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--> 00:06.831\n今天我跟大家分享的是肺血栓栓塞症与肺源性心脏病。\n\n00:07.282 --> 00:07.682\n嗯，\n\n00:07.682 --> 00:10.781\n就是肺血管疾病的相关科普解读。\n\n00:13.338 --> 00:13.387\n嗯，\n\n00:13.387 --> 00:15.288\n我将从以下几个方面来讲，\n\n00:15.937 --> 00:16.312\n嗯，\n\n00:16.312 --> 00:20.138\n首先是肺血栓栓塞症与肺源性心脏病的概述，\n\n00:20.638 --> 00:24.337\n还有肺血栓栓塞症的临床表现与诊断，\n\n00:25.388 --> 00:27.538\n还有它的治疗和预防。\n\n00:28.288 --> 00:31.613\n再就是肺源性心脏病的临床表现与诊断，\n\n00:31.613 --> 00:33.537\n还有它的治疗预后。\n\n00:37.043 --> 00:40.793\n首先是肺血栓栓塞症与肺源性心脏病的概述。\n\n00:41.765 --> 00:42.116\n嗯。\n\n00:45.589 --> 00:45.688\n嗯，\n\n00:45.688 --> 00:47.714\n肺血栓栓塞症的定义呢，\n\n00:47.714 --> 00:55.938\n是指来自静脉系统或右心的血栓阻塞肺动脉或其分支所致的疾病。\n\n00:56.388 --> 00:56.738\n嗯，\n\n00:56.738 --> 00:57.688\n这些栓子呢，\n\n00:57.688 --> 01:03.738\n多来源于下肢深静脉脱落后随着血流进入肺动脉啊，\n\n01:03.738 --> 01:05.539\n引发肺循环的障碍。\n\n01:06.138 --> 01:06.463\n嗯，\n\n01:06.463 --> 01:13.338\n该病是以肺循环和呼吸功能障碍为主要病理生理特征啊，\n\n01:13.338 --> 01:15.164\n它可以导致肺动脉高压，\n\n01:15.164 --> 01:15.789\n右心功。\n\n01:15.844 --> 01:17.543\n不全等严重后果，\n\n01:18.094 --> 01:20.168\n而肺源性心脏病的定义呢，\n\n01:20.168 --> 01:25.944\n是指因支气管、肺组织、胸廓或者肺血管的病变，\n\n01:26.293 --> 01:28.293\n使肺血管阻力增加，\n\n01:28.694 --> 01:31.244\n嗯引起肺动脉高压，\n\n01:31.244 --> 01:33.744\n继而引起一些右心室肥厚，\n\n01:34.194 --> 01:37.994\n伴或不伴右心衰竭的一种疾病。\n\n01:37.994 --> 01:42.744\n急性的肺肺源性心脏病是常见于急性肺动脉栓塞，\n\n01:43.143 --> 01:45.694\n而慢性的肺源性心脏病是。\n\n01:45.856 --> 01:50.206\n多由慢性支气管炎等这些慢性的肺部疾病引起。\n\n01:52.884 --> 01:53.083\n嗯。\n\n01:54.956 --> 01:55.081\n嗯，\n\n01:55.081 --> 01:57.706\n流行病学与发病率，\n\n01:57.706 --> 02:00.255\n肺血栓栓塞症的流行病学是，\n\n02:00.255 --> 02:07.780\n肺血栓栓塞症的发病率约为每10万人中有39.115例啊。\n\n02:07.780 --> 02:13.156\n美国每年约有35万例静脉血栓栓塞症的发生，\n\n02:13.505 --> 02:16.305\n其中肺栓塞占相当大的比例。\n\n02:16.906 --> 02:17.231\n嗯，\n\n02:17.231 --> 02:21.505\n我国近年来肺血栓栓塞症的例数迅速增加，\n\n02:21.555 --> 02:25.156\n住院患者中肺栓塞的比例。\n\n02:25.231 --> 02:27.781\n也从97年的0.62%，\n\n02:28.031 --> 02:30.731\n上升到08年的1.45%，\n\n02:31.481 --> 02:31.882\n嗯，\n\n02:31.932 --> 02:34.231\n肺源性心脏病的流行病学。\n\n02:35.233 --> 02:38.783\n是我国20世纪70年代的数据显示，\n\n02:39.483 --> 02:39.884\n嗯，\n\n02:39.934 --> 02:46.634\n14岁以上人群慢性肺心病的发病率为4.8%啊。\n\n02:46.634 --> 02:49.059\n慢性肺源性心脏病啊，\n\n02:49.059 --> 02:52.033\n发病率是随着年龄的增长而增加，\n\n02:52.434 --> 02:57.033\n寒冷地区和经济落后的地区发病率会更高一些。\n\n03:00.990 --> 03:04.039\n肺血栓栓塞症的临床表现和诊断？\n\n03:06.089 --> 03:12.289\n它的临床表现是从呼吸系统和循环系统两个方面，\n\n03:12.539 --> 03:15.789\n呼吸系统是呼吸困难、气促，\n\n03:16.289 --> 03:18.990\n这也是肺血栓栓塞症最常见的症状。\n\n03:19.692 --> 03:22.141\n还有就是活动后啊。\n\n03:23.522 --> 03:24.147\n活动后，\n\n03:24.147 --> 03:28.147\n这个气促和呼吸困难会出现加重，\n\n03:28.147 --> 03:31.072\n静息时可缓解或者消失啊。\n\n03:31.072 --> 03:33.296\n患者可能主诉大便后啊，\n\n03:33.296 --> 03:35.421\n上楼梯后，\n\n03:35.472 --> 03:39.871\n就这些运动后会出现一些胸部的憋闷，\n\n03:40.222 --> 03:41.722\n咳嗽也较为常见，\n\n03:42.072 --> 03:42.421\n嗯，\n\n03:42.421 --> 03:44.972\n多为干咳或者有少量的白痰。\n\n03:45.421 --> 03:47.671\n部分患者还可能出现咯血，\n\n03:48.272 --> 03:48.621\n嗯，\n\n03:48.621 --> 03:50.022\n多为小量的咯血，\n\n03:50.421 --> 03:50.772\n嗯，\n\n03:50.772 --> 03:53.421\n这是提示是肺梗死的重要症状。\n\n03:53.925 --> 03:54.326\n嗯，\n\n03:54.326 --> 03:55.001\n还可以，\n\n03:55.001 --> 03:58.126\n有一些少见的一些大咯血，\n\n03:58.475 --> 03:58.876\n嗯，\n\n03:58.925 --> 04:00.326\n有的会导致晕厥。\n\n04:01.710 --> 04:02.110\n嗯，\n\n04:02.110 --> 04:05.259\n循环系统的症状就包括胸痛，\n\n04:05.610 --> 04:07.860\n这是常见的症状之一。\n\n04:08.360 --> 04:08.735\n嗯，\n\n04:08.735 --> 04:10.759\n包括胸膜炎一样的胸痛，\n\n04:10.809 --> 04:12.960\n还有心绞痛一样的疼痛。\n\n04:13.460 --> 04:18.160\n胸膜炎一样的疼痛就是在深呼吸或者是咳嗽时会加重，\n\n04:18.559 --> 04:20.859\n提示有肺梗死的存在。\n\n04:21.459 --> 04:21.859\n嗯，\n\n04:21.859 --> 04:24.160\n患者可能出现晕厥，\n\n04:24.910 --> 04:30.010\n这是肺血栓栓塞症的唯一或者是首发的症状。\n\n04:31.216 --> 04:34.515\n主要的原因是大块的肺血栓栓塞，\n\n04:34.765 --> 04:37.466\n阻塞了50%以上的肺血管，\n\n04:37.665 --> 04:40.115\n引起这个脑供血的不足。\n\n04:45.394 --> 04:45.769\n嗯，\n\n04:45.769 --> 04:46.993\n诊断方法上，\n\n04:47.243 --> 04:47.644\n嗯，\n\n04:47.644 --> 04:50.644\n一个是实验室的检查和一个影像学的检查。\n\n04:50.993 --> 04:53.993\n实验室的检查就是血浆第二聚体，\n\n04:54.394 --> 05:01.194\n它是交联纤维蛋白在纤溶系统作用下产生的可降可溶性的降解产物。\n\n05:01.743 --> 05:02.093\n嗯，\n\n05:02.093 --> 05:03.419\n在血栓栓塞时呢，\n\n05:03.419 --> 05:04.644\n血中浓度会升高，\n\n05:05.093 --> 05:08.593\n对肺血栓栓塞症诊断的敏感度，\n\n05:08.644 --> 05:10.894\n是达到92%到百分之百的，\n\n05:10.944 --> 05:13.794\n但是特异度是比较低的，\n\n05:13.794 --> 05:15.243\n动脉血气分析可。\n\n05:15.395 --> 05:18.295\n出现低氧血症、低碳酸血症，\n\n05:18.346 --> 05:21.196\n肺泡动脉血氧分压差增大，\n\n05:21.446 --> 05:24.545\n还有呼吸性碱中毒的表现啊，\n\n05:24.545 --> 05:27.145\n影像学上就是CT，\n\n05:27.145 --> 05:28.946\n肺动脉造影就是CTA。\n\n05:29.196 --> 05:29.520\n嗯，\n\n05:29.520 --> 05:34.246\n它是诊断肺肺血栓栓塞症的重要的无创检查的技术，\n\n05:34.446 --> 05:37.196\n它可以直观的判断肺动脉栓塞，\n\n05:37.596 --> 05:37.971\n嗯，\n\n05:37.971 --> 05:39.895\n累积的部位还有范围，\n\n05:40.096 --> 05:42.196\n那么敏感性是90%，\n\n05:42.446 --> 05:43.971\n特异性，\n\n05:43.971 --> 05:45.346\n达到78%到。\n\n05:45.372 --> 05:45.872\n百分之百。\n\n05:46.648 --> 05:51.273\n放射性核素肺通气灌注扫描的典型征象呢，\n\n05:51.273 --> 05:53.798\n是与通气显像不匹配的。\n\n05:54.048 --> 05:54.347\n嗯，\n\n05:54.347 --> 06:00.997\n肺段分布的灌注缺损对亚段以下动脉血栓栓塞的诊断价值较高。\n\n06:05.618 --> 06:05.944\n嗯，\n\n06:05.944 --> 06:08.919\n肺炎性心脏病的临床表现与诊断呢，\n\n06:09.368 --> 06:14.819\n是临床表现是分为代偿期和失代偿期的表现。\n\n06:15.319 --> 06:16.968\n代偿期啊，\n\n06:16.968 --> 06:21.894\n表现为像咳嗽、咳痰、气促啊，\n\n06:21.894 --> 06:26.819\n呼吸困难、心悸乏力还有劳动耐力的下降。\n\n06:27.368 --> 06:27.769\n嗯，\n\n06:27.769 --> 06:29.993\n体检时可以，\n\n06:29.993 --> 06:31.769\n有明显的肺气肿征。\n\n06:32.269 --> 06:32.593\n嗯，\n\n06:32.593 --> 06:34.368\n听诊呼吸音会减弱，\n\n06:34.618 --> 06:35.468\n偶尔会有。\n\n06:35.555 --> 06:36.656\n干湿性的罗音，\n\n06:37.105 --> 06:38.705\n下肢轻微的水肿，\n\n06:38.906 --> 06:39.281\n嗯，\n\n06:39.281 --> 06:40.156\n下午明显，\n\n06:40.156 --> 06:41.855\n次晨的时候一般会消失。\n\n06:44.781 --> 06:46.180\n失代偿期的表现呢，\n\n06:46.480 --> 06:46.855\n嗯，\n\n06:46.855 --> 06:48.430\n是以呼吸衰竭为主，\n\n06:48.480 --> 06:50.781\n严重者可以出现右心衰竭。\n\n06:51.381 --> 06:51.730\n嗯，\n\n06:51.730 --> 06:54.430\n右心衰可以表现为呼吸困难加重，\n\n06:54.580 --> 06:57.031\n胸闷心悸啊，\n\n06:57.031 --> 07:00.480\n气促乏力还有发干多汗等。\n\n07:01.031 --> 07:01.430\n嗯，\n\n07:01.580 --> 07:04.730\n右心衰竭这是呼吸系统的表现，\n\n07:04.881 --> 07:07.080\n还有一些体循环淤血的症状，\n\n07:07.230 --> 07:08.730\n像颈静脉怒张，\n\n07:09.031 --> 07:09.381\n嗯，\n\n07:09.381 --> 07:10.381\n食欲下降，\n\n07:10.580 --> 07:12.531\n腹胀恶心呕吐，\n\n07:12.680 --> 07:14.480\n还有肝脏的肿大，\n\n07:14.531 --> 07:14.980\n还有。\n\n07:15.040 --> 07:16.239\n下肢的水肿等。\n\n07:17.044 --> 07:17.444\n嗯。\n\n07:21.290 --> 07:21.390\n嗯，\n\n07:21.390 --> 07:23.015\n诊断方法啊，\n\n07:23.015 --> 07:24.716\n包括心电图的检查，\n\n07:24.716 --> 07:26.390\n还有超声心动图的检查。\n\n07:27.240 --> 07:27.591\n嗯，\n\n07:27.591 --> 07:29.466\n心电图的检查啊，\n\n07:29.466 --> 07:31.640\n可出现电轴的右偏，\n\n07:31.691 --> 07:33.490\nST段和梯部的改变。\n\n07:34.040 --> 07:34.441\n嗯，\n\n07:34.441 --> 07:37.390\n额面的平均电轴大于等于+90°，\n\n07:37.790 --> 07:38.165\n嗯，\n\n07:38.165 --> 07:40.441\n会有重度的顺中向转位。\n\n07:40.941 --> 07:41.490\n嗯，\n\n07:41.490 --> 07:44.390\nV1导联RS比值大于等于一，\n\n07:44.640 --> 07:45.990\n这是常见的表现。\n\n07:47.447 --> 07:49.048\n超声心动图的检查，\n\n07:49.597 --> 07:49.923\n嗯，\n\n07:49.923 --> 07:53.447\n这是评估右心功能的首选的无创的检查。\n\n07:53.947 --> 07:54.273\n嗯，\n\n07:54.273 --> 08:01.847\n慢性肺源性心脏病超声心动图这个表现是右心室和右心房的增大。\n\n08:01.847 --> 08:05.048\n通过测定右心室的流出道内径，\n\n08:05.048 --> 08:08.197\n右心室内径这些指标可以帮助诊断。\n\n08:13.000 --> 08:15.200\n肺血栓栓塞症的治疗和预防？\n\n08:16.386 --> 08:16.736\n嗯。\n\n08:18.674 --> 08:18.774\n嗯，\n\n08:18.774 --> 08:19.774\n肺血栓栓塞，\n\n08:19.975 --> 08:20.299\n嗯，\n\n08:20.299 --> 08:21.924\n一般是一个急性的过程，\n\n08:22.375 --> 08:22.774\n嗯。\n\n08:24.584 --> 08:30.434\n要需要一些抗凝或者溶栓的治疗去将这个血栓溶解。\n\n08:31.135 --> 08:31.459\n嗯，\n\n08:31.459 --> 08:36.734\n首先抗凝治疗它是它是是肺炎栓塞症的基础治疗，\n\n08:36.984 --> 08:40.359\n可以防止血栓进一步形成和扩展。\n\n08:40.359 --> 08:44.835\n普通的肝素和低分子量肝素都是常用的抗凝药物。\n\n08:45.284 --> 08:45.635\n嗯，\n\n08:45.635 --> 08:48.885\n而华法林是长期抗凝治疗的常用药物。\n\n08:49.442 --> 08:49.791\n嗯，\n\n08:49.791 --> 08:57.291\n使用华法林要控制这个国际标准化比值在二到三之间。\n\n08:58.091 --> 08:58.466\n嗯，\n\n08:58.466 --> 09:02.742\n溶栓治疗就适用于大块的肺血栓栓塞症的患者，\n\n09:03.041 --> 09:05.666\n它可以迅速的溶解血栓啊，\n\n09:05.666 --> 09:07.892\n恢复肺组织的灌注，\n\n09:08.192 --> 09:09.892\n减轻肺动脉的高压。\n\n09:10.791 --> 09:11.142\n嗯，\n\n09:11.142 --> 09:19.442\n常用的溶栓药物包括尿激酶还有重组组织型纤溶酶原激活剂像RTPA。\n\n09:19.916 --> 09:20.315\n嗯。\n\n09:25.513 --> 09:25.763\n嗯，\n\n09:25.763 --> 09:29.614\n预防的措施包括基础的预防和药物的预防。\n\n09:30.064 --> 09:30.439\n嗯，\n\n09:30.439 --> 09:33.314\n基础的预防就是避免长时间的卧床，\n\n09:34.013 --> 09:34.414\n嗯，\n\n09:35.013 --> 09:38.314\n但是如果说不得不长期卧床的，\n\n09:38.614 --> 09:39.013\n嗯，\n\n09:39.013 --> 09:39.414\n像。\n\n09:40.468 --> 09:40.617\n嗯，\n\n09:40.617 --> 09:42.018\n刚做过手术的，\n\n09:42.367 --> 09:42.718\n嗯，\n\n09:42.718 --> 09:43.867\n受伤的啊，\n\n09:43.867 --> 09:44.893\n这种，\n\n09:44.893 --> 09:47.067\n必须要长期卧床的，\n\n09:47.067 --> 09:50.918\n也要鼓励他在床上去进行自主的活动。\n\n09:51.367 --> 09:51.742\n嗯，\n\n09:51.742 --> 09:53.218\n像这种踝泵运动，\n\n09:53.668 --> 09:54.067\n嗯，\n\n09:54.268 --> 09:56.117\n促进下肢血液的循环。\n\n09:56.218 --> 10:01.067\n踝泵运动就是主动的脚踝的屈伸运动，\n\n10:01.367 --> 10:01.768\n嗯，\n\n10:01.768 --> 10:03.418\n去，\n\n10:04.168 --> 10:10.567\n促进那个下肢的锻炼是以。\n\n10:10.835 --> 10:15.585\n这个脚踝的屈伸来模拟这个泵的作用，\n\n10:15.885 --> 10:18.685\n是一种简单的下肢锻炼。\n\n10:19.786 --> 10:20.187\n嗯，\n\n10:20.637 --> 10:24.236\n具体的做法就是背屈，\n\n10:24.586 --> 10:28.986\n背屈就是脚尖绷绷起来啊。\n\n10:29.586 --> 10:31.812\n背屈15，\n\n10:31.812 --> 10:33.286\n大概10.15秒。\n\n10:33.736 --> 10:34.111\n嗯，\n\n10:34.111 --> 10:40.836\n尽量的向上向上背屈，\n\n10:40.937 --> 10:43.637\n尽量缓慢的向上背屈10.15秒。\n\n10:43.986 --> 10:44.336\n嗯，\n\n10:44.336 --> 10:46.437\n然后在指屈。\n\n10:47.179 --> 10:50.080\n就是脚尖向下，\n\n10:50.080 --> 10:54.630\n像做芭蕾舞的那个那样的一个脚型，\n\n10:54.979 --> 10:56.679\n然后也是10.15秒，\n\n10:57.179 --> 10:57.554\n嗯，\n\n10:57.554 --> 11:00.780\n每次做个20.30次，\n\n11:01.380 --> 11:01.780\n嗯，\n\n11:01.780 --> 11:04.280\n每天做个8.10组，\n\n11:04.429 --> 11:04.780\n嗯，\n\n11:04.780 --> 11:05.780\n尽量多做。\n\n11:07.145 --> 11:07.546\n嗯，\n\n11:07.596 --> 11:11.245\n再就是踝关节的一个环绕运动，\n\n11:11.596 --> 11:11.995\n嗯，\n\n11:12.096 --> 11:14.346\n可以以脚尖为，\n\n11:14.346 --> 11:16.221\n以脚踝为关，\n\n11:16.221 --> 11:17.096\n关节为中心，\n\n11:17.495 --> 11:17.895\n嗯，\n\n11:18.195 --> 11:21.846\n用脚尖做360°的环绕运动，\n\n11:21.846 --> 11:23.445\n顺时针和逆时针，\n\n11:23.695 --> 11:24.070\n嗯，\n\n11:24.070 --> 11:26.145\n分别各做个10.15次。\n\n11:27.357 --> 11:27.658\n去，\n\n11:28.807 --> 11:29.208\n嗯，\n\n11:29.458 --> 11:31.557\n促进下肢的血液循环，\n\n11:32.357 --> 11:32.732\n嗯，\n\n11:32.732 --> 11:33.807\n药物治疗。\n\n11:35.556 --> 11:36.830\n还有就是啊，\n\n11:36.830 --> 11:39.205\n保持一个良好的生活习惯啊，\n\n11:39.205 --> 11:42.406\n避免吸烟和过度的饮酒啊，\n\n11:42.406 --> 11:43.380\n控制体重，\n\n11:43.431 --> 11:44.531\n预防肥胖。\n\n11:44.931 --> 11:45.330\n嗯，\n\n11:45.431 --> 11:50.481\n让自己的就是血通俗来讲就是血粘度不要太高。\n\n11:51.031 --> 11:51.431\n嗯，\n\n11:51.531 --> 11:54.231\n药物预防，\n\n11:54.231 --> 11:55.931\n对于高危因素的患者，\n\n11:56.330 --> 11:56.705\n嗯，\n\n11:56.705 --> 11:57.656\n手术后啊，\n\n11:57.656 --> 11:59.731\n创伤后的这些，\n\n12:00.531 --> 12:04.330\n可以使用一些低分子肝素进行药物的预防，\n\n12:04.330 --> 12:04.931\n抗凝。\n\n12:09.617 --> 12:12.367\n肺源性心脏病的治疗和预防？\n\n12:15.286 --> 12:16.286\n那的治疗方法，\n\n12:16.736 --> 12:17.536\n嗯，\n\n12:17.536 --> 12:19.460\n一般治疗是，\n\n12:19.460 --> 12:20.585\n也是注意休息，\n\n12:20.585 --> 12:22.135\n避免劳累和感染。\n\n12:22.335 --> 12:24.885\n在性功能允许的前提下，\n\n12:24.885 --> 12:26.585\n进行适当的体育运动，\n\n12:26.585 --> 12:27.486\n增强体质。\n\n12:28.135 --> 12:28.536\n嗯，\n\n12:28.585 --> 12:30.385\n保持良好的生活环境，\n\n12:30.385 --> 12:34.536\n也是避免接触有害的气体粉尘这些啊，\n\n12:34.536 --> 12:35.935\n避免呼吸道感染。\n\n12:36.536 --> 12:36.885\n嗯，\n\n12:36.885 --> 12:38.536\n药物治疗，\n\n12:38.536 --> 12:40.385\n主要是以对症为主。\n\n12:41.056 --> 12:41.231\n嗯，\n\n12:41.231 --> 12:43.306\n用正性正性肌力药物，\n\n12:43.306 --> 12:47.156\n像洋地黄类的药物可以增强心肌的收缩力，\n\n12:47.156 --> 12:48.955\n缓解心力衰竭的症状。\n\n12:49.406 --> 12:50.755\n再就是利尿剂，\n\n12:50.755 --> 12:53.806\n如氢氯噻嗪和螺内酯，\n\n12:53.806 --> 12:55.531\n这些可以减轻水肿，\n\n12:55.531 --> 12:57.056\n降低右心的负荷。\n\n13:01.263 --> 13:04.013\n预后和转归情况。\n\n13:05.200 --> 13:05.575\n嗯，\n\n13:05.575 --> 13:08.400\n慢性肺源性心脏病是不可逆的。\n\n13:08.700 --> 13:09.025\n嗯，\n\n13:09.025 --> 13:10.250\n它不能被治愈，\n\n13:10.549 --> 13:12.049\n但经积极的治疗，\n\n13:12.049 --> 13:14.000\n可以改善患者的生活环境。\n\n13:14.500 --> 13:14.900\n嗯，\n\n13:15.099 --> 13:16.775\n急性肺源性心脏病，\n\n13:16.775 --> 13:18.849\n它去除病因后，\n\n13:18.849 --> 13:21.700\n心脏功能有恢复的可能，\n\n13:21.750 --> 13:27.250\n但是治疗上也是以那个对症为主。\n\n13:29.072 --> 13:32.572\n并发症的预防要积极控制感染，\n\n13:33.122 --> 13:37.721\n嗯预防呼吸衰竭、心力衰竭这些并发症的发生。\n\n13:37.971 --> 13:39.421\n定期进行体检，\n\n13:40.021 --> 13:40.421\n嗯，\n\n13:40.572 --> 13:42.372\n监测病情变化，\n\n13:42.421 --> 13:45.271\n及时调整这个治疗的方案。\n\n13:49.306 --> 13:49.606\n嗯，\n\n13:49.656 --> 13:51.255\n我进行一个总结。\n\n13:52.056 --> 13:52.455\n嗯，\n\n13:52.505 --> 13:54.181\n肺血栓栓塞症呢，\n\n13:54.181 --> 13:57.455\n它主要是一个急性病的过程，\n\n13:57.806 --> 13:58.205\n嗯，\n\n13:58.205 --> 13:59.556\n但也可以慢性化。\n\n13:59.556 --> 14:03.880\n如果说抗凝或者是溶栓不彻底，\n\n14:03.880 --> 14:09.356\n有一些血栓激化或者附于血管壁的话，\n\n14:09.606 --> 14:12.255\n可能会形成慢性化。\n\n14:13.926 --> 14:14.226\n嗯，\n\n14:14.476 --> 14:17.575\n而肺炎性心脏病它是一个慢性的，\n\n14:17.875 --> 14:18.226\n嗯，\n\n14:18.226 --> 14:19.926\n是一个中末期的状态。\n\n14:20.729 --> 14:20.979\n嗯，\n\n14:20.979 --> 14:23.403\n而肺血栓栓塞症它的病因呢，\n\n14:23.403 --> 14:26.929\n是血栓堵塞了肺动脉。\n\n14:27.328 --> 14:27.703\n嗯，\n\n14:27.703 --> 14:31.528\n一般是下肢的血栓比较多见。\n\n14:32.028 --> 14:32.403\n嗯，\n\n14:32.403 --> 14:34.179\n像肺源性心脏病的病因呢，\n\n14:34.179 --> 14:35.528\n它就是，\n\n14:36.129 --> 14:37.703\n病因很多，\n\n14:37.703 --> 14:39.328\n像各种肺部的疾病，\n\n14:39.328 --> 14:41.679\n比如说COPD呀，\n\n14:41.979 --> 14:43.129\n就是慢阻肺，\n\n14:43.429 --> 14:43.778\n嗯，\n\n14:43.778 --> 14:45.778\n然后还有间质性的肺病啊，\n\n14:45.979 --> 14:48.679\n还有肺血栓栓塞症的，\n\n14:48.679 --> 14:50.778\n慢性化都可以导致。\n\n14:51.036 --> 14:53.135\n这个长期的肺动脉高压，\n\n14:53.435 --> 14:53.835\n嗯，\n\n14:54.036 --> 14:56.435\n然后最终导致肺源性心脏病。\n\n14:58.007 --> 14:58.406\n嗯，\n\n14:58.856 --> 15:00.231\n肺血栓栓塞症，\n\n15:00.231 --> 15:06.007\n它的核心的病理就是肺动脉的机械性的梗阻。\n\n15:06.406 --> 15:08.206\n而肺源性心脏病，\n\n15:08.456 --> 15:08.831\n嗯，\n\n15:08.831 --> 15:11.106\n它是一个右心室的肥大，\n\n15:11.156 --> 15:13.007\n肥肥厚扩张，\n\n15:13.257 --> 15:13.656\n嗯，\n\n15:13.706 --> 15:15.307\n还有一个功能的衰竭。\n\n15:16.601 --> 15:17.000\n嗯，\n\n15:17.000 --> 15:21.051\n肺血栓栓塞症的主要的症状啊，\n\n15:21.051 --> 15:24.500\n是突发性的胸痛、呼吸困难，\n\n15:24.950 --> 15:25.351\n嗯，\n\n15:25.401 --> 15:26.500\n有些有咯血，\n\n15:26.750 --> 15:27.700\n还有晕厥。\n\n15:28.601 --> 15:29.976\n而肺源性心脏病，\n\n15:29.976 --> 15:32.750\n它是一个渐进性的慢性的过程，\n\n15:33.250 --> 15:33.651\n嗯，\n\n15:33.651 --> 15:35.250\n会有一些呼吸困难，\n\n15:35.301 --> 15:37.950\n尤其是活动后会加重啊，\n\n15:37.950 --> 15:38.901\n会有乏力，\n\n15:38.950 --> 15:40.101\n下肢水肿，\n\n15:40.200 --> 15:41.101\n还有腹胀，\n\n15:41.601 --> 15:42.000\n嗯，\n\n15:42.301 --> 15:44.901\n就是一些右心衰的表现。\n\n15:46.382 --> 15:46.757\n嗯，\n\n15:46.757 --> 15:48.132\n在治疗上，\n\n15:48.581 --> 15:48.932\n嗯，\n\n15:48.932 --> 15:50.331\n肺血栓栓塞症，\n\n15:50.731 --> 15:58.132\n它是一个要有一个急救急性的抗抗凝溶栓或者是取栓，\n\n15:58.682 --> 16:02.981\n它的目标就是恢复这个肺动脉的血流。\n\n16:03.531 --> 16:05.132\n而肺炎性心脏病，\n\n16:05.382 --> 16:07.432\n它是一个长期管理的过程，\n\n16:07.981 --> 16:08.382\n嗯，\n\n16:08.481 --> 16:15.682\n平常的管理包括吸氧去改善这个呼吸的症状啊，\n\n16:15.682 --> 16:16.281\n然后。\n\n16:16.572 --> 16:17.396\n还有利尿剂，\n\n16:17.396 --> 16:18.822\n就减轻一些水肿，\n\n16:19.372 --> 16:24.622\n还有降低那个肺动脉高压的一些靶性药物。\n\n16:24.921 --> 16:25.322\n嗯，\n\n16:25.421 --> 16:28.921\n也最重要的是治疗一些治疗原发病啊，\n\n16:28.921 --> 16:31.921\n原发的这个肺部疾病或者是血管的疾病。\n\n16:33.130 --> 16:33.455\n嗯，\n\n16:33.455 --> 16:35.429\n目标就是控制症状，\n\n16:35.679 --> 16:36.030\n嗯，\n\n16:36.030 --> 16:37.979\n改善这个患者的心功能，\n\n16:37.979 --> 16:39.530\n延缓它的进展。\n\n16:41.859 --> 16:42.260\n嗯，\n\n16:42.260 --> 16:43.909\n肺血栓栓塞症，\n\n16:43.909 --> 16:48.835\n它是肺心病的就是原因之一，\n\n16:48.835 --> 16:50.909\n众多的原因之一。\n\n16:52.799 --> 16:53.200\n嗯，\n\n16:54.250 --> 16:55.474\n还有那个肺心病，\n\n16:55.474 --> 16:56.849\n就是，\n\n16:57.950 --> 17:02.400\n这各种肺部疾病导致的肺动脉高压，\n\n17:02.799 --> 17:03.200\n嗯，\n\n17:03.450 --> 17:07.400\n然后时间久了变成肺心病。\n\n17:07.650 --> 17:13.224\n它是一个长期发展的一个严重的结果之一，\n\n17:13.224 --> 17:14.400\n严重的后果之一。\n\n17:17.536 --> 17:19.911\n嗯，\n\n17:19.911 --> 17:21.536\n对于肺心病，\n\n17:21.837 --> 17:22.237\n嗯，\n\n17:22.737 --> 17:25.786\n就是要积极的预防感染。\n\n17:26.337 --> 17:26.687\n嗯，\n\n17:26.687 --> 17:32.312\n肺血栓栓塞症大多就是见于这种，\n\n17:32.312 --> 17:32.937\n卧床，\n\n17:33.136 --> 17:34.737\n然后下肢深静脉血栓，\n\n17:35.187 --> 17:35.587\n嗯，\n\n17:35.837 --> 17:38.411\n跑到肺动脉中，\n\n17:38.411 --> 17:40.337\n所以就是。\n\n17:42.173 --> 17:44.823\n像肺动肺血栓栓塞症的预防，\n\n17:45.124 --> 17:45.524\n嗯，\n\n17:45.624 --> 17:50.024\n就是如果说你卧床要积极的在床上活动，\n\n17:50.323 --> 17:50.723\n嗯，\n\n17:50.723 --> 17:51.973\n然后，\n\n17:51.973 --> 17:54.698\n肺源性心脏病就是积极的啊，\n\n17:54.698 --> 17:56.124\n控制原发病啊，\n\n17:56.124 --> 17:57.124\n预防感染，\n\n17:57.323 --> 18:00.374\n然后平时的护理要做好。\n\n18:00.723 --> 18:01.124\n嗯，\n\n18:01.124 --> 18:02.274\n大概就是这样。\n\n18:05.553 --> 18:06.154\n谢谢大家。\n\n","v0347cg10004d60lla2ljhtdm7vcsvm0",1092,557,"2026-01-24 19:21:04"," 肺血栓栓塞症与肺源性心脏病：肺血管疾病的科普解读与防治指南  \n"," 肺血栓栓塞症,肺源性心脏病,肺血管疾病,肺动脉高压,血栓预防,心肺健康,呼吸系统疾病,症状诊断  \n"," 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