n就是肺肺炎链球菌感染的高危人群，\n\n03:29.039 --> 03:31.289\n刚才已经说过了一个抵抗力弱，\n\n03:31.490 --> 03:32.514\n免疫力低下，\n\n03:32.514 --> 03:34.740\n刚才说的老年人还有那些。\n\n03:36.354 --> 03:39.654\n大于50岁的中老年幼儿有慢性疾病，\n\n03:39.953 --> 03:44.203\n包括心血管疾病、肝病、高血压、糖尿病等等。\n\n03:44.404 --> 03:45.003\n当然。\n\n03:46.069 --> 03:46.194\n嗯，\n\n03:46.194 --> 03:48.119\n呼吸道系统的疾病，\n\n03:48.619 --> 03:49.794\n例如COPD，\n\n03:49.794 --> 03:52.468\n就是慢性阻塞性肺病、支气管扩张，\n\n03:52.819 --> 03:54.369\n病毒感染等等。\n\n03:55.270 --> 03:59.520\n也是链球菌感染人群的好发人群，\n\n03:59.770 --> 04:01.445\n然后免疫力低下的人，\n\n04:01.445 --> 04:03.246\n就是HIV的感染者，\n\n04:03.246 --> 04:04.220\n就是艾滋病的人，\n\n04:04.220 --> 04:05.871\n还有恶性肿瘤病人，\n\n04:05.921 --> 04:07.270\n器官移植以后。\n\n04:08.139 --> 04:10.539\n一、需要长期应用怀孕药物的，\n\n04:10.539 --> 04:12.589\n也就是免疫抑制剂治疗者，\n\n04:12.589 --> 04:14.889\n这些人免疫功能低下，\n\n04:14.938 --> 04:16.289\n所以容易。\n\n04:17.809 --> 04:19.359\n肺炎链球菌。\n\n04:21.305 --> 04:23.605\n它有一个特殊环境或者社会环境，\n\n04:23.605 --> 04:24.156\n居住者，\n\n04:24.156 --> 04:25.656\n也就是说我们说，\n\n04:25.756 --> 04:29.305\n经济条件比较差的一个地。\n\n04:30.561 --> 04:36.960\n人群中有拥挤住在拥挤的地方或者无家可归者。\n\n04:39.602 --> 04:44.528\n那我们下面说一说肺炎链球菌菌血症的流行病学啊。\n\n04:44.528 --> 04:46.553\n这是美国的CDC治疗。\n\n04:47.190 --> 04:49.390\n那每年的病例数呢？\n\n04:49.589 --> 04:50.239\n大于。\n\n04:51.933 --> 04:52.283\n万，\n\n04:52.334 --> 04:53.933\n病死率20%，\n\n04:53.933 --> 04:56.384\n老年病人达到60%。\n\n04:58.109 --> 05:04.760\n肺炎球菌性肺炎病人中发生是会达到25%.30%。\n\n05:08.230 --> 05:12.031\n看一下我们肺肺炎链球菌脑膜炎的流行病学，\n\n05:12.031 --> 05:14.281\n这也是美国的CDC资料。\n\n05:15.272 --> 05:18.022\n他每年的病例数是3000.6000例，\n\n05:18.071 --> 05:19.821\n病死率是30%，\n\n05:19.921 --> 05:22.122\n老年病人达到80%。\n\n05:23.029 --> 05:25.380\n所有细菌性脑膜炎病例中，\n\n05:25.380 --> 05:30.529\n肺炎球菌性脑膜炎占了13%.19%。\n\n05:32.226 --> 05:39.076\n我们看一下亚洲的社区获得性感染的常见的致病菌是有哪些啊？\n\n05:39.326 --> 05:41.427\n肺炎链球菌是？\n\n05:42.441 --> 05:44.566\n占的比例是最高的，\n\n05:44.566 --> 05:47.091\n占到29.2%，\n\n05:47.441 --> 05:49.390\n然后是克雷伯菌。\n\n05:50.346 --> 05:51.796\n流感嗜血杆菌。\n\n05:53.477 --> 05:55.377\n红绿假单胞菌，\n\n05:55.727 --> 05:57.477\n金黄色葡萄球菌，\n\n05:57.727 --> 05:59.428\n还有一些其他的菌体。\n\n06:00.743 --> 06:02.694\n有阿他莫拉菌，\n\n06:03.044 --> 06:04.944\n还有一个就非典型的。\n\n06:05.794 --> 06:06.294\n病原体。\n\n06:08.138 --> 06:10.088\n也占到了25.5%，\n\n06:10.088 --> 06:12.113\n那么非典型的包括很多，\n\n06:12.113 --> 06:14.037\n那我以前的非典也是一种，\n\n06:14.138 --> 06:15.937\n也是一种病原体，\n\n06:16.838 --> 06:18.988\n包括其实好多种没有细分，\n\n06:18.988 --> 06:21.138\n统称为非典型病原体。\n\n06:25.653 --> 06:28.829\n那么很多部分人群肺炎链球菌感染，\n\n06:28.829 --> 06:30.454\n它表现不典型，\n\n06:30.704 --> 06:32.604\n那么容易漏诊、误诊。\n\n06:36.561 --> 06:37.010\n所以说，\n\n06:37.010 --> 06:39.061\n如果有感染，\n\n06:39.360 --> 06:39.760\n嗯，\n\n06:40.411 --> 06:42.760\n症状有呼吸困难，\n\n06:42.811 --> 06:44.411\n有咳嗽、咳痰，\n\n06:44.710 --> 06:45.536\n有发烧，\n\n06:45.536 --> 06:47.260\n还是要去医院就诊，\n\n06:47.360 --> 06:48.760\n然后查一个病人。\n\n06:49.648 --> 06:50.148\n病原菌，\n\n06:50.298 --> 06:54.997\n然后这样可以查到有有那个才可以，\n\n06:55.648 --> 06:56.048\n嗯，\n\n06:56.398 --> 06:59.148\n就是减少漏诊和误诊。\n\n07:01.049 --> 07:02.398\n我们现在看看肺炎，\n\n07:02.398 --> 07:05.348\n链球菌性肺炎的主要临床症状。\n\n07:06.109 --> 07:06.309\n嗯，\n\n07:06.709 --> 07:07.934\n肺炎链球菌呢，\n\n07:07.934 --> 07:10.709\n是社区获得性肺炎的首要致病菌。\n\n07:11.626 --> 07:11.876\n嗯，\n\n07:12.026 --> 07:13.626\n它的表现有发热，\n\n07:14.126 --> 07:14.726\n你在。\n\n07:15.825 --> 07:16.526\n胸膜炎，\n\n07:16.776 --> 07:17.575\n胸痛，\n\n07:17.876 --> 07:18.575\n咳痰。\n\n07:19.842 --> 07:21.167\n会有铁锈色痰，\n\n07:21.167 --> 07:22.942\n那如果是大叶性肺炎，\n\n07:23.143 --> 07:25.342\n就会有一个铁锈色痰，\n\n07:25.692 --> 07:26.993\n然后心动过速。\n\n07:28.115 --> 07:30.716\n全身症状包括虚、虚弱不适，\n\n07:31.165 --> 07:33.115\n严重者会有呼吸困难。\n\n07:33.768 --> 07:35.768\n及急促缺氧。\n\n07:36.720 --> 07:36.920\n嗯，\n\n07:36.920 --> 07:41.070\n这张片子就可以看得出是左肺的大片渗出，\n\n07:41.070 --> 07:41.869\n这是一个。\n\n07:42.628 --> 07:44.729\n典型的一个，\n\n07:44.979 --> 07:47.653\n大严重的肺炎的表，\n\n07:47.653 --> 07:49.678\n那个胸片的X线的表现，\n\n07:49.878 --> 07:52.428\n那么我们支气管肺炎，\n\n07:52.928 --> 07:54.854\n嗯不获得性肺炎，\n\n07:54.854 --> 07:58.628\n链球菌肺炎链球菌社区获得性肺炎啊，\n\n07:58.628 --> 08:00.278\n它并发症有脓胸，\n\n08:00.278 --> 08:01.178\n心包炎，\n\n08:01.428 --> 08:03.229\n支气管堵塞等等。\n\n08:05.045 --> 08:07.320\n还要说一下肺肺炎链球菌性。\n\n08:08.334 --> 08:08.459\n嗯，\n\n08:08.459 --> 08:10.785\n菌血症的主要临床表现，\n\n08:11.035 --> 08:12.859\n它也有一个感染的症状，\n\n08:12.859 --> 08:15.535\n就是最常见的发热咳嗽。\n\n08:17.287 --> 08:18.412\n寒在高热的话，\n\n08:18.412 --> 08:19.537\n会有寒在，\n\n08:19.838 --> 08:21.988\n会有咳嗽、咳痰啊。\n\n08:22.287 --> 08:23.787\n部分人会有胸痛，\n\n08:23.988 --> 08:26.287\n有些人还会有胃肠道的症状。\n\n08:28.937 --> 08:29.437\n痛啊，\n\n08:29.437 --> 08:30.238\n腹泻啊，\n\n08:30.238 --> 08:31.388\n也可以会有，\n\n08:31.738 --> 08:34.138\n然后还有严重的并发症，\n\n08:34.138 --> 08:35.538\n就是一个是脑膜炎。\n\n08:36.567 --> 08:37.567\n刚才已经说过了，\n\n08:38.517 --> 08:44.817\n肺肺炎球菌性链球菌性脑膜炎也是一个致死率很高的一个一个疾病，\n\n08:44.817 --> 08:46.666\n还有呼吸衰竭、休克，\n\n08:46.817 --> 08:50.017\n还有最严重的一个播散性血管内淤血，\n\n08:50.067 --> 08:52.916\n这不及时就诊都会引起失明的。\n\n08:53.590 --> 08:54.390\n危及到生命。\n\n08:58.392 --> 09:00.892\n那么肺炎链球菌性脑膜炎，\n\n09:00.992 --> 09:04.091\n它会它有哪些临床症状呢？\n\n09:04.142 --> 09:06.692\n一个因为它侵犯到脑脑膜，\n\n09:06.692 --> 09:09.166\n它会有一个颅内高压的症状，\n\n09:09.166 --> 09:13.216\n它表现为头痛嗜睡呕吐啊，\n\n09:13.216 --> 09:16.341\n它的呕吐是喷喷射样的呕吐。\n\n09:18.057 --> 09:20.458\n就是人情绪比较烦躁，\n\n09:20.807 --> 09:22.533\n发热、感染的症状，\n\n09:22.533 --> 09:24.158\n然后有颈项强直。\n\n09:25.479 --> 09:27.528\n有脑膜刺激刺激症嘛，\n\n09:27.679 --> 09:29.229\n还有颅神经的症状，\n\n09:29.778 --> 09:30.179\n嗯。\n\n09:31.348 --> 09:32.723\n可以侵犯到脑组织，\n\n09:32.723 --> 09:36.497\n可以引起继发性的癫痫甚至昏迷啊，\n\n09:36.648 --> 09:39.447\n这并发症有局部性的神经性异常。\n\n09:40.247 --> 09:42.497\n颅内并发症就是个颅内高压，\n\n09:42.598 --> 09:43.947\n它会压迫中枢，\n\n09:43.947 --> 09:46.072\n然后引起呼吸的抑制，\n\n09:46.072 --> 09:47.997\n然后引起危及生命。\n\n09:48.348 --> 09:50.047\n还有个全身的并发症，\n\n09:50.297 --> 09:51.497\n刚才已经说过了，\n\n09:51.497 --> 09:53.148\n包括一个菌血症，\n\n09:53.297 --> 09:55.297\n一个一个DIC，\n\n09:55.348 --> 09:57.497\n都是一个全身性的并发症。\n\n10:02.166 --> 10:05.017\n那么肺炎链球菌疾病的诊断呢，\n\n10:05.166 --> 10:07.392\n首先要知道它的流行病学，\n\n10:07.392 --> 10:13.716\n一个发病的季节就是冬春季播程常与呼吸道病毒感染相伴行，\n\n10:14.216 --> 10:19.442\n那么虽然上呼吸道感染的是90%以上都是病毒性的，\n\n10:19.442 --> 10:21.416\n但是它可以和。\n\n10:22.447 --> 10:25.747\n细菌也就是肺炎链球菌合并感染相伴性，\n\n10:25.997 --> 10:28.497\n所以在病毒性感染的患者，\n\n10:28.497 --> 10:29.721\n特别是那些老年人，\n\n10:29.721 --> 10:30.697\n抵抗力差的人，\n\n10:30.697 --> 10:32.296\n同时还是要有用，\n\n10:32.747 --> 10:34.521\n早些要用抗菌素，\n\n10:34.521 --> 10:35.346\n就是这个道理，\n\n10:35.346 --> 10:40.146\n因为它病毒和细菌是相伴行的症状。\n\n10:40.844 --> 10:42.844\n都有上呼吸道感染前驱症状，\n\n10:42.844 --> 10:45.145\n就刚才说的高热、咳嗽、胸痛，\n\n10:45.395 --> 10:46.344\n铁锈是痰。\n\n10:48.231 --> 10:50.281\n有些患者会有消化道的症状，\n\n10:50.531 --> 10:52.281\n空腹泻喷，\n\n10:52.281 --> 10:57.130\n他体征就是口角及皮周有单纯性的疱疹。\n\n10:57.330 --> 11:00.880\n患者肺部听诊可以闻及思维重症。\n\n11:01.791 --> 11:03.991\n神经系统的消化系统的症状，\n\n11:04.291 --> 11:06.341\n自然的病程是一到两周。\n\n11:07.067 --> 11:08.843\n那我们检查实验室检查呢，\n\n11:08.843 --> 11:11.067\n可以发现白细胞激数是增加的，\n\n11:11.117 --> 11:13.718\n中性粒子细胞是增加的，\n\n11:14.018 --> 11:14.418\n嗯。\n\n11:15.427 --> 11:17.776\n痰涂片是格兰氏阳性菌，\n\n11:18.276 --> 11:20.577\n痰培养、血培养都可以。\n\n11:21.353 --> 11:21.703\n发现，\n\n11:22.153 --> 11:22.552\n嗯，\n\n11:22.653 --> 11:23.453\n肺炎链，\n\n11:23.453 --> 11:25.502\n链球菌的证据。\n\n11:26.377 --> 11:28.377\n严重的感染者可以有核作用，\n\n11:28.377 --> 11:30.377\n就是白细胞激素核作用。\n\n11:30.578 --> 11:34.028\nX线检查呈多形性及速变性。\n\n11:37.375 --> 11:39.801\n我们下面看看老年人的肺炎，\n\n11:39.901 --> 11:41.301\n老年人肺炎呢？\n\n11:42.380 --> 11:44.781\n它会延误诊断比较多，\n\n11:44.781 --> 11:45.531\n为什么呢？\n\n11:45.531 --> 11:47.880\n一个它临床症状不典型。\n\n11:49.804 --> 11:50.379\n肺炎的患者，\n\n11:50.379 --> 11:52.403\n他可以20%没有咳嗽，\n\n11:52.854 --> 11:55.203\n有40%.50%没有发热，\n\n11:55.504 --> 11:58.403\n那都是一个老年人的反应。\n\n11:59.416 --> 12:02.166\n就全身的一个反应比较差引起的，\n\n12:02.166 --> 12:05.166\n还有25%肺部听诊它是正常，\n\n12:05.466 --> 12:06.366\n没有萝音。\n\n12:07.244 --> 12:09.594\n还有50%白细胞总数不升高，\n\n12:09.594 --> 12:10.044\n所以。\n\n12:10.799 --> 12:15.999\n这些这些的不典型会误诊为一个单纯的上呼吸道感染而。\n\n12:17.031 --> 12:19.156\n没有及时抗炎的治疗，\n\n12:19.156 --> 12:20.031\n会引起。\n\n12:20.911 --> 12:22.460\n疾病的进一步加重，\n\n12:22.560 --> 12:25.510\n所以说老年人有上呼吸道感染，\n\n12:25.510 --> 12:27.010\n我们一定是要。\n\n12:28.617 --> 12:29.367\n重视重视，\n\n12:29.367 --> 12:30.117\n再重视。\n\n12:33.801 --> 12:36.901\n那因首发症状不典型而导致延误治疗，\n\n12:36.901 --> 12:38.200\n就是老年型的肺炎，\n\n12:38.250 --> 12:39.375\n它也常以呢，\n\n12:39.375 --> 12:39.976\n为什么呢？\n\n12:39.976 --> 12:43.700\n它也常以消化、呼吸、精神、神经方面的症状出现，\n\n12:43.801 --> 12:48.801\n和40%以食欲锐减、恶心、呕吐、腹泻等为早期表现。\n\n12:49.380 --> 12:51.229\n误诊为胃肠炎、肝炎等，\n\n12:51.280 --> 12:54.104\n有些首先表现了心慌、胸闷，\n\n12:54.104 --> 12:55.880\n而被误诊为心力衰竭。\n\n12:57.205 --> 13:06.354\n也有些患者、老年患者以精神萎靡、倦睡、乏力或头晕、头痛、神志模糊等为首发症状，\n\n13:06.405 --> 13:09.804\n易误诊为脑血管病、老年性精神病等。\n\n13:13.211 --> 13:18.161\n因为它常伴有多种疾病而掩盖他的肺炎的症状，\n\n13:18.262 --> 13:20.161\n如他有慢性支气管炎，\n\n13:20.161 --> 13:25.512\n有肺心病、高血压、冠心病、糖尿病、胆囊炎和胆结石、肿瘤等等，\n\n13:25.512 --> 13:30.711\n它会掩盖它本身的肺肺炎的症状。\n\n13:33.413 --> 13:37.963\n我们下面说一说如何治疗肺炎链球菌的疾病啊。\n\n13:37.963 --> 13:38.812\n肺炎和。\n\n13:39.914 --> 13:40.539\n菌血症呢，\n\n13:40.539 --> 13:44.515\n我们可以用第三代头孢菌素连用或者不连用万古霉素。\n\n13:45.289 --> 13:46.564\n也可以用啊，\n\n13:46.564 --> 13:48.138\n困同类啊。\n\n13:49.486 --> 13:53.687\n贝塔内酰胺类抗生素加大环内酯类啊。\n\n13:55.135 --> 13:58.135\n这是在合并非典型病原体的时候，\n\n13:58.135 --> 14:02.335\n首选贝塔内酰胺类抗生素加大环内酯类，\n\n14:02.835 --> 14:06.284\n那脑膜炎我们首选第三代头孢加万古霉素。\n\n14:07.336 --> 14:10.312\n如果要减少神经系统后遗症，\n\n14:10.312 --> 14:12.536\n可短期使用糖皮质激素。\n\n14:14.284 --> 14:22.184\n那么我们还要说一说现在因为大广泛的运用那个抗菌素而引起的耐药，\n\n14:22.434 --> 14:25.234\n那肺炎链球菌感染如何来防止？\n\n14:25.234 --> 14:26.934\n那么我们需要新的策略。\n\n14:28.646 --> 14:29.146\n首先。\n\n14:31.687 --> 14:37.736\n要相继对贝塔内酰胺类、大环内酯类、磺胺类、林可霉素等多重耐药株。\n\n14:39.926 --> 14:40.801\n可以可以，\n\n14:40.801 --> 14:42.926\n如果经验治疗失失败，\n\n14:42.926 --> 14:46.276\n那么用更高级的更大剂量住院天数。\n\n14:47.299 --> 14:49.950\n也要延长治疗费用就会增加。\n\n14:51.270 --> 14:55.120\n那我们看一下肺炎链球菌对大环内酯类抗生素的耐药，\n\n14:55.270 --> 14:58.520\n那这个表格就说明在全世界。\n\n14:59.791 --> 14:59.992\n都，\n\n15:00.091 --> 15:00.692\n都有。\n\n15:01.531 --> 15:04.231\n那最最最最严重的是在法国，\n\n15:04.231 --> 15:06.481\n它的耐药有达到了百分之，\n\n15:06.481 --> 15:06.781\n哦，\n\n15:06.831 --> 15:07.531\n是日本。\n\n15:09.056 --> 15:10.481\n日本是百分之耐药，\n\n15:10.481 --> 15:12.255\n达到了77.2%，\n\n15:12.255 --> 15:13.656\n其次是中国。\n\n15:14.356 --> 15:16.455\n然后再次是法国，\n\n15:16.505 --> 15:18.955\n然后加拿大是耐药性是最低的。\n\n15:20.354 --> 15:22.330\n那我们亚洲的青霉素的耐药性，\n\n15:22.330 --> 15:23.755\n我们来看一下。\n\n15:27.359 --> 15:28.359\n这张表格就说，\n\n15:28.359 --> 15:31.458\n我们耐药性会很很高很高，\n\n15:31.458 --> 15:35.833\n特别是我们在香港地区是最高的。\n\n15:35.833 --> 15:39.158\n然后我们是中国大陆。\n\n15:39.882 --> 15:40.632\n然后接下来，\n\n15:40.632 --> 15:41.981\n其次是印度，\n\n15:42.432 --> 15:43.481\n然后越南，\n\n15:43.831 --> 15:47.632\n都会很高到硬值达到了100%以上。\n\n15:50.448 --> 15:51.499\n这张表格也说，\n\n15:51.499 --> 15:55.098\n我们我国的肺炎链球菌对青霉素耐药较高，\n\n15:55.249 --> 15:58.799\n所以说你大剂量用青霉素来治疗它效果不好。\n\n16:01.814 --> 16:04.664\n这个22005年到2006年，\n\n16:04.664 --> 16:08.263\n它的达到了24.5%那样。\n\n16:09.015 --> 16:09.515\n耐药率。\n\n16:11.900 --> 16:12.500\n这也是的，\n\n16:12.549 --> 16:16.200\n2001南阳是42%.50%上海地区。\n\n16:17.252 --> 16:17.453\n嗯，\n\n16:17.453 --> 16:18.127\n不敏感率，\n\n16:18.127 --> 16:21.052\n对青霉素不敏感率达到了72.7%。\n\n16:22.085 --> 16:23.835\n儿童耐药率也很高。\n\n16:25.593 --> 16:27.567\n那对大环内酯类药物呢？\n\n16:27.567 --> 16:31.343\n肺炎链球菌和红霉素等大环内酯类的耐药有50%。\n\n16:32.000 --> 16:33.476\n上海报道是53%，\n\n16:33.476 --> 16:35.500\n但也有部分在70%。\n\n16:35.851 --> 16:40.051\n那耐药菌增加的原因就是刚才说过了一个，\n\n16:40.051 --> 16:42.176\n由于医生过度的使用抗菌素，\n\n16:42.176 --> 16:47.200\n造成了基因突变及耐药基因转移的耐药性进行筛选。\n\n16:47.301 --> 16:52.700\n然后我们看一下2011年全国抗菌药物临床应用项目诊治指控，\n\n16:52.750 --> 16:56.450\n三级医院抗菌药物品种原则上不超过50种，\n\n16:56.500 --> 17:00.051\n两级医院抗菌药物品种原则上不超过35种。\n\n17:00.573 --> 17:06.048\n碳青霉烯类抗菌素药物制注射剂型不超过3个，\n\n17:06.048 --> 17:11.274\n平规喹仑酮类抗菌素药物口服剂型和注射剂型各不超过4个评分，\n\n17:11.323 --> 17:14.874\n深度抗真菌类抗菌药物不超过5个评分。\n\n17:15.173 --> 17:18.774\n住院患者抗菌药物使用率不超过60%，\n\n17:18.874 --> 17:22.723\n门诊患者抗菌药物处方比例不超过20%。\n\n17:23.937 --> 17:28.411\n这是2011年全国抗菌药物临床应用专项整治质控标准。\n\n17:28.612 --> 17:32.786\n抗菌药物使用强度力争控制在40 DDD以下，\n\n17:32.786 --> 17:37.812\n一类切口手术患者预防使用抗菌素药物比例不超过30%，\n\n17:37.962 --> 17:38.737\n住院患者，\n\n17:38.737 --> 17:43.911\n外科手术预防使用抗菌素药物时间控制在术前30分钟至两小时。\n\n17:43.962 --> 17:45.487\n一类切口手术预防，\n\n17:45.487 --> 17:49.862\n使用抗菌素药物不超过24小时微生物检验。\n\n17:51.416 --> 17:53.590\n样本送检率不得低于30%，\n\n17:53.590 --> 17:57.566\n对主要目标细菌耐药率超过75%的抗菌药物，\n\n17:57.566 --> 18:01.316\n应当暂停针对此目标细菌的临床应用。\n\n18:01.416 --> 18:07.765\n那么预防策略接种肺炎球菌疫苗是最优先的预防方式，\n\n18:07.765 --> 18:10.465\n尤其是合并慢性基础疾病的老年人。\n\n18:10.465 --> 18:10.865\n所以，\n\n18:10.865 --> 18:12.015\n作为一个全科医生，\n\n18:12.066 --> 18:13.365\n在诊治的时候，\n\n18:13.365 --> 18:18.916\n特别是有呼吸道症状的老年人的慢性合并有慢性病的病人。\n\n18:19.066 --> 18:19.916\n希望他在。\n\n18:20.609 --> 18:25.560\n应该大力的说服他在秋季、秋冬季的时候接种肺炎。\n\n18:26.557 --> 18:27.708\n菌疫苗啊，\n\n18:27.958 --> 18:31.057\n这样可以降低肺炎球菌感染的严重危害。\n\n18:31.208 --> 18:33.407\n那么抗生素的耐药性等等。\n\n18:33.807 --> 18:34.157\n嗯，\n\n18:34.157 --> 18:36.282\n老年人肺炎关键在预防，\n\n18:36.282 --> 18:39.157\n一个是积极参加体育锻炼以增强体质，\n\n18:39.307 --> 18:40.733\n要注意居室卫生，\n\n18:40.733 --> 18:42.508\n居室要经常保持清洁，\n\n18:42.508 --> 18:43.657\n要注意保暖。\n\n18:43.708 --> 18:45.557\n肺炎链球菌疫苗接种，\n\n18:45.557 --> 18:48.733\n流行流感病毒疫苗接种等等，\n\n18:48.733 --> 18:50.307\n还有就戒烟限酒。\n\n18:51.404 --> 18:55.604\n我们今天关于肺炎链球菌的一些。\n\n18:57.250 --> 18:57.750\n有疾病，\n\n18:57.750 --> 18:59.175\n疾病的和预防，\n\n18:59.175 --> 19:00.224\n我们就说到这里，\n\n19:00.224 --> 19:00.699\n谢谢，\n\n19:00.800 --> 19:01.650\n谢谢大家。\n\n","v0247cg10004d6206r2ljht5l73fjgdg",1152,812,"2026-01-25 03:37:04","肺炎的危害与防治 - 症状识别、预防措施及科学治疗指南  ","肺炎危害, 肺炎预防, 肺炎症状, 肺炎治疗, 呼吸道感染防护, 肺炎并发症, 免疫力提升  ","了解肺炎的严重危害、常见症状及科学防治方法。本文提供实用的预防措施、治疗建议和免疫力提升技巧，帮助您有效降低肺炎风险，保护呼吸健康。","2026-04-19 12:00:00",[37],{"menuId":38,"menuName":39,"parentId":21,"orderNum":40,"path":41,"component":42,"isFrame":43,"isCache":44,"menuType":45,"visible":26,"status":21,"createDept":6,"remark":24,"createTime":46,"children":47,"columnImage":48,"columnLogo":49,"uncheckedLogo":6,"checkedLogo":6,"isHot":21,"isHome":21,"forceLogin":21,"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,"传染病,重大疾病",4,"https://vod.haohuanjiao.com/huanjiao/specialistVideo/825416/4ab5d550-2ab1-4d35-9541-caa4e8edc989.tmp?a=0&auth_key=1789028961-c6b1e44f147e42248073157f68dad9d2-0-95fd76db383716043436702411854f04&br=604&bt=604&cd=0%7C0%7C0&ch=0&cr=0&cs=0&dr=0&ds=4&eid=v0247cg10004d6206r2ljht5l73fjgdg&er=0&l=202608110610066CAE21803D7E8F041D7E&lr=&mime_type=video_mp4&net=0&pl=0&qs=13&rc=amppOjhrb3UzOTczNGY3M0ApZ202b3dtNTk1ZzMzajo1eWdhZzBpcWcvMy9hLS1kNC9zc2RkYzQyZWlvLTMxLS5gMS06Yw%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":26,"pageSize":63,"result":64,"totalSize":21},10,[],{"code":9,"msg":10,"message":6,"data":66,"success":59},{"authors":67,"appraiseDimensionScoresVos":68},[],[]]