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--> 00:03.410\n大家好，\n\n00:03.460 --> 00:06.960\n我今天要讲的是变应性鼻炎。\n\n00:08.909 --> 00:11.609\n我从以下几个方面来讲，\n\n00:12.109 --> 00:14.760\n第一个是封面与目录，\n\n00:15.310 --> 00:17.459\n第二个是疾病概述，\n\n00:18.059 --> 00:21.110\n第三个是病因与发病机制，\n\n00:21.559 --> 00:23.809\n第四个是流行病学，\n\n00:24.360 --> 00:26.809\n第五个是临床表现，\n\n00:28.110 --> 00:31.510\n第六个诊断与鉴别诊断。\n\n00:32.216 --> 00:34.466\n第七个治疗与预后，\n\n00:34.817 --> 00:37.567\n第8个预防与控制，\n\n00:38.016 --> 00:40.466\n第9个是一个案例分享，\n\n00:40.966 --> 00:43.916\n第10个是总结与答疑。\n\n00:46.110 --> 00:46.709\n首先，\n\n00:46.709 --> 00:47.459\n第一部分。\n\n00:54.557 --> 00:56.958\n我们来看一下鼻子的解剖啊。\n\n01:00.958 --> 01:01.257\n这是。\n\n01:19.765 --> 01:19.916\n哦，\n\n01:19.916 --> 01:22.640\n鼻子有大体的结构，\n\n01:22.640 --> 01:25.466\n是分为外鼻、外鼻呢，\n\n01:25.466 --> 01:29.716\n有鼻根、鼻梁、鼻尖和鼻翼。\n\n01:30.316 --> 01:31.191\n第二个呢，\n\n01:31.191 --> 01:32.566\n是鼻前庭。\n\n01:32.966 --> 01:34.916\n鼻前庭有鼻孔，\n\n01:34.916 --> 01:39.115\n内侧还有有鼻孔内侧有鼻毛啊，\n\n01:39.515 --> 01:41.566\n容易长疖痈啊。\n\n01:41.966 --> 01:44.716\n然后第三个是固有的鼻腔，\n\n01:45.265 --> 01:47.365\n它是一个真正的通气腔，\n\n01:47.666 --> 01:49.966\n分内侧壁外。\n\n01:50.019 --> 01:53.019\n侧壁、顶壁、底壁。\n\n01:54.765 --> 01:58.015\n那鼻腔外侧壁是很重要的啊，\n\n01:58.316 --> 01:59.666\n有三个鼻甲，\n\n01:59.865 --> 02:01.916\n分为上中、下。\n\n02:04.482 --> 02:07.781\n然后下鼻的下鼻甲是最大的，\n\n02:07.931 --> 02:09.531\n位于面颊部。\n\n02:10.485 --> 02:13.985\n中鼻甲与鼻窦开口密切相关，\n\n02:14.535 --> 02:16.934\n上鼻甲是最小的，\n\n02:17.035 --> 02:18.384\n靠近嗅区。\n\n02:19.134 --> 02:21.723\n然后鼻窦有4对，\n\n02:21.723 --> 02:23.535\n开口于鼻腔。\n\n02:24.729 --> 02:27.304\n首先上颌窦是最大的，\n\n02:27.304 --> 02:28.729\n位于面颊部，\n\n02:29.330 --> 02:30.529\n然后是筛窦，\n\n02:30.979 --> 02:33.080\n眼眶内侧蜂窝状。\n\n02:33.679 --> 02:35.229\n然后是额窦，\n\n02:35.729 --> 02:37.580\n额窦是在前额部，\n\n02:37.880 --> 02:40.479\n还有蝶窦在颅底的深处。\n\n02:42.871 --> 02:44.121\n鼻腔内侧壁。\n\n02:45.065 --> 02:48.490\n等于中鼻格前下方离市区，\n\n02:48.490 --> 02:51.164\n是鼻出血最常见的部位，\n\n02:51.664 --> 02:52.764\n容易偏曲，\n\n02:52.964 --> 02:56.414\n导致鼻塞、头痛、反复出血等。\n\n02:59.628 --> 03:02.429\n然后第二个是疾病的概述。\n\n03:05.246 --> 03:07.046\n变应性鼻炎的定义，\n\n03:07.345 --> 03:11.996\n它是由过敏原引起鼻粘膜慢性炎症。\n\n03:13.929 --> 03:20.179\n它是IGE介导的鼻粘膜非感染性慢性炎症，\n\n03:20.479 --> 03:22.828\n接触过敏原后发作。\n\n03:25.479 --> 03:27.779\n它的历史与研究进展。\n\n03:29.059 --> 03:31.208\n常见的过敏性疾病。\n\n03:33.257 --> 03:36.757\n痰也是以最常见的过敏性疾病之一。\n\n03:37.158 --> 03:39.608\n它的发病率相关因素有。\n\n03:40.468 --> 03:42.968\n环境的污染、生活方式。\n\n03:46.421 --> 03:49.621\n第三个是病因与发病机制。\n\n03:50.798 --> 03:52.248\n过敏原的分析，\n\n03:52.897 --> 03:55.598\n主要的过敏源有花粉，\n\n03:56.147 --> 03:56.897\n尘螨，\n\n03:57.248 --> 03:58.498\n动物皮屑，\n\n03:59.147 --> 04:01.647\n其他的过敏源有霉菌。\n\n04:02.947 --> 04:04.548\n过敏原影响。\n\n04:06.580 --> 04:09.479\n引发鼻粘膜慢性炎症。\n\n04:11.852 --> 04:15.503\n它的免疫反应机制我刚刚也讲到过了啊，\n\n04:15.552 --> 04:20.252\n是IGE介导的免疫过敏原刺激。\n\n04:20.252 --> 04:22.252\nIGE介导免疫反应，\n\n04:22.903 --> 04:24.502\n炎症介质释放，\n\n04:24.703 --> 04:27.303\n导致导致症状的出现。\n\n04:31.997 --> 04:32.847\n病理变化，\n\n04:33.697 --> 04:35.148\n鼻粘膜的变化，\n\n04:35.347 --> 04:36.148\n充血，\n\n04:36.548 --> 04:37.347\n水肿，\n\n04:37.847 --> 04:39.697\n腺体分泌增加，\n\n04:40.298 --> 04:41.697\n细胞浸润，\n\n04:41.697 --> 04:44.597\n它它是嗜酸性粒细胞浸润。\n\n04:46.305 --> 04:48.605\n第四个是流行病学。\n\n04:53.278 --> 04:57.227\n全球患病率在10%.20%，\n\n04:57.528 --> 05:00.678\n我国成人约17.6%。\n\n05:03.477 --> 05:03.578\n嗯，\n\n05:03.578 --> 05:07.252\n它的发病率与高危人群是儿童，\n\n05:07.252 --> 05:08.727\n青少年高发，\n\n05:09.278 --> 05:12.678\n多见于儿童和青少年群体。\n\n05:13.441 --> 05:15.717\n城市居民发病率高，\n\n05:15.717 --> 05:19.891\n城市居民发病率高于农村的居民。\n\n05:21.114 --> 05:22.764\n高危人群的明确。\n\n05:23.213 --> 05:27.664\n高危人群包括易接触过敏源的个体。\n\n05:32.592 --> 05:34.391\n地区的分布与原因，\n\n05:34.891 --> 05:42.492\n高发地区明确高发地区为气候湿润、空气污染较重区。\n\n05:43.427 --> 05:45.027\n气候湿润相关，\n\n05:45.326 --> 05:49.677\n气候湿润是发病的一个重要环境因素，\n\n05:50.127 --> 05:51.877\n空气污染的影响，\n\n05:52.177 --> 05:56.027\n空气污染加重变异性鼻炎的发生。\n\n05:58.678 --> 06:01.578\n还有一些是遗传也有关系啊，\n\n06:01.727 --> 06:04.953\n比如说特异性体质的过敏体质，\n\n06:04.953 --> 06:07.428\n也就是说有家族倾向的。\n\n06:09.298 --> 06:11.697\n还有少数人会对牛奶啊，\n\n06:11.747 --> 06:12.798\n鸡蛋啊，\n\n06:12.847 --> 06:14.148\n海鲜等过敏。\n\n06:16.786 --> 06:18.486\n然后是临床表现。\n\n06:20.261 --> 06:24.962\n典型的临床症状有鼻痒喷嚏，\n\n06:25.462 --> 06:28.161\n鼻痒喷嚏频繁发作，\n\n06:28.812 --> 06:31.661\n它可以是阵发性的喷嚏，\n\n06:32.111 --> 06:34.712\n一次几个到几十个，\n\n06:35.062 --> 06:39.812\n晨起夜间与过敏源会加重。\n\n06:40.361 --> 06:42.011\n然后鼻痒是。\n\n06:43.002 --> 06:45.152\n看到一个人会反复的揉鼻，\n\n06:45.502 --> 06:49.302\n可伴眼痒、咽痒、耳痒，\n\n06:50.252 --> 06:52.402\n然后是清水样的鼻涕，\n\n06:52.902 --> 06:55.802\n流大量清水样鼻涕。\n\n06:56.644 --> 06:57.244\n然后鼻塞，\n\n06:57.595 --> 07:00.744\n鼻塞严重会影响到呼吸，\n\n07:01.295 --> 07:04.945\n鼻塞是间歇性或者持续性。\n\n07:06.121 --> 07:06.670\n都有啊。\n\n07:09.726 --> 07:13.526\n然后非典型的症状有嗅觉减退。\n\n07:15.248 --> 07:16.998\n嗅觉敏感度下降。\n\n07:18.360 --> 07:20.010\n然后头痛疲劳，\n\n07:20.510 --> 07:22.911\n伴有头痛疲劳感。\n\n07:25.078 --> 07:27.953\n还会有严重影响睡眠啊，\n\n07:27.953 --> 07:31.428\n严重时影响睡眠和生活质量。\n\n07:31.977 --> 07:32.328\n嗯，\n\n07:32.328 --> 07:34.727\n还有眼结膜充血，\n\n07:35.377 --> 07:38.028\n还会引起咳嗽的啊。\n\n07:39.545 --> 07:41.545\n影像学的表现有。\n\n07:43.740 --> 07:47.591\nX线或CT显示鼻粘膜增厚。\n\n07:48.976 --> 07:53.476\n还会看到鼻甲肥大等异常的表现啊。\n\n07:56.144 --> 07:57.994\n诊断与鉴别诊断。\n\n07:59.415 --> 08:02.865\n诊断的标准有根据病史、症状啊。\n\n08:04.117 --> 08:04.516\n病史，\n\n08:05.066 --> 08:07.416\n典型的症状诊断，\n\n08:08.117 --> 08:09.816\n然后体格检查，\n\n08:10.217 --> 08:17.066\n可以做鼻镜检查等体格检查辅助还有过敏原的检测啊，\n\n08:17.266 --> 08:20.516\n结合过敏原检测结果确诊。\n\n08:22.250 --> 08:24.299\n鉴别诊断要点，\n\n08:24.750 --> 08:29.549\n急性鼻炎需与急性鼻炎症状区分。\n\n08:30.493 --> 08:31.393\n慢性鼻炎，\n\n08:31.893 --> 08:34.393\n慢性鼻炎病史长，\n\n08:34.543 --> 08:35.793\n无过敏史，\n\n08:36.343 --> 08:37.543\n还有鼻息肉，\n\n08:38.043 --> 08:39.893\n鼻息肉有肿物，\n\n08:40.242 --> 08:42.343\n过敏检测是阴性的。\n\n08:44.684 --> 08:46.533\n诊断的工具介绍一下，\n\n08:46.783 --> 08:48.533\n有鼻镜的检查，\n\n08:48.934 --> 08:53.133\n鼻镜检查是直接观察鼻粘膜情况，\n\n08:53.684 --> 08:55.583\n还有过敏原检测。\n\n08:56.495 --> 08:59.995\n皮肤点刺血清IGE的检测啊。\n\n09:03.755 --> 09:06.306\n它还有常常见的并发症是。\n\n09:07.505 --> 09:08.679\n气管哮喘，\n\n09:08.679 --> 09:09.054\n嗯，\n\n09:09.104 --> 09:10.804\n它是一个最常见的，\n\n09:11.354 --> 09:13.854\n还有变异性鼻窦炎啊，\n\n09:14.155 --> 09:15.955\n分泌性中耳炎，\n\n09:16.455 --> 09:18.705\n还有过敏性咽喉炎。\n\n09:20.656 --> 09:21.031\n嗯，\n\n09:21.031 --> 09:23.255\n第七个是治疗预后，\n\n09:23.955 --> 09:25.856\n治疗原则的阐述。\n\n09:26.895 --> 09:28.745\n避免过敏原接触，\n\n09:29.096 --> 09:33.296\n减少花粉、尘螨等过敏原接触。\n\n09:35.737 --> 09:36.687\n药物的治疗，\n\n09:36.788 --> 09:39.687\n抗组胺药、鼻用激素等。\n\n09:39.788 --> 09:42.288\n鼻用激素等症状控制。\n\n09:43.383 --> 09:45.833\n免疫治疗、脱敏治疗，\n\n09:45.833 --> 09:47.783\n改善长期预后。\n\n09:51.281 --> 09:52.932\n常用的药物说明啊，\n\n09:53.182 --> 09:56.132\n抗组胺药有氯雷他定，\n\n09:56.331 --> 09:57.981\n可以缓解鼻痒，\n\n09:58.331 --> 09:59.081\n喷嚏，\n\n09:59.481 --> 10:02.831\n还有鼻用的激素如布地奈德，\n\n10:02.831 --> 10:04.831\n减轻鼻粘膜炎症。\n\n10:05.653 --> 10:07.854\n还有白三烯受体拮抗剂，\n\n10:08.504 --> 10:10.153\n如孟鲁司特，\n\n10:10.304 --> 10:11.403\n辅助治疗，\n\n10:11.554 --> 10:12.804\n控制症状。\n\n10:16.010 --> 10:17.960\n那如果是规范的治疗，\n\n10:18.059 --> 10:20.460\n又包括四步法，\n\n10:20.510 --> 10:21.960\n一个阶梯式的，\n\n10:21.960 --> 10:25.835\n第一个是环境的控制是最基础的，\n\n10:25.835 --> 10:27.559\n也是没有副作用的。\n\n10:27.859 --> 10:34.609\n比如说尘螨可以用55°C的热水洗床品，\n\n10:35.010 --> 10:39.559\n还有除湿要温度要小于50%啊，\n\n10:39.909 --> 10:42.085\n然后除地毯，\n\n10:42.085 --> 10:43.260\n毛绒玩具。\n\n10:44.369 --> 10:45.669\n还可以用吸尘器。\n\n10:46.814 --> 10:47.064\n然后，\n\n10:47.064 --> 10:50.364\n花粉在花粉季要减少出门，\n\n10:51.164 --> 10:55.388\n那十点到上午十点到下午4点的时候，\n\n10:55.388 --> 10:56.864\n是浓度最高的。\n\n10:57.539 --> 10:58.189\n还要关窗，\n\n10:58.789 --> 11:01.088\n戴N95加护目镜，\n\n11:01.539 --> 11:03.489\n回家要洗鼻子，\n\n11:03.689 --> 11:04.689\n换衣服，\n\n11:05.539 --> 11:06.463\n还有宠物，\n\n11:06.463 --> 11:07.838\n要避免接触。\n\n11:08.661 --> 11:09.810\n或者勤洗澡，\n\n11:10.361 --> 11:11.460\n隔离卧室，\n\n11:12.760 --> 11:15.661\n那还有第二步是药物的治疗。\n\n11:16.661 --> 11:19.086\n也就是刚刚所说的抗组胺药，\n\n11:19.086 --> 11:21.361\n氯雷他定、西替利嗪等，\n\n11:22.262 --> 11:24.461\n然后可以快速的止痒啊，\n\n11:24.711 --> 11:26.262\n打喷嚏流涕。\n\n11:27.301 --> 11:28.250\n然后是激素，\n\n11:28.750 --> 11:30.551\n就是说的布地奈德。\n\n11:32.200 --> 11:33.051\n局部用。\n\n11:34.794 --> 11:36.093\n全身吸收较少，\n\n11:36.143 --> 11:37.044\n比较安全。\n\n11:37.643 --> 11:38.593\n然后就是，\n\n11:39.494 --> 11:39.843\n嗯，\n\n11:39.843 --> 11:40.593\n白三烯，\n\n11:40.643 --> 11:41.893\n孟鲁司特钠。\n\n11:43.914 --> 11:44.864\n孟鲁司特钠，\n\n11:45.065 --> 11:47.315\n然后还有鼻用的抗组胺药，\n\n11:48.265 --> 11:50.715\n有个盐酸氮卓斯汀，\n\n11:50.864 --> 11:51.965\n它起效快，\n\n11:52.364 --> 11:54.914\n配合鼻喷激素更佳啊。\n\n11:55.880 --> 11:56.255\n然后，\n\n11:56.255 --> 12:01.481\n免疫治疗是唯一的一个治本的方向啊，\n\n12:01.781 --> 12:02.330\n比如说，\n\n12:02.330 --> 12:06.781\n皮下或舌下过敏原疫苗逐步脱敏，\n\n12:06.981 --> 12:09.580\n长期有效减少复发。\n\n12:10.380 --> 12:10.880\n然后，\n\n12:10.880 --> 12:12.931\n适合这种药物控制不佳，\n\n12:13.281 --> 12:15.031\n不愿长期用药，\n\n12:15.031 --> 12:16.931\n过敏原明确者。\n\n12:18.520 --> 12:20.770\n然后是手术治疗。\n\n12:21.947 --> 12:24.247\n这个是仅少数的情况啊，\n\n12:24.796 --> 12:26.872\n它用于严重的鼻塞啊，\n\n12:26.872 --> 12:27.947\n药物无效，\n\n12:28.447 --> 12:30.396\n如下鼻甲成型，\n\n12:30.497 --> 12:31.997\n神经阻断等。\n\n12:35.924 --> 12:38.924\n那后面讲一下预后与生存率啊，\n\n12:40.075 --> 12:42.575\n大多数的预后是良好的，\n\n12:42.875 --> 12:45.525\n多数患者症状可控，\n\n12:45.724 --> 12:47.174\n生活质量高。\n\n12:48.335 --> 12:50.135\n少数发展成哮喘。\n\n12:51.109 --> 12:54.958\n少数患者可能并发哮喘等过敏性疾病。\n\n12:55.781 --> 12:57.781\n那生存率是较高的。\n\n12:58.081 --> 13:00.731\n变异性鼻炎本身不影响。\n\n13:02.073 --> 13:02.823\n生存率。\n\n13:07.111 --> 13:08.437\n那刚刚也讲过了啊，\n\n13:08.437 --> 13:10.012\n改善生活的环境。\n\n13:11.603 --> 13:13.302\n还有个人的防护措施，\n\n13:13.653 --> 13:14.752\n佩戴口罩，\n\n13:15.103 --> 13:16.002\n勤洗手，\n\n13:16.153 --> 13:17.703\n避免接触宠物。\n\n13:19.177 --> 13:21.978\n然后是健康教育的推广，\n\n13:22.728 --> 13:24.978\n提高公众健康意识，\n\n13:25.177 --> 13:27.627\n了解变异性鼻炎知识，\n\n13:28.028 --> 13:29.978\n开展科普宣传，\n\n13:30.328 --> 13:31.502\n预防过敏，\n\n13:31.502 --> 13:32.728\n减少发病。\n\n13:34.218 --> 13:39.468\n推广的预防措施有改善环境、个人防护等。\n\n13:46.408 --> 13:48.359\n然后下面讲一个案例分析啊。\n\n13:49.705 --> 13:52.705\n青少年患者春季发病，\n\n13:53.005 --> 13:54.306\n鼻痒、喷嚏，\n\n13:54.556 --> 13:56.856\n它和季节性发作相关，\n\n13:57.106 --> 14:00.106\n与特定的季节过敏源相关。\n\n14:00.455 --> 14:02.755\n影像学辅助诊断，\n\n14:03.106 --> 14:06.356\n通过影像学图片辅助确诊。\n\n14:08.968 --> 14:11.117\n常年性变异性鼻炎，\n\n14:11.518 --> 14:14.668\n有成人患者常年鼻塞、流涕。\n\n14:15.637 --> 14:16.086\n症状，\n\n14:16.086 --> 14:16.661\n持续，\n\n14:16.661 --> 14:18.437\n不受季节限制。\n\n14:18.786 --> 14:20.036\n康复训练，\n\n14:20.036 --> 14:24.036\n通过康复训练改善生活质量。\n\n14:26.882 --> 14:29.232\n如果被误诊为慢性鼻炎，\n\n14:29.232 --> 14:32.833\n初步误诊后确诊为变异性鼻炎，\n\n14:33.182 --> 14:36.283\n过敏原检测是确诊的关键。\n\n14:37.510 --> 14:40.909\n要强调鉴别诊断的重要性。\n\n14:44.372 --> 14:45.646\n那成功治疗呢，\n\n14:45.646 --> 14:47.221\n是早期治疗，\n\n14:47.572 --> 14:49.372\n症状完全缓解。\n\n14:50.021 --> 14:52.971\n治疗前后症状对比明显，\n\n14:53.721 --> 14:56.046\n遵循规范治疗流程，\n\n14:56.046 --> 15:00.822\n取得佳效预防措施效果啊。\n\n15:02.125 --> 15:03.676\n改善室内环境，\n\n15:04.125 --> 15:07.026\n通过改善环境降低发病率，\n\n15:07.526 --> 15:12.526\n然后家庭预防措施效果是显著的。\n\n15:13.653 --> 15:15.267\n室内环境改善后，\n\n15:15.267 --> 15:17.804\n发病率也明显的下降了啊。\n\n15:21.818 --> 15:26.169\n那我们下面来讲一下还有个日常的护理要点啊，\n\n15:26.369 --> 15:28.669\n坚持生理盐水洗鼻，\n\n15:28.919 --> 15:30.419\n每日一到两次，\n\n15:30.818 --> 15:32.018\n清洁鼻腔，\n\n15:32.119 --> 15:33.369\n减轻炎症，\n\n15:33.919 --> 15:35.169\n避免吸烟，\n\n15:35.169 --> 15:37.568\n二手烟刺激性气味，\n\n15:37.919 --> 15:39.068\n规律作息，\n\n15:39.218 --> 15:40.468\n适度运动，\n\n15:40.669 --> 15:43.568\n增强体质的那么好。\n\n15:43.568 --> 15:44.294\n总结一下，\n\n15:44.294 --> 15:44.968\n最后啊，\n\n15:45.218 --> 15:47.119\n变异性鼻炎的定义，\n\n15:47.869 --> 15:50.968\n膜过敏源治鼻粘膜炎症。\n\n15:51.718 --> 15:57.968\n病因与发病的机制是过敏原刺激IGE介导的免疫反应。\n\n15:58.317 --> 15:59.668\n预防与治疗，\n\n15:59.668 --> 16:00.718\n保持清洁，\n\n16:00.867 --> 16:02.268\n避免过敏原，\n\n16:02.617 --> 16:03.867\n药物治疗等。\n\n16:06.085 --> 16:06.184\n好，\n\n16:06.184 --> 16:06.934\n谢谢大家，\n\n16:06.934 --> 16:09.434\n我的课讲完了啊。\n\n","v0d47cg10004d734i4qljht5jou4mqt0",975,798,"2026-03-25 00:04:50","2026-06-11 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