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--> 00:01.712\n嗯，\n\n00:01.712 --> 00:02.687\n大家中午好，\n\n00:02.687 --> 00:06.811\n今天跟大家分享一下支气管哮喘的基础认知。\n\n00:11.895 --> 00:14.045\n支气管什么是支气管哮喘呢？\n\n00:14.395 --> 00:15.496\n支气管哮喘，\n\n00:15.496 --> 00:21.246\n是一种以慢性气道炎症和气道高反应性为特征的抑制性疾病。\n\n00:22.076 --> 00:22.177\n嗯，\n\n00:22.177 --> 00:25.627\n这种炎症涉及多种细胞和细胞组分，\n\n00:25.627 --> 00:29.627\n如嗜酸性粒细胞、肥大细胞、T淋巴细胞等。\n\n00:29.627 --> 00:30.076\n例如，\n\n00:30.076 --> 00:31.851\n在哮喘患者气道中，\n\n00:31.851 --> 00:35.076\n嗜酸粒细胞数量往往显著高于正常人。\n\n00:35.929 --> 00:36.578\n通俗来说，\n\n00:36.778 --> 00:37.104\n嗯，\n\n00:37.104 --> 00:39.854\n支气管哮喘就是气管变得很敏感，\n\n00:39.854 --> 00:41.929\n像一个容易发脾气的管道，\n\n00:42.129 --> 00:43.828\n在接触到一些刺激物，\n\n00:43.828 --> 00:45.429\n比如花粉、灰尘等后。\n\n00:46.911 --> 00:48.236\n气管就会出现收缩，\n\n00:48.236 --> 00:48.812\n肿胀，\n\n00:49.111 --> 00:50.337\n会产生很多粘液，\n\n00:50.337 --> 00:52.062\n导致呼吸变得困难。\n\n00:53.942 --> 00:56.091\n支气管哮喘的发病机制主要有，\n\n00:56.192 --> 00:56.716\n第一，\n\n00:56.716 --> 00:58.192\n免疫力失衡机制，\n\n00:58.442 --> 01:02.291\n人体免疫系统在哮喘发病中起着关键作用，\n\n01:02.541 --> 01:05.741\n正常情况下免疫系统能维持平衡。\n\n01:05.842 --> 01:08.541\n但哮喘患者体内辅助T细胞。\n\n01:09.263 --> 01:11.163\n一和辅助T细胞2失衡。\n\n01:12.262 --> 01:12.461\n嗯，\n\n01:13.162 --> 01:16.162\n辅助T细胞二细胞功能亢进。\n\n01:16.361 --> 01:16.887\n例如，\n\n01:16.887 --> 01:18.211\n一项研究发现，\n\n01:18.211 --> 01:26.361\n哮喘患者体内T、H二细胞分泌的白细胞计数4、白细胞计数五等细胞因子水平明显升高，\n\n01:26.561 --> 01:29.311\n这些细胞因子会促进炎症反应。\n\n01:31.808 --> 01:32.609\n遗传易感性，\n\n01:32.908 --> 01:33.308\n嗯，\n\n01:33.859 --> 01:36.609\n支气管哮喘具有明显的遗传倾向。\n\n01:36.808 --> 01:37.658\n研究表明，\n\n01:37.658 --> 01:39.509\n如果父母双方都有哮喘，\n\n01:39.609 --> 01:42.359\n子女患哮喘的几率高达70%。\n\n01:42.859 --> 01:44.509\n若只有一方有哮喘，\n\n01:44.509 --> 01:47.759\n子女患病率为30%.50%。\n\n01:48.009 --> 01:52.759\n某些特定基因的突变或多态性与哮喘发病密切相关。\n\n01:55.080 --> 01:55.305\n第三，\n\n01:55.305 --> 01:56.230\n环境因素。\n\n01:57.029 --> 02:00.129\n环境因素在哮喘发病中也至关重要。\n\n02:00.129 --> 02:02.980\n比如空气污染中的可吸入颗粒物，\n\n02:03.129 --> 02:06.680\n二氧化硫等污染物会刺激气道黏膜，\n\n02:06.879 --> 02:08.679\n诱发哮喘发作。\n\n02:08.779 --> 02:09.955\n有研究显示，\n\n02:09.955 --> 02:11.279\n在雾霾天气下，\n\n02:11.380 --> 02:13.880\n哮喘急诊就诊人数明显增加。\n\n02:14.029 --> 02:14.554\n此外，\n\n02:14.554 --> 02:15.705\n过敏原如尘螨，\n\n02:15.705 --> 02:19.130\n动物毛皮屑等也是常见的触发因素。\n\n02:21.684 --> 02:24.634\n支气管哮喘的病理生理学改变主要有，\n\n02:24.684 --> 02:25.134\n第一，\n\n02:25.134 --> 02:26.283\n气道炎症改变。\n\n02:26.533 --> 02:27.697\n哮喘发作时，\n\n02:27.697 --> 02:30.384\n气道内会出现以嗜酸性粒细胞，\n\n02:30.483 --> 02:33.934\n淋巴细胞等为主的炎症细胞浸润，\n\n02:34.033 --> 02:37.134\n这些炎症细胞释放多种炎症介质，\n\n02:37.333 --> 02:38.158\n如组胺，\n\n02:38.158 --> 02:39.184\n白三烯等。\n\n02:39.733 --> 02:41.134\n以白三烯为例，\n\n02:41.134 --> 02:43.783\n它能引起气道平滑肌强烈收缩，\n\n02:43.783 --> 02:45.309\n使气道痉挛变窄，\n\n02:45.309 --> 02:46.684\n增加气道阻力。\n\n02:47.184 --> 02:48.833\n气道高反应性变化，\n\n02:49.033 --> 02:51.884\n气道高反应性是哮喘的重要病。\n\n02:51.960 --> 02:53.059\n生理特征，\n\n02:53.460 --> 02:57.460\n哮喘患者的气道对各种刺激物如冷空气，\n\n02:57.610 --> 02:58.184\n运动，\n\n02:58.184 --> 03:02.009\n化学物质等表现出过度敏感和强烈反应。\n\n03:02.259 --> 03:02.759\n例如，\n\n03:02.759 --> 03:06.910\n例如一些哮喘患者在吸入少量组胺气雾剂后，\n\n03:07.110 --> 03:08.910\n气道阻力会迅速增加，\n\n03:08.910 --> 03:11.009\n而正常人则反应轻微。\n\n03:13.195 --> 03:15.095\n支气管哮喘的病理改变，\n\n03:15.395 --> 03:16.695\n气道成熟表现。\n\n03:17.550 --> 03:17.750\n嗯，\n\n03:18.350 --> 03:21.949\n长期反复发作的哮喘可导致气道重塑，\n\n03:22.100 --> 03:23.899\n这表现为气道壁增厚，\n\n03:24.000 --> 03:27.050\n包括平滑肌增生、基底膜增厚等。\n\n03:27.199 --> 03:28.350\n有研究发现，\n\n03:28.449 --> 03:33.300\n哮喘患者气道平滑肌厚度较正常人可增加2.3倍，\n\n03:33.649 --> 03:36.300\n这会进一步加重气道狭窄，\n\n03:36.350 --> 03:37.600\n影响肺功能，\n\n03:37.699 --> 03:40.050\n使哮喘病情难以控制。\n\n03:41.781 --> 03:43.932\n支气管哮喘的临床表现。\n\n03:44.998 --> 03:45.248\n嗯，\n\n03:45.397 --> 03:46.447\n有哪些呢？\n\n03:46.697 --> 03:48.723\n典型的症状特征，\n\n03:48.723 --> 03:49.147\n第一，\n\n03:49.147 --> 03:50.947\n反复发作的一个喘息。\n\n03:52.817 --> 03:55.617\n喘息是支气管哮喘的常见症状之一，\n\n03:55.716 --> 03:59.016\n患者会感觉呼吸时伴有明显的哮鸣音，\n\n03:59.067 --> 04:00.317\n就像吹哨一样。\n\n04:00.367 --> 04:03.067\n这种喘息症状通常呈发作性，\n\n04:03.167 --> 04:05.317\n可在睡数分钟内发作，\n\n04:05.417 --> 04:07.516\n持续数小时甚至数天。\n\n04:07.716 --> 04:08.167\n例如，\n\n04:08.167 --> 04:10.617\n有些患者在接触花花粉后，\n\n04:10.817 --> 04:13.216\n很快就会出现喘息症状，\n\n04:13.417 --> 04:15.667\n严重的影响正常呼吸。\n\n04:16.476 --> 04:17.177\n气急症状，\n\n04:17.277 --> 04:18.527\n哮喘发作时，\n\n04:18.527 --> 04:20.476\n患者会感到呼吸困难，\n\n04:20.677 --> 04:21.627\n呼吸急促，\n\n04:21.777 --> 04:24.027\n有一种空气不够用的感觉。\n\n04:24.226 --> 04:25.427\n轻度发作时，\n\n04:25.576 --> 04:28.226\n可能只是在活动后感觉气急。\n\n04:28.576 --> 04:30.027\n大家重度发作时，\n\n04:30.177 --> 04:33.476\n即使休息状态下也会出现明显的气急，\n\n04:33.677 --> 04:35.877\n甚至需要端促呼吸来缓解。\n\n04:38.421 --> 04:38.647\n例如，\n\n04:38.647 --> 04:40.510\n一位患者在爬几层楼梯后，\n\n04:40.510 --> 04:42.346\n就会出现明显的气急症状，\n\n04:42.346 --> 04:43.821\n必须停下来休息。\n\n04:44.829 --> 04:44.904\n哎，\n\n04:44.904 --> 04:45.255\n第三，\n\n04:45.255 --> 04:45.829\n胸闷。\n\n04:46.179 --> 04:49.079\n胸闷也是哮喘典型症状之一，\n\n04:49.230 --> 04:49.929\n通常。\n\n04:50.997 --> 04:54.347\n患者常感觉胸部有压迫感、憋闷感，\n\n04:54.447 --> 04:57.048\n这种感觉可能会持续存在，\n\n04:57.247 --> 05:00.747\n也可能在哮哮喘发作的不同阶段出现。\n\n05:00.898 --> 05:01.398\n例如，\n\n05:01.398 --> 05:06.298\n有的患者在哮哮喘发作前就会先出现胸闷症状，\n\n05:06.447 --> 05:09.697\n随后才逐渐出现喘息、气急等表现。\n\n05:10.197 --> 05:10.798\n咳嗽，\n\n05:10.997 --> 05:13.847\n咳嗽在支气管哮喘中较为常见，\n\n05:13.997 --> 05:14.847\n可为干咳，\n\n05:14.847 --> 05:17.247\n也可伴有少量白色粘液痰。\n\n05:17.447 --> 05:20.747\n咳嗽症状在夜间或清晨可能会加重。\n\n05:21.316 --> 05:21.915\n部分咳嗽，\n\n05:22.165 --> 05:22.566\n嗯，\n\n05:23.515 --> 05:26.165\n部分患者可能以咳嗽为唯一症状，\n\n05:26.265 --> 05:28.265\n被称为咳嗽变异性哮喘。\n\n05:31.998 --> 05:35.449\n有些患者在夜间睡眠时会突然咳嗽不止，\n\n05:35.699 --> 05:36.998\n影响睡眠质量。\n\n05:37.821 --> 05:41.022\n不同发展、不同发作阶段的一个症状，\n\n05:41.071 --> 05:42.372\n先兆期症状。\n\n05:44.924 --> 05:47.274\n在咳嗽正式发作前，\n\n05:47.274 --> 05:48.787\n在哮喘正式发作前，\n\n05:48.787 --> 05:51.674\n部分患者会出现一些先兆症状，\n\n05:51.774 --> 05:55.375\n常见的有鼻痒、打喷嚏、眼睛痒、流泪等，\n\n05:55.475 --> 05:59.575\n这些症状提示气道已经开始出现轻度的炎症反应。\n\n05:59.725 --> 06:04.375\n例如有的患者在接触过敏原后会先连续打几个喷嚏，\n\n06:04.524 --> 06:08.375\n随后可能就会出现哮喘的发作的其他症状。\n\n06:08.928 --> 06:10.628\n急性发作期症状。\n\n06:13.037 --> 06:15.738\n急性发作期症状较为明显和严重，\n\n06:15.937 --> 06:20.437\n患者会突然出现喘息、气息加重、呼吸困难，\n\n06:20.488 --> 06:23.738\n可伴有端状呼吸、大汗淋漓等表现，\n\n06:23.888 --> 06:26.488\n听诊时可闻及广泛的哮鸣音。\n\n06:26.588 --> 06:30.138\n例如一位患者在跑步后突然哮喘急性发作，\n\n06:30.287 --> 06:31.138\n呼吸急促，\n\n06:31.187 --> 06:33.388\n只能坐在椅子上大口喘气，\n\n06:33.638 --> 06:35.988\n肺部可听到响亮的哮鸣音。\n\n06:38.506 --> 06:41.356\n慢性期慢性持续期的一个症状，\n\n06:41.557 --> 06:45.006\n慢性持续期患者症状相对较轻，\n\n06:45.157 --> 06:46.606\n但会持续存在，\n\n06:46.756 --> 06:51.320\n可能表现为轻度的喘息、咳嗽、活动耐力下降等。\n\n06:51.320 --> 06:56.057\n比如有些患者日常活动时会感觉呼吸不太顺畅，\n\n06:56.256 --> 06:58.006\n偶尔会有轻微的咳嗽，\n\n06:58.106 --> 07:00.907\n这种状态可能持续较长的时间。\n\n07:02.611 --> 07:04.611\n缓解期症状啊。\n\n07:04.611 --> 07:07.712\n缓解期患者症状基本消失，\n\n07:08.062 --> 07:11.261\n肺功能也可恢复到接近正常水平，\n\n07:11.361 --> 07:13.962\n但这并不意味着哮喘已经治愈。\n\n07:15.928 --> 07:19.278\n在某某些诱因下仍可能再次发作。\n\n07:19.377 --> 07:19.877\n例如，\n\n07:19.877 --> 07:21.703\n经过规范治疗后，\n\n07:21.703 --> 07:24.928\n患者一段时间内没有出现任何哮喘症状，\n\n07:24.977 --> 07:26.678\n能正常生活和运动，\n\n07:26.778 --> 07:31.727\n但在接触到冷空气或刺激性气味时仍有可能诱发哮喘。\n\n07:37.416 --> 07:39.316\n特殊类型哮喘症状，\n\n07:39.516 --> 07:41.566\n咳嗽变异性哮喘症状，\n\n07:41.766 --> 07:45.416\n口嗽变异性哮喘以咳嗽为主要或唯一症状，\n\n07:45.617 --> 07:47.316\n通常为刺激性干咳，\n\n07:47.467 --> 07:49.416\n多在夜间或清晨发作。\n\n07:49.516 --> 07:53.766\n运动、冷空气、过敏原等可诱发或加重咳嗽。\n\n07:54.016 --> 07:56.266\n例如有位患者长期咳嗽，\n\n07:56.416 --> 07:58.967\n尤其是在晚上睡觉时咳嗽明显，\n\n07:59.217 --> 08:01.967\n使用多种止咳药物效果不佳，\n\n08:02.117 --> 08:04.516\n最终诊断为咳嗽变异性哮喘。\n\n08:05.207 --> 08:06.457\n运动性哮喘症状。\n\n08:08.613 --> 08:12.763\n运动性哮喘在运动过程中或运动后数分钟内发作，\n\n08:12.863 --> 08:15.963\n主要症状为喘息、咳嗽、胸闷等，\n\n08:16.113 --> 08:18.713\n一般在剧烈运动后更容易出现，\n\n08:18.863 --> 08:21.088\n比如跑步、打篮球等。\n\n08:21.088 --> 08:25.187\n比如一些运动员在进行高强度训练或比赛后，\n\n08:25.187 --> 08:28.162\n会突然出现呼吸急促、喘息等症状，\n\n08:28.213 --> 08:30.763\n这可能就是运动性哮喘发作。\n\n08:35.268 --> 08:36.518\n职业性哮喘症状。\n\n08:38.270 --> 08:41.270\n职业性哮喘与工作环境中的某些物质有关，\n\n08:41.669 --> 08:47.520\n患者在接触特定职业性过敏原或刺激后会出现哮喘症状，\n\n08:47.570 --> 08:50.770\n症状可在工作期间或下班后出现，\n\n08:50.919 --> 08:52.869\n脱离接触后症状缓解。\n\n08:53.169 --> 08:53.645\n例如，\n\n08:53.645 --> 08:55.520\n在面粉厂工作的工人，\n\n08:55.520 --> 08:57.419\n长期接触面粉粉尘，\n\n08:57.820 --> 09:01.270\n可能会逐渐出现喘息、咳嗽等哮喘症状，\n\n09:01.419 --> 09:04.320\n离开工作环境后症状会有所减轻。\n\n09:07.088 --> 09:08.888\n支气管哮喘的诊断方法，\n\n09:09.288 --> 09:10.538\n临床诊断标准，\n\n09:10.838 --> 09:13.487\n第一症状发作特点标准。\n\n09:14.478 --> 09:20.228\n患者需具备反复发作的喘息、气急、胸闷或咳嗽症状。\n\n09:20.377 --> 09:28.877\n发作往往与接触过敏原、冷空气、物理或化学性刺激、病毒性上呼吸道感染、运动等有关。\n\n09:29.177 --> 09:29.728\n例如，\n\n09:29.728 --> 09:36.578\n许多患者在春秋季节接触花粉后容易频繁出现喘息、咳嗽等症状，\n\n09:36.627 --> 09:41.078\n这符合哮喘症状发作与过敏原相关的特点。\n\n09:42.901 --> 09:43.601\n体征标准，\n\n09:43.801 --> 09:49.500\n发作时在双肺可闻及散在或弥漫性以呼气相为主的哮鸣音，\n\n09:49.651 --> 09:50.750\n呼气相延长，\n\n09:50.950 --> 09:55.450\n哮鸣音的强度和分布范围可因病情轻重而有所不同。\n\n09:55.700 --> 09:58.401\n比如在哮喘急性发作严重时，\n\n09:58.700 --> 10:00.901\n双肺哮鸣音明显且广泛，\n\n10:01.200 --> 10:02.426\n而轻度发作时，\n\n10:02.426 --> 10:05.901\n可能仅占部分肺叶能听到较轻微的哮鸣音。\n\n10:08.276 --> 10:09.927\n症状缓解标准。\n\n10:15.356 --> 10:15.481\n嗯，\n\n10:15.481 --> 10:20.505\n上述症状和体征可经过治疗缓解或自行缓解。\n\n10:20.606 --> 10:23.505\n有些患者在使用支气管舒张剂后，\n\n10:23.556 --> 10:26.856\n喘息、气急等症状能迅速得到改善。\n\n10:27.156 --> 10:30.606\n部分病情较轻的患者即使不使用药物，\n\n10:30.705 --> 10:32.531\n在脱离诱发因素后，\n\n10:32.531 --> 10:36.205\n症状也可能在数小时至数天内自行减轻。\n\n10:36.887 --> 10:37.236\n例如，\n\n10:37.236 --> 10:40.937\n一位轻度哮喘患者在离开充满烟雾的环境后，\n\n10:41.036 --> 10:43.336\n咳嗽、胸闷症状逐渐缓解。\n\n10:44.908 --> 10:45.807\n肺功能标准，\n\n10:46.158 --> 10:48.057\n对于疑似哮喘患者，\n\n10:48.507 --> 10:51.208\n肺功能检查具有重要诊断价值。\n\n10:51.408 --> 10:52.908\n支气管舒张试验，\n\n10:52.958 --> 10:54.908\n吸入支气管舒张剂后，\n\n10:55.007 --> 10:58.757\nF 1 V1较用药前增加12%，\n\n10:58.857 --> 11:02.007\n且绝对值增加大于等于200ml，\n\n11:02.057 --> 11:04.307\n或支气管激发试验阳性，\n\n11:04.458 --> 11:05.307\n或呼气。\n\n11:06.978 --> 11:10.677\n流量峰值日日内变异率大于等于20%。\n\n11:10.828 --> 11:13.728\n例如我们患者进行支气管舒张试验，\n\n11:13.778 --> 11:17.028\n用药前F 1 V1为1.5L，\n\n11:17.028 --> 11:19.328\n用药后增加至1.7L，\n\n11:19.328 --> 11:21.528\n增加幅度超过12%，\n\n11:21.528 --> 11:24.078\n且绝对值增加超过200ml，\n\n11:24.177 --> 11:26.877\n提示支气管舒张试验阳性，\n\n11:26.978 --> 11:28.328\n支持哮喘诊断。\n\n11:29.525 --> 11:31.174\n常用的诊断检查手段，\n\n11:31.224 --> 11:35.875\n肺功能检测肺功能检查是诊断哮喘的重要手段，\n\n11:35.974 --> 11:37.674\n包括通气功能检测，\n\n11:37.775 --> 11:40.174\n可了解患者的用力肺活量，\n\n11:40.325 --> 11:42.075\n第一秒用力呼吸。\n\n11:42.732 --> 11:43.682\n容积等指标。\n\n11:43.932 --> 11:50.382\n哮喘患者在发作期FEVEFEVE比FVC等比直肠降低。\n\n11:50.533 --> 11:54.132\n支气管舒张试验用于评估气道阻塞的可逆性，\n\n11:54.333 --> 11:57.333\n如吸入沙丁胺醇等支气管舒张剂后。\n\n11:58.716 --> 12:01.166\nF 1 V1改善率达到一定。\n\n12:03.645 --> 12:03.846\n嗯。\n\n12:06.203 --> 12:07.653\n现率达到一定标准。\n\n12:11.705 --> 12:14.156\nF 1 V1改善率达到一定标准，\n\n12:14.455 --> 12:15.955\n有助于改善哮喘。\n\n12:15.955 --> 12:19.255\n支气管激发试验则通过吸入激发剂。\n\n12:20.888 --> 12:25.138\n如组胺、乙酰甲胆碱等诱发气道收缩，\n\n12:25.187 --> 12:26.888\n观察肺功能变化，\n\n12:26.937 --> 12:30.138\n若F 1 V1下降超过一定程度为阳性，\n\n12:30.237 --> 12:31.888\n提高气道高反应性。\n\n12:33.143 --> 12:34.943\n对哮喘诊断有重要意义。\n\n12:35.044 --> 12:35.494\n例如，\n\n12:35.494 --> 12:36.843\n一项针对100例。\n\n12:38.320 --> 12:40.469\n疑似哮喘患者的研究中，\n\n12:40.520 --> 12:44.320\n通过支气管激发试验诊断出60例哮喘患者。\n\n12:47.695 --> 12:49.245\n常用的诊断检查手段，\n\n12:49.296 --> 12:52.445\n胸部影像学检查、胸部X线检查。\n\n12:52.445 --> 12:53.895\n在哮喘发作时，\n\n12:54.046 --> 12:59.846\n多数表现为肺纹理增多、增粗、紊乱、透亮度增加等非特异性改变。\n\n13:01.645 --> 13:03.645\n主要用于排除其他肺部疾病，\n\n13:03.796 --> 13:05.296\n如肺炎、气胸等。\n\n13:05.495 --> 13:12.046\n胸部CT检查对于一些复杂病例或与其他肺部疾病鉴别困难时更有价值。\n\n13:13.000 --> 13:15.099\n可清晰显示肺部细微结构。\n\n13:15.349 --> 13:15.799\n例如，\n\n13:15.799 --> 13:18.900\n当患者同时存在咳嗽、呼吸困难等症状，\n\n13:19.099 --> 13:21.799\n通过胸部X线难以明确诊断时，\n\n13:22.150 --> 13:27.200\n胸部CT检查可帮助医生发现是否存在其他肺部疾病，\n\n13:27.299 --> 13:29.000\n如肺部肿瘤等，\n\n13:29.000 --> 13:30.849\n以准确诊断哮喘。\n\n13:40.622 --> 13:41.422\n过敏原检测，\n\n13:41.723 --> 13:45.172\n过敏原检测有助于明确哮喘的诱发因素。\n\n13:45.322 --> 13:47.247\n常见的检测方法有，\n\n13:47.247 --> 13:48.572\n皮肤点刺试验，\n\n13:48.672 --> 13:52.223\n将少量常见过敏原提取物滴在皮肤上，\n\n13:52.422 --> 13:54.172\n用点刺针轻刺。\n\n13:55.013 --> 13:56.963\n如皮肤观察局部皮肤反应，\n\n13:57.114 --> 13:59.963\n如出现风团、红晕等炎性反应，\n\n14:00.013 --> 14:02.114\n提示对该过敏原反过敏。\n\n14:02.943 --> 14:06.593\n血清特异性IG检测则通过采集血液样本，\n\n14:06.643 --> 14:10.544\n检测血液中针对不同过敏原的特异性IG抗体水平。\n\n14:10.843 --> 14:13.093\n比如通过皮肤点测试验发现，\n\n14:13.093 --> 14:17.093\n许多哮喘患者对尘螨、花粉等过敏原呈阳性反应。\n\n14:19.497 --> 14:24.846\n血清特异性癌基因检测可定量分析患者对各种过敏原的严重程度，\n\n14:25.046 --> 14:27.747\n为后续的脱敏治疗提供依依据。\n\n14:30.367 --> 14:33.418\n痰液检查痰液检查可发现嗜酸，\n\n14:33.468 --> 14:35.168\n嗜酸性粒细胞增多，\n\n14:35.268 --> 14:38.218\n这在哮喘诊断中具有一定参考价值。\n\n14:38.367 --> 14:40.768\n诱导痰液技术是常用方法，\n\n14:40.968 --> 14:41.793\n通过雾化，\n\n14:41.793 --> 14:45.367\n吸入高渗盐水等手段促使患者咳出痰液，\n\n14:45.468 --> 14:46.617\n然后进行涂片，\n\n14:46.768 --> 14:48.067\n染色等检查。\n\n14:48.218 --> 14:49.093\n研究表明，\n\n14:49.093 --> 14:53.418\n哮喘患者痰液中嗜酸性粒细胞比例明显高于正常人，\n\n14:53.518 --> 14:56.067\n其比例可高达20%.50%，\n\n14:56.268 --> 15:00.317\n而正常人痰液中嗜酸性粒细胞比例通常低于5%。\n\n15:01.374 --> 15:05.374\n痰液中嗜酸性粒细胞增多有助于支持哮喘的诊断，\n\n15:05.473 --> 15:09.773\n并可作为评估病情严重程度和治疗效果的指标之一。\n\n15:12.380 --> 15:12.580\n与。\n\n15:14.265 --> 15:17.265\n鉴别诊断要点与慢阻肺的鉴别，\n\n15:17.416 --> 15:21.815\n慢阻肺都有长期吸烟史或有害气体颗粒接触史，\n\n15:21.966 --> 15:25.315\n以进行加重的呼吸困难为主要表现，\n\n15:25.416 --> 15:27.315\n喘息症状相对不典型，\n\n15:27.666 --> 15:30.416\n肺功能检查显示不可逆的气流受验，\n\n15:30.515 --> 15:32.815\n支气管舒张试验改善不明显。\n\n15:32.966 --> 15:34.966\n而哮喘多为发作性喘息，\n\n15:35.216 --> 15:36.966\n气流受限具有可逆性。\n\n15:37.116 --> 15:39.416\n例如一位60岁男性患者，\n\n15:39.466 --> 15:41.015\n有30年吸烟史，\n\n15:41.166 --> 15:43.666\n逐渐出现活动后呼吸困难，\n\n15:43.666 --> 15:44.216\n肺功。\n\n15:44.273 --> 15:48.523\n功能检测F 1 V1比FVC持续低于70%，\n\n15:48.674 --> 15:53.823\n且支气管舒张试验后FEVE改善率小于12%更强，\n\n15:53.823 --> 15:55.723\n更倾向于慢阻肺的诊断。\n\n15:57.033 --> 15:59.908\n而一位年轻患者反复发作性喘息，\n\n15:59.908 --> 16:01.458\n支气管舒张试验阳性，\n\n16:01.458 --> 16:03.083\n则更符合哮喘的表现。\n\n16:04.026 --> 16:05.427\n与心源性哮喘的鉴别，\n\n16:05.526 --> 16:07.927\n心源性哮喘常见于左心衰竭，\n\n16:08.077 --> 16:13.276\n如高血压、冠心病等心脏病史患者除有呼吸困难、喘息症状外，\n\n16:13.276 --> 16:17.877\n常伴有端坐呼吸、咳粉红色泡沫样痰等表现症，\n\n16:17.877 --> 16:20.427\n体征上可闻及双肺湿性啰音，\n\n16:20.526 --> 16:23.377\n且心界扩大、心率增快、奔马率等。\n\n16:23.526 --> 16:27.577\n胸部X线检查可见心脏增大、肺淤血等表现。\n\n16:27.726 --> 16:30.927\n而支气管哮喘患者一般无心脏疾病。\n\n16:32.002 --> 16:33.127\n咳白色粘液痰，\n\n16:33.127 --> 16:34.651\n肺部以哮鸣音为主。\n\n16:34.752 --> 16:36.702\n例如一位有冠心病史的患者，\n\n16:36.702 --> 16:38.302\n突发呼吸困难、喘息，\n\n16:38.302 --> 16:41.052\n伴有咳粉红色泡沫样痰，\n\n16:41.202 --> 16:43.151\n双肺底可闻及湿罗音，\n\n16:43.202 --> 16:45.252\n考虑是心源性哮喘。\n\n16:46.070 --> 16:47.544\n无心脏病死的患者，\n\n16:47.895 --> 16:51.044\n以发作性喘息、咳白黏痰为主，\n\n16:51.044 --> 16:52.794\n更可能是支气管哮喘。\n\n16:54.736 --> 16:56.086\n与上气道阻塞鉴别，\n\n16:56.086 --> 17:00.286\n上气道阻塞多由喉部或支气管的病变引起引起，\n\n17:00.486 --> 17:01.437\n如喉部肿瘤，\n\n17:01.437 --> 17:02.336\n气道异物等。\n\n17:02.336 --> 17:04.837\n患者主要表现为吸气性的呼吸困难，\n\n17:04.937 --> 17:06.786\n可伴有吸气性喘鸣音，\n\n17:06.837 --> 17:08.886\n肺部听诊时喘鸣音多较单一，\n\n17:08.886 --> 17:09.437\n响亮，\n\n17:09.487 --> 17:10.837\n且部位较固定。\n\n17:10.886 --> 17:13.036\n而哮喘主要为呼气性哮鸣音，\n\n17:13.087 --> 17:15.886\n哮鸣音多弥漫分布于双肺，\n\n17:16.036 --> 17:19.411\n例如儿童患者若突然出现有吸气性呼吸困难，\n\n17:19.411 --> 17:21.337\n喘鸣音且伴有呛咳时，\n\n17:21.386 --> 17:24.036\n需警惕气道异物导致的上气道阻塞。\n\n17:24.631 --> 17:26.781\n而反复出现呼气性呼吸困难，\n\n17:26.832 --> 17:28.607\n双肺广泛哮鸣音的患者，\n\n17:28.607 --> 17:30.281\n更符合哮喘的一个诊断。\n\n17:33.060 --> 17:36.260\n与变态反应性支气管肺曲霉病鉴别。\n\n17:36.359 --> 17:40.160\n变态反应性支气管肺曲霉病患者有反复哮喘，\n\n17:40.160 --> 17:43.635\n发作时常伴有咳嗽、咳痰、痰中咳，\n\n17:43.635 --> 17:45.260\n咳出中褐色痰酸。\n\n17:45.459 --> 17:48.410\n患者外周血嗜酸应粒细胞显著增高，\n\n17:48.510 --> 17:50.959\n血千种R基因水平明显升高，\n\n17:51.010 --> 17:56.410\n对烟曲霉抗原皮呈速发和迟发双向阳性反应。\n\n17:56.510 --> 18:01.310\n胸部影像学检查可发现肺部浸润影、支气管扩张等表现。\n\n18:01.895 --> 18:04.171\n与支气管哮喘不同的是，\n\n18:04.171 --> 18:05.970\nA BPA患者除哮喘症状外，\n\n18:05.970 --> 18:08.696\n与其特征性的临床表现和检查结果。\n\n18:09.854 --> 18:12.655\n例如某患者哮喘发作频繁伴咳嗽，\n\n18:12.704 --> 18:14.604\n痰中可见综合血糖酸，\n\n18:14.755 --> 18:17.655\n血清总氨基因水平高达1000。\n\n18:19.185 --> 18:19.510\n嗯，\n\n18:19.510 --> 18:22.035\n每毫升烟曲酶抗原皮试阳性，\n\n18:22.385 --> 18:25.310\n结合患者影像学表现考虑A，\n\n18:25.310 --> 18:28.435\nBPA诊断需与单纯性支气管哮喘相鉴别。\n\n18:32.302 --> 18:33.378\n非常感谢各位，\n\n18:33.378 --> 18:33.677\n嗯，\n\n18:33.677 --> 18:34.902\n今天讲解结束，\n\n18:34.902 --> 18:35.353\n谢谢。\n\n","v0247cg10004d625bealjht12nupt2e0",1116,921,"2026-01-25 15:50:04"," 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,呼吸系统疾病  "," 本文全面介绍支气管哮喘的基础认知，包括常见症状、主要病因、诊断方法和有效治疗方案，帮助您更好地了解和应对这一慢性呼吸系统疾病，提高生活质量。","2026-04-26 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