WEBVTT00:00:01.080 --> 00:00:06.740本次课间的主题是肺寄生虫病临床症状与诊断方法00:00:08.040 --> 00:00:10.260肺寄生虫病的典型症状00:00:11.240 --> 00:00:14.740咳嗽是肺寄生虫病常见症状之一00:00:15.200 --> 00:00:19.220不同寄生虫感染引发的咳嗽特点有所不同00:00:19.560 --> 00:00:20.940例如肺吸虫00:00:21.120 --> 00:00:24.820肺吸虫病患者咳嗽可持续存在00:00:24.960 --> 00:00:30.780且伴有咳痰痰中常带有果酱药或铁锈色血液00:00:30.960 --> 00:00:33.740而蛔虫引发的肺寄生虫病00:00:34.000 --> 00:00:36.620咳嗽多在感染初期出现00:00:36.760 --> 00:00:38.380程度轻重不一00:00:38.560 --> 00:00:42.700据统计约百分之八十的肺寄生虫病患者00:00:42.800 --> 00:00:46.940和百分之六十的蛔虫型肺寄生虫患者00:00:47.120 --> 00:00:48.940会出现咳嗽症状00:00:49.480 --> 00:00:54.260全身症状中发热也是肺寄生虫病的常见症状00:00:54.440 --> 00:00:55.780在感染早期00:00:55.880 --> 00:00:58.500由于寄生虫的代谢产物00:00:58.560 --> 00:01:02.220分泌物等作为炙热源刺激机体00:01:02.600 --> 00:01:04.220可引起发热00:01:04.520 --> 00:01:11.260如钩虫导致的肺寄生虫病患者在感染初期可能出现低热00:01:11.520 --> 00:01:16.340体温一般在三十七点五摄氏度到三十八摄氏度之间00:01:16.440 --> 00:01:21.020部分患者还伴有乏力肌肉酸痛等症状00:01:21.240 --> 00:01:24.540影响患者日常生活和工作00:01:28.360 --> 00:01:30.900对寄生虫病的典型症状00:01:34.280 --> 00:01:40.700东部体质胸痛在部分肺寄生虫病患者中较为明显00:01:41.360 --> 00:01:45.660肺寄生虫在肺部寄生形成囊肿00:01:46.240 --> 00:01:49.460囊肿侵犯胸膜时可引发胸痛00:01:49.680 --> 00:01:51.460疼痛性质多样00:01:51.560 --> 00:01:54.700可为隐痛刺痛或胀痛00:01:55.160 --> 00:01:58.340部分患者还可出现胸部压痛00:01:58.560 --> 00:02:02.900在进行体格检查时可发现曾有病例00:02:03.000 --> 00:02:06.660患者因肺吸虫感染出现持续性增重00:02:06.840 --> 00:02:10.900经检查确诊为肺吸虫病导致胸膜受累00:02:12.280 --> 00:02:16.380常用的诊断技术手段病原学检查00:02:16.600 --> 00:02:20.540痰液检查是病原学检查的重要方法之一00:02:20.800 --> 00:02:23.060通过收集患者痰液00:02:23.120 --> 00:02:27.460在显微镜下查找寄生虫虫卵或幼虫00:02:27.800 --> 00:02:33.540例如肺吸虫病患者的痰液中可找到肺吸虫虫00:02:34.280 --> 00:02:43.940蛔虫性肺寄生虫患者痰液中有时可发现蛔虫幼虫液检查的阳性率与痰液收集方法00:02:44.320 --> 00:02:46.460检查技术等有关00:02:46.720 --> 00:02:49.340规范操作可提高阳性率00:02:50.920 --> 00:02:52.260以降学检查00:02:52.440 --> 00:02:58.620x线检查在肺肌成风病患者断中具有重要价值00:02:58.720 --> 00:03:03.460不同寄生虫感染在x线片上可呈现不同特征00:03:03.680 --> 00:03:06.380如蛔虫引发的肺寄生虫病00:03:06.520 --> 00:03:12.020早期x线表现为肺部所在的边缘模糊的近热阴影00:03:12.160 --> 00:03:13.580肺寄生虫病00:03:13.640 --> 00:03:17.700则可见肺部有结节状斑片状阴影00:03:18.160 --> 00:03:20.780有时还可发现胸腔积液00:03:21.280 --> 00:03:26.060胸部ct检查能更清晰的显示肺部病变的细节00:03:26.280 --> 00:03:29.540对于诊断病情评估更有帮助00:03:30.800 --> 00:03:34.860常用的诊断技术手段免疫学检查00:03:35.760 --> 00:03:39.300内试验是常用的免疫学检查方法之一00:03:40.080 --> 00:03:43.380通过将寄生虫抗原注入患者体内00:03:43.600 --> 00:03:46.900观察局部皮肤反应判断是否感应00:03:47.600 --> 00:03:50.140例如对于肺吸虫病00:03:50.440 --> 00:03:52.700体内试验阳性率较高00:03:53.120 --> 00:03:55.820但可能存在假阳性情况00:03:56.240 --> 00:03:58.220酶联免疫吸附试验00:03:58.560 --> 00:04:01.860则可检测患者血清中的特异性抗体00:04:02.160 --> 00:04:04.740敏感性和特异性都较好00:04:04.840 --> 00:04:07.540在临床诊断中应用广泛00:04:09.400 --> 00:04:11.700鉴别诊断的药检与溶解00:04:12.360 --> 00:04:16.460肺寄生虫病与肺炎在症状上有相似之处00:04:16.840 --> 00:04:20.140都可出现发热咳嗽咳痰等症状00:04:20.240 --> 00:04:22.700但病因和治疗方法不同00:04:23.200 --> 00:04:26.900肺炎多由细菌病毒等病原体引起00:04:27.120 --> 00:04:32.180血常规检查中白细胞计数分类等指标有相应变化00:04:32.560 --> 00:04:34.620抗菌抗病毒治疗有效00:04:34.800 --> 00:04:39.140而肺寄生虫病是由寄生虫感染导致00:04:39.360 --> 00:04:42.900病原学检查可发现寄生虫相关证据00:04:43.200 --> 00:04:45.900曾有患者因发热咳嗽就诊00:04:45.960 --> 00:04:51.420最初被误诊为肺炎经进一步检查发现是肺吸虫病00:04:52.680 --> 00:04:57.860肺结核与肺寄生虫病在影像学表现上可能有重结00:04:58.440 --> 00:05:01.980都可出现肺部结节斑片状阴影等00:05:02.240 --> 00:05:08.380但肺结核患者常有积热盗汗乏力消瘦等全身症状00:05:08.600 --> 00:05:12.140弹图片或培养可找到结核杆菌00:05:12.200 --> 00:05:14.060抗结核治疗有效00:05:14.360 --> 00:05:18.660肺寄生虫病则需要通过查找寄生虫病原体00:05:19.000 --> 00:05:21.300或检测特异性抗体来鉴别00:05:21.720 --> 00:05:23.020鉴别过程中00:05:23.080 --> 00:05:26.100需要综合考虑患者的病史症状00:05:26.200 --> 00:05:27.860检查结果等因00:05:30.960 --> 00:05:33.500多种肺寄生虫病之间的鉴别00:05:33.840 --> 00:05:38.340不同种类的肺寄生虫病之间鉴别也有一定难度00:05:38.800 --> 00:05:43.420例如蛔虫钩虫肺吸虫引发的肺寄生虫病00:05:43.560 --> 00:05:46.820症状和影像学表现有相似之处00:05:47.160 --> 00:05:50.140需要详细询问患者的生活食00:05:50.320 --> 00:05:51.780饮食习惯等00:05:52.120 --> 00:05:54.780如是否有生食淡水蟹00:05:54.920 --> 00:05:57.260赤足接触土壤等经历00:05:57.880 --> 00:06:02.180结合病原学免疫学检查结果进行综合判断00:06:03.760 --> 00:06:06.860越鉴别不同种类的被寄生虫病00:06:07.040 --> 00:06:10.540对于制定针对性的治疗方案至关重要00:06:12.840 --> 00:06:15.140治疗策略与药物选择00:06:16.520 --> 00:06:19.380针对不同寄生虫的治疗方案00:06:21.240 --> 00:06:23.660蛔虫引发肺寄生虫病的治疗00:06:24.000 --> 00:06:26.940对于蛔虫引发的肺寄生虫病00:06:27.640 --> 00:06:29.740防用不同药物进行治疗00:06:31.240 --> 00:06:32.380比如apple00:06:33.240 --> 00:06:36.380它能抑制蛔虫对葡萄糖的摄取00:06:36.680 --> 00:06:38.980与黄体黄源耗竭00:06:39.320 --> 00:06:41.420从而达到驱虫效果00:06:41.720 --> 00:06:47.020一般成人及两岁以上儿童冻服四百毫克率率较高00:06:48.160 --> 00:06:50.780在一些蛔虫感染高发地区00:06:50.960 --> 00:06:52.580通过大规模使用00:06:55.160 --> 00:06:59.380有效降低了蛔虫引发肺寄生虫病的发病00:07:00.920 --> 00:07:03.900针针对钩虫导致的肺寄生虫00:07:04.720 --> 00:07:07.300甲苯吡唑是常用药物之一00:07:07.600 --> 00:07:11.020它可直接抑制昆虫的生长和繁殖00:07:11.240 --> 00:07:13.940阻断虫体对营养物质的吸收00:07:14.320 --> 00:07:17.900成人剂量为每次一百到两百毫克00:07:18.120 --> 00:07:19.380每日两次00:07:19.400 --> 00:07:21.260连服三到四天00:07:21.680 --> 00:07:23.140在农村播种00:07:23.640 --> 00:07:31.460感染病菌采用甲苯醚做规范治疗后患者的肺部症状得到明显改善00:07:31.600 --> 00:07:33.900多重感染率明显下降00:07:36.480 --> 00:07:38.900针对不同寄生虫的治疗方案00:07:39.560 --> 00:07:42.980下面我们讲常用抗寄生虫药物介绍00:07:43.400 --> 00:07:46.300阿苯达唑是一种广谱驱虫药00:07:46.440 --> 00:07:49.980对多种肠道寄生虫都有良好的驱虫效果00:07:50.320 --> 00:07:55.020其作用机制主要是抑制寄生虫对葡萄糖的摄取00:07:55.200 --> 00:07:57.300使虫体无法获取能量00:07:57.440 --> 00:07:59.260从而达到去除目的00:07:59.520 --> 00:08:01.580它在体内代谢迅速00:08:02.080 --> 00:08:03.900副作用相对较小00:08:04.240 --> 00:08:08.340常见的不良反应有轻度头痛乏力等00:08:08.600 --> 00:08:10.500一般可自行缓解00:08:11.360 --> 00:08:12.580甲苯米唑00:08:12.760 --> 00:08:15.500能选择性地使线虫体被00:08:15.720 --> 00:08:18.260和肠细胞的微管消失00:08:18.360 --> 00:08:21.220抑制虫体对葡萄糖的摄取00:08:21.320 --> 00:08:22.860减少糖原料00:08:23.280 --> 00:08:25.780使虫体无法生存和繁殖00:08:26.000 --> 00:08:29.940但适用于治疗多种肠道寄生虫感染00:08:30.080 --> 00:08:32.220包括钩虫蛔虫等00:08:32.680 --> 00:08:36.740在治疗期疗下甲苯丙唑对人体的毒性较低00:08:36.960 --> 00:08:39.940但孕妇和哺乳期妇女应慎用00:08:42.719 --> 00:08:47.540乙酮酮对多种吸虫和绦虫都有强大的杀灭作用00:08:47.800 --> 00:08:54.820尤其对肺吸虫有效有特效它能增加虫体细胞膜对钙离子的通透性00:08:55.040 --> 00:08:59.220使虫体肌肉发生强直性收缩而被排出体外00:08:59.560 --> 00:09:03.300鼻昆虫的疗效确切副作用相对较轻00:09:03.480 --> 00:09:06.300常见的有头晕乏力腹痛等00:09:06.320 --> 00:09:09.220一般在停药后可自行消失00:09:10.000 --> 00:09:13.300治疗过程中的注意事项首先00:09:13.400 --> 00:09:15.540在治疗肺寄生虫病时00:09:15.560 --> 00:09:16.980严格按照医嘱00:09:17.520 --> 00:09:20.260控制药物剂量和疗程至关重要00:09:20.600 --> 00:09:24.840不同药物针对不同寄生虫的剂量和疗程有所不同00:09:25.280 --> 00:09:28.860如阿苯达唑治疗蛔虫引发的非寄生虫病00:09:29.040 --> 00:09:32.620成人及两岁以上儿童需重复四百毫克00:09:33.520 --> 00:09:36.940若剂量不足可能无法彻底清除寄生虫00:09:38.880 --> 00:09:42.860而过量服用则可能增加不良反应的发生风险00:09:44.280 --> 00:09:46.300必须完成规定疗程00:09:46.560 --> 00:09:48.180确保治疗效果00:09:49.120 --> 00:09:52.420治疗过程中要密切监测药物不良反应00:09:52.840 --> 00:09:56.220对使用吡喹酮治疗肺吸虫病时00:09:56.360 --> 00:09:59.740不管患者可能出现头晕乏力等症状00:09:59.920 --> 00:10:01.900严重程度因人而异00:10:02.160 --> 00:10:05.980而医护人员应告知患者可能出现的不良反应00:10:06.080 --> 00:10:08.020一旦出现异常情况00:10:08.120 --> 00:10:10.940及时进行处理确保患者安全00:10:13.080 --> 00:10:15.020治疗后的复查与随访00:10:15.280 --> 00:10:20.820治疗后进行复查与随访是确保对寄生虫并彻底治愈的关键环节00:10:21.320 --> 00:10:24.100通过复查痰液血液等检查项目00:10:24.320 --> 00:10:27.180观察寄生虫是否被彻底清除00:10:27.560 --> 00:10:29.500作物病变是否好转00:10:29.800 --> 00:10:32.660例如治疗肺系肿病之后00:10:32.760 --> 00:10:35.580定期复查胸部影像学检查00:10:35.920 --> 00:10:39.020了解肺部囊肿等病变的吸收情况00:10:39.200 --> 00:10:43.260随访过程中还需关注患者的症状是否复发00:10:43.280 --> 00:10:45.580以便及时调整治疗方案00:10:46.960 --> 00:10:49.460预防措施与公共卫生意义00:10:51.640 --> 00:10:54.420个人需养成勤洗手的习惯00:10:54.560 --> 00:10:56.700尤其是在饭前便后00:10:56.920 --> 00:11:00.740例如蛔虫卵可通过污染的手进入口腔00:11:00.800 --> 00:11:02.140进而引发感染00:11:02.480 --> 00:11:07.340用肥皂和流动水洗手能有效去除手上的虫卵和病菌00:11:07.520 --> 00:11:09.100降低感染风险00:11:09.240 --> 00:11:16.780据统计坚持正确洗手习惯可使肠道寄生虫感染几率降低约百分之三十00:11:17.640 --> 00:11:22.300另外要避免食用生的或未煮熟的食物至关重要00:11:22.560 --> 00:11:25.020像肺吸虫多因食用生的00:11:25.120 --> 00:11:28.580或未熟透的淡水蟹拉过而感染00:11:28.800 --> 00:11:31.020在食用海鲜河鲜时00:11:31.040 --> 00:11:40.340务必确保其经过充分烹饪高温加热能杀死其中可能存在的寄生虫和虫卵保障饮食安全00:11:42.200 --> 00:11:45.860在特定环境下要加强个人防护措施00:11:46.320 --> 00:11:54.820比如在钩虫易感染地区从事农业劳动时应尽量避免自主接触土壤可穿好鞋袜00:11:55.400 --> 00:11:58.820因为钩虫丝状疣能通过皮肤侵入人体00:12:00.080 --> 00:12:02.540做好防护可有效防止感染00:12:02.680 --> 00:12:07.300减少因接触感染源而引发肺寄生虫病的可能性00:12:09.040 --> 00:12:13.140公共卫生部门应着重加强对环境卫生的管理00:12:13.720 --> 00:12:18.860定期清理公共区域的垃圾尤其是污水排放和垃圾处理环节00:12:19.280 --> 00:12:21.740减少寄生虫的滋生环境00:12:22.400 --> 00:12:26.220例如对下水道进行定期疏通和消毒00:12:26.400 --> 00:12:30.940可有效控制蛔虫卵钩虫卵等在污水中的传播00:12:31.280 --> 00:12:34.020降低肺寄生虫病的传播风险00:12:34.840 --> 00:12:38.620保障水源安全是防控寄生虫病的关键00:12:39.440 --> 00:12:42.100对饮用水源进行严格保护00:12:42.480 --> 00:12:44.100防止其受到污染00:12:46.160 --> 00:12:50.340同时加强对水源的监测频率和力度00:12:50.400 --> 00:12:54.380检测水中是否存在寄生虫虫卵或幼虫00:12:54.640 --> 00:12:58.060如定期对自来水厂的水源进行检测00:12:58.200 --> 00:13:00.380确保居民饮用水安全00:13:00.400 --> 00:13:03.780从源头阻断肺寄生虫病的传播途径00:13:08.080 --> 00:13:10.500开展肺寄生虫病的重要意义00:13:11.200 --> 00:13:13.260首先保障了个人健康00:13:13.400 --> 00:13:18.220预防肺寄生虫病对个人健康有着直接且重要的影响00:13:18.480 --> 00:13:21.100肺寄生虫病会损害肺部功能00:13:21.240 --> 00:13:26.980引发多种并发症严重影响患者的生活质量和劳动能力00:13:27.200 --> 00:13:30.020预防感染可避免这些疾病的发生00:13:30.160 --> 00:13:33.340使个人能够保持良好的身体状态00:13:33.440 --> 00:13:36.340正常参加工作学习和生活00:13:36.600 --> 00:13:40.660例如一个原本健康的人若感染肺吸虫病00:13:40.840 --> 00:13:44.940可能肺会因肺部病变而长期咳嗽呼吸困难00:13:45.040 --> 00:13:47.340无法正常工作和生活00:13:53.600 --> 00:13:56.380另外它能减轻社会经济负担00:13:56.600 --> 00:14:00.420有效预防肺寄生虫病能减轻社会的经济负担00:14:00.600 --> 00:14:04.500肺寄生虫病的治疗需要耗费大量的医疗资源00:14:04.600 --> 00:14:15.580包括药品医疗器械以及医护人员的人力成本等同时患者因患病无法工作以后对家庭和社会的经济发展造成一定影响00:14:16.040 --> 00:14:22.340通过预防措施降低发病率可减少医疗资源的消耗促进社会经济的健康发展00:14:22.680 --> 00:14:30.260据估算在寄生虫病高发地区做好预防工作可节省约百分之二十到百分之三十的医疗支出00:14:31.280 --> 00:14:33.380维护公共卫生安全00:14:33.840 --> 00:14:35.620预防肺寄生虫病00:14:35.680 --> 00:14:39.060是维护公共卫生安全的重要环节00:14:39.280 --> 00:14:42.380肺寄生虫病具有一定的传播性00:14:42.720 --> 00:14:45.260若不加以哮喘防控00:14:45.400 --> 00:14:47.940可能在人群中广泛传播00:14:48.000 --> 00:14:49.980引发公共卫生事件00:14:50.600 --> 00:14:52.740通过采取预防措施00:14:52.760 --> 00:14:55.220控制肺寄生虫病的传播00:14:55.320 --> 00:14:59.060能够保障整个社会的公共卫生安全00:14:59.320 --> 00:15:01.900营造健康的生活环境00:15:02.240 --> 00:15:06.660例如在学校工厂等人员密集场所00:15:06.960 --> 00:15:12.460做好预防工作可防止肺寄生虫病的爆发流行00:15:14.600 --> 00:15:18.420这些都是预防肺寄生虫病的重要意义00:15:22.760 --> 00:15:25.860次我的讲课到此结束00:15:26.280 --> 00:15:30.940大家现在对肺寄生虫病有没有充分的了解和认知呢00:15:34.760 --> 00:15:37.220希望大家可以业余的时候00:15:37.760 --> 00:15:39.860学习一下肺寄生虫病00:15:41.240 --> 00:15:43.300我的演讲到此结束00:15:43.400 --> 00:15:44.420谢谢大家