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--> 00:00.457\n是。\n\n00:01.778 --> 00:02.028\n好，\n\n00:02.078 --> 00:02.477\n嗯，\n\n00:03.128 --> 00:04.427\n各位同道啊，\n\n00:04.427 --> 00:06.177\n各位医生下午好，\n\n00:06.177 --> 00:09.402\n我们今天讲了一个课件，\n\n00:09.402 --> 00:12.878\n是主要是诊断慢性咳嗽的啊，\n\n00:12.878 --> 00:14.027\n诊断思路啊。\n\n00:14.378 --> 00:18.728\n我想这个从这几个方面来跟大家分享一下，\n\n00:19.027 --> 00:21.128\n第一个是诊断的流程，\n\n00:21.827 --> 00:22.552\n第二个呢，\n\n00:22.552 --> 00:24.527\n是从鉴别诊断方面。\n\n00:25.225 --> 00:25.576\n第三，\n\n00:26.025 --> 00:27.275\n选择几个。\n\n00:28.912 --> 00:30.062\n临床的病例分析，\n\n00:30.461 --> 00:33.012\n最后展望一下这个总结展望，\n\n00:33.361 --> 00:33.762\n嗯。\n\n00:34.567 --> 00:41.966\n慢性咳嗽那个综述一些病因分析跟诊断方法跟大家一起来分享一下。\n\n00:42.367 --> 00:45.567\n那么首先讲慢性咳嗽的。\n\n00:46.501 --> 00:52.501\n概述主要是了解一下慢性咳嗽的基本定义及流行病学的特点。\n\n00:53.529 --> 00:54.005\n那么，\n\n00:54.005 --> 00:57.080\n首先讲慢性咳嗽的基本定义，\n\n00:57.080 --> 00:58.680\n进全球的流行趋势，\n\n00:59.180 --> 01:05.279\n慢性定义慢性咳嗽的定义主要是咳嗽必须持续8周以上，\n\n01:05.730 --> 01:06.629\n同时呢，\n\n01:06.680 --> 01:10.330\n胸片X光检查没有明显的异常，\n\n01:11.080 --> 01:16.330\n多为隐匿性的那个肺部的疾病的表现啊。\n\n01:16.879 --> 01:19.055\n全球流行病学呢，\n\n01:19.055 --> 01:20.004\n研究显示，\n\n01:20.004 --> 01:23.529\n慢性咳嗽在成年人的发病率。\n\n01:23.978 --> 01:27.579\n现在已经达到9%.33%了，\n\n01:27.878 --> 01:36.429\n所以当然它还是随着那个地域跟季节的变化都有相相关的那个区别，\n\n01:37.028 --> 01:37.429\n嗯，\n\n01:37.728 --> 01:40.179\n在年龄跟性别的差别上，\n\n01:40.778 --> 01:43.929\n慢性咳嗽在老年人跟。\n\n01:44.737 --> 01:47.188\n女性的病例中特别常见，\n\n01:47.538 --> 01:50.987\n可能与生理结构跟差别有关，\n\n01:51.538 --> 01:51.938\n嗯。\n\n01:53.466 --> 01:53.916\n第三个，\n\n01:53.916 --> 01:54.640\n第四个呢，\n\n01:54.640 --> 02:00.291\n我们讲跟职业与环境因素影响特定的职业，\n\n02:00.291 --> 02:00.865\n比如。\n\n02:01.753 --> 02:02.253\n教师。\n\n02:03.199 --> 02:04.699\n矿工跟环境，\n\n02:05.050 --> 02:06.849\n那个环境比较污染地区，\n\n02:06.849 --> 02:10.550\n会影响慢性咳嗽的风险会明显的加大啊。\n\n02:10.800 --> 02:12.649\n第五个因素呢，\n\n02:12.649 --> 02:13.399\n就是。\n\n02:14.479 --> 02:15.828\n社会经济的影响，\n\n02:16.078 --> 02:18.479\n慢性咳嗽不仅影响个人的健康，\n\n02:18.828 --> 02:20.779\n还增加的医疗的负担，\n\n02:20.979 --> 02:24.828\n同时大大的影响我们的生活质量。\n\n02:26.619 --> 02:28.820\n从病因分析。\n\n02:29.779 --> 02:30.378\n来讲啊，\n\n02:30.578 --> 02:38.929\n那么慢性咳嗽主要的病因跟作用机制从这几个方面常见的病因是。\n\n02:40.460 --> 02:44.210\n鉴别导致慢性咳嗽的重要的因素，\n\n02:44.561 --> 02:47.811\n那我们现在主要分了几个部位啊。\n\n02:47.811 --> 02:48.610\n主要因素，\n\n02:48.910 --> 02:52.511\n一个是诊断为上气道咳嗽综合症，\n\n02:52.910 --> 02:56.910\n由鼻后滴漏引起的咳嗽，\n\n02:56.910 --> 02:58.860\n常伴有鼻塞跟流涕。\n\n02:59.410 --> 02:59.811\n嗯，\n\n03:00.160 --> 03:04.710\n这个在我们整个的慢性咳嗽中断的比例还是比较高的。\n\n03:05.011 --> 03:06.436\n那个第二个场景，\n\n03:06.436 --> 03:09.261\n现在就胃食管反流症，\n\n03:09.360 --> 03:10.460\n胃酸反流。\n\n03:10.705 --> 03:11.106\n刺激。\n\n03:12.309 --> 03:15.208\n咽喉跟气管导致的慢性咳嗽，\n\n03:16.108 --> 03:17.858\n哮喘啊。\n\n03:17.858 --> 03:19.033\n第三个重要原因，\n\n03:19.033 --> 03:23.908\n那个就是气道的高反应以及炎症引起的反复咳嗽，\n\n03:24.458 --> 03:26.708\n夜间加重特别明显。\n\n03:28.695 --> 03:30.070\n相对少见一点呢，\n\n03:30.070 --> 03:34.845\n一个就是嗜嗜酸细胞的性的支气管炎，\n\n03:35.195 --> 03:40.345\n气道内的那个嗜酸细胞总数明显的增加，\n\n03:40.345 --> 03:45.070\n导致慢性咳嗽加重跟药物副作用，\n\n03:45.070 --> 03:46.619\n我们讲比较常见的。\n\n03:46.619 --> 03:51.544\n所以我们在门诊病人中慢性咳嗽还要问一下这个基础的病史，\n\n03:51.645 --> 03:54.244\n特别是a CER抑制剂的应用，\n\n03:54.395 --> 03:56.345\n它它它比较多见，\n\n03:56.345 --> 03:57.395\n引起的是一种。\n\n03:58.052 --> 04:01.003\n刺激性的干咳停药后就可以缓解啊。\n\n04:01.203 --> 04:04.402\n那么还有一个就是环境因素。\n\n04:04.753 --> 04:08.753\n如果这个病人他也是个空气污染啊，\n\n04:09.102 --> 04:13.152\n过敏原暴露时间长会引起的这个咳嗽。\n\n04:14.029 --> 04:14.429\n嗯，\n\n04:14.479 --> 04:18.778\n当然还有一些比较少见一点的是一个心理性的因素，\n\n04:18.778 --> 04:21.329\n焦虑压力也会心源性的咳嗽。\n\n04:21.729 --> 04:24.653\n还有个这个不算少见，\n\n04:24.653 --> 04:25.503\n也是比较多见。\n\n04:25.503 --> 04:26.878\n我们讲感染后的咳嗽，\n\n04:27.079 --> 04:28.854\n感染呼吸道感染以后，\n\n04:28.854 --> 04:31.878\n咳嗽可以反复持续数周跟数月。\n\n04:31.979 --> 04:32.604\n这个呢，\n\n04:32.604 --> 04:36.979\n当然还有伴发的一些临床的其他的症状，\n\n04:36.979 --> 04:39.153\n比如像那个有痰啊，\n\n04:39.153 --> 04:40.128\n黄叶的痰啊，\n\n04:40.128 --> 04:42.229\n这是这个过程的，\n\n04:42.628 --> 04:44.178\n通过一些血象也可以进。\n\n04:44.203 --> 04:44.752\n进行鉴别，\n\n04:45.303 --> 04:50.153\n我们探讨一下那个慢性咳嗽的病理机制慢，\n\n04:51.102 --> 04:58.153\n它主要还是由这几个刚刚我们讲的那个因素来相关的引起的，\n\n04:58.153 --> 04:58.502\n对吧？\n\n04:58.502 --> 05:02.153\n一个是气道炎性跟高反应性，\n\n05:02.903 --> 05:03.303\n嗯，\n\n05:04.053 --> 05:08.403\n炎性介质释放导致气道的高反应性引起的咳嗽。\n\n05:09.460 --> 05:09.985\n那么，\n\n05:09.985 --> 05:15.911\n神经源性的咳嗽主要是咳嗽受体敏感度增加，\n\n05:16.110 --> 05:17.411\n神经反射增强。\n\n05:18.311 --> 05:21.210\n第三个就是免疫反应的异常，\n\n05:21.661 --> 05:27.010\n免疫细胞活化异常导致的那个持续性的咳嗽，\n\n05:27.811 --> 05:29.210\n粘液分泌过多，\n\n05:29.510 --> 05:33.760\n粘液分泌增加导致刺激气道引起的咳嗽。\n\n05:34.696 --> 05:36.270\n然后呢，\n\n05:36.270 --> 05:37.496\nCOPD或者慢性炎症，\n\n05:37.645 --> 05:40.145\n炎症后的咳嗽主要是气道的重塑，\n\n05:40.545 --> 05:43.545\n慢性炎症导致气道结构的改变，\n\n05:43.746 --> 05:45.496\n增加咳嗽的风险。\n\n05:46.045 --> 05:46.996\n心理因素，\n\n05:47.295 --> 05:48.545\n那个主要是。\n\n05:49.524 --> 05:50.549\n精神压力啊，\n\n05:50.549 --> 05:51.299\n焦虑啊，\n\n05:51.299 --> 05:53.850\n可导致加重，\n\n05:53.850 --> 05:54.825\n咳嗽增加。\n\n05:55.766 --> 05:56.516\n环境因素，\n\n05:56.516 --> 06:00.666\n那个空气污染和过敏暴露。\n\n06:02.000 --> 06:02.950\n原的诱发，\n\n06:03.049 --> 06:04.700\n使咳嗽反应增加。\n\n06:06.867 --> 06:11.266\n我们诊断方法主要大概也就是这个主要的，\n\n06:11.666 --> 06:15.717\n临床上实际我们用的也比较多的诊断工具首先呢，\n\n06:15.717 --> 06:20.717\n就是通过了解病史跟体格检查进行初步的筛选。\n\n06:21.367 --> 06:23.484\n病史中我们刚刚讲了一个，\n\n06:23.484 --> 06:28.416\n是要了解患者咳嗽的持续时间特点跟伴随的症状，\n\n06:29.066 --> 06:31.666\n有助于对病情的筛选。\n\n06:32.420 --> 06:33.720\n进行初步的评判，\n\n06:34.119 --> 06:34.869\n就是说，\n\n06:34.920 --> 06:36.869\n那个比如像服药史啊，\n\n06:37.070 --> 06:40.119\n这个病人是不是有过敏性鼻炎等等，\n\n06:40.220 --> 06:44.970\n那么职业暴露史也是一个重要的问题啊。\n\n06:45.320 --> 06:46.170\n在工作中，\n\n06:46.170 --> 06:47.320\n盛螨的环境啊，\n\n06:47.320 --> 06:48.494\n化学物质刺激啊，\n\n06:48.494 --> 06:49.670\n潜在因素比较多，\n\n06:49.920 --> 06:51.570\n用药时对吧，\n\n06:51.570 --> 06:54.845\n刚刚讲了那么在临床体格检查中，\n\n06:54.845 --> 06:57.095\n我们可以看看是不是有哮鸣音啊，\n\n06:57.095 --> 06:57.795\n罗音啊，\n\n06:57.795 --> 06:59.519\n提供临床的诊断线索，\n\n07:00.019 --> 07:00.644\n还有嘛，\n\n07:00.644 --> 07:02.570\n就是本身这个患者。\n\n07:02.692 --> 07:08.643\n有没有过敏性体质引起的这个过敏原的那个因素家族史？\n\n07:08.643 --> 07:14.842\n这个人是不是有以前的这个遗传基因、遗传因素、生活习惯，\n\n07:15.192 --> 07:18.667\n还有这个抽烟啊，\n\n07:18.667 --> 07:19.493\n饮酒啊，\n\n07:19.493 --> 07:22.792\n这些常常比较多见的病史。\n\n07:22.942 --> 07:23.842\n既往史中，\n\n07:23.842 --> 07:24.917\n我们可以看到，\n\n07:24.917 --> 07:26.542\n它是不是有手术史，\n\n07:26.542 --> 07:32.493\n或者说呼吸系统本身的那个病史基础影响当前的那个。\n\n07:34.063 --> 07:35.063\n临床症状，\n\n07:35.614 --> 07:38.414\n那么在诊断的辅助检查中，\n\n07:38.813 --> 07:41.864\n现代医学技术层出不穷，\n\n07:42.264 --> 07:42.764\n对吧？\n\n07:42.764 --> 07:49.713\n特别是我们现在临床中几个大的项目的检查已经比较成熟了。\n\n07:50.114 --> 07:52.313\n第一个影像学的检查，\n\n07:52.764 --> 07:58.264\n如肺部CT可以清晰的显示肺部细。\n\n07:59.401 --> 08:05.401\n毛细血管的显微细微的变化有益有助于排查那个隐患的病灶。\n\n08:06.001 --> 08:11.851\n肺功能检查通过测定呼气的那个流速跟肺容量，\n\n08:12.101 --> 08:16.050\n可以帮助判断气道阻力及通气功能的障碍。\n\n08:16.851 --> 08:19.651\n第三个就是过敏原的测定。\n\n08:20.269 --> 08:27.670\n通过皮肤点刺及血清检测可以识别可能引起咳嗽的过敏原。\n\n08:27.720 --> 08:34.320\n诱导痰细胞学的检查可以分析痰液中细胞成分，\n\n08:34.419 --> 08:38.794\n辅助诊断嗜酸细胞性支气管炎的诊断。\n\n08:38.794 --> 08:39.119\n所以，\n\n08:39.119 --> 08:42.669\n这个在临床中的诱导痰细胞的检查，\n\n08:42.669 --> 08:44.820\n我们一般也是门诊做的少，\n\n08:44.820 --> 08:47.020\n但主要在病房里做的比较多一点。\n\n08:47.270 --> 08:47.645\n嗯，\n\n08:47.645 --> 08:50.469\n特别是现在我们讲对那个。\n\n08:50.559 --> 08:57.758\n哮喘诊断EEOS的这个细胞技术在临床中越来越得到重视，\n\n08:58.059 --> 09:01.109\n第五个就是24小时的食道PH测定，\n\n09:01.158 --> 09:06.109\n这个主要是监测胃酸反流的频率跟程度，\n\n09:06.359 --> 09:12.458\n对辅助诊断胃食管反流症病达到的一个重要的一个支持。\n\n09:15.090 --> 09:15.440\n那么，\n\n09:15.440 --> 09:16.539\n诊断流程呢，\n\n09:16.539 --> 09:21.840\n我们还是需要提供那个系统化按规范来，\n\n09:22.239 --> 09:26.890\n我们初步诊断这个结果。\n\n09:26.890 --> 09:27.940\n从这几点啊，\n\n09:28.090 --> 09:34.640\n一个是详细分析咳嗽的性质、频率、诱因，\n\n09:34.789 --> 09:39.340\n为诊断提供初步的线索。\n\n09:39.739 --> 09:40.390\n第二，\n\n09:40.690 --> 09:42.989\n利用简单的检查手段，\n\n09:43.390 --> 09:43.789\n嗯，\n\n09:44.039 --> 09:45.440\n如肺功能。\n\n09:45.547 --> 09:48.547\n检测过敏原检测进行初步的筛选。\n\n09:48.997 --> 09:51.247\n第三个就是病史回顾。\n\n09:51.697 --> 09:53.997\n通过回顾患者的病史，\n\n09:54.247 --> 09:56.898\n包括既往病史跟家族史，\n\n09:57.098 --> 09:59.598\n以辅助检测啊，\n\n09:59.848 --> 10:03.497\n那个第四个通过体格检查，\n\n10:03.898 --> 10:05.848\n通过详细的体格检查。\n\n10:06.684 --> 10:07.835\n发现可能的。\n\n10:08.697 --> 10:08.898\n嗯，\n\n10:09.398 --> 10:13.898\n体征异常的体征缩小诊断的范围，\n\n10:14.047 --> 10:18.848\n给我们提供更好的诊断支持。\n\n10:19.598 --> 10:23.447\n影像学检查现在我们临床中越的越来越多，\n\n10:23.447 --> 10:25.898\n也更加重要。\n\n10:26.098 --> 10:26.547\n那么，\n\n10:26.547 --> 10:29.473\n我们常规的在那个社区医院啊，\n\n10:29.473 --> 10:30.497\n地段医院我们。\n\n10:31.119 --> 10:34.169\n看到很多的那个慢性咳嗽病人首诊的可能比较多，\n\n10:34.669 --> 10:37.270\n他们通过那个X胸片也可以。\n\n10:37.270 --> 10:37.744\n当然，\n\n10:37.744 --> 10:38.869\n你到三甲医院啊，\n\n10:38.869 --> 10:39.969\n或者那个，\n\n10:39.969 --> 10:42.369\n多做做就是相对来说吧，\n\n10:42.369 --> 10:45.119\n那个可以使用那个肺部CT扫描啊，\n\n10:45.219 --> 10:49.294\n精细的那个排查肺部其他的疾病啊，\n\n10:49.294 --> 10:50.895\n潜在的疾病进行排查，\n\n10:50.895 --> 10:54.119\n那可以得到更准确的那个影像学的支持。\n\n10:54.619 --> 10:55.645\n实验室检查，\n\n10:55.645 --> 10:57.619\n我们常规进行那个血常规，\n\n10:57.869 --> 10:59.994\n痰培养等，\n\n10:59.994 --> 11:01.369\n实验室进一步明确。\n\n11:01.429 --> 11:01.679\n去。\n\n11:03.080 --> 11:03.931\n病因啊，\n\n11:03.981 --> 11:07.080\n这个是一个流程进一步诊断呢。\n\n11:07.531 --> 11:07.931\n嗯，\n\n11:08.681 --> 11:11.856\n我们主要进行深入的检查了。\n\n11:11.856 --> 11:13.380\n那主要是进入专科了，\n\n11:13.580 --> 11:19.431\n比如像进在我们初步检测也没有检测明显的时候呢，\n\n11:19.481 --> 11:22.330\n可以做进行针对性的检测，\n\n11:22.431 --> 11:26.330\n比如显微支气管镜的检查以明确诊断啊。\n\n11:26.380 --> 11:28.556\n比如有些少见病例啊，\n\n11:28.556 --> 11:33.481\n有些异物卡在那个气管里面也会引起比较少见的一种特殊。\n\n11:33.559 --> 11:34.359\n性的慢性咳嗽，\n\n11:34.609 --> 11:35.708\n这个可以，\n\n11:35.708 --> 11:36.283\n气管镜呢，\n\n11:36.283 --> 11:37.458\n可以明显很。\n\n11:38.966 --> 11:39.166\n嗯，\n\n11:39.166 --> 11:40.466\n达到我们的诊断啊。\n\n11:40.466 --> 11:41.767\n第二个嘛，\n\n11:41.867 --> 11:44.817\n通过那个远程的医疗咨询，\n\n11:45.166 --> 11:46.517\n我们进行会诊。\n\n11:46.517 --> 11:48.916\n有些诊断病例比较特殊，\n\n11:49.117 --> 11:55.492\n利用远程的医疗平台获取那个其他异地专家的意见，\n\n11:55.492 --> 11:56.466\n辅助诊断。\n\n11:57.017 --> 11:57.416\n嗯，\n\n11:57.567 --> 12:00.541\n动态的评估患者症状啊，\n\n12:00.541 --> 12:04.466\n经过治疗诊断性治疗或者以后效果不明显，\n\n12:04.867 --> 12:09.166\n及时调整那个诊断策略还可以。\n\n12:09.242 --> 12:10.017\n所以呢，\n\n12:10.017 --> 12:17.242\n多学科会诊邀请呼吸科、五病眼鼻喉科等多学科专家会诊，\n\n12:17.591 --> 12:22.192\n明确诊断的全面性跟准准确性，\n\n12:22.692 --> 12:23.091\n嗯。\n\n12:24.905 --> 12:25.854\n实验室的诊断，\n\n12:25.854 --> 12:27.630\n我们叫诊断性的治疗啊。\n\n12:27.630 --> 12:29.054\n诊断实在不明确，\n\n12:29.054 --> 12:30.705\n可以尝试短期的治疗，\n\n12:30.705 --> 12:32.354\n以反映，\n\n12:32.554 --> 12:36.804\n这个观察辅助诊断的那个明确性。\n\n12:38.606 --> 12:42.205\n最后一个还要用个体化的诊断方案，\n\n12:42.656 --> 12:46.955\n根据患者的具体情况制定个性化的治疗的计划，\n\n12:46.955 --> 12:48.556\n提高诊断效率。\n\n12:50.502 --> 12:52.052\n那么我们讲到了。\n\n12:52.896 --> 12:56.521\n鉴别诊断慢性咳嗽的常见原因很多，\n\n12:56.521 --> 12:57.546\n也容易误诊，\n\n12:57.846 --> 13:02.046\n那么我们讲讲鉴别诊断的误诊的常见的原因。\n\n13:02.096 --> 13:06.346\n那么一个是症状的相似性，\n\n13:06.796 --> 13:09.096\n不同病因的诊断可以相似，\n\n13:09.096 --> 13:12.947\n如果食道反流症跟哮喘诊断思路的局限性，\n\n13:13.447 --> 13:15.447\n医生可能局限于某种病因，\n\n13:15.447 --> 13:19.497\n忽视了罕见病种患者病史讲的不清楚，\n\n13:19.497 --> 13:22.146\n导致诊断的困难跟实验室。\n\n13:23.013 --> 13:25.414\n检查的手段不够那个。\n\n13:27.956 --> 13:28.606\n完善啊，\n\n13:28.656 --> 13:29.656\n那么还有呢，\n\n13:29.656 --> 13:31.182\n多学科缺乏合作，\n\n13:31.182 --> 13:33.856\n跟患者的依从性差。\n\n13:33.906 --> 13:36.007\n在那个环境污染的干扰，\n\n13:36.606 --> 13:40.557\n所以说鉴别诊断的要点我们要从这几个方面来讲，\n\n13:40.807 --> 13:42.106\n一个是，\n\n13:42.156 --> 13:43.206\n患者的病史，\n\n13:43.906 --> 13:45.656\n所以我们在看病人的时候，\n\n13:45.656 --> 13:46.182\n首先呢，\n\n13:46.182 --> 13:47.856\n病史一定要尽量问的详细，\n\n13:48.156 --> 13:51.557\n伴随的症状是否有咳嗽，\n\n13:51.606 --> 13:52.856\n呼吸困难啊，\n\n13:52.856 --> 13:56.132\n胸闷这些症状帮助鉴别。\n\n13:56.132 --> 13:58.206\n第三个就是咳嗽的性质。\n\n13:58.247 --> 13:59.898\n干咳多见，\n\n13:59.898 --> 14:01.247\n还是有痰湿咳，\n\n14:01.398 --> 14:02.497\n跟感染有关，\n\n14:02.848 --> 14:05.297\n环境的因素诱发的因素，\n\n14:05.648 --> 14:06.072\n对吧，\n\n14:06.072 --> 14:07.247\n这些要要重视。\n\n14:07.398 --> 14:08.197\n还有一个呢，\n\n14:08.197 --> 14:09.697\n就是时间的规律。\n\n14:09.797 --> 14:10.273\n那么，\n\n14:10.273 --> 14:12.997\n我们讲晨咳还是夜间咳？\n\n14:13.247 --> 14:14.398\n我们夜间咳。\n\n14:15.309 --> 14:16.760\n加剧的常见于哮喘，\n\n14:16.760 --> 14:21.260\n而晨起咳嗽与上呼吸道综合症有关。\n\n14:21.460 --> 14:23.859\n那么我举两个简单的病例分析，\n\n14:24.010 --> 14:31.260\n一个是有个患者是45岁吸烟时有的20年持续咳嗽了3个月，\n\n14:31.559 --> 14:33.960\n咳嗽常伴有少量的白痰加重，\n\n14:34.159 --> 14:36.210\n没有呼吸困难。\n\n14:36.409 --> 14:41.409\n然后进一步的进行的肺功能跟肺CT的明确检查，\n\n14:41.510 --> 14:44.010\n诊断他这个病人其实是。\n\n14:44.864 --> 14:48.164\n慢性阻塞性肺病制定的个体化的治疗，\n\n14:48.864 --> 14:49.890\n有的时候也咳嗽，\n\n14:49.890 --> 14:51.315\n它就是COPD了。\n\n14:51.614 --> 14:55.190\n第二个病例就是一个比较相对复杂点的病例，\n\n14:55.190 --> 14:56.015\n她是一个女性，\n\n14:56.015 --> 14:57.265\n30岁的老师，\n\n14:57.614 --> 14:59.515\n咳嗽持续的6个多月。\n\n15:00.302 --> 15:00.627\n嗯，\n\n15:00.627 --> 15:01.653\n没有吸烟症状，\n\n15:01.802 --> 15:03.502\n以干咳流鼻涕为主。\n\n15:03.703 --> 15:04.328\n然后呢，\n\n15:04.328 --> 15:10.403\n初步检测是个过敏过敏性鼻炎跟上气道综合症。\n\n15:10.502 --> 15:13.578\n进一步过敏试验跟鼻腔镜检查以后呢，\n\n15:13.578 --> 15:16.953\n诊断为是过敏性鼻炎跟上气道综合症。\n\n15:17.002 --> 15:17.453\n所以，\n\n15:17.453 --> 15:20.453\n这个要制定个体化的治疗方案。\n\n15:20.953 --> 15:22.302\n展望跟那个。\n\n15:23.440 --> 15:23.966\n方向啊，\n\n15:23.966 --> 15:25.991\n我们所以要诊断思路系统化，\n\n15:26.140 --> 15:27.741\n多学科合作化，\n\n15:27.940 --> 15:31.091\n跟那个个体化的那个诊断，\n\n15:31.341 --> 15:33.940\n所以对我们临床中个的重要。\n\n15:34.140 --> 15:36.241\n所以在持续医疗教育中，\n\n15:36.241 --> 15:38.841\n作为医务人员的培训，\n\n15:39.241 --> 15:41.366\n更新诊断知识，\n\n15:41.366 --> 15:43.491\n提高整体的诊疗水平，\n\n15:43.791 --> 15:45.140\n这个是更加重要。\n\n15:45.140 --> 15:45.716\n还有呢，\n\n15:45.716 --> 15:48.640\n患者的教育加强患者的健康教育，\n\n15:48.791 --> 15:53.640\n提高患者对咳嗽的那个认知跟治理范围是。\n\n15:53.729 --> 15:54.530\n很重要的，\n\n15:54.729 --> 15:55.630\n展望未来，\n\n15:55.630 --> 15:56.554\n咳嗽的未来，\n\n15:56.554 --> 16:04.929\n我们在新技术、新药研发、远程医疗、个性化的治疗中都会得到很好的进步。\n\n16:05.229 --> 16:05.755\n好吧，\n\n16:05.755 --> 16:10.380\n今天就简单的跟大家汇报一下啊，\n\n16:10.630 --> 16:11.630\n那就这样。\n\n","v0247cg10004d71nopiljht4fsje18tg",976,612,"2026-01-26 12:28:47","慢性咳嗽诊断思路：病因分析、检查方法与治疗建议  \n","慢性咳嗽,咳嗽诊断,咳嗽病因,咳嗽检查,咳嗽治疗,持续性咳嗽,咳嗽原因  \n","本文提供详细的慢性咳嗽诊断思路，包括常见病因分析、临床检查方法和治疗建议，帮助患者和医生系统了解慢性咳嗽的可能原因及应对措施。","2026-05-01 00:30:00",[36],{"menuId":37,"menuName":38,"parentId":17,"orderNum":39,"path":40,"component":41,"isFrame":42,"isCache":43,"menuType":44,"visible":25,"status":17,"createDept":6,"remark":23,"createTime":45,"children":46,"columnImage":47,"columnLogo":48,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":49,"seoKeywords":50,"seoDescription":51,"contentNum":6,"promotionalPoster":52,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":53,"routerPath":40,"componentInfo":41},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 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