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--> 00:03.650\n各位晚上好啊，\n\n00:03.650 --> 00:04.250\n今天呢，\n\n00:04.250 --> 00:05.574\n很荣幸为大家。\n\n00:06.614 --> 00:08.515\n讲一下那个尘肺病的讲座资料。\n\n00:10.366 --> 00:12.442\n一共分以下几个方面。\n\n00:13.331 --> 00:13.882\n第一部分呢，\n\n00:13.882 --> 00:15.182\n是封面与目录。\n\n00:16.069 --> 00:16.593\n第二部分呢，\n\n00:16.593 --> 00:17.968\n是疾病与概述，\n\n00:18.218 --> 00:20.669\n第三部分是病因与发病机制。\n\n00:21.503 --> 00:22.128\n第四部分呢，\n\n00:22.128 --> 00:23.304\n是流行病学。\n\n00:23.753 --> 00:26.628\n第五部分是临床表现。\n\n00:26.628 --> 00:29.454\n第六部分是诊断与鉴别诊断。\n\n00:29.503 --> 00:31.653\n第七部分是治疗与预后。\n\n00:32.004 --> 00:34.653\n第八部分是预防与控制。\n\n00:34.754 --> 00:36.354\n第九部分是案例分享。\n\n00:37.301 --> 00:37.652\n最后呢，\n\n00:37.652 --> 00:38.926\n是总结与答疑。\n\n00:38.926 --> 00:39.501\n答疑。\n\n00:41.166 --> 00:42.515\n首先是封面与目录。\n\n00:43.567 --> 00:46.817\n我们今天主要是了解一个职业性的肺病。\n\n00:47.166 --> 00:47.766\n就是。\n\n00:49.347 --> 00:50.647\n肺尘埃沉着病。\n\n00:51.474 --> 00:52.799\n然后呢，\n\n00:52.799 --> 00:53.750\n主要的场景呢，\n\n00:53.750 --> 00:56.575\n是在矿山或者建筑工地场景比较多的。\n\n00:59.099 --> 00:59.799\n疾病的概述。\n\n01:01.749 --> 01:04.698\n定义与别名尘肺病的定义。\n\n01:06.039 --> 01:07.613\n是长期吸入粉尘，\n\n01:07.613 --> 01:09.189\n导致肺部纤维化，\n\n01:09.238 --> 01:12.588\n就是个粉尘引起的肺部的纤维化。\n\n01:12.988 --> 01:13.738\n然后呢，\n\n01:13.738 --> 01:15.888\n别名就是肺尘埃沉着病。\n\n01:17.045 --> 01:18.096\n主要类型呢，\n\n01:18.096 --> 01:19.496\n是分为吸肺。\n\n01:20.421 --> 01:22.671\n煤工程费和石棉费。\n\n01:23.963 --> 01:24.338\n吸费呢，\n\n01:24.338 --> 01:27.064\n可能是我们最见得最多的吸费。\n\n01:28.934 --> 01:31.410\n历史与进展，\n\n01:31.559 --> 01:35.184\n最早发现的是在古古代的矿工当中啊，\n\n01:35.184 --> 01:36.260\n发病率的变化呢，\n\n01:36.260 --> 01:38.760\n是因为工业化以后呢，\n\n01:39.209 --> 01:40.360\n随着采矿啊，\n\n01:40.860 --> 01:43.660\n或者是一些工业工业活动。\n\n01:44.438 --> 01:46.587\n加多增加的话呢，\n\n01:46.587 --> 01:48.237\n是发病率会上升的，\n\n01:48.337 --> 01:50.612\n但是现在因为我们保护措施比较好了，\n\n01:50.612 --> 01:53.087\n现在发病率明显下降了。\n\n01:53.759 --> 01:56.009\n研究的进展是粉尘。\n\n01:57.075 --> 01:58.325\n治病机机制。\n\n01:59.218 --> 02:00.818\n还有诊断技术改进。\n\n02:01.738 --> 02:03.238\n这个是我们要研究的方向。\n\n02:05.662 --> 02:07.061\n病因与发病机制。\n\n02:08.143 --> 02:08.444\n北京。\n\n02:09.412 --> 02:10.013\n病因分析。\n\n02:11.100 --> 02:11.425\n病因呢，\n\n02:11.425 --> 02:13.500\n是一个是无机的矿物粉尘，\n\n02:14.000 --> 02:16.500\n常见的致病粉尘有二氧化硅，\n\n02:16.500 --> 02:17.800\n还有煤层等。\n\n02:19.636 --> 02:20.486\n颗粒大小呢，\n\n02:20.486 --> 02:22.337\n一般都是直径小于5μm的，\n\n02:22.587 --> 02:24.662\n然后更容易沉积在肺泡中，\n\n02:24.662 --> 02:26.236\n大一点的吸不进去，\n\n02:26.236 --> 02:26.886\n可能被。\n\n02:27.796 --> 02:30.947\n被那个呼吸道就是挡在外面了，\n\n02:30.947 --> 02:31.697\n小一点呢，\n\n02:31.697 --> 02:33.746\n可能就也是吸收掉了。\n\n02:33.897 --> 02:34.671\n5μm呢，\n\n02:34.671 --> 02:36.147\n更容易沉积在肺泡当中。\n\n02:37.029 --> 02:37.929\n吸收也吸收不掉。\n\n02:39.716 --> 02:43.865\n然后还有一个暴露时间长长时间暴露。\n\n02:44.811 --> 02:45.886\n粉尘致病性啊，\n\n02:45.886 --> 02:47.412\n与暴露时间密切相关的，\n\n02:47.511 --> 02:48.712\n暴露时间越长呢，\n\n02:48.712 --> 02:51.761\n可能可能鸡的这种沉积越来越多，\n\n02:52.162 --> 02:55.611\n肯定是患病的概率会。\n\n02:56.585 --> 02:57.035\n比较高。\n\n02:58.057 --> 02:59.057\n一般都是长期暴，\n\n02:59.057 --> 03:01.807\n积年累月的暴露才患这种病的。\n\n03:03.388 --> 03:05.087\n发病机制，\n\n03:05.138 --> 03:08.438\n一个是炎症介质的释放粉尘呢，\n\n03:08.438 --> 03:10.162\n引发肺泡的巨噬细胞激活，\n\n03:10.162 --> 03:10.888\n然后呢，\n\n03:11.087 --> 03:12.537\n释放炎症介质。\n\n03:14.117 --> 03:14.841\n然后第二部分呢，\n\n03:14.841 --> 03:16.216\n是肺组织的纤维化。\n\n03:16.970 --> 03:17.544\n慢性炎症呢，\n\n03:17.544 --> 03:18.744\n导致肺组织纤维化，\n\n03:18.744 --> 03:19.619\n气道重塑。\n\n03:20.475 --> 03:23.550\n就是个肺组织纤维化核心的病理改变，\n\n03:23.550 --> 03:27.250\n核心的病理病理改变就是一个其实就是个纤维化，\n\n03:27.250 --> 03:28.425\n肺组织的纤维化，\n\n03:28.675 --> 03:29.425\n然后呢。\n\n03:30.863 --> 03:34.914\n就是它其实是一个肺组织吸入很多粉尘以后，\n\n03:35.063 --> 03:37.714\n形成了一个粉尘的粉尘的一个肺泡。\n\n03:38.813 --> 03:39.488\n粉尘啊，\n\n03:39.488 --> 03:40.563\n占满了整个肺泡。\n\n03:41.565 --> 03:46.615\n就是个然后继发的纤维化导致的各种呼吸道症状。\n\n03:47.901 --> 03:50.751\n这就是核心的病理改变，\n\n03:50.951 --> 03:52.151\n早期的肺泡炎，\n\n03:52.151 --> 03:53.776\n这个是病理病理的变化。\n\n03:53.776 --> 03:56.951\n我们活检下来的一个病例啊，\n\n03:57.302 --> 03:58.501\n早期的肺泡炎，\n\n03:59.451 --> 04:02.901\n早期的病理表现就是个简单的肺泡炎，\n\n04:03.102 --> 04:06.052\n没有什么其其他的就是个炎症。\n\n04:07.175 --> 04:07.699\n晚期呢，\n\n04:07.699 --> 04:09.175\n肺肺组织纤维化的，\n\n04:09.175 --> 04:12.300\n就是有些纤维化结节形成啊，\n\n04:12.300 --> 04:14.524\n都是这种粉尘引起的结节，\n\n04:14.524 --> 04:16.424\n肺泡的粉尘引起的结节的形成。\n\n04:18.269 --> 04:19.494\n吸肺的典型表现呢，\n\n04:19.494 --> 04:21.320\n是病例为细结节，\n\n04:21.720 --> 04:23.769\n就肺泡里面都是息肉的。\n\n04:24.770 --> 04:27.420\n我们矿物的矿物的稀的粉尘啊，\n\n04:27.420 --> 04:28.446\n积年累月以后，\n\n04:28.446 --> 04:30.770\n这个肺泡里面全是被吸吸。\n\n04:31.984 --> 04:32.834\n然后吸收嘛，\n\n04:32.834 --> 04:35.033\n吸收不掉就变成一个结节了，\n\n04:35.334 --> 04:36.134\n细结节。\n\n04:37.283 --> 04:39.433\n就是肺吸肺的典型的。\n\n04:40.286 --> 04:40.585\n病理。\n\n04:42.743 --> 04:43.592\n流行病学。\n\n04:45.079 --> 04:46.329\n发病率高危人群，\n\n04:46.329 --> 04:47.454\n这个发病率，\n\n04:47.454 --> 04:49.130\n这个流行病学很有意义，\n\n04:49.579 --> 04:51.654\n都是一个矿工啊，\n\n04:51.654 --> 04:52.480\n建筑工人等，\n\n04:52.880 --> 04:57.029\n这明显的有职业因素的职业高发病的一般的一般的人是不，\n\n04:57.029 --> 05:03.829\n一般不不会有这个细这个尘肺这种病的。\n\n05:05.514 --> 05:06.813\n高发职业是一个职业病，\n\n05:06.813 --> 05:07.463\n其实是，\n\n05:07.914 --> 05:10.039\n然后累计的报告患者数呢，\n\n05:10.039 --> 05:12.139\n我国累计报告了91.5万人，\n\n05:12.139 --> 05:13.889\n其实这么多年下来，\n\n05:13.889 --> 05:14.989\n其实也不算很多，\n\n05:14.989 --> 05:16.063\n也不算非常多。\n\n05:17.893 --> 05:20.667\n然后现存活数是约45万45万人，\n\n05:20.667 --> 05:24.167\n几乎一半人现在是存活的，\n\n05:24.167 --> 05:25.393\n说明这个死亡率。\n\n05:26.317 --> 05:27.018\n还是比较高的，\n\n05:27.268 --> 05:28.692\n就是得了矽肺以后，\n\n05:28.692 --> 05:30.368\n这个肺功能差了以后影响了。\n\n05:31.433 --> 05:32.483\n正常的生命了。\n\n05:34.813 --> 05:36.213\n地区分布与原因。\n\n05:37.559 --> 05:39.434\n我国的高发地区不是我国，\n\n05:39.434 --> 05:39.684\n是。\n\n05:40.773 --> 05:41.673\n全球的高发地区，\n\n05:41.673 --> 05:42.747\n中国、印度、南非嘛，\n\n05:42.747 --> 05:45.673\n都是采矿采煤这种地方。\n\n05:47.821 --> 05:48.071\n然后呢，\n\n05:48.071 --> 05:50.020\n主要原因就是防护措施不足。\n\n05:51.406 --> 05:53.006\n防护措施相当重要的。\n\n05:55.321 --> 05:55.971\n临床表现。\n\n05:57.768 --> 05:58.567\n早期的症状。\n\n05:59.958 --> 06:00.132\n咳嗽，\n\n06:00.132 --> 06:00.507\n咳痰。\n\n06:02.080 --> 06:02.506\n咳嗽咳痰，\n\n06:02.506 --> 06:03.355\n因为感冒啊，\n\n06:03.355 --> 06:04.330\n气管炎啊，\n\n06:04.781 --> 06:07.131\n这些都是有咳嗽咳痰的，\n\n06:07.430 --> 06:07.930\n所以呢，\n\n06:07.930 --> 06:08.781\n这个症状啊，\n\n06:08.781 --> 06:10.055\n还是隐匿的，\n\n06:10.055 --> 06:11.180\n容易相混淆，\n\n06:11.480 --> 06:14.830\n然后都不会引起很大的重视。\n\n06:15.721 --> 06:15.997\n所以呢，\n\n06:15.997 --> 06:18.772\n一开始早期的症状一般不是很典型的，\n\n06:19.122 --> 06:21.346\n然后到进展期，\n\n06:21.346 --> 06:22.372\n可能有胸闷不适，\n\n06:22.372 --> 06:23.171\n胸闷呢，\n\n06:23.321 --> 06:24.522\n也容易被忽视。\n\n06:25.402 --> 06:26.451\n因为胸闷也很有，\n\n06:26.451 --> 06:27.351\n也有很多病，\n\n06:27.902 --> 06:28.402\n然后呢，\n\n06:28.402 --> 06:29.052\n诊断延误呢，\n\n06:29.052 --> 06:29.701\n早期症状呢，\n\n06:29.701 --> 06:31.552\n易导致诊断延误。\n\n06:32.630 --> 06:34.529\n早期因为症状确实隐匿。\n\n06:35.394 --> 06:37.743\n我呼吸道的像咳嗽咳痰都是很常见的。\n\n06:39.101 --> 06:39.451\n所以。\n\n06:40.566 --> 06:42.117\n容易早期延误诊断。\n\n06:44.537 --> 06:45.238\n晚期的症状，\n\n06:45.338 --> 06:46.488\n晚期的症状呢，\n\n06:46.838 --> 06:48.338\n叫进行性的呼吸困难，\n\n06:48.338 --> 06:49.687\n就是呼吸困难越来越严重。\n\n06:51.497 --> 06:52.596\n一直越来越严重。\n\n06:54.294 --> 06:55.218\n就是一个月，\n\n06:55.218 --> 06:56.194\n一个月比一个月差，\n\n06:56.644 --> 06:57.419\n这个是晚期，\n\n06:57.419 --> 06:59.144\n因为肺肺组织纤维化的。\n\n06:59.813 --> 07:01.713\n通气通气功能障碍的，\n\n07:01.914 --> 07:03.063\n然后肺功能下降。\n\n07:04.160 --> 07:05.434\n影响生活质量，\n\n07:05.434 --> 07:07.959\n这个呼呼吸啊。\n\n07:08.911 --> 07:09.361\n呼吸啊，\n\n07:09.361 --> 07:10.962\n换气肺肺的换气啊，\n\n07:10.962 --> 07:13.212\n都功能功能下降了，\n\n07:13.511 --> 07:15.986\n所以可能有这种缺氧的症状，\n\n07:15.986 --> 07:17.236\n有时候胸闷气急，\n\n07:17.236 --> 07:18.911\n什么缺缺氧的症状出来了。\n\n07:19.963 --> 07:20.338\n然后呢，\n\n07:20.338 --> 07:22.764\n还有可能严重的就合并肺心病了。\n\n07:22.764 --> 07:24.427\n这个是晚期的，\n\n07:24.427 --> 07:25.963\n心肺功能都不好了。\n\n07:26.945 --> 07:27.945\n氢可以酸结了的。\n\n07:28.873 --> 07:29.723\n影像学表现。\n\n07:31.078 --> 07:32.428\n一个是肺纹理增粗，\n\n07:32.877 --> 07:34.178\n还有X线。\n\n07:35.191 --> 07:36.441\n那表现为肺为肺，\n\n07:36.441 --> 07:37.266\n肺纹理增粗，\n\n07:37.266 --> 07:39.891\n这个肯定是比较早的吧？\n\n07:40.092 --> 07:42.092\n早期的改变就肺纹理增粗嘛。\n\n07:42.937 --> 07:43.187\n然后，\n\n07:43.187 --> 07:44.462\n稍微进展一点，\n\n07:44.462 --> 07:46.500\n它就有有这个结节影了。\n\n07:46.500 --> 07:47.587\n结节影纤维化，\n\n07:47.587 --> 07:49.786\n就是肺结可见的结节影，\n\n07:49.786 --> 07:51.136\n跟肺肺纤维化。\n\n07:52.390 --> 07:54.540\n这是已经中晚期，\n\n07:55.589 --> 07:56.690\n中期到晚期了，\n\n07:56.690 --> 07:59.065\n已经有肺纤维化了。\n\n07:59.065 --> 07:59.315\nHRCT呢，\n\n07:59.315 --> 08:03.239\n诊断早期的是早期的尘肺病的重要工具HRCT。\n\n08:04.437 --> 08:06.037\n看的清楚一点可以。\n\n08:07.520 --> 08:09.520\n诊断与鉴别诊断。\n\n08:09.871 --> 08:11.520\n诊断标准是。\n\n08:13.020 --> 08:14.420\n职业是结核症状。\n\n08:15.399 --> 08:16.774\n一般都是明确的职业，\n\n08:16.774 --> 08:17.250\n是的。\n\n08:18.260 --> 08:20.459\n采矿工人、建筑工人、挖矿的。\n\n08:21.622 --> 08:21.898\n然后呢，\n\n08:21.898 --> 08:23.673\n一些呼吸道的症状，\n\n08:23.673 --> 08:26.722\n咳嗽咳嗽的胸闷气急的症状。\n\n08:26.722 --> 08:27.097\n这个呢，\n\n08:27.097 --> 08:29.173\n我们只要有职业史，\n\n08:29.173 --> 08:32.473\n那我们医生一般都会想到有这个尘肺病。\n\n08:33.533 --> 08:33.932\n然后呢，\n\n08:33.982 --> 08:37.182\n进一步检查可以查X线或者CT，\n\n08:37.632 --> 08:42.083\n查查肺部的有没有子宫纤维化或者是结节之类的。\n\n08:43.375 --> 08:44.424\n以辅助诊断，\n\n08:44.424 --> 08:44.924\n然后呢，\n\n08:44.924 --> 08:48.325\n肺功能判断这个疾病的严重程度，\n\n08:48.325 --> 08:51.325\n它到底现在梗阻的吸道阻塞的程度。\n\n08:52.267 --> 08:52.567\n第一个呢，\n\n08:52.567 --> 08:55.192\n是能够辅助判断尘肺病。\n\n08:55.192 --> 08:55.642\n第二个呢，\n\n08:55.642 --> 08:58.966\n是看看他目前的一个肺功能功能的情况，\n\n08:59.117 --> 09:00.117\n损伤程度。\n\n09:01.937 --> 09:02.711\n鉴别诊断，\n\n09:02.711 --> 09:03.361\n肺结核，\n\n09:03.361 --> 09:07.236\n肺结核也是以前都是很多的一个疾病，\n\n09:07.236 --> 09:09.437\n现在现在都是也是蛮多的，\n\n09:09.437 --> 09:09.836\n其实。\n\n09:10.721 --> 09:14.497\n肺结肺结核需要与与肺结核鉴别的，\n\n09:14.796 --> 09:18.997\n一般我们通过那个职业史，\n\n09:19.546 --> 09:21.896\n基本上大大致的能判断，\n\n09:22.247 --> 09:23.146\n然后CT呢，\n\n09:23.146 --> 09:24.447\n结节还是有区别的。\n\n09:25.416 --> 09:25.767\n肺癌，\n\n09:25.767 --> 09:26.591\n肺癌鉴别，\n\n09:26.591 --> 09:27.767\n因为肺癌也比较多的，\n\n09:27.767 --> 09:28.666\n肺癌还是。\n\n09:29.648 --> 09:30.049\n相对来讲，\n\n09:30.049 --> 09:31.848\n好鉴别的职业室加上一个C。\n\n09:33.218 --> 09:35.068\n区别的话还是比较好鉴别的。\n\n09:35.068 --> 09:36.218\n特发性肺纤维化。\n\n09:37.231 --> 09:40.205\n你才发现肺纤维化区分主要还是一个职业，\n\n09:40.205 --> 09:41.281\n职业的暴露史。\n\n09:42.226 --> 09:44.575\n长期的吸入粉尘还是好，\n\n09:44.575 --> 09:46.176\n相对来讲还是好区分的，\n\n09:46.426 --> 09:48.101\n只要只要能想到这方面，\n\n09:48.101 --> 09:48.676\n只要能。\n\n09:50.825 --> 09:51.900\n看病的时候啊，\n\n09:51.900 --> 09:52.775\n能能。\n\n09:53.958 --> 09:54.682\n或者是医生提，\n\n09:54.682 --> 09:57.958\n或者是患者主动提出这种职业式的，\n\n09:58.107 --> 10:00.958\n那还是相对来讲好区分的。\n\n10:01.817 --> 10:04.442\n诊断工具一个是影像学检查，\n\n10:04.442 --> 10:06.218\n就是X线跟CT影像学检查，\n\n10:06.668 --> 10:07.617\n肺功能测试，\n\n10:07.617 --> 10:09.768\n评评估一下肺功能的状态。\n\n10:11.283 --> 10:13.008\nBALF分析啊，\n\n10:13.008 --> 10:15.908\n支气胞支气管肺泡灌洗液分析，\n\n10:16.258 --> 10:17.508\n这辅助诊断的。\n\n10:18.547 --> 10:19.348\n这个一般比较少。\n\n10:20.835 --> 10:21.685\n治疗与预后。\n\n10:23.846 --> 10:24.497\n治疗原则，\n\n10:24.497 --> 10:25.896\n那肯定是脱离粉尘了，\n\n10:26.396 --> 10:27.646\n脱离粉尘环境，\n\n10:27.646 --> 10:29.122\n你就是职业使的，\n\n10:29.122 --> 10:31.146\n你可能不能从事这个职业了，\n\n10:31.346 --> 10:32.447\n采矿什么的，\n\n10:32.747 --> 10:33.447\n然后呢？\n\n10:34.877 --> 10:37.278\n尽早的避免继续损坏药物治疗，\n\n10:37.278 --> 10:40.278\n我们一般用抗纤维化的药物来缓解症状。\n\n10:40.578 --> 10:41.103\n然后呢，\n\n10:41.103 --> 10:42.728\n还可以有些缺氧情况呢，\n\n10:42.728 --> 10:44.728\n我们还可以给予氧，\n\n10:45.328 --> 10:46.677\n然后改善呼吸功能，\n\n10:46.677 --> 10:47.927\n提高生活质量。\n\n10:51.471 --> 10:52.572\n常用的药物，\n\n10:52.572 --> 10:54.046\n抗纤维化的药物呢，\n\n10:54.046 --> 10:56.521\n是是比非尼酮啊，\n\n10:56.521 --> 10:58.471\n然后它能够延缓病情进展。\n\n10:59.568 --> 11:00.869\n然后有些。\n\n11:02.463 --> 11:05.963\n炎症抗抗炎的还是用糖皮质激素。\n\n11:06.729 --> 11:07.528\n长期使用呢，\n\n11:07.629 --> 11:09.078\n需要逐渐减量的，\n\n11:09.078 --> 11:11.078\n因为肠糖皮质激素呢，\n\n11:11.078 --> 11:14.729\n长期用药可能有一些身体的不良反应。\n\n11:16.205 --> 11:16.806\n还有个支气管，\n\n11:16.806 --> 11:17.906\n支气管扩张剂。\n\n11:18.955 --> 11:20.106\n有呼吸困难的时候。\n\n11:21.237 --> 11:24.963\n用这呼呼气管支气管扩张剂来改善一下胸闷气息的症状，\n\n11:24.963 --> 11:25.737\n改善通气。\n\n11:28.508 --> 11:29.758\n预后与生存率啊。\n\n11:31.723 --> 11:33.047\n早期的愈合比较好的，\n\n11:33.047 --> 11:34.822\n早期早点发现以后。\n\n11:35.685 --> 11:40.361\n第一时间去脱离暴露环境啊，\n\n11:40.361 --> 11:44.236\n就是可能职业可能要从事别的职业去了。\n\n11:44.236 --> 11:44.835\n然后呢，\n\n11:45.185 --> 11:46.135\n如果这样的话呢，\n\n11:46.135 --> 11:47.710\n愈后还是比较好的。\n\n11:47.710 --> 11:49.536\n晚期肺功能因为是不可逆的。\n\n11:50.409 --> 11:52.609\n肺功能损损害很严重，\n\n11:52.710 --> 11:53.859\n肺纤维化了，\n\n11:54.010 --> 11:56.409\n这种结节在形成以后不可逆的。\n\n11:58.067 --> 11:59.317\n就是预后是比较差的，\n\n11:59.317 --> 11:59.817\n然后呢，\n\n11:59.817 --> 12:06.093\n治疗依从性影响也是非常影响预后的诊断时机啊，\n\n12:06.093 --> 12:07.067\n治疗依从性，\n\n12:07.067 --> 12:07.817\n依从性呢，\n\n12:07.817 --> 12:09.668\n就是不配合治疗嘛，\n\n12:09.918 --> 12:12.518\n有些有些采矿工人你让他。\n\n12:13.426 --> 12:14.325\n赖以生存的。\n\n12:15.109 --> 12:15.434\n职业，\n\n12:15.434 --> 12:16.909\n你要让他更换职业，\n\n12:17.159 --> 12:20.309\n有些是可能依从性比较差的，\n\n12:20.309 --> 12:22.609\n那可能也会影响影响预后。\n\n12:24.715 --> 12:25.565\n预防与控制，\n\n12:26.164 --> 12:28.140\n改善工作环境，\n\n12:28.140 --> 12:32.265\n加强通过一些一些工场地，\n\n12:32.265 --> 12:33.414\n一些装修的。\n\n12:34.257 --> 12:34.658\n场地，\n\n12:35.007 --> 12:35.482\n然后呢，\n\n12:35.482 --> 12:37.607\n降低工作场所的粉尘浓度嘛，\n\n12:38.158 --> 12:38.908\n通通风。\n\n12:39.107 --> 12:39.982\n然后第二个呢，\n\n12:39.982 --> 12:41.357\n使用除尘设备。\n\n12:42.164 --> 12:43.814\n有效减少粉尘暴露，\n\n12:44.213 --> 12:46.114\n第3个是降低粉尘浓度。\n\n12:47.469 --> 12:49.270\n工程控制是预防关键，\n\n12:49.270 --> 12:50.520\n就我们工程控控，\n\n12:50.919 --> 12:51.869\n工程控制。\n\n12:53.307 --> 12:53.981\n个人防护，\n\n12:54.331 --> 12:56.031\n第一个是佩戴防尘口罩，\n\n12:56.031 --> 12:57.007\n这是最最重要的，\n\n12:57.007 --> 12:57.481\n我觉得。\n\n12:59.635 --> 13:01.784\n特别是用一些好一点的口罩的话，\n\n13:01.784 --> 13:04.635\n能够防止大部分的粉尘吸入肺部。\n\n13:05.085 --> 13:05.784\n然后呢，\n\n13:06.135 --> 13:07.135\n穿防护服，\n\n13:07.534 --> 13:09.585\n身体免受粉尘侵害。\n\n13:09.934 --> 13:11.784\n定期的健健康检查呢，\n\n13:11.784 --> 13:12.784\n也是非常重要的。\n\n13:14.000 --> 13:16.349\n尽早发现并处理健康的问题。\n\n13:18.853 --> 13:19.552\n健康教育。\n\n13:22.617 --> 13:23.268\n第一个呢，\n\n13:23.268 --> 13:24.718\n是提高防护意识。\n\n13:25.729 --> 13:26.880\n认识尘肺危害，\n\n13:27.030 --> 13:28.854\n然后开展职业健康培训，\n\n13:28.854 --> 13:30.030\n学习预防措施。\n\n13:30.934 --> 13:32.409\n然后强调预防重要性呢，\n\n13:32.409 --> 13:33.135\n通过教育呢，\n\n13:33.135 --> 13:33.835\n降低发病率，\n\n13:33.835 --> 13:37.159\n这些都应该对一些职业病患者，\n\n13:37.159 --> 13:40.335\n职业患者就是一些采矿工人或者建筑工人，\n\n13:40.434 --> 13:43.434\n我们要做做好这这方面的健康教育。\n\n13:45.765 --> 13:46.616\n案例分析。\n\n13:47.853 --> 13:49.552\n矽肺患者背景矿工啊，\n\n13:49.552 --> 13:50.478\n长期二氧化硅，\n\n13:50.478 --> 13:52.877\n二氧化硅吸吸入的，\n\n13:52.877 --> 13:54.453\n诊断是吸肺，\n\n13:54.453 --> 13:55.127\n然后呢。\n\n13:56.177 --> 13:56.651\n类型呢，\n\n13:56.651 --> 13:57.077\n吸肺呢，\n\n13:57.077 --> 13:57.927\n是最常见的，\n\n13:57.927 --> 13:59.427\n确实是最常见的一个类型。\n\n14:00.762 --> 14:01.262\n没工程，\n\n14:01.512 --> 14:02.512\n没工程费。\n\n14:04.398 --> 14:06.249\n煤矿工人长期接触煤层的。\n\n14:07.250 --> 14:09.250\n霉斑和纤维化病理类型啊，\n\n14:09.400 --> 14:13.500\n发展为纤维化了已经那治疗起来稍微难一点。\n\n14:14.150 --> 14:17.299\n这个是误诊肺结核的影像学呢，\n\n14:17.299 --> 14:18.900\n查出确诊是吸肺的。\n\n14:20.416 --> 14:22.992\n他因为没有缺乏职业史的影像学不典型，\n\n14:22.992 --> 14:24.517\n所以容易误诊。\n\n14:26.247 --> 14:29.547\n成功案例早期脱离暴露并治疗。\n\n14:30.429 --> 14:31.905\n这个这个是最重要的，\n\n14:31.905 --> 14:34.280\n早期彻底暴露并治疗，\n\n14:34.729 --> 14:35.729\n治疗效果呢。\n\n14:36.653 --> 14:39.129\n我们达到有症状的部分缓解啊，\n\n14:39.129 --> 14:41.254\n成功要素还是一个早诊断跟治疗。\n\n14:42.947 --> 14:44.296\n预防措施。\n\n14:46.476 --> 14:48.702\n改善通风和个人防护前面也讲过了，\n\n14:48.702 --> 14:50.427\n强改善通风很重要，\n\n14:50.427 --> 14:53.677\n个人防护最重要的一定要做好防尘工作。\n\n14:54.026 --> 14:54.702\n然后呢，\n\n14:54.702 --> 14:56.202\n尘肺发病率显著下降，\n\n14:56.202 --> 14:58.877\n因为现在我们防护工作做好了。\n\n14:59.651 --> 15:00.551\n显著下降。\n\n15:01.051 --> 15:01.851\n煤矿山。\n\n15:03.247 --> 15:04.997\n这是一个职业暴露点。\n\n15:07.521 --> 15:07.872\n总结。\n\n15:10.335 --> 15:11.635\n早期预防很重要，\n\n15:12.085 --> 15:14.585\n早期治疗提高防护意识。\n\n15:16.646 --> 15:16.947\n好，\n\n15:16.947 --> 15:17.697\n谢谢大家。\n\n","v0347cg10004d734staljht78keqfvv0",922,692,"2026-03-25 00:02:20","2026-06-11 19:02:45",[32],{"menuId":33,"menuName":34,"parentId":17,"orderNum":35,"path":36,"component":37,"isFrame":38,"isCache":39,"menuType":40,"visible":24,"status":17,"createDept":6,"remark":15,"createTime":41,"children":42,"columnImage":43,"columnLogo":44,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":45,"seoKeywords":46,"seoDescription":47,"contentNum":6,"promotionalPoster":48,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":49,"routerPath":36,"componentInfo":37},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 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