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--> 00:01.763\n大家好，\n\n00:01.763 --> 00:06.337\n今天我们所分享的是这个病毒性肺炎的一个简单的一个。\n\n00:07.304 --> 00:07.804\n课件，\n\n00:07.804 --> 00:11.404\n那我们我们先了解一下什么是病毒性肺炎。\n\n00:11.604 --> 00:12.680\n病毒性肺炎啊，\n\n00:12.680 --> 00:13.979\n在我们的流行病学，\n\n00:13.979 --> 00:18.155\n他说病毒是肺炎的重要原因之一，\n\n00:18.354 --> 00:21.155\n约占社区获得性肺炎的8%。\n\n00:21.555 --> 00:25.004\n但目前对病毒性肺炎仍缺乏足够的认识。\n\n00:25.354 --> 00:26.454\n2023年呢，\n\n00:26.454 --> 00:27.454\n流行的SARS，\n\n00:27.655 --> 00:30.204\n我们高致病性的禽流感，\n\n00:30.454 --> 00:33.854\n还有202292009年的甲型流感，\n\n00:33.904 --> 00:35.455\n还有2013年的禽流感，\n\n00:35.455 --> 00:37.654\n都是我们这个病毒性。\n\n00:37.749 --> 00:39.598\n肺炎的分支。\n\n00:41.058 --> 00:43.159\n那么病毒性肺炎的概念我们看一下，\n\n00:43.208 --> 00:44.133\n病毒性肺炎呢，\n\n00:44.133 --> 00:48.558\n是由上呼吸道病毒感染向下蔓延所致的肺部炎症。\n\n00:48.708 --> 00:49.859\n可发生于。\n\n00:50.777 --> 00:55.627\n但免疫功能正常或者抑制的儿童和成人，\n\n00:55.627 --> 01:00.478\n大多发生的于冬春季节可爆发或散发流行。\n\n01:00.877 --> 01:04.527\n密切接触的人群或有心肺疾病者容易被传染。\n\n01:04.627 --> 01:10.402\n婴幼儿、老人、妊娠妇女或者原有慢性心肺疾病者病情较重，\n\n01:10.402 --> 01:12.578\n甚至可能会导致死亡。\n\n01:14.710 --> 01:14.861\n那么，\n\n01:14.861 --> 01:16.286\n病因和发病机制呢，\n\n01:16.286 --> 01:17.511\n我们也可以了解一下。\n\n01:17.661 --> 01:18.310\n首先，\n\n01:18.310 --> 01:28.161\n成人感染常见为甲乙型流感病毒、腺病毒、副流感病毒、呼吸道合胞病毒和巨细胞病毒等。\n\n01:28.611 --> 01:32.911\n免疫抑制宿主感染疱疹病毒和麻疹病毒，\n\n01:33.111 --> 01:36.361\n骨髓移植和器官移植受者。\n\n01:39.152 --> 01:39.602\n这些人呢，\n\n01:39.602 --> 01:44.377\n他是易患疱疹病毒和巨细胞病毒性肺炎的患者，\n\n01:44.377 --> 01:46.703\n可同时受一种以上病毒感染，\n\n01:46.752 --> 01:48.553\n并常激发细菌感染，\n\n01:48.652 --> 01:49.453\n免疫抑制。\n\n01:49.453 --> 01:51.453\n宿主还常继发真菌感染。\n\n01:51.453 --> 01:55.078\n卡氏肺孢子菌飞沫与直接接触传播，\n\n01:55.078 --> 01:56.402\n且传播迅速，\n\n01:56.703 --> 01:57.703\n传播面广。\n\n01:57.852 --> 02:01.727\n病毒性肺炎为吸入性肺炎感染，\n\n02:01.727 --> 02:03.803\n常有气管支气管炎。\n\n02:04.527 --> 02:04.752\n那么，\n\n02:04.752 --> 02:05.477\n病理报告呢，\n\n02:05.477 --> 02:09.277\n我们可以看一下病毒侵入细支气管上皮，\n\n02:09.277 --> 02:14.727\n细支气管炎感染可波及肺间质与肺泡肺炎。\n\n02:15.567 --> 02:17.843\n气道上皮广泛受损，\n\n02:17.843 --> 02:19.167\n粘膜发生溃疡，\n\n02:19.468 --> 02:21.867\n其上覆盖纤维蛋白膜，\n\n02:22.218 --> 02:23.768\n气道防御功能降低，\n\n02:23.917 --> 02:25.817\n易招致细菌感染。\n\n02:26.268 --> 02:27.992\n单纯病毒性肺炎呢，\n\n02:27.992 --> 02:29.317\n多为间质性肺炎，\n\n02:29.417 --> 02:32.417\n肺泡间隔有大量的单核细胞浸润，\n\n02:32.617 --> 02:33.593\n肺泡水肿，\n\n02:33.593 --> 02:37.617\n被富含蛋白及纤维蛋白的透明膜，\n\n02:37.867 --> 02:40.067\n使肺泡弥散距离加宽。\n\n02:40.772 --> 02:40.973\n那么，\n\n02:40.973 --> 02:41.647\n病理二呢，\n\n02:41.647 --> 02:43.673\n我们可以看一下肺炎啊，\n\n02:43.673 --> 02:45.973\n它多为局灶性或弥漫性，\n\n02:46.272 --> 02:52.473\n可呈10片肺泡细胞及巨噬细胞内可见病毒包涵体。\n\n02:53.417 --> 02:56.216\n炎性介质渗出啊，\n\n02:57.117 --> 02:59.466\n直接作用于我们支气管平滑肌，\n\n02:59.466 --> 03:01.216\n致使支气管痉挛。\n\n03:01.466 --> 03:02.367\n临床上呢，\n\n03:02.367 --> 03:04.766\n表现为气道的反应性增高。\n\n03:06.055 --> 03:09.955\n病变吸收后可留有肺间质的纤维化。\n\n03:13.968 --> 03:16.617\n这是我们的这个病理的一个图啊，\n\n03:16.617 --> 03:17.593\n我们可以看到啊，\n\n03:17.593 --> 03:18.817\n有点复杂，\n\n03:19.117 --> 03:20.768\n那么多核巨细胞。\n\n03:21.796 --> 03:24.397\n之内的这个病毒包涵体。\n\n03:25.608 --> 03:26.408\n还有病毒性肺炎，\n\n03:26.408 --> 03:29.557\n我们看一下这个巨细胞巨细胞的一个包含体。\n\n03:29.957 --> 03:31.158\n那么临床表现呢？\n\n03:31.158 --> 03:34.257\n病毒性肺炎好发于病毒疾病流行季节，\n\n03:34.507 --> 03:36.358\n临床症状通常较轻，\n\n03:36.908 --> 03:40.707\n与支原体肺炎的症状是相似的。\n\n03:40.807 --> 03:42.158\n但起病较急，\n\n03:42.158 --> 03:44.608\n发热、头痛、全身酸痛，\n\n03:44.658 --> 03:46.057\n倦怠较突出。\n\n03:46.408 --> 03:53.707\n常在急性流感症状尚未消退时即出现咳嗽少痰或白色粘液痰，\n\n03:53.908 --> 03:55.807\n咽痛等呼吸道的症状。\n\n03:55.826 --> 03:56.126\n症状。\n\n03:58.011 --> 03:58.537\n临床表现，\n\n03:58.537 --> 04:01.611\n老年人易发生重症病毒性肺炎，\n\n04:01.611 --> 04:05.837\n表现为呼吸困难、发干、嗜睡、精神萎靡，\n\n04:05.837 --> 04:11.912\n甚至发生休克、心力衰竭和呼吸衰竭等合并症，\n\n04:11.962 --> 04:15.212\n也可发生急性呼吸窘迫综合征。\n\n04:15.511 --> 04:17.712\n常无显著的胸部体征，\n\n04:18.011 --> 04:19.236\n病情严重者呢，\n\n04:19.236 --> 04:24.562\n有呼吸浅速、心率增快、发干、肺部干湿啰音。\n\n04:27.618 --> 04:27.717\n那么，\n\n04:27.717 --> 04:29.567\n实验室和其他检查我们可以看一下。\n\n04:29.667 --> 04:30.542\n血常规的话，\n\n04:30.542 --> 04:31.717\n白细胞是正常的，\n\n04:31.717 --> 04:33.667\n稍高或偏低都有可能。\n\n04:34.394 --> 04:36.795\nI培养常无致病菌生长，\n\n04:36.894 --> 04:38.570\n痰涂片白细胞呢，\n\n04:38.570 --> 04:40.394\n以单核细胞居多。\n\n04:40.644 --> 04:42.045\n胸部的X腺癌，\n\n04:42.045 --> 04:43.244\n肺纹理增多。\n\n04:44.803 --> 04:45.352\n磨玻璃，\n\n04:45.703 --> 04:46.653\n放阴影。\n\n04:47.730 --> 04:48.006\n还有呢，\n\n04:48.006 --> 04:51.930\n小片状浸润或广泛浸润实变病情严重，\n\n04:51.930 --> 04:54.881\n主要显示双肺弥漫性结节性浸润，\n\n04:55.230 --> 04:58.230\n大叶实变及胸腔积液者均不多见。\n\n04:58.531 --> 05:00.580\n病毒性肺炎的致病原不同，\n\n05:00.730 --> 05:03.381\n其X线真相亦有不同特征。\n\n05:03.730 --> 05:06.631\n诊断依据我们可以看一下临床症状，\n\n05:06.730 --> 05:08.031\nX线改变，\n\n05:08.131 --> 05:12.180\n并排除由其他病原体引起的肺炎临床诊断。\n\n05:13.098 --> 05:15.598\n确诊有赖于病原学的检查，\n\n05:15.898 --> 05:19.299\n病毒分离血清学检查、病毒抗原检测。\n\n05:19.699 --> 05:25.098\n呼吸道分泌物中的细细胞核内的包涵体提示病毒感染，\n\n05:25.098 --> 05:26.998\n但并非一定来自肺部，\n\n05:27.299 --> 05:31.848\n需进一步收集下呼吸道分泌物或肺活检标本，\n\n05:31.848 --> 05:35.223\n做培养分离病毒血清学检查呢，\n\n05:35.223 --> 05:38.699\n常用特异性的IGGIGM抗体检测。\n\n05:39.199 --> 05:39.949\n治疗的话，\n\n05:39.949 --> 05:41.348\n我们还是以对症为主。\n\n05:42.346 --> 05:42.622\n首先，\n\n05:42.622 --> 05:43.147\n休息，\n\n05:43.346 --> 05:44.397\n卧床休息。\n\n05:44.747 --> 05:45.071\n嗯，\n\n05:45.071 --> 05:46.296\n居室空气流通，\n\n05:46.647 --> 05:48.546\n温度湿度适宜。\n\n05:48.747 --> 05:49.497\n饮食呢，\n\n05:49.497 --> 05:53.796\n要多食富含维生素、蛋白质、易消化的清淡饮食，\n\n05:53.796 --> 05:54.596\n多饮水，\n\n05:54.997 --> 05:56.421\n酌情静脉输液，\n\n05:56.421 --> 05:57.096\n吸氧，\n\n05:57.296 --> 05:58.796\n保持呼吸道通畅，\n\n05:58.997 --> 06:02.747\n以及持续进入呼吸道分泌物。\n\n06:03.346 --> 06:03.897\n同时呢，\n\n06:03.897 --> 06:05.147\n我们还要隔离消毒，\n\n06:05.147 --> 06:07.046\n预防我们的交叉感染。\n\n06:07.397 --> 06:08.096\n治疗的话，\n\n06:08.096 --> 06:09.997\n首先第一个抗病毒治疗，\n\n06:09.997 --> 06:10.622\n目前啊，\n\n06:10.622 --> 06:12.497\n已证实较有效的。\n\n06:12.618 --> 06:14.919\n病毒抑制药物有利巴韦林。\n\n06:15.808 --> 06:18.458\n三氮唑核苷病毒唑，\n\n06:18.657 --> 06:20.083\n广谱抗病毒药。\n\n06:20.083 --> 06:22.157\n对呼吸道和胞病毒。\n\n06:23.878 --> 06:30.329\n腺病毒副流感病毒和流感病毒有效阿昔洛韦无环戊肝啊，\n\n06:30.829 --> 06:33.928\n它主要是有化学合合的。\n\n06:33.928 --> 06:37.778\n这个抗病毒药具有广谱强效和起效快的特点。\n\n06:38.079 --> 06:41.528\n临床用于疱疹病毒、水痘病毒感染，\n\n06:41.528 --> 06:45.878\n尤其对免疫缺陷或者应用免疫抑制剂者应尽早应用。\n\n06:46.278 --> 06:49.178\n根西洛维尔为五环尿苷类似物，\n\n06:49.329 --> 06:50.678\n抑制电内合成，\n\n06:50.829 --> 06:52.979\n主要用于T细胞病毒感染。\n\n06:53.645 --> 06:55.496\n抗病毒的治疗看一下。\n\n06:56.263 --> 06:56.537\n首先，\n\n06:56.537 --> 07:04.213\n奥司他韦神经氨酸酶抑制剂对甲、乙型流感病毒均有很好的作用，\n\n07:04.613 --> 07:06.162\n但发生率低。\n\n07:06.662 --> 07:10.062\n阿糖腺苷为嘌呤核苷类化合物。\n\n07:10.648 --> 07:12.549\n具有广泛的抗病毒作用，\n\n07:12.699 --> 07:17.898\n多用于治疗免疫缺陷患者的疱疹病毒与水痘病毒感染。\n\n07:18.299 --> 07:19.299\n金刚烷胺，\n\n07:19.299 --> 07:22.549\n金刚胺也就是人工合成的胺类药物，\n\n07:22.699 --> 07:25.699\n有些病毒进入人体细胞及退热作用。\n\n07:25.699 --> 07:28.148\n临床用于流感病毒等感染。\n\n07:30.239 --> 07:31.690\n治疗抗生素的应用，\n\n07:31.839 --> 07:33.714\n无继发性细菌感染时，\n\n07:33.714 --> 07:35.790\n不宜预防性应用抗生素。\n\n07:36.040 --> 07:38.089\n一旦明确已合并细菌感染，\n\n07:38.089 --> 07:40.239\n应及时选用敏感的抗生素。\n\n07:42.604 --> 07:43.378\n糖皮质激素呢，\n\n07:43.378 --> 07:45.653\n对我们病毒性肺炎疗效仍有争论。\n\n07:45.854 --> 07:53.403\n中要的应用热毒宁注射液、痰热清注射液、喜炎平注射液和血不净注射液、生脉注射液。\n\n07:54.102 --> 07:55.602\n临床常见的病毒性肺炎呢，\n\n07:55.602 --> 07:56.127\n我们可以看到，\n\n07:56.127 --> 07:58.428\n首先第一个流感病毒肺炎，\n\n07:58.428 --> 08:00.528\n第二麻疹病毒肺炎，\n\n08:00.528 --> 08:04.303\n第三疱疹病毒肺炎也是我们的带状疱疹及单纯疱疹。\n\n08:04.602 --> 08:06.653\n四巨细胞病毒肺炎。\n\n08:06.653 --> 08:09.453\n首先看一下流感病毒肺炎，\n\n08:09.703 --> 08:14.053\n季节性流行性感冒基本都发生在冬季，\n\n08:14.053 --> 08:15.303\n2.3周达到高峰，\n\n08:15.303 --> 08:17.303\n可持续2.3个月。\n\n08:17.855 --> 08:22.154\n传播咳嗽和喷嚏所形成的气溶胶受接触，\n\n08:22.505 --> 08:25.329\n原发性流感病毒肺炎临床表现，\n\n08:25.329 --> 08:26.154\n持续高热，\n\n08:26.505 --> 08:27.204\n咳嗽，\n\n08:27.605 --> 08:28.605\n肺部感染。\n\n08:29.708 --> 08:30.632\n听听诊啊，\n\n08:30.632 --> 08:31.507\n湿罗音明显，\n\n08:31.608 --> 08:32.908\nX线的表现呢，\n\n08:32.908 --> 08:35.607\n两肺弥漫性间质性是出现病变，\n\n08:35.857 --> 08:36.932\n病情进展呢，\n\n08:36.932 --> 08:38.357\n出现进行性的一个。\n\n08:39.385 --> 08:39.986\n呼吸困难。\n\n08:40.633 --> 08:43.434\n治疗还是以这个抗生素治疗无效，\n\n08:43.583 --> 08:46.684\n用奥司他韦75mg DID，\n\n08:46.934 --> 08:49.333\n疗程10天或以上。\n\n08:51.146 --> 08:51.296\n那么，\n\n08:51.296 --> 08:52.896\n什么是麻疹病毒肺炎？\n\n08:53.296 --> 08:55.747\n主要出现在出疹前和出疹期，\n\n08:56.197 --> 08:57.896\n表现为高热、咳嗽，\n\n08:57.896 --> 09:00.622\n肺部听诊无干湿罗音胸片，\n\n09:00.622 --> 09:03.247\n两肺纹理增多及网状阴影，\n\n09:03.346 --> 09:06.747\n合并细菌感染可出现肺部实变。\n\n09:07.716 --> 09:08.317\n治疗的话，\n\n09:08.367 --> 09:11.216\n麻有无明确有效的抗病毒药物，\n\n09:11.216 --> 09:14.117\n抗生素预防细菌感染合并细菌性肺炎，\n\n09:14.367 --> 09:16.916\n针对病原菌选用敏感抗生素，\n\n09:17.267 --> 09:18.517\n疱疹病毒肺炎，\n\n09:18.517 --> 09:20.767\n水痘带状疱疹肺炎。\n\n09:22.127 --> 09:24.976\n发病前有明显的水痘或带状疱疹的一个皮疹。\n\n09:26.120 --> 09:26.245\n那么，\n\n09:26.245 --> 09:28.070\n临床症状及体征也是不明显。\n\n09:28.520 --> 09:31.421\nX线的两肺弥漫性的结核浸润，\n\n09:31.870 --> 09:34.820\n或这个结节浸润或网格状硬，\n\n09:35.471 --> 09:39.320\n单纯疱疹病毒肺炎表示多性免疫缺陷患者，\n\n09:39.471 --> 09:42.320\n此类患者早期呼吸道的症状不明显。\n\n09:42.671 --> 09:46.520\nX线呢出现两肺弥漫性减脂肺病例，\n\n09:46.721 --> 09:50.346\n同时伴有口腔面部生殖性的疱疹治疗呢，\n\n09:50.346 --> 09:52.070\n是阿昔洛韦是有效的。\n\n09:52.421 --> 09:52.820\n那么，\n\n09:52.820 --> 09:54.046\n巨细胞病毒性肺炎，\n\n09:54.046 --> 09:55.445\n免疫功能正常者呢，\n\n09:55.445 --> 09:56.320\n巨细胞病毒性。\n\n09:56.375 --> 09:59.174\n变成自限性病程四周左右，\n\n09:59.525 --> 10:01.775\n免疫缺陷患者的发病率高，\n\n10:01.974 --> 10:02.974\n病死率高。\n\n10:03.224 --> 10:06.200\n临床表现一是干干咳，\n\n10:06.200 --> 10:06.875\n发热，\n\n10:07.424 --> 10:08.349\n呼吸困难，\n\n10:08.349 --> 10:11.174\n严重低氧血症提示病情危重。\n\n10:11.674 --> 10:13.424\n见两肺弥漫性浸润，\n\n10:13.625 --> 10:14.424\n明确呢，\n\n10:14.424 --> 10:15.375\n诊断困难，\n\n10:15.575 --> 10:16.875\n肺泡灌溉。\n\n10:18.161 --> 10:20.986\n肺泡灌洗及活活检，\n\n10:20.986 --> 10:26.111\n肺肺活检、病毒分离及病理学检查。\n\n10:27.861 --> 10:28.687\n外周血啊，\n\n10:28.687 --> 10:31.111\n检出CMV抗原。\n\n10:34.648 --> 10:37.598\n是CMV活动性感染的重要标志，\n\n10:37.948 --> 10:40.398\n血清型诊断AI、GG阳性，\n\n10:40.398 --> 10:42.924\n感染过IgM阳性，\n\n10:42.924 --> 10:45.198\n考虑急性感染治疗呢，\n\n10:45.198 --> 10:47.348\n跟西洛联合免疫球蛋白，\n\n10:47.648 --> 10:49.398\n我们下面有个病例分享啊，\n\n10:49.398 --> 10:49.874\n首先，\n\n10:49.874 --> 10:51.598\n患者是老年女性，\n\n10:51.848 --> 10:54.098\n以咳嗽发热一周入院。\n\n10:54.348 --> 10:54.973\n患者呢，\n\n10:54.973 --> 10:58.749\n一周前受凉后出现咳嗽干咳为主。\n\n10:59.276 --> 10:59.927\n伴有发热，\n\n11:00.026 --> 11:01.726\n体温在38°以上，\n\n11:01.927 --> 11:03.052\n伴有乏力，\n\n11:03.052 --> 11:03.601\n纳差，\n\n11:03.601 --> 11:05.177\n无头痛、头晕，\n\n11:05.276 --> 11:06.276\n四肢酸软。\n\n11:06.377 --> 11:07.077\n既往呢，\n\n11:07.077 --> 11:08.627\n是有高血压病史的。\n\n11:10.083 --> 11:11.458\n多年入院检查，\n\n11:11.458 --> 11:12.434\n神志清，\n\n11:12.484 --> 11:13.383\n精神软，\n\n11:13.633 --> 11:15.783\n浅表淋巴结未及肿大，\n\n11:15.783 --> 11:17.633\n颈软血管居中，\n\n11:17.684 --> 11:19.283\n颈静脉无怒张，\n\n11:19.484 --> 11:21.133\n胸廓无畸形，\n\n11:21.133 --> 11:22.783\n两肺呼吸音低，\n\n11:23.083 --> 11:25.883\n左下肺无及湿性啰音，\n\n11:26.033 --> 11:27.783\n心率85次每分，\n\n11:27.783 --> 11:28.309\n节律，\n\n11:28.309 --> 11:29.633\n脐腹平软，\n\n11:29.783 --> 11:31.533\n肝脾肋下未及，\n\n11:31.533 --> 11:32.984\n双下肢不肿。\n\n11:33.646 --> 11:34.372\n辅助检查呢，\n\n11:34.372 --> 11:35.546\n血常规什么的。\n\n11:36.440 --> 11:37.940\n这个WBC是2.2。\n\n11:40.450 --> 11:41.849\nX 58.3 H,\n\n11:41.849 --> 11:43.424\nB是12.4，\n\n11:43.424 --> 11:44.674\nPLT 33,\n\n11:44.674 --> 11:46.150\nCRP是64.82，\n\n11:46.549 --> 11:50.500\n肺炎支原体IGGIG都是呈阴性的。\n\n11:52.418 --> 11:53.692\n生化全套基本正常，\n\n11:53.692 --> 11:55.168\n肿瘤指标基本正常。\n\n11:55.218 --> 11:56.192\n胸部CT呢，\n\n11:56.192 --> 11:57.918\n是两肺下叶炎症，\n\n11:58.018 --> 11:59.867\n左肺下叶明显，\n\n12:00.168 --> 12:01.268\n那我们可以看到，\n\n12:01.268 --> 12:02.218\n这是它的一个。\n\n12:03.565 --> 12:04.864\n肺的一个CT。\n\n12:06.343 --> 12:07.343\n从左到右，\n\n12:07.543 --> 12:10.968\n我们依次看一下它这边的这个肺的纹理啊，\n\n12:10.968 --> 12:12.692\n都是这增粗的对不对？\n\n12:12.692 --> 12:14.742\n然后这边还是模模糊状语。\n\n12:15.192 --> 12:16.418\n那么药物治疗啊，\n\n12:16.418 --> 12:16.893\n首先啊，\n\n12:16.893 --> 12:17.793\n我们可以看到啊，\n\n12:17.793 --> 12:18.968\n要化痰啊，\n\n12:18.968 --> 12:21.843\n所以我们要用氨溴索60MGQD，\n\n12:22.192 --> 12:24.293\n那么是氨茶碱0.25。\n\n12:25.182 --> 12:25.482\n对比。\n\n12:26.510 --> 12:27.085\n接下来呢？\n\n12:27.085 --> 12:27.635\n抗病毒，\n\n12:27.635 --> 12:30.335\n那么要哌拉西林舒巴坦。\n\n12:32.849 --> 12:33.849\n我点了一遍ID。\n\n12:34.793 --> 12:35.742\n治疗半个月，\n\n12:35.992 --> 12:38.018\n左氧氟沙星零点四QD，\n\n12:38.018 --> 12:38.843\n治疗7天。\n\n12:40.883 --> 12:42.158\n治疗前后的血常规，\n\n12:42.158 --> 12:43.208\n我们CRP的一个变化，\n\n12:43.208 --> 12:46.033\n我们可以看见3月1月18日时呢，\n\n12:46.033 --> 12:52.109\n这个WPC是2.2M是58.3 HB是幺幺四，\n\n12:52.109 --> 12:54.234\nPLT是33，\n\n12:54.234 --> 12:55.684\nDRP是64.8，\n\n12:55.984 --> 13:00.883\n到了在23月24日变成了五点零六十五。\n\n13:01.547 --> 13:04.447\n幺幺六幺八三二十一点七，\n\n13:04.898 --> 13:06.223\n那4月2号的时候，\n\n13:06.223 --> 13:08.723\n你就是3:55，\n\n13:08.723 --> 13:10.747\n112174，\n\n13:10.848 --> 13:12.622\n它是成了一个质的飞跃啊，\n\n13:12.622 --> 13:14.111\n有些接近正潮了，\n\n13:14.111 --> 13:17.398\n然后去看一下他的肺的CT。\n\n13:19.219 --> 13:20.619\n炎炎症细胞呢，\n\n13:20.619 --> 13:23.320\n已经开始慢慢的这个吸收了。\n\n13:26.202 --> 13:26.427\n但是，\n\n13:26.427 --> 13:29.026\n还没有完全吸收体温单的话，\n\n13:29.026 --> 13:31.952\n也是呈一个下降的趋势。\n\n13:32.601 --> 13:33.901\n其实还有个困惑，\n\n13:34.302 --> 13:37.651\n病因诊的基层医院缺少我们病毒后面及。\n\n13:38.854 --> 13:41.729\n被活检病理调检查的一个条件，\n\n13:41.729 --> 13:42.280\n也就是说，\n\n13:42.280 --> 13:43.755\n我们其实有这个心，\n\n13:43.755 --> 13:44.905\n但是没有这个力，\n\n13:45.405 --> 13:45.905\n对吧？\n\n13:45.905 --> 13:46.255\n那么，\n\n13:46.255 --> 13:47.580\n临床简单诊断呢，\n\n13:47.580 --> 13:51.705\n用于我们鉴别细菌性肺炎及病毒性片的指标，\n\n13:51.705 --> 13:57.755\n血常规范、细胞技术、C反应蛋白降解素源、胸部CT影像学对抗。\n\n13:59.059 --> 14:01.260\n生素治疗的敏感性，\n\n14:01.309 --> 14:05.859\n那么临卷临床实践中关于病毒性肺炎鉴别指的那个路径？\n\n14:06.973 --> 14:07.797\n第二个治疗，\n\n14:07.797 --> 14:08.997\n我们抗菌治疗，\n\n14:08.997 --> 14:11.572\n首先病毒性肺炎是否都需要抗菌治疗，\n\n14:11.572 --> 14:12.572\n因为都是病毒嘛，\n\n14:12.572 --> 14:14.072\n怎么哪来的细细菌呢？\n\n14:14.172 --> 14:17.273\n那其实抗病毒的药物利巴韦林、奥司他韦等，\n\n14:17.322 --> 14:19.273\n疗效评价也是不确定的。\n\n14:20.708 --> 14:24.908\n那么中医中药在治疗病毒性肺炎中的作用也是我们需要探讨的，\n\n14:25.109 --> 14:25.783\n还有一个，\n\n14:25.783 --> 14:27.008\n有些肺炎比较厉害的，\n\n14:27.008 --> 14:31.809\n我们是不是需要用糖皮质激素在病毒性肺炎治疗中的应用？\n\n14:33.559 --> 14:35.059\n那么接下来我们再看一下，\n\n14:35.258 --> 14:35.583\n嗯，\n\n14:35.583 --> 14:38.109\n再带大家了解一下我们这个。\n\n14:39.939 --> 14:41.439\n病毒性肺炎具体。\n\n14:43.354 --> 14:44.679\n的个这个重点，\n\n14:44.679 --> 14:47.328\n首先它是病毒感染，\n\n14:47.328 --> 14:49.379\n它不是细菌感染，\n\n14:49.379 --> 14:51.754\n所以不要随便用抗生素。\n\n14:52.403 --> 14:53.054\n第二，\n\n14:53.153 --> 14:56.028\n它是免疫功能正常或者抑制的，\n\n14:56.028 --> 14:57.929\n儿童成人都可能会发生，\n\n14:57.929 --> 15:00.203\n就是你身体好与不好都有可能会感染。\n\n15:00.403 --> 15:01.104\n大多呢，\n\n15:01.104 --> 15:02.379\n发生在冬春季节，\n\n15:02.379 --> 15:04.004\n也就是我们现在这个季节，\n\n15:04.153 --> 15:06.453\n还有爆发或者散发流行，\n\n15:06.453 --> 15:10.304\n就可能是一堆人一起得密切接触的人群啊，\n\n15:10.304 --> 15:12.903\n会有心肺疾病者容易被感染。\n\n15:13.104 --> 15:13.554\n那么。\n\n15:13.596 --> 15:18.421\n我们婴幼儿、老人、妊娠妇女会原有慢性心肺疾病症断，\n\n15:18.421 --> 15:19.096\n病情加重，\n\n15:19.296 --> 15:21.096\n可能会导致我们的死亡。\n\n15:21.245 --> 15:31.046\n那其实最主要还是因为感染了这个甲乙是如果是毒血病毒、副流感病毒、呼吸道合胞病毒和巨噬病毒等等病毒全都是病毒。\n\n15:32.773 --> 15:36.473\n免疫抑制素主感染了疱疹病毒和麻疹病毒，\n\n15:36.674 --> 15:38.549\n骨髓抑制和器官移植，\n\n15:38.549 --> 15:41.723\n受诊的易患疱疹病毒和巨细胞病毒，\n\n15:41.723 --> 15:46.374\n与肺炎患者可同时受到一种或者以上的这个病毒感染，\n\n15:46.374 --> 15:48.773\n并出现继发性的这个细菌感染。\n\n15:48.773 --> 15:49.573\n也就是说，\n\n15:49.573 --> 15:51.848\n等你得了这个病毒性肺炎，\n\n15:51.848 --> 15:54.573\n其实也是可以用一定的抗生素，\n\n15:54.573 --> 15:55.973\n但不是所有的人都用啊，\n\n15:55.973 --> 15:56.473\n切记，\n\n15:56.823 --> 15:58.223\n免疫抑制素呢，\n\n15:58.223 --> 15:59.473\n还可继防真菌感染，\n\n15:59.473 --> 16:00.773\n卡氏肺孢子菌。\n\n16:03.278 --> 16:03.653\n哎，\n\n16:03.653 --> 16:05.479\n卡氏肺孢子菌肺炎，\n\n16:05.479 --> 16:09.179\n这个其实我我临床上我见有见过，\n\n16:09.578 --> 16:12.304\n这个的话可能还是跟h HIV的患者有关，\n\n16:12.304 --> 16:13.479\n但有hi IV的话，\n\n16:13.479 --> 16:15.028\n它就是免疫抑制剂嘛，\n\n16:15.229 --> 16:16.328\n免疫抑制了之后，\n\n16:16.328 --> 16:20.179\n它可能会就出现这个卡氏卡氏肺孢子菌肺炎。\n\n16:20.994 --> 16:22.869\n飞沫与直接接触传播，\n\n16:22.869 --> 16:24.619\n且传播迅速，\n\n16:24.619 --> 16:25.445\n传播面早。\n\n16:25.494 --> 16:27.344\n病毒性肺炎等为吸入性肺炎，\n\n16:27.344 --> 16:28.994\n常有器官支气管炎。\n\n16:29.786 --> 16:30.111\n还有呢，\n\n16:30.111 --> 16:31.335\n它的这个病毒啊，\n\n16:31.335 --> 16:34.236\n侵入细支气管上面的细支气管炎。\n\n16:35.070 --> 16:37.046\n感染可波及肺间质与肺泡。\n\n16:37.046 --> 16:39.520\n肺气道上皮广泛受损，\n\n16:39.570 --> 16:40.921\n粘膜发生溃疡，\n\n16:40.921 --> 16:42.971\n其上覆盖纤维蛋白膜。\n\n16:43.270 --> 16:44.971\n气道发育功能较低，\n\n16:45.971 --> 16:47.671\n常是细菌感染。\n\n16:47.971 --> 16:51.171\n单纯病毒性肺炎多为间质性肺炎。\n\n16:52.155 --> 16:52.955\n肺泡间隔呢，\n\n16:52.955 --> 16:55.255\n有大量的单核细胞浸润。\n\n16:56.572 --> 17:03.096\n肺泡水肿被富含蛋白及纤维蛋白的透明膜使肺泡弥散距离加宽。\n\n17:03.096 --> 17:04.072\n病理2的话，\n\n17:04.322 --> 17:06.472\n肺炎多为局灶性或弥漫性，\n\n17:06.521 --> 17:07.621\n易合成实变。\n\n17:07.921 --> 17:11.621\n肺泡细菌及巨噬细胞内可见病毒包涵体，\n\n17:11.822 --> 17:15.121\n炎性介质释出直接作用于支气管平滑肌，\n\n17:15.271 --> 17:16.671\n致使支气管痉挛。\n\n17:16.771 --> 17:19.021\n临床上表现为气道反应性增高。\n\n17:21.109 --> 17:23.208\n因被吸收可留有肺间质纤维化。\n\n17:25.568 --> 17:28.644\n那么其实病毒性肺炎的还有一个特点呢，\n\n17:28.644 --> 17:30.968\n它首先它的通常临床症状比较轻，\n\n17:31.468 --> 17:33.693\n但是与支原体肺炎的症状是相似的，\n\n17:33.693 --> 17:34.744\n但是它起病很急，\n\n17:34.744 --> 17:35.218\n发热，\n\n17:35.218 --> 17:36.793\n有可能是高热40°的，\n\n17:36.793 --> 17:38.769\n这种会出现头痛，\n\n17:38.918 --> 17:39.918\n全身酸痛，\n\n17:39.968 --> 17:41.519\n倦怠等较突出。\n\n17:41.519 --> 17:42.968\n这好像我以前也得过，\n\n17:43.168 --> 17:44.394\n反正得了之后，\n\n17:44.394 --> 17:45.269\n反正要死要活，\n\n17:45.269 --> 17:46.168\n也瘦了十斤，\n\n17:46.369 --> 17:48.957\n那其实也也是跟他这个来，\n\n17:48.957 --> 17:49.619\n来也匆匆，\n\n17:49.619 --> 17:50.168\n去也匆匆，\n\n17:50.168 --> 17:51.668\n有关就是等你好了，\n\n17:51.668 --> 17:52.918\n真的就很快就好了。\n\n17:52.968 --> 17:55.718\n那常在我们急性流感症状尚未消退时。\n\n17:55.803 --> 17:59.354\n即出现咳嗽少痰或者白色粘液痰，\n\n17:59.404 --> 18:01.203\n咽痛等呼吸道的症状。\n\n18:01.254 --> 18:02.078\n老年人呢，\n\n18:02.078 --> 18:03.629\n易发生重症病毒性肺炎，\n\n18:03.629 --> 18:04.953\n出现呼吸困难。\n\n18:05.402 --> 18:07.478\n发干、嗜睡、精神萎靡，\n\n18:07.478 --> 18:08.703\n甚至发生休克，\n\n18:08.902 --> 18:11.353\n心力衰竭和呼吸衰竭的合并症，\n\n18:11.453 --> 18:14.453\n也可发生急性呼吸诱迫综合征，\n\n18:14.603 --> 18:16.328\n掌握显著的胸部体征，\n\n18:16.328 --> 18:17.453\n病情严重者呢，\n\n18:17.453 --> 18:19.728\n可能有呼吸前索心率增快，\n\n18:19.728 --> 18:21.453\n发干、肺部干湿啰音。\n\n18:23.504 --> 18:24.729\n实验室和其他检查，\n\n18:24.729 --> 18:25.154\n血常规，\n\n18:25.154 --> 18:27.604\n我们白细胞增长较高或者偏低，\n\n18:27.904 --> 18:28.678\n但图片呢，\n\n18:28.678 --> 18:30.604\n白细胞以单核细细胞居多。\n\n18:30.854 --> 18:34.053\n安眠药产物致病细菌的生长，\n\n18:34.053 --> 18:34.803\nMS线呢，\n\n18:34.803 --> 18:36.354\n肺活理增多。\n\n18:37.081 --> 18:39.456\n我玻璃状因小片状浸，\n\n18:39.456 --> 18:47.931\n然后广泛进入识别隐性炎症中显示双慢性结节性痉、单叶实变及胸腔积液者均不多见。\n\n18:49.151 --> 18:50.901\n病毒性肺炎的致病医院不同，\n\n18:50.901 --> 18:53.701\n其X线的真相也是有不同的。\n\n18:58.319 --> 19:00.244\n其实还有一个要注意的是什么，\n\n19:00.244 --> 19:01.420\n就是我们的治疗啊，\n\n19:01.420 --> 19:03.295\n还是要以抗病毒治疗为准，\n\n19:03.694 --> 19:08.045\n那目前已经实较有效的病毒抑制药物有利巴韦林啊，\n\n19:08.444 --> 19:08.994\n对吧，\n\n19:09.145 --> 19:10.194\n然后那个。\n\n19:11.197 --> 19:11.897\n阿奇罗文。\n\n19:13.390 --> 19:13.740\n好的，\n\n19:13.740 --> 19:14.590\n接下来的话，\n\n19:14.590 --> 19:17.090\n我分享就就先结束了，\n\n19:17.090 --> 19:18.541\n那感谢各位的聆听。\n\n","v0347cg10004d76co8aljht7lgsekp4g",1164,661,"2026-01-26 11:26:47"," \"高效会议记录与策略讨论 - meeting_01.mp4 完整内容解析\"  "," \"会议记录, 团队协作, 商业策略, 会议视频, 项目管理, 沟通技巧, meeting_01.mp4\"  "," \"观看 meeting_01.mp4 的详细内容解析，了解高效会议记录和团队协作策略。本视频涵盖关键讨论点、决策过程和行动项，适合项目管理者和团队领导者参考。\"","2026-06-10 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