WEBVTT00:00:02.880 --> 00:00:06.020今天跟大家分享的是00:00:06.080 --> 00:00:09.240急性间质性肺炎的呃00:00:09.240 --> 00:00:10.300基础认知00:00:17.400 --> 00:00:19.940急性间质性肺炎的定义00:00:20.920 --> 00:00:26.140医学专业定义急性间质性肺炎AIP00:00:26.640 --> 00:00:29.740是一种罕见的原因不明的00:00:30.000 --> 00:00:33.780以急性呼吸衰竭为主要表现的00:00:33.800 --> 00:00:35.420间质性肺疾病00:00:36.640 --> 00:00:39.100它起病急骤00:00:39.480 --> 00:00:42.980通常在数周内迅速进展00:00:46.200 --> 00:00:48.740病理特征角度的定义是00:00:49.240 --> 00:00:51.300从病理特征来看00:00:51.560 --> 00:00:53.360急性间质性肺炎00:00:53.360 --> 00:00:57.220表现为弥漫性肺泡损伤00:00:57.920 --> 00:01:00.380涉及肺泡上皮细胞00:01:00.480 --> 00:01:05.460和肺毛细血管内细胞的广泛损伤00:01:09.840 --> 00:01:12.340急性间质性肺炎的分类00:01:14.240 --> 00:01:15.900按病因分类00:01:16.760 --> 00:01:21.500可分为特发性急性间质性肺炎00:01:22.240 --> 00:01:24.820即原因不明的类型00:01:26.080 --> 00:01:29.620以及继发性急性间质性肺炎00:01:30.280 --> 00:01:34.580常继发于感染药物不良反应00:01:35.160 --> 00:01:38.300自身免疫性疾病等因素00:01:40.240 --> 00:01:45.980按病理的形态分类根据病理的形态00:01:46.000 --> 00:01:48.980可以分为早期肾初期00:01:49.960 --> 00:01:53.280此阶段肺泡腔内有水肿00:01:53.280 --> 00:01:56.580液炎性细胞等渗出00:01:56.920 --> 00:01:59.220以及激化期00:01:59.720 --> 00:02:01.480可见成纤维00:02:01.480 --> 00:02:05.300细胞增生和胶原沉积等表现00:02:08.880 --> 00:02:10.620临床病程分类00:02:11.880 --> 00:02:16.500按临床病程分类可以分为急性型00:02:17.160 --> 00:02:19.100病情进展迅速00:02:19.680 --> 00:02:24.380短时间内出现严重呼吸功能障碍00:02:25.320 --> 00:02:27.580以及亚急性型00:02:28.800 --> 00:02:30.740病程相对较长00:02:31.320 --> 00:02:33.340症状逐渐加重00:02:39.600 --> 00:02:43.020性间质性肺炎的病因探寻00:02:47.960 --> 00:02:52.740常见的病因概述一感染因素00:02:55.280 --> 00:02:57.180病毒细菌00:02:57.560 --> 00:02:59.780真菌等感染00:03:00.120 --> 00:03:03.780是急性间质性肺炎常见的病因00:03:04.680 --> 00:03:06.740如流感病毒感染00:03:07.320 --> 00:03:10.500在某些大规模流感爆发中00:03:10.680 --> 00:03:14.140约有10%至15%患者00:03:14.200 --> 00:03:16.940可并发急性间质性肺炎00:03:18.120 --> 00:03:23.340药物因素多种药物可以引发该病00:03:23.960 --> 00:03:27.540如抗肿瘤药物抗生素等00:03:28.480 --> 00:03:30.580以珀莱霉素为例00:03:31.080 --> 00:03:35.180使用该药物可以进行化疗的患者中00:03:36.000 --> 00:03:39.660约5%至10%的患者00:03:39.880 --> 00:03:43.220可能出现急性限制性肺炎00:03:45.480 --> 00:03:51.120三自身免疫因素自身免疫性疾病00:03:51.120 --> 00:03:56.740如系统性红斑狼疮类风湿关节炎等00:03:57.200 --> 00:03:58.960累及肺部时00:03:58.960 --> 00:04:02.420可以引发急性间质性肺炎00:04:03.320 --> 00:04:06.380在自身免疫性疾病患者中00:04:06.640 --> 00:04:13.460约有8%至12%出现肺部间歇性改变00:04:17.280 --> 00:04:20.020环境因素与发病关系00:04:24.760 --> 00:04:27.280污染的影响那00:04:27.280 --> 00:04:31.960长期暴露在高浓度的有害气体颗粒00:04:31.960 --> 00:04:33.180的环境中00:04:33.240 --> 00:04:37.300如工业废气雾霾等00:04:38.080 --> 00:04:40.260会损伤肺部组织00:04:40.840 --> 00:04:44.220增加急性间质性肺炎的发病风险00:04:44.840 --> 00:04:45.980研究表明00:04:46.280 --> 00:04:49.380生活在重度污染地区的人群00:04:49.760 --> 00:04:54.860发病几率比清洁地区人群高2-3倍00:04:56.640 --> 00:05:00.600职业暴露的作用某些职业00:05:00.600 --> 00:05:05.060如煤矿工人石棉工人等00:05:05.840 --> 00:05:09.740长期接触粉尘纤维等物质00:05:09.920 --> 00:05:12.900可以导致肺部的慢性炎症00:05:13.320 --> 00:05:16.460进而引发急性间质性肺炎00:05:17.480 --> 00:05:20.480那煤矿工人患该病的几率00:05:20.480 --> 00:05:25.620比普通人群高出约15%至20%00:05:27.960 --> 00:05:30.540环境因素的影响机制00:05:31.240 --> 00:05:33.080环境中的有害物质00:05:33.080 --> 00:05:36.020可以激活肺部的免疫细胞00:05:36.680 --> 00:05:38.460释放炎症介质00:05:38.640 --> 00:05:42.060引起肺部炎症反应和纤维化00:05:42.520 --> 00:05:46.540最终导致急性间质性肺炎的发生00:05:50.200 --> 00:05:52.500遗传因素的潜在影响00:05:54.600 --> 00:05:58.900那家族性聚集现象有研究发现00:05:59.240 --> 00:06:03.620急性间质性肺炎存在家族聚集现象00:06:04.440 --> 00:06:06.220部分家族中00:06:08.040 --> 00:06:10.820呃有多个成员患该病00:06:13.400 --> 00:06:14.200提示00:06:14.760 --> 00:06:17.080遗传因素在发病中00:06:17.080 --> 00:06:19.420可能起到重要的作用00:06:20.000 --> 00:06:21.620在某些家族中00:06:21.720 --> 00:06:25.700患病的几率比普通人群高3-5倍00:06:26.960 --> 00:06:30.620相关基因的研究科学家发现00:06:31.240 --> 00:06:34.500多个急性间质性肺炎相关的基因00:06:35.280 --> 00:06:37.580如某些基因突变00:06:38.200 --> 00:06:41.200可以影响肺部细胞的正常功能00:06:41.200 --> 00:06:42.540和修复能力00:06:43.200 --> 00:06:44.740增加发病风险00:06:45.440 --> 00:06:49.540目前呢已经确定的相关基因有5-8种00:06:51.000 --> 00:06:52.700遗传易感性分析00:06:53.800 --> 00:06:56.300具有特定遗传背景的人群00:06:57.040 --> 00:06:58.120对急性间质00:06:58.120 --> 00:07:00.220性肺炎的易感性增高00:07:01.200 --> 00:07:03.500通过基因检测和分析00:07:03.520 --> 00:07:06.340可以识别出这些高风险人群00:07:06.920 --> 00:07:10.140以便提前采取预防措施00:07:13.120 --> 00:07:16.740急性间质性肺炎的症状表现有哪些00:07:17.280 --> 00:07:19.500那典型的症状呈现00:07:19.680 --> 00:07:21.580一呼吸困难00:07:22.560 --> 00:07:23.440呼吸困难00:07:23.440 --> 00:07:27.340是急性间质性肺炎最为突出的症状00:07:28.080 --> 00:07:29.100急病急奏00:07:29.440 --> 00:07:31.940患者往往在短时间内00:07:32.520 --> 00:07:35.580就会感觉到呼吸费力00:07:35.760 --> 00:07:37.740活动耐力明显下降00:07:37.840 --> 00:07:42.000比如日常的步行上下楼梯等活动00:07:42.000 --> 00:07:44.420都会引起严重的气短00:07:44.720 --> 00:07:48.260甚至在休息时也会出现呼吸困难00:07:48.880 --> 00:07:52.900据统计约超过80%的患者00:07:52.960 --> 00:07:55.420首发症状就是呼吸困难00:07:57.160 --> 00:08:01.040咳嗽咳嗽也是一个常见症状00:08:01.040 --> 00:08:04.980多为干咳少痰或无痰00:08:05.680 --> 00:08:09.220咳嗽通常较为剧烈且持续存在00:08:09.920 --> 00:08:12.080严重影响患者的日常生活00:08:12.080 --> 00:08:13.500和睡眠质量00:08:14.160 --> 00:08:17.240约70%的患者在疾病过程中00:08:17.240 --> 00:08:19.700会出现明显的咳嗽症状00:08:20.680 --> 00:08:25.660发热多数患者会伴发伴有发热症状00:08:26.040 --> 00:08:29.500体温可高达38摄氏度甚至更高00:08:30.120 --> 00:08:32.180发热一般持续存在00:08:32.360 --> 00:08:35.260在病情未得到有效控制00:08:36.000 --> 00:08:38.000呃未得未得到有效控制前00:08:38.000 --> 00:08:39.900是不会轻易的消退00:08:40.080 --> 00:08:43.740给患者带来身体不适和精神压力00:08:45.760 --> 00:08:48.520那非典型的症状包括00:08:48.520 --> 00:08:49.660关节疼痛00:08:50.360 --> 00:08:52.600部分急性间质性肺炎患者00:08:52.600 --> 00:08:55.100会出现关节的疼痛症状00:08:55.280 --> 00:08:57.940这种症状相对不那么常见00:08:58.480 --> 00:09:00.600疼痛可累积多个环节00:09:00.600 --> 00:09:04.460如手腕脚踝膝关节等00:09:04.960 --> 00:09:07.060给患者的行动带来不便00:09:07.480 --> 00:09:10.840容易被误诊为其他关节疾病00:09:10.840 --> 00:09:15.780如呃约10%-15%的患者会出现此类症状00:09:16.960 --> 00:09:20.960乏力和消瘦有些患者在患病期间00:09:20.960 --> 00:09:22.740会感到全身乏力00:09:23.560 --> 00:09:25.060身体极度疲倦00:09:25.320 --> 00:09:27.060日常活动能力受限00:09:27.160 --> 00:09:29.720同时由于疾病消耗00:09:29.720 --> 00:09:32.340以及可能伴随的食欲不振00:09:32.760 --> 00:09:34.680患者还可能出现体00:09:34.680 --> 00:09:36.060重快速下降00:09:36.080 --> 00:09:37.340消瘦的情况00:09:37.520 --> 00:09:39.160有近20%的患者00:09:39.160 --> 00:09:42.820会出现不同程度的乏力与消瘦症状00:09:43.800 --> 00:09:46.940那非典型的症状还有皮疹00:09:47.360 --> 00:09:50.500少数患者可能出现皮疹00:09:50.920 --> 00:09:52.560皮疹的形态多样00:09:52.560 --> 00:09:56.820可表现为红疹红斑丘疹等00:09:56.920 --> 00:09:59.900常见于四肢躯干等部位00:10:00.960 --> 00:10:02.000皮疹的出现00:10:02.000 --> 00:10:03.480容易让患者忽视00:10:03.480 --> 00:10:07.700与其其与急性间质性肺炎的关联00:10:08.000 --> 00:10:09.060延误诊断00:10:09.440 --> 00:10:12.360皮疹症状在患者中的出现比例00:10:12.360 --> 00:10:14.860约为5%至10%00:10:17.320 --> 00:10:19.860急性间质性肺炎的诊断方法00:10:20.160 --> 00:10:21.340影像学诊断00:10:21.680 --> 00:10:23.540x光检查的原理00:10:24.280 --> 00:10:25.720x光检查利于00:10:25.720 --> 00:10:29.100x线射线穿透人体的不同组织时00:10:29.160 --> 00:10:30.980由于组织密度差异00:10:31.000 --> 00:10:33.300对x射线吸收程度不同00:10:33.440 --> 00:10:35.880从而在胶片和数字探测器上00:10:35.880 --> 00:10:37.900形成了黑板对比的影像00:10:38.160 --> 00:10:40.440在急性间质性肺炎的诊断中00:10:40.440 --> 00:10:44.180可显示肺部大致的形态纹理等情况00:10:45.120 --> 00:10:48.360x光检查的特点优点是操作简便00:10:48.360 --> 00:10:49.300价格低廉00:10:49.680 --> 00:10:53.540能迅快速获得肺部整体的影像00:10:53.760 --> 00:10:54.560缺点是00:10:54.560 --> 00:10:57.780对细微病变的显示能力是有限00:10:57.920 --> 00:10:59.720对于早期急性间质性肺炎00:10:59.720 --> 00:11:02.860可能无法准确诊断00:11:03.920 --> 00:11:05.400影像学的诊断手段00:11:05.400 --> 00:11:07.660我们包括一个CT的检查00:11:08.040 --> 00:11:09.500CT检查的原理00:11:09.800 --> 00:11:11.800CT检查是利用x线素00:11:11.800 --> 00:11:15.500对原体某一部位进行断层扫描00:11:15.800 --> 00:11:18.240探测器氨穿收00:11:18.240 --> 00:11:21.100穿过人体后的x射线信号00:11:21.160 --> 00:11:22.480经计算机处理后00:11:22.480 --> 00:11:24.760重建出人体内部的一个横断面00:11:24.760 --> 00:11:25.580的影像00:11:26.320 --> 00:11:29.680那CT检查的特点它具有高分辨率00:11:29.680 --> 00:11:32.340能够清晰显示肺部的细微结构00:11:32.440 --> 00:11:35.360对于早期急性间质性肺炎的诊断00:11:35.360 --> 00:11:37.580较为准准确性较高00:11:37.920 --> 00:11:40.260缺点是辐射剂量相对较大00:11:40.360 --> 00:11:41.820检查费用又较高00:11:42.760 --> 00:11:45.640那实验室的诊断指标它包括00:11:45.640 --> 00:11:47.060血液检查的指标00:11:47.440 --> 00:11:47.960血液中00:11:47.960 --> 00:11:50.520可以辅助诊断急性间质性肺炎00:11:50.520 --> 00:11:52.580例如血沉可能增快00:11:52.680 --> 00:11:54.780c反应蛋白水平可能升高00:11:54.840 --> 00:11:56.240这些指标的变化00:11:56.240 --> 00:11:58.620反映了体内的炎症状态00:11:59.160 --> 00:12:00.060痰液检查00:12:00.480 --> 00:12:04.760可以发现一些异常的细菌和细胞00:12:04.760 --> 00:12:05.860或者病原体00:12:06.240 --> 00:12:08.240如通过痰液图片或培养00:12:08.240 --> 00:12:10.900可能检测到细菌病毒等病原体00:12:10.920 --> 00:12:12.940有助于明确病因00:12:13.560 --> 00:12:15.260那其他的实验室检查00:12:16.760 --> 00:12:20.080呃某些自身抗体检测也可能有异常00:12:20.080 --> 00:12:21.640如抗核抗体等00:12:21.640 --> 00:12:24.160对于排除自身免疫性的疾病00:12:24.160 --> 00:12:25.840导致的急性间质性肺炎00:12:25.840 --> 00:12:27.700是有非常重要的意义00:12:29.440 --> 00:12:33.380肺功能的检测意义评估通气功能00:12:33.640 --> 00:12:34.840肺功能检测00:12:34.840 --> 00:12:37.520可以评估患者的通气功能00:12:37.520 --> 00:12:40.500如肺活量用力肺活量等指标00:12:40.640 --> 00:12:42.880在急性间质性肺炎患者中00:12:42.880 --> 00:12:44.940这些指标往往会降低00:12:44.960 --> 00:12:47.580反映了肺部通气受限的情况00:12:48.680 --> 00:12:50.060判断换气功能00:12:50.280 --> 00:12:52.900通过检测肺弥散功能等指标00:12:52.960 --> 00:12:55.460才能够判断肺部的换气功能00:12:55.520 --> 00:12:56.640急性间质性肺炎00:12:56.640 --> 00:12:57.900会影响气体00:12:57.920 --> 00:13:00.140在肺泡和血液之间的交换00:13:00.400 --> 00:13:02.940导致肺弥散功能下降00:13:05.440 --> 00:13:08.280呃指导治疗与预后评估00:13:08.280 --> 00:13:09.840肺功能的检测结果呢00:13:09.840 --> 00:13:13.320还可以作为诊治疗方案的制定00:13:13.320 --> 00:13:14.360提供依据00:13:14.360 --> 00:13:17.140同时动态监测肺功能变化00:13:17.320 --> 00:13:20.100有助于评估患者的预后情况00:13:20.200 --> 00:13:24.060对判断病情的发展趋势有用00:13:25.720 --> 00:13:28.580那急性间质性肺炎的治疗策略00:13:29.120 --> 00:13:32.820药物治疗它包括第一糖皮质激素00:13:33.480 --> 00:13:35.480它是治疗急性间质性肺炎的00:13:35.480 --> 00:13:36.480常用药物00:13:36.480 --> 00:13:37.660如泼尼松等00:13:37.720 --> 00:13:39.460一般其实剂量较大00:13:39.880 --> 00:13:42.760泼尼松每日每公斤1-2毫克00:13:42.760 --> 00:13:45.420之后根据患者的病情逐渐减量00:13:45.600 --> 00:13:47.000通过抑制炎症反应00:13:47.000 --> 00:13:49.700可以减轻肺部的渗出和损伤00:13:50.800 --> 00:13:53.720免疫抑制剂部分患者会00:13:53.720 --> 00:13:55.380联合使用免疫抑制剂00:13:55.920 --> 00:13:57.040如环磷酰胺00:13:57.040 --> 00:14:00.460常用的剂量为每日50-150毫克00:14:00.920 --> 00:14:02.800或者采用静脉冲击疗法00:14:02.800 --> 00:14:04.500它能调节免疫系统00:14:04.800 --> 00:14:07.980减少免疫攻击对肺部组织的破坏00:14:08.880 --> 00:14:10.060抗纤维化药00:14:10.480 --> 00:14:12.640像吡非尼酮等抗纤维化药物00:14:12.640 --> 00:14:14.340也逐渐应用于治疗00:14:14.520 --> 00:14:15.160吡酚尼酮00:14:15.160 --> 00:14:17.720一般起始剂量为每次200毫克00:14:17.720 --> 00:14:19.580一日3次00:14:19.760 --> 00:14:22.580可以根据耐受情况逐渐增加剂量00:14:23.920 --> 00:14:27.200其作用是延缓肺部纤维化的进程00:14:27.200 --> 00:14:28.660改善患者的预后00:14:29.680 --> 00:14:31.100支持治疗措施00:14:31.560 --> 00:14:33.180它包括呼吸支持00:14:33.320 --> 00:14:35.580营养支持和心理支持00:14:36.440 --> 00:14:38.200对于呼吸困难的患者00:14:38.200 --> 00:14:39.940常给予一个吸氧治疗00:14:41.520 --> 00:14:44.620根据血氧饱和度的调整氧流量00:14:44.920 --> 00:14:45.720严重的时候00:14:45.720 --> 00:14:47.200可能使用无创通气00:14:47.200 --> 00:14:48.900或者有创机械通气00:14:49.000 --> 00:14:50.660以维持气体的交换00:14:51.640 --> 00:14:54.600呃因为该疾病会使患者的消耗大00:14:54.600 --> 00:14:56.240需要保证一个充足的营养00:14:56.240 --> 00:14:59.200可以通过鼻屎或者胃肠燥漏等方式00:14:59.200 --> 00:15:01.180给予一个肠内的营养支持00:15:02.120 --> 00:15:03.500另外心理支持00:15:03.920 --> 00:15:06.780患者因病情严重而产生焦虑00:15:06.920 --> 00:15:10.020医护人员需与患者充分沟通00:15:10.040 --> 00:15:11.460给予心理疏导00:15:11.600 --> 00:15:13.900必要时可以请心理医生的介入00:15:14.640 --> 00:15:16.120那新性的治疗技术00:15:16.120 --> 00:15:18.580还包括干细胞的治疗00:15:20.320 --> 00:15:21.920体外膜肺的养合00:15:21.920 --> 00:15:24.220以及一个精准的医学治疗00:15:25.160 --> 00:15:26.840通过基因检测和分析00:15:26.840 --> 00:15:29.220可以了解患者个体的遗传特征00:15:29.280 --> 00:15:31.620为其制定个性化的治疗方案00:15:32.320 --> 00:15:33.160如例如00:15:33.160 --> 00:15:35.720针对特定的基因突变的一个靶向00:15:35.720 --> 00:15:36.820药物的研发00:15:36.960 --> 00:15:39.560有望为急性间质性肺炎的治疗00:15:39.560 --> 00:15:40.860带来新的突破00:15:42.080 --> 00:15:44.980那急性间质性肺炎的护理要点包括00:15:45.040 --> 00:15:46.980日常护理的注意事项00:15:48.480 --> 00:15:49.780休息与活动00:15:50.280 --> 00:15:53.840呃患者需要保证保证充足的休息00:15:53.840 --> 00:15:56.180每日睡眠应不少于8小时00:15:56.400 --> 00:15:58.200避免剧烈的运动和重00:15:58.200 --> 00:15:59.180体力劳动00:15:59.200 --> 00:16:00.960但可以根据身体状况00:16:00.960 --> 00:16:02.980进行适量的舒缓活动00:16:03.120 --> 00:16:04.060如慢走00:16:04.880 --> 00:16:06.320每次15-20分钟00:16:06.320 --> 00:16:07.720每周3-4次00:16:07.720 --> 00:16:09.460增强机体的抵抗力00:16:10.080 --> 00:16:11.940饮食调整在饮食上00:16:11.960 --> 00:16:14.620患者应多摄入富含蛋白质的食物00:16:15.320 --> 00:16:17.820诸如鸡蛋牛奶鱼肉等00:16:17.840 --> 00:16:19.380每天蛋白摄入量00:16:19.600 --> 00:16:23.020约为每千克体重的1.2-1.5克00:16:23.120 --> 00:16:26.020同时要多吃新鲜水果蔬菜00:16:26.280 --> 00:16:29.000保证维生素和矿物质的摄入00:16:29.000 --> 00:16:30.900维持身体的正常代谢00:16:31.400 --> 00:16:34.080那日常护理的注意事项还包括00:16:34.080 --> 00:16:34.400一个00:16:34.400 --> 00:16:37.700环境的维护和心理护理的重要性00:16:40.480 --> 00:16:41.720心理护理的重要性00:16:41.720 --> 00:16:43.660是促进康复的一个进程00:16:43.960 --> 00:16:46.440它可以调节患者的内分泌00:16:46.440 --> 00:16:47.620和免疫系统00:16:47.680 --> 00:16:49.140促进身体康复00:16:49.200 --> 00:16:50.440良好的心理状态00:16:50.440 --> 00:16:52.440可以使患者身体的免疫细胞00:16:52.440 --> 00:16:53.620活性增强00:16:53.840 --> 00:16:55.700加快身体的康复速度00:16:55.880 --> 00:16:57.220缩短住院时间00:16:57.600 --> 00:16:59.840例如接受心理护理的患者00:16:59.840 --> 00:17:01.280平均住院时间00:17:01.280 --> 00:17:04.300比未接受患者缩短2-3分钟00:17:05.360 --> 00:17:07.200好我的分享到此结束00:17:07.200 --> 00:17:08.140谢谢大家