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慢性阻塞性肺疾病、支气管哮喘、支气管扩张等呼吸系统常见病的规范诊断与治疗 肺癌的规范诊断与综合治疗；肺癌的规范诊断与综合治疗","上海市东方医院","呼吸内科","主治医师",9,"慢性咳嗽规范化诊治","","https://cdn.yishi-tong.com/console/3/h7etaT1WX27htBXiXIT8Kk9eeuf2K5BH.png",1,"WEBVTT\n\n00:02.311 --> 00:03.111\n各位大家好，\n\n00:03.411 --> 00:05.960\n今天给大家做一个临床讲座，\n\n00:06.410 --> 00:08.711\n慢性咳嗽规范化诊治。\n\n00:11.173 --> 00:12.798\n今天讲座的内容呢，\n\n00:12.798 --> 00:14.373\n分为以下七个方面。\n\n00:15.729 --> 00:16.579\n第一个部分呢，\n\n00:16.579 --> 00:17.930\n是开篇引言。\n\n00:18.629 --> 00:19.780\n第二个部分呢，\n\n00:19.780 --> 00:21.930\n是慢性咳嗽病因分类。\n\n00:22.479 --> 00:23.204\n第三呢，\n\n00:23.204 --> 00:26.879\n是慢性咳嗽临床表现和鉴别诊断的要点。\n\n00:27.530 --> 00:28.454\n第四呢，\n\n00:28.454 --> 00:31.479\n是慢性咳嗽规范诊断的流程。\n\n00:32.080 --> 00:32.854\n第五呢，\n\n00:32.854 --> 00:35.729\n是慢性咳嗽针对性的治疗方案。\n\n00:36.229 --> 00:37.005\n第六呢，\n\n00:37.005 --> 00:39.630\n是慢性咳嗽临床管理与预后。\n\n00:39.930 --> 00:40.729\n第七呢，\n\n00:40.729 --> 00:43.279\n是慢性咳嗽总结与展望。\n\n00:45.299 --> 00:48.549\n接下来就进入今天讲座的第一个内容，\n\n00:48.549 --> 00:49.650\n开篇引言。\n\n00:50.894 --> 00:51.844\n咳嗽呢，\n\n00:51.844 --> 00:57.444\n按照时间分为急性咳嗽、亚急性咳嗽、慢性咳嗽。\n\n00:57.993 --> 01:00.293\n咳嗽时间小于3周，\n\n01:00.493 --> 01:02.293\n我们称为急性咳嗽。\n\n01:02.694 --> 01:04.719\n咳嗽时间3.8周，\n\n01:04.719 --> 01:06.293\n称为亚急性咳嗽。\n\n01:06.744 --> 01:09.543\n反复的咳嗽大于等于8周。\n\n01:10.870 --> 01:12.220\n称为慢性咳嗽。\n\n01:13.047 --> 01:14.898\n慢性咳嗽有很多原因，\n\n01:15.148 --> 01:16.072\n常见呢，\n\n01:16.072 --> 01:16.972\n比如说咳嗽，\n\n01:16.972 --> 01:18.947\n变异性哮喘引起的咳嗽。\n\n01:19.847 --> 01:21.197\n慢性咳嗽呢，\n\n01:21.197 --> 01:22.447\n以咳嗽为主，\n\n01:22.998 --> 01:23.797\n患者呢，\n\n01:23.797 --> 01:24.873\n痰比较少，\n\n01:24.873 --> 01:26.097\n有些患者呢，\n\n01:26.097 --> 01:26.998\n没有咳痰，\n\n01:27.148 --> 01:28.398\n表现为干咳，\n\n01:28.998 --> 01:32.697\n像上气道咳嗽综合征引起的慢性咳嗽。\n\n01:33.797 --> 01:34.047\n对。\n\n01:34.809 --> 01:37.059\n介绍一下流行病学的情况，\n\n01:37.660 --> 01:40.209\n根据流行病学的调查显示，\n\n01:40.559 --> 01:44.184\n在中国慢性咳嗽的发病率非常高，\n\n01:44.184 --> 01:47.059\n约12%.33%。\n\n01:47.809 --> 01:49.235\n在不同的地区呢，\n\n01:49.235 --> 01:50.360\n有一定的差异。\n\n01:51.027 --> 01:52.552\n慢性咳嗽这个疾病呢，\n\n01:52.552 --> 01:54.126\n影响了众多的人群。\n\n01:55.352 --> 02:00.053\n慢性咳嗽在儿童和老年人当中更为常见，\n\n02:00.652 --> 02:03.803\n而且根据流行病学的调查显示，\n\n02:04.053 --> 02:07.152\n慢性咳嗽的城市发病率高于农村。\n\n02:08.852 --> 02:14.902\n目前近年来慢性咳嗽的发病率在中国呈上升趋势，\n\n02:15.102 --> 02:18.003\n所以需要引起我们更多的关注。\n\n02:21.195 --> 02:22.645\n慢性咳嗽的患者呢，\n\n02:22.695 --> 02:27.445\n长期的就医用药给家庭和社会呢，\n\n02:27.445 --> 02:29.645\n带来了沉重的经济压力。\n\n02:30.563 --> 02:31.188\n患者，\n\n02:31.188 --> 02:34.964\n反复的频繁的咳嗽干扰了白天的工作，\n\n02:35.464 --> 02:37.113\n干扰了晚上的睡眠。\n\n02:38.029 --> 02:40.130\n有些患者是因为演员，\n\n02:40.380 --> 02:43.979\n他可以因慢性咳嗽影响表演状态。\n\n02:44.679 --> 02:45.804\n有些患者呢，\n\n02:45.804 --> 02:49.979\n是教师或者销售人员在工作的时候呢，\n\n02:49.979 --> 02:51.880\n反复的咳嗽影响工作。\n\n02:53.238 --> 02:55.188\n慢性咳嗽长期不愈，\n\n02:55.388 --> 02:58.138\n会导致患者焦虑抑郁。\n\n02:58.587 --> 02:59.337\n比如说，\n\n02:59.337 --> 03:01.113\n白领因为咳嗽呢，\n\n03:01.113 --> 03:02.388\n造成工作分心。\n\n03:03.414 --> 03:03.664\n嗯。\n\n03:04.707 --> 03:06.233\n对于慢性咳嗽呢，\n\n03:06.233 --> 03:08.957\n我们要介绍一下它的诊断步骤，\n\n03:09.257 --> 03:11.608\n比如说病史的采集，\n\n03:11.908 --> 03:12.257\n嗯，\n\n03:12.257 --> 03:14.557\n要做些哪些检查项目。\n\n03:15.358 --> 03:15.733\n嗯，\n\n03:15.733 --> 03:18.108\n不同的原因导致的慢性咳嗽，\n\n03:18.207 --> 03:19.908\n治疗方案是不同的，\n\n03:20.207 --> 03:21.707\n像药物治疗啊，\n\n03:21.707 --> 03:23.257\n物理疗法治疗啊。\n\n03:25.904 --> 03:29.154\n介绍一下慢性咳嗽的病因分类，\n\n03:30.255 --> 03:30.654\n嗯，\n\n03:30.705 --> 03:33.054\n根据流行病学调查显示，\n\n03:33.604 --> 03:37.029\n非常多的原因都会造成反复的咳嗽，\n\n03:37.029 --> 03:38.955\n超过8周的慢性咳嗽，\n\n03:39.755 --> 03:42.455\n比如说咳嗽、病性哮喘。\n\n03:44.434 --> 03:45.884\n上气道咳嗽综合征，\n\n03:46.235 --> 03:48.134\n胃食管反流性咳嗽，\n\n03:48.485 --> 03:49.934\n变异性咳嗽，\n\n03:50.384 --> 03:52.485\n嗜酸粒细胞性支气管炎，\n\n03:53.035 --> 03:54.184\n慢性鼻炎，\n\n03:54.235 --> 03:55.535\n慢性鼻窦炎。\n\n03:56.886 --> 04:05.686\n慢性咽炎、感冒后咳嗽、慢性支气管炎、慢性阻塞性肺疾病、支气管扩张。\n\n04:06.578 --> 04:09.578\n左心衰竭、肺间质纤维化等。\n\n04:10.710 --> 04:11.011\n嗯，\n\n04:11.011 --> 04:13.311\n根据流行病学的调查显示，\n\n04:13.811 --> 04:15.511\n咳嗽病性哮喘呢，\n\n04:15.511 --> 04:17.311\n在慢性咳嗽当中呢，\n\n04:17.460 --> 04:18.773\n占比非常高，\n\n04:18.773 --> 04:20.460\n约占30%。\n\n04:21.554 --> 04:25.005\n上气道咳嗽综合征引起的慢性咳嗽，\n\n04:25.204 --> 04:29.154\n在慢性咳嗽的患者中占比约25%。\n\n04:30.954 --> 04:32.755\n胃食管反流咳嗽呢，\n\n04:32.804 --> 04:35.204\n是慢性咳嗽的常见病因，\n\n04:35.755 --> 04:36.130\n嗯，\n\n04:36.130 --> 04:38.304\n占比约占20%。\n\n04:41.032 --> 04:42.833\n介绍一下特殊人群。\n\n04:43.859 --> 04:44.484\n小朋友，\n\n04:44.484 --> 04:45.509\n儿童患者。\n\n04:46.882 --> 04:49.183\n慢性咳嗽的发病率非常高，\n\n04:49.833 --> 04:51.683\n儿童的慢性咳嗽呢，\n\n04:51.683 --> 04:54.433\n可能与呼吸道的发育不完善有关，\n\n04:54.882 --> 04:59.833\n比如说小儿的哮喘常常引起慢性的咳嗽。\n\n05:00.786 --> 05:02.036\n老年的患者呢，\n\n05:02.036 --> 05:03.087\n抵抗力下降，\n\n05:03.386 --> 05:06.437\n老年患者慢性咳嗽的发病率也非常高。\n\n05:07.136 --> 05:09.187\n老年人慢性咳嗽呢，\n\n05:09.636 --> 05:12.636\n多和患者的心肺功能下降有关。\n\n05:13.087 --> 05:15.136\n像慢性支气管炎啊，\n\n05:15.136 --> 05:17.087\n慢性阻塞性肺疾病啊，\n\n05:17.136 --> 05:20.386\n支气管扩张引起的慢性咳嗽就非常常见。\n\n05:21.763 --> 05:22.588\n孕妇呢，\n\n05:22.588 --> 05:23.713\n慢性咳嗽呢，\n\n05:23.763 --> 05:26.263\n受到激素变化的影响。\n\n05:26.912 --> 05:28.513\n对于孕妇患者呢，\n\n05:28.562 --> 05:30.388\n我们临床医生呢，\n\n05:30.388 --> 05:31.463\n要谨慎用药，\n\n05:31.513 --> 05:33.412\n要保证母婴的安全。\n\n05:36.597 --> 05:38.747\n今天讲座的第三内容呢，\n\n05:38.898 --> 05:43.097\n是慢性咳嗽的临床表现和鉴别诊断的要点。\n\n05:46.019 --> 05:49.093\n不同的慢性咳嗽的病因呢，\n\n05:49.093 --> 05:50.769\n造成的慢性咳嗽呢？\n\n05:50.868 --> 05:52.569\n有时间段的差异。\n\n05:53.782 --> 05:54.132\n嗯，\n\n05:54.132 --> 05:58.382\n比如说咳嗽变异性哮喘是慢性咳嗽最常见的原因。\n\n05:58.833 --> 05:59.558\n患者呢，\n\n05:59.558 --> 06:02.433\n经常表现为夜间咳嗽特别明显。\n\n06:02.683 --> 06:03.882\n有些患者呢，\n\n06:03.882 --> 06:05.233\n会告知医师，\n\n06:05.583 --> 06:06.933\n夜间的时候呢，\n\n06:06.933 --> 06:08.683\n因为咳嗽而惊醒。\n\n06:10.041 --> 06:11.441\n咳嗽的性质呢，\n\n06:11.441 --> 06:15.041\n对于慢性咳嗽病因也有很好的提示作用。\n\n06:15.492 --> 06:19.266\n比如说咽炎引起的慢性咳嗽呢，\n\n06:19.266 --> 06:20.791\n患者表现为干咳，\n\n06:21.092 --> 06:22.191\n痰非常少。\n\n06:23.144 --> 06:26.045\n而慢性支气管炎导致的慢性咳嗽呢，\n\n06:26.045 --> 06:28.320\n患者会告知患，\n\n06:28.320 --> 06:29.644\n咳嗽有痰。\n\n06:31.829 --> 06:33.503\n如果咳嗽伴发热呢，\n\n06:33.503 --> 06:35.166\n可能是有感染，\n\n06:35.166 --> 06:36.553\n有些患者呢，\n\n06:36.553 --> 06:37.729\n会告知医师，\n\n06:37.979 --> 06:39.778\n咳嗽的厉害的时候呢，\n\n06:39.829 --> 06:42.278\n会有气喘加重的症状，\n\n06:42.428 --> 06:43.378\n这时候呢，\n\n06:43.479 --> 06:46.528\n必须要警惕哮喘引起的慢性咳嗽。\n\n06:50.569 --> 06:52.819\n部分的慢性咳嗽患者呢，\n\n06:52.819 --> 06:54.769\n症状轻微不典型，\n\n06:55.519 --> 06:56.669\n有些患者呢，\n\n06:56.669 --> 06:57.618\n偶尔干咳，\n\n06:57.618 --> 06:58.968\n但是时间比较长，\n\n06:59.819 --> 07:03.343\n常被误诊为普通的感冒。\n\n07:03.343 --> 07:05.569\n临床上也碰到有些患者呢，\n\n07:05.569 --> 07:07.769\n同时有慢性鼻炎等疾病，\n\n07:08.218 --> 07:10.169\n反复的鼻塞流涕。\n\n07:10.894 --> 07:11.493\n然后呢，\n\n07:11.493 --> 07:13.993\n患者有咳嗽反反复复的症状，\n\n07:14.493 --> 07:15.769\n他自己以为呢，\n\n07:15.769 --> 07:18.593\n因为是鼻炎造成的慢性咳嗽，\n\n07:18.944 --> 07:19.843\n其实呢，\n\n07:19.894 --> 07:22.044\n掩盖了咳嗽真正的病因。\n\n07:23.380 --> 07:24.554\n有些患者呢，\n\n07:24.554 --> 07:26.179\n长期处于污染环境。\n\n07:27.221 --> 07:27.520\n他呢，\n\n07:27.520 --> 07:29.371\n常被忽略的环境影响，\n\n07:29.670 --> 07:32.170\n误诊为呼吸道的其他疾病。\n\n07:32.371 --> 07:32.971\n其实，\n\n07:32.971 --> 07:35.371\n患者脱离了污染的环境呢，\n\n07:35.371 --> 07:36.571\n咳嗽就会好转。\n\n07:39.024 --> 07:41.100\n今天讲座的第四个内容呢，\n\n07:41.100 --> 07:44.125\n是规范慢性咳嗽的诊断流程。\n\n07:45.048 --> 07:47.197\n对于慢性咳嗽的患者呢，\n\n07:47.298 --> 07:50.097\n应该详细的询问患者的病史，\n\n07:50.997 --> 07:54.097\n要询问患者咳嗽的时间。\n\n07:55.170 --> 07:55.369\n嗯，\n\n07:55.470 --> 07:57.019\n到底多长时间啊。\n\n07:58.348 --> 07:59.199\n咳嗽的频率，\n\n07:59.598 --> 08:02.549\n白天咳嗽还是夜间咳嗽为主，\n\n08:02.848 --> 08:04.799\n还是白天夜间都有？\n\n08:05.348 --> 08:06.648\n有没有诱因啊？\n\n08:06.648 --> 08:08.998\n有些患者会告知，\n\n08:08.998 --> 08:10.174\n开始的时候呢，\n\n08:10.174 --> 08:13.248\n是鼻塞流涕、急性感冒，\n\n08:13.598 --> 08:14.373\n然后呢，\n\n08:14.373 --> 08:16.598\n反反复复咳嗽迁延不愈。\n\n08:17.098 --> 08:18.549\n经过检查发现呢，\n\n08:18.549 --> 08:20.549\n其实就是一个感冒后咳嗽。\n\n08:22.778 --> 08:24.729\n对于慢性咳嗽的患者呢，\n\n08:24.928 --> 08:27.128\n应该进行全面的体格检查，\n\n08:27.778 --> 08:33.278\n尤其必须注重检查咽喉、肺部等部位。\n\n08:33.278 --> 08:35.679\n肺部要听诊是否有罗音，\n\n08:35.828 --> 08:37.129\n有些患者呢，\n\n08:37.229 --> 08:40.179\n会听到患者呼气期的哮鸣音，\n\n08:40.528 --> 08:41.254\n那个呢，\n\n08:41.254 --> 08:46.429\n就可以根据进一步的检查就发现是哮喘引起的慢性咳嗽。\n\n08:47.468 --> 08:49.418\n对于慢性咳嗽的患者呢，\n\n08:49.468 --> 08:51.468\n应该收集相关的信息，\n\n08:52.067 --> 08:54.367\n比如患者的职业啊，\n\n08:54.518 --> 08:56.468\n有没有特殊的过敏史啊。\n\n08:57.067 --> 08:58.192\n有些患者呢，\n\n08:58.192 --> 09:00.268\n他是接触了特殊的粉尘，\n\n09:00.718 --> 09:03.768\n因为对粉尘污染造成的咳嗽，\n\n09:03.968 --> 09:05.867\n如果脱离了这个环境呢，\n\n09:05.867 --> 09:09.018\n有些患者咳嗽就会明显的减轻。\n\n09:11.343 --> 09:12.893\n对于慢性咳嗽的患者呢，\n\n09:12.893 --> 09:14.843\n要进行进一步的辅助检查，\n\n09:15.593 --> 09:18.393\n比如胸部的X光片啊，\n\n09:18.443 --> 09:20.143\n胸部的CT扫描。\n\n09:20.494 --> 09:21.119\n这个呢，\n\n09:21.119 --> 09:22.794\n可以排查肺部的病变，\n\n09:23.143 --> 09:27.343\n比如说肺部感染、肺炎、肺恶性肿瘤等。\n\n09:28.236 --> 09:28.637\n嗯，\n\n09:28.637 --> 09:29.486\n建议呢，\n\n09:29.486 --> 09:31.836\n患者进行肺功能的测试，\n\n09:32.086 --> 09:33.937\n检测患者的通气功能。\n\n09:34.833 --> 09:35.934\n哮喘的患者呢，\n\n09:35.934 --> 09:39.684\n可以可以根据此评估气道阻塞程度。\n\n09:40.984 --> 09:42.533\n对于慢性咳嗽的患者，\n\n09:42.533 --> 09:44.133\n如果患者会告知，\n\n09:44.283 --> 09:45.984\n比如说他有药物啊，\n\n09:45.984 --> 09:46.883\n食物过敏，\n\n09:47.283 --> 09:49.783\n可以建议做一个过敏原的检测。\n\n09:50.133 --> 09:52.734\n通过皮肤点刺或者血液检测，\n\n09:52.934 --> 09:56.083\n帮助过敏性咳嗽的患者找到病因。\n\n09:58.989 --> 10:01.390\n对于慢性咳咳嗽的患者呢，\n\n10:01.390 --> 10:02.890\n诊断性的治疗呢，\n\n10:03.190 --> 10:09.489\n就是比如说患者会告知经常有反酸嗳气的表现，\n\n10:10.039 --> 10:12.789\n然后晚上吃的多一点以后呢，\n\n10:12.789 --> 10:13.890\n咳嗽会加重。\n\n10:14.390 --> 10:15.215\n这时候呢，\n\n10:15.215 --> 10:18.489\n我们要考虑患者是胃食管反流引起的咳嗽，\n\n10:18.890 --> 10:20.590\n建议做胃镜检查，\n\n10:21.090 --> 10:24.590\n建议进行食道PH值的测定。\n\n10:25.456 --> 10:28.132\n然后确诊胃食管反流的患者，\n\n10:28.132 --> 10:29.656\n引起的慢性咳嗽呢，\n\n10:29.757 --> 10:32.557\n可以应用质子泵抑制剂等药物治疗。\n\n10:32.856 --> 10:33.932\n通过治疗呢，\n\n10:33.932 --> 10:36.007\n咳嗽症状可以明显的缓解。\n\n10:36.940 --> 10:38.039\n有些患者呢，\n\n10:38.039 --> 10:40.289\n是过敏性咳嗽，\n\n10:40.340 --> 10:42.390\n可以针对过敏原的检测，\n\n10:42.739 --> 10:45.390\n如果过敏原检测是阳性的话呢，\n\n10:45.539 --> 10:47.390\n可以试用抗组胺药，\n\n10:47.390 --> 10:48.690\n比如说氯雷他定，\n\n10:48.690 --> 10:50.440\n治疗效果也非常好。\n\n10:51.421 --> 10:54.572\n如果患者是呼吸道感染导致的咳嗽，\n\n10:54.771 --> 10:57.021\n可以短期应用抗生素治疗。\n\n10:57.421 --> 11:01.171\n对针对针对病因治疗效果非常好。\n\n11:03.221 --> 11:05.171\n今天讲座的第五个内容呢，\n\n11:05.171 --> 11:07.171\n是针对性的治疗方案。\n\n11:08.296 --> 11:10.346\n对于慢性咳嗽的患者呢？\n\n11:11.744 --> 11:12.893\n针对慢性咳嗽，\n\n11:12.994 --> 11:15.494\n可以应用止咳、祛痰、平喘的药物。\n\n11:16.856 --> 11:17.007\n嗯，\n\n11:17.007 --> 11:19.057\n建议患者戒烟，\n\n11:19.156 --> 11:20.356\n避免过敏源。\n\n11:20.906 --> 11:21.257\n嗯，\n\n11:21.257 --> 11:22.507\n空气污染多，\n\n11:22.706 --> 11:24.182\n雾霾天的时候呢，\n\n11:24.182 --> 11:25.456\n建议佩戴口罩，\n\n11:25.656 --> 11:26.382\n这样呢，\n\n11:26.382 --> 11:27.606\n可以减少刺激，\n\n11:28.057 --> 11:29.156\n预防咳嗽。\n\n11:30.156 --> 11:31.382\n有些患者呢，\n\n11:31.382 --> 11:35.606\n比如说有些学生会考试前反复咳嗽，\n\n11:35.956 --> 11:39.257\n这个其实因为焦虑等心理因素呢，\n\n11:39.257 --> 11:40.706\n会导致患者的咳嗽。\n\n11:41.007 --> 11:42.432\n对于这些患者呢，\n\n11:42.432 --> 11:44.856\n建议进行心理干预进行疏导。\n\n11:45.992 --> 11:46.392\n嗯。\n\n11:48.367 --> 11:50.218\n对于慢性咳嗽的患者呢，\n\n11:50.268 --> 11:52.817\n建议保持室内清洁通风。\n\n11:53.518 --> 11:54.367\n然后呢，\n\n11:54.968 --> 11:58.268\n使用空气那个湿度计的检测，\n\n11:58.768 --> 12:02.418\n使得空气的湿度40%.60%。\n\n12:02.918 --> 12:04.742\n因为过度干燥的话呢，\n\n12:04.742 --> 12:06.367\n患者会诱发咳嗽，\n\n12:06.867 --> 12:07.593\n建议呢，\n\n12:07.593 --> 12:08.768\n定期打扫房间。\n\n12:09.551 --> 12:09.726\n嗯，\n\n12:09.726 --> 12:11.000\n使用空气净化器，\n\n12:11.200 --> 12:11.851\n这样呢，\n\n12:11.851 --> 12:13.601\n可以减少过敏源的摄入。\n\n12:14.601 --> 12:15.000\n嗯，\n\n12:15.000 --> 12:16.776\n对于慢性咳嗽的患者呢，\n\n12:16.776 --> 12:18.351\n规律作息非常重要。\n\n12:19.200 --> 12:22.500\n早睡早起有利于患者身体的恢复。\n\n12:23.497 --> 12:27.047\n慢性咳嗽的患者也不是说一点都不能运动，\n\n12:27.197 --> 12:29.148\n适度的运动是有效的。\n\n12:29.348 --> 12:30.098\n平常呢，\n\n12:30.098 --> 12:31.172\n可以散散步啊，\n\n12:31.172 --> 12:32.447\n打打太极拳啊，\n\n12:32.547 --> 12:34.348\n可以增加患者的免疫力。\n\n12:36.708 --> 12:38.557\n对于有些难治性咳嗽，\n\n12:38.757 --> 12:39.833\n比如说咳嗽，\n\n12:39.833 --> 12:42.107\n变异性哮喘导致的咳嗽，\n\n12:42.458 --> 12:46.107\n可以适当的加入吸入的激素的用量，\n\n12:46.107 --> 12:47.807\n提高患者的治疗效果。\n\n12:48.888 --> 12:54.489\n可以使用结合物理疗法缓解难治性咳嗽的症状。\n\n12:56.166 --> 12:57.716\n对于慢性咳嗽呢，\n\n12:57.716 --> 13:00.315\n其实是病因治疗非常非常重要。\n\n13:00.515 --> 13:02.166\n搞清楚患者的病因。\n\n13:03.080 --> 13:04.229\n非常非常重要，\n\n13:04.530 --> 13:06.929\n不是单单止咳化痰。\n\n13:09.763 --> 13:10.163\n嗯，\n\n13:10.312 --> 13:14.312\n接下来讲一下慢性咳嗽的临床管理和预后。\n\n13:15.377 --> 13:18.851\n慢性咳嗽的患者经过治疗以后呢，\n\n13:18.851 --> 13:20.976\n建议患者进行门诊的随访。\n\n13:21.677 --> 13:22.077\n嗯，\n\n13:22.476 --> 13:25.877\n询问患者咳嗽频率和程度有没有减轻。\n\n13:26.526 --> 13:28.276\n建议随访肺功能。\n\n13:28.627 --> 13:32.877\n如果哮喘或者咳嗽变异性哮喘导致的咳嗽，\n\n13:33.177 --> 13:33.976\n肺功能。\n\n13:34.784 --> 13:38.184\n通气功能指标有没有变化？\n\n13:38.184 --> 13:39.309\n生活方式呢，\n\n13:39.309 --> 13:40.934\n要对患者进行指导，\n\n13:41.184 --> 13:42.784\n提醒患者戒烟，\n\n13:42.934 --> 13:44.184\n避免过敏源。\n\n13:45.921 --> 13:46.296\n嗯，\n\n13:46.296 --> 13:47.921\n对于患者的教育呢，\n\n13:48.021 --> 13:52.122\n要讲解慢性咳嗽的病因啊、症状啊。\n\n13:52.671 --> 13:53.796\n对于患者呢，\n\n13:53.796 --> 13:55.471\n进行疾病知识的普及。\n\n13:56.299 --> 13:57.299\n告知患者，\n\n13:57.549 --> 13:58.599\n经过治疗呢，\n\n13:58.599 --> 14:00.299\n要按时按量用药。\n\n14:00.799 --> 14:02.900\n如果患者觉得症状改善，\n\n14:03.000 --> 14:04.450\n不能随意停药。\n\n14:06.739 --> 14:07.640\n避免过敏源，\n\n14:07.840 --> 14:10.039\n对于污空气污染的时候呢，\n\n14:10.039 --> 14:10.965\n出门的时候呢，\n\n14:10.965 --> 14:13.340\n佩戴口罩非常非常的重要。\n\n14:17.427 --> 14:19.827\n慢性咳嗽经过规范的治疗，\n\n14:20.276 --> 14:22.502\n明确的病因症状呢，\n\n14:22.502 --> 14:23.677\n会明显减轻。\n\n14:25.010 --> 14:26.010\n有些患者呢，\n\n14:26.260 --> 14:28.710\n有复发的可能，\n\n14:28.710 --> 14:30.210\n临床调查显示，\n\n14:30.510 --> 14:34.810\n约20%的患者在治愈以后一年会复发。\n\n14:35.111 --> 14:35.760\n这个呢，\n\n14:35.760 --> 14:38.161\n受到环境等一些因素的影响。\n\n14:41.679 --> 14:46.129\n肺功能比如说是哮喘或者咳嗽变异性哮喘，\n\n14:46.328 --> 14:47.778\n经过治疗以后呢，\n\n14:47.778 --> 14:49.578\n肺功能会恢恢复。\n\n14:50.129 --> 14:51.229\n多数患者呢，\n\n14:51.229 --> 14:54.729\n会肺功能可以恢复到正常，\n\n14:54.729 --> 14:57.879\n患者的咳嗽症状也可以得到明显的控制。\n\n14:58.328 --> 14:59.028\n所以呢，\n\n14:59.028 --> 15:01.586\n治疗一定就是要坚持，\n\n15:01.586 --> 15:03.179\n不能随便的停药。\n\n15:06.864 --> 15:08.463\n目前慢性咳嗽呢。\n\n15:09.708 --> 15:12.557\n经过临床的详细的问诊和检查，\n\n15:12.807 --> 15:13.958\n明确了病因。\n\n15:15.440 --> 15:15.890\n治疗呢，\n\n15:15.890 --> 15:17.241\n非常是有效的。\n\n15:17.741 --> 15:18.716\n按照指南，\n\n15:18.716 --> 15:20.541\n对于患者精准的用药，\n\n15:20.890 --> 15:24.940\n合理的应用止咳抗炎的药物非常非常的重要。\n\n15:25.841 --> 15:28.140\n对于慢性患咳嗽的患者呢，\n\n15:28.241 --> 15:30.241\n临床的随访非常重要，\n\n15:30.690 --> 15:33.640\n可以跟跟踪患者的治疗效果，\n\n15:33.940 --> 15:38.241\n根据患者的症状体征调整治疗方案。\n\n15:41.348 --> 15:44.398\n目前慢性咳嗽的研究要点呢，\n\n15:44.549 --> 15:50.648\n比如说目前有呼出气的一氧化氮检测技术非常简单，\n\n15:51.098 --> 15:53.948\n老人和小朋友也可以做。\n\n15:54.448 --> 15:55.348\n可这个呢，\n\n15:55.348 --> 15:55.924\n检查呢，\n\n15:55.924 --> 15:59.098\n为慢性咳嗽的精准诊断提供了新的途径。\n\n16:00.473 --> 16:01.023\n目前。\n\n16:02.111 --> 16:05.262\n科学家在研究病毒感染诱发咳嗽的机制，\n\n16:05.562 --> 16:08.012\n助力找到新的治疗靶点。\n\n16:09.567 --> 16:10.518\n研究热点呢，\n\n16:10.518 --> 16:14.242\n还有就是目前可以按照基因检测的结果，\n\n16:14.492 --> 16:19.242\n为每个患者可以量量身定制慢性咳嗽的治疗方案。\n\n16:21.526 --> 16:23.575\n今天的讲座内容就到这儿，\n\n16:23.726 --> 16:25.125\n多谢大家的聆听。\n\n","v0347cg10004d71nuaqljhtc69r3ga2g",989,655,"2026-01-26 12:31:47","慢性咳嗽病因分类。第三是慢性咳嗽临床表现和鉴别诊断的要点。第四是慢性咳嗽规范诊断的流程。第五是慢性咳嗽针对性的治疗方案。 ","2026-06-11 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