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--> 00:01.667\n大家好，\n\n00:01.667 --> 00:04.767\n今天我们来学习一下急性上呼吸道感染。\n\n00:06.901 --> 00:09.701\n从以下几个方面来进行讲述，\n\n00:09.902 --> 00:13.652\n首先是急性上呼吸道感染概概述，\n\n00:13.902 --> 00:16.802\n第二是急性上呼吸道感染的诊断，\n\n00:16.951 --> 00:19.552\n第三是急性上呼吸道感染的治疗。\n\n00:20.101 --> 00:22.201\n急性上呼吸道感染概述，\n\n00:22.502 --> 00:25.576\n急性上呼吸道感染的定义与分类，\n\n00:25.576 --> 00:28.351\n可以分为上呼吸道感染和下呼吸道感染。\n\n00:28.502 --> 00:29.652\n上呼吸道感染呢，\n\n00:29.652 --> 00:31.502\n包括鼻腔、咽喉，\n\n00:31.802 --> 00:33.001\n下呼吸道感染呢，\n\n00:33.001 --> 00:36.701\n包括这个气管、支气管和肺定义呢，\n\n00:36.701 --> 00:37.152\n急性。\n\n00:37.240 --> 00:38.014\n上呼吸道感染，\n\n00:38.014 --> 00:38.990\n简称上感，\n\n00:39.040 --> 00:42.615\n为外鼻孔至环状软骨下缘，\n\n00:42.615 --> 00:47.540\n包括鼻腔、咽喉或喉部急性炎症的炎症的总称。\n\n00:47.790 --> 00:48.540\n病因呢，\n\n00:48.540 --> 00:52.090\n病毒感染约占70%.80%，\n\n00:52.189 --> 00:55.290\n细菌感染约占20%.30%。\n\n00:55.939 --> 00:58.290\n主要包括流感病毒。\n\n00:58.290 --> 00:58.939\n病毒的话，\n\n00:58.939 --> 01:04.839\n主要包括流感病毒、副流感病毒、呼吸道合胞病毒、腺病毒、鼻病毒。\n\n01:06.137 --> 01:09.887\n埃克病毒、土发奇病毒的细菌感染呢，\n\n01:09.887 --> 01:12.236\n以溶血性链球菌最为多见，\n\n01:12.287 --> 01:17.336\n其次为流血嗜血杆菌、肺炎链链球菌和葡萄球菌，\n\n01:17.537 --> 01:20.287\n偶见革兰性阴性杆菌。\n\n01:21.568 --> 01:24.417\n流行病学全年皆可防病发病，\n\n01:24.867 --> 01:26.318\n冬春季节多发，\n\n01:26.367 --> 01:31.267\n可通过含有病毒的飞沫或被污染的手或用具传播，\n\n01:31.367 --> 01:32.367\n多为散发，\n\n01:32.468 --> 01:35.468\n但可在气候突变时小规模流行。\n\n01:35.718 --> 01:38.517\n由于引起上感的病毒类型较多，\n\n01:38.667 --> 01:43.767\n机体对各种病毒感染后产生的免疫力较弱且短暂，\n\n01:43.968 --> 01:46.068\n病毒之间无交叉免疫。\n\n01:46.907 --> 01:47.108\n嗯。\n\n01:48.731 --> 01:50.930\n同时在健康人群亦可携带，\n\n01:51.130 --> 01:57.880\n根据2022年中国卫生年鉴、2018年我国居民疾病两周就诊率，\n\n01:57.930 --> 01:59.206\n流行病学数据，\n\n01:59.206 --> 02:01.130\n急性上呼吸道感染就诊率。\n\n02:02.236 --> 02:03.536\n首位，\n\n02:03.536 --> 02:04.011\n此外，\n\n02:04.011 --> 02:11.485\n根据2018年调查地区居民疾病住疾病病别住院率数据，\n\n02:11.485 --> 02:15.636\n急性上呼吸道感染仍是导致居民住院主要呼吸疾病。\n\n02:17.302 --> 02:19.677\n上呼吸道感染发病率高，\n\n02:19.677 --> 02:22.001\n尤其是5下5岁以下儿童，\n\n02:22.102 --> 02:25.802\n呼吸道感染仍然是全世界主要的公共卫生问题，\n\n02:25.901 --> 02:27.951\n影响到所有的年龄组的人。\n\n02:28.102 --> 02:34.501\n使用2019年全球疾病负担研发的这个数据的结果的数据评估，\n\n02:34.602 --> 02:36.602\n1990年到2019年，\n\n02:36.602 --> 02:40.951\n亚洲国家是上呼吸道感染负担的这个现状和趋势。\n\n02:41.052 --> 02:43.852\n5岁以下儿童的上呼吸道感染啊，\n\n02:43.852 --> 02:45.102\n发病率较最高。\n\n02:45.251 --> 02:46.126\n老年人呢，\n\n02:46.126 --> 02:47.701\n这个上呼吸道感染死亡率。\n\n02:47.759 --> 02:52.059\n最高流感引起的这个呼吸道感染可累积所有年龄组的人群，\n\n02:52.160 --> 02:54.410\n每年导致300.500例病重，\n\n02:55.460 --> 03:00.009\n重症病例约29.65万死亡。\n\n03:02.009 --> 03:05.835\n急性上呼吸道感染分类是不是一个，\n\n03:05.835 --> 03:08.985\n首先这个急性上呼吸道感染不是一个疾病的诊断，\n\n03:08.985 --> 03:10.509\n而是一组疾病的总称，\n\n03:10.910 --> 03:12.485\n包括这个普通感冒，\n\n03:12.485 --> 03:19.059\n病毒性咽炎、喉炎、疱疹性咽峡炎、咽结膜热、细菌性咽扁桃体炎。\n\n03:21.865 --> 03:24.164\n主要病毒病原体是病毒，\n\n03:24.264 --> 03:25.365\n少数为细菌。\n\n03:25.365 --> 03:26.615\n通常病情轻，\n\n03:27.115 --> 03:27.889\n病程短，\n\n03:27.889 --> 03:29.115\n可多自愈。\n\n03:30.539 --> 03:31.289\n预后好，\n\n03:31.539 --> 03:32.652\n但发病率高，\n\n03:32.652 --> 03:34.164\n有时伴有严重的并发症，\n\n03:34.164 --> 03:35.289\n需要积极治疗。\n\n03:36.770 --> 03:37.820\n临床表现呢，\n\n03:37.869 --> 03:42.619\n普通感冒是鼻咽部卡他症状为主要临床表现。\n\n03:42.720 --> 03:44.070\n病毒性咽炎呢，\n\n03:44.070 --> 03:45.720\n咽部发痒或灼热感，\n\n03:45.720 --> 03:46.570\n咳嗽少见，\n\n03:46.570 --> 03:48.220\n一般咽痛不明显。\n\n03:48.320 --> 03:49.445\n病毒性喉炎呢，\n\n03:49.445 --> 03:49.845\n声嘶，\n\n03:49.845 --> 03:50.619\n发声困难，\n\n03:50.619 --> 03:52.244\n咳嗽时疼痛，\n\n03:52.244 --> 03:53.070\n常有发热，\n\n03:53.070 --> 03:54.220\n咽痛或咳嗽。\n\n03:54.570 --> 03:56.794\n体检可见喉部水肿，\n\n03:56.794 --> 03:57.320\n充血，\n\n03:57.419 --> 04:00.494\n局部淋巴结肿大和触痛，\n\n04:00.494 --> 04:02.369\n可闻及喉部的喘鸣音。\n\n04:02.419 --> 04:04.220\n急性疱疹性咽峡炎，\n\n04:04.270 --> 04:05.244\n明显咽痛，\n\n04:05.244 --> 04:05.744\n发热，\n\n04:05.744 --> 04:06.869\n体检可见咽。\n\n04:07.212 --> 04:14.111\n充血软腭、悬雍垂咽及扁桃体发表面有灰白色疱疹及浅表溃疡，\n\n04:14.162 --> 04:15.361\n周围有红晕，\n\n04:15.662 --> 04:18.236\n以后形成疱疹，\n\n04:18.236 --> 04:19.761\n病程约一周。\n\n04:19.962 --> 04:21.062\n咽结膜热，\n\n04:21.111 --> 04:21.761\n发热，\n\n04:21.761 --> 04:23.962\n咽炎、结膜炎三大症状，\n\n04:23.962 --> 04:25.161\n病程4.6天。\n\n04:26.652 --> 04:28.326\n细菌性咽扁桃体炎，\n\n04:28.326 --> 04:28.902\n咽痛，\n\n04:28.902 --> 04:29.951\n畏寒发热，\n\n04:30.002 --> 04:31.851\n体温可达39°以上。\n\n04:31.902 --> 04:35.351\n检查检体检可见咽部明显充血，\n\n04:35.451 --> 04:36.502\n扁桃体肿大，\n\n04:36.502 --> 04:39.502\n充血表面可有黄色脓性分泌物，\n\n04:39.502 --> 04:41.902\n可伴有颌下淋巴结肿大，\n\n04:41.902 --> 04:42.877\n压痛。\n\n04:42.877 --> 04:44.802\n肺部无异常体征，\n\n04:45.152 --> 04:48.502\n病原普遍病原谱存在地域差异。\n\n04:48.552 --> 04:49.226\n首先呢，\n\n04:49.226 --> 04:52.851\n是目前尚缺全国性的呼吸道感染。\n\n04:53.453 --> 04:58.127\n病毒流感染的这个流行病学数据，\n\n04:58.127 --> 04:58.477\n2013.2015年，\n\n04:58.477 --> 05:00.778\n这个河北省4家医院收集到的，\n\n05:00.778 --> 05:04.977\n门诊就诊的这个急性上呼吸道感染患者的咽拭子标本，\n\n05:04.977 --> 05:06.602\n一千一五百五十一份。\n\n05:06.653 --> 05:14.602\n排名前五名的依次是鼻病毒、副流感病毒、三型呼吸道呼吸道合胞病毒、腺病毒、乙型流感病毒。\n\n05:14.703 --> 05:15.602\n在甘肃省，\n\n05:15.602 --> 05:17.345\n2010年至2013年，\n\n05:17.345 --> 05:23.653\n10所哨点医院942例大于等于15例的中流感病毒人贯。\n\n05:23.704 --> 05:26.079\n状病毒和呼吸道合胞病毒啊，\n\n05:26.079 --> 05:26.954\n位居前三。\n\n05:28.041 --> 05:30.141\n在2015.2017年间，\n\n05:30.141 --> 05:30.916\n上海地区，\n\n05:30.916 --> 05:35.641\n大于等于15岁的287例严重急性上呼吸道感染住院病例，\n\n05:35.691 --> 05:43.742\n前五位分别是流感病毒、人鼻病毒、肠道病毒、冠状病毒、肺炎、支原体和副流感病毒。\n\n05:44.500 --> 05:49.075\n徐超等的一项是纳入59篇文献，\n\n05:49.075 --> 05:53.549\n覆盖全国26省、自治区、直辖市数据的meta分析显示，\n\n05:53.549 --> 06:00.174\n我国不同类型肠道病毒血清学的病例数季流行趋势存在较大差异。\n\n06:00.174 --> 06:00.799\n4.7月。\n\n06:01.638 --> 06:04.088\n胃肠道病毒的高发期，\n\n06:04.238 --> 06:07.412\n肠道病毒中容易导致呼吸道感染，\n\n06:07.412 --> 06:09.338\n是柯萨奇病毒和艾克病毒。\n\n06:11.027 --> 06:13.902\n社会分担世界卫生数据显示，\n\n06:13.902 --> 06:19.752\n每年有100万到200万例住院儿童被诊断为严重急性上呼吸道感染，\n\n06:19.752 --> 06:22.076\n导致10万例儿童死亡。\n\n06:22.177 --> 06:22.826\n在我国，\n\n06:22.826 --> 06:27.177\n4岁以下儿童每年急性上呼吸道感染发病率约为8%，\n\n06:27.226 --> 06:28.927\n成年人约为4%。\n\n06:29.177 --> 06:32.826\n急性上呼吸道感染严重影响日常基本生活，\n\n06:32.826 --> 06:33.201\n工作，\n\n06:33.201 --> 06:33.951\n睡眠质量，\n\n06:33.951 --> 06:36.527\n从而产生经济和社会的负担，\n\n06:36.677 --> 06:41.027\n经济影响首先是美国对美国、瑞典、中国。\n\n06:41.096 --> 06:41.571\n国的话，\n\n06:41.571 --> 06:44.596\n它都是有一个较大的这个经济影响。\n\n06:44.795 --> 06:45.270\n那么，\n\n06:45.270 --> 06:47.371\n哪类人需要积极治疗呢？\n\n06:47.371 --> 06:51.596\n对于因感冒而继发的这个CAP或慢性基础疾病，\n\n06:51.996 --> 06:54.645\n急性恶化高危人群包括老年人。\n\n06:56.019 --> 06:56.244\n嗯，\n\n06:56.244 --> 06:56.970\n大于6，\n\n06:56.970 --> 06:58.170\n大于65岁，\n\n06:58.269 --> 06:59.720\n免疫力低下人群，\n\n06:59.720 --> 07:01.369\n重要器官具有基础疾病，\n\n07:01.369 --> 07:08.320\n如冠状冠心病、慢性心衰、慢性肝功能不全、支气管哮喘和慢性结构性肺病，\n\n07:08.820 --> 07:10.619\n以及孕妇这个特殊群体，\n\n07:10.619 --> 07:12.920\n推荐尽早积极预防治。\n\n07:14.263 --> 07:14.937\n首先呢，\n\n07:14.937 --> 07:16.838\n就是越来越多的数据表明，\n\n07:16.838 --> 07:19.187\n这个包括很多这个病毒在内的，\n\n07:19.187 --> 07:24.388\n可以诱发这个CAP以及COPD哮喘和支气管扩张这个急性发作，\n\n07:24.388 --> 07:26.113\n甚至心肌梗死啊。\n\n07:26.113 --> 07:27.988\n慢性呼吸道疾病的患者呢，\n\n07:27.988 --> 07:32.037\n对RV易感对Co OPD患者长期最终研究发现，\n\n07:32.037 --> 07:35.312\nCOPD急性与感冒互为因感因果，\n\n07:35.562 --> 07:38.162\n因感冒频率与吸烟程度有关联。\n\n07:38.847 --> 07:39.648\n等等等等，\n\n07:40.097 --> 07:41.372\n高危人群的话呢，\n\n07:41.372 --> 07:42.747\n普通感冒后啊，\n\n07:42.747 --> 07:45.548\n易导致基础疾病恶化和肺炎的高危人群。\n\n07:47.082 --> 07:52.981\n包括老年人、重要器官、具有基础疾病的、免疫力低下的孕妇、胎儿等等。\n\n07:53.381 --> 07:55.932\n急性上呼吸道感染的诊断呢，\n\n07:56.432 --> 07:59.932\n首先是要根据患者受凉、疲劳等诱因，\n\n07:59.981 --> 08:03.932\n鼻鼻咽部的卡他炎症症状以及相应的体征，\n\n08:03.932 --> 08:06.131\n结合外周血常规检查结果，\n\n08:06.131 --> 08:08.981\n可导可做出本病的这个临床诊断。\n\n08:09.082 --> 08:09.957\n一般情况下，\n\n08:09.957 --> 08:12.057\n它是无需进行病因诊断的，\n\n08:12.057 --> 08:15.932\n需要注意急性喉炎、扁桃体炎所致的上呼吸道梗阻情况。\n\n08:15.981 --> 08:17.481\n体格检查过程中需要。\n\n08:17.555 --> 08:22.805\n判断患者是否具有呼吸频率增快以及呼吸吸气性三凹征等表现。\n\n08:23.355 --> 08:31.205\n鉴别诊断的话要需要与普通感冒、变异性鼻炎、流行性感冒、支性急性支气管炎，\n\n08:31.205 --> 08:34.606\n急性细菌性细菌性鼻副窦鼻。\n\n08:36.023 --> 08:36.874\n鼻副鼻窦炎。\n\n08:38.765 --> 08:41.315\n进行相鉴别诊断方法的话，\n\n08:41.315 --> 08:43.440\n临床表现首先是危险因素，\n\n08:43.440 --> 08:50.716\n受凉、淋雨、气候突变、过度疲劳导致全身或呼吸道局部防御性功能降低的因素，\n\n08:50.815 --> 08:51.616\n第二是病史，\n\n08:51.616 --> 08:53.565\n急性起病上以上。\n\n08:54.340 --> 08:55.640\n呼吸道卡他症状，\n\n08:55.789 --> 08:58.039\n咽干咽痒为临床表现，\n\n08:58.090 --> 08:59.890\n可合并发热头痛。\n\n08:59.890 --> 09:02.940\n患者亦可出现咽痒咽痛啊。\n\n09:03.239 --> 09:07.390\n查体可见这个鼻腔粘膜咽部充血水肿，\n\n09:07.390 --> 09:08.539\n有分泌物，\n\n09:08.590 --> 09:10.515\n颏下淋巴结肿大且触痛，\n\n09:10.515 --> 09:12.190\n扁桃体肿大充血，\n\n09:12.239 --> 09:14.190\n表面有黄色脓性分泌物，\n\n09:14.190 --> 09:16.289\n肺部无异常体征。\n\n09:16.289 --> 09:18.515\n如存在这个上呼吸道梗阻，\n\n09:18.515 --> 09:21.489\n以及这个闻及喉部的这个哮鸣。\n\n09:23.643 --> 09:24.593\n辅助检查呢，\n\n09:24.593 --> 09:25.968\n首先是外周血常规，\n\n09:25.968 --> 09:29.193\n其次是X胸片啊。\n\n09:29.343 --> 09:32.093\n鉴别胸肺炎时可以考虑病原学。\n\n09:32.093 --> 09:33.768\n病原学检查呢，\n\n09:33.768 --> 09:34.568\n一般可以不做。\n\n09:34.568 --> 09:35.994\n如需鉴别这个流感，\n\n09:36.044 --> 09:40.468\n就可以考虑进行一些就是检查诊断方法呢，\n\n09:40.468 --> 09:42.093\n病原学检查呢，\n\n09:42.244 --> 09:49.193\n就是我们成就是成人普通感冒诊断和临床治疗实践指南2023推荐。\n\n09:49.443 --> 09:49.794\n嗯，\n\n09:49.794 --> 09:53.369\n是需要这个对于平素健康的感冒患者，\n\n09:53.369 --> 09:53.794\n基于。\n\n09:54.080 --> 09:57.330\n诊断可基于详细询问病史和体格检查，\n\n09:57.330 --> 09:59.380\n不建议做影像学和实验室检查。\n\n09:59.429 --> 10:07.429\n但对于合并有发热大于38°、气短、咳血、疑似肺炎、心力衰竭、免疫缺陷、吸吸入性中毒患者，\n\n10:07.429 --> 10:11.679\n尽快建议尽快进行相应的影像学和实验室检查。\n\n10:12.080 --> 10:12.830\n推荐呢，\n\n10:12.830 --> 10:15.729\n它是感冒症状持续5天不缓解，\n\n10:15.729 --> 10:19.880\n反而加重或症状超过10天并出现以下情况啊，\n\n10:19.880 --> 10:21.229\n浓稠性啊，\n\n10:21.229 --> 10:22.679\n鼻涕和黏痰液，\n\n10:22.679 --> 10:23.830\n副鼻窦和咽。\n\n10:23.880 --> 10:24.630\n部疼痛加剧，\n\n10:24.630 --> 10:26.005\n发热大于等于38°，\n\n10:26.005 --> 10:28.880\nC反应蛋白和降钙素原增高，\n\n10:28.979 --> 10:30.580\n红细胞沉降率加快，\n\n10:30.679 --> 10:32.580\n呼吸困难和血动力学。\n\n10:33.575 --> 10:36.776\n血流动力学不稳定等严重情况应考虑并发症，\n\n10:36.875 --> 10:40.276\n建议尽早进行相应的影像学和实验室检查。\n\n10:40.676 --> 10:42.676\n诊断方法的病原学检查呢，\n\n10:42.676 --> 10:45.625\n感冒症状通常在2.3天达到高峰，\n\n10:45.625 --> 10:47.526\n五五天后逐步缓解，\n\n10:47.575 --> 10:49.625\n持续时间通常小于10天。\n\n10:49.726 --> 10:51.950\n感冒可诱发多种疾病啊，\n\n10:51.950 --> 10:55.125\n急性发作和原有基础疾病的恶化。\n\n10:55.125 --> 10:57.750\n若感冒5天以后不缓不缓解，\n\n10:57.750 --> 10:58.700\n反而加重的话，\n\n10:58.700 --> 11:03.776\n或持续症状时间超过10天大但大于小于12周啊。\n\n11:03.934 --> 11:08.359\n就是2020年这个欧洲这鼻副窦鼻副。\n\n11:09.606 --> 11:11.681\n鼻副窦炎和鼻息肉。\n\n11:11.681 --> 11:17.755\n意见书将这种状况定义为急性病毒性感染后鼻副副鼻窦炎。\n\n11:17.955 --> 11:22.156\n若后者出现以下罗列的三种或以上状况，\n\n11:22.156 --> 11:23.505\n如发热大于38°，\n\n11:23.705 --> 11:25.406\n症状缓解后又加重，\n\n11:25.406 --> 11:28.156\n单侧鼻副副鼻窦局部症状，\n\n11:28.156 --> 11:31.156\n局部疼痛加重以及CRP和E、S2增高。\n\n11:32.096 --> 11:33.796\n应考虑并发a BRS，\n\n11:33.947 --> 11:38.596\n由于由于这个呼吸道病毒感染后易诱发这个呼吸道感染，\n\n11:38.947 --> 11:40.271\n对于感冒诱发，\n\n11:40.271 --> 11:45.197\n诱发的这个社区获得性肺炎和结构性肺炎急性恶化的患者高危，\n\n11:45.197 --> 11:50.796\n考虑这个a BRS为耐药细菌感染的患者应做病原检的检查。\n\n11:51.726 --> 11:52.827\n那么它的治疗呢，\n\n11:52.976 --> 11:55.127\n首先就是解热镇痛药的治疗，\n\n11:55.127 --> 11:58.377\n有头痛、发热、全身肌肉酸痛等症状者，\n\n11:58.377 --> 12:00.226\n酌情使用解热镇痛药。\n\n12:00.226 --> 12:03.851\n对于如对乙酰氨基酚、阿司匹林啊，\n\n12:03.851 --> 12:05.026\n布洛芬等等。\n\n12:05.947 --> 12:08.572\n对鼻塞抗过敏的复方制剂呢，\n\n12:08.572 --> 12:11.497\n又就是要给予有出现以下情况，\n\n12:11.497 --> 12:14.997\n就是有鼻塞、鼻粘膜水肿、充血、咽痛等症状患者，\n\n12:14.997 --> 12:17.521\n应给予这个伪麻黄碱等，\n\n12:17.671 --> 12:22.197\n有可选择收缩上呼吸道粘膜水肿的药物，\n\n12:22.197 --> 12:24.072\n也可以用1%麻黄碱滴鼻。\n\n12:24.122 --> 12:28.296\n有频繁喷嚏、多量流涕等症状的这个患者呢，\n\n12:28.296 --> 12:34.771\n可酌情使用马来酸氯苯那敏、氯雷他定或苯海拉明等抗过敏的药物。\n\n12:35.703 --> 12:36.403\n镇咳呢，\n\n12:36.403 --> 12:39.479\n对于治咳嗽症状较为明显的，\n\n12:39.479 --> 12:42.828\n可给予这个氢溴酸右美沙芬啊，\n\n12:42.828 --> 12:45.528\n可待因等镇咳药物治疗啊。\n\n12:45.528 --> 12:46.453\n一般治疗呢，\n\n12:46.453 --> 12:47.903\n发热病情较重呢，\n\n12:47.903 --> 12:51.504\n或老年老体弱应卧床休息，\n\n12:51.504 --> 12:52.153\n多饮水，\n\n12:52.153 --> 12:54.304\n保持室内空气流通。\n\n12:55.489 --> 12:56.690\n抗病毒药物呢，\n\n12:56.690 --> 12:58.340\n就是治疗的话，\n\n12:58.340 --> 13:01.690\n就是我们一般有这个利巴韦林啊，\n\n13:01.690 --> 13:03.390\n病毒抑咳抑制剂啊，\n\n13:03.390 --> 13:05.590\n神经氨酸酶抑制剂啊，\n\n13:05.590 --> 13:06.840\n马巴洛沙韦啊，\n\n13:06.840 --> 13:10.015\n阿比多尔等等抗菌药物的治疗呢。\n\n13:10.015 --> 13:11.914\n单纯病毒感染呢，\n\n13:11.914 --> 13:13.114\n无需使用抗生素，\n\n13:13.114 --> 13:14.690\n如白细胞计数升高，\n\n13:14.789 --> 13:18.239\n咽部脓痰咳黄痰等细菌感染症状时，\n\n13:18.289 --> 13:19.789\n可酌情使用青霉素，\n\n13:19.789 --> 13:24.015\n第一代头孢素、大环内酯类和喹诺酮类啊，\n\n13:24.015 --> 13:25.890\n极少需要根据患者的这个。\n\n13:25.932 --> 13:29.882\n病原学菌选用这个敏感的抗菌药物啊，\n\n13:29.882 --> 13:30.706\n治疗的话，\n\n13:30.706 --> 13:32.382\n病首先就是病因治疗，\n\n13:32.432 --> 13:35.531\n要如何判断感冒合并的这个细菌感染，\n\n13:35.531 --> 13:38.731\n如何要进行一个经验性的抗感染治疗。\n\n13:40.661 --> 13:42.161\n若感冒这个持续大，\n\n13:42.161 --> 13:45.512\n超过7到十天或五天后症状不缓解反而加重，\n\n13:45.562 --> 13:47.661\n且出现以下情况，\n\n13:47.911 --> 13:51.961\n鼻鼻涕或这个痰液性状和颜色的病变，\n\n13:51.961 --> 13:53.062\n发热大于38°，\n\n13:53.062 --> 13:54.611\n症状缓解后又加重，\n\n13:54.711 --> 13:57.161\n单侧颌面部疼痛，\n\n13:57.161 --> 13:57.661\nCRPPCT增高，\n\n13:57.661 --> 13:59.411\n可考虑并发这个a BRS，\n\n13:59.711 --> 14:02.012\n然后经经验性抗感染治疗。\n\n14:02.012 --> 14:08.437\n建议当地根据当地这个细菌耐药流行病学选用青霉素、阿莫西林等等啊。\n\n14:08.437 --> 14:11.062\n在肺炎链球菌对青霉素不敏感较高的。\n\n14:11.140 --> 14:16.414\n地区或九十天内服用过抗生素的成人患者可考虑选择呼吸喹诺酮。\n\n14:16.414 --> 14:21.539\n若怀疑金葡萄菌感染或副鼻窦吸取物培养为金葡菌感染，\n\n14:21.539 --> 14:23.739\n针对甲氧西林敏感的，\n\n14:23.739 --> 14:27.590\n这可选用这个苯唑西林或氟氯西林等抗生素。\n\n14:27.590 --> 14:29.414\n针对甲氧西林耐葡萄酒菌，\n\n14:29.414 --> 14:33.940\n可选用糖肽类或恶唑烷酮类等抗生素进行治疗。\n\n14:34.568 --> 14:35.869\n中医治疗的优势呢，\n\n14:35.869 --> 14:39.994\n初期就是尚不明确病原体时可运用这个中药进行，\n\n14:39.994 --> 14:41.768\n减少抗生素的不合理使用，\n\n14:41.768 --> 14:43.968\n安全性及有效性较高。\n\n14:44.018 --> 14:44.593\n后期呢，\n\n14:44.593 --> 14:45.318\n缩短病情，\n\n14:45.369 --> 14:46.494\n缩短退热时间，\n\n14:46.494 --> 14:49.968\n改善鼻塞、咽喉肿痛、咳嗽等临床症状和体征，\n\n14:50.068 --> 14:52.544\n调节患儿的这个整体免疫能力，\n\n14:52.544 --> 14:53.718\n实现标本兼治。\n\n14:53.768 --> 14:55.143\n中医药物治疗呢，\n\n14:55.143 --> 14:56.843\n远期疗效较好啊，\n\n14:56.843 --> 14:59.068\n总体费用是较抗生素低廉的。\n\n15:00.127 --> 15:03.452\n急性上呼吸道感染中成药的这个专家共识呢，\n\n15:03.452 --> 15:04.877\n我们也可以看一下，\n\n15:04.927 --> 15:07.377\n就是中医将感冒分为风寒感冒，\n\n15:07.377 --> 15:10.177\n风热感冒就是暑湿感冒等类型。\n\n15:10.276 --> 15:16.202\n风热以发热就是重恶寒、轻鼻塞、流黄涕、咽痛等等为辨别要点。\n\n15:16.202 --> 15:18.052\n中医总的这种治疗原则呢，\n\n15:18.052 --> 15:20.526\n是疏风解表或辛温解表，\n\n15:20.577 --> 15:22.776\n辛风辛凉解表等等。\n\n15:24.258 --> 15:25.059\n总结一下，\n\n15:25.158 --> 15:26.958\n急性上呼吸道感染简称上感，\n\n15:26.958 --> 15:28.908\n为外鼻孔制啊，\n\n15:28.908 --> 15:29.508\n环鼻症，\n\n15:29.508 --> 15:35.434\n包括鼻腔或咽或鼻部的这个喉部的这个急性炎症的总称上感呢，\n\n15:35.434 --> 15:37.008\n它是不是一个疾病的诊断，\n\n15:37.008 --> 15:38.059\n而是一个组啊，\n\n15:38.158 --> 15:40.158\n一组疾病的总称啊。\n\n15:40.359 --> 15:41.533\n急性上感的话，\n\n15:41.533 --> 15:42.408\n全年皆可发，\n\n15:42.408 --> 15:43.809\n以病毒为主啊，\n\n15:43.809 --> 15:45.658\n不同地区有较大的差异。\n\n15:45.809 --> 15:47.484\n急性上呼吸道感染治疗呢，\n\n15:47.484 --> 15:49.408\n包括对症治疗和对因治疗。\n\n15:50.197 --> 15:51.646\n病病因治疗的话，\n\n15:51.646 --> 15:52.921\n以病毒治疗为主，\n\n15:52.921 --> 15:54.271\n通常不大选择抗生素，\n\n15:54.271 --> 15:59.171\n需要综合症状严重程度进行一个方案的选择啊。\n\n15:59.421 --> 16:00.322\n讲解完毕，\n\n16:00.322 --> 16:00.971\n谢谢各位。\n\n","v0247cg10004d767pdiljht5p4f5caog",965,528,"2026-01-28 10:13:02","急性上呼吸道感染概述、症状、治疗","急性上呼吸道感染的定义与分类， 可以分为上呼吸道感染和下呼吸道感染。","2026-06-11 14:55:29",[36],{"menuId":37,"menuName":38,"parentId":17,"orderNum":39,"path":40,"component":41,"isFrame":42,"isCache":43,"menuType":44,"visible":26,"status":17,"createDept":6,"remark":24,"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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