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--> 00:10.625\n大家好，\n\n00:10.925 --> 00:15.024\n今天我来讲一下慢性阻塞性肺疾病。\n\n00:20.899 --> 00:22.000\n那么今天分三点，\n\n00:22.450 --> 00:26.399\n首先讲一下慢性阻塞性肺疾病的概述。\n\n00:29.381 --> 00:29.756\n那么，\n\n00:29.756 --> 00:35.480\n慢性阻塞性肺疾病是一种具有气流受阻特征的肺部疾病，\n\n00:36.030 --> 00:38.280\n气流受阻不完全可逆，\n\n00:38.480 --> 00:40.081\n呈进行性发展。\n\n00:40.908 --> 00:42.333\n那么COPD，\n\n00:42.333 --> 00:46.958\n它是和慢性支气管炎和肺气肿密切相关的。\n\n00:48.021 --> 00:48.521\n那么，\n\n00:48.521 --> 00:53.722\n慢性支气管炎是指支气管管壁的慢性非特异性的炎症。\n\n00:54.271 --> 00:57.672\n患者每年咳嗽、咳痰达3个月以上，\n\n00:57.872 --> 00:59.672\n连续两年或以上，\n\n00:59.922 --> 01:03.172\n并排除其他已知原因的慢性咳嗽。\n\n01:04.216 --> 01:11.066\n肺气肿是指肺部终末细支气管远端气腔出现异常的、持久的扩张，\n\n01:11.365 --> 01:17.416\n并且伴有肺泡壁和细支气管的破坏而无明显的肺纤维化。\n\n01:22.610 --> 01:25.260\n那么慢性阻塞性肺疾病。\n\n01:27.224 --> 01:34.237\n慢性支气管炎、肺气肿患者肺功能检查出现不完全可逆的气流受限时，\n\n01:34.237 --> 01:36.275\n则诊断为COPD。\n\n01:36.775 --> 01:42.525\n如只有慢性支气管炎和或肺气肿而没有气流受限时，\n\n01:42.775 --> 01:45.125\n那么视为COPD的高危期。\n\n01:45.846 --> 01:47.045\n那么需要注意，\n\n01:47.295 --> 01:50.795\n支气管哮喘是一种可逆性的气流受限，\n\n01:51.146 --> 01:53.096\n因此不属于COPD。\n\n01:54.780 --> 01:56.030\n肺囊性纤维化，\n\n01:56.331 --> 01:58.581\n弥漫性泛细支气管炎。\n\n01:59.518 --> 02:02.694\n闭塞性细支气管炎有气流受限，\n\n02:02.694 --> 02:04.319\n但不属于COPD。\n\n02:09.123 --> 02:12.423\n那么病因和发病机制首先是外因，\n\n02:12.623 --> 02:14.223\n包括一个吸烟。\n\n02:15.055 --> 02:15.856\n职业因素，\n\n02:16.305 --> 02:20.856\n感染、理化因素、过敏、空气污染。\n\n02:21.832 --> 02:25.481\n内因的话是呼吸道和局部防御功能降低，\n\n02:25.682 --> 02:27.481\n自主神经功能紊乱。\n\n02:29.992 --> 02:31.091\n看一下病理改变。\n\n02:32.197 --> 02:37.298\n那么慢支的改变是一个支气管粘膜上皮细胞变性坏死。\n\n02:38.195 --> 02:39.046\n溃疡形成。\n\n02:40.207 --> 02:44.606\n纤毛倒伏、变短、不齐、粘连，\n\n02:44.957 --> 02:46.057\n部分脱落，\n\n02:46.307 --> 02:48.106\n基底膜变厚、坏死。\n\n02:48.457 --> 02:50.007\n炎症细胞浸润，\n\n02:50.507 --> 02:53.106\n以浆细胞和淋巴细胞为主。\n\n02:53.557 --> 02:56.856\n急性发作期可以看见大量的中性粒细胞。\n\n02:57.507 --> 03:02.807\n主要的病理改变是一个慢性支气管炎及肺气肿的病理改变。\n\n03:03.694 --> 03:05.093\n那么肺气肿，\n\n03:05.244 --> 03:07.294\n它是一个肺过度膨胀，\n\n03:07.794 --> 03:08.944\n弹性减退，\n\n03:09.343 --> 03:10.643\n肺泡壁变薄，\n\n03:11.093 --> 03:12.494\n肺泡腔扩大，\n\n03:12.794 --> 03:15.194\n破裂或者形成一个大泡。\n\n03:17.966 --> 03:19.516\nCo pd的病理生理，\n\n03:19.966 --> 03:23.216\n它早期反映了大气道功能的检查，\n\n03:23.716 --> 03:26.791\n如第一秒用力呼气容积，\n\n03:26.791 --> 03:29.166\nFEV one最大通气量多少，\n\n03:29.365 --> 03:31.666\n但小气道功能已发生异常。\n\n03:32.468 --> 03:34.018\n随着病情的加重，\n\n03:34.317 --> 03:35.817\n气道阻力增加，\n\n03:36.067 --> 03:38.617\n通气功能可有不同程度的异常，\n\n03:39.218 --> 03:41.768\n气流受限成为不可逆，\n\n03:41.968 --> 03:44.817\n最终可出现一个呼吸功能的衰竭。\n\n03:48.641 --> 03:50.942\n那么通气血流比值，\n\n03:51.542 --> 03:58.442\n通气血流比值是指每分钟肺泡通气量与每分钟肺血流的比值。\n\n03:58.742 --> 04:02.292\n正常成人安静状态下是0.84。\n\n04:04.082 --> 04:04.356\n那么，\n\n04:04.356 --> 04:06.531\n无论比值增大还是减小，\n\n04:06.731 --> 04:09.231\n都妨害了有效的气体交换，\n\n04:09.682 --> 04:12.031\n可导致血液缺氧，\n\n04:12.031 --> 04:16.082\n或者C二二氧化碳的留它主要是缺氧。\n\n04:16.282 --> 04:22.981\n它的原因是动静脉血液之间氧分压远远大于二氧化碳分压，\n\n04:23.332 --> 04:25.631\n所以动静脉短路时，\n\n04:25.932 --> 04:32.932\n动脉血二氧化碳分压下降的程度大于二氧化碳升高的程度。\n\n04:33.963 --> 04:34.613\n那么。\n\n04:35.791 --> 04:39.342\n二氧化碳的扩散系数是氧气的十二十倍，\n\n04:39.641 --> 04:43.191\n所以二氧化碳扩散较氧气快，\n\n04:43.492 --> 04:44.742\n不宜储留。\n\n04:45.705 --> 04:48.705\n动脉血二氧化碳下降和。\n\n04:50.041 --> 04:51.842\n二氧化碳分压升高时，\n\n04:52.141 --> 04:53.492\n可以刺激呼吸，\n\n04:53.791 --> 04:55.641\n增加肺泡通气量，\n\n04:55.842 --> 04:57.742\n有助于二氧化碳的排出，\n\n04:58.191 --> 05:01.441\n却几乎没有助于氧气的摄取。\n\n05:04.714 --> 05:09.040\nCPD的症状和体征包括一个生活质量下降，\n\n05:09.339 --> 05:11.140\n甚至丧失劳动能力，\n\n05:11.440 --> 05:13.089\n气短或呼吸困难。\n\n05:13.888 --> 05:16.088\n标志性的症状就是一个。\n\n05:16.989 --> 05:18.440\n气短或呼吸困难，\n\n05:18.790 --> 05:20.390\n另外还有慢性咳嗽，\n\n05:20.790 --> 05:27.589\n还有体重下降、喘息、胸闷、精神抑郁或焦虑、咳嗽、食欲减退。\n\n05:30.437 --> 05:30.863\nCop.\n\n05:30.863 --> 05:31.937\nD的病程分期，\n\n05:31.937 --> 05:34.588\n它分为一个急性加重期和稳定期。\n\n05:35.388 --> 05:37.613\n急性加重期是指在疾病过程中，\n\n05:37.613 --> 05:38.588\n短期内咳嗽，\n\n05:38.588 --> 05:38.988\n咳痰，\n\n05:38.988 --> 05:41.437\n气短或者是喘息加重，\n\n05:41.437 --> 05:42.437\n痰量增多，\n\n05:42.588 --> 05:44.738\n呈脓性或粘液脓性，\n\n05:44.888 --> 05:45.937\n可伴发热。\n\n05:47.572 --> 05:52.122\n稳定期是指咳嗽、咳痰、气短等症状稳定或者症状轻微。\n\n05:55.670 --> 05:56.471\n并发症的话，\n\n05:56.571 --> 05:58.020\n慢性呼吸衰竭，\n\n05:58.071 --> 06:00.020\n它在急性加重时发生，\n\n06:00.270 --> 06:02.821\n有低氧血症和高碳酸血症。\n\n06:03.743 --> 06:04.169\n那么，\n\n06:04.169 --> 06:05.444\n还有自发性的气胸，\n\n06:05.794 --> 06:07.769\n突发加重呼吸困难，\n\n06:07.769 --> 06:08.743\n加上鼓音，\n\n06:09.044 --> 06:11.593\n还有胸片是有气胸的征象。\n\n06:12.444 --> 06:15.894\n然后是一个慢性肺源性的心脏病。\n\n06:16.394 --> 06:19.794\n那么COPD会引起肺动脉高压结果，\n\n06:19.794 --> 06:21.694\n然后导致一个右心室肥厚，\n\n06:21.843 --> 06:23.493\n最终发生一个右心衰。\n\n06:26.083 --> 06:28.132\n第二部分讲一下检查和化验。\n\n06:30.963 --> 06:33.914\n肺功能是判断气流受限的主要客观标准。\n\n06:34.514 --> 06:44.264\n那么第一秒用力呼气容积占肺肺的活量的百分比fevo比F、fe、C是评价气流受限的一项敏感指标。\n\n06:44.864 --> 06:49.213\n那么1秒率F、fe、B预预计值是评估Co、PD。\n\n06:49.936 --> 06:51.635\n严重程度的良好指标。\n\n06:51.835 --> 06:53.786\n在吸入支气管扩张后。\n\n06:54.954 --> 06:58.128\nFEV和FEC一般小于70%，\n\n06:58.579 --> 07:01.128\n大于七十要考虑是一个哮喘。\n\n07:02.466 --> 07:07.466\nF1\u003C80%预计值可以确定为一个完不完全可逆的气流受限。\n\n07:11.238 --> 07:11.588\n那么，\n\n07:11.588 --> 07:14.138\n检查和化验首先是一个肺总量。\n\n07:14.488 --> 07:15.013\n它呢，\n\n07:15.013 --> 07:19.888\n是指肺总量是一个深吸气后肺内所含气体的总量，\n\n07:20.088 --> 07:22.437\n即等于肺活量和产气量。\n\n07:24.359 --> 07:25.359\n如果异常增加，\n\n07:25.510 --> 07:27.959\n是由于一个肺气肿和老年肺。\n\n07:28.712 --> 07:29.562\n异常降低，\n\n07:29.611 --> 07:30.236\n它呢，\n\n07:30.236 --> 07:33.361\n常常是导致限制性通气障碍的各种情况，\n\n07:33.562 --> 07:35.462\n使肺总量明显降低。\n\n07:35.861 --> 07:37.011\n需要注意的是，\n\n07:37.261 --> 07:40.062\n肺总量正常不一定代表肺功能正常。\n\n07:40.700 --> 07:43.649\n因为肺活量和残气量的增减可以互相弥补。\n\n07:45.286 --> 07:46.937\n然后是一个功能残气量，\n\n07:47.136 --> 07:51.236\n它是指平静呼吸后肺内残余的气量。\n\n07:51.937 --> 07:52.354\n那么，\n\n07:52.354 --> 07:53.511\nF、C呢，\n\n07:53.511 --> 07:57.886\n在生理上起着一个稳定肺泡气体分压的缓冲作用，\n\n07:58.386 --> 07:59.986\n减少了通气间歇。\n\n08:00.756 --> 08:02.756\n对肺泡内气体交换的影响，\n\n08:03.205 --> 08:09.031\n如果没有FRC呼气末肺泡将是完全闭塞的。\n\n08:09.031 --> 08:12.131\nFRC增加是提示肺泡扩张，\n\n08:12.131 --> 08:15.006\nFRC减少说明肺泡缩小或陷闭。\n\n08:19.675 --> 08:21.126\n还有一个残气量，\n\n08:21.526 --> 08:24.526\n深呼吸后肺内剩余的气量，\n\n08:24.925 --> 08:27.675\n它反映了肺泡静态的膨胀度，\n\n08:27.976 --> 08:30.976\n具有稳定肺泡气体分压的作用。\n\n08:31.175 --> 08:32.575\n减少了通气间。\n\n08:33.450 --> 08:36.450\n些对肺泡内气体风压的影响。\n\n08:37.791 --> 08:42.541\n限制性疾病患残气量与功能残气量减少，\n\n08:42.640 --> 08:44.491\n阻塞性疾病则增高。\n\n08:45.291 --> 08:48.791\n肺活量是指在不限时间的情况下，\n\n08:48.940 --> 08:53.640\n一次最大吸气后再尽最大能力所呼出的气体量。\n\n08:53.841 --> 08:57.690\n它是代表肺一次最大机能活动量。\n\n08:57.690 --> 08:59.491\nCOPD患者肺活动量降低，\n\n09:00.241 --> 09:01.741\n那么还有一些其他检查。\n\n09:02.685 --> 09:04.585\n如血常规、痰检、血气，\n\n09:04.736 --> 09:06.585\n还有胸部的X线检查。\n\n09:09.908 --> 09:11.908\n那么这是一个血气分析的正常值，\n\n09:11.908 --> 09:13.158\n大家参考一下。\n\n09:16.142 --> 09:16.966\nCOPD的话呢，\n\n09:16.966 --> 09:18.942\n它一般轻度的是正常，\n\n09:19.242 --> 09:20.267\n如果进展的话，\n\n09:20.267 --> 09:22.541\n那么它会出现以下一些变化，\n\n09:22.841 --> 09:23.716\n严重的话，\n\n09:23.716 --> 09:26.091\n它会出现一个二型呼衰。\n\n09:29.476 --> 09:30.427\n那么治疗要点，\n\n09:30.627 --> 09:32.677\n它首先是避免诱因，\n\n09:32.927 --> 09:34.276\n支气管舒张剂，\n\n09:34.476 --> 09:36.177\n祛痰、镇咳平喘，\n\n09:36.476 --> 09:37.502\n控制感染，\n\n09:37.502 --> 09:39.327\n家庭氧疗和康复训练。\n\n09:41.648 --> 09:42.049\n那么，\n\n09:42.049 --> 09:44.448\n慢性阻塞性肺疾病的护理。\n\n09:46.682 --> 09:48.281\n首先要做一个护理评估。\n\n09:49.424 --> 09:51.973\n包括一个症状的和身体的评估，\n\n09:52.773 --> 09:54.674\n其次是一个辅助的检查，\n\n09:55.674 --> 09:57.823\n还有就是评估一个健康史，\n\n09:58.573 --> 10:01.174\n另外要评估一个心理社会的状况。\n\n10:03.469 --> 10:04.520\n护理诊断的话，\n\n10:04.669 --> 10:06.469\n包括以下这点。\n\n10:07.818 --> 10:08.718\n大家可以看一下。\n\n10:13.458 --> 10:15.507\n那么护理的目标有以下8点，\n\n10:16.057 --> 10:17.557\n大家也再看一下。\n\n10:21.317 --> 10:23.216\n主要讲一下呼吸的措施，\n\n10:23.617 --> 10:29.892\n那么首先清理呼吸道需要协助病人取一个舒适的体位和外或体位，\n\n10:29.892 --> 10:30.767\n比如半卧位。\n\n10:31.067 --> 10:33.267\n另外给予一个化痰平喘的药物，\n\n10:33.317 --> 10:35.517\n观察药物疗效和不良反应。\n\n10:35.916 --> 10:37.466\n然后保持气道通畅，\n\n10:37.466 --> 10:38.916\n加强气道湿化，\n\n10:38.916 --> 10:39.817\n及时吸痰。\n\n10:40.466 --> 10:42.091\n另外指导病人深呼吸，\n\n10:42.091 --> 10:43.916\n有效咳嗽和正确排痰，\n\n10:44.317 --> 10:46.216\n给病人进行胸部叩击，\n\n10:46.617 --> 10:48.067\n进行病情观察。\n\n10:48.754 --> 10:50.278\n咳嗽、咳痰、喘息，\n\n10:50.278 --> 10:52.104\n生命体征、肺部体征的变化。\n\n10:54.473 --> 10:56.198\n那么深呼吸、有效咳嗽，\n\n10:56.198 --> 10:57.174\n正确的排痰。\n\n10:59.093 --> 10:59.794\n首先坐位，\n\n10:59.794 --> 11:00.693\n身体前倾，\n\n11:01.294 --> 11:04.593\n进行数次深而缓慢的腹式呼吸，\n\n11:04.943 --> 11:07.443\n深吸气后屏息3.5秒。\n\n11:07.643 --> 11:10.994\n那么然后再连续2.3次短促有力的咳嗽，\n\n11:11.193 --> 11:12.443\n使痰液排出。\n\n11:12.843 --> 11:13.369\n同时，\n\n11:13.369 --> 11:14.718\n可以用手按住下腹部，\n\n11:14.718 --> 11:15.994\n也可以帮助排痰。\n\n11:17.711 --> 11:18.211\n那么这是？\n\n11:19.356 --> 11:21.706\n胸部叩击的方法和注意事项？\n\n11:25.497 --> 11:27.546\n另外就是气体交换受损，\n\n11:27.846 --> 11:31.497\n那么需要保持适宜的温度、湿度，\n\n11:31.846 --> 11:36.747\n还有就是病人根据情况和利用一个呼吸机做好呼吸相关的护理，\n\n11:37.046 --> 11:38.947\n还有持续低流量的氧疗。\n\n11:39.679 --> 11:42.179\n进行病情观察和呼吸功能锻炼。\n\n11:44.273 --> 11:49.973\n呼吸功能锻炼包括一个缩唇呼吸和腹式呼吸、格式呼吸等。\n\n11:52.070 --> 11:53.695\n那么自理能力缺陷的话，\n\n11:53.695 --> 11:55.344\n那么就要加强基础护理，\n\n11:55.344 --> 11:56.520\n做到三短六节。\n\n11:56.919 --> 11:58.570\n还有就是与病人多沟通，\n\n11:58.719 --> 12:03.169\n消除病人依赖心理鼓励做一些能力范围内的一些活动。\n\n12:04.414 --> 12:06.114\n对于有一些焦虑的患者，\n\n12:06.213 --> 12:08.664\n我们需要鼓励病人表达自己的感受。\n\n12:09.531 --> 12:11.182\n还有就是讲解相关知识，\n\n12:11.632 --> 12:14.581\n另外建立良好的互患关系，\n\n12:14.932 --> 12:18.481\n对于病人提出的问题给予明确、有效、积极的信息。\n\n12:19.869 --> 12:25.968\n还有就是注意在操作过程中要注意一个感染的危险因素。\n\n12:28.693 --> 12:31.843\n那么以下就是一些皮肤完整性受损的一些危险，\n\n12:32.443 --> 12:33.494\n需要注意的。\n\n12:36.302 --> 12:36.578\n还有，\n\n12:36.578 --> 12:37.478\n活动无耐力，\n\n12:37.478 --> 12:38.278\n营养失调，\n\n12:38.278 --> 12:39.103\n知识缺乏，\n\n12:39.453 --> 12:42.953\n那么我们就是需要循序渐进的增进活动，\n\n12:43.103 --> 12:45.353\n以恢复体力和增加抵抗力。\n\n12:46.138 --> 12:49.088\n慢阻肺病人合理的饮食包括以下这些。\n\n12:49.916 --> 12:50.216\n另外，\n\n12:50.216 --> 12:55.190\n要向病人讲解慢阻肺的主要临床表现、发生发展过程和原因。\n\n12:55.190 --> 12:56.565\n并发症治疗经过。\n\n12:58.286 --> 13:00.036\n如果病人进行气管插管了，\n\n13:00.036 --> 13:02.135\n那么需要进行以下这些护理。\n\n13:05.044 --> 13:07.494\n还有就是经口插管吸痰的方法，\n\n13:07.544 --> 13:08.843\n大家要注意一下。\n\n13:12.085 --> 13:14.534\n最后就是一个护理疗效的评价，\n\n13:15.085 --> 13:19.534\n那么首先需要看一下病人能否掌握呼吸功能锻炼的方法。\n\n13:20.401 --> 13:22.851\n病人的自理能力要得到锻炼。\n\n13:23.913 --> 13:28.463\n病人家属要了解胸部叩击的方法和注意的事项，\n\n13:29.263 --> 13:32.513\n还有就是病人呼吸道要保持一个通畅。\n\n13:34.158 --> 13:37.857\n最后就是要病人的心理状态得到一个调节。\n\n13:41.322 --> 13:43.172\n那么以上就是我今天讲的内容，\n\n13:43.973 --> 13:45.223\n谢谢各位老师。\n\n13:47.486 --> 13:48.236\n那么最后。\n\n13:49.479 --> 13:53.630\n稍微提几句就是我们的吸痰方法。\n\n13:56.132 --> 13:57.831\n因为这个是比较重要的，\n\n13:58.081 --> 14:00.981\n首先要进行一个严格的无菌操作。\n\n14:02.664 --> 14:04.864\n然后要调整至一个负压，\n\n14:04.864 --> 14:05.888\n表头要调整，\n\n14:05.888 --> 14:07.713\n调整一个适当的负压。\n\n14:08.114 --> 14:11.351\n还有就是将吸痰管伸入气管插管内，\n\n14:11.351 --> 14:13.513\n需要边旋转边吸引，\n\n14:13.513 --> 14:14.614\n要动作轻柔。\n\n14:15.239 --> 14:16.914\n以免刺激到了，\n\n14:16.914 --> 14:18.840\n损伤到了里面的气道，\n\n14:19.090 --> 14:21.190\n动作不能超过一个15秒。\n\n14:22.585 --> 14:26.934\n一般我们是要先吸气管后吸口鼻腔分泌物，\n\n14:27.135 --> 14:29.534\n这要注意不能先后顺序错误。\n\n14:29.784 --> 14:32.335\n还有若需气囊放气，\n\n14:32.585 --> 14:35.135\n应该先行气管吸引，\n\n14:35.234 --> 14:37.684\n再行口咽部吸引再放气。\n\n14:38.432 --> 14:39.932\n换另一根吸痰管，\n\n14:40.033 --> 14:42.432\n要再次吸引吸管内的痰液。\n\n14:44.062 --> 14:45.861\n那么吸引气管时，\n\n14:46.361 --> 14:48.161\n我们要鼓励病人咳嗽，\n\n14:48.361 --> 14:51.411\n那么这样可以吸出一些生物的分泌物。\n\n14:52.309 --> 14:53.734\n如果痰液粘稠时，\n\n14:53.734 --> 14:56.059\n需要向里面注入3.5ml湿化液，\n\n14:56.059 --> 14:57.508\n再吸更加方便。\n\n14:58.508 --> 14:59.008\n另外，\n\n14:59.008 --> 15:03.559\n吸痰是严密观察病人神色、面色、生命体征的变化，\n\n15:04.658 --> 15:05.809\n谢谢各位老师。\n\n","v0247cg10004d77124aljht01gpegnl0",912,858,"2026-01-25 06:55:33"," 慢性阻塞性肺病（COPD）症状、治疗与预防指南  "," 慢性阻塞性肺病,COPD症状,COPD治疗,肺病预防,慢阻肺管理  "," 了解慢性阻塞性肺病（COPD）的常见症状、最新治疗方法及有效预防措施。获取专业建议，帮助患者改善呼吸健康，提升生活质量。","2026-04-14 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