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--> 00:03.970\n各位专家、各位教授、各位同道，\n\n00:03.970 --> 00:04.645\n大家好。\n\n00:05.402 --> 00:11.253\n今天我给大家带来的题目是急性上呼吸道感染的临床与诊断。\n\n00:14.501 --> 00:14.751\n嗯。\n\n00:21.843 --> 00:25.694\n急性上呼感染的症状和总体特征？\n\n00:27.201 --> 00:29.400\n疾病特点，\n\n00:29.801 --> 00:34.951\n这个急性上呼吸道感染疾病通常是焦急的。\n\n00:35.859 --> 00:36.808\n多数患者吧，\n\n00:37.258 --> 00:41.308\n在接触病原体后一到三天内就会出现症状。\n\n00:42.064 --> 00:43.740\n比如在流感高发季节，\n\n00:43.740 --> 00:46.215\n很多人可能前一天还好好的，\n\n00:46.615 --> 00:50.764\n第二天就突然出现发热、头痛等不适症状。\n\n00:51.528 --> 00:54.479\n就是因为病原体入侵人体后，\n\n00:54.479 --> 00:57.203\n迅速引发了身体的免疫反应，\n\n00:57.203 --> 00:59.929\n导致各种症状快速呈现。\n\n01:00.942 --> 01:01.692\n症状多样性，\n\n01:02.141 --> 01:03.742\n其症状具有多样性，\n\n01:03.742 --> 01:07.092\n涵盖了呼吸道局部症状和全身症状。\n\n01:07.838 --> 01:12.588\n呼吸道局部局部症状包括鼻塞、流涕、咽痛、咳嗽等。\n\n01:13.227 --> 01:14.428\n全身症状都有，\n\n01:14.428 --> 01:15.527\n发热、乏力。\n\n01:16.445 --> 01:20.346\n肌肉酸痛的不同患者的症状表现可能有所差异，\n\n01:20.695 --> 01:23.596\n有的患者以呼吸道局部症状为主，\n\n01:23.596 --> 01:25.420\n如频繁的打喷嚏啊，\n\n01:25.420 --> 01:26.346\n流鼻涕啊。\n\n01:27.063 --> 01:29.688\n而有的患者则全身症状较为突出，\n\n01:29.688 --> 01:31.413\n像高热、全身乏力，\n\n01:31.663 --> 01:33.612\n甚至影响到正常的。\n\n01:34.640 --> 01:36.841\n日常的活动和工作。\n\n01:41.617 --> 01:42.917\n症状的总体特征。\n\n01:45.755 --> 01:47.005\n症状的发展过程。\n\n01:47.932 --> 01:50.083\n症状发展有一定的阶段性，\n\n01:50.532 --> 01:53.483\n初期可能以呼吸道局部症状为主，\n\n01:53.483 --> 01:56.108\n如轻微的鼻塞、咽干等，\n\n01:56.108 --> 01:57.958\n随着病情的进展，\n\n01:57.958 --> 02:00.282\n可能出现发热等全身的症状。\n\n02:01.264 --> 02:03.415\n体温可逐渐升高。\n\n02:04.508 --> 02:04.758\n嗯。\n\n02:06.947 --> 02:08.272\n在发病后的3.5天，\n\n02:08.272 --> 02:09.723\n症状可能达到高峰，\n\n02:09.723 --> 02:11.598\n之后逐渐缓解。\n\n02:11.897 --> 02:12.397\n例如，\n\n02:12.397 --> 02:16.447\n普通感冒患者的开始能只有鼻子不通气，\n\n02:16.447 --> 02:20.098\n过两天可能出现发热、咳嗽加重等情况。\n\n02:20.098 --> 02:21.598\n在一周左右，\n\n02:21.598 --> 02:24.298\n症状会慢慢减轻，\n\n02:24.397 --> 02:25.348\n直至恢复。\n\n02:36.158 --> 02:36.332\n嗯，\n\n02:36.332 --> 02:39.257\n普通感冒的症状表现。\n\n02:40.639 --> 02:43.440\n主要包括一个是鼻部的症状。\n\n02:44.317 --> 02:47.341\n鼻部症状是普通感冒的常见的表现。\n\n02:47.341 --> 02:48.016\n往往。\n\n02:49.097 --> 02:50.597\n患者往往出现一个鼻塞，\n\n02:50.697 --> 02:52.022\n感觉鼻子不通气，\n\n02:52.022 --> 02:54.347\n严重时甚至需要张口呼吸。\n\n02:54.746 --> 02:56.246\n流涕也较为常见，\n\n02:56.697 --> 02:58.746\n初期多为清水样鼻涕，\n\n02:58.746 --> 02:59.947\n之后可变为。\n\n03:01.063 --> 03:01.962\n粘脓性鼻涕。\n\n03:02.063 --> 03:02.863\n据统计，\n\n03:02.863 --> 03:05.712\n约80%的普通患者。\n\n03:06.460 --> 03:09.259\n感冒患者在发病初期就出现流涕症状。\n\n03:10.031 --> 03:12.580\n比如很多人在感冒时不停的流鼻涕，\n\n03:12.930 --> 03:15.380\n需要频繁的使用纸巾擦拭。\n\n03:16.406 --> 03:18.205\n对患者带来很多的不便。\n\n03:19.735 --> 03:20.585\n咽部的症状，\n\n03:20.886 --> 03:24.085\n咽部的症状在普通感冒中也较为突出。\n\n03:25.083 --> 03:26.583\n患者常感到咽部不适，\n\n03:26.583 --> 03:28.233\n有咽干咽痒的感觉，\n\n03:28.283 --> 03:29.983\n最后可能发展为咽痛。\n\n03:30.824 --> 03:32.125\n严重程度因人而异，\n\n03:32.125 --> 03:34.125\n有的患者只是轻微的疼痛，\n\n03:34.125 --> 03:35.925\n再有的疼痛较为剧烈。\n\n03:37.167 --> 03:38.218\n尤其在吞咽时，\n\n03:38.218 --> 03:39.917\n疼痛会明显的加剧。\n\n03:40.845 --> 03:43.845\n检查时可发现咽部黏膜轻度充血。\n\n03:44.714 --> 03:48.865\n例如一些患者在感冒时总觉得嗓子里有东西痒痒的。\n\n03:51.216 --> 03:52.666\n忍不住想咳嗽，\n\n03:52.716 --> 03:54.115\n随着疾病的发展，\n\n03:54.416 --> 03:55.865\n嗓子开始疼痛，\n\n03:55.865 --> 03:57.766\n吃饭喝水都要受到影响。\n\n03:59.052 --> 04:01.052\n普通感冒的症状表现。\n\n04:02.274 --> 04:03.473\n一个是全身症状，\n\n04:03.473 --> 04:04.298\n头痛、感冒，\n\n04:04.298 --> 04:05.774\n全身症状相对较轻，\n\n04:06.123 --> 04:08.574\n部分患者可能会出现低热。\n\n04:08.824 --> 04:09.774\n体温在。\n\n04:10.669 --> 04:12.820\n37°3到三十八度之间。\n\n04:13.554 --> 04:15.955\n同时伴有轻度的乏力、头痛等症状。\n\n04:16.786 --> 04:17.635\n与流感相比，\n\n04:17.635 --> 04:20.686\n普通感冒的全身症状持续时间更短。\n\n04:21.466 --> 04:23.115\n通常都要23天左右。\n\n04:24.006 --> 04:24.455\n例如，\n\n04:24.455 --> 04:27.705\n有些患者感冒后感觉身体有点发热，\n\n04:28.006 --> 04:29.205\n浑身没力气，\n\n04:29.705 --> 04:30.705\n头有点痛，\n\n04:30.756 --> 04:33.305\n但经过适当的休息和调整治疗，\n\n04:33.605 --> 04:35.355\n很快就能恢复到正常。\n\n04:38.148 --> 04:39.947\n流感的典型症状。\n\n04:41.368 --> 04:42.467\n一个是高热。\n\n04:42.618 --> 04:44.567\n高热是流感的典型症状，\n\n04:44.567 --> 04:48.967\n体温通常可高达39°甚至40°C以上，\n\n04:49.417 --> 04:51.467\n且发热持续时间较长，\n\n04:51.467 --> 04:53.317\n一般会持续3.5天。\n\n04:54.174 --> 04:56.424\n例如在流感的爆发时间，\n\n04:56.424 --> 04:59.373\n很多患者就诊时停在39°。\n\n05:00.346 --> 05:01.395\n服用退烧药后，\n\n05:01.446 --> 05:03.020\n体温可能暂时下降，\n\n05:03.020 --> 05:04.696\n但很快又回到回升。\n\n05:05.618 --> 05:08.444\n高热会使患者感到极度不适，\n\n05:08.444 --> 05:11.718\n出现了面色潮红、皮肤发胖等表现。\n\n05:13.023 --> 05:19.674\n全身肌肉酸痛全身肌肉酸痛流感患者常伴有明显的全身肌肉酸痛症状，\n\n05:20.074 --> 05:23.074\n尤其是四肢、腰背等部位的肌肉。\n\n05:23.760 --> 05:25.773\n这是因为流感病毒侵入人体后，\n\n05:25.773 --> 05:27.710\n会引发身体的炎症反应，\n\n05:28.010 --> 05:30.510\n释放一些炎性介质刺激肌肉。\n\n05:31.536 --> 05:33.936\n末梢神经末梢导致肌肉酸痛，\n\n05:33.985 --> 05:39.536\n很多患者描述肌肉酸痛的感觉就像巨量运动后乳酸堆积一样。\n\n05:40.423 --> 05:43.548\n甚至疼痛到影响到正常的生活，\n\n05:43.548 --> 05:46.122\n连抬手走路都感觉困难。\n\n05:48.743 --> 05:50.393\n流感的典型症状。\n\n05:51.523 --> 05:52.273\n还有个乏力。\n\n05:53.295 --> 05:55.244\n乏力在流感中也非常常见，\n\n05:55.295 --> 05:57.644\n患者感到全身轻度的疲乏。\n\n05:58.513 --> 06:00.062\n疲倦、体力下降。\n\n06:00.113 --> 06:03.363\n这种乏力会严重影响患者的生活和工作，\n\n06:03.713 --> 06:07.162\n即使经过充分休息也难以在短时间内恢复。\n\n06:07.950 --> 06:11.899\n例如一些上班族在患上流感以后根本无法正常工作。\n\n06:13.725 --> 06:15.225\n需要请假在家里休息，\n\n06:15.225 --> 06:18.524\n甚至休息几天后仍感觉没力气，\n\n06:18.524 --> 06:20.774\n无法全身心的投入到工作中。\n\n06:21.766 --> 06:23.066\n流感的典型症状，\n\n06:23.266 --> 06:27.566\n呼吸道症状流感症状也是流感的重要表现，\n\n06:27.916 --> 06:30.566\n包括咳嗽、咳痰、鼻塞、流涕。\n\n06:30.916 --> 06:32.717\n咳嗽一般较为剧烈，\n\n06:32.717 --> 06:34.367\n且持续时间较长，\n\n06:34.367 --> 06:37.916\n有的患者咳嗽甚至会持续两周左右。\n\n06:38.217 --> 06:41.166\n咳痰可能为白色粘液痰、黄色脓稠痰。\n\n06:41.937 --> 06:45.388\n鼻塞、流涕等症状也会给患者带来诸多不便。\n\n06:47.178 --> 06:48.678\n影响呼吸和睡眠质量。\n\n06:50.122 --> 06:52.622\n例如有些流感患者咳嗽的很厉害，\n\n06:52.923 --> 06:55.822\n晚上甚至会出现咳嗽而无法入睡，\n\n06:56.122 --> 06:58.072\n严重影响生活的质量。\n\n07:00.420 --> 07:01.269\n临床症状。\n\n07:02.356 --> 07:03.106\n诊断要点。\n\n07:04.158 --> 07:06.259\n一个是发热特点的判断，\n\n07:06.658 --> 07:10.259\n不同类型的急性上呼道感染发病特点有所不同。\n\n07:11.130 --> 07:13.529\n普通的感冒多为低热和中度发热，\n\n07:13.529 --> 07:15.279\n病温一般在38°，\n\n07:15.730 --> 07:17.304\n很少经过38°，\n\n07:17.304 --> 07:19.179\n且发热持续时间较短。\n\n07:19.830 --> 07:20.781\n等上2到三天，\n\n07:20.881 --> 07:23.080\n例如一位普通的感冒患者，\n\n07:23.381 --> 07:25.019\n体温在37°八，\n\n07:25.019 --> 07:27.281\n三十八度2出现波动，\n\n07:27.680 --> 07:29.430\n经过简单的对症治疗，\n\n07:29.430 --> 07:31.281\n第三天体温恢复正常。\n\n07:32.002 --> 07:33.351\n而流感往往是高热，\n\n07:33.601 --> 07:36.402\n体温可达39°甚至40°以上。\n\n07:37.299 --> 07:38.449\n发热期间时间长。\n\n07:39.535 --> 07:40.535\n一般3.5天，\n\n07:40.885 --> 07:43.309\n像在流感高发季节，\n\n07:43.309 --> 07:45.734\n不少患者会持续高热4天左右。\n\n07:46.744 --> 07:47.945\n即便是使用退烧药，\n\n07:47.945 --> 07:50.595\n体温下降以后不久又会回升的。\n\n07:51.916 --> 07:52.117\n嗯。\n\n07:53.036 --> 07:54.687\n临床症状诊断要点。\n\n07:55.520 --> 07:56.670\n呼吸道症状分析，\n\n07:57.170 --> 07:58.770\n呼吸道症状的表现。\n\n07:59.911 --> 08:03.061\n对于诊断有很重关键不通，\n\n08:03.860 --> 08:06.860\n感冒的鼻塞流涕症状较为突出，\n\n08:06.860 --> 08:09.561\n初期为清水一样流涕，\n\n08:09.561 --> 08:11.561\n之后转变为粘液脓性，\n\n08:11.960 --> 08:14.210\n咽喉疼痛相对是较轻的，\n\n08:14.460 --> 08:15.811\n咳嗽一般不剧烈，\n\n08:15.811 --> 08:22.411\n比如多数普通的感冒患者在发病第一天就会出现鼻塞、流清涕，\n\n08:22.411 --> 08:23.911\n第三天左右。\n\n08:24.606 --> 08:26.557\n那个鼻涕变稠，\n\n08:26.557 --> 08:28.106\n嗓子只是轻微的疼痛，\n\n08:28.506 --> 08:32.106\n而流感的患者症状通常比较剧烈，\n\n08:32.406 --> 08:33.706\n且持续时间长，\n\n08:33.757 --> 08:37.057\n还可能伴有咳嗽、鼻塞、流涕症状。\n\n08:37.882 --> 08:39.081\n相对没有不同。\n\n08:40.169 --> 08:41.044\n感冒那么典型。\n\n08:41.044 --> 08:42.619\n例如有的流感患者。\n\n08:45.861 --> 08:46.611\n咳嗽剧烈，\n\n08:46.810 --> 08:48.111\n持续两周左右，\n\n08:48.111 --> 08:50.161\n咳痰变为黄脓色。\n\n08:51.322 --> 08:53.223\n鼻塞症状相对不那么明显了，\n\n08:54.273 --> 08:57.023\n临床症状诊断的要点。\n\n08:58.658 --> 09:00.557\n一是全身的症状考量。\n\n09:01.208 --> 09:05.757\n考量全身的症状在诊断中有重要的参考价值。\n\n09:06.520 --> 09:08.820\n头痛感冒全身症状相对较轻，\n\n09:08.820 --> 09:11.370\n可能仅有的轻度的乏力，\n\n09:11.370 --> 09:12.020\n头痛，\n\n09:12.020 --> 09:13.671\n很少出现肌肉酸痛。\n\n09:14.736 --> 09:16.710\n而流感患者全身的症状明显，\n\n09:16.710 --> 09:17.685\n除了高热外，\n\n09:17.935 --> 09:19.861\n全身的肌肉酸痛较为常见，\n\n09:19.861 --> 09:23.911\n尤其是四肢、腰背等部位乏力感也十分突出，\n\n09:23.911 --> 09:26.335\n严重影响日常生活和活动。\n\n09:27.020 --> 09:27.244\n例如，\n\n09:27.244 --> 09:30.445\n普通感冒患者可能只是感觉有点没力气，\n\n09:30.445 --> 09:32.219\n不影响正常行走和工作，\n\n09:32.520 --> 09:35.619\n但流感患者会觉得全身的肌肉酸痛，\n\n09:35.919 --> 09:37.070\n连抬手啊。\n\n09:38.293 --> 09:39.968\n起身都困难、乏力等，\n\n09:39.968 --> 09:41.942\n感到无法正常工作和生活。\n\n09:45.447 --> 09:47.148\n实验室检查项目。\n\n09:47.989 --> 09:49.739\n包括一个是血常规检查。\n\n09:51.296 --> 09:56.146\n血常规检查是最常用的检实验室检查项目之一，\n\n09:56.346 --> 09:59.997\n通过检测白细胞、红细胞、血小板等指标，\n\n10:00.296 --> 10:02.296\n可以初步判断感染的类型。\n\n10:03.007 --> 10:03.958\n在病毒感染时，\n\n10:03.958 --> 10:06.908\n白细胞计数通常正常或偏低，\n\n10:07.208 --> 10:09.208\n淋巴细胞比例可能升高。\n\n10:09.507 --> 10:12.208\n例如一位急性上呼吸道感染的患者，\n\n10:12.908 --> 10:16.232\n血常规显示白细胞数5×19的，\n\n10:16.232 --> 10:18.408\n每升正常范围4×10的。\n\n10:19.270 --> 10:19.919\n90毫每升。\n\n10:20.822 --> 10:22.523\n淋巴细胞比例为45，\n\n10:22.523 --> 10:24.872\n正常范围是20%.40%，\n\n10:24.872 --> 10:26.322\n提示可能为病毒感染。\n\n10:27.301 --> 10:28.325\n而在细菌感染时，\n\n10:28.325 --> 10:29.901\n白细胞计数往往升高，\n\n10:29.901 --> 10:31.651\n中性细胞比例也会增加。\n\n10:32.051 --> 10:34.051\n比如另一位白细胞计数。\n\n10:34.987 --> 10:36.538\n为12×49L，\n\n10:36.538 --> 10:38.987\n每升中性粒细胞比例70%，\n\n10:39.338 --> 10:41.788\n正常范围50%.70%。\n\n10:45.424 --> 10:46.174\n更倾向于。\n\n10:47.190 --> 10:48.041\n细菌的感染。\n\n10:49.138 --> 10:51.788\n实验室检查项目当中还有一个是。\n\n10:52.875 --> 10:54.362\n病毒抗原的感染，\n\n10:54.362 --> 10:59.924\n病毒抗原的感染可以通过是否感染特定的病毒，\n\n11:00.375 --> 11:03.775\n这个常见的检测方法有免疫荧光法。\n\n11:04.551 --> 11:05.250\n胶体金法，\n\n11:05.250 --> 11:08.000\n以流感病毒抗原检测为例，\n\n11:08.351 --> 11:09.526\n采用免疫荧光法，\n\n11:09.526 --> 11:13.301\n通过检测患者呼吸道分泌物的流感病毒抗原，\n\n11:13.700 --> 11:14.801\n若结果阳性，\n\n11:14.801 --> 11:17.000\n即可确诊为流感病毒感染，\n\n11:17.250 --> 11:19.825\n这种检测方法操作简便、快速，\n\n11:19.825 --> 11:22.526\n一般在30分钟内就能出结果。\n\n11:22.526 --> 11:25.450\n对于流感的早期诊断和治疗。\n\n11:26.124 --> 11:27.023\n具有重要意义。\n\n11:27.323 --> 11:28.773\n在流感的高发季节，\n\n11:28.773 --> 11:30.973\n很多医院通过这种检测方法，\n\n11:31.223 --> 11:36.124\n很快能快速准确的诊断出流感患者，\n\n11:36.124 --> 11:38.374\n以便及时采取治疗措施。\n\n11:39.138 --> 11:39.338\n嗯。\n\n11:41.361 --> 11:43.010\n实验室检查方法还有一个，\n\n11:43.010 --> 11:43.911\n细菌培养。\n\n11:44.260 --> 11:49.460\n细菌培养主要用于检测是否存在细菌感染及明确病原菌的。\n\n11:50.377 --> 11:53.726\n种类对明确有细菌感染的患者，\n\n11:53.726 --> 11:57.877\n采取痰液、咽拭子等标本进行细菌培养。\n\n11:58.127 --> 12:01.052\n如果培养结果显示有特定细菌生长，\n\n12:01.052 --> 12:03.976\n如溶血球链球菌、病原量细菌，\n\n12:03.976 --> 12:06.827\n不仅可不仅可以确诊细菌感染，\n\n12:06.827 --> 12:09.776\n还能通过药物敏感实验指导后续的。\n\n12:11.898 --> 12:12.698\n抗生素应用。\n\n12:13.635 --> 12:16.435\n例如从患者痰液中培养出肺炎链球菌，\n\n12:16.736 --> 12:20.486\n通过药敏实验发现该病菌对青霉素敏感，\n\n12:20.486 --> 12:25.835\n那么在治疗当中可以选择青霉素类抗生素进行针对性治疗。\n\n12:28.573 --> 12:29.473\n影像学检查。\n\n12:30.333 --> 12:32.533\n影像学检查包括胸部X光，\n\n12:32.682 --> 12:38.333\n胸部X光检查在急性上呼吸道感染的诊断中，\n\n12:38.333 --> 12:41.482\n可用于排除下腹的感染的并发症。\n\n12:41.482 --> 12:42.408\n一般情况，\n\n12:42.408 --> 12:44.232\n单纯的急性上部感染，\n\n12:44.232 --> 12:45.232\n胸部X光。\n\n12:46.156 --> 12:47.056\n表现多为正常，\n\n12:47.306 --> 12:49.080\n但如果患者病情较重，\n\n12:49.080 --> 12:51.356\n出现咳嗽、咳痰加重。\n\n12:52.481 --> 12:53.931\n伴发热持续不退的，\n\n12:53.981 --> 12:56.231\n我们就进行胸部X光检查，\n\n12:56.231 --> 13:00.981\n可以帮助判断是否合并了肺炎等下呼吸道的疾病。\n\n13:01.330 --> 13:01.755\n例如，\n\n13:01.755 --> 13:03.731\n一位急性上呼感染的患者，\n\n13:03.981 --> 13:06.731\n经过1周感染症状未控制，\n\n13:06.731 --> 13:09.431\n胸部X光显示肺伴有片状阴影，\n\n13:09.681 --> 13:11.281\n提示可能合并了肺炎，\n\n13:11.281 --> 13:13.031\n需要进一步调整治疗方案。\n\n13:16.044 --> 13:17.693\n影像学检查的作用，\n\n13:18.044 --> 13:18.943\n再一个吧，\n\n13:19.294 --> 13:21.044\n影像学检查吧，\n\n13:21.494 --> 13:23.544\n还有一个是胸部吸气。\n\n13:24.482 --> 13:25.158\n大家都知道，\n\n13:25.158 --> 13:26.232\n众所周知啊，\n\n13:26.232 --> 13:29.033\n胸部CT比肺部X光。\n\n13:30.111 --> 13:30.711\n更敏感，\n\n13:30.812 --> 13:31.611\n更准确。\n\n13:33.091 --> 13:37.015\n一个胸部CT可以顶X光片，\n\n13:37.015 --> 13:37.966\n顶个几百张，\n\n13:37.966 --> 13:38.890\n六七百张，\n\n13:39.091 --> 13:41.890\n所以它能够早期的发现。\n\n13:42.924 --> 13:44.125\n细微的一些变化。\n\n13:45.057 --> 13:48.958\n特别对一些临床表现又不典型。\n\n13:50.127 --> 13:52.478\n又高度怀疑肺部有并发症的患者。\n\n13:53.981 --> 13:59.330\n胸部CT检查可以提供更详细的肺部的信息。\n\n14:01.177 --> 14:02.578\n例如有的患者吧。\n\n14:03.614 --> 14:06.414\n上呼吸道感染后咳嗽、低热持续存在。\n\n14:07.242 --> 14:08.242\n胸部X光。\n\n14:09.223 --> 14:10.773\n不能明显的发现异常。\n\n14:11.776 --> 14:14.127\n但胸部CT发现肺部有小结节等。\n\n14:14.127 --> 14:15.627\n阴因早期发展。\n\n14:16.476 --> 14:18.476\n肺部的隐匿性的疾病。\n\n14:19.721 --> 14:21.120\n可以为后续的治疗。\n\n14:22.153 --> 14:25.552\n和诊断提供重要的依据啊，\n\n14:26.552 --> 14:28.877\n在这里我讲一个病例，\n\n14:28.877 --> 14:30.103\n很简单的一个病例，\n\n14:30.403 --> 14:30.752\n嗯，\n\n14:30.752 --> 14:33.078\n一个病人到我这里，\n\n14:33.078 --> 14:34.403\n急性上呼吸道感染。\n\n14:35.466 --> 14:36.216\n呼吸道感染，\n\n14:36.216 --> 14:37.190\n白细胞比较高。\n\n14:38.099 --> 14:40.450\n然而我们胸片来给他拍了一个，\n\n14:40.700 --> 14:42.299\n没什么大的问题。\n\n14:44.374 --> 14:46.323\n当时他是拍了个正片。\n\n14:48.018 --> 14:49.093\n侧乳片没拍。\n\n14:50.543 --> 14:51.567\n病人来了以后，\n\n14:51.567 --> 14:55.067\n我们给予一定的一些药物治疗以后效果不太好。\n\n14:55.961 --> 14:56.262\n然后。\n\n14:58.127 --> 14:59.627\n就他拍了个侧位片。\n\n15:00.697 --> 15:02.421\n同时做了一个胸部CT，\n\n15:02.421 --> 15:06.197\n胸部CT在心脏后面发现一个。\n\n15:08.257 --> 15:12.356\n四四四四厘米大小的一个一个阴影，\n\n15:12.807 --> 15:14.706\n这个阴影正好在心脏的后面。\n\n15:15.536 --> 15:16.335\n这正好挡着。\n\n15:17.052 --> 15:19.377\n所以这个肺炎就就是肺炎了，\n\n15:19.377 --> 15:21.103\n就不是我们的上呼吸道感染了。\n\n15:21.896 --> 15:22.146\n所以说，\n\n15:22.146 --> 15:23.447\n我们马上调整了药，\n\n15:23.747 --> 15:24.671\n没出三天，\n\n15:24.671 --> 15:25.896\n病人体温就降下来。\n\n15:26.895 --> 15:29.395\n然后用到肺炎的疗程组以后，\n\n15:29.395 --> 15:30.544\n然后复查CT。\n\n15:32.070 --> 15:34.471\n这个阴影就消失了。\n\n15:34.471 --> 15:34.796\n嗯，\n\n15:34.796 --> 15:35.495\n这个片状，\n\n15:35.495 --> 15:36.020\n这个板，\n\n15:36.120 --> 15:37.695\n这个这个这个板，\n\n15:37.695 --> 15:38.445\n片状阴影，\n\n15:38.445 --> 15:40.320\n这个渗出实变影就消失。\n\n15:41.085 --> 15:43.135\n所以在影像学检查当中有X线，\n\n15:43.236 --> 15:45.885\n还有一个CTCT检查，\n\n15:46.385 --> 15:50.335\n比那个X光检查单纯的一个胸片检查。\n\n15:51.120 --> 15:51.620\n更准确，\n\n15:51.620 --> 15:52.370\n更敏锐，\n\n15:52.971 --> 15:53.745\n更敏感，\n\n15:53.745 --> 15:58.270\n能够早期发现一些轻微的一些变化，\n\n15:58.471 --> 16:01.171\n所以说还是极其有用的。\n\n16:01.520 --> 16:01.921\n好，\n\n16:02.120 --> 16:04.120\n今天这个内容就到这儿，\n\n16:04.320 --> 16:05.145\n谢谢大家，\n\n16:05.145 --> 16:06.370\n谢谢诸位的聆听，\n\n16:06.370 --> 16:07.070\n谢谢。\n\n","v0d47cg10004d60p5c2ljhtdhjvnjrr0",969,552,"2026-01-24 20:17:34","急性上呼吸道感染临床诊断指南：症状识别与治疗方案  ","上呼吸道感染,感冒症状,病毒性感染,咽炎诊断,鼻塞治疗,发热管理,抗生素使用  ","本文详解急性上呼吸道感染的典型临床表现、诊断标准及治疗策略，涵盖病毒性与细菌性感染的鉴别要点、对症处理方案及预防措施，帮助患者和医生快速识别并科学应对。","2026-02-20 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