WEBVTT00:00:07.400 --> 00:00:08.660呃大家好00:00:08.760 --> 00:00:10.280今天我们很高兴00:00:10.280 --> 00:00:13.300在这里和大家一起分享的内容是00:00:13.600 --> 00:00:15.560慢性呃慢阻肺00:00:15.560 --> 00:00:18.260与肺部的一个疾病的一个解析00:00:18.640 --> 00:00:20.500那么我们也知道现在呢00:00:20.680 --> 00:00:22.120现在我们国内呢00:00:22.120 --> 00:00:24.380就说是在这一块的研究00:00:24.440 --> 00:00:26.040也有了一个新的进展00:00:26.040 --> 00:00:28.360所以今天在这里呃00:00:28.360 --> 00:00:30.200给大家讲一下慢阻肺00:00:30.200 --> 00:00:32.980嗯慢阻肺和肺部疾病的一个解析00:00:33.840 --> 00:00:34.640那么00:00:44.840 --> 00:00:49.940真的看到说是呃慢阻肺的概素00:00:50.400 --> 00:00:53.040那么慢阻肺是一种慢性的00:00:53.040 --> 00:00:54.660阻塞性的一个肺病00:00:55.360 --> 00:00:59.300他呢一个有一个比较长的一个嗯00:00:59.480 --> 00:01:00.660发展的过程00:01:01.120 --> 00:01:02.240然后呢他呢00:01:02.240 --> 00:01:05.160就说是一个慢性的支气管炎00:01:05.160 --> 00:01:07.420导致的一个阻塞性的肺气肿00:01:07.960 --> 00:01:09.040那么慢阻肺呢00:01:09.040 --> 00:01:11.440我们也知道它有多个类型00:01:11.440 --> 00:01:13.740它有一个阻塞性肺病的00:01:14.000 --> 00:01:16.260有一个支气管炎的表现00:01:16.840 --> 00:01:18.520那么流行病学这一块呢00:01:18.520 --> 00:01:19.780我们也看到了00:01:19.840 --> 00:01:22.280它还是一个在我国一个发生病00:01:22.280 --> 00:01:25.960发生的一个比较多见常见的疾病00:01:25.960 --> 00:01:26.800那慢阻肺00:01:26.800 --> 00:01:29.580我们知道它逐渐的发生发展以后呢00:01:29.640 --> 00:01:31.420它的危害还是很大的00:01:31.800 --> 00:01:35.320他是会引起一个呃慢性气管炎00:01:35.320 --> 00:01:36.620阻塞性肺气肿00:01:36.760 --> 00:01:39.660然后间歇性的呼吸功能减退00:01:39.800 --> 00:01:41.740然后出现一个心衰00:01:41.840 --> 00:01:43.940直至死亡的这一过程00:01:44.440 --> 00:01:45.800那么我们也知道00:01:45.800 --> 00:01:48.000慢阻肺在他的病因这一块呢00:01:48.000 --> 00:01:51.480就是一个包括一个长期的一个吸00:01:51.480 --> 00:01:52.640呃吸烟啊00:01:52.640 --> 00:01:53.760咳嗽咳痰啊00:01:53.760 --> 00:01:55.060职业暴露啊00:01:55.360 --> 00:01:56.320一个粉尘啊00:01:56.320 --> 00:01:57.620化学物质啊00:01:57.720 --> 00:02:01.180以及呃室内外空气质量的下降00:02:01.360 --> 00:02:03.520那么各种各种各样因素00:02:03.520 --> 00:02:05.000包括一个遗传因素00:02:05.000 --> 00:02:08.380都是会导致一个慢阻肺的一个发生00:02:09.360 --> 00:02:12.160那么我们也知道他的病理生理呢00:02:12.160 --> 00:02:14.080就说是一个慢性的00:02:14.080 --> 00:02:16.040一个肺的一个炎症00:02:16.040 --> 00:02:18.040气道的重构以及导致00:02:18.040 --> 00:02:21.360一个肺泡以及呃一个氧化的反应00:02:21.360 --> 00:02:23.080这个机制是相互作用的00:02:23.080 --> 00:02:25.200所以说导致气道的受限00:02:25.200 --> 00:02:26.700和肺功能的下降00:02:27.080 --> 00:02:30.660那么慢阻肺这个情况呢00:02:31.080 --> 00:02:34.360由于它的一个进行性的恶化00:02:34.360 --> 00:02:35.840以及相互的作用呢00:02:35.840 --> 00:02:38.520会最终导致一个肺功能的00:02:38.520 --> 00:02:39.840一个急剧的恶化00:02:39.840 --> 00:02:42.280而出现了一个呃00:02:42.280 --> 00:02:45.100有严重的一个呼吸功能的减退00:02:45.600 --> 00:02:48.780那么在遗传和环境因素这一块呢00:02:48.840 --> 00:02:49.960我们也看到了00:02:49.960 --> 00:02:50.960慢阻肺呢00:02:50.960 --> 00:02:53.860都是有一个气体的00:02:53.920 --> 00:02:55.400气道的一个反应00:02:55.400 --> 00:02:57.400一个一个受限00:02:57.400 --> 00:02:59.460以及一个呃00:02:59.720 --> 00:03:02.860一个炎症的一个减退的一个表现00:03:03.600 --> 00:03:06.000那么我们也看到他的诊断00:03:06.000 --> 00:03:08.180诊断我们现在还是很清楚00:03:08.400 --> 00:03:10.960一个是一个慢性的反复发作00:03:10.960 --> 00:03:14.880对吧我们也看到一个呃临床表现00:03:14.880 --> 00:03:16.700及一个肺功能的检测00:03:16.960 --> 00:03:20.860那么多数我们经常会提到一个FFEVY00:03:21.000 --> 00:03:24.200像FBC作为一个慢阻肺的诊断00:03:24.200 --> 00:03:26.080那么检查的方式和手段00:03:26.080 --> 00:03:28.440我们也是在平时工作中00:03:28.440 --> 00:03:29.600会经常遇到的00:03:29.600 --> 00:03:32.340那么最主要的一个一个检查00:03:32.680 --> 00:03:34.000一个CT的检查00:03:34.000 --> 00:03:35.980以及一个肺功能的检测00:03:36.360 --> 00:03:38.040那么治疗的原理呢00:03:38.040 --> 00:03:39.880就说是一个急性期00:03:39.880 --> 00:03:41.400一个长期的00:03:41.400 --> 00:03:43.280一个急性期的管理00:03:43.280 --> 00:03:44.980和一个长期的管理00:03:45.200 --> 00:03:46.760那么预防和康复00:03:46.760 --> 00:03:47.960预防呢就是防00:03:47.960 --> 00:03:49.360防止它反复发作00:03:49.360 --> 00:03:50.740进行性的破坏00:03:51.000 --> 00:03:53.420那么康复就是在原来00:03:55.160 --> 00:03:57.940原来情况不是很好的前提下面的00:03:58.240 --> 00:03:59.920我们给他做一个呃00:03:59.920 --> 00:04:02.960保持他的肺功能不要定型期的恶化00:04:02.960 --> 00:04:05.440这方面我们可以做一些自己00:04:05.440 --> 00:04:06.840我们医生的干预00:04:06.840 --> 00:04:08.080或者设施努力00:04:08.080 --> 00:04:11.420这一块也是会有一些很多的帮助的00:04:12.080 --> 00:04:13.960那么理化因素所致的00:04:13.960 --> 00:04:16.340一个肺部的疾病的影响啊00:04:16.520 --> 00:04:18.000一个是呃呃00:04:18.000 --> 00:04:20.520第一个是职业性的肺病的分类00:04:20.520 --> 00:04:24.580那么职业病是我们大家经常会在00:04:24.720 --> 00:04:27.480嗯就说是一个呃00:04:27.480 --> 00:04:29.840门诊也会经常会跟大呃00:04:29.840 --> 00:04:32.160跟病人进行一个排除性的00:04:32.160 --> 00:04:34.220一个或者是一个确诊性的00:04:34.520 --> 00:04:37.220那么会问他有没有尘肺啊00:04:37.400 --> 00:04:39.560吸肺啊这种接触史00:04:39.560 --> 00:04:42.260那么有的病人还是蛮蛮明确的啊00:04:42.440 --> 00:04:43.840呃呃00:04:43.840 --> 00:04:45.200常见的理化因素00:04:45.200 --> 00:04:48.860是一个炎症的反应和一个空气污染00:04:48.880 --> 00:04:52.000然后呢一个病理于临床症状00:04:52.000 --> 00:04:54.080我们也知道一个嗯00:04:54.080 --> 00:04:56.140就说是一个肺气肿啊00:04:56.440 --> 00:04:58.660气道的改变啊00:04:58.760 --> 00:04:59.780严重的坏00:04:59.840 --> 00:05:01.300影响肺功能啊00:05:01.720 --> 00:05:03.480那么预防和控制这一块呢00:05:03.480 --> 00:05:04.400我们也知道的00:05:04.400 --> 00:05:07.480就说是嗯呃00:05:07.480 --> 00:05:09.680就是既要预防感染的发生00:05:09.680 --> 00:05:11.160同时也要嗯00:05:11.160 --> 00:05:13.260避免情绪的焦虑啊00:05:13.360 --> 00:05:14.320紧张啊00:05:14.320 --> 00:05:17.340就是这种刺激的反复的发作00:05:18.440 --> 00:05:19.800那么一个嗯00:05:19.800 --> 00:05:22.060粉尘粉尘呃00:05:23.640 --> 00:05:25.440那么粉尘这一块呢00:05:25.440 --> 00:05:26.240我们也知道00:05:26.240 --> 00:05:28.760粉尘呢也有一个分类和来源的00:05:28.760 --> 00:05:30.420一个种类和来源00:05:30.800 --> 00:05:31.960那么我们知道00:05:31.960 --> 00:05:33.320有的有的地方的00:05:33.320 --> 00:05:35.840工作环境非常差的情况下00:05:35.840 --> 00:05:37.460长期的一个粉尘00:05:37.640 --> 00:05:40.120那么这个细小颗粒物的吸入00:05:40.120 --> 00:05:41.880都会引起这种嗯00:05:41.880 --> 00:05:44.480这种就说是在肺泡啊00:05:44.480 --> 00:05:46.420我们的我们的呃00:05:46.800 --> 00:05:48.320我们的肺泡壁啊呃00:05:48.320 --> 00:05:49.760以及一个黏膜的00:05:49.760 --> 00:05:52.540这种都会有一个沉积啊00:05:52.960 --> 00:05:55.320诊断呢就说我们刚才也讲了00:05:55.320 --> 00:05:57.660诊断就是一个CT00:05:57.840 --> 00:05:59.740一个肺功能检测00:06:00.000 --> 00:06:02.800那么粉尘疾病的一个危害00:06:02.800 --> 00:06:03.760我们也知道了00:06:03.760 --> 00:06:06.620就是长期的在这个肺组织里面00:06:06.840 --> 00:06:08.600会有一个嗯00:06:08.600 --> 00:06:11.400会有一个沉沉沉的积00:06:11.400 --> 00:06:14.400积攒那么他肯定会引起炎性反应00:06:14.400 --> 00:06:17.440同时呢也会引起一个肺泡表面00:06:17.440 --> 00:06:18.920呼吸面积的减小00:06:18.920 --> 00:06:21.340那么治疗和康复这一块呢00:06:21.600 --> 00:06:23.420呃还是一个脱离00:06:23.600 --> 00:06:25.600脱离一个对00:06:25.600 --> 00:06:27.260过敏的环境啊00:06:27.320 --> 00:06:28.900及一个呃00:06:29.040 --> 00:06:30.880养疗啊康复治疗啊00:06:30.880 --> 00:06:32.840同时合并药物治疗00:06:32.840 --> 00:06:34.140改善肺功能00:06:34.480 --> 00:06:35.800那么养疗这一块呢00:06:35.800 --> 00:06:38.960我们也是看到很多的报道啊00:06:38.960 --> 00:06:41.000这一块它是在积极的00:06:41.000 --> 00:06:43.780有效的治疗的呼吸功能的同时呢00:06:43.920 --> 00:06:45.640也是改善一个呃00:06:45.640 --> 00:06:47.340患者的一个呼吸功能00:06:47.440 --> 00:06:49.920提高一个患者的一个嗯00:06:49.920 --> 00:06:51.480肺的一个总体的00:06:51.480 --> 00:06:54.760一个呼吸的一个有效的面积00:06:54.760 --> 00:06:56.980然后达到一个肺功能的00:06:57.080 --> 00:06:58.580不要进行性的恶化00:06:59.720 --> 00:07:02.040那么我们也知道还有一个呃00:07:02.040 --> 00:07:03.760除了粉尘这一类呢00:07:03.760 --> 00:07:05.620还有一个化学性肺00:07:06.080 --> 00:07:07.880化学性肺肺损伤呢00:07:07.880 --> 00:07:10.520就包括一个药物和一个刺激性的00:07:10.520 --> 00:07:12.500一个吸入的一个00:07:13.800 --> 00:07:18.140一个一个一个一个接触的一个反应00:07:18.240 --> 00:07:19.760那么疾病呢00:07:19.760 --> 00:07:21.660也包括一个嗯00:07:22.240 --> 00:07:22.960药呃00:07:22.960 --> 00:07:25.620呃化学药物的气体的吸入00:07:25.880 --> 00:07:27.400以及一种蒸汽啊00:07:27.400 --> 00:07:29.500长期处于这种嗯00:07:29.680 --> 00:07:32.260化学性药物的一个环境当中啊00:07:32.280 --> 00:07:35.640那么可以导致一个气道的炎症啊00:07:35.640 --> 00:07:36.400水肿啊00:07:36.400 --> 00:07:38.940同时一个进行性的肺功能减退00:07:39.360 --> 00:07:40.200临床表现呢00:07:40.200 --> 00:07:41.880也是一个咳嗽啊00:07:41.880 --> 00:07:43.980胸闷啊气喘啊00:07:44.160 --> 00:07:45.200严重的时候呢00:07:45.200 --> 00:07:46.980可以引起一个呼吸00:07:47.360 --> 00:07:49.640呼吸呃呼吸麻痹00:07:49.640 --> 00:07:51.840这种这种呼吸减退00:07:51.840 --> 00:07:53.260呼吸功能下降00:07:53.640 --> 00:07:54.600那么治疗呢00:07:54.600 --> 00:07:58.400也是一个就说是去朋友因对症治疗00:07:58.400 --> 00:08:02.040养疗呃改善康复个人00:08:02.040 --> 00:08:03.320个人以及家庭的00:08:03.320 --> 00:08:06.260这一块的一个有效的一个干预00:08:07.800 --> 00:08:09.880那么接下去我们再分享一个00:08:09.880 --> 00:08:12.100就是放射性的被损伤00:08:12.400 --> 00:08:14.040那么放射性的被损伤的00:08:14.040 --> 00:08:16.860一个放射性物质的接触以后呢00:08:17.240 --> 00:08:18.680呃放射性物质00:08:18.680 --> 00:08:21.120比如说是几种阿尔法粒子啊00:08:21.120 --> 00:08:21.840白塔粒子啊00:08:21.840 --> 00:08:23.220伽马射线啊00:08:23.240 --> 00:08:24.600以及对背的损伤00:08:24.600 --> 00:08:25.480这些东西呢00:08:25.480 --> 00:08:27.960也会导致一个呃00:08:27.960 --> 00:08:29.400这这种气道的高00:08:29.400 --> 00:08:32.340反应啊以及分子结构的改变啊00:08:32.440 --> 00:08:33.960然后呢呃00:08:33.960 --> 00:08:38.020导致这个肺泡的一个进行性的下降00:08:38.080 --> 00:08:40.420炎症啊纤维化的产生00:08:40.680 --> 00:08:43.520那么放射性被被损伤的类型呢00:08:43.520 --> 00:08:45.420也是分为呃00:08:46.160 --> 00:08:47.800同时呢也是不可分为00:08:47.800 --> 00:08:50.280一个慢性的放射性肺炎00:08:50.280 --> 00:08:51.680和一个呃00:08:51.680 --> 00:08:54.600就说是就是急性的放射性肺炎00:08:54.600 --> 00:08:56.700那么急慢性放射性肺炎00:08:56.760 --> 00:08:58.400在治疗的这一块呢00:08:58.400 --> 00:09:01.600就说是一个时间的呃00:09:01.600 --> 00:09:03.700程度会有所不同00:09:03.880 --> 00:09:05.740那么就说是00:09:06.080 --> 00:09:07.920治疗的方向还是一样的00:09:07.920 --> 00:09:10.880因为他放射性肺炎临床表现00:09:10.880 --> 00:09:12.440一个干咳00:09:12.440 --> 00:09:13.580呼吸困难00:09:13.960 --> 00:09:15.120胸闷啊嗯00:09:15.120 --> 00:09:16.360甚至有的胸痛啊00:09:16.360 --> 00:09:20.160发烧啊这些都是有类似的一点00:09:20.160 --> 00:09:23.200但是最终都是导致一个嗯00:09:23.200 --> 00:09:24.400肺功能减退00:09:24.400 --> 00:09:26.460甚至一个肺心病的发生00:09:27.040 --> 00:09:29.680那么放射性肺损伤的一个危害因素00:09:29.680 --> 00:09:30.720大家也知道00:09:30.720 --> 00:09:33.040就说是一个呃00:09:33.040 --> 00:09:35.000肺的一个功能的减呃00:09:35.000 --> 00:09:36.500肺功能的减退00:09:36.600 --> 00:09:38.640那么就说是呃00:09:38.640 --> 00:09:40.680我们也看到了一些化疗药物00:09:40.680 --> 00:09:41.800由于年龄啊00:09:41.800 --> 00:09:44.920各方面的患者身体体质差什么的00:09:44.920 --> 00:09:47.280这种放射性肺炎的这这一块呢00:09:47.280 --> 00:09:48.840也是在近几年00:09:48.840 --> 00:09:49.800也是得到了00:09:49.800 --> 00:09:52.320大家的进一步的一个认同00:09:52.320 --> 00:09:53.860和观察吧00:09:54.160 --> 00:09:57.280那么临床临床症状和体征呢00:09:57.280 --> 00:09:59.600是跟呃呃00:09:59.600 --> 00:10:00.680是跟00:10:00.680 --> 00:10:03.560就说是我们刚才说的一个慢阻肺00:10:03.560 --> 00:10:06.700有类似的一个发生发展00:10:06.800 --> 00:10:10.520那么它会一个进行性的一个加重00:10:10.520 --> 00:10:13.340那么我们也要通过体格检查00:10:13.760 --> 00:10:15.500详细的询问病史00:10:15.640 --> 00:10:18.300那么放射呃x线检查00:10:18.400 --> 00:10:19.920然后呼吸啊00:10:19.920 --> 00:10:21.500肺的运动评估00:10:21.680 --> 00:10:24.360来来来评价这个患者00:10:24.360 --> 00:10:26.580放射性肺炎的严重程度00:10:26.840 --> 00:10:29.400那么我们也看到一个影像学的检测00:10:29.400 --> 00:10:30.200在这里面呢00:10:30.200 --> 00:10:33.100有助于病情的判断和严重度的判断00:10:33.520 --> 00:10:35.200那么鉴别诊断这一块00:10:35.200 --> 00:10:36.660呢我们也看到了00:10:36.760 --> 00:10:38.760主要是根据患者的症状00:10:38.760 --> 00:10:41.440影像学检查以及呃00:10:41.440 --> 00:10:42.520排除肺炎00:10:42.520 --> 00:10:43.560肺结核00:10:43.560 --> 00:10:47.080以及其他原因的肺的肺水肿以后呢00:10:47.080 --> 00:10:49.260我们再进一步进行确诊00:10:49.280 --> 00:10:52.560那么我们也可以通过实验室检测00:10:52.560 --> 00:10:54.060血液检测啊00:10:54.160 --> 00:10:56.220这种肺功能检测啊00:10:56.720 --> 00:11:00.260呃然后就是查一些炎症标志物00:11:00.320 --> 00:11:01.280那么这一块呢00:11:01.280 --> 00:11:02.160我们给患者00:11:02.160 --> 00:11:05.140一个比较明确的一个诊断00:11:05.600 --> 00:11:07.840那么放射性肺炎的治疗的00:11:07.840 --> 00:11:09.440一个是支持治疗00:11:09.440 --> 00:11:11.460养疗和呼吸支持00:11:11.600 --> 00:11:13.600就说是呃00:11:13.600 --> 00:11:15.400严重的一个确诊的00:11:15.400 --> 00:11:17.340一个放射性肺损伤00:11:17.560 --> 00:11:20.520有有有低氧血症之类的00:11:20.520 --> 00:11:22.520我们也考虑用一个呼吸支持00:11:22.520 --> 00:11:24.760白怕怕那么药物呢00:11:24.760 --> 00:11:25.480这一块呢00:11:25.480 --> 00:11:27.180也是一个呃00:11:27.320 --> 00:11:29.480就说是根据合理的使用00:11:29.480 --> 00:11:30.860对放射性治疗00:11:30.880 --> 00:11:33.240这个放射性肺炎的治疗呢00:11:33.240 --> 00:11:34.200也是一个提倡00:11:34.200 --> 00:11:35.940一个药物的合理使用00:11:36.080 --> 00:11:38.800那么根据患者的情况00:11:38.800 --> 00:11:40.540选择合适的药物00:11:41.480 --> 00:11:42.560那么最重要的呢00:11:42.560 --> 00:11:43.720我们看到了啊00:11:43.720 --> 00:11:44.880接下去这一部分呢00:11:44.880 --> 00:11:47.820就是慢阻肺的预防和控制这一块00:11:48.040 --> 00:11:49.920那么戒烟是最重要的00:11:49.920 --> 00:11:52.580就说是就说呃00:11:52.880 --> 00:11:54.220最好没有吸过烟00:11:54.240 --> 00:11:57.340吸过烟的也要劝他要戒烟00:11:57.520 --> 00:11:59.680那么有二手烟倾向的患者00:11:59.680 --> 00:12:00.640我们也要跟他说00:12:00.640 --> 00:12:02.780要脱离这个二手烟的环境00:12:03.200 --> 00:12:04.560均衡饮食和锻炼00:12:04.560 --> 00:12:05.480我们也知道的00:12:05.480 --> 00:12:07.080那那个新冠期间00:12:07.080 --> 00:12:08.120我们张文宏老师00:12:08.120 --> 00:12:10.260一直跟大家强调的一个00:12:10.360 --> 00:12:13.120就说是要补充优质的蛋白质啊00:12:13.120 --> 00:12:15.700多吃新鲜的蔬菜水果啊00:12:16.000 --> 00:12:17.720同时呢也要建议啊00:12:17.720 --> 00:12:21.120就说是这种肺功能初初级阶00:12:21.120 --> 00:12:22.280初步的患者的00:12:22.280 --> 00:12:23.980也还是要建议他00:12:24.120 --> 00:12:26.000做一些有氧的一个训练00:12:26.000 --> 00:12:27.480如果如散步啊00:12:27.480 --> 00:12:29.660这个还是比较基础的对吧00:12:29.680 --> 00:12:31.640如果患者一般情况可以的话00:12:31.640 --> 00:12:31.920我们00:12:31.920 --> 00:12:35.660也建议可以去游游泳啊或者怎么样00:12:35.960 --> 00:12:38.560但是不建议剧烈的运动00:12:38.560 --> 00:12:42.120或者是一个对患者来说压力很大00:12:42.120 --> 00:12:44.480或者是对体能有挑战的运动00:12:44.480 --> 00:12:46.840这个事情还是应该避免的00:12:46.840 --> 00:12:48.140合理的运动00:12:48.240 --> 00:12:50.840那么避免有害气体的暴露00:12:50.840 --> 00:12:52.080就说这种患者00:12:52.080 --> 00:12:55.320同时也不能再受到其他的00:12:55.320 --> 00:12:58.080一个肺的一个刺激和损伤了00:12:58.080 --> 00:13:00.320就说有毒有害的气体啊00:13:00.320 --> 00:13:02.420这个暴露的环境应该避免00:13:03.160 --> 00:13:05.320那么定期的体检与监测呢00:13:05.320 --> 00:13:06.820也非常的重要00:13:06.880 --> 00:13:10.700就是这类患者他这个情况以后00:13:10.720 --> 00:13:13.400那么他定期的要做一个嗯00:13:13.400 --> 00:13:14.800胸部CT的检查00:13:14.800 --> 00:13:17.520一般我们建议这类患者是半年啊00:13:17.520 --> 00:13:19.960如果咳嗽咳痰症状加重的话00:13:19.960 --> 00:13:21.580那么呃00:13:22.480 --> 00:13:25.400有炎症继续加重的这一块00:13:25.400 --> 00:13:26.280我们也要定00:13:26.280 --> 00:13:28.460呃就复查的00:13:28.520 --> 00:13:31.440那么也要监测一个肺功能呃00:13:31.440 --> 00:13:34.340也建议患者买一个手指痒00:13:35.040 --> 00:13:37.160手指脉氧的一个测试00:13:37.160 --> 00:13:40.700自己在家就可以测试到最近的情况00:13:41.360 --> 00:13:43.820那么环境的保护和改善00:13:43.920 --> 00:13:45.720那么减少空气污染00:13:45.720 --> 00:13:48.060提高室内空气质量00:13:48.360 --> 00:13:50.240工作环境安全的措施00:13:50.240 --> 00:13:53.380以及政策法律的一个制定和执行啊00:13:53.440 --> 00:13:54.880这里也强调了一个00:13:54.880 --> 00:13:55.400就说是00:13:55.400 --> 00:13:58.560我们劳动者应该是自己保护好自己00:13:58.560 --> 00:13:59.200同时呢00:13:59.200 --> 00:14:01.580也是希望我们政府在这一块00:14:01.600 --> 00:14:02.960能够给我们更多的00:14:02.960 --> 00:14:04.400一个劳动者的保护00:14:04.400 --> 00:14:06.060在法律上的支持00:14:06.360 --> 00:14:08.080那么我们也看到了00:14:08.080 --> 00:14:09.720就说是呃00:14:09.720 --> 00:14:10.960健康科普啊00:14:10.960 --> 00:14:12.120健康宣传啊00:14:12.120 --> 00:14:13.320家庭的支持啊00:14:13.320 --> 00:14:14.720社区健康的干预00:14:14.720 --> 00:14:15.700这一块的00:14:15.760 --> 00:14:17.680也是大家在公共交呃00:14:17.680 --> 00:14:18.560公共呃00:14:18.560 --> 00:14:22.700公共医疗这一块也是会有强调00:14:22.960 --> 00:14:25.480那么那么我们接下去看00:14:25.480 --> 00:14:27.560肺部疾病的一个治疗的进展00:14:27.560 --> 00:14:30.040那么我们现在临床上也很多碰到了00:14:30.040 --> 00:14:32.060一个吸入性药物的使用00:14:32.200 --> 00:14:34.380那么备胎儿受体激动剂啊00:14:34.400 --> 00:14:37.300呃吸入性的糖皮质激素啊00:14:37.480 --> 00:14:40.080甚至于我们现在已经很多的00:14:40.080 --> 00:14:42.320都是用到了一个呃00:14:42.320 --> 00:14:43.280三联的药物00:14:43.280 --> 00:14:45.560对吧口服药我们也知道了00:14:45.560 --> 00:14:46.760我们会用一些00:14:46.760 --> 00:14:49.520就说是磷酸二酯酶的抑制剂啊00:14:49.520 --> 00:14:50.480皮质激素啊00:14:50.480 --> 00:14:52.360急性发作剂的一个抗生素啊00:14:52.360 --> 00:14:53.280等等等等00:14:53.280 --> 00:14:56.780我们都会在临床上会有接触和碰到00:14:57.080 --> 00:15:00.160那么这里还有一个新型的生物制剂00:15:00.160 --> 00:15:02.880那么这两年也是很多的呃00:15:02.880 --> 00:15:04.300药厂在研发00:15:04.320 --> 00:15:06.760以及进一步的在呃00:15:06.760 --> 00:15:09.040做一些关于一个炎症00:15:09.040 --> 00:15:11.640炎症因子的一个单克隆抗体00:15:11.640 --> 00:15:15.280和相关的一个炎症因子的抑制00:15:15.280 --> 00:15:18.100抑制剂的抑制剂的研发00:15:18.280 --> 00:15:19.080那么药物呢00:15:19.080 --> 00:15:21.080在进行进进一步研发00:15:21.080 --> 00:15:24.220以及会有一个更安全更有效00:15:24.240 --> 00:15:25.640然后对我们来说00:15:25.640 --> 00:15:28.640是一个很好的一个一个预呃00:15:28.640 --> 00:15:30.080就是一个前景吧00:15:30.080 --> 00:15:31.240那么物理治疗呢00:15:31.240 --> 00:15:33.780还是强调一个个体化的治疗00:15:34.040 --> 00:15:35.320那么我们也知道00:15:35.320 --> 00:15:36.920一个呼吸的康复训练00:15:36.920 --> 00:15:39.080同时呢肺康复的技术呢00:15:39.080 --> 00:15:39.680这两年呢00:15:39.680 --> 00:15:41.820也是得到了很好的发展00:15:42.000 --> 00:15:42.720我们的养疗00:15:42.720 --> 00:15:44.000我们的呼吸支持00:15:44.000 --> 00:15:46.160这一块也是有很多的医生00:15:46.160 --> 00:15:49.520会进一步的跟大家在这块这块提到00:15:49.520 --> 00:15:50.600或者是一个00:15:50.600 --> 00:15:53.620大家做到一个很好的一个学习00:15:53.880 --> 00:15:55.840那么我们也看到手术00:15:55.840 --> 00:15:59.520那么对于一个肺的一个减容手术00:15:59.520 --> 00:16:01.680以及一个肺的移植手术00:16:01.680 --> 00:16:03.020微创手术00:16:03.200 --> 00:16:05.000手术的适应症和风险00:16:05.000 --> 00:16:06.000那么这一块呢00:16:06.000 --> 00:16:07.900我们胸外科的同事们00:16:08.280 --> 00:16:11.040在这一块有一个进一步的解释00:16:11.040 --> 00:16:13.580但是呢真的走到这一期的话00:16:13.600 --> 00:16:15.640那么跟患者也要有一个充分的00:16:15.640 --> 00:16:17.240一个疾病的交代00:16:17.240 --> 00:16:18.200以及前期呢00:16:18.200 --> 00:16:20.200有有一个很好的一个肺功能00:16:20.200 --> 00:16:21.740的一个保保留00:16:22.000 --> 00:16:25.760那么基础我们也看到研究的方向00:16:25.760 --> 00:16:28.400一个是发病的机制研究00:16:28.400 --> 00:16:30.660以及基础疾病的研究探讨00:16:30.800 --> 00:16:32.760新型治疗方式的探讨00:16:32.760 --> 00:16:34.440个性化医疗的发展00:16:34.440 --> 00:16:36.500以及国际合作与交流00:16:36.840 --> 00:16:38.320那么我们也看到他的挑战00:16:38.320 --> 00:16:39.480一个疾病的负担00:16:39.480 --> 00:16:40.980以及经济的压力00:16:41.000 --> 00:16:42.720医疗资源分配的不均00:16:42.720 --> 00:16:45.520都是会有这些矛盾在里面00:16:45.520 --> 00:16:47.580但是呃00:16:47.600 --> 00:16:49.160总之就说是00:16:49.160 --> 00:16:51.040今天我们跟大家讨论了00:16:51.040 --> 00:16:52.880一个慢性阻塞性肺病00:16:52.880 --> 00:16:53.640及肺疾病00:16:53.640 --> 00:16:57.240的一个现在的一个先新的发发展00:16:57.240 --> 00:17:00.260以及他的疾病的总体的认识00:17:00.520 --> 00:17:02.240那么今天的分享就到这里00:17:02.240 --> 00:17:03.340谢谢大家