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--> 00:01.235\n对。\n\n00:06.323 --> 00:07.024\n大家好，\n\n00:07.073 --> 00:12.923\n我是来自静安区宝山路街道社区卫生服务中心中医科张玉兰。\n\n00:17.160 --> 00:22.260\n今天很高兴和大家一起来分享急性扁桃体炎。\n\n00:28.791 --> 00:28.941\n嗯，\n\n00:28.941 --> 00:30.041\n那我们将从。\n\n00:31.212 --> 00:36.162\n初始扁桃体病因大揭秘症状快速查表。\n\n00:38.092 --> 00:38.893\n精确诊断。\n\n00:39.737 --> 00:40.537\n治疗策略。\n\n00:41.512 --> 00:42.611\n预防与手术。\n\n00:43.590 --> 00:47.990\n六个方面来揭秘我们的急性扁桃体炎。\n\n00:51.305 --> 00:51.855\n第一部分，\n\n00:52.055 --> 00:55.405\n我们首先来认识一下我们的扁桃体。\n\n00:59.227 --> 01:03.876\n其实大家对扁桃体应该还是相对非常熟悉的。\n\n01:04.513 --> 01:07.638\n因为它第一个其实就是疼痛嘛，\n\n01:07.638 --> 01:08.563\n大家知道。\n\n01:10.053 --> 01:14.203\n我们扁桃体其实它是有一个免疫功能。\n\n01:15.517 --> 01:19.468\n腭扁桃体是咽淋巴环的核心的成员。\n\n01:20.349 --> 01:24.550\n它的淋巴细胞和吞噬细胞能够产生抗体。\n\n01:26.117 --> 01:26.992\n第一时间的话，\n\n01:26.992 --> 01:30.568\n能够拦截经口鼻入侵的病原体。\n\n01:31.349 --> 01:36.199\n为人体尤其是儿童期提供关键的免疫屏障，\n\n01:36.650 --> 01:38.800\n功能活跃且不可太低。\n\n01:39.663 --> 01:40.038\n其实，\n\n01:40.038 --> 01:44.237\n它也就是我们日常感冒、感冒咳嗽，\n\n01:44.237 --> 01:46.087\n一个第一道门户，\n\n01:46.087 --> 01:47.513\n就是我们的扁桃体。\n\n01:48.644 --> 01:49.444\n扁桃体呢，\n\n01:49.595 --> 01:54.394\n有的人会说扁桃体没那么重要，\n\n01:54.444 --> 01:56.595\n就是把手术去切除了。\n\n01:56.845 --> 01:57.644\n其实呢，\n\n01:57.944 --> 02:00.194\n它并非是一个退化的器官。\n\n02:00.968 --> 02:05.318\n它在人体免疫系统中扮演着非常重要的角色，\n\n02:05.867 --> 02:08.518\n能够有效抵御病原体的入侵，\n\n02:08.968 --> 02:12.268\n保护人体免受感染，\n\n02:12.468 --> 02:15.468\n是人体免疫防线的重要组成部分。\n\n02:28.093 --> 02:31.393\n我们再来看一下扁桃体的结构和它的位置。\n\n02:32.481 --> 02:33.630\n它的表面结构，\n\n02:33.630 --> 02:35.630\n其实它是有非常多的隐窝。\n\n02:36.604 --> 02:37.554\n这些隐窝呢，\n\n02:37.554 --> 02:40.054\n增加了与病原体接触的面积，\n\n02:40.505 --> 02:43.380\n有利于扁桃体发生，\n\n02:43.380 --> 02:45.755\n发挥免疫的监视功能。\n\n02:46.054 --> 02:46.804\n及时。\n\n02:47.740 --> 02:50.391\n发现并清除入侵的病原体。\n\n02:51.552 --> 02:53.951\n它的内部结构负极。\n\n02:55.714 --> 02:58.164\n淋巴细胞与巨噬细胞，\n\n02:58.315 --> 03:02.865\n它是一张非常密集的免疫监视网。\n\n03:03.988 --> 03:07.164\n这些细胞能够识别并消除，\n\n03:07.164 --> 03:08.438\n消灭病原体，\n\n03:08.738 --> 03:11.488\n保护我们人体受到感染。\n\n03:13.160 --> 03:13.785\n扁桃体在哪？\n\n03:13.785 --> 03:14.761\n它在哪里呢？\n\n03:15.110 --> 03:18.561\n它位于口咽、口和咽的两侧。\n\n03:20.253 --> 03:25.304\n它的解剖位置决定了它必须直面空气与食物中的病原体。\n\n03:25.654 --> 03:26.304\n因此，\n\n03:26.753 --> 03:32.354\n红、肿、热、痛是扁桃体与病原体进行免疫激战的外在信号。\n\n03:40.925 --> 03:43.475\n第二个我们来讲一讲它的病因，\n\n03:43.776 --> 03:45.576\n也就是他为什么会发病。\n\n03:59.927 --> 04:01.328\n它的发发病呢，\n\n04:01.727 --> 04:04.078\n病毒占主角，\n\n04:04.378 --> 04:06.977\n但是细菌也非常的凶猛。\n\n04:08.203 --> 04:08.753\n病毒，\n\n04:08.904 --> 04:11.304\n在急性扁桃体中，\n\n04:11.554 --> 04:15.054\n病毒感染占到了5到八成的比例。\n\n04:15.764 --> 04:19.713\n常见的像我们现在非常熟悉的腺病毒啊，\n\n04:19.764 --> 04:21.114\n流感病毒啊，\n\n04:21.313 --> 04:25.614\n这些病毒都是引发扁桃体的主要病原体之一。\n\n04:27.617 --> 04:28.416\n当然了，\n\n04:28.666 --> 04:29.066\n嗯，\n\n04:29.266 --> 04:32.467\n很多人在得了扁桃体炎以后，\n\n04:32.617 --> 04:37.516\n常常会想要用一些头孢啊、青霉素之类。\n\n04:37.666 --> 04:40.316\n他们觉得这样的话效果很好。\n\n04:40.617 --> 04:41.467\n那没错，\n\n04:42.016 --> 04:44.242\n就是因为细菌感染，\n\n04:44.242 --> 04:48.117\n也是扁桃体炎中占到了两到三成。\n\n04:48.846 --> 04:49.371\n其中，\n\n04:49.371 --> 04:54.496\nA组贝塔溶血性链球菌是最需要警惕的病原体。\n\n04:54.645 --> 04:58.996\n病原体它可能引发严重的并发症。\n\n04:59.395 --> 04:59.795\n嗯，\n\n05:00.496 --> 05:01.821\n说到这个并发症，\n\n05:01.821 --> 05:03.645\n其实它真的是非常可怕的。\n\n05:03.795 --> 05:06.020\n就是我们有过病例，\n\n05:06.020 --> 05:09.996\n就是因为感染了这个溶血性的链球菌以后呢，\n\n05:10.096 --> 05:13.045\n引发了肾功能衰竭，\n\n05:13.045 --> 05:13.496\n对吧，\n\n05:13.496 --> 05:15.295\n这个就是非常恐怖了。\n\n05:15.346 --> 05:18.846\n所以我们说预防感冒和预防病毒还是。\n\n05:19.095 --> 05:20.195\n非常有必要的。\n\n05:21.071 --> 05:22.621\n还有一个诱发的因素，\n\n05:22.971 --> 05:27.071\n它是一个受凉、过度劳累等因素，\n\n05:27.621 --> 05:32.471\n会导致局部细菌菌局部的菌群失调，\n\n05:32.721 --> 05:35.270\n它也会引起扁桃体炎。\n\n05:35.571 --> 05:36.471\n因此，\n\n05:36.471 --> 05:38.270\n在日常生活中，\n\n05:38.270 --> 05:40.920\n我们要避免这些诱发因素，\n\n05:41.270 --> 05:45.321\n其实也就是要增增强我们自身的免疫力。\n\n05:57.743 --> 05:59.593\n那我们扁桃体炎，\n\n05:59.743 --> 06:02.394\n它一个是由病毒引起。\n\n06:03.227 --> 06:03.977\n另外一个呢，\n\n06:03.977 --> 06:05.627\n它是由细菌引起，\n\n06:05.928 --> 06:10.178\n那病毒和细菌它们到底有什么差异呢？\n\n06:11.984 --> 06:15.433\n首先我们来看一下病毒的特点。\n\n06:17.177 --> 06:19.726\n病毒性的扁桃体炎起病的话，\n\n06:19.726 --> 06:20.826\n相对比较缓，\n\n06:21.527 --> 06:24.826\n常伴有咳嗽啊、流鼻涕这些症状。\n\n06:25.177 --> 06:26.101\n分泌物呢，\n\n06:26.101 --> 06:28.226\n比较清晰稀薄。\n\n06:28.677 --> 06:31.177\n一般不需要特别使用抗生素治疗，\n\n06:31.427 --> 06:32.527\n因为大家知道，\n\n06:32.527 --> 06:35.527\n病毒它都是有自愈和自限性的。\n\n06:36.960 --> 06:38.661\n细菌性扁桃体炎呢，\n\n06:38.760 --> 06:40.510\n它起病非常急骤。\n\n06:40.911 --> 06:41.661\n患者呢，\n\n06:41.661 --> 06:44.061\n常常会出现高热、寒颤，\n\n06:44.460 --> 06:46.360\n扁桃体红肿明显，\n\n06:46.760 --> 06:48.811\n并并伴有脓点。\n\n06:49.360 --> 06:50.186\n颌下呢，\n\n06:50.186 --> 06:51.661\n这个颌下淋巴结呢，\n\n06:51.661 --> 06:52.811\n肿大压痛，\n\n06:53.411 --> 06:56.911\n常常需要抗生素来进行精准打击。\n\n06:57.617 --> 06:57.816\n嗯，\n\n06:57.816 --> 07:00.041\n像有的时候如果你太过严重，\n\n07:00.041 --> 07:02.217\n比如说是化脓性扁桃体炎的话，\n\n07:02.316 --> 07:05.717\n那我们可能还会加用一点激素。\n\n07:05.916 --> 07:06.441\n当然，\n\n07:06.441 --> 07:11.367\n大家这个时候对于激素也不必要产生特别的抗拒，\n\n07:11.467 --> 07:13.766\n因为它只是短暂的冲击疗法。\n\n07:23.317 --> 07:23.717\n下面呢，\n\n07:23.717 --> 07:26.717\n我们要讲一下年龄与病原体的对应。\n\n07:27.938 --> 07:29.789\n我们三岁以下儿童的话，\n\n07:30.239 --> 07:32.639\n他链球菌感染的话，\n\n07:32.639 --> 07:34.639\n会是比较少见的。\n\n07:35.355 --> 07:38.305\n主要是以病毒感染为主。\n\n07:39.298 --> 07:48.347\n这跟他们的小朋友的免疫系统发育还没有完全的成熟这些特点有关，\n\n07:48.648 --> 07:51.597\n还有跟他的接触的环境有关。\n\n07:51.847 --> 07:55.523\n因为小朋友一般都是喜欢户外活动啊，\n\n07:55.523 --> 08:01.597\n这些那他就比较容易被这种病毒所侵，\n\n08:02.097 --> 08:03.648\n就是侵侵袭。\n\n08:06.674 --> 08:07.723\n5.15岁呢，\n\n08:08.023 --> 08:11.723\n这个时段是链球菌感染，\n\n08:11.773 --> 08:15.473\n链球菌感染也就是细菌感染的高发的年龄段。\n\n08:17.589 --> 08:18.239\n这个时期。\n\n08:19.233 --> 08:20.382\n的儿童，\n\n08:20.532 --> 08:25.183\n他们的免疫系统和发育的状态还没有完全成熟，\n\n08:25.382 --> 08:28.433\n他们还是在慢慢的发育中。\n\n08:29.032 --> 08:29.433\n嗯，\n\n08:29.433 --> 08:33.833\n而且这个这个年龄段的小朋友都是比较爱小朋友，\n\n08:33.833 --> 08:35.333\n都是有爱玩的那种天性。\n\n08:35.732 --> 08:36.382\n他呢，\n\n08:36.432 --> 08:38.882\n与外界也接触很频繁，\n\n08:39.232 --> 08:41.982\n容易感受感染链球菌。\n\n08:45.466 --> 08:46.166\n婴幼儿呢，\n\n08:46.416 --> 08:48.716\n他们是以病毒为主的。\n\n08:49.328 --> 08:50.778\n他们的免疫系统也。\n\n08:51.952 --> 08:53.252\n尚未完全的成熟，\n\n08:53.601 --> 08:54.002\n嗯，\n\n08:54.151 --> 08:56.702\n对于抵抗力相对比较弱，\n\n08:56.901 --> 08:59.601\n因此更容易遭到病毒感染。\n\n08:59.752 --> 09:05.002\n就是一般小朋友在6个月以内是由母体带来的抗体，\n\n09:05.101 --> 09:10.502\n那发病就是感染细菌还有病毒的机会是比较少的。\n\n09:10.552 --> 09:12.002\n那六个月以后，\n\n09:12.151 --> 09:17.151\n从母体带来的这些抗体全部已经消耗。\n\n09:17.971 --> 09:19.146\n就是已经没有了，\n\n09:19.146 --> 09:22.072\n那么这个时候他们的免疫功能呢，\n\n09:22.072 --> 09:23.721\n还没有完全的成熟。\n\n09:24.616 --> 09:27.616\n所以这个六个月以上的小朋友，\n\n09:27.716 --> 09:28.466\n他就会。\n\n09:29.523 --> 09:30.023\n容易。\n\n09:31.018 --> 09:33.218\n如果抵抗力先天不足啊，\n\n09:33.218 --> 09:34.968\n或者体质比较不好的话，\n\n09:35.067 --> 09:39.817\n就相对来说容易被病毒侵蚀而发生。\n\n09:40.755 --> 09:41.554\n扁桃体炎。\n\n09:45.012 --> 09:50.262\n我们为什么要讲年龄的病原特点呢？\n\n09:50.512 --> 09:55.262\n这就是因为有助于我们临床医生快速的判断病原，\n\n09:55.611 --> 09:58.711\n合理的选择检测与治疗方法，\n\n09:58.961 --> 10:01.661\n提高诊断和治疗的准确性。\n\n10:05.075 --> 10:05.351\n比如说，\n\n10:05.351 --> 10:08.075\n我们对于3岁以下婴幼儿的话，\n\n10:08.375 --> 10:09.575\n以病毒为主，\n\n10:09.575 --> 10:13.776\n那么我们可能要给他测一些病毒的指标。\n\n10:14.325 --> 10:18.875\n那在5岁以到十五岁以上的小朋友呢，\n\n10:18.976 --> 10:22.825\n那我们要做血常规啊。\n\n10:22.825 --> 10:23.151\n当然，\n\n10:23.151 --> 10:24.825\n那个婴幼儿也要做血常规。\n\n10:24.976 --> 10:28.426\n我们还要完善一些细菌的那个。\n\n10:29.570 --> 10:31.094\n细菌培培养啊，\n\n10:31.094 --> 10:34.020\n这些来明确一下是不是病原菌。\n\n10:35.534 --> 10:38.085\n然后获得更好的治疗方案。\n\n10:40.051 --> 10:43.200\n提高诊断和治疗的准确性。\n\n10:45.754 --> 10:48.854\n第三个我们来讲一下症状速查表。\n\n10:49.304 --> 10:50.554\n这个大家应该。\n\n10:51.757 --> 10:53.057\n比较更感兴趣。\n\n11:03.742 --> 11:09.242\n其实扁桃体炎最最突出的信号就是我喉咙痛了，\n\n11:09.242 --> 11:09.992\n就这里痛。\n\n11:10.692 --> 11:15.041\n剧烈的咽痛是急性扁桃体炎的。\n\n11:16.335 --> 11:17.935\n典型的局部症状，\n\n11:18.335 --> 11:18.986\n当然呢，\n\n11:18.986 --> 11:19.635\n有的时候，\n\n11:19.885 --> 11:20.286\n嗯，\n\n11:20.385 --> 11:21.685\n喉咙干啊。\n\n11:23.015 --> 11:23.616\n还有就是，\n\n11:23.815 --> 11:26.866\n喉咙痛的没有办法咽口水或者吃东西，\n\n11:27.616 --> 11:28.216\n对吧？\n\n11:28.916 --> 11:29.565\n然后，\n\n11:29.666 --> 11:34.216\n这些会严重影响我们的日常生活。\n\n11:37.158 --> 11:37.859\n还有的人呢，\n\n11:37.859 --> 11:40.708\n他就是因为扁桃体已经肿大了。\n\n11:41.208 --> 11:42.158\n肿大了以后呢，\n\n11:42.158 --> 11:43.984\n就等于他门户有一扇门，\n\n11:43.984 --> 11:45.208\n就像卡住了，\n\n11:45.408 --> 11:47.708\n他会出现吞咽困难的情况。\n\n11:48.502 --> 11:50.802\n还有些就是因为太痛了，\n\n11:50.953 --> 11:52.502\n每吞咽一次，\n\n11:52.502 --> 11:56.603\n他就会有剧烈的疼痛而拒绝进食和进水。\n\n12:00.198 --> 12:00.848\n还有的呢，\n\n12:01.049 --> 12:02.948\n就会出现口臭啊，\n\n12:03.398 --> 12:04.999\n言语含糊的症状。\n\n12:05.348 --> 12:07.098\n因为它扁桃体，\n\n12:07.549 --> 12:09.249\n它就在口腔，\n\n12:09.348 --> 12:09.698\n嗯，\n\n12:09.698 --> 12:11.174\n就在喉，\n\n12:11.174 --> 12:12.198\n就是咽喉部。\n\n12:12.749 --> 12:14.049\n它对整个，\n\n12:14.049 --> 12:16.299\n它如果有炎症有感染的话，\n\n12:16.299 --> 12:20.348\n它会导致我们整个嘴巴就是口腔内环境的改变，\n\n12:20.598 --> 12:22.799\n影响我们正常的语言功能。\n\n12:24.833 --> 12:25.109\n其实，\n\n12:25.109 --> 12:25.434\n嗯。\n\n12:28.229 --> 12:30.903\n扁桃体它你张开嘴巴，\n\n12:30.903 --> 12:36.129\n其实就非常容易查到扁桃体目前的状况是什么样子的。\n\n12:36.880 --> 12:37.781\n我们可以看到。\n\n12:38.926 --> 12:40.426\n他充血肿胀。\n\n12:41.562 --> 12:41.763\n嗯。\n\n12:43.239 --> 12:45.390\n还有的病毒性的扁桃体的话，\n\n12:45.440 --> 12:48.340\n可以表现有滤泡的增生。\n\n12:49.494 --> 12:50.395\n细菌性的。\n\n12:51.989 --> 12:52.890\n扁桃体炎的话，\n\n12:52.890 --> 12:55.039\n还可以见到黄白的脓胎，\n\n12:55.789 --> 12:57.315\n还可以有的时候就疼痛。\n\n12:57.315 --> 13:00.190\n它会放射到这边耳部、耳根部这里。\n\n13:01.747 --> 13:03.122\n然后你查体还可以看到，\n\n13:03.122 --> 13:06.546\n有的甚至在上面可以看到白色的脓点这些。\n\n13:19.117 --> 13:19.267\n嗯，\n\n13:19.267 --> 13:20.916\n你不要看就是扁桃体，\n\n13:20.916 --> 13:23.166\n它是在这里咽喉部位，\n\n13:23.367 --> 13:28.716\n就是它其实对于全身的反应也是非常敏感的，\n\n13:29.317 --> 13:30.067\n比如说。\n\n13:31.760 --> 13:33.710\n我们病毒型的全身反应。\n\n13:35.067 --> 13:38.768\n很多患者表现为低到中度的发热，\n\n13:39.168 --> 13:43.317\n还会伴有咳嗽啊、鼻塞这些症状。\n\n13:44.710 --> 13:46.909\n全身反应相对比较轻一点。\n\n13:47.755 --> 13:50.205\n那细菌性的扁桃体炎。\n\n13:51.202 --> 13:51.452\n他。\n\n13:52.359 --> 13:54.210\n这个细菌还是非常厉害的，\n\n13:54.859 --> 13:57.760\n它常常会出现高热、寒颤。\n\n13:58.109 --> 13:58.885\n体温呢，\n\n13:58.885 --> 14:00.210\n有可能达到40°，\n\n14:00.409 --> 14:02.409\n有的小朋友可能达到41°，\n\n14:02.809 --> 14:04.909\n还有头痛啊，\n\n14:05.409 --> 14:06.460\n人没有力气，\n\n14:07.059 --> 14:08.460\n食欲也不好了。\n\n14:08.809 --> 14:12.034\n然后颌下这些淋巴结肿大的话，\n\n14:12.034 --> 14:13.059\n你会压一压坏。\n\n14:13.778 --> 14:13.927\n嗯，\n\n14:13.927 --> 14:15.228\n压痛非常的明显，\n\n14:15.677 --> 14:16.528\n儿童呢，\n\n14:16.528 --> 14:20.028\n还可能因为拒食而出现脱水。\n\n14:22.963 --> 14:25.414\n那我们通过观察患者的。\n\n14:27.086 --> 14:27.937\n全身反应，\n\n14:28.336 --> 14:31.687\n尤其是看看发热的程度和伴随的症状，\n\n14:31.937 --> 14:35.137\n可以辅助医生初步判断病原体的类型，\n\n14:35.887 --> 14:38.036\n从而制定合理的治疗方案。\n\n14:38.187 --> 14:40.137\n那我们知道就是病毒的话，\n\n14:40.236 --> 14:41.586\n它还是比较轻的，\n\n14:41.687 --> 14:42.736\n细菌的话。\n\n14:43.783 --> 14:46.482\n相对来说他全身反应是相对比较重的。\n\n14:46.533 --> 14:47.132\n那么。\n\n14:48.796 --> 14:50.747\n及早的使用抗生素的话。\n\n14:52.229 --> 14:54.879\n对于病情的预后也应该是相对比较好。\n\n14:56.643 --> 14:58.068\n那对于扁桃体炎，\n\n14:58.068 --> 14:59.994\n如果他有非常严重的。\n\n15:01.012 --> 15:02.262\n全身症状的话，\n\n15:02.611 --> 15:06.361\n那非常有赖于我们的精准诊断。\n\n15:07.869 --> 15:09.919\n那我们怎么来进行诊断呢？\n\n15:10.841 --> 15:11.591\n我们有个。\n\n15:13.395 --> 15:14.895\n四步诊断流程。\n\n15:19.101 --> 15:19.476\n第一步，\n\n15:19.476 --> 15:22.750\n当然非常重要的就是病史的询问。\n\n15:23.200 --> 15:25.750\n我们要详细的询问患者的病史，\n\n15:26.151 --> 15:31.250\n包括他发病之前有什么病史，\n\n15:31.700 --> 15:36.401\n然后发病的时间、症状的起始和变化的情况。\n\n15:37.317 --> 15:42.416\n这些都能够帮助我们了解病情发展的过程。\n\n15:47.495 --> 15:48.895\n第二个就是体格检查，\n\n15:49.546 --> 15:51.245\n我们可以通过观察，\n\n15:51.645 --> 15:53.796\n首先是扁桃体炎的外观，\n\n15:54.145 --> 15:55.296\n肿胀程度，\n\n15:55.846 --> 15:57.195\n有没有脓点，\n\n15:57.745 --> 16:00.495\n同时检查颌下淋巴结。\n\n16:01.351 --> 16:02.901\n是否肿胀、压痛。\n\n16:04.831 --> 16:07.031\n为诊断提供重要的线索。\n\n16:11.580 --> 16:14.280\n第三个就是实验室的检测。\n\n16:16.025 --> 16:22.224\n快速的抗原检测可以在10分钟内筛查出A组链球菌。\n\n16:23.090 --> 16:25.739\n那我们之前说了A组链球菌。\n\n16:26.997 --> 16:27.596\n有的，\n\n16:27.646 --> 16:32.096\n他就会发生慢性急性的肾衰，\n\n16:32.796 --> 16:35.122\n而导致慢性的肾功能不全。\n\n16:35.122 --> 16:37.896\n这个临床上我们也是有见过的。\n\n16:38.473 --> 16:39.523\n那其他的话，\n\n16:40.023 --> 16:42.874\n正最重要的就是血常规的检查，\n\n16:43.273 --> 16:47.773\n其中中性粒细胞与C反应蛋C反应蛋白升高，\n\n16:48.023 --> 16:49.624\n提示细菌感染。\n\n16:50.374 --> 16:53.073\n血培养虽然是精标准，\n\n16:53.273 --> 16:55.698\n但它的是需要的时间比较久，\n\n16:55.698 --> 16:56.773\n因为大家知道，\n\n16:56.773 --> 16:57.523\n培养的话，\n\n16:57.523 --> 17:00.973\n基本是要在48小时之内才有培养结果。\n\n17:01.872 --> 17:07.572\n所以要等到细菌培养出来结果再来用药的话，\n\n17:07.722 --> 17:11.222\n那可能有时间为时已晚。\n\n17:20.982 --> 17:21.982\n那扁桃体炎呢，\n\n17:21.982 --> 17:24.932\n我们还需要进行一些鉴别的诊断。\n\n17:25.760 --> 17:29.311\n目前需要诊鉴别诊断的疾病呢，\n\n17:29.561 --> 17:34.811\n就是需要与第一个传染性单核细胞增多症。\n\n17:35.619 --> 17:38.369\n猩红热烦上咽峡炎。\n\n17:39.843 --> 17:45.093\n白喉以及白血病咽部表现进行鉴别诊断。\n\n17:47.233 --> 17:47.782\n那其实。\n\n17:49.704 --> 17:50.604\n这个鉴别诊断。\n\n17:51.811 --> 18:01.399\n差异包括皮疹啊、甲膜啊、肝脾淋巴结特征以及血象异型淋巴比例等。\n\n18:01.399 --> 18:06.411\n我们可以通过这些的特征可以有效区分不同的疾病。\n\n18:11.116 --> 18:14.266\n讲完了我们的诊断以后呢，\n\n18:14.616 --> 18:20.516\n那我们如果判断它是一个淋巴急性扁桃体炎，\n\n18:20.516 --> 18:22.266\n那我们要开始给他治疗。\n\n18:22.916 --> 18:23.616\n第五个，\n\n18:23.616 --> 18:25.766\n我们就来说一下治疗的策略。\n\n18:31.592 --> 18:32.541\n在治疗中，\n\n18:32.942 --> 18:35.741\n对症支持治疗是基础。\n\n18:36.751 --> 18:37.401\n也就是说，\n\n18:37.852 --> 18:42.702\n因为病扁桃体炎很多是病毒感染，\n\n18:42.901 --> 18:45.302\n那它就是有自愈的可能。\n\n18:45.602 --> 18:46.352\n那这些，\n\n18:46.352 --> 18:47.577\n那这个方面的话，\n\n18:47.577 --> 18:49.401\n我们只要对症治疗，\n\n18:49.552 --> 18:52.602\n比如说他需要充分的休息，\n\n18:52.901 --> 18:54.702\n避免过度的劳累，\n\n18:55.102 --> 18:57.702\n帮助身体恢复免疫力，\n\n18:57.901 --> 19:01.452\n那它就能很好的对抗病原体了。\n\n19:03.067 --> 19:04.817\n第二个是引申调整。\n\n19:07.055 --> 19:07.354\n我们。\n\n19:08.807 --> 19:09.483\n建议患者，\n\n19:09.483 --> 19:12.057\n因为他吞咽的时候会有疼痛啊，\n\n19:12.057 --> 19:13.208\n这样吞咽困难。\n\n19:15.314 --> 19:17.864\n我们建议患者多饮软食。\n\n19:19.088 --> 19:19.639\n避免呢，\n\n19:19.688 --> 19:21.038\n刺激性的食物。\n\n19:22.322 --> 19:23.572\n减轻咽部不适，\n\n19:23.871 --> 19:24.521\n同时呢，\n\n19:24.521 --> 19:25.871\n保证营养的摄入。\n\n19:26.222 --> 19:28.871\n那只为因为只有有足够的营养，\n\n19:29.072 --> 19:33.371\n它的营养才能对来对抗这些病毒和细菌，\n\n19:33.621 --> 19:35.722\n然后促进我们身体的健康。\n\n19:36.555 --> 19:37.255\n第三个呢，\n\n19:37.255 --> 19:38.755\n就是退热镇痛。\n\n19:40.937 --> 19:45.036\n使用对乙酰氨基酚或者布洛芬等药物进行退热镇痛，\n\n19:45.437 --> 19:47.237\n缓解患者的不适症状，\n\n19:47.386 --> 19:49.136\n提高他的生活质量。\n\n19:51.145 --> 19:53.594\n我们扁桃体炎还可以，\n\n19:53.994 --> 19:55.895\n它因为就是在口腔之内。\n\n19:55.895 --> 19:57.869\n口腔里面啊，\n\n19:57.869 --> 19:59.994\n可以进行局部的护理。\n\n20:00.094 --> 20:04.545\n比如说漱口含片可以缓解咽部的不适。\n\n20:04.694 --> 20:07.795\n还有我们要保持我们口腔的清洁，\n\n20:08.045 --> 20:10.395\n减少口腔细菌的滋生，\n\n20:10.744 --> 20:14.395\n促进扁桃体炎的炎症的消退。\n\n20:23.253 --> 20:24.052\n扁桃体炎呢，\n\n20:24.253 --> 20:26.103\n那如果是细菌性的，\n\n20:26.103 --> 20:28.552\n那我们首选是抗生素。\n\n20:30.589 --> 20:33.939\n对确诊为A组链球菌感染后，\n\n20:34.089 --> 20:37.189\n我们首选是青霉素类进行口服治疗。\n\n20:37.847 --> 20:38.847\n疗程为10天，\n\n20:39.597 --> 20:40.521\n青霉素呢，\n\n20:40.521 --> 20:45.296\n也就是我们大家常常知道最最常见的阿莫西林这些。\n\n20:46.000 --> 20:51.400\n足量足疗程用药可以有效防止并发症的发生。\n\n20:51.400 --> 20:52.800\n发生那么，\n\n20:52.800 --> 20:55.849\n我们不要说我们用了两天其实还没特别好，\n\n20:56.150 --> 20:57.925\n病毒细菌还没被杀灭，\n\n20:57.925 --> 20:59.150\n但是你就停药了，\n\n20:59.150 --> 21:02.099\n那有可能产生细菌的耐药性。\n\n21:02.349 --> 21:04.699\n所以我们一般使用抗生素，\n\n21:04.849 --> 21:08.650\n我们都是要足量足疗程的用药。\n\n21:11.386 --> 21:12.487\n然后是过敏。\n\n21:13.566 --> 21:14.265\n替代方案，\n\n21:14.715 --> 21:17.666\n如果对于青霉素过敏，\n\n21:18.015 --> 21:21.865\n那我们可以选择用头孢类或者大环内酯类的药物。\n\n21:22.762 --> 21:24.713\n但需要评估耐药的情况，\n\n21:24.912 --> 21:26.762\n确保治疗的有效性。\n\n21:30.338 --> 21:32.288\n还有病毒感染的处理，\n\n21:32.538 --> 21:34.489\n对于病毒性的扁桃体炎，\n\n21:34.588 --> 21:37.088\n使用抗生素是无效的，\n\n21:37.139 --> 21:39.239\n但是可能增加耐药的风险，\n\n21:39.538 --> 21:42.588\n因此我们就避免滥用抗生素。\n\n21:43.302 --> 21:47.251\n以上就是和大家分享了扁桃体炎的诊断。\n\n21:48.219 --> 21:48.619\n治疗。\n\n21:49.779 --> 21:50.428\n谢谢大家。\n\n","v0347cg10004d70hi4aljht5i96ng70g",1314,1078,"2026-01-26 11:18:47"," \"高效会议管理技巧 - meeting_01.mp4 内容解析\"  "," \"会议管理,高效会议技巧,团队协作,会议记录,meeting_01.mp4,商务会议,时间管理\"  "," \"通过meeting_01.mp4学习如何高效组织和管理会议，提升团队协作效率。视频涵盖会议准备、议程设定、时间控制及跟进执行等实用技巧，适合职场人士和团队领导者参考。\"","2026-06-10 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