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--> 00:04.606\n嗯，\n\n00:04.606 --> 00:05.331\n大家好。\n\n00:05.432 --> 00:05.831\n嗯，\n\n00:05.831 --> 00:09.031\n今天我们分享的科普主题是，\n\n00:09.281 --> 00:09.632\n嗯，\n\n00:09.632 --> 00:10.432\n真菌性，\n\n00:10.632 --> 00:10.982\n嗯，\n\n00:10.982 --> 00:11.682\n鼻窦炎。\n\n00:18.114 --> 00:18.165\n嗯，\n\n00:18.165 --> 00:22.315\n我们先我们从这以下七个方面来认识这个疾病，\n\n00:22.565 --> 00:25.590\n疾病认识、临床表现，\n\n00:25.590 --> 00:28.014\n诊断与鉴别诊断，\n\n00:28.215 --> 00:30.415\n以以及它的这个治疗与预防。\n\n00:35.504 --> 00:35.629\n嗯，\n\n00:35.629 --> 00:36.828\n真菌性鼻窦炎呢，\n\n00:36.828 --> 00:40.754\n它是由真菌引起的一个鼻窦粘膜的炎症。\n\n00:41.054 --> 00:42.078\n它的症状呢，\n\n00:42.078 --> 00:44.403\n较细菌性鼻窦炎更为顽固。\n\n00:45.703 --> 00:48.179\n那么根据它的病因和临床表现，\n\n00:48.179 --> 00:54.453\n真菌性鼻窦炎可以分为侵袭性真菌性鼻窦炎和非侵袭性真菌性鼻窦炎。\n\n00:58.860 --> 00:59.659\n它的发病机制，\n\n01:00.060 --> 01:01.610\n那么真菌的话，\n\n01:01.610 --> 01:07.410\n它喜好在温暖湿润、缺氧的环境中生长迅速。\n\n01:08.197 --> 01:08.373\n嗯，\n\n01:08.373 --> 01:10.222\n鼻窦内的环境呢，\n\n01:10.222 --> 01:12.148\n它就比较适宜真菌的生长。\n\n01:13.785 --> 01:13.885\n那么，\n\n01:13.885 --> 01:14.809\n真菌感染呢，\n\n01:14.809 --> 01:19.385\n会引起鼻窦粘膜的炎症水肿，\n\n01:19.735 --> 01:23.834\n严重时可能会导致组织的坏死和真菌的侵袭。\n\n01:24.999 --> 01:25.098\n那么，\n\n01:25.098 --> 01:29.549\n它常常是通过吸入含有真菌孢子的空气，\n\n01:29.749 --> 01:32.598\n或者通过接触感染源而感染的。\n\n01:32.899 --> 01:33.448\n那么，\n\n01:33.448 --> 01:35.448\n免疫力功能低下的人群，\n\n01:35.549 --> 01:37.149\n他更易感染真菌，\n\n01:37.499 --> 01:40.448\n导致鼻窦炎的发生和加重。\n\n01:44.150 --> 01:44.900\n的临床表现。\n\n01:45.778 --> 01:47.228\n那么常见的症状啊，\n\n01:47.228 --> 01:48.478\n真菌性鼻窦炎，\n\n01:48.528 --> 01:55.028\n它常见的症状包括鼻塞、流涕、嗅觉减退等等，\n\n01:55.278 --> 01:57.378\n与一般的鼻窦炎症状相似，\n\n01:57.679 --> 01:59.378\n但是持续的时间更长。\n\n02:00.245 --> 02:05.995\n患者可能会出现发热、头痛、面部疼痛等伴随症状，\n\n02:06.294 --> 02:11.345\n严重者还会出现乏力、体重减轻等全身症状。\n\n02:13.317 --> 02:17.117\n那么它体征表现为鼻粘膜的充血、肿胀，\n\n02:17.417 --> 02:19.167\n鼻腔内分泌物增多。\n\n02:19.367 --> 02:21.518\n有时可以看到真菌菌丝。\n\n02:24.152 --> 02:25.052\n影像学的检查，\n\n02:25.352 --> 02:29.953\n通过CT检查可以看到鼻窦内密度增高影，\n\n02:30.302 --> 02:30.652\n嗯，\n\n02:30.652 --> 02:31.602\n窦壁增厚，\n\n02:32.052 --> 02:35.003\n有时可见真菌球或，\n\n02:35.003 --> 02:36.703\n洞内的气体影。\n\n02:38.255 --> 02:41.356\n磁共振的检查对软组织分辨率更高，\n\n02:41.755 --> 02:43.906\n可见鼻窦内异常信号，\n\n02:44.356 --> 02:47.606\n有助于鉴别真菌性鼻窦炎与其他疾病。\n\n02:48.479 --> 02:51.078\n内窥镜检查可以直接观察，\n\n02:51.328 --> 02:51.679\n嗯，\n\n02:51.679 --> 02:52.979\n鼻窦内部情况。\n\n02:53.757 --> 02:56.156\n活检可确诊真菌的种类，\n\n02:56.606 --> 02:58.957\n那么为治疗提供依据。\n\n03:08.182 --> 03:08.281\n嗯，\n\n03:08.281 --> 03:09.882\n它的诊断与鉴别诊断。\n\n03:10.860 --> 03:11.035\n那么，\n\n03:11.035 --> 03:16.710\n它一个临床的诊断主要是依据病史、症状和体征。\n\n03:17.160 --> 03:18.311\n实验室的检查，\n\n03:18.311 --> 03:21.811\n包括真菌培养、血清学检测等等。\n\n03:22.311 --> 03:23.386\n病理检查呢，\n\n03:23.386 --> 03:26.811\n可以发现真菌的菌丝和特征性的病理改变。\n\n03:29.957 --> 03:32.057\n需要与其他的鼻窦炎鉴别，\n\n03:32.158 --> 03:34.957\n与细菌性或者病毒性鼻窦炎相区分。\n\n03:35.891 --> 03:37.942\n还应该排除鼻窦肿瘤的可能性，\n\n03:38.091 --> 03:40.091\n特别是侵袭性的真菌感染。\n\n03:40.945 --> 03:44.945\n还需要与过敏性疾病、免疫系统疾病等鉴别。\n\n03:48.994 --> 03:49.244\n那么，\n\n03:49.244 --> 03:50.494\n真菌性鼻窦炎。\n\n03:51.673 --> 03:55.022\n它根据它病原的真菌类型以及病情，\n\n03:55.173 --> 03:57.723\n它分为侵袭性和非侵袭性两类。\n\n04:02.820 --> 04:03.119\n那么，\n\n04:03.419 --> 04:05.195\n真菌感染之后呢，\n\n04:05.195 --> 04:11.294\n它的病理表现就是粘膜炎症、肉芽肿形成和真菌侵袭，\n\n04:11.294 --> 04:13.320\n温暖环境和免疫力下降，\n\n04:13.470 --> 04:15.220\n有利于真菌的生长。\n\n04:15.869 --> 04:16.519\n那么，\n\n04:16.670 --> 04:20.269\n免疫功能低下者更易感染真菌性鼻窦炎。\n\n04:20.994 --> 04:21.195\n嗯，\n\n04:21.295 --> 04:24.994\n它往往通过呼吸道吸入或者局部侵犯引起感染。\n\n04:28.716 --> 04:28.790\n嗯，\n\n04:28.790 --> 04:29.466\n鼻塞呀，\n\n04:29.716 --> 04:30.566\n脓涕呀，\n\n04:30.566 --> 04:33.066\n头痛和面部疼痛是常见症状。\n\n04:33.891 --> 04:37.342\n而且可伴随嗅觉减退、发热和全身不适。\n\n04:38.312 --> 04:38.537\n嗯，\n\n04:38.537 --> 04:41.412\n查体你会发现他的鼻腔粘膜充血肿胀，\n\n04:41.613 --> 04:43.812\n中鼻道内有脓性的分泌物。\n\n04:45.873 --> 04:46.674\n影像学检查，\n\n04:46.873 --> 04:50.123\n内窥镜可以直观的观察到，\n\n04:50.123 --> 04:50.498\n嗯，\n\n04:50.498 --> 04:52.523\n那个鼻腔鼻窦内的病变，\n\n04:52.873 --> 04:54.123\n那么磁共振呢？\n\n04:55.162 --> 04:55.763\n磁共振，\n\n04:55.763 --> 04:57.963\n它是对软组织显示更清晰，\n\n04:58.162 --> 05:00.162\n有助于鉴别诊断。\n\n05:00.162 --> 05:00.562\nCT呢，\n\n05:00.562 --> 05:03.713\n会显示鼻窦有密度增高影，\n\n05:03.713 --> 05:05.412\n粘膜增厚和骨质破坏。\n\n05:10.122 --> 05:10.872\n实验室检查，\n\n05:11.022 --> 05:15.272\n那么通过组织病理学检查可以见到真菌菌丝和孢子。\n\n05:17.675 --> 05:19.126\n那么再根据他的症状啊，\n\n05:19.126 --> 05:21.876\n体征和影像学检查进行一个初步的诊断。\n\n05:22.276 --> 05:26.325\n那么最终是通过这个什么真菌培养和病理检查来确诊的。\n\n05:29.342 --> 05:32.342\n需要与细菌性鼻窦炎、病毒性鼻窦炎鉴别。\n\n05:32.592 --> 05:34.691\n需要与鼻腔鼻窦肿瘤鉴别，\n\n05:34.691 --> 05:35.492\n以防误诊。\n\n05:35.742 --> 05:37.992\n需要与过敏性鼻炎等疾病鉴别。\n\n05:41.277 --> 05:41.351\n嗯，\n\n05:41.351 --> 05:42.226\n他治疗的话，\n\n05:42.377 --> 05:44.527\n主要是使用抗真菌的药物，\n\n05:44.527 --> 05:47.726\n口服或者鼻用抗炎药物缓解症状，\n\n05:48.076 --> 05:49.802\n手术清除病变组织，\n\n05:49.802 --> 05:51.877\n改善鼻窦的通气和引流。\n\n05:52.226 --> 05:52.677\n那么，\n\n05:52.677 --> 05:53.277\n物理治疗，\n\n05:53.277 --> 05:54.476\n例如鼻腔冲洗，\n\n05:54.677 --> 05:56.476\n免疫治疗提高免疫力。\n\n05:56.627 --> 05:57.027\n那么，\n\n05:57.027 --> 05:58.851\n药物治疗与手术治疗相结合，\n\n05:58.851 --> 06:00.277\n个体化的一个治疗。\n\n06:01.158 --> 06:03.709\n那么要保持保持一个良好的生活习惯，\n\n06:03.959 --> 06:05.859\n避免过度的劳累和受凉，\n\n06:06.209 --> 06:07.308\n那么增强体质，\n\n06:07.308 --> 06:08.234\n提高免疫力，\n\n06:08.234 --> 06:09.158\n预防感染，\n\n06:09.408 --> 06:11.109\n保持室内空气流通，\n\n06:11.259 --> 06:13.459\n避免接触过敏源和污染物，\n\n06:13.759 --> 06:16.209\n还要定期进行一个鼻部的检查，\n\n06:16.209 --> 06:17.959\n及时治疗一个鼻部的疾病。\n\n06:20.794 --> 06:22.618\n那么通过今天这个以上科普，\n\n06:22.618 --> 06:27.343\n我们大致对这个真菌性鼻窦炎有了一个初步的一个认识。\n\n06:29.061 --> 06:29.186\n那么，\n\n06:29.186 --> 06:30.760\n我再详细的补充一些内容。\n\n06:31.110 --> 06:31.510\n嗯，\n\n06:31.860 --> 06:35.061\n那么就是真菌性鼻窦炎，\n\n06:35.061 --> 06:37.260\n就是它与这个细菌性鼻窦炎，\n\n06:37.411 --> 06:37.811\n嗯，\n\n06:38.360 --> 06:40.485\n在这个病因呀，\n\n06:40.485 --> 06:41.210\n症状啊，\n\n06:41.210 --> 06:43.485\n严重程度和治疗方法上，\n\n06:43.485 --> 06:45.960\n都是有着这个显著的差异的。\n\n06:47.032 --> 06:47.808\n因为这个真菌呢，\n\n06:47.808 --> 06:49.882\n它在我们环境中是无处不在的。\n\n06:49.933 --> 06:50.282\n嗯，\n\n06:50.282 --> 06:51.882\n比如空气呀、土壤呀，\n\n06:51.983 --> 06:52.282\n嗯，\n\n06:52.282 --> 06:55.933\n它通常会会就是那些免疫力低下的人群，\n\n06:56.132 --> 06:58.632\n或者有一些特定的解剖结构异常，\n\n06:58.882 --> 07:00.483\n比如说像鼻息肉啊，\n\n07:00.483 --> 07:01.483\n窦口堵塞啊，\n\n07:01.532 --> 07:04.733\n或者一些长期使用了抗生素激素这类人群，\n\n07:04.933 --> 07:08.483\n真菌就很容易趁虚而入，\n\n07:08.532 --> 07:10.583\n那么在鼻窦内定植和生长。\n\n07:12.003 --> 07:14.454\n前面提到它分为侵袭性和非侵袭性。\n\n07:14.854 --> 07:15.303\n那么，\n\n07:15.303 --> 07:16.503\n什么什么是非侵袭性？\n\n07:16.503 --> 07:17.278\n非侵袭性，\n\n07:17.278 --> 07:18.053\n它就是真菌，\n\n07:18.053 --> 07:21.354\n仅限在鼻窦、鼻窦、鼻鼻腔内生长，\n\n07:21.503 --> 07:23.454\n它不侵犯粘膜组织。\n\n07:23.704 --> 07:24.104\n那么，\n\n07:24.104 --> 07:26.653\n此类型多见于免疫功能正常的人群，\n\n07:27.403 --> 07:27.803\n嗯。\n\n07:28.819 --> 07:31.468\n真菌球就是我们说的真菌孢子，\n\n07:31.769 --> 07:33.718\n它最常位于这个上颌窦内，\n\n07:34.069 --> 07:34.769\n聚集呀，\n\n07:34.769 --> 07:35.444\n缠绕啊，\n\n07:35.444 --> 07:36.769\n它会形成一个团块状，\n\n07:36.769 --> 07:37.718\n所以我们叫真菌球。\n\n07:38.118 --> 07:39.468\n它一般不侵犯骨质，\n\n07:39.919 --> 07:41.269\n患者更多的症状呢，\n\n07:41.269 --> 07:43.069\n它是单侧的一个。\n\n07:44.018 --> 07:45.018\n鼻塞，\n\n07:45.018 --> 07:45.643\n流脓涕，\n\n07:45.643 --> 07:46.917\n有恶臭，\n\n07:46.917 --> 07:48.717\n面部的压痛或者有疼痛感，\n\n07:48.768 --> 07:50.167\n通常为单侧的啊，\n\n07:50.268 --> 07:54.368\n而且可能会伴有鼻涕带血或者回吸痰中带血。\n\n07:55.533 --> 07:58.334\n那么预后通常良好的通过手术清除即可。\n\n07:59.825 --> 08:00.026\n嗯，\n\n08:00.476 --> 08:02.776\n关于这个变异性真菌性鼻窦炎，\n\n08:02.876 --> 08:09.925\n就是患者对环境当中的这些真菌产生了一个强烈的一个过敏反应。\n\n08:10.075 --> 08:13.526\n它主要是一个IGE介导的一个一型的超敏反应，\n\n08:13.575 --> 08:15.401\n它并非真正的组织感染，\n\n08:15.401 --> 08:16.876\n而是一种过敏性的炎症。\n\n08:17.541 --> 08:20.592\n那么患者会出现一个顽固的复发的一个鼻塞流涕，\n\n08:20.791 --> 08:22.242\n而且常伴有鼻息肉，\n\n08:22.391 --> 08:24.291\n严重时可以导致面部的畸形，\n\n08:24.342 --> 08:26.092\n比如说眼眶间距增宽，\n\n08:26.291 --> 08:28.816\n那么多见于年轻的有过敏史，\n\n08:28.816 --> 08:29.891\n比如哮喘的患者，\n\n08:30.092 --> 08:31.191\n他很容易复发。\n\n08:31.641 --> 08:35.492\n那么需要一个综合的一个治疗。\n\n08:41.362 --> 08:41.562\n嗯，\n\n08:41.963 --> 08:44.413\n关于这个侵袭性的真菌性鼻窦炎啊。\n\n08:45.133 --> 08:45.583\n那么，\n\n08:45.583 --> 08:45.934\n嗯，\n\n08:46.333 --> 08:47.059\n真菌呢，\n\n08:47.059 --> 08:50.484\n它侵犯并且破坏了这个，\n\n08:50.734 --> 08:53.383\n鼻窦的粘膜、血管甚至骨质。\n\n08:53.783 --> 08:54.184\n嗯，\n\n08:54.184 --> 08:55.008\n这个类型呢，\n\n08:55.008 --> 08:56.984\n它比较少见。\n\n08:57.781 --> 08:59.132\n但是是非常的危险。\n\n09:00.336 --> 09:00.411\n嗯，\n\n09:00.411 --> 09:04.036\n它主要见于免疫功能严重受损的患者。\n\n09:04.757 --> 09:04.932\n嗯，\n\n09:04.932 --> 09:06.958\n比如说未控制的糖尿病啊，\n\n09:07.158 --> 09:08.458\n艾滋病，\n\n09:08.458 --> 09:09.482\n器官移植后啊，\n\n09:09.482 --> 09:10.908\n或者长期使用这个，\n\n09:11.007 --> 09:11.408\n嗯。\n\n09:12.500 --> 09:13.250\n免疫抑制剂。\n\n09:17.718 --> 09:18.919\n或者是一些化疗的患者。\n\n09:22.388 --> 09:24.289\n那么急性侵袭性的真菌性鼻窦炎，\n\n09:24.289 --> 09:29.088\n它的病情是进展是比较迅速的。\n\n09:29.770 --> 09:30.969\n它是耳鼻喉科的一个急症，\n\n09:31.219 --> 09:33.570\n那么真菌因为它会迅速的侵犯血管，\n\n09:33.820 --> 09:35.820\n导致一个组织的缺血坏死，\n\n09:35.969 --> 09:37.969\n并且可以向眼眶和颅内扩散。\n\n09:38.864 --> 09:39.963\n那么患者会出现。\n\n09:41.874 --> 09:41.973\n嗯，\n\n09:41.973 --> 09:42.424\n发热，\n\n09:42.523 --> 09:44.749\n面部剧烈的一个那个疼痛，\n\n09:44.749 --> 09:45.174\n肿胀，\n\n09:45.523 --> 09:47.148\n鼻部会出现坏死，\n\n09:47.148 --> 09:48.573\n坏死性黑色结痂，\n\n09:48.973 --> 09:49.874\n视力下降，\n\n09:50.023 --> 09:50.973\n眼球突出，\n\n09:51.073 --> 09:51.973\n活动受限，\n\n09:52.023 --> 09:53.374\n那就眼眶受累了，\n\n09:53.624 --> 09:54.624\n还有头痛啊，\n\n09:54.624 --> 09:55.674\n意识改变呀，\n\n09:56.023 --> 09:56.424\n嗯，\n\n09:56.773 --> 09:58.823\n癫痫就颅内受累了，\n\n09:58.973 --> 10:00.523\n这个毛病的死亡率比较高，\n\n10:00.523 --> 10:03.223\n需要紧急积极的药物和手术治疗。\n\n10:04.320 --> 10:07.369\n对于这个慢性的侵袭性真菌性鼻窦炎呢，\n\n10:08.119 --> 10:10.869\n它的病情进展通常比较缓慢一些。\n\n10:12.263 --> 10:12.664\n嗯，\n\n10:12.713 --> 10:13.789\n比较缓慢一些，\n\n10:13.789 --> 10:15.638\n然后它是病情进展，\n\n10:15.638 --> 10:17.914\n它会超过这个十二周，\n\n10:18.364 --> 10:19.364\n嗯但是呢，\n\n10:19.364 --> 10:21.614\n它仍具有一个组织的侵袭性，\n\n10:21.614 --> 10:25.114\n多见于有轻度免疫功能缺陷的一个患者。\n\n10:25.463 --> 10:26.614\n嗯比如说糖尿病，\n\n10:26.864 --> 10:29.213\n那么它与这个真菌球类似，\n\n10:29.314 --> 10:31.364\n但是这个症状更持久，\n\n10:31.864 --> 10:35.414\n而且影像学检查可能还看到一些什么骨质的一个侵袭。\n\n10:36.585 --> 10:36.909\n预后呢，\n\n10:36.909 --> 10:38.184\n是比急性的要好一些，\n\n10:38.284 --> 10:41.484\n但是仍需要手术和长期的一个抗抗真菌治疗。\n\n10:42.406 --> 10:42.781\n那么，\n\n10:42.781 --> 10:46.906\n我们医生要结合一个多种的方法来确诊。\n\n10:47.205 --> 10:49.356\n一般我们常规的鼻内镜检查，\n\n10:49.406 --> 10:52.556\n我们要观察鼻腔内是否有息肉啊，\n\n10:52.556 --> 10:56.606\n脓性分泌物、坏死组织或者是真菌球。\n\n10:57.642 --> 10:57.992\n那么，\n\n10:57.992 --> 10:59.841\n影像学的检查呢，\n\n10:59.992 --> 11:01.142\n通过CT扫描，\n\n11:01.392 --> 11:03.017\n那么对于侵袭性的话，\n\n11:03.017 --> 11:05.642\n你可以见到它的骨质破坏。\n\n11:06.041 --> 11:06.442\n嗯，\n\n11:06.541 --> 11:11.591\n骨质破坏以及鼻腔外侧壁眼眶获得颅底的软组织浸润。\n\n11:12.679 --> 11:12.830\n那么，\n\n11:12.830 --> 11:13.604\n非侵袭性的话，\n\n11:13.604 --> 11:15.429\n它又常常显示是窦腔混浊，\n\n11:15.729 --> 11:17.679\n其中有不规则的钙化点，\n\n11:17.780 --> 11:19.330\n有真菌球特的特征，\n\n11:19.530 --> 11:22.429\n还有窦壁的骨质可能被压迫吸收或者硬化。\n\n11:22.979 --> 11:23.429\n那么，\n\n11:23.429 --> 11:25.330\n组织病理学的检查是一个金标准。\n\n11:25.679 --> 11:26.130\n那么，\n\n11:26.130 --> 11:27.679\n通过手术获取组织样本，\n\n11:27.880 --> 11:30.929\n在显微镜下看到真菌菌丝侵入组织，\n\n11:31.080 --> 11:32.880\n即可确诊侵袭性的类型。\n\n11:33.874 --> 11:35.323\n那么它要真菌培养，\n\n11:35.424 --> 11:36.299\n真菌培养呢，\n\n11:36.299 --> 11:37.948\n它它确定是它哪种种类，\n\n11:37.948 --> 11:39.073\n比如说是曲霉菌啦，\n\n11:39.073 --> 11:40.023\n还是毛霉菌啦，\n\n11:40.124 --> 11:44.223\n那么它有助于选择一些敏感的抗真菌的药物。\n\n11:45.179 --> 11:45.429\n嗯，\n\n11:45.429 --> 11:48.979\n它的治疗方案是完全取决于这个，\n\n11:49.280 --> 11:50.280\n它的类型。\n\n11:50.630 --> 11:51.979\n比如像真菌球的话，\n\n11:51.979 --> 11:54.604\n那么首选的肯定是我们的face手术。\n\n11:54.604 --> 11:56.655\n通过鼻内镜一个微创的手术，\n\n11:56.655 --> 12:00.030\n彻底的清除这个窦腔内的真菌团块，\n\n12:00.179 --> 12:02.729\n并且扩大窦口以及引流啊，\n\n12:02.729 --> 12:04.880\n通常术后是不需要抗真菌药物的。\n\n12:05.080 --> 12:07.205\n但是对于变异性真菌性鼻窦炎，\n\n12:07.205 --> 12:08.330\n除了我们手术之外，\n\n12:08.530 --> 12:10.830\n那么术后的一个综合治疗也是很关键的，\n\n12:10.929 --> 12:11.280\n嗯，\n\n12:11.280 --> 12:13.830\n包括一个局部的鼻用糖皮质激素呀，\n\n12:13.979 --> 12:14.280\n嗯，\n\n12:14.280 --> 12:15.530\n它要减轻炎症和。\n\n12:15.567 --> 12:16.168\n预防复发，\n\n12:16.418 --> 12:16.742\n嗯，\n\n12:16.742 --> 12:18.367\n还有口服糖皮质激素啊。\n\n12:18.418 --> 12:19.518\n在术后初期，\n\n12:19.668 --> 12:20.718\n短期使用，\n\n12:20.718 --> 12:21.968\n强力控制过敏，\n\n12:21.968 --> 12:27.018\n过敏反应和鼻腔冲洗需要保持一个术腔的一个清洁。\n\n12:30.577 --> 12:30.776\n嗯。\n\n12:34.418 --> 12:36.968\n那么对于侵袭性真菌性鼻窦炎呢，\n\n12:37.067 --> 12:37.442\n嗯，\n\n12:37.442 --> 12:38.367\n紧急处理，\n\n12:38.468 --> 12:38.742\n嗯，\n\n12:38.742 --> 12:39.817\n它需要是住院的。\n\n12:39.867 --> 12:41.992\n那么还有静脉抗真菌药物，\n\n12:41.992 --> 12:43.617\n比如说两性霉素B呀，\n\n12:43.617 --> 12:44.668\n氟利康唑啊，\n\n12:44.668 --> 12:45.518\n疗程比较长。\n\n12:45.867 --> 12:46.317\n那么，\n\n12:46.317 --> 12:50.918\n紧急的清创手术需要广泛的切除所有坏死和受侵犯的组织，\n\n12:51.067 --> 12:52.867\n直至健康出血的组织。\n\n12:53.168 --> 12:53.643\n那么，\n\n12:53.643 --> 12:54.867\n控制它的基础疾病，\n\n12:54.918 --> 12:56.843\n积极纠正免疫缺陷状态，\n\n12:56.843 --> 12:58.067\n比如说控制血糖。\n\n12:59.754 --> 12:59.953\n嗯，\n\n13:00.554 --> 13:02.278\n那么预防和注意事项当中呢，\n\n13:02.278 --> 13:03.304\n我们再进行一些补充，\n\n13:03.854 --> 13:09.453\n就是你要保持一个室内的一个环境的干燥，\n\n13:09.554 --> 13:11.354\n因为真菌它喜欢潮湿，\n\n13:11.604 --> 13:13.453\n所以你需要使用除湿机呀，\n\n13:13.453 --> 13:14.604\n保持家居通风。\n\n13:14.854 --> 13:16.804\n那么还要注意鼻腔的一个卫生，\n\n13:16.953 --> 13:20.254\n可以用生理盐水进行一个鼻腔的冲洗，\n\n13:20.653 --> 13:22.604\n那么均衡的饮食啊，\n\n13:22.754 --> 13:23.604\n规律作息，\n\n13:23.854 --> 13:25.304\n那么适度的一个锻炼，\n\n13:25.653 --> 13:29.554\n特别是糖尿病患者需要严格控制血糖至关重要。\n\n13:30.153 --> 13:30.353\n那么，\n\n13:30.353 --> 13:31.453\n还有及早的就医。\n\n13:31.603 --> 13:35.353\n如果出现了一个单侧顽固的鼻部症状，\n\n13:35.453 --> 13:36.502\n尤其是鼻涕，\n\n13:36.603 --> 13:37.927\n或者是有恶臭啊，\n\n13:37.927 --> 13:38.752\n或者带血啊，\n\n13:38.752 --> 13:40.453\n应该及时到耳鼻喉科就诊。\n\n13:43.580 --> 13:43.880\n所以，\n\n13:43.931 --> 13:44.330\n嗯。\n\n13:46.153 --> 13:50.004\n今天今天就是我们就是这个对这个真菌性鼻窦炎呢，\n\n13:50.054 --> 13:52.304\n进行了一个全面的详细的一个解释。\n\n13:52.304 --> 13:53.604\n解析，\n\n13:53.703 --> 13:54.278\n内容呢，\n\n13:54.278 --> 13:56.254\n涵盖了一个它的类型，\n\n13:56.304 --> 13:58.304\n嗯症状诊断啊，\n\n13:58.304 --> 14:00.403\n治疗以及预防，\n\n14:00.554 --> 14:05.104\n希望能够帮助大家更好的去理解这个疾病。\n\n14:27.512 --> 14:28.161\n嗯，\n\n14:28.461 --> 14:31.411\n需要然后就是通过今天的这次科普呢，\n\n14:31.461 --> 14:31.861\n嗯，\n\n14:31.861 --> 14:33.187\n我们认识了这个疾病，\n\n14:33.187 --> 14:40.262\n然后就是我们这个医生在平常的临床工作当中需要需要更好的去认识，\n\n14:40.411 --> 14:40.762\n嗯，\n\n14:40.762 --> 14:42.512\n并且明确诊断。\n\n14:42.611 --> 14:43.012\n嗯，\n\n14:43.312 --> 14:44.661\n这个类型的鼻窦炎。\n\n14:44.812 --> 14:45.187\n嗯，\n\n14:45.187 --> 14:51.062\n因为我我们门诊大多数可能遇到的是一些急性或者慢性的鼻窦炎，\n\n14:51.262 --> 14:54.062\n或者单纯的一些鼻息肉患者会居多一些，\n\n14:54.262 --> 14:55.812\n还有一些过敏性的疾病。\n\n14:56.211 --> 14:57.711\n过敏性鼻炎那。\n\n14:57.760 --> 14:57.909\n那么，\n\n14:57.909 --> 15:03.260\n我们需要更好的来甄甄别出哪种类型它是属于真菌性的鼻窦炎，\n\n15:03.409 --> 15:03.809\n嗯，\n\n15:03.960 --> 15:07.109\n那么这样的话才能对症治疗。\n\n","v0d47cg10004d70h8filjht781gf6g30",927,540,"2026-01-26 11:20:17","高效会议速记技巧与实用方法 - meeting_quick_record指南  ","会议记录,高效会议,速记技巧,会议纪要,职场效率,meeting_quick_record,时间管理  ","通过meeting_quick_record.mp4学习快速会议记录的核心方法，掌握高效整理会议重点、行动项的实用技巧，提升职场沟通与工作效率。适合商务人士、团队领导及行政人员。","2026-04-25 20:00:00",[37],{"menuId":38,"menuName":39,"parentId":17,"orderNum":40,"path":41,"component":42,"isFrame":43,"isCache":44,"menuType":45,"visible":26,"status":17,"createDept":6,"remark":24,"createTime":46,"children":47,"columnImage":48,"columnLogo":49,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"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 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