WEBVTT00:00:02.800 --> 00:00:04.280嗯各位大家好00:00:04.280 --> 00:00:05.420然后今天呢00:00:05.520 --> 00:00:07.160嗯给大家嗯00:00:07.160 --> 00:00:09.500讲一下这个咳嗽的抗生素治疗00:00:09.960 --> 00:00:11.740那么抗生素的治疗呢00:00:11.840 --> 00:00:13.080在咳嗽当中呢00:00:13.080 --> 00:00:14.560也是比较常见的00:00:14.560 --> 00:00:17.400我们主要要针对这个咳嗽的病因00:00:17.400 --> 00:00:18.940发病的情况00:00:19.040 --> 00:00:21.380然后做出一个相应的诊断00:00:21.560 --> 00:00:24.140呃同时给予这个抗生素的用药00:00:24.560 --> 00:00:26.240要做到一个科学用药00:00:26.240 --> 00:00:27.660精准治疗的一个00:00:29.440 --> 00:00:30.660呃用药方案00:00:33.680 --> 00:00:35.020嗯首先呢00:00:35.240 --> 00:00:37.680介绍是咳嗽的一个基础知识00:00:37.680 --> 00:00:38.540然后呢00:00:38.600 --> 00:00:41.600这个抗生素治疗咳嗽的一个方案00:00:41.600 --> 00:00:43.300同时呢嗯00:00:43.760 --> 00:00:44.360介绍一个00:00:44.360 --> 00:00:46.620抗生素的一个其他治疗方法00:00:48.360 --> 00:00:50.780抗生首先是抗生素的基础定义00:00:52.120 --> 00:00:53.480那么抗生素呃00:00:53.480 --> 00:00:55.420那个咳嗽的生理作用00:00:55.480 --> 00:00:56.320咳嗽呢是00:00:56.320 --> 00:00:57.800身体清除呼吸道异物的00:00:57.800 --> 00:00:58.960一个自然反应00:00:58.960 --> 00:01:00.280它主要分为干咳00:01:00.280 --> 00:01:03.300湿咳根据痰液的有无呢进行区分00:01:03.640 --> 00:01:04.800呃像有的白痰00:01:04.800 --> 00:01:06.080黄脓痰嗯00:01:06.080 --> 00:01:07.980都是有很好的鉴定意义的00:01:08.000 --> 00:01:09.280那么常见原因呢00:01:09.280 --> 00:01:10.640像我们这个感冒00:01:10.640 --> 00:01:11.860上呼吸道感染00:01:12.080 --> 00:01:13.460呃细菌性感染00:01:13.560 --> 00:01:15.000过敏等因素呢00:01:15.000 --> 00:01:16.940都会导致这种咳嗽00:01:17.440 --> 00:01:19.840那么咳嗽根据咳嗽的时间呢00:01:19.840 --> 00:01:21.280可以分为呃00:01:21.280 --> 00:01:23.300急性咳嗽和慢性咳嗽00:01:23.480 --> 00:01:25.440急性咳嗽一般是少于三周00:01:25.440 --> 00:01:26.360慢性咳嗽呢00:01:26.360 --> 00:01:27.980则是超过八周00:01:28.680 --> 00:01:30.340那么咳嗽的病因呢00:01:32.000 --> 00:01:33.440第一个就是病毒感染00:01:33.440 --> 00:01:34.720常见的病毒感染呢00:01:34.720 --> 00:01:36.940它容易引发这个急性咳嗽00:01:37.640 --> 00:01:38.880嗯细菌感染呢00:01:38.880 --> 00:01:40.320像肺炎链球菌啊00:01:40.320 --> 00:01:43.540呃它这种引起的咳嗽是呃00:01:43.800 --> 00:01:46.580往往会有带有黄脓痰啊什么之类的00:01:46.600 --> 00:01:47.680那么过敏性咳嗽00:01:47.680 --> 00:01:48.480像花粉啊00:01:48.480 --> 00:01:50.560尘螨等过敏原接触之后00:01:50.560 --> 00:01:52.400会导致这种喉咙干痒00:01:52.400 --> 00:01:53.620咳嗽不舒服的00:01:54.080 --> 00:01:55.280嗯同时另外呢00:01:55.280 --> 00:01:56.600像一些环境因素00:01:56.600 --> 00:01:57.560像空气污染00:01:57.560 --> 00:01:58.480烟雾刺激00:01:58.480 --> 00:02:01.260它也易诱发这个咳嗽00:02:03.800 --> 00:02:05.640咳嗽的表现形式都有哪些呢00:02:05.640 --> 00:02:09.020第一个就是干咳无痰或者说少痰00:02:09.240 --> 00:02:12.500常见于这个病毒感染的初期呃00:02:12.520 --> 00:02:13.200另外一个呢00:02:13.200 --> 00:02:14.180就是湿咳00:02:14.280 --> 00:02:15.760它呢伴有痰液00:02:15.760 --> 00:02:17.960可能是细菌感染的一个标志00:02:17.960 --> 00:02:20.420像特别是黄脓痰的症状的出现00:02:20.800 --> 00:02:21.840呃另呃00:02:21.840 --> 00:02:23.620还有呢就是夜间咳嗽00:02:23.640 --> 00:02:25.720它是夜间加重00:02:25.720 --> 00:02:26.980影响睡眠质量00:02:27.200 --> 00:02:29.320同时呢咳嗽如果伴发热00:02:29.320 --> 00:02:30.700可能气室有感染00:02:30.760 --> 00:02:32.780嗯需要及时呢就医00:02:35.760 --> 00:02:38.540还有一个该如何确诊咳嗽的原因呢00:02:38.600 --> 00:02:39.040首先呢00:02:39.040 --> 00:02:41.620我们需要一个详细的病史询问00:02:41.800 --> 00:02:43.400呃以及呃00:02:43.400 --> 00:02:44.640准确的体格检查00:02:44.640 --> 00:02:47.580和实验室和影像学的一个检查00:02:47.880 --> 00:02:48.800那么病史询问呢00:02:48.800 --> 00:02:52.140我们需要进行一个详细的判判定00:02:52.280 --> 00:02:53.820像咳嗽的时间00:02:53.880 --> 00:02:56.240咳嗽的一个症状呃00:02:56.240 --> 00:02:57.660咳嗽的严重程度00:02:58.600 --> 00:02:58.960呃呃00:02:58.960 --> 00:03:02.060以及这个是否伴有这个发热00:03:02.160 --> 00:03:04.320黄脓痰以及这个鼻塞00:03:04.320 --> 00:03:05.800头晕头痛呃00:03:05.800 --> 00:03:08.100全身的有无这个四肢酸软00:03:08.240 --> 00:03:09.680呃等不舒服的00:03:09.680 --> 00:03:10.440另外一个呢00:03:10.440 --> 00:03:12.300还有一个患者的病史00:03:12.360 --> 00:03:13.820像一些老慢支00:03:14.040 --> 00:03:15.200哮喘嗯00:03:15.200 --> 00:03:17.000这些情况同时呃00:03:17.000 --> 00:03:17.480同时呢00:03:17.480 --> 00:03:20.600像一些这个过敏性的一个支气管炎00:03:20.600 --> 00:03:23.380咽喉炎和这个过敏性的鼻炎00:03:24.160 --> 00:03:25.160这些因素呢00:03:25.160 --> 00:03:27.140都是要进行一个询问的00:03:28.600 --> 00:03:31.380呃依据他这个不同的问诊00:03:31.400 --> 00:03:32.200呃00:03:32.640 --> 00:03:34.000对疾病的诊断00:03:34.000 --> 00:03:35.520可引起咳嗽的因素呢00:03:35.520 --> 00:03:39.460进行一个嗯主观的一个判断00:03:39.600 --> 00:03:42.220嗯然后依据相应的判断00:03:42.280 --> 00:03:44.620去进行一个体格的检查00:03:44.640 --> 00:03:46.960还有这个相应的影像00:03:46.960 --> 00:03:49.780和实验室的一个呃检查00:03:50.120 --> 00:03:51.160那么体格检查呢00:03:51.160 --> 00:03:53.160我们主要可以一个听诊的方式00:03:53.160 --> 00:03:54.620评估呼吸道系统00:03:54.800 --> 00:03:57.200像我们这个听诊呃00:03:57.200 --> 00:04:00.320肺功能就是听诊肺部的一个呼吸00:04:00.320 --> 00:04:01.620有无干湿罗音00:04:01.760 --> 00:04:02.560嗯00:04:03.040 --> 00:04:03.720这种情况00:04:03.720 --> 00:04:04.440还有一个呢00:04:04.440 --> 00:04:05.480我们这个咽喉00:04:05.480 --> 00:04:06.280部呃00:04:06.280 --> 00:04:07.900是否有滤泡增生00:04:08.480 --> 00:04:11.900有有无这个急性充血等这个情况00:04:12.360 --> 00:04:13.680那么实验室检查呢00:04:13.680 --> 00:04:16.500它主要包括像血常规crp00:04:16.640 --> 00:04:18.420然后痰培养00:04:18.880 --> 00:04:20.860以确定这个病原体00:04:20.960 --> 00:04:22.080那么实验室检查呢00:04:22.080 --> 00:04:24.880我们呃应用最多的00:04:24.880 --> 00:04:26.860像这个血常规crp00:04:26.960 --> 00:04:28.800嗯这种在临床当中00:04:28.800 --> 00:04:30.520是应用的还是比较多的00:04:30.520 --> 00:04:31.980特别是在门诊当中00:04:32.160 --> 00:04:33.560那么除此之外呢00:04:33.560 --> 00:04:35.280还有一些像嗯00:04:35.280 --> 00:04:36.980这个呼吸道三联五联00:04:37.200 --> 00:04:39.040像呃支原体啊00:04:39.040 --> 00:04:41.320甲流乙流这些呢00:04:41.320 --> 00:04:43.840它也会引起呃00:04:43.840 --> 00:04:46.160有像也会引起这种情况00:04:46.160 --> 00:04:48.480像有一些支原体肝脏患者00:04:48.480 --> 00:04:52.460他的首先首先表现症状的有些是呃00:04:53.000 --> 00:04:55.860当第一天他可能会出现一个高热00:04:55.960 --> 00:04:56.720第二天呢00:04:56.720 --> 00:04:58.740就开始一个只有干咳00:04:58.880 --> 00:05:00.880喉咙痛干咳00:05:00.880 --> 00:05:02.360没有痰没有发热00:05:02.360 --> 00:05:03.860没有其他全身症状00:05:04.080 --> 00:05:05.440嗯像这种情况的话00:05:05.440 --> 00:05:07.280我们都要把这个病毒的因素00:05:07.280 --> 00:05:08.300考虑进去00:05:08.360 --> 00:05:11.020把这个支原体的因素考虑进去00:05:11.040 --> 00:05:13.760进行相应的这个检查00:05:13.760 --> 00:05:14.780明确诊断00:05:16.160 --> 00:05:17.040呃同时呢00:05:17.040 --> 00:05:18.840痰培养在临床当中呢00:05:18.840 --> 00:05:22.960使用呃使用是比较这个明确的00:05:22.960 --> 00:05:24.240但是在临床当中呢00:05:24.240 --> 00:05:25.920他往往就是由于病人呢00:05:25.920 --> 00:05:29.260可能就是这个从就诊00:05:29.520 --> 00:05:33.160首先呢他可能是需要到医院来00:05:33.160 --> 00:05:36.640需要医生呢就是给一个大致的判断00:05:36.640 --> 00:05:38.280药物的及时用上00:05:38.280 --> 00:05:40.620就是症状呢及时得到缓解00:05:41.000 --> 00:05:42.440嗯如果说往往呢00:05:42.440 --> 00:05:43.240这个痰培养00:05:43.240 --> 00:05:46.140有的是需要一周甚至更长时间00:05:46.320 --> 00:05:47.440那么时间呃00:05:47.440 --> 00:05:50.920这个痰培养细菌培养出来的结果呢00:05:50.920 --> 00:05:54.240还有呃针对性更好00:05:54.240 --> 00:05:56.280但是存在它一个时间的限制00:05:56.280 --> 00:05:57.340就导致了00:05:57.440 --> 00:05:59.400这个在临床当中的00:05:59.400 --> 00:06:01.140一个大范围的推广00:06:01.440 --> 00:06:04.660嗯比起这个血常规来说还是差的00:06:05.080 --> 00:06:07.140嗯没有那么完美00:06:07.240 --> 00:06:08.040所以说往往痰00:06:08.040 --> 00:06:09.040培养像病00:06:09.040 --> 00:06:12.220像一些微重症患者也住院的00:06:12.240 --> 00:06:13.480呃病因不明的00:06:13.480 --> 00:06:15.040用药效果不好的00:06:15.040 --> 00:06:15.920这些病人呢00:06:15.920 --> 00:06:18.820可能也可以选择痰培养和药品培养00:06:19.200 --> 00:06:21.640嗯培养确定了这个病原体之后00:06:21.640 --> 00:06:23.920然后进行相应的一个呃00:06:23.920 --> 00:06:24.720用药00:06:25.240 --> 00:06:26.240呃另外呢00:06:26.240 --> 00:06:27.420影像学检查00:06:28.120 --> 00:06:30.020像胸部的xpn ct00:06:30.160 --> 00:06:31.620排除肺部的病变00:06:31.640 --> 00:06:33.800呃这个也是比较关键的00:06:33.800 --> 00:06:34.560像喉咙的00:06:34.560 --> 00:06:36.740像一些我们嗯00:06:37.520 --> 00:06:38.080喉咙的话00:06:38.080 --> 00:06:38.840一个喉镜00:06:38.840 --> 00:06:39.480支气管00:06:39.480 --> 00:06:42.580以及肺部的支气管镜影像的一个00:06:42.760 --> 00:06:43.760这些检查呢00:06:43.760 --> 00:06:46.660它都是有一个比较好的一个针对的00:06:46.760 --> 00:06:47.560嗯00:06:52.080 --> 00:06:52.680第二部分呢00:06:52.680 --> 00:06:54.740就是这个抗生素的一个00:06:55.000 --> 00:06:57.100在治疗咳嗽当中的作用00:06:57.480 --> 00:06:58.860抗生素的性征呢00:06:58.920 --> 00:06:59.820就是00:07:00.520 --> 00:07:03.060也就是说何时使用抗生素00:07:03.120 --> 00:07:03.760首先呢00:07:03.760 --> 00:07:06.300就是有确诊细菌性感染的时候00:07:06.360 --> 00:07:06.960抗生素呢00:07:06.960 --> 00:07:08.420是主要的治疗手段00:07:08.800 --> 00:07:09.800呃明确00:07:09.800 --> 00:07:11.760当然就像刚才所介绍的00:07:11.760 --> 00:07:13.420如果能进行谈培养00:07:13.440 --> 00:07:14.940明确是什么菌00:07:14.960 --> 00:07:18.340呃对这个何种抗生素敏感00:07:18.440 --> 00:07:20.680那么我们在选择抗生素的时候呢00:07:20.680 --> 00:07:22.860他都是具有一个针对性00:07:23.160 --> 00:07:24.820同时呢就是说00:07:25.560 --> 00:07:26.360嗯00:07:26.920 --> 00:07:28.960这个因为这个谈培养00:07:28.960 --> 00:07:30.040或者说细菌培养00:07:30.040 --> 00:07:31.220它的一个结果00:07:31.360 --> 00:07:33.780呃可能是没有那么迅速00:07:33.840 --> 00:07:35.480时间呢没有那么好00:07:35.480 --> 00:07:36.240所以说00:07:36.240 --> 00:07:38.720在这个医生做出相应的判断之后呢00:07:38.720 --> 00:07:42.480我们就需要选择一个对嗯00:07:42.480 --> 00:07:45.100常见的一个病菌呢嗯00:07:46.360 --> 00:07:49.760这个敏感菌敏感的一个抗生素00:07:49.760 --> 00:07:52.780进行一个初期早期的一个使用00:07:53.040 --> 00:07:54.440嗯第三个呢00:07:54.440 --> 00:07:54.840就是说00:07:54.840 --> 00:07:58.120一个非抗生素治疗没有效果的时候00:07:58.120 --> 00:07:59.940可能需要抗生素的介入00:08:00.000 --> 00:08:01.160这这一部分呢00:08:01.160 --> 00:08:03.260特别是像针对支原体感染00:08:03.520 --> 00:08:06.380那么可能患者在家已经咳一周啊00:08:06.400 --> 00:08:07.700呃多长时间了00:08:07.880 --> 00:08:09.860呃用过各种抗病毒的00:08:09.960 --> 00:08:11.240刺激病毒口服液啊00:08:11.240 --> 00:08:11.920什么之类的00:08:11.920 --> 00:08:14.060止咳的咳嗽糖浆啊什么之类00:08:14.160 --> 00:08:15.440但是呢效果不好00:08:15.440 --> 00:08:16.540那么这个时候00:08:16.680 --> 00:08:18.740患者来求医问药的时候呢00:08:18.960 --> 00:08:20.080嗯都需要考虑到00:08:20.080 --> 00:08:22.400是否有特殊的感染因素产生的00:08:22.400 --> 00:08:24.680而不再是单纯的一个病毒啊00:08:24.680 --> 00:08:26.600或者说其他特殊的呃00:08:26.600 --> 00:08:28.380常见的病毒感染之类的00:08:28.440 --> 00:08:28.680嗯00:08:28.680 --> 00:08:31.720这个时候也是需要抗生素的一个啊00:08:31.720 --> 00:08:33.760介入那么同时呢00:08:33.760 --> 00:08:35.860像一些预防并发症呢00:08:35.880 --> 00:08:37.160呃防止细菌感染00:08:37.160 --> 00:08:38.900引起的一个严重并发症00:08:39.160 --> 00:08:40.920这个呢也是可以使用的00:08:40.920 --> 00:08:42.380特别是有一些病人00:08:42.520 --> 00:08:43.580这个00:08:44.440 --> 00:08:45.960嗯有些老年病人00:08:45.960 --> 00:08:49.080他可能就是每次在感冒00:08:49.080 --> 00:08:50.000或者说呃00:08:50.000 --> 00:08:52.380呃这个不舒服00:08:52.440 --> 00:08:54.880呃简单的这个不舒服之后00:08:54.880 --> 00:08:58.200刚他后期可能是呃00:08:58.200 --> 00:09:00.040不舒服过来找你看病00:09:00.040 --> 00:09:02.180当时你这个血培养各方面00:09:02.280 --> 00:09:04.280血细胞里面不一定有什么结果00:09:04.280 --> 00:09:06.000但是回去过了两三天之后00:09:06.000 --> 00:09:07.780他就会合并细菌性感染00:09:07.800 --> 00:09:09.040所以很多人有些时候00:09:09.040 --> 00:09:10.700对当他发生感冒00:09:10.800 --> 00:09:11.800病毒性感冒的时候00:09:11.800 --> 00:09:13.280他都很明确过来00:09:13.280 --> 00:09:14.960他一定要加抗生素啊00:09:14.960 --> 00:09:16.120就是除了对症治疗00:09:16.120 --> 00:09:17.620另外就是抗生素预防00:09:17.840 --> 00:09:19.360这个也是在临床当中00:09:19.360 --> 00:09:21.420也有患者有这样的要求00:09:21.920 --> 00:09:23.900嗯那么抗生素的种类呢00:09:24.960 --> 00:09:26.280嗯我们都知道00:09:26.280 --> 00:09:27.320这个青霉素类呢00:09:27.320 --> 00:09:28.640是最早发现的00:09:28.640 --> 00:09:29.720然后后续呢00:09:29.720 --> 00:09:31.480像头孢菌素呃00:09:31.480 --> 00:09:33.420大环内酯类和奎诺酮类00:09:33.880 --> 00:09:36.600嗯等几种常见的一个呃00:09:36.600 --> 00:09:37.840药物像阿莫西林啊00:09:37.840 --> 00:09:39.360它主要这个治疗00:09:39.360 --> 00:09:41.020广泛的一个细菌性感染00:09:41.200 --> 00:09:42.560嗯头孢菌素类呢00:09:42.560 --> 00:09:43.960适用于多种细菌性感染00:09:43.960 --> 00:09:44.520副作用呢00:09:44.520 --> 00:09:45.820相对来比较少00:09:45.960 --> 00:09:46.720青霉素类呢00:09:46.720 --> 00:09:48.280还有一个它容易过敏00:09:48.280 --> 00:09:49.460所以说这一点呢00:09:49.480 --> 00:09:50.640在临床使用当中呢00:09:50.640 --> 00:09:52.320也可能会受到限制我00:09:52.320 --> 00:09:53.540们往往呃00:09:53.600 --> 00:09:55.600针对一些既往没有用00:09:55.600 --> 00:09:56.700应用过的00:09:56.720 --> 00:09:58.740往往需要进行一个批示00:09:59.000 --> 00:10:00.460那么大环内酯类呢00:10:00.840 --> 00:10:02.040没这些呢00:10:02.040 --> 00:10:03.360对细菌性感染啊00:10:03.360 --> 00:10:05.560像刚才说的支原体这些00:10:05.560 --> 00:10:07.040它都是有效果的00:10:07.040 --> 00:10:09.660嗯就是临床用药的一个00:10:09.960 --> 00:10:10.880嗯还是不错的00:10:10.880 --> 00:10:12.320但是他的副反应呢00:10:12.320 --> 00:10:13.400也是比较大的00:10:13.400 --> 00:10:15.360所以我们针对这个有心脏啊00:10:15.360 --> 00:10:17.400或者肝脏功能的一个呃00:10:17.400 --> 00:10:18.560有影响的患者00:10:18.560 --> 00:10:19.740还是要慎用00:10:20.160 --> 00:10:21.880呃同奎诺酮类的呢00:10:21.880 --> 00:10:23.520它主要一个耐药00:10:23.520 --> 00:10:24.520细菌性感染00:10:24.520 --> 00:10:26.240它主要呃00:10:26.240 --> 00:10:28.660使用呢也需要相应的比较谨慎00:10:28.800 --> 00:10:28.960那么00:10:28.960 --> 00:10:31.320针对小于十八岁的一个非成年人呢00:10:31.320 --> 00:10:32.080惠诺酮类呢00:10:32.080 --> 00:10:33.300还是要禁用的00:10:33.320 --> 00:10:34.240嗯因为他00:10:34.240 --> 00:10:37.060有些也会影响小朋友的发育的00:10:40.840 --> 00:10:42.600那么抗生素的使用方法呢00:10:42.600 --> 00:10:44.000就是首先呢00:10:44.000 --> 00:10:44.960我们要遵医嘱00:10:44.960 --> 00:10:46.360严格按照医生的指导00:10:46.360 --> 00:10:47.820进行抗生素的使用00:10:47.960 --> 00:10:50.620同时呢确保每次的用药的剂量呢00:10:50.640 --> 00:10:52.200也要准确无误的00:10:52.200 --> 00:10:54.660呃进行一个使用00:10:54.760 --> 00:10:55.960嗯同时呢00:10:55.960 --> 00:10:58.560在整个要按照一个疗程使用00:10:58.560 --> 00:11:00.200往往有些病人呢00:11:00.200 --> 00:11:04.480可能说我用了这个三两天00:11:04.480 --> 00:11:06.400一天两天好了00:11:06.400 --> 00:11:07.980然后他就不用了00:11:08.040 --> 00:11:10.640可能这个病还没有好彻底00:11:10.640 --> 00:11:12.040病毒或者这个细菌呢00:11:12.040 --> 00:11:13.400没有完全被清除00:11:13.400 --> 00:11:15.660一直到正常的这个范围以内00:11:15.800 --> 00:11:17.200嗯这样的话00:11:17.200 --> 00:11:21.140他就会导致了患者出现嗯00:11:21.360 --> 00:11:23.460这个症状的反复00:11:23.560 --> 00:11:25.020疾病再次的发作00:11:25.080 --> 00:11:27.120同时如果反反复复这样的话00:11:27.120 --> 00:11:29.820有可能会造成一个细菌的耐药00:11:29.880 --> 00:11:31.160嗯这样的话00:11:31.160 --> 00:11:33.980就是很不利于自身的一个健康00:11:34.320 --> 00:11:34.720同时呢00:11:34.720 --> 00:11:37.820我们要需要注意一个副作用的问题00:11:37.840 --> 00:11:38.720那么这个时候00:11:38.720 --> 00:11:41.760就需要观察这个身体的反应00:11:41.760 --> 00:11:43.740呃及时报告这个副作用00:11:43.760 --> 00:11:45.600像有些这个尿血啊00:11:45.600 --> 00:11:46.800有一些皮疹啊00:11:46.800 --> 00:11:47.640皮炎啊00:11:47.640 --> 00:11:50.620或者啥过敏啊等这种情况的出现00:11:50.680 --> 00:11:53.660呃都是需要及时的给医生沟通的00:11:55.280 --> 00:11:58.160嗯抗生素的副作用呢00:11:58.160 --> 00:12:00.580也就是说我们常见的一个注意事项00:12:00.800 --> 00:12:01.960像过敏反应00:12:01.960 --> 00:12:03.840像皮疹瘙痒等情况呢00:12:03.840 --> 00:12:04.980都需要停药00:12:05.080 --> 00:12:05.880还有一个呢00:12:05.880 --> 00:12:07.360就是如果过度使用00:12:07.360 --> 00:12:10.920长期或者反复不按规定疗程使用的00:12:10.920 --> 00:12:13.540它往往会造成一个耐药菌株的产生00:12:13.560 --> 00:12:15.660这个时候呢呃00:12:15.960 --> 00:12:18.000当你后续再去反复使用00:12:18.000 --> 00:12:19.160长期使用的话00:12:19.160 --> 00:12:21.100它可能效果都会受到控制00:12:21.160 --> 00:12:22.040呃抑制00:12:22.040 --> 00:12:23.000那么所以说有00:12:23.000 --> 00:12:24.000因为有很多人呢00:12:24.000 --> 00:12:25.760可能就是因为呃00:12:25.760 --> 00:12:29.220这个长期反复的不舒服00:12:30.960 --> 00:12:32.840他就会吃这个阿莫西林00:12:32.840 --> 00:12:34.480那么胃肠道不舒服00:12:34.480 --> 00:12:35.580他也吃阿莫西林00:12:35.680 --> 00:12:36.520这样的时候呢00:12:36.520 --> 00:12:40.040他就可能会导致这个体内一个呃00:12:40.040 --> 00:12:41.460耐药菌株的产生00:12:41.480 --> 00:12:43.360进而导致你后续再出现00:12:43.360 --> 00:12:44.380这个阿莫西林00:12:44.680 --> 00:12:45.620吃这个药00:12:45.800 --> 00:12:46.600吃青霉素类的00:12:46.600 --> 00:12:48.140你会发现没有效果00:12:48.440 --> 00:12:49.680吃到药的量00:12:49.680 --> 00:12:51.520或者是时间相应的都延长00:12:51.520 --> 00:12:54.260但是效果往往没有像之前那么好00:12:54.440 --> 00:12:57.040这也是有可能就是耐药菌株的产生00:12:57.040 --> 00:12:58.100造成的影响00:12:58.680 --> 00:12:59.480还有一个呢00:12:59.480 --> 00:13:03.100就是说胃肠道不适的反应00:13:03.240 --> 00:13:04.680那么常见呢像恶心00:13:04.680 --> 00:13:05.640腹泻呃00:13:05.640 --> 00:13:06.280这个时候呢00:13:06.280 --> 00:13:09.040往往需要进行一个电解质呃00:13:09.040 --> 00:13:10.660防止这个电解质紊乱00:13:10.720 --> 00:13:11.840呃要饮食呢00:13:11.840 --> 00:13:13.140要进行一个均衡00:13:13.520 --> 00:13:14.360嗯同时呢00:13:14.360 --> 00:13:16.800像一个对肝肾功能的损害啊00:13:16.800 --> 00:13:18.840这个也是需要定期复查的00:13:18.840 --> 00:13:21.960那么短期内使用的还问题不大00:13:21.960 --> 00:13:24.000但是如果病人存在一个长期00:13:24.000 --> 00:13:25.620反复使用抗生素的话00:13:25.640 --> 00:13:27.020这个也是要注意的00:13:29.360 --> 00:13:30.160嗯咳00:13:30.160 --> 00:13:30.880针对咳嗽00:13:30.880 --> 00:13:32.420其他的治疗方案呢00:13:32.440 --> 00:13:33.300嗯00:13:34.240 --> 00:13:37.180像这个不使用药物的治疗方式00:13:37.320 --> 00:13:38.840像这个保持湿润00:13:38.840 --> 00:13:40.920多喝水保持喉咙湿润呢00:13:40.920 --> 00:13:42.520它能够有助于呃00:13:42.520 --> 00:13:43.860缓解这个咳嗽00:13:44.080 --> 00:13:45.240同时呢充足的休息00:13:45.240 --> 00:13:46.560有利于身体的恢复00:13:46.560 --> 00:13:49.000抵抗力得到充足的恢复之后呢00:13:49.000 --> 00:13:51.820呃他也是有利于这个咳嗽的缓解00:13:52.040 --> 00:13:55.540嗯像有一些这个嗯00:13:55.880 --> 00:13:56.960过敏因素刺激的00:13:56.960 --> 00:13:57.920像烟雾啊00:13:57.920 --> 00:14:01.640出呃这个灰尘啊等刺激产生的话00:14:01.640 --> 00:14:03.000我们要尽量避免00:14:03.000 --> 00:14:05.200早期的脱离这个环境00:14:05.200 --> 00:14:07.940然后再通过戴口罩啊等进行隔离00:14:10.320 --> 00:14:12.260还有一个就是说改变体位00:14:12.280 --> 00:14:14.320那么抬高头部啊00:14:14.320 --> 00:14:15.560或者减少夜间咳嗽00:14:15.560 --> 00:14:17.820像有一些这个气道一个敏感00:14:17.920 --> 00:14:18.960敏感反应引起的00:14:18.960 --> 00:14:20.460这个时候也是有效的00:14:20.720 --> 00:14:22.060那么中医中药呢00:14:22.840 --> 00:14:24.960在这个咳嗽治疗当中的作用呢00:14:24.960 --> 00:14:26.200是不容小觑的00:14:26.200 --> 00:14:27.640它也是呃00:14:27.640 --> 00:14:30.880这在中国这个数千年来00:14:30.880 --> 00:14:32.940积累下来一个中医的经验00:14:33.000 --> 00:14:35.220那么在治疗这个咳嗽方面00:14:35.600 --> 00:14:37.680特别是慢性咳嗽呃00:14:37.680 --> 00:14:41.100他也是效果是很明确的那么00:14:42.520 --> 00:14:44.180降一些化痰止咳的00:14:44.240 --> 00:14:46.640他能够缓解这个咳嗽00:14:46.640 --> 00:14:48.460同时呢让痰液排出00:14:48.800 --> 00:14:49.720呃清热解毒00:14:49.720 --> 00:14:52.640适用于这个病毒感染引起的咳嗽00:14:52.640 --> 00:14:54.600当病因解除之后00:14:54.600 --> 00:14:56.940他的咳嗽症状也就相应的减少00:14:57.000 --> 00:14:58.580同时呢增强免疫力00:14:58.720 --> 00:14:59.800中药调节呢00:14:59.800 --> 00:15:02.240他可能够增强免疫力之后呢呃00:15:02.240 --> 00:15:03.960减少这个咳嗽的发作00:15:03.960 --> 00:15:05.080或者说病菌00:15:05.080 --> 00:15:06.160或者说细呃00:15:06.160 --> 00:15:08.500细菌病毒的一个入侵00:15:08.760 --> 00:15:12.380然后进而呢也减少这个咳嗽的出现00:15:12.480 --> 00:15:15.060还有一个就是一个个体化的治疗00:15:15.080 --> 00:15:16.800那么根据个人的体质呢00:15:16.800 --> 00:15:18.740他能够进行一个辨证施治00:15:19.360 --> 00:15:20.880物理方法有哪些呢00:15:20.880 --> 00:15:22.520像热敷呃00:15:22.520 --> 00:15:23.720热敷背部啊00:15:23.720 --> 00:15:24.920或者哪里00:15:24.920 --> 00:15:27.540这些都能够缓解这个咳嗽的症状00:15:27.680 --> 00:15:28.960蒸汽湿用呢00:15:28.960 --> 00:15:30.840它也是能够湿润呼吸道00:15:30.840 --> 00:15:32.340减轻咳嗽的情况00:15:32.560 --> 00:15:34.720同时呢像按摩呼吸训练00:15:34.720 --> 00:15:37.580它也能够一定程度上缓解00:15:38.080 --> 00:15:40.840那么咳嗽呢发作呢00:15:40.840 --> 00:15:43.960会给病人呢带来一个不适的体验00:15:43.960 --> 00:15:46.820那么如何能够预防咳嗽的发作00:15:46.840 --> 00:15:49.720这个也是呃我们需要注意的00:15:49.720 --> 00:15:51.240像个人的卫生00:15:51.240 --> 00:15:52.340增强免疫力00:15:52.640 --> 00:15:54.580避免接触过敏源00:15:54.680 --> 00:15:57.120定期体检等各种呢00:15:57.120 --> 00:15:58.620都是一个很好的方案00:15:59.440 --> 00:16:01.340嗯谢谢各位