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--> 00:01.771\n就是今天录制的这个，\n\n00:01.771 --> 00:07.721\n我们这个课课程的主题是胃食管反流病的一个现代诊疗观，\n\n00:08.071 --> 00:10.871\n从小毛病到慢性病的一个全面解读。\n\n00:15.697 --> 00:21.597\n首先就是我想大概周围每身身边每六个人就有一位患者，\n\n00:21.597 --> 00:24.023\n他是有这种烧心症状。\n\n00:24.023 --> 00:24.697\n但是呢，\n\n00:24.747 --> 00:25.523\n烧心呢，\n\n00:25.523 --> 00:28.347\n往往被人认为是啊，\n\n00:28.697 --> 00:30.697\n这个上火或者是压力大，\n\n00:30.697 --> 00:33.323\n习惯自行购药缓解啊，\n\n00:33.323 --> 00:34.897\n直到症状反复发作，\n\n00:34.897 --> 00:36.248\n出现了吞咽困难，\n\n00:36.248 --> 00:38.097\n甚至检出癌前病变，\n\n00:38.397 --> 00:40.198\n才意识到问题的严重性。\n\n00:40.897 --> 00:41.498\n那么，\n\n00:41.498 --> 00:41.847\n嗯，\n\n00:41.847 --> 00:42.698\n其实烧心呢，\n\n00:42.698 --> 00:45.347\n就是胃食管反流病的最典型的症状。\n\n00:45.708 --> 00:50.632\n中国胃食管反流病的总患病人数是1.65亿啊，\n\n00:50.632 --> 00:53.458\n这和零五年的5.5.2%，\n\n00:53.708 --> 00:55.858\n它这个比例是16.7%，\n\n00:56.108 --> 00:58.458\n这和零五年的5.2%啊，\n\n00:58.458 --> 01:00.557\n有了一个非常大幅度的一个增加，\n\n01:01.057 --> 01:02.708\n增加超过40%。\n\n01:03.307 --> 01:05.258\n那么胃食管反流病呢，\n\n01:05.258 --> 01:06.932\n早已经不是小胃病了，\n\n01:06.932 --> 01:10.157\n它其实急需引起我们的一个高度的重视。\n\n01:14.199 --> 01:14.625\n那么，\n\n01:14.625 --> 01:16.500\n这是本次分享内容的一个概览。\n\n01:16.599 --> 01:17.199\n首先，\n\n01:17.300 --> 01:19.474\n认识我们的消化道啊，\n\n01:19.474 --> 01:24.150\n食管和胃其实是存在一个默契配合的一个关系啊，\n\n01:24.150 --> 01:26.699\n探索消化道系统当中的精密运作。\n\n01:27.330 --> 01:27.855\n第二呢，\n\n01:27.855 --> 01:28.879\n就是啊，\n\n01:28.930 --> 01:32.080\n这个了解一下good的幕后元凶，\n\n01:32.330 --> 01:38.180\n也就是我们的抗反流屏障的三重防御机制是如何逐渐失效的。\n\n01:38.580 --> 01:39.254\n第三呢，\n\n01:39.254 --> 01:41.455\n就是谁更容易中招啊，\n\n01:41.455 --> 01:46.629\n深度解析各地的高危人群特征与关键诱发危险因素。\n\n01:47.251 --> 01:47.851\n第四呢，\n\n01:47.851 --> 01:50.351\n就是典型与非典型症状，\n\n01:50.601 --> 01:54.152\n从熟悉的烧心到容易误诊的伪装者症状。\n\n01:54.914 --> 01:55.289\n第五，\n\n01:55.289 --> 01:56.289\n就是啊，\n\n01:56.289 --> 01:58.263\n一些不容忽视的潜在危害，\n\n01:58.564 --> 02:03.013\n长期忽视病情可能导致食管损伤以及严重并发症。\n\n02:03.414 --> 02:04.164\n第六呢，\n\n02:04.164 --> 02:06.513\n是科学的诊断与治疗方案，\n\n02:06.763 --> 02:11.514\n从精准的临床诊断流程到个体化的综合治疗策略。\n\n02:12.014 --> 02:14.813\n第七就是长期管理与未来展望，\n\n02:15.113 --> 02:18.113\n拥抱全周期管理时代，\n\n02:18.113 --> 02:20.539\n从共同展望疾病的防治。\n\n02:20.539 --> 02:21.714\n未来啊，\n\n02:21.714 --> 02:22.688\n我们的目的呢，\n\n02:22.688 --> 02:24.389\n是关注食管健康，\n\n02:24.389 --> 02:25.313\n让每一次吞咽。\n\n02:25.380 --> 02:26.580\n都轻松自在。\n\n02:28.656 --> 02:29.856\n首先呢，\n\n02:29.856 --> 02:34.055\n我们来了解一下食管和胃的这个默契配合。\n\n02:34.888 --> 02:35.587\n食管呢，\n\n02:35.587 --> 02:37.537\n就像柔软的运输管道，\n\n02:37.587 --> 02:40.888\n负责将食物平稳的输送至胃内。\n\n02:41.138 --> 02:42.988\n胃则是强力搅拌机，\n\n02:43.188 --> 02:48.238\n通过胃酸与胃蛋白酶将大块食物高效分解为食糜。\n\n02:48.837 --> 02:50.287\n而在这个过程当中呢，\n\n02:50.287 --> 02:51.287\n有一个守门员，\n\n02:51.337 --> 02:58.488\n就是食管下括约肌胃和食管交界处的LES如同精密的单向阀门，\n\n02:58.837 --> 03:01.688\n吞咽时受到自主神经的支配，\n\n03:01.688 --> 03:03.287\n会自动打开放行。\n\n03:03.287 --> 03:05.037\n食物闭合时呢，\n\n03:05.037 --> 03:05.287\n则。\n\n03:05.337 --> 03:07.236\n保持一个高压的状态，\n\n03:07.386 --> 03:09.886\n从而起到一个抗反流的作用，\n\n03:10.236 --> 03:14.386\n这是消化道功能正常运转的核心保障。\n\n03:15.347 --> 03:17.697\n如果L、S关闭不紧，\n\n03:17.847 --> 03:20.847\n过于松弛或者是频繁异常打开，\n\n03:21.197 --> 03:24.496\n胃酸胆汁就会反流进入食管，\n\n03:24.897 --> 03:27.296\n持续刺激脆弱的黏膜，\n\n03:27.347 --> 03:28.496\n造成损伤，\n\n03:28.897 --> 03:32.996\n进而引发烧心、反酸等一系列不适症状。\n\n03:36.419 --> 03:39.820\n那么这个G是如何发生的呢？\n\n03:40.070 --> 03:41.270\n现代医学认为，\n\n03:41.419 --> 03:46.369\nG的发生本质上是食管与胃之间的抗反流屏障失效。\n\n03:46.919 --> 03:49.520\n这个屏障如同三重防御体系，\n\n03:49.820 --> 03:53.669\n任何一道防线失守都有可能引发个的。\n\n03:54.248 --> 03:57.397\n第一重防线就是我们食管下括约肌，\n\n03:57.498 --> 03:59.647\n就是LES的一个完整性。\n\n04:00.983 --> 04:01.632\nLES呢，\n\n04:01.632 --> 04:08.707\n作为核心单向阀门若出现一过性松弛过度压力过低或结构受损。\n\n04:10.341 --> 04:12.490\n第一道防线就会告失守。\n\n04:13.981 --> 04:15.055\n第二重防线呢，\n\n04:15.055 --> 04:17.430\n是食管的蠕动清除能力，\n\n04:17.830 --> 04:19.230\n就是健康食管。\n\n04:19.230 --> 04:21.131\n它通过强力蠕动，\n\n04:21.131 --> 04:23.480\n将反流入推回胃当中。\n\n04:23.781 --> 04:24.631\n同时呢，\n\n04:24.830 --> 04:26.506\n唾液持续分泌，\n\n04:26.506 --> 04:27.580\n中和胃酸，\n\n04:27.781 --> 04:30.980\n构成高效的物理化学清除机制。\n\n04:31.664 --> 04:35.514\n第三重防线就是食管黏膜的保护屏障。\n\n04:36.014 --> 04:38.864\n食管黏膜如同坚硬的盔甲，\n\n04:38.914 --> 04:42.164\n通过粘液层、上皮细胞连接等机制，\n\n04:42.364 --> 04:45.364\n抵御酸反流物的化学性损伤。\n\n04:49.519 --> 04:49.994\n那么，\n\n04:49.994 --> 04:52.195\n谁更容易得个的呢？\n\n04:52.195 --> 04:52.920\n以下呢，\n\n04:52.920 --> 04:57.845\n是容易得个的的一些高危人群与危险因素啊，\n\n04:57.845 --> 05:02.744\n包括一些不可改变的危险因素和可干预的生活方式。\n\n05:02.744 --> 05:07.769\n危险因素不可改变的危险因素包括年龄、性别。\n\n05:08.269 --> 05:10.095\n随着年龄的增长，\n\n05:10.095 --> 05:11.970\nLES功能是逐渐减弱的。\n\n05:12.320 --> 05:13.970\n男性的患病率呢，\n\n05:13.970 --> 05:19.920\n略风险略高于女性遗传与妊娠直系亲属患病风。\n\n05:19.968 --> 05:20.569\n风险增加，\n\n05:20.819 --> 05:25.769\n约30%.50%的孕妇受激素压迫的影响，\n\n05:26.519 --> 05:29.569\n可干预的生活方式包括肥胖，\n\n05:29.919 --> 05:32.118\n肥胖是个的头号风险，\n\n05:32.569 --> 05:35.118\n腹型肥胖会显著增加腹压，\n\n05:35.468 --> 05:38.819\n患病风险是正常人的2.3倍。\n\n05:39.476 --> 05:41.075\n不良的饮食与习惯，\n\n05:41.325 --> 05:45.175\n比如高脂辛辣饮食、吸烟、饮酒，\n\n05:45.226 --> 05:46.726\n均会松弛L、S，\n\n05:46.726 --> 05:48.575\n并刺激食管粘膜。\n\n05:51.760 --> 05:54.210\n那么各自的。\n\n05:55.701 --> 05:58.101\n典型症状是烧心和反流。\n\n05:58.351 --> 05:59.451\n什么是烧心呢？\n\n05:59.451 --> 06:00.851\n即胃灼热，\n\n06:01.101 --> 06:04.152\n它是指胸骨后或者是心窝处的一个烧灼感，\n\n06:04.502 --> 06:07.252\n通常在餐后1.2小时发作，\n\n06:07.601 --> 06:09.851\n弯腰平卧时会加重。\n\n06:10.536 --> 06:10.885\n注意，\n\n06:10.885 --> 06:12.335\n这并非心脏问题，\n\n06:12.436 --> 06:15.286\n而是食管黏膜受刺激产生的。\n\n06:15.885 --> 06:17.135\n那什么是反流呢？\n\n06:17.135 --> 06:21.485\n它是指胃内容物不费力的反流至咽喉或口腔，\n\n06:21.885 --> 06:24.885\n常伴随酸味液体。\n\n06:25.235 --> 06:28.286\n它是一种被动不费力的永生感，\n\n06:28.686 --> 06:32.085\n与主动用力的呕吐有本质区别。\n\n06:32.635 --> 06:36.735\n如果每周出现烧心反流症状超过两次，\n\n06:37.135 --> 06:40.436\n请及时前往消化科就诊排查。\n\n06:43.222 --> 06:43.597\n那么，\n\n06:43.597 --> 06:46.072\n除了典型的烧心和反流外。\n\n06:47.071 --> 06:48.371\n个的还有一些。\n\n06:50.088 --> 06:53.688\n不典型症状和食管外症状容易被误诊。\n\n06:54.139 --> 06:57.239\n各的非典型症状包括胸痛，\n\n06:57.739 --> 06:58.813\n痛感剧烈，\n\n06:58.813 --> 07:00.889\n极易被误诊为心绞痛。\n\n07:01.338 --> 07:02.514\n吞咽困难呢，\n\n07:02.514 --> 07:06.789\n是因为长期反流导致食管黏膜水肿、痉挛，\n\n07:07.039 --> 07:08.639\n甚至形成狭窄。\n\n07:09.592 --> 07:13.643\n上腹痛常被误认为胃炎或消化性溃疡，\n\n07:13.893 --> 07:16.092\n按胃病治疗效果不佳。\n\n07:17.183 --> 07:21.907\n食管外症状包括反流物的远程攻击咽喉部，\n\n07:21.907 --> 07:24.483\n咽喉部引发慢性咽炎，\n\n07:24.483 --> 07:27.183\n表现为咽部异物感、咽干痒感，\n\n07:27.183 --> 07:28.282\n声音嘶哑。\n\n07:28.782 --> 07:30.032\n呼吸系统呢，\n\n07:30.083 --> 07:31.882\n会引起慢性咳嗽，\n\n07:31.882 --> 07:33.132\n哮喘样发作，\n\n07:33.333 --> 07:35.782\n严重时可致吸入性肺炎。\n\n07:36.433 --> 07:39.782\n耳鼻喉科牙齿腐蚀，\n\n07:39.782 --> 07:43.933\n胃酸腐蚀牙齿还可能诱发鼻窦炎、中耳炎等等。\n\n07:44.434 --> 07:45.059\n如果呢，\n\n07:45.059 --> 07:47.184\n您有上述久治不愈的症状，\n\n07:47.184 --> 07:48.785\n且常规治疗无效，\n\n07:49.035 --> 07:52.434\n请务必考虑是否与胃食管反流有关。\n\n07:55.199 --> 07:55.723\n那么，\n\n07:55.723 --> 07:58.424\n如果长期忽视胃食管反流的症状，\n\n07:58.424 --> 07:59.898\n不及时规范治疗，\n\n08:00.049 --> 08:01.648\n不仅影响生活，\n\n08:01.748 --> 08:04.299\n还可能引发一系列的严重并发症，\n\n08:04.398 --> 08:06.248\n甚至危及生命健康。\n\n08:07.098 --> 08:09.648\n包括最常见的反流性食管炎，\n\n08:09.848 --> 08:14.898\n它是指胃酸长期刺激导致胃黏膜出现糜烂、溃疡，\n\n08:15.148 --> 08:19.098\n引起持续性的胸骨后疼痛感与烧灼感，\n\n08:19.648 --> 08:21.148\n还有食管狭窄，\n\n08:21.598 --> 08:23.424\n食管炎反复发作，\n\n08:23.424 --> 08:24.998\n形成疤痕组织。\n\n08:25.303 --> 08:27.303\n导致食管管腔缩窄，\n\n08:27.553 --> 08:30.753\n最终表现为进行性的吞咽困难。\n\n08:31.403 --> 08:36.653\nBarret食管是指食管下段正常鳞状上皮被柱状上皮取代，\n\n08:36.953 --> 08:41.804\n其癌变风险比普通人群高出30.125倍，\n\n08:42.054 --> 08:44.653\n是食管腺癌的主要原因。\n\n08:45.554 --> 08:46.278\n因此呢，\n\n08:46.278 --> 08:50.953\n积极治疗控制症状是预防严重并发症的关键。\n\n08:53.885 --> 08:56.234\n那么good的是如何诊断的呢？\n\n08:56.484 --> 08:59.109\n我们近年来它的一个诊断的发展，\n\n08:59.109 --> 09:03.484\n已经从症状判断到证据导向为主要方向，\n\n09:04.184 --> 09:07.684\n内镜检查可以直观的评估食管粘膜，\n\n09:07.784 --> 09:11.085\n它是诊断膈的最重要的手段之一，\n\n09:11.484 --> 09:14.734\n可以直接观察食管粘膜形态，\n\n09:15.034 --> 09:22.585\n判断是否存在食管炎、巴沃特食管食管狭窄或食管肿瘤等病变。\n\n09:23.184 --> 09:24.284\n若内镜下。\n\n09:24.383 --> 09:28.408\n发现明确的食管炎或巴尔的食管即可确诊。\n\n09:28.408 --> 09:32.934\nGD反流监测是诊断GD的金标准，\n\n09:33.383 --> 09:38.684\n食管PH阻抗监测是目前诊断个的金标准，\n\n09:39.184 --> 09:44.684\n可以连续24小时监测食管酸碱度与反流事件，\n\n09:45.083 --> 09:47.734\n精准判断病理性酸反流。\n\n09:48.622 --> 09:50.822\n无线P胶囊技术，\n\n09:50.971 --> 09:54.171\n它可以更舒适的监测方案，\n\n09:54.421 --> 09:56.421\n患者可自由活动，\n\n09:56.471 --> 09:59.171\n监测时长可达48小时，\n\n09:59.521 --> 10:04.072\n适合症状不典型或药物治疗效果不佳的患者。\n\n10:07.512 --> 10:08.012\n那么，\n\n10:08.012 --> 10:15.062\n各的治疗它的治疗的总体的原则是阶梯式治疗与个性化方案。\n\n10:15.861 --> 10:21.661\n治疗的核心目标是快速缓解反酸烧心等不适症状，\n\n10:21.911 --> 10:26.062\n促进受食管黏膜愈合与修复，\n\n10:26.762 --> 10:30.961\n长期预防疾病复发以及相关并发症，\n\n10:31.512 --> 10:34.762\n全面提升患者的生活质量水平。\n\n10:35.570 --> 10:38.020\n阶梯式的治疗路径包括，\n\n10:38.020 --> 10:39.520\n基础治疗，\n\n10:39.671 --> 10:47.320\n也就是限制烟酒、控制体重、调整饮食与睡眠姿势等生活方式的干预，\n\n10:47.921 --> 10:54.020\n药物治疗是按需服用抑酸剂或进行长程维持治疗，\n\n10:54.570 --> 10:57.770\n间接治疗主要针对难治性病例，\n\n10:57.921 --> 11:01.370\n考虑内镜下治疗或外科手术。\n\n11:02.327 --> 11:05.726\n个体化定制方案拒绝千人一方，\n\n11:05.976 --> 11:10.927\n医生会综合评估以下维度制定专属方案，\n\n11:11.377 --> 11:23.026\n包括疾病的分型与严重程度、患者的年龄、合并症情况、患者的个人意愿与依从性的这个方面的考量。\n\n11:26.554 --> 11:27.104\n首先，\n\n11:27.104 --> 11:31.254\n基础治疗它是生活方式干预的一个新内涵，\n\n11:31.653 --> 11:33.653\n是个的治疗的基石，\n\n11:34.153 --> 11:35.854\n贯穿于治疗的始终。\n\n11:36.403 --> 11:38.403\n通过科学的自我管理，\n\n11:38.653 --> 11:40.854\n可显著改善患者症状。\n\n11:41.710 --> 11:46.809\n基础治疗的方法包括饮食调整、精准避坑，\n\n11:47.510 --> 11:49.510\n记录饮食日志，\n\n11:49.510 --> 11:53.359\n识别触发食物并严格规避。\n\n11:54.015 --> 11:55.614\n坚持少吃多餐，\n\n11:55.864 --> 11:59.065\n睡前2.3小时尽量不进食。\n\n12:00.109 --> 12:02.008\n体重管理呢，\n\n12:02.158 --> 12:05.008\n也是能够明显获益的。\n\n12:05.408 --> 12:07.958\n因为肥胖是个的重要诱因，\n\n12:08.309 --> 12:11.109\n即使仅减重5%.10%，\n\n12:11.458 --> 12:13.609\n也能有效降低腹压，\n\n12:13.859 --> 12:16.908\n显著缓解反流烧心症状。\n\n12:17.749 --> 12:19.749\n体位调整啊，\n\n12:19.749 --> 12:21.299\n借力重力。\n\n12:22.500 --> 12:27.400\n床头抬高15.20cm是证据最充分的措施。\n\n12:27.849 --> 12:30.349\n睡眠时采取左侧卧位，\n\n12:30.650 --> 12:34.849\n可有效减少夜间反流习惯的养成，\n\n12:34.849 --> 12:36.799\n主要是规避风险，\n\n12:37.250 --> 12:39.099\n严格戒烟戒酒。\n\n12:39.898 --> 12:43.948\n避免穿紧身衣、束带等增加腹压的行为。\n\n12:50.349 --> 12:52.974\n药物治疗也是观念，\n\n12:52.974 --> 12:57.299\n从抑酸为主到多靶点治疗进行了一个更新。\n\n12:58.450 --> 13:01.400\n强效的抑酸药PPI是治疗的基石，\n\n13:01.849 --> 13:04.849\n可以有效减少胃酸生成。\n\n13:05.599 --> 13:09.200\n建议早餐前30.60分钟服用，\n\n13:09.549 --> 13:11.950\n以发挥最佳抑酸效果。\n\n13:12.744 --> 13:16.344\n轻型的抑酸药PCA以弗罗拉生为代表，\n\n13:16.594 --> 13:19.744\n具有起效更快、作用更强的特点，\n\n13:19.994 --> 13:22.744\n提供24小时持续保护，\n\n13:22.994 --> 13:25.844\n适用于传统PPI反应不佳者。\n\n13:26.507 --> 13:27.557\n黏膜保护剂呢，\n\n13:27.557 --> 13:30.057\n它可以在黏膜表面形成防护衣。\n\n13:30.307 --> 13:33.906\n新型海藻酸盐可形成粘性阀子，\n\n13:34.307 --> 13:37.557\n有效物理阻止反流物损伤。\n\n13:38.106 --> 13:42.906\n促动力药物通过增强食管蠕动和加快胃排空，\n\n13:43.456 --> 13:46.956\n快速帮助食物更快被清除。\n\n13:47.307 --> 13:48.981\n常用于辅助治疗，\n\n13:48.981 --> 13:50.706\n减少反流的频率。\n\n13:54.567 --> 13:54.992\n那么，\n\n13:54.992 --> 13:57.018\n进阶治疗呢，\n\n13:57.018 --> 14:01.367\n包括内镜和手术进入到了一个微创时代。\n\n14:01.867 --> 14:03.442\n内镜治疗啊，\n\n14:03.442 --> 14:05.067\n是个的治疗，\n\n14:05.518 --> 14:08.867\n这个有创治疗的一个微创高效的新选择。\n\n14:09.218 --> 14:18.018\n内镜治疗的方法包括经口无切口胃底折叠术、TF经胃镜缝合重建抗反流屏障，\n\n14:18.218 --> 14:19.317\n无需开腹。\n\n14:19.919 --> 14:22.270\n抗反流黏膜切除术arms，\n\n14:22.520 --> 14:24.645\n它可以切除贲门粘膜，\n\n14:24.645 --> 14:28.219\n利用疤痕收缩物理性缩窄贲门。\n\n14:28.992 --> 14:29.992\n手术治疗呢，\n\n14:29.992 --> 14:35.242\n是从精标准到个体化及腹腔镜胃底折叠术，\n\n14:35.593 --> 14:37.992\n它是抗反流手术的金标准，\n\n14:38.492 --> 14:42.043\n从解剖结构上根本解决反流问题。\n\n14:43.023 --> 14:45.023\n磁性括约肌增强术，\n\n14:45.372 --> 14:47.872\n它是植入磁磁珠，\n\n14:48.572 --> 14:52.672\n这个磁珠环增强LAES的压力，\n\n14:52.822 --> 14:54.172\n无结构改变，\n\n14:54.322 --> 14:56.223\n术后恢复极快。\n\n14:59.273 --> 14:59.698\n那么，\n\n14:59.698 --> 15:00.773\n长期管理呢，\n\n15:00.773 --> 15:04.874\n它的目标是从症状控制到复发的预防，\n\n15:05.374 --> 15:08.223\n个的是一种慢性易复发疾病。\n\n15:08.424 --> 15:12.273\n单纯的症状控制不足以应对长期的风险，\n\n15:12.573 --> 15:15.424\n应当建立全周期的管理体系，\n\n15:15.773 --> 15:27.424\n包括疾病分期管理策略、白尔食管的监测与治疗、难治性个的多学科协作、关注患者报告结局等多个方面。\n\n15:30.909 --> 15:31.335\n那么，\n\n15:31.335 --> 15:33.059\n特殊人群个的管理，\n\n15:33.159 --> 15:35.909\n老年个的患者应当谨慎用药，\n\n15:36.159 --> 15:38.909\n妊娠个的患者应该安全优先。\n\n15:39.210 --> 15:40.760\n肥胖个的患者呢，\n\n15:40.760 --> 15:42.559\n以减重为核心，\n\n15:42.710 --> 15:45.210\n科学关于精准防护。\n\n15:46.387 --> 15:47.586\n最后总结一下，\n\n15:47.736 --> 15:49.986\n个得是不容忽视的常见病，\n\n15:50.137 --> 15:52.336\n它的临床表现复杂多样，\n\n15:52.586 --> 15:55.387\n延误治疗会产生一些严重的危害。\n\n15:55.786 --> 16:00.961\n精准明确病因的方法包括胃镜和食管监测，\n\n16:00.961 --> 16:05.086\nPH监测应当阶梯式个体化治疗，\n\n16:05.387 --> 16:08.437\n还需要慢性长期随访管理。\n\n16:08.786 --> 16:09.361\n总之，\n\n16:09.361 --> 16:12.486\n各的诊疗已经进入全周期管理时代，\n\n16:12.536 --> 16:16.736\n患者的自我管理与医生的密切配合是战胜。\n\n16:16.840 --> 16:18.090\n疾病的关键因素。\n\n16:20.783 --> 16:21.059\n好，\n\n16:21.059 --> 16:21.934\n谢谢聆听。\n\n","v0d47cg10004d9cq1ia7dlddlslo6plg",987,962,"2026-07-17 00:03:08","2026-08-07 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