WEBVTT00:00:01.360 --> 00:00:06.900大家好今天我们要讲的是理化因素所致的肺部疾病00:00:07.120 --> 00:00:15.700气道灼伤与类脂性肺炎啊我们主要从以下五个方面来讲述00:00:15.920 --> 00:00:20.300第一个部分是理化因素所致肺部疾病的概述00:00:20.440 --> 00:00:22.820第二部分是气道灼伤00:00:23.440 --> 00:00:26.140第三部分是类脂性肺炎00:00:26.240 --> 00:00:30.420第四部分是理化因素所致肺部疾病的预防00:00:30.520 --> 00:00:35.700最后一部分是理化因素所致肺部疾病的政策与保障00:00:36.520 --> 00:00:41.860首先我们要讲一下理化因素所致肺部疾病的概数00:00:42.640 --> 00:00:45.260啊理化因素与肺部疾病00:00:45.520 --> 00:00:47.060理化因素的定义00:00:47.320 --> 00:00:53.380理化因素是指物理和化学因素如高温有害气体矿物油等00:00:53.440 --> 00:00:55.500可引起肺部损伤00:00:56.000 --> 00:00:59.260常见的理化因素有高温气流00:00:59.400 --> 00:01:07.020烟雾化学毒气矿物油汽油等这些因素可导致气道灼伤和类质性肺炎00:01:07.680 --> 00:01:09.860嗯疾病的范围与危害00:01:10.080 --> 00:01:16.060理化因素所致的肺部疾病包括气道灼伤类直性肺炎等00:01:16.120 --> 00:01:18.340严重时可危及生命00:01:19.760 --> 00:01:30.580第二部分我们要来讲一下气道灼伤啊它的病因与发病机制啊吸入性损伤是它的智商原因00:01:30.600 --> 00:01:46.340比如吸入高热气流烟雾化邪毒气等可导致气道黏膜充血水肿坏死啊发病机制是经过前面的病因热力和化学物质作用于气道00:01:46.480 --> 00:01:48.220引起炎症反应00:01:48.320 --> 00:01:50.820导致气道狭窄阻塞00:01:52.000 --> 00:01:58.260容易患此类疾病的人群主要有嗯常见于火灾现场00:01:58.280 --> 00:02:00.700化工厂事故现场的人员00:02:00.760 --> 00:02:04.100以及长期接触有害气体的工人00:02:04.960 --> 00:02:11.340嗯临床表现主要有以下两个方面呼吸系统的症状00:02:11.360 --> 00:02:18.540主要包括咳嗽咳痰呼吸困难喉部疼痛声音嘶哑等症状00:02:19.360 --> 00:02:29.580全身症状可出现发热低氧血症休克等常见的并发症包括肺部感染肺水肿呼吸衰竭等00:02:31.080 --> 00:02:36.060该类疾病的诊断与检查主要包括下面几个方法00:02:36.440 --> 00:02:54.100诊断依据就是结合患者的病史临床表现体格检查和辅助检查进行诊断检查方法主要用于啊主要常见肺部x光或ct检查可以观察到气道和肺部的损伤情况00:02:54.560 --> 00:02:59.300纤维支气管镜检查可以直接观察气道损伤程度00:03:00.040 --> 00:03:01.020鉴别诊断00:03:01.400 --> 00:03:02.420主要有00:03:02.680 --> 00:03:07.740要和其他原因引起的呼吸困难咳嗽等疾病相鉴别00:03:07.880 --> 00:03:09.620如哮喘肺炎等00:03:11.040 --> 00:03:13.300该类疾病的治疗与预后00:03:13.520 --> 00:03:17.140其治疗原则是保持呼吸道通畅00:03:17.720 --> 00:03:19.500预防和控制感染00:03:19.560 --> 00:03:21.100纠正低氧血症00:03:21.520 --> 00:03:25.820常见的治疗方法有吸氧气管切开00:03:25.920 --> 00:03:29.180机械通气抗感染治疗等00:03:29.600 --> 00:03:32.420早期诊断和治疗可改善预后00:03:32.520 --> 00:03:36.060但严重者可遗留气道狭窄等后遗症00:03:37.360 --> 00:03:40.460第三部分我们来讲一下类脂性肺炎00:03:40.960 --> 00:03:51.420其病因与发病机制是啊外源性的类脂性肺炎是由于吸入矿物油植物油动物油等酯类物质00:03:51.440 --> 00:03:54.100可引起肺部炎症和纤维化00:03:54.480 --> 00:04:03.700内源性的类脂性肺炎主要是因为肺癌支气管扩张放射治疗等疾病的被并发症00:04:03.880 --> 00:04:06.740可引起肺部的局限性病变00:04:07.400 --> 00:04:12.900其发病机制是因为酯类物质被巨噬细胞吞噬后00:04:12.920 --> 00:04:16.180可引起肺泡间质增厚水肿00:04:16.280 --> 00:04:18.220导致肺纤维化00:04:19.400 --> 00:04:27.260其临床表现主要包括咳嗽活动后呼吸困难胸痛咯血等00:04:27.760 --> 00:04:34.460其病发部分患者可以出现低热盗汗乏力体重减轻等全身症状00:04:35.040 --> 00:04:38.940并发症主要见于肺部感染肺心病00:04:39.040 --> 00:04:41.700严重者也可以见到呼吸衰竭00:04:43.200 --> 00:04:47.620其诊断依据主要是通过详细的询问病史00:04:47.720 --> 00:04:53.140结合痰液检查影像学检查和肺功能检查进行诊断00:04:53.800 --> 00:05:00.420检查方法主要包括啊痰液检查可以发现充满体质的巨噬细胞00:05:00.800 --> 00:05:05.940肺部x光或ct检查可以观察到肺部的病变00:05:06.560 --> 00:05:13.420其鉴别诊断主要常与肺癌肺结核细菌性肺炎等疾病进行鉴别00:05:14.680 --> 00:05:18.340该类疾病的治疗原则是外脂类00:05:18.400 --> 00:05:22.100外源性类脂性肺炎以对症治疗为主00:05:22.160 --> 00:05:26.540内源性类脂性肺炎需要先治疗其原发疾病00:05:27.080 --> 00:05:30.300常见的治疗方法有止咳抗感染00:05:30.480 --> 00:05:32.460支气管肺泡灌洗等00:05:32.480 --> 00:05:34.380必要时需要手术治疗00:05:34.840 --> 00:05:36.460嗯愈后的话00:05:36.560 --> 00:05:39.540外源性类脂性肺炎愈后较好00:05:40.680 --> 00:05:45.740肺源系有类脂性肺炎的预后和其原发病相关00:05:46.880 --> 00:05:52.140第四个部分我们要讲理化因素所致肺部疾病的预防00:05:53.280 --> 00:05:58.580个人防护首先我们要正确的佩戴防护装备00:05:58.960 --> 00:06:06.500比如在接触有害气体或者充满粉尘的环境中我们应该佩戴防毒面具00:06:06.920 --> 00:06:09.300防尘口罩等防护装备00:06:10.720 --> 00:06:13.140其次要定期更换与维护00:06:13.680 --> 00:06:18.620防护装备需要定期更换和维护从而确保其防护效果00:06:19.680 --> 00:06:22.980其次我们要养成良好的卫生习惯00:06:23.240 --> 00:06:26.540在工作后及时清洁面部和手部00:06:26.600 --> 00:06:28.580避免有害物质残留00:06:29.320 --> 00:06:34.900嗯对于工作场所的管理主要有以下几个方面开展00:06:35.800 --> 00:06:39.180首先是改善通气通风条件00:06:39.360 --> 00:06:42.220加强工作场所的通风换气00:06:42.360 --> 00:06:45.100降低有害气体和粉尘的浓度00:06:45.760 --> 00:06:52.180其次要采取安全措施在高温有害气体环境中工作时00:06:52.280 --> 00:06:54.300应采取安全措施00:06:54.360 --> 00:06:56.500如设置警示标志00:06:56.520 --> 00:06:58.220配备急救设备00:06:58.600 --> 00:07:01.420最后要定期检测与评估00:07:01.560 --> 00:07:07.140定期对工作场所中的有害物质浓度进行检测和评估00:07:07.600 --> 00:07:09.700及时发现和解决问题00:07:11.600 --> 00:07:17.460对于该类疾病的健康管理首先要定期体检00:07:17.760 --> 00:07:22.740定期进行职业健康检查早期发现肺部疾病00:07:23.360 --> 00:07:25.260及时采取干预措施00:07:26.360 --> 00:07:32.540其次要健康教育培训对劳动者进行职业健康教育和培训00:07:32.680 --> 00:07:36.340提高其对理化因素所致肺部疾病的认识00:07:36.920 --> 00:07:39.100最后要建立健康档案00:07:39.160 --> 00:07:45.540为劳动者建立职业健康档案记录其疾病史健康检查结果等信息00:07:47.120 --> 00:07:53.140最后我们来讲一下理化因素所致肺部疾病的政策与保障00:07:54.280 --> 00:07:58.420相关的法律法规与政策支持00:07:59.520 --> 00:08:04.900首先是我国制定了职业病防治法等法律法规00:08:05.000 --> 00:08:07.820规范了职业病防治工作00:08:08.960 --> 00:08:12.180再就是职业病的诊断与鉴定00:08:12.880 --> 00:08:19.860依据职业病诊断与鉴定管理办法劳动者可到职业病诊断机构进行诊断00:08:19.960 --> 00:08:23.500对诊断结果有异议的可申请鉴别00:08:24.480 --> 00:08:25.980啊可申请鉴定00:08:26.920 --> 00:08:29.060工伤保险与赔偿00:08:29.240 --> 00:08:39.420职业性肺病患者可依法享受工伤保险待遇获得医疗救治康复康复护理经济补偿等保障00:08:40.400 --> 00:08:43.540嗯用人单位的责任与义务00:08:43.800 --> 00:08:47.220第一是要提供安全工作的环境00:08:47.560 --> 00:08:53.420用人单位应该为劳动者提供符合职业卫生标准的工作环境00:08:53.520 --> 00:08:59.300采取有效措施控制职业危害啊00:08:59.760 --> 00:09:03.300第二是组织职业健康检查00:09:03.400 --> 00:09:09.100要定期组织劳动者进行职业健康检查及时发现职业病患者00:09:09.640 --> 00:09:12.020安排其进行治疗和康复00:09:13.120 --> 00:09:16.020第三点是开展职业健康教育00:09:16.120 --> 00:09:19.420对劳动者进行职业健康教育和培训00:09:19.560 --> 00:09:21.900使其了解职业防护00:09:22.560 --> 00:09:26.700职业危害防护知识掌握个人防护技能00:09:28.680 --> 00:09:32.340作为劳动者我们也有相应的权利与义务00:09:33.200 --> 00:09:36.740首先我们享有职业病健康保护权00:09:36.880 --> 00:09:39.820劳动者有权获得职业卫生保护00:09:39.880 --> 00:09:42.940包括了解工作场所职业危害00:09:43.000 --> 00:09:47.140接受职业健康检查享受工伤保险待遇等00:09:48.200 --> 00:09:54.540除了我们享有的义务我们应该履行职业病防治义呃义务00:09:54.800 --> 00:09:57.900劳动者应遵守职业病00:09:59.600 --> 00:10:08.380防治法律法规和用人单位规章制度正确佩戴防护装备积极参加职业健康教育和培训00:10:09.360 --> 00:10:11.980我们应该主动维护自身权益00:10:12.160 --> 00:10:15.620劳动者应该主动关注自身健康状态00:10:15.640 --> 00:10:18.340发现职业病症状及时就医00:10:18.640 --> 00:10:21.660依法维护自身合法权益00:10:25.520 --> 00:10:28.860呼吸是生命最基础的律动00:10:29.240 --> 00:10:34.140而肺部与库与气道则是这场律动的核心通道00:10:34.280 --> 00:10:37.260当物理化学因素意外侵入00:10:37.280 --> 00:10:43.220这条通道可能遭遇灼伤的剧痛或是被油脂悄悄堵塞00:10:43.280 --> 00:10:47.780这便是理化因素所致肺部疾病中极具代表性的00:10:48.040 --> 00:10:50.300气道灼伤与类脂性肺炎00:10:50.400 --> 00:10:52.380它们虽然诱因不同00:10:52.440 --> 00:10:53.660表现各异00:10:53.720 --> 00:10:57.060却都可能悄悄侵蚀呼吸功能00:10:57.160 --> 00:10:58.740甚至危及生命00:10:59.160 --> 00:11:05.100了解这两种疾病的来龙去脉是守护呼吸健康的重要一步00:11:07.440 --> 00:11:09.300首先是气道灼伤00:11:09.560 --> 00:11:29.420它的元凶元凶是多样的物理与化学因素是双重甲基的啊在日常生活和职业范围内我们要警惕下面的一些因素比如说高温气体干冷空气或者是激光微波等物理00:11:29.480 --> 00:11:35.020特殊的物理能量也可能破坏我们的气道上皮细胞引发损伤00:11:35.600 --> 00:11:37.740再就是化学性因素00:11:38.160 --> 00:11:41.020它更为隐秘而且危害更广00:11:41.120 --> 00:11:46.500常见的刺激性气体如氯气氨气二氧化硫00:11:46.720 --> 00:11:49.140清洁剂的混合气体00:11:49.560 --> 00:11:50.860农药物滴00:11:50.920 --> 00:11:54.580以及职业环境中的甲醛苯蒸汽00:11:54.600 --> 00:11:58.820也能通过呼吸道侵入引发化学性损伤00:11:59.920 --> 00:12:13.020再就是我们要重视症状的阶梯性加重从咳嗽到窒息是一种预警首先我们气道灼伤是啊00:12:13.360 --> 00:12:18.300逐步发生的他首先出现的症状是局部黏膜刺激症状00:12:18.360 --> 00:12:22.420如咽喉部灼热感干燥疼痛00:12:22.600 --> 00:12:25.780伴随着频繁的干咳声音嘶哑00:12:26.200 --> 00:12:28.660部分人会出现鼻塞流涕00:12:29.200 --> 00:12:31.500如果此时没有脱离环境00:12:31.680 --> 00:12:35.820症状就会向下下气道蔓延出现呼吸困难00:12:36.160 --> 00:12:41.620典型的比如说呼吸频率加快吸气时胸骨上窝凹陷00:12:42.440 --> 00:12:44.500甚至出现喘息胸闷00:12:44.560 --> 00:12:49.740这是气道黏膜水肿分泌物增多导致气道狭窄的信号00:12:50.400 --> 00:12:55.540严重灼伤时气道粘膜会出现水泡脱落形成假膜00:12:55.680 --> 00:12:58.820这些物质可阻塞气道引发窒息00:12:59.520 --> 00:13:07.620同时损伤的黏膜屏障会诱发感染出现发热和脓痰进一步加重呼吸衰竭00:13:09.160 --> 00:13:10.780在治疗方面00:13:11.280 --> 00:13:16.220时间很重要我们要分秒必争守护祈祷通畅00:13:16.600 --> 00:13:20.220现场急救需要遵循三不原则00:13:20.440 --> 00:13:24.060一个是立刻带患者脱离污染环境00:13:24.120 --> 00:13:26.260转移至空气新鲜处00:13:26.360 --> 00:13:28.180若为化学气体泄漏00:13:28.200 --> 00:13:30.140需向上风向撤离00:13:30.640 --> 00:13:36.300二若患者意识清醒和循住其低头前倾无力咳嗽00:13:36.400 --> 00:13:38.740排出气道内残留的刺激物00:13:39.080 --> 00:13:41.980三若患者出现呼吸困难窒息00:13:42.080 --> 00:13:46.420需立即拨打急救电话同时准备好人工呼吸设备00:13:46.760 --> 00:13:50.580避免因舌根后坠或分泌物阻塞加重缺氧00:13:55.520 --> 00:13:58.500而与气道灼上的急性突吸不同00:13:58.520 --> 00:14:01.420类脂性肺炎多是慢性潜伏00:14:01.480 --> 00:14:07.060由吸入脂肪或类脂性物质引起这些物质在肺泡内堆积00:14:07.120 --> 00:14:10.780逐渐破坏肺组织影响气体交换功能00:14:10.920 --> 00:14:14.260它们分为外源性与内源性两类00:14:14.280 --> 00:14:21.020其中外源性指性肺炎更常见与日常生活习惯密切相关00:14:23.640 --> 00:14:26.620类质性肺炎的症状缺乏特异性00:14:26.880 --> 00:14:31.060常被误认为是慢性支气管炎或者是哮喘00:14:31.120 --> 00:14:32.980导致延误诊断00:14:33.800 --> 00:14:43.140所以在诊断上面关键是找到酯类吸入证据避免与普通肺炎混淆00:14:46.360 --> 00:14:52.260气道灼伤与类质性肺炎虽发病机制不同但预防逻辑相通00:14:52.360 --> 00:14:56.620核心是减少理化因素对呼吸道的侵入00:14:56.680 --> 00:15:02.700尤其需关注特殊人群如如婴幼儿老年人职业暴露者的防护00:15:04.240 --> 00:15:07.100呼吸健康是生命质量的基石00:15:07.400 --> 00:15:12.300气道灼伤的急性危机与类脂性肺炎的慢性潜伏00:15:12.400 --> 00:15:17.380都在提醒我们关注呼吸细节规避潜在风险00:15:17.480 --> 00:15:20.940才能让生命的呼吸通道始终通畅00:15:21.240 --> 00:15:23.140一旦出现持续咳嗽00:15:23.200 --> 00:15:25.180呼吸困难等异常症状00:15:25.440 --> 00:15:26.700切勿拖延00:15:26.720 --> 00:15:28.300及时就医排查00:15:28.360 --> 00:15:31.580才能最大限度的减少肺部损伤00:15:31.600 --> 00:15:33.820守护呼吸健康00:15:34.160 --> 00:15:37.444今天的内容到此结束谢谢大家