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--> 00:02.145\n大家好，\n\n00:02.145 --> 00:06.046\n今天讲的题题目是关于心血管哮喘。\n\n00:08.364 --> 00:11.314\n我们将从以下几个方面来进行学习。\n\n00:13.121 --> 00:16.471\n一、第一个方面是关于哮喘的概述与流行病学。\n\n00:17.986 --> 00:21.035\n我们全球已经有两点六亿的患者。\n\n00:22.417 --> 00:22.818\n哦。\n\n00:23.562 --> 00:24.888\n然后患哮喘，\n\n00:24.888 --> 00:26.863\n然后有严峻的公共的卫生挑战。\n\n00:28.048 --> 00:30.698\n中国的话是有4570万，\n\n00:30.749 --> 00:32.798\n然后患病率是持续上升的。\n\n00:33.519 --> 00:36.243\n控制率的话是仅28.5%，\n\n00:36.243 --> 00:38.019\n然后规范化的管理呢，\n\n00:38.019 --> 00:39.868\n是时代加强。\n\n00:41.493 --> 00:47.068\n然支气管哮喘的概念就是它是有多种细胞，\n\n00:47.068 --> 00:56.542\n如那个嗜酸性细胞、肥大细胞、以T淋巴细胞还有中中性粒细胞等和细胞组分参与的慢性气道的。\n\n00:57.780 --> 00:58.081\n炎，\n\n00:58.081 --> 00:59.305\n炎症性的疾病。\n\n01:00.145 --> 01:00.395\n哦，\n\n01:00.595 --> 01:02.970\n它是一个抑制性的疾病，\n\n01:02.970 --> 01:04.544\n它有不同的临床表现，\n\n01:05.544 --> 01:06.444\n主要分为。\n\n01:07.391 --> 01:08.842\n临床表型跟那个类型，\n\n01:08.842 --> 01:09.991\n那临床表现的话，\n\n01:09.991 --> 01:12.616\n主要是关于过敏性或者是过敏性的，\n\n01:12.616 --> 01:14.291\n或者是嗜酸性、细胞性，\n\n01:14.291 --> 01:15.491\n还有感染诱发性。\n\n01:16.153 --> 01:16.304\n然后，\n\n01:16.304 --> 01:16.853\n类型的话，\n\n01:16.853 --> 01:20.503\n是二型炎症型与非二型炎症型。\n\n01:20.804 --> 01:21.228\n然后，\n\n01:21.228 --> 01:23.454\n它需要个体化的诊疗策略。\n\n01:24.172 --> 01:24.347\n嗯，\n\n01:24.347 --> 01:26.523\n病理特征方面主要是，\n\n01:26.523 --> 01:28.498\n一个气道的高反应性啊，\n\n01:28.498 --> 01:30.123\n对刺激物过度的敏感，\n\n01:30.422 --> 01:33.722\n还有就是可变的气道气流受限，\n\n01:34.023 --> 01:36.023\n还有就是气道的重塑。\n\n01:36.322 --> 01:36.797\n然后，\n\n01:36.797 --> 01:37.672\n长期病程的话，\n\n01:37.672 --> 01:39.422\n容易导致结构的改变。\n\n01:41.206 --> 01:42.030\n临床表现的话，\n\n01:42.030 --> 01:43.555\n就是喘息，\n\n01:43.655 --> 01:46.606\n然后就是反复发作的那个呼吸性哮鸣音，\n\n01:46.856 --> 01:49.055\n然后夜间或者是凌晨加重。\n\n01:50.000 --> 01:50.699\n然后气急，\n\n01:50.849 --> 01:53.349\n然后活动后或者是休息时，\n\n01:53.349 --> 01:54.300\n然后呼吸困难，\n\n01:54.300 --> 01:55.800\n严重的严重的话，\n\n01:55.800 --> 01:57.550\n然后需要端端坐呼吸。\n\n01:58.694 --> 01:59.293\n还有胸闷，\n\n01:59.543 --> 02:01.594\n然后胸部压迫感，\n\n02:01.594 --> 02:02.893\n然后可伴有胸痛。\n\n02:03.936 --> 02:05.186\n他一般还有咳嗽，\n\n02:05.186 --> 02:06.986\n它一般是以干咳或者少痰，\n\n02:07.387 --> 02:07.787\n嗯，\n\n02:07.887 --> 02:10.111\n咳嗽性变变性哮喘的话，\n\n02:10.111 --> 02:11.587\n可仅表现为咳嗽。\n\n02:13.192 --> 02:13.343\n然后，\n\n02:13.343 --> 02:14.242\n症状特点的话，\n\n02:14.242 --> 02:15.192\n就是反复发，\n\n02:15.192 --> 02:15.942\n反复发作，\n\n02:15.942 --> 02:17.067\n然后可自行缓解，\n\n02:17.067 --> 02:18.692\n或者是进行治疗后缓解。\n\n02:23.444 --> 02:27.244\n然后全球与中国哮喘的流行的现状。\n\n02:29.757 --> 02:31.807\n全球的疾病的负担。\n\n02:32.852 --> 02:33.102\n嗯。\n\n02:35.716 --> 02:38.542\n仅有2.6亿，\n\n02:38.542 --> 02:41.966\n然后年死亡病例的话有43.6万。\n\n02:43.220 --> 02:45.220\n中国流行的话就是，\n\n02:45.220 --> 02:47.919\n20岁以上的患病率是4.2%，\n\n02:48.220 --> 02:49.470\n然后患者的总数，\n\n02:49.570 --> 02:53.119\n20252015年推算是4570万。\n\n02:54.093 --> 02:55.468\n流行趋势的话，\n\n02:55.468 --> 02:56.843\n就是2010年后，\n\n02:56.843 --> 02:59.869\n然后中国青少年14.18岁，\n\n02:59.869 --> 03:04.593\n然后和成年成年人的哮喘患病率是呈上升趋势的。\n\n03:08.593 --> 03:08.768\n然后，\n\n03:08.768 --> 03:10.843\n中国哮喘的危险因素是，\n\n03:11.093 --> 03:12.843\n一般是吸烟呀，\n\n03:13.143 --> 03:14.069\n或是二手烟，\n\n03:14.069 --> 03:17.069\n还有一些肥胖而且过敏性鼻炎，\n\n03:17.069 --> 03:20.244\n一些宠物的饲养，\n\n03:20.244 --> 03:21.944\n还有是遗传的易感性，\n\n03:21.944 --> 03:23.343\n还有一些非母乳的喂养。\n\n03:24.201 --> 03:27.227\n哮喘控制的现状与疾病的负担啊，\n\n03:27.227 --> 03:30.401\n就是尽管这个哮喘控制的概念提出很多年，\n\n03:30.401 --> 03:34.602\n但是全球的范围内哮喘控制情况仍不理想。\n\n03:35.307 --> 03:39.707\n然后中国门诊哮喘患病患者的总体的控制率的话，\n\n03:39.707 --> 03:41.307\n仅28.5%，\n\n03:41.457 --> 03:45.106\n然后诊断率的话是仅28.8%，\n\n03:45.307 --> 03:47.057\n然后远低于国际水平。\n\n03:47.785 --> 03:50.485\n凸显了加强哮喘防治工作的紧迫性。\n\n03:52.332 --> 03:52.483\n然后，\n\n03:52.483 --> 03:55.233\n2024年版的中国指南管理目标是，\n\n03:55.632 --> 03:56.033\n嗯，\n\n03:56.082 --> 03:58.233\n主要提升诊断力，\n\n03:58.233 --> 04:00.483\n然后就是完善诊断标准，\n\n04:00.483 --> 04:02.007\n然后推广拟诊路径，\n\n04:02.007 --> 04:04.382\n然后提高基层的诊断的。\n\n04:05.354 --> 04:05.755\n能力，\n\n04:06.154 --> 04:08.304\n而是提高控制率，\n\n04:08.304 --> 04:10.054\n然后规范的阶梯治疗，\n\n04:10.054 --> 04:11.904\n然后加强患者的教育。\n\n04:11.904 --> 04:13.005\n定期的随访，\n\n04:13.054 --> 04:14.104\n随访评估。\n\n04:15.341 --> 04:16.966\n实现临床的治愈，\n\n04:16.966 --> 04:17.790\n无症状的话，\n\n04:17.790 --> 04:18.691\n大于一年的话，\n\n04:18.691 --> 04:20.091\n且无需全身激素，\n\n04:20.290 --> 04:21.691\n而部分患者的话。\n\n04:22.485 --> 04:22.760\n可达，\n\n04:22.760 --> 04:23.686\n无需用药。\n\n04:24.545 --> 04:26.045\n个体化的精准治疗，\n\n04:26.346 --> 04:26.696\n嗯，\n\n04:26.696 --> 04:28.946\n是基于二型二型炎症分型，\n\n04:28.946 --> 04:30.545\n选择生物靶向药物。\n\n04:32.845 --> 04:34.394\n疾病负担的话就是。\n\n04:35.351 --> 04:35.552\n哦。\n\n04:37.713 --> 04:37.888\n然后，\n\n04:37.888 --> 04:40.213\n这个还有一个关于哮喘控制力的对比。\n\n04:40.412 --> 04:40.812\n然后，\n\n04:40.812 --> 04:41.613\n诊断率的话，\n\n04:41.613 --> 04:44.662\n然后中国与发达国家来水平来相比，\n\n04:44.662 --> 04:45.888\n然后明显的话，\n\n04:45.888 --> 04:49.162\n中国是低于发达发达国家的。\n\n04:49.897 --> 04:50.096\n嗯，\n\n04:50.796 --> 04:53.622\n控制力也是疾病的负担的话，\n\n04:53.622 --> 04:55.796\n它容易干扰睡眠呀，\n\n04:55.796 --> 04:57.397\n工作和其他日常的活动。\n\n04:58.096 --> 04:58.247\n嗯，\n\n04:58.247 --> 04:59.997\n然后集中急性发作的话，\n\n04:59.997 --> 05:04.497\n可以导导致然后急诊就诊和住院的治疗，\n\n05:04.647 --> 05:05.921\n然后长期用药的话，\n\n05:05.921 --> 05:07.397\n也可以产生副作用，\n\n05:07.596 --> 05:09.596\n还有医疗费用负担重，\n\n05:09.747 --> 05:12.696\n然后约占哮喘的总费用50%。\n\n05:13.046 --> 05:15.296\n然后心理的影响就是一些焦虑啊，\n\n05:15.296 --> 05:15.796\n抑郁啊，\n\n05:15.796 --> 05:17.296\n还有一些生活质量的下降。\n\n05:19.109 --> 05:20.709\n发病机制与病理的生理。\n\n05:23.063 --> 05:23.914\n型炎症，\n\n05:23.914 --> 05:26.164\n然后它是哮喘的核心的病理机制。\n\n05:27.265 --> 05:28.540\n它分为三个阶段，\n\n05:28.540 --> 05:31.114\n一个是启动和放启动阶段，\n\n05:31.114 --> 05:32.190\n还有放大阶段，\n\n05:32.190 --> 05:33.114\n还有效应阶段。\n\n05:34.350 --> 05:36.549\n一些关键的、关键的细胞因子。\n\n05:38.151 --> 05:39.651\n气道炎症的病理生理方面，\n\n05:39.651 --> 05:42.325\n主要是气道上皮的屏障的破坏，\n\n05:42.425 --> 05:43.976\n还有嗜酸性粒细胞的，\n\n05:44.726 --> 05:45.976\n还有气道的重塑。\n\n05:46.798 --> 05:46.947\n哦，\n\n05:46.947 --> 05:48.322\n还有气道高反应的话，\n\n05:48.322 --> 05:50.648\n它是哮喘的核心的特征。\n\n05:51.048 --> 05:51.472\n然后，\n\n05:51.472 --> 05:53.548\n白介素四和白介素十三，\n\n05:53.548 --> 05:56.322\n然后能够诱导气道的病化的收缩，\n\n05:56.322 --> 05:59.247\n然后感觉神经元被激活，\n\n05:59.447 --> 06:02.298\n然后可能会导致对冷空气、烟雾、运动，\n\n06:02.447 --> 06:04.298\n然后等刺激物过度的敏感。\n\n06:04.398 --> 06:04.822\n然后，\n\n06:04.822 --> 06:06.947\n支气管收缩反应是增强的。\n\n06:08.877 --> 06:14.552\n哮喘的临床表现与类型是基于炎症细胞的分型。\n\n06:14.552 --> 06:15.927\n分为然后。\n\n06:16.973 --> 06:17.523\n嗜酸型，\n\n06:17.523 --> 06:18.623\n然后嗜酸细胞，\n\n06:18.723 --> 06:19.998\n嗜酸性粒细胞型，\n\n06:19.998 --> 06:21.123\n还有一个中性粒胞型，\n\n06:21.123 --> 06:22.123\n还有少细胞型。\n\n06:22.919 --> 06:24.444\n基于发病的时间的分析，\n\n06:24.894 --> 06:27.118\n主要是一些早发的过敏性的哮喘，\n\n06:27.118 --> 06:29.593\n还有一些晚发的嗜酸性粒细胞的哮喘。\n\n06:30.407 --> 06:32.808\n基于触触发因素的分型是，\n\n06:33.208 --> 06:33.608\n嗯，\n\n06:33.757 --> 06:35.282\n过敏性的哮喘，\n\n06:35.282 --> 06:36.608\n还有感染诱发性的，\n\n06:36.708 --> 06:37.958\n然后运动诱发性的，\n\n06:37.958 --> 06:38.808\n还有阿司匹林的，\n\n06:39.058 --> 06:40.407\n阿司匹林敏感性的。\n\n06:41.915 --> 06:42.864\n临床表现与诊断，\n\n06:42.864 --> 06:45.515\n临床表现主要典型的症状就是喘息、气急，\n\n06:45.515 --> 06:47.315\n然后胸闷与咳嗽。\n\n06:47.315 --> 06:50.165\n客观的证据就是可变的气流受限的诊断标准。\n\n06:51.920 --> 06:52.971\n典型表现，\n\n06:52.971 --> 06:53.996\n典型的临床表现，\n\n06:53.996 --> 06:56.670\n喘息特点就是呼呼吸性的哮鸣音，\n\n06:56.971 --> 06:58.295\n然后持续时间比较长，\n\n06:58.295 --> 07:00.270\n要夜间凌晨凌晨加重，\n\n07:00.471 --> 07:04.071\n然后严重的时候可以称沉默肺成沉默肺。\n\n07:04.371 --> 07:05.170\n危重患者话，\n\n07:05.170 --> 07:06.346\n气流严重的受限，\n\n07:06.346 --> 07:08.670\n然后休眠音反而减弱或者是消失。\n\n07:09.290 --> 07:10.466\n气机就是活动后，\n\n07:10.466 --> 07:12.115\n休息后呼吸困难，\n\n07:12.115 --> 07:13.740\n严重的时候是端坐呼吸，\n\n07:14.140 --> 07:15.640\n就无法平平卧，\n\n07:15.640 --> 07:17.341\n需要坐位或前倾位，\n\n07:17.490 --> 07:19.240\n然后缓解呼吸的困难。\n\n07:20.684 --> 07:20.809\n然后，\n\n07:20.809 --> 07:21.359\n胸闷的话，\n\n07:21.359 --> 07:22.510\n就是胸部的压迫感，\n\n07:22.510 --> 07:23.410\n然后紧缩感，\n\n07:23.410 --> 07:25.084\n可以快可伴有胸痛，\n\n07:25.484 --> 07:25.834\n嗯，\n\n07:25.834 --> 07:27.635\n类似于心绞痛的发作。\n\n07:29.756 --> 07:31.407\n需要与心血管疾病鉴别，\n\n07:31.606 --> 07:33.106\n咳嗽就是干咳少痰，\n\n07:33.106 --> 07:34.532\n然后粘液是呈粘稠，\n\n07:34.532 --> 07:35.756\n呈白色泡沫状，\n\n07:36.057 --> 07:36.907\n然后咳嗽。\n\n07:38.075 --> 07:39.050\n变异性哮喘，\n\n07:39.050 --> 07:40.401\n他咳仅表现为咳嗽，\n\n07:40.401 --> 07:42.126\n然后无喘息和气，\n\n07:42.126 --> 07:42.925\n夜间加重。\n\n07:44.255 --> 07:44.480\n嗯，\n\n07:44.480 --> 07:46.204\n典型的体征的话，\n\n07:46.204 --> 07:47.730\n就是一些发作期的体征，\n\n07:47.730 --> 07:49.454\n就是双肺可闻及哮鸣音，\n\n07:49.804 --> 07:51.954\n呼吸呼气像是延长的。\n\n07:52.105 --> 07:52.579\n然后，\n\n07:52.579 --> 07:54.279\n重症哮喘的体征的话，\n\n07:54.279 --> 07:55.855\n就是典型的三凹症，\n\n07:56.005 --> 07:57.779\n然后胸骨上窝呀，\n\n07:57.779 --> 07:59.304\n锁骨上和肋间隙凹陷。\n\n07:59.654 --> 08:00.054\n然后，\n\n08:00.054 --> 08:03.855\n辅助的呼吸肌的参与是胸锁乳突肌以斜角肌的收缩。\n\n08:04.507 --> 08:04.632\n嗯，\n\n08:04.632 --> 08:07.358\n端坐体呼吸就是被迫坐位或前倾位。\n\n08:08.369 --> 08:11.795\n危重哮喘的体征就是沉默肺，\n\n08:11.795 --> 08:14.519\n然后哮鸣音反而就是减弱或消失了，\n\n08:14.570 --> 08:15.970\n起到了严重阻塞。\n\n08:15.970 --> 08:17.045\n然后意识改变的话，\n\n08:17.045 --> 08:18.470\n就是烦躁嗜睡，\n\n08:18.470 --> 08:19.420\n然后意识模糊。\n\n08:19.519 --> 08:21.720\n发干的话就是咳咳嗽呀，\n\n08:22.070 --> 08:24.369\n发干的话就是口唇及指指甲，\n\n08:24.369 --> 08:26.269\n然后甲床视野青紫的。\n\n08:28.244 --> 08:30.845\n症状特症状特点就是一个发作性的，\n\n08:30.845 --> 08:31.945\n然后可逆性的，\n\n08:31.945 --> 08:34.794\n然后春季节性的一般春春秋季高发，\n\n08:35.094 --> 08:37.494\n与接触过敏原等相关，\n\n08:37.594 --> 08:38.794\n然后夜间加重。\n\n08:39.594 --> 08:40.744\n不典型哮喘的话，\n\n08:40.744 --> 08:45.945\n主要分为一些咳嗽变异性的哮喘及胸闷胸闷性的变异性哮喘，\n\n08:45.945 --> 08:48.294\n还有一些运动性多发性的哮喘。\n\n08:49.992 --> 08:51.692\n哮喘的诊断标准与流程？\n\n08:54.187 --> 08:58.536\n2024版的中国指南是根据它有主要有三点，\n\n08:58.536 --> 09:00.262\n是根据典型的症状与病史，\n\n09:00.262 --> 09:02.836\n还有一个可变的气流受限的客观证据。\n\n09:03.627 --> 09:07.327\n还有以及排除了其他的疾病。\n\n09:08.914 --> 09:11.614\n可变的气流受限的标准就是支气管舒张试验。\n\n09:14.208 --> 09:17.934\n然后F一V增加是大于百分之大于等于12%的，\n\n09:17.934 --> 09:19.684\n且大于200ml的，\n\n09:19.684 --> 09:21.309\n然后支气管激发试验的话。\n\n09:22.031 --> 09:22.981\n是一个阳性的。\n\n09:24.013 --> 09:27.513\nPF变异率的话是日间的变异率是大于10%的，\n\n09:27.664 --> 09:31.013\n然后连续两周诊断要点的话就是，\n\n09:31.164 --> 09:32.763\n拟诊入进症状典型，\n\n09:32.763 --> 09:34.489\n但无条件做肺功能的患者，\n\n09:34.489 --> 09:36.564\n然后可使用支气管扩张剂或者是。\n\n09:37.650 --> 09:39.224\nICS治疗2.3个月，\n\n09:39.224 --> 09:40.224\n然后症状改善的话，\n\n09:40.224 --> 09:41.450\n就是支持治疗的。\n\n09:41.599 --> 09:44.349\n比如检查与生物的标志物，\n\n09:44.700 --> 09:46.400\n主要主要是肺功能的检查。\n\n09:48.765 --> 09:50.340\n通气功能的测定，\n\n09:50.340 --> 09:50.614\nFEV,\n\n09:50.614 --> 09:52.715\n然后比F 1 C哮喘发作的时候，\n\n09:52.715 --> 09:56.515\n是降低小于百分小小于0.7的支气管舒张。\n\n09:56.664 --> 09:57.515\n舒张后的话，\n\n09:57.515 --> 09:58.265\n是改善的。\n\n09:59.354 --> 10:00.005\nFEV,\n\n10:00.005 --> 10:04.755\n然后占预计值的百分比是是用来评估气流受限的严重程度的。\n\n10:05.864 --> 10:09.190\n然后PF就是呼吸呼呼气的风流速，\n\n10:09.190 --> 10:10.664\n还有监测的病情的变化，\n\n10:11.015 --> 10:13.465\n还有支气管镜服装试验的话。\n\n10:15.294 --> 10:16.018\n方法就是，\n\n10:16.268 --> 10:19.119\n吸入那个我促销那个沙丁胺醇，\n\n10:19.119 --> 10:19.794\n400μg，\n\n10:19.794 --> 10:21.456\n然后15.20分钟。\n\n10:21.456 --> 10:23.968\n后来观察来来测F一V一。\n\n10:24.973 --> 10:28.598\n阳性的话是大于大于等于12%，\n\n10:28.598 --> 10:31.223\n且大于200%大于200ml的。\n\n10:33.153 --> 10:34.728\n还有一个支气管激发试验，\n\n10:34.728 --> 10:36.802\n主要是提示一个气道的高反应性，\n\n10:37.103 --> 10:39.853\n它主要常用的是有吸入组胺和甲胆碱。\n\n10:40.572 --> 10:41.122\n然后测定。\n\n10:43.828 --> 10:45.778\n一个气道的炎症的标志物，\n\n10:46.179 --> 10:46.578\n嗯，\n\n10:47.278 --> 10:50.028\n外周血的话就是一个嗜酸性粒细胞的增高，\n\n10:50.028 --> 10:53.229\n还有一个呼出期一氧化碳。\n\n10:53.229 --> 10:55.729\n它主要是反映气道嗜酸性粒细胞的炎症。\n\n10:56.497 --> 10:57.547\n来一个喜庆的爱记。\n\n10:58.481 --> 11:00.807\n然后总的IG升高的话，\n\n11:00.807 --> 11:03.331\n就是提示一个过敏性的体质。\n\n11:06.341 --> 11:09.166\n影像学的检查主要一个胸部癌线，\n\n11:09.166 --> 11:09.642\n然后。\n\n11:10.421 --> 11:12.971\n发作时可以见肺过度的冲击，\n\n11:12.971 --> 11:15.320\n然后用于排出肺炎以及气胸等。\n\n11:15.520 --> 11:16.520\n还有个胸部CT，\n\n11:16.520 --> 11:19.370\n它可以评估气道壁的增厚，\n\n11:19.370 --> 11:20.171\n支气管扩张，\n\n11:20.171 --> 11:20.971\n还有气体的。\n\n11:22.502 --> 11:22.776\n腺鼻，\n\n11:22.776 --> 11:23.651\n还有肺气肿等。\n\n11:25.802 --> 11:28.202\n四点是从严重的程度评估与分级。\n\n11:29.383 --> 11:31.333\n哮喘的三个临床分期的话，\n\n11:31.333 --> 11:32.633\n就是急性发作期。\n\n11:33.604 --> 11:33.780\n嗯，\n\n11:33.780 --> 11:36.005\n还有慢性持续是移植临床的控制期。\n\n11:38.028 --> 11:38.853\n急性发作期的话，\n\n11:38.853 --> 11:40.353\n主要是关于喘息啊，\n\n11:40.353 --> 11:41.578\n气急胸闷等症状。\n\n11:41.578 --> 11:44.203\n突然加突然发生或者急剧加重，\n\n11:44.203 --> 11:44.927\n常伴有。\n\n11:45.843 --> 11:47.268\n呼吸困难诱因的话，\n\n11:47.268 --> 11:48.494\n就是常接触病原，\n\n11:48.494 --> 11:50.343\n或者是刺激呼吸道感染等。\n\n11:51.030 --> 11:52.455\n持慢性持续期的话，\n\n11:52.455 --> 11:56.429\n就是相相当长时间内的不同频率或者程度出现症状，\n\n11:56.429 --> 11:57.830\n肺通气功能是下降的。\n\n11:58.554 --> 11:59.479\n临床控制期的话，\n\n11:59.479 --> 12:00.905\n就是症状和体征消失，\n\n12:01.104 --> 12:03.429\n肺功能恢复到急性发作期水平，\n\n12:03.429 --> 12:05.205\n并维持3个月以上。\n\n12:10.239 --> 12:14.789\n中国指南严重2024版中国指南严重程度的分分级。\n\n12:15.890 --> 12:19.614\n轻度分为轻中度、轻中重度。\n\n12:19.614 --> 12:20.565\n然后轻度的话，\n\n12:20.565 --> 12:22.890\n是每周症状每周小于两次，\n\n12:22.890 --> 12:26.940\n然后夜间症状小于等于每个月两次。\n\n12:26.940 --> 12:29.390\nFEV大于等于大于百分之。\n\n12:30.262 --> 12:31.187\n80的预期值，\n\n12:31.187 --> 12:31.661\n然后P，\n\n12:31.661 --> 12:33.812\nF变异率小于20%中度的话，\n\n12:33.812 --> 12:35.711\n就是每每天都有症状，\n\n12:35.812 --> 12:38.512\n然后夜间的症状是每周大于等于一次，\n\n12:38.611 --> 12:39.861\n然后F一一是。\n\n12:41.507 --> 12:43.257\n60%.79%的预预计值。\n\n12:45.080 --> 12:45.155\nE,\n\n12:45.155 --> 12:46.780\nF变异率是大于30%，\n\n12:46.929 --> 12:48.354\n重症的重度的话，\n\n12:48.354 --> 12:50.330\n就是症状每日都会频繁出现，\n\n12:50.479 --> 12:51.880\n夜间症状频繁，\n\n12:52.179 --> 12:54.304\n然后肺机P\u003C60%的预计值，\n\n12:54.304 --> 12:54.830\n然后P，\n\n12:54.929 --> 12:57.229\nEF变异率大于40%。\n\n12:58.517 --> 13:00.517\n2024版的中南中国指南，\n\n13:00.517 --> 13:02.817\n然后更新为取消间歇状态的分类，\n\n13:02.817 --> 13:04.416\n简化为轻中重度三级，\n\n13:04.617 --> 13:06.666\n然后提出了临床治愈的新概念，\n\n13:06.867 --> 13:08.442\n无症状大于等于一年，\n\n13:08.442 --> 13:09.942\n且无需全身激素治疗，\n\n13:09.942 --> 13:11.416\n采用动态评估的模式。\n\n13:12.486 --> 13:13.885\n哮喘控制的水平。\n\n13:16.875 --> 13:16.976\n嗯，\n\n13:16.976 --> 13:19.776\n主要分为良好控制、部分控制以及未控制。\n\n13:20.966 --> 13:21.690\n评估方法的话，\n\n13:21.690 --> 13:25.716\n主要采用一些HT的评分和或者是a DQ进行量化评估，\n\n13:25.815 --> 13:27.815\n来评估过去四周的控制情况。\n\n13:32.570 --> 13:34.695\n急性发作的严重程度的分级。\n\n13:35.603 --> 13:38.203\n主要也是分为轻、中、重或者重度。\n\n13:42.945 --> 13:44.270\n轻度发作的话，\n\n13:44.270 --> 13:47.796\n可以可以经常可以在家庭或者社区处理的话，\n\n13:47.796 --> 13:49.945\n中度的话主要是在医院处理，\n\n13:49.945 --> 13:52.296\n重度的话就是紧急的抢救，\n\n13:52.296 --> 13:52.796\n然后。\n\n13:53.507 --> 13:54.706\n或者是直接去预约。\n\n13:56.653 --> 13:57.078\n治疗策略，\n\n13:57.078 --> 13:57.853\n药物的选择，\n\n13:58.153 --> 13:59.403\n然可阶梯治疗，\n\n13:59.403 --> 14:01.502\n还有一个生物靶向及药物的分类。\n\n14:03.817 --> 14:05.041\n哮喘药物的治疗的话，\n\n14:05.041 --> 14:07.267\n主要一个控制药物以及缓解药物。\n\n14:07.567 --> 14:08.267\n控制药话，\n\n14:08.267 --> 14:10.905\n主要我们常用的其实就是吸入性的ICS，\n\n14:10.905 --> 14:12.192\n一个白三七啊，\n\n14:12.192 --> 14:15.916\n或者是一个联合的ICS拉板复合制剂。\n\n14:16.017 --> 14:17.642\n复合制剂控制性的话，\n\n14:17.642 --> 14:18.892\n就是一个短效的贝塔，\n\n14:18.892 --> 14:20.267\n然后胆碱药。\n\n14:21.028 --> 14:22.427\n阶梯性的治疗的话，\n\n14:22.427 --> 14:23.627\n一共分为三个，\n\n14:23.627 --> 14:30.078\n主要是根据他们的发作的次数以及肺功能的情况来选来首选方案。\n\n14:33.835 --> 14:35.460\n然生物靶靶向治疗的话，\n\n14:35.460 --> 14:38.960\n主要一些抗癌GE的单抗呀。\n\n14:38.960 --> 14:40.986\n然后我们现在就是阿马珠单抗，\n\n14:41.685 --> 14:46.486\n还有一些什么美伯利单抗或者本瑞利珠单抗治疗啊。\n\n14:46.486 --> 14:47.960\n急性发作期的处理的话，\n\n14:47.960 --> 14:48.435\n就是。\n\n14:49.179 --> 14:49.380\n嗯，\n\n14:49.630 --> 14:50.354\n家庭啊，\n\n14:50.354 --> 14:53.030\n医院或者是呼吸的支持。\n\n14:55.773 --> 14:56.698\n就是立即处理的，\n\n14:56.698 --> 15:02.848\n方轻中度那个急性发作处理就是立即脱敏的立即。\n\n15:03.919 --> 15:04.520\n脱离过敏源，\n\n15:04.520 --> 15:05.369\n然后保持镇静，\n\n15:05.369 --> 15:06.070\n然后舒适，\n\n15:06.119 --> 15:08.719\n然后做有一个合适的体位，\n\n15:08.719 --> 15:09.820\n坐位会前机位。\n\n15:09.869 --> 15:11.244\n然后如果有氧气的话，\n\n15:11.244 --> 15:12.869\n尽量就是高流量吸氧。\n\n15:12.919 --> 15:13.895\n药物治疗的话，\n\n15:13.895 --> 15:15.520\n就是选择一个短效的三管。\n\n15:16.552 --> 15:17.203\n或者是两个，\n\n15:17.552 --> 15:17.927\n嗯，\n\n15:17.927 --> 15:21.203\n异异丙脱溴胺或者是ICS。\n\n15:22.814 --> 15:23.789\n医院的药物治疗的话，\n\n15:23.789 --> 15:25.213\n主要一个支气管扩张剂，\n\n15:25.513 --> 15:25.838\n嗯，\n\n15:25.838 --> 15:29.138\n萨巴达萨或者雾化吸入一些静脉用药的。\n\n15:29.138 --> 15:31.164\n如果对于危重危重症患者的话，\n\n15:31.364 --> 15:33.213\n就是沙丁胺醇加肾上腺素。\n\n15:34.541 --> 15:35.616\n还有一个糖糖病，\n\n15:35.616 --> 15:37.591\n对于中重度发作的话，\n\n15:37.591 --> 15:39.315\n一个静脉的糖霉素激素治疗，\n\n15:39.315 --> 15:40.791\n还有一个口服的糖病激素。\n\n15:41.432 --> 15:43.882\n其他药物就用的是氨茶碱。\n\n15:45.559 --> 15:46.335\n抗菌药物的话，\n\n15:46.335 --> 15:48.734\n主要是根据患者的那个症状，\n\n15:48.734 --> 15:50.085\n然后有没有发烧呀，\n\n15:50.085 --> 15:53.059\n或者合并什么白白细胞增高的。\n\n15:54.473 --> 15:57.122\n或者痰培养出现有原菌感染。\n\n16:01.919 --> 16:02.419\n院的。\n\n16:03.447 --> 16:04.346\n机械通气的病，\n\n16:04.546 --> 16:09.447\n医院的内的治疗处理就是一些呼吸的支持呀，\n\n16:09.447 --> 16:10.096\n氧疗呀。\n\n16:15.629 --> 16:18.254\n最主要的就是一个患者的管理与健康的教育。\n\n16:25.614 --> 16:26.739\n一些关于哮喘，\n\n16:26.739 --> 16:29.414\n那些关于哮喘相关的一些疾病知识，\n\n16:29.414 --> 16:31.414\n还有一些效一些药物的治疗，\n\n16:31.414 --> 16:32.763\n还有一些自我的监测。\n\n16:34.880 --> 16:37.554\n还有一些可以经常反复发作哮喘的话，\n\n16:37.554 --> 16:38.604\n可以啊，\n\n16:38.604 --> 16:41.880\n就是关于那个雾化吸入那个使用的方法。\n\n16:41.929 --> 16:45.604\n雾化就是那个联合那个ICS，\n\n16:45.604 --> 16:49.979\n或者是长效的那个维塔尔受力激动剂那个。\n\n16:50.546 --> 16:51.796\n药物的那个使用。\n\n16:52.687 --> 16:54.286\n要要学会使用。\n\n","v0247cg10004d76c64aljht8goatkvb0",1033,682,"2026-01-26 11:31:47"," \"高效会议管理技巧 - meeting_01.mp4 内容解析\"  "," \"会议管理,高效会议,会议技巧,团队协作,会议记录,meeting_01.mp4\"  "," \"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、时间管理及跟进技巧，助您成为会议主导者。\"  \n\n（注：由于未提供视频具体内容，以上为通用会议主题的SEO优化模板。如需精准内容，建议补充视频关键信息或场景描述。）","2026-05-03 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