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--> 00:02.670\n可以了是吧？\n\n00:03.069 --> 00:03.444\n好，\n\n00:03.444 --> 00:07.570\n我们今天讲的是慢性胃炎指南的核心解读。\n\n00:10.937 --> 00:11.262\n嗯，\n\n00:11.262 --> 00:11.913\n首先呢，\n\n00:11.913 --> 00:13.387\n我们讲一下，\n\n00:13.387 --> 00:15.737\n慢性胃炎的定义。\n\n00:16.187 --> 00:20.937\n它是指胃黏膜长期受炎症刺激导致的持续性病变。\n\n00:21.288 --> 00:28.812\n病理特征包括固有层炎症细胞浸润、腺体萎缩或肠化生，\n\n00:28.812 --> 00:31.038\n病程迁延且反复发作。\n\n00:32.372 --> 00:42.321\n那临床分类体系分为非萎缩性胃炎、粘膜炎症、无腺体减少和萎缩性胃炎伴腺体数目减少或功能丧失。\n\n00:42.622 --> 00:48.321\n后者进一步分分为多灶萎缩性和自身免疫性两种。\n\n00:48.472 --> 00:51.722\n那特殊类型的包括了淋巴细胞性的胃炎，\n\n00:52.122 --> 00:55.622\n它需要通过活检才能确诊。\n\n00:55.972 --> 01:02.372\n那年流行病学特点分为有主要有年龄相关性因。\n\n01:02.487 --> 01:05.462\n幽门螺杆菌感染随年龄的增长上升，\n\n01:05.462 --> 01:09.237\n50岁以上人群萎缩性胃炎检出率达30%，\n\n01:09.737 --> 01:14.038\n那自身免疫性胃炎多见于这个中老年女性。\n\n01:15.648 --> 01:18.347\n它它同时它也有地域性差异。\n\n01:18.347 --> 01:22.623\n发展中国家幽门螺杆菌感染率是70%.90%，\n\n01:22.623 --> 01:24.297\n显著高于发达国家。\n\n01:24.597 --> 01:26.898\n那这个高原地区，\n\n01:26.898 --> 01:28.023\n比如说东亚啊，\n\n01:28.023 --> 01:30.797\n萎缩性胃炎的发病率就更高了。\n\n01:31.047 --> 01:31.498\n另外，\n\n01:31.498 --> 01:32.797\n它还有人群特征，\n\n01:33.047 --> 01:33.447\n嗯，\n\n01:34.047 --> 01:39.648\n长期服用非甾体类抗炎药患者患病的风险增加了2.3倍，\n\n01:39.797 --> 01:44.148\n吸烟酗酒的概率提升了40%.60%，\n\n01:44.547 --> 01:45.547\n慢性胃炎。\n\n01:45.755 --> 01:51.155\n全球患病率高与分布、其分布和病因密切相关。\n\n01:51.155 --> 01:55.555\n不同地区、年龄人人群的这个发病率存在显著差异。\n\n01:57.608 --> 02:00.032\n幽门螺杆菌感染的致病机制是，\n\n02:00.032 --> 02:07.057\n细菌通过尿素酶分解尿素产生氨破坏胃黏膜屏障，\n\n02:07.157 --> 02:10.757\n其独立因子可诱导炎症发生。\n\n02:10.757 --> 02:14.608\n长期感染会导致粘膜萎缩甚至癌变。\n\n02:14.858 --> 02:16.382\n那诊断和干预的话，\n\n02:16.382 --> 02:19.658\n一般是结合碳十三呼气试验和胃镜活检。\n\n02:19.858 --> 02:20.233\n嗯，\n\n02:20.233 --> 02:24.658\n根除治疗采用含含B剂的四联疗法。\n\n02:25.580 --> 02:26.880\n比如说PPI，\n\n02:26.880 --> 02:28.455\n阿莫西林克拉霉素胶体，\n\n02:28.455 --> 02:28.979\n果胶铋，\n\n02:29.330 --> 02:31.830\n那疗程是十十到十四天，\n\n02:32.229 --> 02:35.029\n那主要的这个病因有药物因素，\n\n02:35.029 --> 02:37.330\n也有自自身免疫因素。\n\n02:37.330 --> 02:38.154\n药物的话呢，\n\n02:38.154 --> 02:39.779\n比如说非甾体类抗炎药，\n\n02:39.779 --> 02:43.455\n它可以通过cox one减少前列腺合成，\n\n02:43.455 --> 02:45.654\n消弱粘膜防御功能，\n\n02:45.654 --> 02:46.505\n长期使用呢，\n\n02:46.505 --> 02:48.779\n可以引发这个胃黏膜的糜烂啊，\n\n02:48.779 --> 02:50.505\n建议连用质子棒抑制剂，\n\n02:50.505 --> 02:52.455\n或换成cox two选择性抑制剂，\n\n02:52.455 --> 02:54.205\n比如说塞尔西布。\n\n02:54.205 --> 02:55.729\n另外它还胆汁反流。\n\n02:55.876 --> 02:59.826\n十二指肠内容物反流到胃粘膜的脂质层，\n\n03:00.126 --> 03:00.975\n然后呢，\n\n03:00.975 --> 03:02.876\n常见于胃术后患者。\n\n03:03.925 --> 03:06.175\n治疗需联合促胃动力药，\n\n03:06.376 --> 03:10.675\n比如说莫沙必利和胆汁吸附吸附剂，\n\n03:10.675 --> 03:12.626\n比如说铝碳酸镁。\n\n03:12.925 --> 03:13.401\n另外，\n\n03:13.401 --> 03:14.626\n自身免疫因素，\n\n03:14.876 --> 03:16.576\n比如说病理特征，\n\n03:16.576 --> 03:18.126\n如抗B细胞抗体，\n\n03:18.425 --> 03:18.751\n嗯，\n\n03:18.751 --> 03:20.251\n攻击胃体的腺体，\n\n03:20.251 --> 03:23.876\n导致这个胃酸缺乏和内因子分泌不足，\n\n03:23.975 --> 03:27.701\n可能合并维生素B十二缺乏性恶性贫血啊，\n\n03:27.701 --> 03:31.725\n需要定期监测血清维生素B二B12水平。\n\n03:31.925 --> 03:32.951\n那管理上呢，\n\n03:32.951 --> 03:34.276\n以对症治疗为。\n\n03:34.352 --> 03:34.576\n为主，\n\n03:34.576 --> 03:39.401\n比如说补充维生素B十二肌注或者铁剂。\n\n03:39.951 --> 03:40.352\n嗯，\n\n03:40.651 --> 03:42.201\n然后严重贫血的话呢，\n\n03:42.201 --> 03:43.151\n需输血治疗。\n\n03:43.401 --> 03:44.826\n它的临床表现呢，\n\n03:44.826 --> 03:46.201\n有上腹隐痛和不适。\n\n03:47.682 --> 03:50.983\n表现为长期反复发作的上腹部隐痛或钝痛，\n\n03:51.233 --> 03:53.307\n疼痛多呈持续性，\n\n03:53.307 --> 03:54.632\n餐后可能加重，\n\n03:54.783 --> 04:00.233\n常伴有饱胀感和压迫感症状可持续数月甚至数年。\n\n04:00.432 --> 04:00.733\n另外，\n\n04:00.733 --> 04:02.182\n还有消化功能的紊乱，\n\n04:02.283 --> 04:04.582\n比如说嗳气、反酸、恶心，\n\n04:04.882 --> 04:07.582\n部分患者会出现早饱和食欲减退。\n\n04:08.082 --> 04:08.483\n嗯，\n\n04:09.033 --> 04:10.733\n这些严重者呢，\n\n04:10.733 --> 04:12.332\n可以伴随这个体重的下降，\n\n04:12.332 --> 04:17.333\n这些症状和胃黏膜炎症导致的这个胃动力障碍和消化功能减退有关。\n\n04:17.851 --> 04:20.601\n另外还有一些非特异性的全身症状，\n\n04:20.701 --> 04:25.252\n如少数患者可能会出现乏力、头晕等贫血相关表现，\n\n04:25.252 --> 04:28.002\n尤其在萎缩性胃炎伴恶性贫血的时候呢，\n\n04:28.152 --> 04:29.476\n可能会更加的明显，\n\n04:29.476 --> 04:32.451\n需要通过血常规和维生素B 12检测。\n\n04:32.552 --> 04:32.951\n嗯，\n\n04:33.252 --> 04:34.451\n然后内镜的特点，\n\n04:34.451 --> 04:36.502\n比如说有非萎缩性胃炎的表现，\n\n04:36.502 --> 04:37.351\n胃镜下呢。\n\n04:38.141 --> 04:39.791\n可以看到粘膜充血水肿，\n\n04:39.941 --> 04:42.041\n呈花斑状或弥漫性的发红，\n\n04:42.141 --> 04:44.791\n表面附着粘液，\n\n04:44.992 --> 04:46.941\n粘稠粘液常见于胃窦部，\n\n04:47.092 --> 04:49.566\n也可伴有点状或片状的糜烂。\n\n04:49.566 --> 04:50.791\n但皱屁呢，\n\n04:50.791 --> 04:52.092\n往往是正常的。\n\n04:52.342 --> 04:52.742\n嗯，\n\n04:52.742 --> 04:55.141\n特殊还有一些萎缩性胃炎的特征，\n\n04:55.441 --> 04:58.391\n比如说粘膜色泽灰灰暗变薄，\n\n04:58.791 --> 04:59.191\n嗯，\n\n04:59.191 --> 05:00.641\n这个粘膜平坦。\n\n05:01.355 --> 05:02.055\n或消失，\n\n05:02.256 --> 05:03.805\n血管网清晰透见，\n\n05:03.955 --> 05:07.055\n病变可以局限在胃窦或累及胃体，\n\n05:07.055 --> 05:10.855\n严重者出现粘膜颗粒或结节样改变。\n\n05:11.105 --> 05:11.430\n另外，\n\n05:11.430 --> 05:12.955\n还有特殊形态学的改变。\n\n05:12.955 --> 05:13.881\n改变，\n\n05:13.881 --> 05:18.406\n部分病例可以看到胆汁反流的粘膜黄染糜烂，\n\n05:18.406 --> 05:22.631\n或者幽门螺杆菌相关的点状白斑鸡皮样的病变。\n\n05:22.631 --> 05:29.355\n这些特征对病变对病因的判断是具有提示意义的。\n\n05:30.360 --> 05:30.748\n另外，\n\n05:30.748 --> 05:32.235\n还有一些伴随症状，\n\n05:32.235 --> 05:36.411\n比如说内镜的重点观察有没有肠上皮化生，\n\n05:36.760 --> 05:37.161\n嗯，\n\n05:37.210 --> 05:38.610\n或者是异型增生。\n\n05:39.061 --> 05:42.510\n然后同时需排除早期癌的。\n\n05:43.795 --> 05:47.946\n同时需排除早期胃癌的粘膜微细变化，\n\n05:47.996 --> 05:48.746\n另外呢，\n\n05:48.746 --> 05:52.895\n我们诊断的还要根据这个病理结果去综进行综合判断。\n\n05:52.895 --> 05:53.346\n比如说，\n\n05:53.346 --> 05:55.395\n炎症活动性的这个分分级，\n\n05:55.895 --> 06:00.520\n根据慢性炎细胞淋巴细胞浆细胞浸润深度，\n\n06:00.520 --> 06:03.670\n分为轻度粘膜浅层三的1/3，\n\n06:03.670 --> 06:07.496\n中度达到粘膜中层和重度全层浸润活动期呢，\n\n06:07.496 --> 06:10.545\n可以看到这个中性粒细胞的浸润和隐窝脓肿的形成，\n\n06:10.996 --> 06:11.420\n另外，\n\n06:11.420 --> 06:13.420\n萎缩和肠化也要评估啊。\n\n06:13.420 --> 06:14.145\n评主要。\n\n06:14.220 --> 06:18.720\n是根据这个腺体减少或消失的这个范围，\n\n06:18.970 --> 06:21.769\n可以分为局灶性和弥漫性。\n\n06:21.920 --> 06:23.170\n根据肠上皮化生，\n\n06:23.170 --> 06:25.220\n分为完全型和不完全型。\n\n06:25.420 --> 06:26.119\n后者呢，\n\n06:26.119 --> 06:29.269\n这个不完全型和癌变的风险是息息相关的。\n\n06:30.526 --> 06:33.976\n那它这我们根据悉尼分类的这个标准呢，\n\n06:34.026 --> 06:35.601\n结合内镜和病理结果，\n\n06:35.601 --> 06:39.776\n将慢性胃炎分为非萎缩性胃炎、萎缩性胃炎和特殊类型的胃炎，\n\n06:39.876 --> 06:41.776\n需要标注HP感染的情况。\n\n06:42.175 --> 06:43.501\n那治疗上面的话，\n\n06:43.501 --> 06:45.226\n第一个就是药物治疗啊，\n\n06:45.476 --> 06:46.700\n一般用抑酸剂，\n\n06:46.700 --> 06:51.526\n比如说脂质棒抑制剂如奥美拉唑和HR受体拮抗剂如法莫替汀，\n\n06:51.776 --> 06:53.976\n可以有效的抑制胃酸的分泌，\n\n06:53.976 --> 06:56.200\n缓解胃黏膜的炎症疗程呢，\n\n06:56.200 --> 06:57.601\n通常是4.8周。\n\n06:57.601 --> 06:58.700\n需要注意，\n\n06:58.700 --> 07:00.075\n长期使用可能引起。\n\n07:00.135 --> 07:01.135\n骨质疏松的风险，\n\n07:01.436 --> 07:03.411\n另外第二类就是胃黏膜保护剂，\n\n07:03.411 --> 07:07.735\n比如说铝碳酸镁、氯巴派特等药物可以在胃黏膜形成保护层，\n\n07:07.936 --> 07:09.385\n促进损伤修复，\n\n07:09.385 --> 07:13.335\n尤其可以用于胆汁反流和或者是恩赛的相关胃炎。\n\n07:13.335 --> 07:14.786\n建议餐后一小时服用，\n\n07:15.036 --> 07:15.385\n嗯，\n\n07:15.385 --> 07:16.235\n效果最佳。\n\n07:17.772 --> 07:20.772\n另外还有幽门螺杆菌感染的根除标准四联疗法，\n\n07:20.772 --> 07:24.721\n包括含质子棒抑制剂加B剂下两种抗生素啊，\n\n07:24.721 --> 07:27.821\n如阿莫西林克拉霉素治疗14天可以，\n\n07:27.921 --> 07:29.971\n根除率可以达到85%以上，\n\n07:30.122 --> 07:33.171\n但是也需要注意这个抗生素耐药性的问题。\n\n07:33.622 --> 07:34.747\n那第二个呢，\n\n07:34.747 --> 07:36.346\n就是生活方式的干预，\n\n07:36.346 --> 07:38.022\n饮食结构我们要进行调整，\n\n07:38.221 --> 07:42.071\n采用这个低脂低纤维饮食模式，\n\n07:42.272 --> 07:44.296\n每日蛋白质摄入呢，\n\n07:44.296 --> 07:44.546\n50.70g.\n\n07:44.546 --> 07:46.596\n优选这个鱼肉蛋蛋类，\n\n07:46.596 --> 07:47.921\n避免辛辣过冷。\n\n07:48.225 --> 07:50.475\n过热的食物烹饪方式呢，\n\n07:50.475 --> 07:51.424\n以蒸煮为主，\n\n07:51.424 --> 07:55.200\n食物温度保持在40到五十摄氏度为宜。\n\n07:55.299 --> 07:57.825\n第二个进食习惯的优化，\n\n07:57.825 --> 08:01.700\n实行这个实时定量的进餐，\n\n08:01.700 --> 08:04.049\n每日三餐间隔4.5小时，\n\n08:04.299 --> 08:06.750\n每餐进食时间20.30分钟，\n\n08:06.799 --> 08:08.500\n避免睡前两小时进食。\n\n08:08.500 --> 08:09.250\n研究显示，\n\n08:09.250 --> 08:10.024\n规律进食呢，\n\n08:10.024 --> 08:12.399\n可以提高胃黏膜修复率达到40%。\n\n08:13.000 --> 08:15.350\n还有一个就是第三个危险因素的控制，\n\n08:15.350 --> 08:16.950\n严格戒烟啊，\n\n08:17.000 --> 08:17.700\n戒酒。\n\n08:18.591 --> 08:19.890\nBMI体重呢，\n\n08:19.890 --> 08:21.490\n大于等于二十五的，\n\n08:21.490 --> 08:24.441\n需要通过每周150分钟的运动控制体重，\n\n08:25.841 --> 08:27.441\n然后药物呢，\n\n08:27.441 --> 08:28.479\n使用管理包，\n\n08:28.479 --> 08:31.316\n包括避免长期服用恩赛类药物，\n\n08:31.316 --> 08:32.265\n如阿莫西林，\n\n08:32.265 --> 08:35.565\n必须使用联合胃黏膜保护剂，\n\n08:35.565 --> 08:38.390\n注意餐具的消毒进行分餐。\n\n08:38.841 --> 08:39.190\n嗯，\n\n08:39.190 --> 08:39.815\n另外呢，\n\n08:39.815 --> 08:44.140\n我们中医上也对于这个慢性胃炎有一些他们的诊治方方法，\n\n08:44.541 --> 08:44.940\n嗯，\n\n08:45.491 --> 08:48.041\n慢性胃炎在中医分为肝胃不和。\n\n08:48.111 --> 08:52.836\n型表现是这个肋肋部的胀痛啊，\n\n08:52.836 --> 08:54.361\n嗳气频繁，\n\n08:54.361 --> 08:54.937\n方子呢，\n\n08:54.937 --> 08:56.387\n选这个柴胡啊，\n\n08:56.387 --> 08:58.211\n疏松散，\n\n08:58.211 --> 09:00.637\n还有这个配合针灸啊，\n\n09:00.637 --> 09:02.211\n采用泻法施治。\n\n09:02.461 --> 09:03.562\n那第二个呢，\n\n09:03.562 --> 09:06.312\n就是脾胃虚的虚寒型的，\n\n09:06.611 --> 09:06.937\n嗯，\n\n09:06.937 --> 09:10.711\n比较比较常见的症状有胃痛喜温四肢不温，\n\n09:11.062 --> 09:11.461\n嗯，\n\n09:11.512 --> 09:13.562\n喜欢这这部分患者呢，\n\n09:13.562 --> 09:17.762\n我们可以用黄芪党参干姜然后配合艾灸。\n\n09:18.127 --> 09:20.978\n还有这个神厥穴的这个温补，\n\n09:21.478 --> 09:21.828\n嗯，\n\n09:21.828 --> 09:29.478\n另外第三个就是胃阴不足型特征是胃灼隐痛口干舌燥啊，\n\n09:29.478 --> 09:30.752\n就一般这种情况呢，\n\n09:30.752 --> 09:33.228\n喜欢用一点北沙参麦冬，\n\n09:33.478 --> 09:35.177\n然后配配合针灸。\n\n09:36.627 --> 09:38.427\n那特殊胃炎的管理的话，\n\n09:38.427 --> 09:38.828\n嗯，\n\n09:38.877 --> 09:41.528\n比如说萎缩性胃炎的处理这部分的话，\n\n09:41.778 --> 09:44.927\n我们首先要对他们进行内镜的监测和活检，\n\n09:45.127 --> 09:48.078\n建议每一到三年进行胃镜的随随访。\n\n09:48.244 --> 09:53.544\n重点监测肠上皮化生的不典型增生病变啊，\n\n09:53.794 --> 09:55.369\n然后幽门螺杆菌根除呢，\n\n09:55.369 --> 09:58.693\n我们确诊后要立刻进行这个四联疗法，\n\n09:58.943 --> 10:01.119\n以延缓萎缩进展，\n\n10:01.119 --> 10:02.244\n降低癌变风险。\n\n10:02.244 --> 10:02.544\n另外，\n\n10:02.544 --> 10:04.643\n我们还要进行营养干预和对症治疗。\n\n10:04.943 --> 10:05.318\n嗯，\n\n10:05.318 --> 10:09.143\n来补充这个维生素B十二叶酸铁剂纠正贫血。\n\n10:09.393 --> 10:10.994\n针对胃酸缺乏，\n\n10:11.193 --> 10:13.193\n可短期使用胃蛋白酶合剂，\n\n10:13.193 --> 10:14.744\n同时避免长期抑酸，\n\n10:14.744 --> 10:15.893\n加重这个胃萎缩，\n\n10:16.343 --> 10:17.494\n那肠上皮化生。\n\n10:17.494 --> 10:18.093\n我们也要。\n\n10:18.156 --> 10:19.406\n进行管理啊，\n\n10:19.406 --> 10:21.781\n第一个就是分级干预的策略。\n\n10:21.781 --> 10:26.106\n根据Oga和OL GIM分期系统评估风险。\n\n10:26.306 --> 10:29.255\n然后轻度的肠化需要每年胃镜随诊，\n\n10:29.255 --> 10:33.955\n中重度的话就需要6个月复查并考虑这个粘膜剥离术了。\n\n10:35.877 --> 10:37.778\n胆汁反流控制的话，\n\n10:37.778 --> 10:42.802\n我们一般可以建议患者使用铝碳酸镁和综合胆酸。\n\n10:42.802 --> 10:45.177\n夜间抬高床头15.20cm，\n\n10:45.427 --> 10:48.127\n减少十二指肠内容物反反流，\n\n10:48.127 --> 10:50.177\n刺激饮食结构的调整。\n\n10:50.228 --> 10:50.552\n嗯，\n\n10:50.552 --> 10:53.203\n严格控制腌制烟熏食物，\n\n10:53.203 --> 10:54.978\n增加新鲜蔬菜的水果数量。\n\n10:56.151 --> 10:58.500\n那幽门螺杆菌相关的这个胃炎的话呢，\n\n10:58.500 --> 11:02.500\n我们就要对他们进行一个标准的四联疗法的一个根治了，\n\n11:02.601 --> 11:06.551\n包含PPIBG、阿莫西林克拉霉素疗程14天。\n\n11:06.750 --> 11:08.250\n那停药四周之后呢，\n\n11:08.250 --> 11:11.375\n我们需要复查这个碳十三呼气试验啊。\n\n11:11.375 --> 11:12.875\n对于耐药菌株的话呢，\n\n11:12.875 --> 11:17.801\n对克拉霉素耐药地区高的推荐含左氧氟沙星或四环素的这个治疗啊。\n\n11:17.801 --> 11:18.125\n然后，\n\n11:18.125 --> 11:18.851\n治疗前呢，\n\n11:18.851 --> 11:20.625\n进行一个药敏实验啊。\n\n11:20.625 --> 11:25.000\n所有的共居住的成年成员、家庭成员都要同步的筛查。\n\n11:25.000 --> 11:26.351\nHP阳性的话。\n\n11:26.557 --> 11:27.658\n要跟同时治疗，\n\n11:27.658 --> 11:28.458\n以避免交叉。\n\n11:28.857 --> 11:29.257\n嗯，\n\n11:29.607 --> 11:30.932\n根除治疗之后呢，\n\n11:30.932 --> 11:34.107\n我们需要继续使用替普瑞酮等粘膜保护剂3.6个月，\n\n11:34.107 --> 11:35.757\n促进炎症或粘膜的修复。\n\n11:37.617 --> 11:43.067\n那并发症和常见的并发症有胃溃疡、胃出血和癌变。\n\n11:43.268 --> 11:44.043\n胃溃疡呢，\n\n11:44.043 --> 11:47.117\n是长期炎症导致胃黏膜防御减弱，\n\n11:47.317 --> 11:52.117\n然后让胃黏膜容易受到这个胃酸的侵蚀形成溃疡，\n\n11:52.317 --> 11:54.317\n表现为上腹痛、黑便等。\n\n11:54.518 --> 11:55.893\n那胃出血的话呢，\n\n11:55.893 --> 11:59.718\n就是黏膜糜烂或溃疡引起血管出血，\n\n11:59.718 --> 12:02.067\n导致这个呕血贫血甚至休克。\n\n12:02.367 --> 12:07.617\n那萎缩性胃炎常伴伴上皮化生或者是不典型增生的时候。\n\n12:07.721 --> 12:09.271\n胃癌的发病率显著增高，\n\n12:09.271 --> 12:10.971\n这个是要定期的监测。\n\n12:12.872 --> 12:16.396\n那胃癌的这个癌变的风险的评估呢，\n\n12:16.396 --> 12:19.122\n它主要第一个是幽门螺杆菌感染，\n\n12:19.221 --> 12:20.197\n长期感染呢，\n\n12:20.197 --> 12:21.572\n是它的一个重要的因素，\n\n12:21.572 --> 12:24.796\n根除治疗可延缓降低这个癌变的风险。\n\n12:24.796 --> 12:25.296\n另外呢，\n\n12:25.296 --> 12:27.021\n第二个就是病理类型和分级，\n\n12:27.171 --> 12:30.572\n萎缩性胃炎伴有肠上皮化生或异型增生啊，\n\n12:30.572 --> 12:31.721\n需要密切的监测。\n\n12:31.721 --> 12:34.521\n建议每6.12个月内镜随访。\n\n12:34.771 --> 12:36.122\n有对于高级别，\n\n12:36.622 --> 12:37.471\n尤其是。\n\n12:37.679 --> 12:38.780\n需要这样的一个随访，\n\n12:38.929 --> 12:41.655\n那高盐饮食、吸烟和胃癌家族史患者呢，\n\n12:41.655 --> 12:43.955\n需增加这个加强筛查，\n\n12:43.955 --> 12:49.280\n结合血清胃蛋白酶和胃泌素十七检测啊，\n\n12:49.429 --> 12:50.380\n评估风险。\n\n12:50.729 --> 12:51.130\n嗯，\n\n12:51.380 --> 12:55.729\n长期随诊的随访的这个策略主要是内镜和生活方式的干预。\n\n12:56.080 --> 12:56.429\n嗯，\n\n12:56.429 --> 12:57.755\n单纯萎缩性胃炎呢，\n\n12:57.755 --> 12:58.880\n每3年复查一次，\n\n12:58.929 --> 13:01.530\n若合并肠化则缩短至一到两年。\n\n13:01.929 --> 13:04.479\n那低级别上皮的瘤变的话，\n\n13:04.479 --> 13:07.280\n6到十二个月复查高级别的话呢，\n\n13:07.280 --> 13:07.630\n就需。\n\n13:07.695 --> 13:09.995\n立即进行内镜下的切除了，\n\n13:10.245 --> 13:13.120\n那生活方式干预主要是饮食的调整啊，\n\n13:13.120 --> 13:14.971\n避免腌制烟熏食物，\n\n13:14.971 --> 13:16.395\n增加新鲜水果的摄入，\n\n13:16.596 --> 13:20.245\n然后低低危险因素控制在控制的话，\n\n13:20.245 --> 13:21.721\n就是严格戒酒戒烟，\n\n13:21.721 --> 13:23.245\n慎用赛类药物。\n\n13:23.495 --> 13:26.546\n另外还要对患者加强这个宣教，\n\n13:26.846 --> 13:27.820\n饮食上面呢，\n\n13:27.820 --> 13:29.745\n指导患者每日五到六餐，\n\n13:29.745 --> 13:30.945\n减少胃部负担，\n\n13:30.945 --> 13:32.546\n避免胃酸过度分泌。\n\n13:33.864 --> 13:34.289\n然后，\n\n13:34.289 --> 13:36.914\n避免辛辣刺激油热，\n\n13:37.114 --> 13:38.638\n嗯高盐饮食，\n\n13:38.638 --> 13:40.364\n减少胃黏膜的刺激。\n\n13:40.564 --> 13:41.138\n然后呢，\n\n13:41.138 --> 13:42.064\n增加优质蛋白，\n\n13:42.064 --> 13:44.838\n比如说鱼蛋清和膳食纤维，\n\n13:44.838 --> 13:45.914\n如，\n\n13:46.213 --> 13:47.713\n燕麦南瓜等等，\n\n13:47.713 --> 13:49.713\n避免高脂和难消化的食物。\n\n13:50.013 --> 13:50.388\n嗯，\n\n13:50.388 --> 13:52.513\n最后就是危险因素的控制，\n\n13:52.564 --> 13:54.638\n药物使用管理这一块呢，\n\n13:54.638 --> 13:57.539\n避免长期服用非甾体类抗炎药，\n\n13:57.539 --> 13:59.364\n如阿莫西林。\n\n14:00.390 --> 14:03.991\n阿莫阿阿司匹林肠溶片必须使用的时候呢，\n\n14:03.991 --> 14:05.341\n需联合胃黏膜保护剂，\n\n14:05.341 --> 14:06.890\n比如说铝碳酸镁咀嚼片，\n\n14:07.140 --> 14:09.466\n抗生素治疗幽门螺杆菌感染的话呢，\n\n14:09.466 --> 14:10.690\n需要全程的疗程，\n\n14:10.791 --> 14:12.140\n防止耐药性产生。\n\n14:12.140 --> 14:13.140\n生活方式的话，\n\n14:13.291 --> 14:16.116\n戒烟并减少二手烟暴露。\n\n14:16.116 --> 14:20.466\n烟草中的尼古丁会抑制胃粘膜前列腺素合成，\n\n14:20.466 --> 14:22.765\n保证21点前入睡。\n\n14:22.765 --> 14:23.616\n睡眠不足呢，\n\n14:23.616 --> 14:26.815\n会导致这个胃酸分泌的节律紊乱啊，\n\n14:26.815 --> 14:27.841\n情绪压力的调整，\n\n14:27.841 --> 14:30.390\n比如说通过正念冥想。\n\n14:30.656 --> 14:32.330\n腹式呼吸训训练，\n\n14:32.330 --> 14:34.356\n降低交感神经兴奋性，\n\n14:34.455 --> 14:38.556\n每日建议进行30分钟低强度运动，\n\n14:38.556 --> 14:39.306\n比如说散步，\n\n14:39.306 --> 14:40.806\n促进内啡肽的分泌。\n\n14:40.955 --> 14:42.106\n另外环境因素。\n\n14:43.349 --> 14:43.674\n嗯，\n\n14:43.674 --> 14:44.299\n规避的话，\n\n14:44.299 --> 14:46.500\n注意这个餐具的消毒啊，\n\n14:46.549 --> 14:48.049\n幽门螺杆菌，\n\n14:48.049 --> 14:49.950\n可通过共用餐具进行传播，\n\n14:50.049 --> 14:55.000\n避免工作环境中长期接触粉尘、化学刺激等职业暴露因素。\n\n14:55.703 --> 14:55.778\n嗯，\n\n14:55.778 --> 14:57.028\n但定期复查的建议，\n\n14:57.028 --> 14:59.278\n建议第一个幽门螺杆菌监测啊，\n\n14:59.278 --> 15:01.453\n在根治根除之后四到八周呢，\n\n15:01.453 --> 15:04.254\n要进行这个碳十三和碳十四呼气试验，\n\n15:04.254 --> 15:07.554\n然后进行一个验证疗效阳性者的的话，\n\n15:07.554 --> 15:10.804\n需要跟调整这个方案进行二次治疗。\n\n15:11.104 --> 15:13.104\n另外就是胃镜的复查周期，\n\n15:13.104 --> 15:18.703\n非萎缩性胃炎患者每一到两年复查胃镜伴肠化生或不典型增生的话呢，\n\n15:18.703 --> 15:21.028\n需要缩短至6到十二个月，\n\n15:21.028 --> 15:21.929\n复查的时候呢，\n\n15:21.929 --> 15:24.354\n需要携带既往的病理报告啊，\n\n15:24.354 --> 15:25.903\n对比粘膜的这个。\n\n15:25.960 --> 15:29.109\n变化另外就是对于症状的预警的监测，\n\n15:29.210 --> 15:30.309\n出现黑便，\n\n15:30.460 --> 15:30.809\n嗯，\n\n15:30.809 --> 15:32.335\n就提示上消化道出血了。\n\n15:32.335 --> 15:33.409\n这体重骤降，\n\n15:33.609 --> 15:35.184\n如果每月大于5%，\n\n15:35.184 --> 15:36.284\n持续性呕吐等，\n\n15:36.284 --> 15:37.385\n就需要立刻就医，\n\n15:37.385 --> 15:38.859\n排除恶性病变的可能。\n\n","v0347cg10004d9ji5o27dld3lflpfne0",948,794,"2026-07-25 00:01:54","2026-08-06 10:30:00",[32],{"menuId":33,"menuName":34,"parentId":17,"orderNum":35,"path":36,"component":37,"isFrame":38,"isCache":39,"menuType":40,"visible":22,"status":17,"createDept":6,"remark":18,"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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