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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,"不再咳不停一 慢性咳嗽患者全程自管指南","","https://cdn.yishi-tong.com/console/3/WbCy1E8jWjM0uYFgFI2d6en1SuyJStSj.png",1,"WEBVTT\n\n00:02.658 --> 00:03.207\n大家好，\n\n00:03.408 --> 00:06.458\n今天给大家做一个科普讲座。\n\n00:06.757 --> 00:08.208\n科普讲座的内容是，\n\n00:08.208 --> 00:08.883\n不再咳，\n\n00:08.883 --> 00:13.408\n不停慢性咳嗽患者全程自管指南。\n\n00:16.701 --> 00:18.002\n今天讲座内容呢，\n\n00:18.052 --> 00:19.752\n分为以下六个部分。\n\n00:20.502 --> 00:21.601\n第一个部分呢，\n\n00:21.601 --> 00:24.302\n是认识慢性咳嗽这个情况。\n\n00:24.652 --> 00:25.451\n第二呢，\n\n00:25.451 --> 00:29.052\n慢性咳嗽患者的自我筛查与就诊。\n\n00:29.552 --> 00:30.777\n第三个部分呢，\n\n00:30.777 --> 00:34.051\n是慢性咳嗽患者居家对症管理。\n\n00:34.652 --> 00:35.926\n第四个方面呢，\n\n00:35.926 --> 00:38.951\n是慢性咳嗽的药物与康复训练。\n\n00:39.707 --> 00:40.106\n第五，\n\n00:40.106 --> 00:41.757\n就是特殊人群，\n\n00:41.757 --> 00:43.407\n我们要必须进行关注。\n\n00:43.707 --> 00:44.356\n第六，\n\n00:44.356 --> 00:47.556\n慢性咳嗽患者的长期随访与预防。\n\n00:49.436 --> 00:50.035\n接下来。\n\n00:51.082 --> 00:53.181\n进入今天讲座的第一个环节，\n\n00:53.532 --> 00:56.181\n如何认识慢性咳嗽这个情况，\n\n00:58.332 --> 01:04.332\n咳嗽按照时间分为急性咳嗽、亚急性咳嗽和慢性咳嗽。\n\n01:04.832 --> 01:06.281\n咳嗽小于三周，\n\n01:06.431 --> 01:08.281\n我们称之为急性咳嗽，\n\n01:08.832 --> 01:12.882\n反复的咳嗽3到八周称为亚急性的咳嗽。\n\n01:13.232 --> 01:15.281\n反复的咳嗽大于8周，\n\n01:15.431 --> 01:17.882\n我们临床称为慢性咳嗽。\n\n01:18.681 --> 01:19.982\n慢性咳嗽呢，\n\n01:19.982 --> 01:21.281\n和普通感冒的。\n\n01:21.316 --> 01:22.466\n咳嗽是不同的，\n\n01:22.865 --> 01:25.515\n它并非简单的体质虚弱，\n\n01:25.865 --> 01:31.015\n而是由于气道或灵性器官存在着持续的气机源。\n\n01:33.043 --> 01:35.393\n慢性咳嗽拖延治疗呢，\n\n01:35.494 --> 01:37.944\n可以导致患者的气道重塑。\n\n01:38.543 --> 01:39.643\n有些患者呢，\n\n01:39.643 --> 01:45.643\n其实他是有哮喘、支气管扩张或者肺部肿瘤等严重的疾病。\n\n01:46.293 --> 01:47.069\n所以呢，\n\n01:47.069 --> 01:50.244\n如果拖延治疗会导致严重的后果。\n\n01:51.774 --> 01:55.573\n对于慢性咳嗽的患者必须及时的重视，\n\n01:55.774 --> 01:59.424\n并且记录咳嗽的起始时间和变化规律，\n\n01:59.874 --> 02:02.073\n对就医是至关重要的。\n\n02:03.174 --> 02:06.573\n慢性咳嗽患者反复咳嗽大于八周，\n\n02:06.924 --> 02:11.824\n所以建议患者要记录咳嗽的起始时间和变化规律，\n\n02:12.324 --> 02:12.973\n这样呢，\n\n02:12.973 --> 02:17.123\n就有助于医生快速的判断慢性咳嗽的病因，\n\n02:17.574 --> 02:19.873\n制定针对性的治疗方案。\n\n02:20.505 --> 02:21.856\n避免病情的恶化。\n\n02:26.082 --> 02:27.432\n慢性咳嗽呢，\n\n02:27.432 --> 02:29.656\n其实它有普遍存在特征呢，\n\n02:29.656 --> 02:31.882\n就是患者气道有炎症。\n\n02:32.332 --> 02:34.531\n由于气道炎症的存在呢，\n\n02:34.682 --> 02:37.082\n导致患者的气道上皮受损，\n\n02:37.731 --> 02:41.132\n上皮表面的磷脂破屏障就被破坏，\n\n02:41.531 --> 02:43.932\n纤毛的正常活动也被破坏，\n\n02:44.281 --> 02:47.382\n使得患者的咳嗽感受器暴露过多，\n\n02:47.832 --> 02:50.531\n容易受到物理或化学的刺激。\n\n02:51.332 --> 02:55.481\n患者气道浸润的炎性细胞释放的炎症介质呢。\n\n02:55.985 --> 03:00.136\n可能直接或间接的刺激患者的咳嗽感受器。\n\n03:01.328 --> 03:03.578\n慢性咳嗽的常见病因呢，\n\n03:03.727 --> 03:18.453\n包括上气道咳嗽综合征、咳嗽变异性的哮喘、胃食管反流性的咳嗽、嗜酸粒细胞性支气管炎、慢性支气管炎和药物的副作用等。\n\n03:18.453 --> 03:22.328\n每种病因造成的慢性咳嗽特点是不一样的，\n\n03:22.878 --> 03:23.677\n比如说，\n\n03:23.727 --> 03:27.527\n如果是鼻后滴漏综合征导致的慢性咳嗽，\n\n03:27.677 --> 03:30.477\n患者经常要反复的清嗓子。\n\n03:31.238 --> 03:34.138\n咳嗽变异性哮喘导致的慢性咳嗽呢，\n\n03:34.188 --> 03:36.238\n患者以夜间干咳为主。\n\n03:36.738 --> 03:40.037\n而胃食管反流引起的慢性咳嗽呢，\n\n03:40.087 --> 03:43.787\n患者会告知饭后平卧以后呢，\n\n03:43.787 --> 03:44.988\n症状会加重。\n\n03:48.649 --> 03:50.449\n慢性咳嗽的危害呢，\n\n03:50.548 --> 03:54.574\n不止于喉咙长期反复的咳嗽呢，\n\n03:54.574 --> 03:57.048\n导致患者的胸部压力升高。\n\n03:57.399 --> 03:58.649\n有些患者呢，\n\n03:59.098 --> 04:01.949\n剧烈的咳嗽会引发肋软骨炎，\n\n04:02.348 --> 04:03.348\n肌肉拉伤。\n\n04:04.199 --> 04:05.423\n女性患者呢，\n\n04:05.423 --> 04:07.598\n会有出现小便失禁的情况。\n\n04:08.593 --> 04:10.194\n患者慢性咳嗽，\n\n04:10.393 --> 04:11.494\n有些患者呢，\n\n04:11.494 --> 04:13.494\n表现为夜间频繁的咳嗽，\n\n04:13.744 --> 04:15.794\n导致夜间睡眠不足，\n\n04:16.093 --> 04:21.444\n睡眠碎片化会影响患者的血压和白天的注意力。\n\n04:23.212 --> 04:29.462\n而慢性咳嗽、持续的炎症刺激会导致患者的气道高反应性加重，\n\n04:29.712 --> 04:31.812\n增加哮喘的发病风险。\n\n04:33.096 --> 04:37.045\n慢性咳嗽的患者在公共场合频繁的咳嗽，\n\n04:37.446 --> 04:39.696\n有些会导致社交尴尬，\n\n04:39.996 --> 04:42.645\n进而引发焦虑甚至抑郁的情绪。\n\n04:44.076 --> 04:46.576\n对于儿童、孕妇和老年人，\n\n04:47.027 --> 04:49.252\n因为这些人群呢，\n\n04:49.252 --> 04:50.927\n免疫力或生理差异，\n\n04:51.076 --> 04:53.326\n更容易出现咳嗽的并发症，\n\n04:53.527 --> 04:56.527\n需要医师进行特别的关注。\n\n04:59.968 --> 05:00.343\n嗯，\n\n05:00.343 --> 05:02.343\n今天讲座的第二个内容呢，\n\n05:02.343 --> 05:05.819\n是慢性咳嗽患者的自我筛查与就诊，\n\n05:07.269 --> 05:09.368\n反复的咳嗽超过八周。\n\n05:09.868 --> 05:10.269\n嗯，\n\n05:10.269 --> 05:11.519\n作为患者呢，\n\n05:11.618 --> 05:14.118\n应该自测以下问题，\n\n05:14.368 --> 05:15.169\n第一呢，\n\n05:15.169 --> 05:17.468\n咳嗽持续了多长时间啊？\n\n05:17.919 --> 05:20.919\n咳嗽是干咳还是有痰的？\n\n05:21.419 --> 05:23.468\n有没有鼻后滴漏的症状？\n\n05:23.968 --> 05:25.569\n有没有反酸的表现？\n\n05:26.528 --> 05:26.704\n嗯，\n\n05:26.704 --> 05:28.928\n咳嗽的时候有没有气喘的表现？\n\n05:29.928 --> 05:31.329\n是否吸烟啊？\n\n05:31.979 --> 05:33.678\n有没有接触粉尘啊？\n\n05:34.378 --> 05:37.479\n最近有没有换用降压药物啊？\n\n05:37.628 --> 05:39.528\n通过回答这些问题呢，\n\n05:39.678 --> 05:42.979\n患者可以初步判断咳嗽的可能原因，\n\n05:43.479 --> 05:44.229\n并且呢，\n\n05:44.229 --> 05:46.329\n为医生提供重要的线索。\n\n05:49.170 --> 05:51.121\n对于慢性咳嗽的患者。\n\n05:52.481 --> 05:53.057\n门诊呢，\n\n05:53.057 --> 05:55.332\n常见的检查项目呢，\n\n05:55.381 --> 06:14.782\n包括胸部影像学检查、胸片低剂量螺旋CT、肺功能检查、支气管激发试验、呼出气一氧化氮的测定、鼻窦片检查或者鼻咽镜的检查、胃镜检查、食管PH检测等等。\n\n06:15.903 --> 06:17.153\n这些检查呢，\n\n06:17.553 --> 06:19.053\n都有其注意事项，\n\n06:19.553 --> 06:21.953\n比如说支气管激发试验呢，\n\n06:22.002 --> 06:23.803\n需停药48小时，\n\n06:24.502 --> 06:25.727\n胃镜检查呢，\n\n06:25.727 --> 06:27.453\n需空腹8个小时。\n\n06:28.102 --> 06:30.403\n提前了解这些注意事项呢，\n\n06:30.502 --> 06:33.903\n可以减少不必要的往返和重复的检查。\n\n06:35.468 --> 06:38.419\n通过这些常规的检查检检查，\n\n06:38.669 --> 06:41.618\n有助于医生判断慢性咳嗽的病因，\n\n06:41.968 --> 06:44.569\n从而制定针对性的治疗方案，\n\n06:44.868 --> 06:48.019\n可以避免盲目的用药和过度的治疗。\n\n06:52.549 --> 06:52.924\n嗯，\n\n06:52.924 --> 06:55.149\n作为临床的医生，\n\n06:55.750 --> 07:00.700\n我们会告知患者应该和医生进行高效的沟通。\n\n07:01.450 --> 07:03.950\n慢性咳嗽的患者就诊前呢，\n\n07:04.149 --> 07:06.899\n可以准备时间轴的记录表。\n\n07:07.872 --> 07:08.148\n嗯，\n\n07:08.148 --> 07:09.072\n记录一下。\n\n07:10.095 --> 07:13.144\n咳嗽的诱因、缓解因素的清单。\n\n07:14.117 --> 07:17.217\n已经用的药物和效果评估的资料，\n\n07:17.666 --> 07:19.816\n以便在就诊时候呢，\n\n07:19.816 --> 07:21.666\n和医生进行高效的沟通。\n\n07:23.528 --> 07:25.428\n对于慢性咳嗽的患者，\n\n07:25.729 --> 07:28.829\n在和医生描述咳嗽的症状的时候呢，\n\n07:29.079 --> 07:31.479\n应该避免使用模糊的词汇，\n\n07:31.829 --> 07:33.729\n比如说有些患者会说，\n\n07:33.928 --> 07:35.878\n我反反复复一直咳嗽，\n\n07:36.128 --> 07:37.229\n痰非常多。\n\n07:38.154 --> 07:38.605\n这个呢，\n\n07:38.605 --> 07:41.005\n其实是比较模糊，\n\n07:41.005 --> 07:45.204\n并不会给医生造成很良好的印象。\n\n07:45.704 --> 07:46.554\n建议呢，\n\n07:46.855 --> 07:51.904\n说我反复的咳嗽已经两个月了，\n\n07:51.904 --> 07:54.529\n每天咳嗽咳痰痰呢，\n\n07:54.529 --> 07:56.605\n一天大概是十几次，\n\n07:57.154 --> 07:57.505\n嗯，\n\n07:57.505 --> 07:59.704\n总量大概是50ml左右。\n\n07:59.855 --> 08:00.505\n这样呢，\n\n08:00.505 --> 08:05.554\n就可以使医生快速的抓住患者的慢性咳嗽症状的特征。\n\n08:08.571 --> 08:09.496\n第三个内容呢，\n\n08:09.496 --> 08:12.770\n是慢性咳嗽患者居家地震的管理。\n\n08:13.971 --> 08:15.871\n对于慢性咳嗽的患者。\n\n08:17.085 --> 08:17.635\n建议呢，\n\n08:17.635 --> 08:21.835\n就是用湿度计维持室内的相对湿度。\n\n08:22.186 --> 08:24.385\n建议的室内湿度呢，\n\n08:24.385 --> 08:26.735\n在40%.60%。\n\n08:27.286 --> 08:29.335\n因为过度干燥的环境呢，\n\n08:29.335 --> 08:31.536\n会造成患者的咳嗽加重。\n\n08:32.986 --> 08:34.185\n室内环境呢，\n\n08:34.185 --> 08:36.335\n应该比比较清洁。\n\n08:36.736 --> 08:38.536\n建议每天通风两次。\n\n08:39.328 --> 08:40.978\n每次大于三十分钟，\n\n08:41.278 --> 08:43.078\n这样有助于减少。\n\n08:44.325 --> 08:46.275\n灰尘对气道的刺激。\n\n08:47.771 --> 08:49.971\n空气净化也非常重要，\n\n08:50.421 --> 08:55.021\n在花粉季或者室外空气污染严重的时候呢，\n\n08:55.322 --> 08:55.721\n嗯，\n\n08:55.822 --> 08:56.546\n建议呢，\n\n08:56.546 --> 08:57.471\n关闭窗户，\n\n08:57.822 --> 08:59.372\n启用空气净化器。\n\n08:59.921 --> 09:00.671\n这样呢，\n\n09:00.671 --> 09:03.471\n就减少过敏源和污染物的吸入，\n\n09:03.622 --> 09:05.221\n减少咳嗽的症状。\n\n09:07.077 --> 09:09.127\n对于慢性咳嗽的患者呢，\n\n09:09.327 --> 09:10.377\n建议戒烟，\n\n09:10.877 --> 09:12.726\n并且避免二手烟。\n\n09:13.927 --> 09:17.127\n夏季或冬季应用空调的时候呢，\n\n09:17.276 --> 09:18.002\n建议呢，\n\n09:18.002 --> 09:20.026\n定期清洗空调的滤网，\n\n09:20.377 --> 09:21.026\n这样呢，\n\n09:21.026 --> 09:23.677\n就可以保证室内的环境清洁，\n\n09:24.127 --> 09:26.327\n有助于减少咳嗽的诱因。\n\n09:30.059 --> 09:31.909\n对于饮食策略呢，\n\n09:32.909 --> 09:35.559\n嗯现在进行一个简单的介绍。\n\n09:36.210 --> 09:39.609\n如果是胃食管反流引起的慢性咳嗽，\n\n09:40.010 --> 09:46.359\n应该告知患者避免咖啡呀、巧克力呀、薄荷等刺激性的食物。\n\n09:47.059 --> 09:47.909\n主食呢，\n\n09:47.909 --> 09:52.960\n建议选择燕麦、糙米等低酸高纤维的食物。\n\n09:54.820 --> 10:00.221\n对于鼻后滴漏综合征引起的慢性咳嗽患者的粘液比较多，\n\n10:00.770 --> 10:04.921\n建议减少奶制品和高糖饮料的摄入。\n\n10:05.721 --> 10:07.270\n对于这些患者呢，\n\n10:07.320 --> 10:11.270\n建议多吃点富含维生素C的食果水果，\n\n10:11.570 --> 10:12.995\n比如说猕猴桃啊，\n\n10:12.995 --> 10:13.721\n草莓等。\n\n10:15.116 --> 10:17.666\n对于咳嗽变异性哮喘的患者，\n\n10:18.265 --> 10:19.366\n这些患者呢，\n\n10:19.366 --> 10:20.390\n反复的咳嗽，\n\n10:20.390 --> 10:22.466\n夜间咳嗽尤其严重。\n\n10:22.916 --> 10:23.666\n建议呢，\n\n10:23.666 --> 10:25.765\n每周摄入两次深海鱼，\n\n10:26.116 --> 10:27.515\n补充脂肪酸，\n\n10:27.815 --> 10:30.515\n有助于降低患者的气道炎症。\n\n10:33.758 --> 10:35.559\n慢性咳嗽的患者呢，\n\n10:36.109 --> 10:38.059\n老是觉得咽部不舒服，\n\n10:38.559 --> 10:39.609\n喜欢喝水。\n\n10:39.859 --> 10:41.109\n但是喝水呢，\n\n10:41.109 --> 10:43.008\n有一个正确的技巧，\n\n10:43.859 --> 10:45.158\n建议的患者呢，\n\n10:45.158 --> 10:46.758\n少量多次饮水，\n\n10:47.059 --> 10:47.883\n而且呢，\n\n10:47.883 --> 10:50.809\n不建议饮用过烫的水或冰水，\n\n10:51.208 --> 10:52.658\n建议使用温水，\n\n10:53.208 --> 10:55.158\n每次喝水的量不要太多，\n\n10:55.408 --> 10:56.109\n建议呢，\n\n10:56.109 --> 10:57.708\n每次100ml左右，\n\n10:57.958 --> 10:58.758\n水温呢，\n\n10:58.758 --> 10:59.708\n40°左右，\n\n11:00.158 --> 11:01.958\n每天的饮水总量呢，\n\n11:01.958 --> 11:03.658\n是1500到两。\n\n11:03.810 --> 11:04.411\n千毫升，\n\n11:04.760 --> 11:05.435\n这样呢，\n\n11:05.435 --> 11:07.960\n有助于稀释患者的气道分泌物，\n\n11:08.310 --> 11:10.810\n减少咽喉部干痒的触发。\n\n11:12.526 --> 11:12.901\n嗯，\n\n11:12.901 --> 11:14.526\n慢性咳嗽患者呢，\n\n11:14.526 --> 11:16.726\n含服蜂蜜或者硬糖。\n\n11:17.075 --> 11:17.726\n这个呢，\n\n11:17.726 --> 11:20.476\n可以通过局部高渗和吞咽工作，\n\n11:20.825 --> 11:23.026\n可以抑制患者的咳嗽反射。\n\n11:23.825 --> 11:25.075\n糖尿病患者呢，\n\n11:25.075 --> 11:27.125\n可以用木糖醇来替代。\n\n11:27.776 --> 11:30.377\n这个也是一个挺好的治疗方法，\n\n11:34.077 --> 11:35.877\n讲座的第四个内容呢，\n\n11:35.927 --> 11:39.077\n是慢性咳嗽患者药物与康复训练。\n\n11:40.294 --> 11:40.544\n嗯。\n\n11:41.478 --> 11:41.853\n患者，\n\n11:41.853 --> 11:42.828\n反复咳嗽，\n\n11:43.177 --> 11:47.177\n医师有可能会开具中枢性的镇咳药，\n\n11:47.427 --> 11:49.478\n但是中枢性的镇咳药呢，\n\n11:49.478 --> 11:51.627\n仅仅能够抑制咳嗽反射，\n\n11:51.978 --> 11:55.278\n适合在影响睡眠时临时应用。\n\n11:56.197 --> 11:57.822\n外周性的镇咳药呢，\n\n11:57.822 --> 11:59.646\n对刺激性干咳有效，\n\n12:00.096 --> 12:01.896\n有些患者痰比较多，\n\n12:02.197 --> 12:04.346\n如果应用外周性的镇咳药呢，\n\n12:04.346 --> 12:05.596\n可能阻碍排痰，\n\n12:05.796 --> 12:07.447\n需要谨慎使用的。\n\n12:08.732 --> 12:09.932\n有些患者呢，\n\n12:10.333 --> 12:12.232\n反复的咳嗽，\n\n12:12.232 --> 12:15.632\n老师希望就是医师开一些一些抗生素，\n\n12:16.033 --> 12:17.783\n但是大家都要知道。\n\n12:18.958 --> 12:22.107\n抗生素仅仅对细菌性的感染是有效的。\n\n12:22.557 --> 12:24.208\n如果是病毒性。\n\n12:25.593 --> 12:28.293\n感染胃食管反流引起的咳嗽，\n\n12:28.442 --> 12:32.143\n或者咳嗽变异性哮喘引起的慢性咳嗽，\n\n12:32.393 --> 12:34.143\n抗生素没有效果，\n\n12:34.393 --> 12:36.143\n而且滥用抗生素呢，\n\n12:36.143 --> 12:37.643\n会导致菌群失衡。\n\n12:40.000 --> 12:42.726\n对于慢性咳嗽病因治疗呢，\n\n12:42.726 --> 12:46.601\n是根本咳嗽变异性哮喘治疗方案呢，\n\n12:46.601 --> 12:51.651\n是应用糖皮激素加上长效的贝塔受体激动剂吸入治疗。\n\n12:52.200 --> 12:55.101\n如果是胃食管反流引起的慢性咳嗽，\n\n12:55.450 --> 12:57.651\n应用质子泵的抑制剂，\n\n12:57.851 --> 12:59.051\n早晚各一次。\n\n12:59.250 --> 12:59.950\n而且呢，\n\n12:59.950 --> 13:01.750\n建议夜间抬高床头。\n\n13:02.598 --> 13:05.799\n如果是上气道咳嗽综合征引起的慢性咳嗽，\n\n13:06.249 --> 13:10.148\n选用的抗组胺药加上鼻腔激素喷雾。\n\n13:11.213 --> 13:15.013\n如果是嗜酸粒细胞性支气管炎导致的慢性咳嗽，\n\n13:15.164 --> 13:17.463\n需要吸入激素单药治疗。\n\n13:19.664 --> 13:20.690\n慢性咳嗽呢，\n\n13:20.690 --> 13:23.215\n也可以应用呼吸康复锻炼法，\n\n13:23.864 --> 13:28.340\n缩唇呼吸和腹式呼吸联合吸气的时候呢，\n\n13:28.340 --> 13:30.215\n腹部鼓起缩唇，\n\n13:30.215 --> 13:31.164\n缓慢呼吸，\n\n13:31.515 --> 13:33.414\n使吸呼比达到1:2，\n\n13:33.715 --> 13:36.715\n这样有助于降低患者气道塌陷的风险。\n\n13:37.534 --> 13:38.260\n患者呢，\n\n13:38.260 --> 13:40.034\n可以练习咳嗽控制操，\n\n13:40.734 --> 13:43.635\n帮助清除咽喉部的分泌物，\n\n13:43.784 --> 13:45.684\n不引发剧烈的咳嗽。\n\n13:46.434 --> 13:46.809\n嗯，\n\n13:46.809 --> 13:48.534\n将呼吸康复锻炼呢，\n\n13:48.534 --> 13:50.534\n纳入患者的日常习惯，\n\n13:50.585 --> 13:52.734\n有助于提高肺通气效率，\n\n13:52.835 --> 13:54.885\n减少急性加重的次数。\n\n13:56.515 --> 13:56.791\n嗯，\n\n13:56.791 --> 13:59.565\n对于特殊人群儿童呢，\n\n13:59.565 --> 14:02.265\n就是6岁以下的孩儿童呢，\n\n14:02.265 --> 14:02.866\n一般来说，\n\n14:02.866 --> 14:05.466\n医生不会应用中枢性的镇咳药的，\n\n14:05.716 --> 14:09.616\n优先采用生理盐水雾化或者鼻腔清洗，\n\n14:10.116 --> 14:11.716\n可以减少鼻后滴漏。\n\n14:12.515 --> 14:13.315\n家长呢，\n\n14:13.315 --> 14:16.866\n应该观察儿童是不是有喘鸣啊，\n\n14:16.966 --> 14:19.841\n吸气困难等特殊的症状，\n\n14:19.841 --> 14:23.716\n要警惕喉炎和异物吸入造成的反复的咳嗽。\n\n14:25.354 --> 14:26.804\n对小朋友来说，\n\n14:26.953 --> 14:29.004\n夜间抬高床头30°，\n\n14:29.254 --> 14:33.203\n保持室内湿度是40%.60%，\n\n14:33.453 --> 14:35.403\n可以减少咳嗽的发作。\n\n14:36.703 --> 14:38.554\n对于孕妇的患者呢，\n\n14:38.804 --> 14:42.354\n可以使用妊娠AB类相对安全的药物。\n\n14:44.382 --> 14:47.581\n反流性咳嗽导致的慢性咳嗽呢，\n\n14:47.581 --> 14:48.731\n对孕妇来说，\n\n14:48.882 --> 14:51.132\n首选生活方式的干预，\n\n14:51.331 --> 14:53.331\n比如说少食多餐啊，\n\n14:53.331 --> 14:54.531\n枕头垫高等。\n\n14:55.455 --> 14:59.755\n如果出现痰中带血、发热、呼吸急促等症状呢，\n\n14:59.755 --> 15:01.155\n应该立即就医，\n\n15:01.354 --> 15:02.854\n避免自行服药。\n\n15:04.445 --> 15:05.244\n对于老年人。\n\n15:06.088 --> 15:06.538\n患者呢，\n\n15:06.538 --> 15:07.687\n抵抗力比较弱，\n\n15:08.237 --> 15:10.338\n常常合并多种慢性疾病，\n\n15:10.588 --> 15:13.388\n需要在医生的指导下调整药物。\n\n15:15.122 --> 15:16.622\n如果有高血压，\n\n15:16.822 --> 15:21.622\n建议将A、CER类的降压药改成ARB类，\n\n15:21.622 --> 15:23.422\n避免药物性咳嗽。\n\n15:25.192 --> 15:27.317\n使用吸入药物的时候呢，\n\n15:27.317 --> 15:29.192\n应用后建议漱口，\n\n15:29.442 --> 15:31.393\n防止口腔念珠菌。\n\n15:32.192 --> 15:34.343\n如果患者合并骨质疏松，\n\n15:34.393 --> 15:37.143\n长期应用激素的建议患者。\n\n15:38.125 --> 15:40.426\n配合钙片、维生素D的口服。\n\n15:41.898 --> 15:42.797\n对于老年患者，\n\n15:42.797 --> 15:44.747\n建议家属参与监督，\n\n15:45.047 --> 15:47.797\n减少多重用药带来的相互风险。\n\n15:50.156 --> 15:52.156\n对于慢性咳嗽的患者呢，\n\n15:52.205 --> 15:56.330\n建议患者建立一下个人的咳嗽档案，\n\n15:56.330 --> 15:58.806\n使用手机日历或者纸质表格。\n\n15:59.666 --> 16:01.567\n记录咳嗽的表现，\n\n16:02.416 --> 16:02.791\n嗯，\n\n16:02.791 --> 16:06.567\n建议患者每3个月复诊一次流感。\n\n16:06.567 --> 16:07.317\n季前呢，\n\n16:07.517 --> 16:09.666\n接种灭活类流感疫苗。\n\n16:10.567 --> 16:10.966\n嗯，\n\n16:11.067 --> 16:12.767\n准备咳嗽急救包，\n\n16:12.966 --> 16:14.767\n包括吸入激素啊，\n\n16:14.817 --> 16:16.791\n救急的支气管扩张剂啊，\n\n16:16.791 --> 16:17.916\n盐水喷雾等，\n\n16:18.216 --> 16:19.166\n有备无患，\n\n16:19.166 --> 16:20.367\n减少急诊率。\n\n16:22.825 --> 16:24.650\n今天的讲座就到这儿，\n\n16:24.650 --> 16:26.525\n谢谢大家的聆听。\n\n","v0d47cg10004d7686qqljht8044hnk70",992,603,"2026-01-26 13:17:17","慢性咳嗽的症状、自我筛查与就诊","慢性咳嗽患者的长期随访与预防，如何认识慢性咳嗽这个情况，咳嗽按照时间分为急性咳嗽、亚急性咳嗽和慢性咳嗽。","2026-06-11 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