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--> 00:03.278\n嗯。\n\n00:06.242 --> 00:06.441\n嗯，\n\n00:06.892 --> 00:14.192\n今天跟大家分享一下肺结核的诊断与治疗专家共识及实践指南。\n\n00:16.569 --> 00:19.170\n今天将从以下四部分来介绍，\n\n00:19.420 --> 00:23.170\n第一部分是肺结核概述与流行病学，\n\n00:23.420 --> 00:27.270\n第二部分是重症肺结核的定义与诊断标准，\n\n00:27.520 --> 00:30.670\n第三部分是肺结核的诊断方法与流程，\n\n00:30.920 --> 00:34.119\n第四部分是抗结核的治疗原则与策略。\n\n00:36.443 --> 00:36.792\n嗯，\n\n00:36.792 --> 00:40.493\n第五部分是抗结核药物与不良反应管理。\n\n00:40.693 --> 00:43.393\n第六部分综合管理与支持治疗。\n\n00:43.643 --> 00:46.743\n第七部分预防与公共卫生的策略。\n\n00:48.102 --> 00:49.402\n首先讲一下第一部分，\n\n00:49.402 --> 00:51.551\n肺结核的概述与流行病学。\n\n00:53.643 --> 00:59.493\n肺结核的定义肺结核是指发生在肺组织、气管、支气管和胸膜的结核，\n\n00:59.743 --> 01:04.542\n包含肺实质结核、气管支气管结核和结核性胸膜炎，\n\n01:04.943 --> 01:08.492\n占各器官结核病总数的80%.90%。\n\n01:11.045 --> 01:16.096\n它的分类分为原发性肺结核血型、播散性肺结核以及继发性肺结核，\n\n01:16.146 --> 01:19.646\n气管支气管结核以及结核性胸膜炎。\n\n01:20.045 --> 01:23.896\n原发性肺结核它是指初次感染即发病的肺结核，\n\n01:24.295 --> 01:27.545\n包括原发综合症及胸内淋巴结结核，\n\n01:27.795 --> 01:29.496\n多见于儿童胸部，\n\n01:29.496 --> 01:36.846\n影像学表现为肺内原发灶及胸内淋巴结肿大及单纯的胸内淋巴结肿大。\n\n01:38.302 --> 01:39.626\n血型播散性肺结核，\n\n01:39.626 --> 01:44.501\n它是包括了急性、亚急性以及慢性血型播散性肺结核。\n\n01:44.802 --> 01:45.702\n急性型。\n\n01:46.052 --> 01:46.452\n嗯，\n\n01:46.652 --> 01:47.726\n胸部影像学，\n\n01:47.726 --> 01:52.902\n它表现为两肺均匀分布的大小密度一致的粟粒结节。\n\n01:53.942 --> 01:57.092\n亚急性或慢性型的弥漫病灶，\n\n01:57.241 --> 01:59.692\n多分布于两肺的上中部，\n\n01:59.842 --> 02:00.717\n大小不一，\n\n02:00.717 --> 02:01.641\n密度不等，\n\n02:01.641 --> 02:02.541\n可有融合。\n\n02:04.286 --> 02:07.361\n继发性肺结核它是由于初次感染后，\n\n02:07.361 --> 02:11.285\n体内潜伏病灶中的结核菌复燃增殖而发病，\n\n02:11.485 --> 02:14.335\n是成人肺结核的最常见类型。\n\n02:14.686 --> 02:16.785\n胸部影像学表现为多样，\n\n02:16.785 --> 02:24.835\n可分为浸润性肺结核、空洞型肺结核、结核球、干酪性肺、肺炎、浅为空洞型肺结核等亚型。\n\n02:26.373 --> 02:35.473\n气管支气管结核它指发生在气管支气管粘膜、粘膜下层平滑肌、软骨及外膜的结核病。\n\n02:35.772 --> 02:39.322\n主要表现为气管或支气管壁不规则的增厚，\n\n02:39.572 --> 02:41.522\n管腔狭窄或阻塞。\n\n02:41.772 --> 02:43.822\n狭窄支气管远端。\n\n02:48.998 --> 02:51.748\n可出现继发性的肺不张和实变。\n\n02:52.932 --> 02:53.783\n结核性胸膜炎，\n\n02:53.832 --> 02:54.582\n它包括。\n\n02:55.438 --> 02:57.738\n干性胸膜炎和渗出性胸膜炎。\n\n02:58.037 --> 02:59.238\n干性胸膜炎。\n\n03:02.261 --> 03:03.860\n通常无明显异常。\n\n03:04.919 --> 03:08.768\n影像学表现渗出性胸膜炎主要表现为胸腔积液，\n\n03:08.919 --> 03:13.069\n可为少量或中到大量的游离胸腔积液。\n\n03:14.106 --> 03:16.455\n也可为局限性或者包裹性积液。\n\n03:18.602 --> 03:21.701\n那接下来看一下全球结核病的流行病学现状。\n\n03:22.436 --> 03:24.037\n全球感染与发病情况，\n\n03:24.436 --> 03:26.986\n全世界的约有1/4的人口，\n\n03:27.287 --> 03:31.236\n也就是20亿左右的人曾受到结核菌的感染。\n\n03:31.337 --> 03:32.261\n2024年，\n\n03:32.261 --> 03:35.736\n全球约1070万人感染肺结核。\n\n03:36.436 --> 03:36.886\n造成。\n\n03:38.509 --> 03:39.759\n120万人死亡，\n\n03:39.910 --> 03:43.059\n结核病再次成为致死人数最多的传染病。\n\n03:44.643 --> 03:46.343\n那哪些是高负担国家庭？\n\n03:47.294 --> 03:54.843\nWho将印度、印度尼西亚、中国、俄罗斯、南非、秘鲁等30多个国家列为结核病高负担国家，\n\n03:55.244 --> 03:58.893\n全球80%的肺结核患者集中在这些国家。\n\n04:00.932 --> 04:04.733\n那我们目前也面临这个耐药结核结核病的挑战。\n\n04:06.468 --> 04:13.169\n耐药结核、耐药性结核及利福平耐药是全球结核病防控的严峻挑战。\n\n04:13.518 --> 04:15.468\n2017年全球的。\n\n04:16.752 --> 04:19.576\n利福平耐药新发55.8万例，\n\n04:19.576 --> 04:23.101\n其中耐药耐多药结合。\n\n04:24.584 --> 04:25.734\n有46万例，\n\n04:25.734 --> 04:29.234\n其治疗难度大、疗程长、治药率低。\n\n04:31.736 --> 04:34.587\n那我国结核病的疫情情况是怎么样呢？\n\n04:34.986 --> 04:41.437\n总体疫情规模据2010年我国第五次结核病流行病学抽样调查估计，\n\n04:41.837 --> 04:46.136\n全国约有活动性结核患者499万例，\n\n04:46.386 --> 04:50.136\n患病率是10万分之四百五十九例，\n\n04:50.687 --> 04:54.886\n痰涂片阳性的肺结核患者72万例，\n\n04:54.886 --> 04:57.636\n患病率是10万分之六十六例。\n\n04:58.589 --> 05:03.239\n均阴性的肺结核患者120万29万例，\n\n05:03.290 --> 05:05.440\n患病率是10万分之一百一十九。\n\n05:06.794 --> 05:10.194\n结核病年死亡人数是5.4万例，\n\n05:10.343 --> 05:12.593\n死亡率是10万分之四点一。\n\n05:13.243 --> 05:15.419\n那地区分布的情况是怎么样的呢？\n\n05:15.419 --> 05:16.944\n地区分布差异比较大，\n\n05:17.144 --> 05:28.894\n西部地区的活动性肺结核患病率、痰涂片阳性的肺结核和培养阳性肺结核患病率明显高于全国平均水平，\n\n05:29.144 --> 05:31.644\n而东部地区低于平均水平。\n\n05:33.316 --> 05:35.166\n那重点人群情况如何呢？\n\n05:35.217 --> 05:41.166\n我国结核病中高危人群包括免疫力低下群人群，\n\n05:41.166 --> 05:49.117\n像艾滋病患者、免疫抑制剂的使用患者、糖尿病患者、65岁以上老年人以及慢性疾病患者等。\n\n05:50.597 --> 05:54.497\n这些都算在都是结核病患者的高危人群。\n\n05:55.611 --> 05:58.411\n那接下来看一下传播途径和高危人群。\n\n05:58.812 --> 06:02.312\n结核病它主要传播途径是通过空气传播。\n\n06:02.562 --> 06:06.562\n患者通过咳嗽、喷嚏、大笑、大声谈话时，\n\n06:06.812 --> 06:10.312\n将有结核分枝杆菌的飞沫排到空气中，\n\n06:10.462 --> 06:12.661\n健康人吸入就有可能感染。\n\n06:13.585 --> 06:15.411\n那么我们如何识别高危人群呢？\n\n06:15.411 --> 06:17.186\n像免疫力低下的患者，\n\n06:17.235 --> 06:18.510\n像艾滋病患者，\n\n06:18.510 --> 06:20.135\n免疫抑制剂使用的患者，\n\n06:20.385 --> 06:22.210\n65岁以上老年人，\n\n06:22.210 --> 06:23.210\n慢性病患者，\n\n06:23.210 --> 06:24.286\n像糖尿病患者，\n\n06:24.436 --> 06:26.536\n这些都是结核病的高发人群。\n\n06:27.566 --> 06:30.066\n那诱发感染的风险因素如何呢？\n\n06:30.415 --> 06:33.066\n居住或者前往结核病高发地区，\n\n06:33.415 --> 06:35.816\n吸烟饮酒人群聚集，\n\n06:35.816 --> 06:37.091\n通风不良的场所，\n\n06:37.091 --> 06:40.015\n像学校啊、监狱啊、医院等，\n\n06:40.316 --> 06:42.165\n与结核病患者密切接触，\n\n06:42.265 --> 06:44.066\n均会增加患病的风险。\n\n06:46.779 --> 06:50.779\n那我们接下来看一下第二部分重症肺结核的定义与诊断标准。\n\n06:53.842 --> 06:55.742\n重症肺结核的临床分型，\n\n06:56.092 --> 07:01.941\n它分为严重的肺组织损伤型、严重的并发症型以及危重症型。\n\n07:04.016 --> 07:05.742\n那严重的肺组织损伤型，\n\n07:05.742 --> 07:09.066\n它是指肺结核病灶范围小于等于两个肺叶，\n\n07:09.066 --> 07:12.141\n伴有干酪样实变、空洞、坏死等病变，\n\n07:12.141 --> 07:15.217\n或者病灶范围大于等于三个肺叶，\n\n07:15.217 --> 07:16.516\n或者器官狭窄，\n\n07:16.717 --> 07:19.391\n氧合指数小于等于300mmHg，\n\n07:19.391 --> 07:22.217\n或者动脉血氧分压小于60mmHg。\n\n07:23.460 --> 07:24.585\n严重并发症型，\n\n07:24.585 --> 07:31.710\n它指肺结核合并中央气道狭窄、大咯血、张力性气胸、呼吸频率大于等于30次每分钟，\n\n07:31.960 --> 07:32.885\n心衰啊，\n\n07:32.885 --> 07:33.710\n肝衰啊，\n\n07:33.710 --> 07:34.485\n肾衰啊，\n\n07:34.485 --> 07:35.335\n意识障碍啊，\n\n07:35.335 --> 07:37.460\n或者有定向障碍的中的至少一种。\n\n07:37.661 --> 07:40.260\n同时氧合指数小于等于300mmHg，\n\n07:40.260 --> 07:42.860\n或者动脉氧分压小于等于60mmHg。\n\n07:43.994 --> 07:45.070\n那危重症型，\n\n07:45.070 --> 07:48.195\n它指合并的休克或者多器官功能衰竭，\n\n07:48.195 --> 07:52.795\n需要入住ICU获取呼吸、循环或者其他脏器支持的患者。\n\n07:55.675 --> 07:57.251\n那严重肺组织损伤型，\n\n07:57.251 --> 07:58.325\n它诊断标准，\n\n07:58.325 --> 08:00.075\n它首先看一下病灶范围。\n\n08:01.200 --> 08:02.050\n以及性质要求，\n\n08:02.251 --> 08:05.401\n它是肺结核病灶范围小于等于两个肺叶，\n\n08:05.401 --> 08:09.376\n还有干酪样病变、实变、空洞坏死等病变，\n\n08:09.376 --> 08:12.151\n或者病灶范围大于等于三个肺叶，\n\n08:12.151 --> 08:13.550\n或者气管狭窄。\n\n08:13.901 --> 08:15.476\n那氧合功能指标方面，\n\n08:15.476 --> 08:17.800\n氧合指数小于等于300mmHg，\n\n08:17.800 --> 08:20.700\n或者动脉氧分压小于等于60mmHg。\n\n08:22.471 --> 08:24.520\n严重并发症型的诊断要点，\n\n08:24.971 --> 08:27.621\n首先看一下并发症类型与判断标准，\n\n08:27.871 --> 08:29.645\n需合并中央气道狭窄，\n\n08:29.645 --> 08:30.295\n大咯血，\n\n08:30.295 --> 08:32.421\n也就是一次咯血量超过100ml，\n\n08:32.421 --> 08:35.570\n或者24小时内咯血量超过五五百毫升，\n\n08:36.221 --> 08:37.245\n张力性气胸，\n\n08:37.245 --> 08:39.671\n呼吸频率大于等于30次每分。\n\n08:39.721 --> 08:43.721\n心衰、肝衰、肾衰、意识障碍、定向障碍中的至少一种。\n\n08:44.710 --> 08:46.060\n那呼吸功能指标方面，\n\n08:46.060 --> 08:50.560\n同时需满足氧合指数小于等于300mmHg或者动脉氧分压。\n\n08:52.288 --> 08:54.062\n小于等于60mmHg。\n\n08:58.039 --> 09:00.440\n那临床症状与影像学证据？\n\n09:01.814 --> 09:01.963\n患者，\n\n09:01.963 --> 09:03.314\n除了上述并发症外，\n\n09:03.314 --> 09:04.713\n常伴有咳嗽啊。\n\n09:05.575 --> 09:06.825\n咳痰、低热，\n\n09:06.875 --> 09:09.125\n盗汗等肺结核典型症状，\n\n09:09.476 --> 09:13.075\n肺部影像学检查可见有相应的并发症的特征性改变，\n\n09:13.325 --> 09:15.075\n如气胸时的，\n\n09:15.075 --> 09:16.601\n它的肺组织有压缩影，\n\n09:16.601 --> 09:17.575\n气道狭窄，\n\n09:17.875 --> 09:19.375\n管腔狭窄症等。\n\n09:21.723 --> 09:22.874\n那危重症型呢？\n\n09:22.874 --> 09:24.523\n它临床持征与ICU指证。\n\n09:26.361 --> 09:29.411\n危重症型肺结核的核心临床特征是，\n\n09:29.711 --> 09:33.961\n它突出表现为合并有休克或者多器官功能衰竭，\n\n09:34.361 --> 09:35.711\n病情进展迅速，\n\n09:35.711 --> 09:36.661\n全身患者，\n\n09:36.812 --> 09:38.861\n患者全身情况极差，\n\n09:38.961 --> 09:43.411\n需要借助外界声明支持手段来维持基本的生理功能。\n\n09:44.307 --> 09:46.356\n那入住ICU的核心指证是，\n\n09:46.557 --> 09:51.307\n当患者需要出现入住ICU获取呼吸支持，\n\n09:51.307 --> 09:55.906\n向机械通气循环支持如血管活性药物来维持血压，\n\n09:56.007 --> 09:59.757\n或者其他的重要脏器支持如血液净化。\n\n10:00.737 --> 10:00.838\n嗯，\n\n10:00.838 --> 10:02.437\n治疗的肾衰患者，\n\n10:03.138 --> 10:04.088\n像这类情况，\n\n10:04.088 --> 10:06.737\n我们应该立即转入ICU进行一个综合救治。\n\n10:07.825 --> 10:09.875\n多器官功能衰竭的判定标准，\n\n10:09.926 --> 10:13.276\n它是指在严重感染的情况下，\n\n10:13.726 --> 10:19.075\n两个或两个以上的器官或者系统同时或者灌续发生功能障碍。\n\n10:19.125 --> 10:20.676\n如同时出现呼衰，\n\n10:20.926 --> 10:23.226\n也是动脉氧分压小于60mmHg。\n\n10:23.226 --> 10:26.776\n肾衰表现为少尿、无尿、血肌酐的显著升高，\n\n10:26.875 --> 10:29.875\n肝功能衰竭像黄疸、转氨酶显著升高等。\n\n10:31.844 --> 10:35.294\n接下来讲一下第三部分肺结核的诊断方法与流程。\n\n10:36.869 --> 10:37.419\n首先，\n\n10:37.469 --> 10:39.369\n临床症状与体征的评估。\n\n10:40.997 --> 10:46.297\n他全身表现为低热、盗汗、乏力、食欲减退、消瘦等，\n\n10:46.648 --> 10:48.797\n部分女性患者可出现月经失调。\n\n10:49.197 --> 10:50.797\n这些症状缺乏特异性，\n\n10:50.898 --> 10:55.598\n但必须结合其他的一些结果来提高准确的症准确性。\n\n10:56.047 --> 10:57.747\n呼吸系统症状方面，\n\n10:57.747 --> 10:58.747\n它表现为咳嗽，\n\n10:58.747 --> 11:00.848\n咳痰持续至少两周以上，\n\n11:01.098 --> 11:02.047\n痰中带血，\n\n11:02.348 --> 11:02.672\n嗯，\n\n11:02.672 --> 11:04.398\n是肺结核的常见症状。\n\n11:04.648 --> 11:05.497\n咳嗽较轻，\n\n11:05.497 --> 11:06.398\n多为干咳。\n\n11:06.598 --> 11:08.898\n肺内有空洞时痰量增多，\n\n11:09.047 --> 11:11.098\n约有1/3的患者出现咯。\n\n11:11.228 --> 11:12.828\n血多数为少量咯血，\n\n11:12.877 --> 11:14.177\n少数为大咯血。\n\n11:14.377 --> 11:17.103\n大咯血它指一次咯血量超过100ml，\n\n11:17.103 --> 11:19.627\n或者24小时内咯血量超过500ml，\n\n11:19.828 --> 11:23.478\n或者每天咯血量100ml以上，\n\n11:23.478 --> 11:24.778\n持续3.7天。\n\n11:25.994 --> 11:27.443\n在其他症状方面，\n\n11:27.593 --> 11:30.093\n它累积胸膜时可表现为胸痛，\n\n11:30.593 --> 11:34.693\n疼痛的特点为随呼吸运动和咳嗽加重，\n\n11:35.393 --> 11:37.193\n若合并支气管结核，\n\n11:37.193 --> 11:38.843\n可出现刺激性咳嗽，\n\n11:38.943 --> 11:41.943\n部分患者还可能伴有呼吸困难等症状。\n\n11:42.943 --> 11:43.593\n症状方面，\n\n11:43.843 --> 11:45.718\n早期他体征可能不明显。\n\n11:45.718 --> 11:46.893\n随着病情的发展。\n\n11:48.257 --> 11:51.807\n肺部病变可出现局部叩诊浊音，\n\n11:51.857 --> 11:53.807\n听诊可闻及示微音。\n\n11:53.807 --> 11:55.458\n对于慢性显微空洞型。\n\n11:56.375 --> 12:00.625\n肺结核的严重病例可出现胸廓塌陷、气管移位等表现。\n\n12:02.450 --> 12:04.500\n那接下来看一下影像学的表现，\n\n12:05.051 --> 12:06.051\n胸片方面。\n\n12:07.521 --> 12:07.997\n它胸片，\n\n12:07.997 --> 12:10.096\n它是肺结核筛查的基础手段，\n\n12:10.096 --> 12:17.622\n典型表现为肺上叶尖后段或者下叶背段斑片状阴影空洞形成。\n\n12:17.622 --> 12:21.122\n可初步判断病灶部位、范围、形态，\n\n12:21.372 --> 12:24.471\n对活动性肺结核具有重要提示作用。\n\n12:24.471 --> 12:26.521\nCT检查更敏感准确，\n\n12:26.521 --> 12:30.122\n能清晰的显示早期微小病灶淋巴结肿大。\n\n12:30.940 --> 12:37.440\n支气管播散灶及空洞细节有助于早期诊断、鉴别诊断及评估病情，\n\n12:37.440 --> 12:40.991\n病情的严重程度尤其适用于不典型的病例。\n\n12:42.278 --> 12:45.729\n还有一些不同类型的肺结核影像学的特征，\n\n12:46.028 --> 12:47.129\n原发性肺结核，\n\n12:47.129 --> 12:50.528\n它表现为肺内原发灶及胸内淋巴结肿大，\n\n12:50.828 --> 12:51.278\n血型，\n\n12:51.278 --> 12:52.203\n播散性肺结核，\n\n12:52.203 --> 12:55.078\n表现为两肺均匀性的分布的粟粒状结节。\n\n12:55.278 --> 12:56.403\n继发性肺结核，\n\n12:56.403 --> 12:57.729\n影像学表现多样，\n\n12:57.729 --> 13:01.429\n可呈斑片状、结节样、空洞性以及干酪样肺炎等表现。\n\n13:02.700 --> 13:04.375\n那实验室检查方面，\n\n13:04.375 --> 13:06.000\n它有，\n\n13:06.000 --> 13:09.226\n痰涂片、抗酸染色、结核分枝杆菌的培养，\n\n13:09.226 --> 13:12.450\n以及生分子生物学检测和免疫学检测。\n\n13:12.901 --> 13:13.901\n那痰图片。\n\n13:14.916 --> 13:17.991\n它需连续采集3天的沉痰来送检，\n\n13:17.991 --> 13:19.765\n阳性结果具有诊断价值。\n\n13:19.765 --> 13:21.666\n但是阴性并不能排除肺结核。\n\n13:22.216 --> 13:23.666\n结核分枝杆菌的培养，\n\n13:23.666 --> 13:25.265\n它是诊断的金标准，\n\n13:25.366 --> 13:28.015\n能确定结核杆菌的种类及药敏情况，\n\n13:28.116 --> 13:29.491\n但耗时时间比较长，\n\n13:29.491 --> 13:31.815\n通常需要4.8周才能获得结果。\n\n13:33.419 --> 13:34.770\n分子生物学检测，\n\n13:34.869 --> 13:36.719\n它是2小时内出结果，\n\n13:36.770 --> 13:37.770\n快速高效。\n\n13:38.681 --> 13:39.531\n免疫学检测，\n\n13:40.080 --> 13:42.330\n它可以辅助诊断潜伏的感染，\n\n13:42.330 --> 13:45.181\n但不能区分活动性的还是既往感染。\n\n13:47.534 --> 13:50.034\n在分子生物学诊断技术进展，\n\n13:50.135 --> 13:52.085\n它现在有。\n\n13:54.504 --> 13:55.304\nExpert MTB.\n\n13:55.703 --> 13:56.104\n嗯。\n\n13:57.257 --> 13:57.333\nR,\n\n13:57.333 --> 14:05.757\nAF技术以及general expert、MTBF技术以及分子生物学检测。\n\n14:07.937 --> 14:08.161\n嗯，\n\n14:08.161 --> 14:09.611\n接下来讲一下第四部分，\n\n14:09.611 --> 14:11.687\n抗结核治疗原则与策略。\n\n14:15.161 --> 14:15.336\n首先，\n\n14:15.336 --> 14:16.512\n我们要早期治疗。\n\n14:16.611 --> 14:17.961\n早期治疗比较，\n\n14:18.111 --> 14:18.911\n它，\n\n14:18.911 --> 14:23.911\n接下来谈一下早期治疗它的重要性以及如何实施早期治疗。\n\n14:24.312 --> 14:27.711\n它可以快速抑制结核分枝杆菌的繁殖，\n\n14:28.111 --> 14:30.286\n减少肺组织组织的损伤，\n\n14:30.286 --> 14:31.961\n降低并发症的风险，\n\n14:31.961 --> 14:33.411\n提高患者的治愈率。\n\n14:33.762 --> 14:36.062\n世界卫生组织它的数据提示了，\n\n14:36.062 --> 14:40.911\n规范的早期治疗初治肺结核患者治愈率可以达到90%以上。\n\n14:41.835 --> 14:42.684\n那实际上，\n\n14:42.684 --> 14:45.635\n重症肺结核患者在病情允许的情况下，\n\n14:45.635 --> 14:47.484\n应尽早启动抗结核治疗。\n\n14:47.734 --> 14:49.984\n确诊后生命体征相对稳定，\n\n14:49.984 --> 14:51.085\n无严重禁忌症，\n\n14:51.085 --> 14:54.510\n应该在48.78小时内就开始进行药物干预，\n\n14:54.510 --> 14:56.335\n以阻止病情进一步恶化。\n\n14:56.684 --> 14:58.010\n那实施策略方面，\n\n14:58.010 --> 15:00.385\n我们需结合患者的脏器功能情况，\n\n15:00.385 --> 15:02.085\n优先选择疗效确切，\n\n15:02.184 --> 15:03.534\n安全性高的一线。\n\n15:04.585 --> 15:05.986\n联合治疗方案。\n\n15:08.416 --> 15:09.317\n像，\n\n15:09.817 --> 15:12.567\n强化期两个月的异烟肼利福平，\n\n15:12.567 --> 15:14.166\n吡嗪酰胺乙胺丁醇，\n\n15:14.216 --> 15:18.267\n巩固期的四巩固期4个月的异烟肼利福平。\n\n15:18.517 --> 15:21.567\n同时加强治疗初期的病情情况，\n\n15:21.567 --> 15:23.466\n监测及支持治疗。\n\n15:24.892 --> 15:27.291\n那在个体化治疗方案原则方面，\n\n15:27.291 --> 15:29.242\n我们是怎么样一个情况呢？\n\n15:29.242 --> 15:29.841\n首先，\n\n15:29.892 --> 15:32.742\n依据患者脏器功能情况进行一个调整。\n\n15:33.091 --> 15:39.392\n我们要根据患者的肝肾功能情况、造血功能情况来合理选择抗结核药物以及剂量，\n\n15:39.591 --> 15:42.892\n避免药物蓄积及不良反应的加重。\n\n15:43.242 --> 15:44.666\n那第二部分，\n\n15:44.666 --> 15:48.091\n我们要结合耐药性的检测来选择药物。\n\n15:49.534 --> 15:53.835\n第三部分要考虑患者特殊性以及生理特点来选择药物。\n\n15:53.835 --> 15:56.859\n对高龄孕妇、儿童这这些特殊的人群，\n\n15:56.859 --> 15:58.534\n我们要制定差异化的方案。\n\n15:59.184 --> 16:02.234\n孕妇我们要避免使用耳毒性的链霉素。\n\n16:03.103 --> 16:03.228\n嗯，\n\n16:03.228 --> 16:05.203\n儿童我们要精确计算剂量，\n\n16:05.502 --> 16:09.802\n老年人我们要加强肝肾功能监监测来确保治疗的安全。\n\n16:10.153 --> 16:10.828\n第四部分，\n\n16:10.828 --> 16:14.703\n我们要参考患者的基础情情况以及治疗的治疗病史。\n\n16:15.557 --> 16:18.007\n治疗治疗室来选择药物。\n\n16:20.814 --> 16:20.989\n另外，\n\n16:20.989 --> 16:23.513\n我们要全程管理进行一个疗效监测。\n\n16:23.614 --> 16:24.864\n首先要治疗，\n\n16:24.914 --> 16:25.239\n嗯，\n\n16:25.239 --> 16:26.914\n治疗依从性一个管理。\n\n16:27.114 --> 16:27.689\n第二部分，\n\n16:27.689 --> 16:30.039\n我们要不良反应的监测以及去处理，\n\n16:30.039 --> 16:32.064\n以及发现以后及时去处理。\n\n16:32.213 --> 16:33.013\n第三部分，\n\n16:33.013 --> 16:35.614\n疗效评估以及一个周期。\n\n16:35.914 --> 16:36.638\n第四部分，\n\n16:36.638 --> 16:37.789\n我们要长期随访，\n\n16:37.789 --> 16:38.114\n嗯，\n\n16:38.114 --> 16:39.013\n预防复发。\n\n16:41.476 --> 16:44.327\n在短期化疗方案方面，\n\n16:44.526 --> 16:46.026\n嗯以及实施的要点，\n\n16:46.276 --> 16:46.851\n首先，\n\n16:46.851 --> 16:51.776\n初治活动性肺结核治疗方案是强化期两个月，\n\n16:51.827 --> 16:55.427\n每日顿服异烟肼利福平、吡嗪酰胺、乙胺丁醇，\n\n16:55.526 --> 16:56.677\n巩固期4个月，\n\n16:56.677 --> 16:58.577\n每日顿服异烟肼利福平。\n\n16:59.026 --> 17:02.927\n复制活动性肺结核常用的方案是强化期两个月，\n\n17:02.927 --> 17:06.477\n每日顿服异烟肼利福平、吡嗪酰胺、莲霉素、乙胺丁醇，\n\n17:06.727 --> 17:08.901\n巩固期要6.10个月，\n\n17:08.901 --> 17:11.677\n每日顿服异烟肼、利福平、乙胺丁。\n\n17:11.719 --> 17:11.969\n存。\n\n17:13.720 --> 17:20.370\n短程化疗实施的要点是我们要遵循早期联合、适量、规律全程这样一个原则。\n\n","v0247cg10004d74u1faljht685feckt0",1049,908,"2026-03-08 00:00:26","2026-06-11 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