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--> 00:04.538\n我们今天讲一下支气管扩张症。\n\n00:08.317 --> 00:08.491\n嗯，\n\n00:08.491 --> 00:10.366\n关于支气管扩张，\n\n00:10.817 --> 00:11.817\n它的定义，\n\n00:11.866 --> 00:16.816\n它是一种以支气管不可逆的扩张为特性的慢性肺部疾病。\n\n00:17.066 --> 00:18.341\n它的病理表现呢，\n\n00:18.341 --> 00:21.216\n是为支气管的肌肉和弹性组织的破坏，\n\n00:21.316 --> 00:24.367\n导致支气管持久性的一个异常的扩张。\n\n00:24.966 --> 00:25.666\n这个病呢，\n\n00:25.666 --> 00:27.367\n可能发生在任何的年纪，\n\n00:27.617 --> 00:30.716\n但是多数在儿童或者青少年期起病。\n\n00:31.268 --> 00:31.794\n根据统计，\n\n00:31.794 --> 00:34.219\n在我国40岁以上的人群当中，\n\n00:34.469 --> 00:37.719\n支气管扩张症的患病则为1.2%，\n\n00:37.918 --> 00:39.969\n并且女性略多于男性。\n\n00:40.519 --> 00:42.543\n在流行病学特点方面，\n\n00:42.543 --> 00:45.868\n支气管扩张的发病与多种因素相关，\n\n00:46.118 --> 00:48.969\n比如地域上如果潮湿寒冷的地方，\n\n00:49.019 --> 00:50.719\n发病率相对会较高，\n\n00:50.918 --> 00:53.819\n社会经济条件状况较差的人群当中，\n\n00:53.819 --> 00:56.969\n由于居住环境差、医疗条件有限等，\n\n00:57.019 --> 00:58.769\n发病率也有所上升。\n\n01:01.148 --> 01:01.723\n病因方面，\n\n01:01.723 --> 01:03.249\n第一点还是感染因素，\n\n01:03.249 --> 01:05.549\n首先会有一个呼吸道的感染史，\n\n01:05.799 --> 01:13.749\n在童年时期的麻疹、百日咳等急性呼吸道传染疾病引发的支气管、肺组织感染和免疫损伤，\n\n01:13.899 --> 01:16.948\n这些都是导致支扩的最重要的原因之一。\n\n01:17.740 --> 01:23.740\n这些感染会导致支气管粘膜充血、水肿、纤毛柱状上皮坏死、细胞坏死脱落，\n\n01:23.941 --> 01:27.191\n导致气管的管壁的防御功能受损。\n\n01:27.940 --> 01:29.864\n从而为细菌滋生创造条件，\n\n01:29.864 --> 01:32.040\n进一步加重支气管的炎症反应，\n\n01:32.040 --> 01:34.089\n最终发展为支气管扩张。\n\n01:34.839 --> 01:36.264\n而细菌感染类呢，\n\n01:36.264 --> 01:40.989\n常见的致病菌包括铜绿假单胞菌、金黄色葡萄球菌。\n\n01:40.989 --> 01:45.690\n铜绿假单胞菌是具有较耐较强的耐药性和生物病膜形成能力，\n\n01:46.239 --> 01:48.464\n容易在支气管内长期的定植，\n\n01:48.464 --> 01:52.540\n并且反复的感染造成支气管管壁的结构破坏。\n\n01:53.121 --> 01:56.621\n金葡菌产生的毒素则可以直接损伤支气管黏膜，\n\n01:56.621 --> 01:58.521\n引起局部反应，\n\n01:58.570 --> 01:59.545\n炎症反应，\n\n01:59.545 --> 02:01.621\n导致一个支气管扩张的发生。\n\n02:02.121 --> 02:03.570\n而遗传方面呢，\n\n02:03.621 --> 02:04.021\n嗯，\n\n02:04.221 --> 02:07.195\n它主要相关的是有某些遗传疾病，\n\n02:07.195 --> 02:10.921\n比如囊性纤维化、阿尔法一抗凝蛋白酶缺乏等，\n\n02:10.921 --> 02:13.070\n与支气管扩张密切相关。\n\n02:13.421 --> 02:17.121\n囊性纤维化是一种常染色体的隐性遗传病。\n\n02:17.740 --> 02:22.940\n患者因基因缺陷导致汗腺、呼吸道等外分泌的水盐代谢障碍，\n\n02:23.190 --> 02:24.339\n粘液分泌过度，\n\n02:24.339 --> 02:25.490\n且粘稠度增加，\n\n02:25.690 --> 02:26.615\n不容易排出，\n\n02:26.615 --> 02:27.740\n堵塞了支气管，\n\n02:27.889 --> 02:29.690\n从而引发支气管扩张。\n\n02:30.039 --> 02:34.289\n阿法一抗抗酶抗胰酶蛋白缺乏症呢，\n\n02:34.289 --> 02:37.690\n是由于阿尔法一抗胰酶蛋白基因的突变，\n\n02:37.940 --> 02:40.539\n导致钙酶的活性降低或者缺失，\n\n02:40.690 --> 02:45.139\n无法有效抑制中性粒细胞弹力蛋白酶对肺组织的破坏作用。\n\n02:45.190 --> 02:47.990\n从而使得支气管的弹力纤维。\n\n02:48.072 --> 02:48.522\n会受损，\n\n02:48.522 --> 02:50.022\n逐渐形成一个支扩。\n\n02:53.309 --> 02:53.460\n嗯，\n\n02:53.460 --> 02:55.059\n在临床表现方面呢，\n\n02:55.059 --> 02:57.759\n主要还是一个慢性的咳嗽与咳痰。\n\n02:58.802 --> 02:59.302\n患者呢，\n\n02:59.302 --> 03:01.602\n长期存在慢性的咳嗽，\n\n03:01.701 --> 03:03.901\n而咳嗽的程度是不等的，\n\n03:04.102 --> 03:05.352\n可轻可重。\n\n03:05.751 --> 03:08.701\n咳痰是支气管扩张症的主要症状之一，\n\n03:09.102 --> 03:10.451\n痰液量比较多，\n\n03:10.552 --> 03:14.852\n颜色会呈黄绿色或者白色粘液的脓性痰。\n\n03:15.938 --> 03:17.863\n部分患者痰液静置之后呢，\n\n03:17.863 --> 03:18.488\n会分层，\n\n03:18.888 --> 03:19.738\n主要三层，\n\n03:19.938 --> 03:21.287\n上层为泡沫，\n\n03:21.638 --> 03:22.938\n中层为粘液，\n\n03:23.238 --> 03:24.837\n下层则为坏死。\n\n03:24.837 --> 03:26.537\n坏死的组织沉淀物。\n\n03:27.348 --> 03:28.748\n当合并感染的时候呢，\n\n03:28.748 --> 03:30.998\n咳嗽和咳痰会明显增加。\n\n03:31.917 --> 03:34.268\n痰量增多且性质发生改变，\n\n03:34.268 --> 03:35.968\n会伴有一个恶臭味。\n\n03:37.201 --> 03:40.602\n反复的咯血是支气管扩张较为常见的症状，\n\n03:40.901 --> 03:42.852\n咯血量的差异比较大，\n\n03:43.302 --> 03:46.102\n会从痰中带血丝到大量的咯血。\n\n03:47.177 --> 03:54.626\n咯血的主要原因是支气管动脉与肺动脉之间的终末支、终末支的吻合支破裂出血。\n\n03:54.977 --> 03:59.576\n小量的咯血可能是由于支气管黏膜微血管破裂所导致，\n\n03:59.876 --> 04:04.326\n而大量的咯血则往往是由于支气管动脉分支畸形，\n\n04:04.326 --> 04:08.477\n或者扩张的支气管壁血管破裂引起。\n\n04:08.727 --> 04:09.901\n严重的时候呢，\n\n04:09.901 --> 04:12.126\n大量的咯血是会危及生命的。\n\n04:14.360 --> 04:15.360\n在体征方面，\n\n04:15.860 --> 04:17.826\n医生肺部听诊会发现，\n\n04:17.826 --> 04:22.660\n在病变的部位会听到局限性、固定性的湿罗音，\n\n04:23.059 --> 04:28.309\n这是因为支气管扩张处的集聚了大量的粘液粘性渗出物，\n\n04:28.660 --> 04:29.798\n当呼吸时，\n\n04:29.798 --> 04:35.309\n气体通过这些粘稠物质会产生类似水泡破裂的声音。\n\n04:35.609 --> 04:37.510\n而随着病情的发展，\n\n04:37.709 --> 04:41.859\n若并发前并发肺气肿或肺心病，\n\n04:41.959 --> 04:44.559\n还会听到哮鸣音和其他的。\n\n04:44.600 --> 04:45.299\n异常弧形。\n\n04:49.664 --> 04:51.313\n在诊断方法方面，\n\n04:51.313 --> 04:54.213\n首先是影血影像学的检查。\n\n04:54.614 --> 04:56.313\n高分辨率的CT。\n\n04:57.136 --> 04:57.911\n嗯，\n\n04:57.911 --> 05:02.136\nHICT是目前诊断支扩最常用且最准确的方法，\n\n05:02.486 --> 05:09.536\n它能够清晰的显示支气管扩张的形态、范围以及伴随肺部病变的情况。\n\n05:10.466 --> 05:13.816\n典型的HICT表现包括硬结症，\n\n05:14.165 --> 05:17.566\n支气管扩张伴相邻的肺动脉增粗，\n\n05:17.966 --> 05:20.441\n二者横断面类似介质，\n\n05:20.441 --> 05:21.265\n轨道针，\n\n05:21.615 --> 05:26.265\n扩张的支气管与伴行的肺动脉平行排列类似轨道。\n\n05:27.436 --> 05:30.985\nHRCT还能区分不同类型的支气管扩张，\n\n05:31.286 --> 05:34.635\n如柱状扩张、囊状扩张等等，\n\n05:34.835 --> 05:39.135\n有助于评估病情严重的程度和指导治疗方案的选择。\n\n05:39.885 --> 05:43.085\n而在用X线胸片诊断的时候，\n\n05:43.085 --> 05:46.985\n对于支扩的诊断是具有一定的局限性的，\n\n05:47.235 --> 05:51.585\n但对于初步的筛查和观察并发症还是有价值的。\n\n05:52.618 --> 05:53.592\nX线胸片呢，\n\n05:53.592 --> 05:56.692\n是可以看到双轨针卷发样阴影等，\n\n05:56.692 --> 06:01.167\n借鉴间接的真相提示可能存在支气管扩张。\n\n06:01.368 --> 06:01.917\n然而，\n\n06:01.917 --> 06:03.467\n由于分辨率较低，\n\n06:03.667 --> 06:08.018\n是难以判断支气管扩张的具体部位、形态等情况。\n\n06:08.855 --> 06:12.804\n因此也需要结合其他检查手段进行一个综合的诊断。\n\n06:14.630 --> 06:16.130\n在实验室检查方面，\n\n06:16.130 --> 06:18.130\n我们主要用痰液检查。\n\n06:18.480 --> 06:22.179\n痰液检查是可以了解感染的病原菌的种类，\n\n06:22.380 --> 06:24.980\n而为抗生素的选择提供依据。\n\n06:25.429 --> 06:27.454\n通过痰液的涂片镜检，\n\n06:27.454 --> 06:32.029\n可以发现白细胞、红细胞、夏克莱登结晶等成分，\n\n06:32.529 --> 06:36.179\n有助于判断是否存在感染以及感染的程度。\n\n06:36.579 --> 06:41.279\n痰培养则是确定致病菌以及药药物敏感性的金标准。\n\n06:42.053 --> 06:43.204\n根据痰培养的结果，\n\n06:43.204 --> 06:44.528\n合理选用抗生素，\n\n06:44.528 --> 06:45.854\n提高治疗效果。\n\n06:46.739 --> 06:48.040\n在血液检查方面，\n\n06:48.040 --> 06:51.690\n血常规的检查是可以看到白细胞的升高，\n\n06:51.890 --> 06:54.390\n尤其是中性粒细胞的比例增加，\n\n06:54.640 --> 06:56.890\n表明机体存在感染状态。\n\n06:58.898 --> 07:01.174\nCP和P、CT等炎症指标呢，\n\n07:01.174 --> 07:04.299\n也可能会升高反映炎症反应的程度。\n\n07:05.001 --> 07:05.351\n此外，\n\n07:05.450 --> 07:08.151\n对于怀疑有免疫系统异常的患者，\n\n07:08.151 --> 07:10.501\n还需要进行免疫功能检测，\n\n07:10.851 --> 07:15.101\n比如测定免疫球蛋白水平、T细胞亚群等，\n\n07:15.200 --> 07:19.601\n排除相关免疫性疾病引起的继发性的支气管扩张。\n\n07:21.669 --> 07:23.069\n在治疗措施方面，\n\n07:23.118 --> 07:24.493\n普通的一般治疗呢，\n\n07:24.493 --> 07:27.218\n主要是病情的监测和健康的教育。\n\n07:27.569 --> 07:32.669\n对于支扩患者进行定期进行病情的监测是非常重要的，\n\n07:32.669 --> 07:36.368\n包括肺功能的检测、肺部影像学检查等等，\n\n07:36.769 --> 07:39.044\n以便及时掌握病情的变化，\n\n07:39.044 --> 07:40.319\n调整治疗方案。\n\n07:40.618 --> 07:42.419\n同时加强健康教育，\n\n07:42.419 --> 07:44.769\n可以向患者普及疾病的知识，\n\n07:44.968 --> 07:47.019\n使其了解疾病的危害性，\n\n07:47.269 --> 07:49.468\n诱发因素以及预防的措施。\n\n07:49.868 --> 07:50.868\n避免吸烟，\n\n07:50.919 --> 07:51.868\n减少接。\n\n07:51.959 --> 07:53.709\n接触有害的气体和粉尘，\n\n07:54.160 --> 07:56.359\n提高患者的自我管理能力，\n\n07:56.410 --> 07:57.660\n积极配合治疗。\n\n07:59.596 --> 08:03.796\n呼吸功能的锻炼指导患者进行有效的呼吸功能锻炼，\n\n08:03.997 --> 08:06.997\n如缩成呼吸、腹式呼吸等等，\n\n08:07.196 --> 08:09.247\n可以增加呼吸肌的力量，\n\n08:09.446 --> 08:10.846\n改善通气功能，\n\n08:10.997 --> 08:12.897\n减轻呼吸困难症状。\n\n08:13.196 --> 08:13.846\n此外，\n\n08:13.897 --> 08:17.846\n适当的体育锻炼也助于有助于提高身体的素质，\n\n08:17.846 --> 08:18.846\n增强免疫力。\n\n08:18.997 --> 08:20.096\n但要注意的是，\n\n08:20.096 --> 08:22.096\n运动强度要循序渐进，\n\n08:22.296 --> 08:25.147\n避免过度劳累而诱发急性发作。\n\n08:27.475 --> 08:28.725\n在药物治疗方面，\n\n08:28.725 --> 08:30.725\n首先是抗感染治疗，\n\n08:31.475 --> 08:33.849\n根据痰培养和药敏实验的结果，\n\n08:33.849 --> 08:36.825\n选择合适匹配的抗菌药物，\n\n08:36.974 --> 08:40.325\n积极控制感染是治疗支扩的关键环节。\n\n08:41.086 --> 08:45.161\n常用的抗菌素包括贝他内酰胺类、喹诺酮类。\n\n08:45.161 --> 08:54.887\n对于铜绿假单胞菌的感染则选用头孢他啶、哌拉西林、他巴唑、巴他他唑、巴坦等较强的抗菌活性的药物。\n\n08:55.236 --> 08:57.536\n在使用抗菌药物的过程当中，\n\n08:57.637 --> 08:59.036\n应该合理用药，\n\n08:59.036 --> 09:02.736\n避免滥用抗生素导导致一个耐药菌株的产生。\n\n09:03.770 --> 09:04.619\n对症治疗方面，\n\n09:04.770 --> 09:06.320\n嗯采取祛痰治疗。\n\n09:06.619 --> 09:09.445\n祛痰有助于清除气道的分泌物，\n\n09:09.445 --> 09:11.094\n保持气道的通畅，\n\n09:11.094 --> 09:12.469\n减少感染机会。\n\n09:12.820 --> 09:17.020\n临床上常用的祛痰药有氨溴索、乙酰半胱氨酸等。\n\n09:17.270 --> 09:20.919\n氨溴索是通过溶解痰液中的黏蛋白，\n\n09:21.219 --> 09:22.869\n降低痰液的粘度，\n\n09:22.969 --> 09:24.419\n促进痰液的排出。\n\n09:25.070 --> 09:29.919\n乙酰半胱氨酸能够裂解黏蛋白分子间的二硫键，\n\n09:29.919 --> 09:31.719\n使其粘液稀释，\n\n09:31.869 --> 09:32.869\n易于咳出。\n\n09:33.478 --> 09:36.828\n雾化吸入祛痰药也是一种有效的给药方式，\n\n09:37.028 --> 09:38.978\n可直接作用于气道黏膜，\n\n09:38.978 --> 09:39.978\n提高疗效。\n\n09:41.271 --> 09:43.072\n在其他的辅助治疗方面，\n\n09:43.322 --> 09:45.521\n对于喘息症状严重的患者，\n\n09:45.521 --> 09:47.921\n可以适当使用支气管舒张剂，\n\n09:48.122 --> 09:50.572\n如沙丁胺醇、气雾剂等等，\n\n09:50.721 --> 09:52.247\n缓解支气管痉挛，\n\n09:52.247 --> 09:53.872\n改善肺通气功能。\n\n09:54.021 --> 09:58.822\n糖皮质激素在某些情况下也可以用于减轻气道炎症反应，\n\n09:59.072 --> 10:00.721\n但是必须谨慎使用，\n\n10:00.921 --> 10:04.021\n避免长期大剂量的使用带来不良的反应。\n\n10:06.185 --> 10:09.786\n然后我们分析一下支气管扩张的一些主要的病因。\n\n10:10.630 --> 10:12.781\n所谓的还是一个呼吸道的感染。\n\n10:13.669 --> 10:14.343\n儿童时期，\n\n10:14.343 --> 10:18.818\n如果频繁反复发作的一个肺部的感染是最常见的诱因，\n\n10:18.919 --> 10:20.268\n比如百日咳啊，\n\n10:20.268 --> 10:21.193\n麻疹肺炎啊，\n\n10:21.193 --> 10:22.919\n肺结核、细菌性肺炎等等，\n\n10:23.169 --> 10:27.318\n这些会损伤肺部支气管支气管壁的一个结构。\n\n10:27.568 --> 10:30.369\n然后还有一个慢性的支气管阻塞，\n\n10:30.369 --> 10:33.468\n比如说异物、肿瘤、淋巴肿大等，\n\n10:33.468 --> 10:35.268\n导致一个支气管的引流不畅，\n\n10:35.369 --> 10:37.518\n分泌物潴留引发的一个感染，\n\n10:37.518 --> 10:39.018\n破坏了支气管的管壁。\n\n10:39.568 --> 10:41.068\n还有先天遗传因素。\n\n10:41.614 --> 10:44.015\n罕见的原因比如囊性的纤维化，\n\n10:44.015 --> 10:46.440\n原发性的纤毛运动障碍，\n\n10:46.440 --> 10:49.465\n先天性的支气管软骨发育不良等等。\n\n10:49.664 --> 10:50.590\n这些患者呢，\n\n10:50.590 --> 10:52.364\n多为青少年期的疾病。\n\n10:53.181 --> 10:53.981\n而其他的因素，\n\n10:53.981 --> 10:56.931\n比如说长期吸入有害的气体或者粉尘，\n\n10:57.181 --> 10:58.481\n免疫功能低下，\n\n10:58.630 --> 11:03.806\n比如艾滋病患者、免疫缺陷患者、类风湿性关节炎等自身免疫疾病，\n\n11:03.806 --> 11:06.181\n也可能会诱发一个支气管的扩张。\n\n11:07.354 --> 11:10.554\n他们大多数的临床表现还是比较典型的，\n\n11:10.554 --> 11:12.179\n是一个慢性的咳嗽，\n\n11:12.179 --> 11:13.554\n伴大量的咳痰。\n\n11:14.153 --> 11:15.754\n支扩患者的咳痰呢，\n\n11:15.754 --> 11:17.653\n是比较有特征性的，\n\n11:17.903 --> 11:22.403\n刚刚讲到的分层咯血也是一个最主要的症状，\n\n11:22.403 --> 11:26.104\n他们大多数的患者会出现一个不同程度的咯血。\n\n11:26.781 --> 11:27.806\n轻的患者呢，\n\n11:27.806 --> 11:29.330\n只是痰中带血，\n\n11:29.380 --> 11:31.431\n而重者突发的大咯血，\n\n11:31.431 --> 11:34.281\n一次性的量可能会大于100ml，\n\n11:34.531 --> 11:37.481\n严重的时候会引发一个窒息或者休克。\n\n11:38.947 --> 11:40.747\n而反复的一个肺部感染，\n\n11:40.747 --> 11:43.997\n因为他的肺部支气管壁受损之后呢，\n\n11:43.997 --> 11:45.997\n会发生一个反复的肺部感染。\n\n11:46.297 --> 11:48.322\n同一个肺段发生的炎症呢，\n\n11:48.322 --> 11:51.547\n表现为发热、咳嗽加剧、脓痰增多，\n\n11:51.747 --> 11:55.997\n还可能伴有乏力、食欲减退、体重下降等等全身症状。\n\n11:56.619 --> 11:59.969\n因为它可能某些程度上也属于一个消耗性的疾病。\n\n12:01.091 --> 12:03.890\n慢慢的患者会出现一个呼吸困难，\n\n12:03.991 --> 12:06.598\n病变范围广或者合并慢，\n\n12:06.598 --> 12:09.440\n阻肺的时候会出现一个活动后的气喘，\n\n12:09.640 --> 12:12.491\n晚期可能会发生呼吸衰竭。\n\n12:14.260 --> 12:15.835\n在查体方面呢，\n\n12:15.835 --> 12:19.460\n我们是可以听到病变部位有着固定的湿罗音，\n\n12:19.661 --> 12:20.736\n部分患者呢，\n\n12:20.736 --> 12:22.411\n还会有一个杵状指，\n\n12:22.411 --> 12:24.560\n是因为长期的一个慢性缺氧。\n\n12:26.099 --> 12:30.875\n临床的诊断还是主要依靠高分辨率的CT啊，\n\n12:30.875 --> 12:37.200\n然后肺功能的检查主要还是用于评估目前的阻塞症状那个程度。\n\n12:37.500 --> 12:38.724\n痰液的检查呢，\n\n12:38.724 --> 12:40.799\n主要还是明确一个致病菌。\n\n12:41.500 --> 12:41.900\n嗯，\n\n12:41.950 --> 12:43.450\n支气管检查呢，\n\n12:43.599 --> 12:49.549\n支气管镜的检查是用于排除支气管内的异物肿瘤等慢性阻塞性的疾病，\n\n12:49.650 --> 12:53.650\n也可以用于咯血时的一个局局部的止血治疗。\n\n12:55.218 --> 12:58.369\n在治疗方面的重中之重还是控制感染，\n\n12:58.419 --> 13:02.018\n不管是在急性加重期还是在缓解期。\n\n13:02.419 --> 13:03.169\n但是呢，\n\n13:03.169 --> 13:06.818\n在缓解期的时候是不建议长期使用口服抗生素，\n\n13:07.068 --> 13:09.968\n可以在医生的指导下用雾化吸入抗生素，\n\n13:09.968 --> 13:11.119\n如妥布霉素，\n\n13:11.169 --> 13:13.718\n减少气道内的细菌定植。\n\n13:14.734 --> 13:15.159\n其次呢，\n\n13:15.159 --> 13:17.234\n还是促进一个痰液的引流。\n\n13:17.585 --> 13:17.984\n嗯，\n\n13:18.135 --> 13:20.835\n常用的还是一个体位的引流，\n\n13:20.835 --> 13:24.085\n运用祛痰药物或者是局部的物理治疗。\n\n13:24.335 --> 13:24.659\n嗯，\n\n13:24.659 --> 13:25.609\n体位引流呢，\n\n13:25.609 --> 13:27.635\n主要还是采取相应的体位，\n\n13:27.635 --> 13:29.460\n使病变段处于一个高位，\n\n13:29.460 --> 13:30.934\n促进痰液的排出。\n\n13:31.335 --> 13:32.934\n每天大概一到两次，\n\n13:32.934 --> 13:34.684\n每次15.30分钟。\n\n13:35.377 --> 13:37.026\n而肺、胸部的物理治疗，\n\n13:37.026 --> 13:40.177\n比如拍背震动排痰仪辅助排痰，\n\n13:40.476 --> 13:43.377\n适合痰液粘稠、体弱无力的咳痰患者。\n\n13:45.094 --> 13:46.994\n而在咯血的时候的处理呢？\n\n13:47.044 --> 13:49.445\n少量的咯血仅需要卧床休息，\n\n13:49.594 --> 13:53.044\n口服氨甲环酸、云南白药等止血药物止血，\n\n13:53.395 --> 13:56.119\n而当处于中大量排血的时候，\n\n13:56.119 --> 13:57.445\n则需要住院治疗，\n\n13:57.844 --> 14:01.445\n静脉使用垂体后叶素、酚托拉明等等，\n\n14:01.594 --> 14:05.945\n必要时则会进行支气管的动脉栓塞术。\n\n14:06.705 --> 14:07.755\n若出现窒息呢，\n\n14:08.005 --> 14:09.604\n则需要立即行插管，\n\n14:09.604 --> 14:11.455\n插气管插管或者气管切开。\n\n14:12.794 --> 14:14.093\n手术治疗的话呢，\n\n14:14.093 --> 14:17.093\n适用于病变比较局限的患者。\n\n14:17.093 --> 14:22.193\n比如说单侧的肺段或者肺叶反复大量的咯血或者感染的时候，\n\n14:22.294 --> 14:24.068\n且药物治疗无效的患者，\n\n14:24.068 --> 14:26.443\n可进行肺段或者肺叶清除术。\n\n14:27.276 --> 14:30.252\n双侧广泛的病变患者一般不建议此治疗。\n\n14:30.252 --> 14:30.726\n手术。\n\n14:32.432 --> 14:33.833\n在长期管理方面，\n\n14:33.833 --> 14:35.682\n还是要建议患者戒烟，\n\n14:35.882 --> 14:38.583\n远离粉尘或者有害气体，\n\n14:38.732 --> 14:40.283\n预防呼吸道的感染。\n\n14:40.632 --> 14:45.682\n然后每年定期接种流感疫苗和肺炎链球菌疫苗，\n\n14:46.033 --> 14:47.583\n防止重症的发生。\n\n14:48.232 --> 14:48.658\n然后，\n\n14:48.658 --> 14:50.958\n其次平时要注意加强营养，\n\n14:50.958 --> 14:52.333\n适度的锻炼，\n\n14:52.533 --> 14:54.132\n增强自身体质。\n\n14:54.132 --> 14:55.982\n免疫功能低下的患者呢，\n\n14:56.033 --> 14:59.833\n则在医生的指导下使用免疫调节剂。\n\n15:00.083 --> 15:02.632\n还有就是需要一个定期的一个。\n\n15:02.692 --> 15:03.492\n健康随访，\n\n15:03.492 --> 15:04.291\n健康观察，\n\n15:04.642 --> 15:07.317\n定期复查CT和肺功能，\n\n15:07.317 --> 15:09.192\n监测病情的变化。\n\n15:10.286 --> 15:10.486\n嗯，\n\n15:10.685 --> 15:11.661\n大咯血呢，\n\n15:11.661 --> 15:14.236\n其实是支气管扩张的一个危急的并发症。\n\n15:14.486 --> 15:18.685\n如果突发的出现咯血增多、胸闷、呼吸困难，\n\n15:18.685 --> 15:20.236\n是需要及时就医的，\n\n15:20.236 --> 15:22.935\n避免窒息以及危及生命。\n\n15:23.036 --> 15:24.960\n反复感染未控制的患者呢，\n\n15:24.960 --> 15:28.236\n可能会进展为肺心病、呼吸衰竭。\n\n15:29.729 --> 15:29.979\n好，\n\n15:30.030 --> 15:31.429\n我的分享到此结束。\n\n","v0247cg10004d71lfnaljht3m21p1fkg",936,964,"2026-01-26 12:09:47","高效会议记录技巧 - 快速掌握会议要点  ","会议记录,高效会议,会议技巧,快速记录,会议管理,职场技能  ","通过\"meeting_quick_record.mp4\"学习高效会议记录方法，掌握快速整理会议核心内容的技巧，提升职场会议效率与信息留存能力。适合所有需要优化会议流程的职场人士观看。","2026-05-02 06:30:00",[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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