WEBVTT00:00:04.880 --> 00:00:08.060今天讲的是哮喘知识科普00:00:09.960 --> 00:00:12.620哮喘分为六个方面讲00:00:12.880 --> 00:00:13.780第一个00:00:14.000 --> 00:00:17.700哮喘的基本概念与发展病因00:00:18.440 --> 00:00:22.300第二个哮喘的病理生理机制00:00:22.840 --> 00:00:27.460第三个哮喘的治疗原则与方法00:00:28.040 --> 00:00:28.940第四00:00:29.200 --> 00:00:33.780哮喘患者生活指导与心理支持00:00:34.520 --> 00:00:39.460五哮喘知识宣传与推广教育00:00:40.040 --> 00:00:45.260第六哮喘研究进展与未来展望00:00:46.280 --> 00:00:47.300第一个00:00:47.840 --> 00:00:51.260哮喘基本概念与发病原因00:00:53.000 --> 00:00:58.060哮喘的定义主要是讲了支气管哮喘00:00:58.080 --> 00:01:03.400是由多种细胞和细胞组分参与的00:01:03.400 --> 00:01:06.420气道慢性炎症性疾病00:01:06.960 --> 00:01:09.460通过这种慢性炎症00:01:09.600 --> 00:01:12.020与气道高反应相关00:01:12.960 --> 00:01:18.280通常出现广泛多变的可逆性呼气00:01:18.280 --> 00:01:19.700气流受阻00:01:20.160 --> 00:01:25.820并引起反复发作性喘息气促00:01:26.200 --> 00:01:29.380胸闷或咳嗽等症状00:01:30.400 --> 00:01:32.140他的临床表现00:01:33.560 --> 00:01:39.580哮喘的典型症状包括喘息气促00:01:40.080 --> 00:01:42.380胸闷和咳嗽等00:01:43.160 --> 00:01:47.540这些症状可能在接触过敏源00:01:48.120 --> 00:01:52.660冷空气或其他刺激物后加重00:01:53.320 --> 00:01:58.060夜间和清晨通常更为严重00:01:58.960 --> 00:02:02.580患者还可能出现哮鸣音00:02:03.360 --> 00:02:07.620这是气流通过狭窄气道时00:02:07.840 --> 00:02:09.180产生的声音00:02:10.760 --> 00:02:11.440接下来00:02:11.440 --> 00:02:16.140讲一下它的发病原因与危险因素00:02:16.960 --> 00:02:21.740发病原因哮喘的发病原因复杂00:02:22.320 --> 00:02:29.580涉及遗传环境生活方式等多个因素00:02:31.080 --> 00:02:32.380遗传因素00:02:32.560 --> 00:02:36.740在哮喘的发病中起重要作用00:02:37.360 --> 00:02:40.140而环境因素00:02:40.360 --> 00:02:46.880如过敏源空气污染感染等00:02:46.880 --> 00:02:49.060也可能诱发哮喘00:02:51.040 --> 00:02:52.420危险因素00:02:53.200 --> 00:03:00.460吸烟空气污染过敏源接触职业暴露00:03:00.920 --> 00:03:04.580以及呼吸道感染等00:03:05.080 --> 00:03:09.900都被认为是哮喘发病的危险因素00:03:10.720 --> 00:03:11.540此外00:03:12.080 --> 00:03:15.020肥胖和缺乏运动00:03:15.280 --> 00:03:18.420也可能增加哮喘的风险00:03:20.480 --> 00:03:22.100接下来讲一下00:03:22.840 --> 00:03:27.500哮喘易感人群及预防措施00:03:28.400 --> 00:03:30.940第一个易感人群00:03:31.680 --> 00:03:35.340哮喘可发生于任何年龄00:03:35.800 --> 00:03:40.260但大多数始发于儿童期00:03:40.840 --> 00:03:42.940有哮喘家族时00:03:43.680 --> 00:03:45.220过敏性鼻炎00:03:45.840 --> 00:03:50.780或湿疹等过敏性疾病的人群00:03:50.880 --> 00:03:52.940更容易患上哮喘00:03:53.840 --> 00:03:57.340第二个哮喘的预防措施00:03:58.080 --> 00:04:01.900通过避免过敏源接触00:04:02.200 --> 00:04:05.180是预防哮喘发作的关键00:04:05.760 --> 00:04:09.260此外保持室内空气清新00:04:09.920 --> 00:04:12.980避免吸烟和二手烟00:04:13.480 --> 00:04:15.260加强体育锻炼00:04:15.800 --> 00:04:21.420合理饮食以及保持良好的心态等00:04:22.160 --> 00:04:26.260也有助于降低哮喘的发病风险00:04:26.800 --> 00:04:32.100以上讲的是易感人群的预防措施00:04:33.040 --> 00:04:33.720接下来00:04:33.720 --> 00:04:40.380讲一下哮喘诊诊断标准与流程简介00:04:40.960 --> 00:04:43.940第一个哮喘的诊断标准00:04:44.840 --> 00:04:47.980医生通常根据患者的症状00:04:48.280 --> 00:04:53.580体征和肺功能检查结果来诊断哮喘00:04:54.200 --> 00:04:55.740肺功能检查00:04:55.760 --> 00:04:59.100是评估哮喘严重程度00:04:59.240 --> 00:05:02.380和控制情况的重要手段00:05:03.520 --> 00:05:04.460第二个00:05:05.400 --> 00:05:07.460哮喘的诊断流程00:05:07.960 --> 00:05:09.300诊断哮喘00:05:09.720 --> 00:05:13.660通常需要进行详细的病史询问00:05:14.160 --> 00:05:18.100体格检查和肺功能测试00:05:19.480 --> 00:05:23.220医生还会根据患者的具体情况00:05:23.640 --> 00:05:25.900进行过敏原检测00:05:26.200 --> 00:05:30.500和影像学检查等辅助检查00:05:31.120 --> 00:05:37.420以排除其他可能的疾病并确诊哮喘00:05:38.680 --> 00:05:41.220以上讲的是他的诊断00:05:42.600 --> 00:05:43.200接下来00:05:43.200 --> 00:05:47.460讲一下他哮喘的病理生理机制00:05:48.840 --> 00:05:52.700第一个气道炎症与免疫反应00:05:53.680 --> 00:05:54.920气道炎症00:05:54.920 --> 00:05:59.500支气管哮喘的主要特征是气道炎症00:06:00.120 --> 00:06:02.420涉及多种细胞00:06:03.240 --> 00:06:07.300包括嗜酸性粒细胞肥大细胞00:06:07.920 --> 00:06:09.660t淋巴细胞等00:06:10.200 --> 00:06:13.740以及这些细胞释放的炎性介质00:06:14.480 --> 00:06:16.740第二个免疫反应00:06:17.880 --> 00:06:22.580气道炎症与免疫反应密切相关00:06:23.400 --> 00:06:27.300包括Ige介导的速发型反应00:06:27.480 --> 00:06:30.540和细胞介导的迟发型反应00:06:31.600 --> 00:06:33.180这些免疫反应00:06:33.480 --> 00:06:37.880导致气道高反应性和可逆性00:06:37.880 --> 00:06:40.540气流受阻受限00:06:41.680 --> 00:06:45.580这是讲的气道炎症和免疫反应00:06:46.680 --> 00:06:48.000接下来讲一下00:06:48.000 --> 00:06:51.540气道重塑和纤维化的过程00:06:52.320 --> 00:06:58.040气道重塑长期的气道炎症和反复发00:06:58.040 --> 00:07:01.660作可导致气道重塑00:07:02.120 --> 00:07:07.340包括上皮下纤维化淋滑肌增生00:07:07.600 --> 00:07:10.900杯状细胞化生等病理改变00:07:11.920 --> 00:07:13.700他的纤维化过程00:07:14.440 --> 00:07:17.380气道重塑中的纤维化过程00:07:17.800 --> 00:07:19.940使得气道壁增厚00:07:20.520 --> 00:07:21.900管腔狭窄00:07:22.720 --> 00:07:24.700导致气流受阻00:07:25.440 --> 00:07:29.460这是哮喘持续存在的重要病理基础00:07:29.880 --> 00:07:32.660这是气道重组纤维化的过程00:07:33.680 --> 00:07:35.220接下来讲一下00:07:35.960 --> 00:07:40.020哮喘肺功能变化及影响因素00:07:40.720 --> 00:07:43.420第一个肺功能变化00:07:44.600 --> 00:07:48.420哮喘患者的肺功能可发生变化00:07:49.120 --> 00:07:53.260主要表现为持续性的气道受阻00:07:53.840 --> 00:07:57.860受限受阻和肺功能下降00:07:58.600 --> 00:08:03.020可逆气流受阻是哮喘的重要特征00:08:04.600 --> 00:08:06.500第二个影响因素00:08:07.440 --> 00:08:12.500哮喘的肺功能变化受多种因素影响00:08:12.880 --> 00:08:17.340包括遗传环境生活方式等00:08:18.120 --> 00:08:20.260其中过敏源暴露00:08:20.720 --> 00:08:26.100空气污染吸烟等是重要的环境因素00:08:27.760 --> 00:08:29.040接下来讲一下00:08:29.040 --> 00:08:33.020哮喘的并发风险和预防措施00:08:34.040 --> 00:08:36.100哮喘的并发症风险00:08:36.640 --> 00:08:40.420支气管哮喘如诊治不及时00:08:41.199 --> 00:08:43.019随病程的延长00:08:43.199 --> 00:08:47.420可产生气道不可逆性缩窄00:08:47.560 --> 00:08:49.340和气道重塑00:08:50.000 --> 00:08:54.140进而引发慢性阻塞性肺疾病00:08:55.040 --> 00:08:58.500呼吸衰竭等严重并发症00:08:59.720 --> 00:09:01.460他的预防措施00:09:02.040 --> 00:09:05.860预防患者哮喘等并发症00:09:06.200 --> 00:09:10.940关键在于早期诊断和积极治疗00:09:12.000 --> 00:09:15.220同时避免过敏源暴露00:09:16.160 --> 00:09:19.460空气污染等环境因素00:09:19.880 --> 00:09:24.180保持良好的生活习惯和心态00:09:24.760 --> 00:09:26.460以上讲的是00:09:27.880 --> 00:09:31.400支气管哮喘炎症00:09:31.400 --> 00:09:35.480气道重塑纤维化和他的一些影响00:09:35.480 --> 00:09:37.500并发症的预防措施00:09:38.200 --> 00:09:43.260第三个哮喘的治疗原则与方法00:09:45.040 --> 00:09:49.500药物治疗方案选择的依据第一个00:09:49.920 --> 00:09:51.700病情严重程度00:09:52.480 --> 00:09:55.580根据患者病情的严重程度00:09:56.040 --> 00:10:00.540选择不同种类和剂量的药物00:10:00.640 --> 00:10:01.940进行治疗00:10:02.880 --> 00:10:08.260第二个病程阶段在哮喘的不同阶段00:10:08.840 --> 00:10:13.440药物治疗的策略也有所不同如00:10:13.440 --> 00:10:18.380急性发作期以快速缓解症状为主00:10:19.040 --> 00:10:23.220缓解期则以控制气道炎症为主00:10:24.800 --> 00:10:28.340第三个年龄与生理特点00:10:29.360 --> 00:10:30.820患者的年龄00:10:31.000 --> 00:10:35.240生理特点和并发症的因素00:10:35.240 --> 00:10:38.860也会影响药物的选择和使用00:10:39.680 --> 00:10:42.020第四个药物00:10:42.120 --> 00:10:43.700选择的抗炎00:10:44.240 --> 00:10:48.700抗过敏解痉平软等作用的药物00:10:49.120 --> 00:10:51.520并根据药物的作用特点00:10:51.520 --> 00:10:53.500进行合理搭配00:10:54.800 --> 00:10:58.760非药物治疗的手段第一个00:10:58.760 --> 00:11:00.060氧气疗法00:11:00.520 --> 00:11:02.620对严重哮喘患者00:11:02.800 --> 00:11:06.860给予吸氧和缓解缺氧症状00:11:07.680 --> 00:11:09.580第二个机械通道00:11:10.080 --> 00:11:14.620在严重哮喘发作导致呼吸衰竭时00:11:15.000 --> 00:11:19.060需使用机械空气辅助呼吸00:11:20.320 --> 00:11:22.180第三个免疫治疗00:11:22.520 --> 00:11:26.420针对过敏原进行特异免疫治疗00:11:26.920 --> 00:11:28.380如脱敏治疗00:11:28.440 --> 00:11:30.060可减轻症状00:11:30.440 --> 00:11:32.220减少发作次数00:11:33.120 --> 00:11:34.580他的物理治疗00:11:34.760 --> 00:11:36.620平时的呼吸锻炼00:11:36.920 --> 00:11:40.620体位的引流等物理治疗方法00:11:40.720 --> 00:11:43.260有助于改善呼吸功能00:11:43.600 --> 00:11:45.620促进痰液的排出00:11:47.440 --> 00:11:48.040接下来00:11:48.040 --> 00:11:52.420讲一下个性化治疗策略制定的方式00:11:52.680 --> 00:11:55.900第一个综合考虑患者特点00:11:56.440 --> 00:11:58.660根据患者的具体情况00:11:58.720 --> 00:12:03.380病情年龄生理特点生活习惯等00:12:03.680 --> 00:12:06.100制定个性化治疗方案00:12:06.960 --> 00:12:09.540治疗方案在治疗过程中00:12:09.840 --> 00:12:13.780根据患者的病情变化和治疗效果00:12:14.000 --> 00:12:16.300及时调整治疗方案00:12:16.320 --> 00:12:18.500已达到最佳治疗效果00:12:19.320 --> 00:12:22.260哮喘的治疗涉及多个学科00:12:22.640 --> 00:12:24.980需要医生药师00:12:25.120 --> 00:12:28.740护士等多个专业人员的协作00:12:29.000 --> 00:12:32.580共同制定和执行治疗计划00:12:33.720 --> 00:12:34.280接下来00:12:34.280 --> 00:12:39.300讲一下哮喘的长期管理与随访建议00:12:39.600 --> 00:12:41.740第一个建立健康档案00:12:42.080 --> 00:12:47.100记录病情治疗经过和疗效等信息00:12:47.680 --> 00:12:48.240第二个00:12:48.240 --> 00:12:52.820进行对患者进行定期随访和评估00:12:53.240 --> 00:12:57.340及时发现病情变化并调整治疗方案00:12:58.200 --> 00:13:02.180第三个指导患者生活方式的改变00:13:02.640 --> 00:13:06.320避免接触过敏原和诱发因00:13:06.320 --> 00:13:08.340素如戒烟00:13:08.480 --> 00:13:09.700加强锻炼00:13:10.400 --> 00:13:12.280对患者及家属00:13:12.280 --> 00:13:15.980进行哮喘相关知识的教育和培训00:13:16.280 --> 00:13:19.540提高自我管理和自我监测能力00:13:20.480 --> 00:13:21.680接下来讲一下00:13:21.680 --> 00:13:25.420哮喘患者生活指导与心理支持00:13:26.000 --> 00:13:27.360避免过敏源00:13:27.360 --> 00:13:31.220接触花粉尘螨宠物等过敏00:13:31.760 --> 00:13:33.580保持空气清新00:13:33.960 --> 00:13:35.780定期通风换气00:13:36.760 --> 00:13:39.100饮食的调理宜清淡00:13:39.240 --> 00:13:43.780避免过度的油腻辛辣刺激性食物00:13:43.920 --> 00:13:46.700多食用新鲜蔬菜和水果00:13:46.920 --> 00:13:48.700保持肠道通畅00:13:50.200 --> 00:13:52.540保证充足的睡眠时间00:13:53.200 --> 00:13:55.980避免熬夜和过度劳累00:13:56.360 --> 00:13:58.740保持规律的作息习惯00:13:59.480 --> 00:14:01.180第四个戒烟00:14:02.440 --> 00:14:07.900戒酒都会加重患者的不同症状00:14:08.040 --> 00:14:11.640哮喘患者应该戒烟限酒00:14:11.640 --> 00:14:13.020远离二手烟00:14:14.320 --> 00:14:18.580第四个运动锻炼对患者的影响00:14:18.600 --> 00:14:20.220改善心肺功能00:14:20.520 --> 00:14:22.760适当提高心肺功能00:14:22.760 --> 00:14:24.760增加体力00:14:24.760 --> 00:14:26.420减少哮喘患者00:14:27.280 --> 00:14:30.300运动可以促进呼吸道通畅00:14:30.480 --> 00:14:32.180改善呼吸功能00:14:32.680 --> 00:14:36.700长期坚持运动可以增强身体免疫力00:14:37.240 --> 00:14:40.460减少感冒等上呼吸道感染的发生00:14:40.680 --> 00:14:43.780降低哮喘患患者的风险00:14:44.560 --> 00:14:47.780运动时应选择空气清新00:14:48.160 --> 00:14:49.980环境安静的地方00:14:50.120 --> 00:14:53.860避免剧烈运动和过度换房00:14:54.320 --> 00:14:57.740防止诱发哮喘患者的发作00:14:59.320 --> 00:15:03.300他的心理调试与压力管理技巧00:15:03.400 --> 00:15:05.700第一个正确认识哮喘00:15:06.240 --> 00:15:08.220了解患者的病情00:15:08.520 --> 00:15:11.000哮喘的本质发病机制00:15:11.000 --> 00:15:12.940消除恐惧焦虑00:15:13.520 --> 00:15:14.820树立信心00:15:15.000 --> 00:15:16.740掌握放松技巧00:15:16.920 --> 00:15:19.940深呼吸瑜伽缓解压力00:15:20.160 --> 00:15:21.800建立良好的心态00:15:21.800 --> 00:15:24.780与家人朋友分享感受00:15:25.800 --> 00:15:29.220如有严重心理问题应及时就医00:15:29.240 --> 00:15:32.420专业的心理医生进行心理治疗00:15:33.680 --> 00:15:36.240接下来讲一下家属的支持00:15:36.240 --> 00:15:37.900关爱的重要性00:15:38.040 --> 00:15:39.820提供安全环境00:15:39.880 --> 00:15:43.460创造一个舒适优美00:15:43.480 --> 00:15:47.420避免刺激刺刺激性气体和过敏源00:15:48.120 --> 00:15:51.480家属应鼓励患者坚持治疗00:15:51.480 --> 00:15:52.720按时服药00:15:52.720 --> 00:15:55.660定期复诊不可随意停药00:15:56.200 --> 00:15:58.060关心患者心理00:15:58.440 --> 00:16:01.480家属给予支持鼓励00:16:01.480 --> 00:16:02.700树立信心00:16:03.480 --> 00:16:05.780家属跟患者同时00:16:06.240 --> 00:16:09.660参加日常生活和运动锻炼00:16:10.000 --> 00:16:11.900增加彼此的情感00:16:12.960 --> 00:16:15.140哮喘的知识与推广00:16:15.360 --> 00:16:17.940它是一个慢性呼吸道疾病00:16:18.600 --> 00:16:20.600哮喘如喘息00:16:20.600 --> 00:16:23.800气促胸闷所带来的危害性00:16:23.800 --> 00:16:25.780与生活日常工作00:16:26.640 --> 00:16:29.700哮喘的防控与自我管理00:16:29.840 --> 00:16:34.020教育公众了解哮喘的预防措施00:16:34.200 --> 00:16:35.800如避免过敏源00:16:35.800 --> 00:16:38.420规范用药和自我管理00:16:39.120 --> 00:16:43.180加强医务人员的培训和专业素养00:16:43.640 --> 00:16:45.780哮喘治疗规范培训00:16:45.800 --> 00:16:49.020提高医务人员的规范化治疗水平00:16:49.840 --> 00:16:51.000注意哮喘能力00:16:51.000 --> 00:16:53.800最新研究成果和临床进展00:16:53.800 --> 00:16:55.500不断更新知识00:16:56.160 --> 00:16:59.220诊疗优程流程优化00:16:59.600 --> 00:17:01.900确保患者及时就医00:17:02.440 --> 00:17:05.340开展健康教育活动和讲座00:17:05.680 --> 00:17:09.500哮喘的知识讲座互动式健康教育00:17:09.680 --> 00:17:12.180健康教育的资料发放00:17:12.600 --> 00:17:14.500如手册折页等00:17:15.320 --> 00:17:18.260利用媒体渠道扩大影响力00:17:18.640 --> 00:17:20.460电视媒体宣传00:17:20.680 --> 00:17:22.460网络媒体宣传00:17:22.560 --> 00:17:25.340和宣传材料制作与传播00:17:25.680 --> 00:17:28.340这些通俗易懂的宣传资料00:17:28.600 --> 00:17:32.620视频动画漫画等多渠道进行传播00:17:33.360 --> 00:17:36.680接下来讲一下哮喘研究进展与未来00:17:36.680 --> 00:17:37.480展望00:17:38.320 --> 00:17:42.740哮喘深入探讨支气管哮喘发病机制00:17:43.520 --> 00:17:46.060包括气道炎症遗传00:17:46.440 --> 00:17:50.160应用基因芯片生物标志性等技术00:17:50.160 --> 00:17:54.340提高哮喘诊断的准确性和敏感性00:17:55.200 --> 00:17:59.060针对哮喘发病机制的药物不断涌现00:17:59.200 --> 00:18:05.180如白三烯调节剂Ige单克隆抗体等00:18:05.720 --> 00:18:08.580新型治疗手段和药物研发00:18:08.600 --> 00:18:13.100生物靶向治疗针对哮喘的发病机制00:18:13.640 --> 00:18:15.440进行特定的炎症00:18:15.440 --> 00:18:17.740介质和生物靶向治疗00:18:18.040 --> 00:18:21.620通过支气管热热成型术00:18:21.760 --> 00:18:24.060减少气道平滑及数量00:18:24.840 --> 00:18:28.960研发更为便捷的吸入装置00:18:28.960 --> 00:18:32.540通过药物在气道沉积力和利用力00:18:33.240 --> 00:18:36.420面临挑育挑战机遇的分析00:18:36.640 --> 00:18:39.940发病机制哮喘未完全阐明00:18:40.240 --> 00:18:42.860导致治疗难以完全治疗00:18:43.400 --> 00:18:45.480针对哮喘的新药研发00:18:45.480 --> 00:18:47.500需要投入大量时间00:18:48.440 --> 00:18:51.400患者长期治疗依从性差00:18:51.400 --> 00:18:53.020影响治疗效果00:18:53.400 --> 00:18:57.080随着生物技术信息不断发展00:18:57.080 --> 00:19:00.780为哮喘研究和治疗提供新的思路00:19:01.360 --> 00:19:04.140未来趋势与个体化治疗00:19:04.320 --> 00:19:05.860生物技术治疗00:19:06.120 --> 00:19:09.180药物治疗和非药物治疗结合00:19:10.360 --> 00:19:11.820互联网的治疗00:19:12.040 --> 00:19:13.600通过互联网治疗00:19:13.600 --> 00:19:16.180为患者提供更为便捷00:19:16.320 --> 00:19:18.420个性化的医疗服务00:19:18.520 --> 00:19:23.300促进患患者哮喘的防控和治疗00:19:23.960 --> 00:19:25.100谢谢大家