WEBVTT00:00:01.040 --> 00:00:05.200呃各位专家呃各位同道下午好00:00:05.200 --> 00:00:07.240呃我今天讲座的题目是00:00:07.240 --> 00:00:09.020急性上呼吸道感染00:00:09.240 --> 00:00:12.920呼吸领域的挑战与应对啊00:00:12.920 --> 00:00:15.040我是浦南医院耳鼻喉科的00:00:15.040 --> 00:00:16.420黄欣妍医生00:00:16.560 --> 00:00:17.280呃下面00:00:17.280 --> 00:00:19.840我从以下10个方面00:00:19.840 --> 00:00:22.540来介绍一下我这次的讲座00:00:23.080 --> 00:00:25.720第一部分急性上呼吸道感染00:00:25.720 --> 00:00:31.460钙素钙素呃先看一下疾病的定义00:00:31.520 --> 00:00:33.260急性上呼吸道感染00:00:33.280 --> 00:00:37.920是指从外鼻孔至环状软骨下缘00:00:37.920 --> 00:00:42.620包括鼻腔咽或喉部急性炎症的肿称00:00:43.160 --> 00:00:44.760包括普通感冒00:00:44.760 --> 00:00:47.420急性病毒性咽炎和喉炎00:00:47.640 --> 00:00:49.820急性疱疹性咽峡炎00:00:49.920 --> 00:00:54.300急性咽结膜炎急性扁桃体炎等等00:00:55.160 --> 00:00:58.080疾病分类根据病因不同00:00:58.080 --> 00:01:01.420可以分为病毒性细菌性00:01:02.920 --> 00:01:06.380和其他病原体引起的上呼吸道感染00:01:06.480 --> 00:01:10.460病毒性感染占70%-80%00:01:10.640 --> 00:01:13.900如鼻病毒冠状病毒腺病毒等等00:01:14.640 --> 00:01:16.680流行病学特点呃00:01:16.680 --> 00:01:18.040急性上呼吸道感染00:01:18.040 --> 00:01:20.380是呼吸道常见传染病00:01:20.400 --> 00:01:22.840可通过含有病毒的飞沫00:01:22.840 --> 00:01:26.660或被污染的手和用具传播00:01:26.800 --> 00:01:29.080多散发于冬春季节00:01:29.080 --> 00:01:32.060常在气候突变时流行00:01:32.120 --> 00:01:34.180由于病毒类型较多00:01:34.280 --> 00:01:38.100且各种病毒间无交叉免疫00:01:39.920 --> 00:01:42.880啊人们对各种病毒感染后00:01:42.880 --> 00:01:44.820产生的免疫力弱00:01:45.000 --> 00:01:47.900且短暂不可多次发病00:01:50.080 --> 00:01:52.180病因与发病机制00:01:55.680 --> 00:02:00.280呃病因呃两个方面是最常见的00:02:00.280 --> 00:02:02.020一个是病毒感染00:02:02.840 --> 00:02:07.380上赶70%-80%是由病毒引起00:02:07.560 --> 00:02:10.360如鼻病毒冠状病毒腺病毒00:02:10.360 --> 00:02:12.420流感病毒副流感病毒00:02:12.440 --> 00:02:14.140呼吸道合胞病毒00:02:14.280 --> 00:02:17.100埃可病毒和可萨奇病毒等等00:02:17.280 --> 00:02:18.580病毒感染后00:02:18.760 --> 00:02:22.260可引起鼻腔和咽黏膜充血水肿00:02:23.040 --> 00:02:24.580上皮细胞破坏00:02:24.680 --> 00:02:27.020伴少量单核细胞浸润00:02:27.080 --> 00:02:31.060浆液性及粘液性炎性渗出00:02:32.200 --> 00:02:33.260细菌感染00:02:33.320 --> 00:02:35.080以口腔定植菌00:02:35.080 --> 00:02:37.900溶血性链球菌最为多见00:02:38.080 --> 00:02:40.340其次为流感嗜血杆菌00:02:40.560 --> 00:02:43.620肺炎链球菌和葡萄球菌等等00:02:43.760 --> 00:02:46.180偶见葛兰阴性杆菌00:02:46.760 --> 00:02:48.520继发细菌感染者00:02:48.520 --> 00:02:52.180出现中性粒细胞浸润及脓性分泌物00:02:53.360 --> 00:02:57.180发病机制主要是以下几个方面00:02:57.600 --> 00:02:59.540免疫防御机制受损00:02:59.560 --> 00:03:01.000当机体或呼吸道00:03:01.000 --> 00:03:03.540局部防御功能降低时00:03:03.760 --> 00:03:06.000如黏膜屏障功能受损00:03:06.000 --> 00:03:08.420纤毛运动障碍等00:03:08.600 --> 00:03:11.900病原体容易侵入并繁殖00:03:11.960 --> 00:03:15.780免疫细胞和免疫因子的活性降低00:03:16.920 --> 00:03:19.180无法有效清除病原体00:03:19.240 --> 00:03:21.820导致感染的发生和发展00:03:22.200 --> 00:03:25.380炎性反应过程病原体侵入后00:03:25.440 --> 00:03:27.580激活局部免疫细胞00:03:27.640 --> 00:03:29.340释放炎性介质00:03:29.360 --> 00:03:33.940如主氨白细胞介素肿瘤坏死因子等00:03:34.280 --> 00:03:37.220引起血管扩张通透性增加00:03:37.280 --> 00:03:38.920黏膜充血水肿等00:03:38.920 --> 00:03:39.980炎性反应00:03:40.400 --> 00:03:43.900炎症反应进一步导致粘液分泌增多00:03:44.000 --> 00:03:45.580纤毛运动受阻00:03:45.840 --> 00:03:48.060清除病原体的能力下降00:03:48.120 --> 00:03:49.740形成恶性循环00:03:50.520 --> 00:03:52.320病原体的致病作用00:03:52.320 --> 00:03:55.820不同病原体具有不同的致病机制00:03:55.880 --> 00:03:59.780如病毒可直接损伤呼吸道上皮细胞00:03:59.880 --> 00:04:02.460细菌可产生毒素和酶类00:04:02.640 --> 00:04:04.140破坏组织结构00:04:04.200 --> 00:04:05.740加重炎症反应00:04:06.520 --> 00:04:10.400病原体的致病力与其独立因子00:04:10.400 --> 00:04:13.540侵袭力繁殖能力等因素有关00:04:13.840 --> 00:04:15.520强致病力的病原体00:04:15.520 --> 00:04:17.820更容易引起严重的感染00:04:23.280 --> 00:04:23.600呃00:04:23.600 --> 00:04:27.900第三部分临床表现以诊断临床表现00:04:27.920 --> 00:04:31.380局部症状与鼻部症状为主00:04:31.400 --> 00:04:33.940初期有咽干喉痒00:04:34.880 --> 00:04:36.080记之打喷嚏00:04:36.080 --> 00:04:37.960鼻塞可致流泪00:04:37.960 --> 00:04:38.980呼吸不畅00:04:39.880 --> 00:04:41.680流涕开始为清水样00:04:41.680 --> 00:04:44.420两两到3天后变稠00:04:44.520 --> 00:04:45.880可出现声嘶00:04:45.880 --> 00:04:48.940干咳或咳少量粘液00:04:49.160 --> 00:04:52.440鼻和咽喉部黏膜充血和水肿00:04:52.440 --> 00:04:53.660可伴咽痛00:04:54.200 --> 00:04:56.880全身症状轻且短暂00:04:56.880 --> 00:04:58.860如畏寒或头痛00:04:58.880 --> 00:05:00.400纳差或引起00:05:00.400 --> 00:05:03.300而咽鼓管炎可致听力减退00:05:03.440 --> 00:05:04.680如无并发症00:05:04.680 --> 00:05:06.380一周左右痊愈00:05:06.600 --> 00:05:09.360并发症本病如不及00:05:09.360 --> 00:05:10.220时治疗00:05:10.360 --> 00:05:13.860部分患者可并发急性鼻窦炎中耳炎00:05:13.960 --> 00:05:15.540气管支气管炎00:05:16.320 --> 00:05:19.220少数患者可继发病毒性心肌炎00:05:19.400 --> 00:05:21.220风湿液风湿热00:05:21.280 --> 00:05:22.860肾小球肾炎等00:05:23.640 --> 00:05:28.140诊断要点呃一病史与体征00:05:28.320 --> 00:05:31.180根据患者的病史流行情况00:05:31.920 --> 00:05:33.860鼻咽部的症状和体征00:05:34.000 --> 00:05:37.560结合周围血项和胸部x线检查00:05:37.560 --> 00:05:39.380可做出临床诊断00:05:39.720 --> 00:05:44.580血清学检查病毒分离和细菌培养等00:05:44.640 --> 00:05:47.580可明确病因诊断00:05:48.640 --> 00:05:52.360实验室检查者常规检查00:05:52.360 --> 00:05:53.720病毒感染者00:05:53.720 --> 00:05:57.140白细胞计数多为正常或偏低00:05:57.520 --> 00:05:59.460淋巴细胞比例增高00:06:00.840 --> 00:06:05.140细菌感染者则白细胞计数增多00:06:05.800 --> 00:06:07.540中性粒细胞增高00:06:07.720 --> 00:06:09.980有合左移现象00:06:10.640 --> 00:06:12.160影像学检查00:06:12.160 --> 00:06:13.880胸部x线检查00:06:13.880 --> 00:06:17.660可帮助排除以下呼吸道感染00:06:18.000 --> 00:06:19.180如肺炎等00:06:19.280 --> 00:06:22.020对于怀疑有并发症的患者00:06:22.040 --> 00:06:23.840如鼻窦炎中耳炎等00:06:23.840 --> 00:06:26.500可进行相应的影像学检查00:06:26.720 --> 00:06:29.900如鼻窦CT中耳磁共振等00:06:30.840 --> 00:06:34.140第四部分治疗与预防00:06:35.560 --> 00:06:38.460治疗原则主要是对症治疗00:06:39.280 --> 00:06:41.580鼻塞可用伪麻黄碱00:06:41.800 --> 00:06:46.420频繁喷嚏流涕可给予抗过敏药物00:06:46.480 --> 00:06:49.060咳嗽明显可使用镇咳药00:06:49.480 --> 00:06:53.360头痛发热全身肌肉酸痛者00:06:53.360 --> 00:06:55.340可给予解热镇痛药00:06:55.760 --> 00:06:58.900对症治疗可缓解患者的不适症状00:06:59.040 --> 00:07:00.540提高生活质量00:07:01.440 --> 00:07:02.860抗菌药物治疗00:07:02.880 --> 00:07:05.580普通感冒无需使用抗生素00:07:05.640 --> 00:07:07.120并发细菌感染时00:07:07.120 --> 00:07:11.140可选用口服青霉素第一代头孢菌素00:07:11.880 --> 00:07:15.280大环内酯类或喹诺酮类药物00:07:15.280 --> 00:07:17.000抗菌药物的选择00:07:17.000 --> 00:07:19.180应根据病原体的种类00:07:19.320 --> 00:07:20.780药物的敏感性00:07:21.400 --> 00:07:25.140以及患者的病情等因素综合考虑00:07:34.160 --> 00:07:36.340对于免疫缺陷患者00:07:36.360 --> 00:07:40.620可早期常规使用抗病毒药物治疗00:07:40.680 --> 00:07:42.980如利巴韦林奥司他韦00:07:44.520 --> 00:07:45.820预防措施00:07:47.440 --> 00:07:49.480主要是增强免疫力00:07:49.480 --> 00:07:51.980比如加强锻炼身体00:07:52.080 --> 00:07:53.380增强体质00:07:53.440 --> 00:07:55.500提高机体抗病能力00:07:55.760 --> 00:07:59.060进食清淡富有营养的饮食00:07:59.120 --> 00:08:01.720多饮水注意休息00:08:01.720 --> 00:08:02.900避免劳累00:08:03.800 --> 00:08:05.900避免接触病原体00:08:06.360 --> 00:08:10.180冬季春节尽量减少去公共场所00:08:10.320 --> 00:08:12.300注意呼吸道隔离00:08:12.360 --> 00:08:13.940防止交叉感染00:08:14.000 --> 00:08:16.300保持室内空气流通00:08:17.080 --> 00:08:18.260疫苗接种00:08:21.200 --> 00:08:24.060除国家免疫规划的疫苗外00:08:24.480 --> 00:08:29.340应对应针对高危人群进行免疫接种00:08:29.400 --> 00:08:32.040建议接种流感疫苗啊00:08:32.040 --> 00:08:36.000每年完成肺炎链球菌疫苗00:08:36.000 --> 00:08:39.700呼吸道荷包病毒新冠病毒疫苗接种00:08:40.480 --> 00:08:44.160接触Ari的医务人员如发热00:08:44.160 --> 00:08:48.460门诊建议接种流感新冠病毒疫苗00:08:50.120 --> 00:08:55.680案例研究案例分析一患儿男00:08:55.680 --> 00:08:58.1808岁发热咳嗽7天00:08:58.680 --> 00:09:00.780体温最高39摄氏度00:09:00.920 --> 00:09:05.460制服退热药后体温可降至37度00:09:05.680 --> 00:09:11.100但隔4-6小时后又腹后腹又上升00:09:11.200 --> 00:09:12.900无畏寒和寒战00:09:13.040 --> 00:09:15.880伴咳嗽初为单声咳无痰00:09:15.880 --> 00:09:19.180不伴咽痛流涕声嘶及喘息00:09:19.640 --> 00:09:22.180亦无呕吐及抽搐00:09:22.960 --> 00:09:24.820就诊于医院门诊00:09:24.880 --> 00:09:29.960血常规提示白细胞9乘以10的9次方00:09:29.960 --> 00:09:35.300每升中性分中性粒细胞 65%00:09:35.480 --> 00:09:37.460淋巴细胞35%00:09:37.640 --> 00:09:39.460诊断为上呼吸道感染00:09:39.520 --> 00:09:43.340给予头孢克罗双黄连等口服治疗00:09:43.480 --> 00:09:45.360患儿应发热病00:09:45.360 --> 00:09:47.640咳嗽加重为刺激性干咳00:09:47.640 --> 00:09:49.740偶有少量白色粘液00:09:49.880 --> 00:09:52.900两天前再次就诊于医院门诊00:09:52.920 --> 00:09:56.040给予头孢塞沃钠静脉点滴00:09:56.040 --> 00:09:58.180两天症状无好转00:09:58.400 --> 00:10:00.720患儿因发热且咳嗽加重00:10:00.720 --> 00:10:03.140拍胸片可见右肺上炎00:10:04.200 --> 00:10:06.160可见片状密度增高00:10:06.160 --> 00:10:07.480影密度较均匀00:10:07.480 --> 00:10:08.680为进一步诊治00:10:08.680 --> 00:10:10.100收至入院00:10:12.880 --> 00:10:14.200患儿女 3岁00:10:14.200 --> 00:10:15.340发热5天00:10:15.400 --> 00:10:17.540测体温39.7度00:10:17.960 --> 00:10:21.540无寒颤口服布洛芬混原液后00:10:21.880 --> 00:10:23.120发热短暂缓解00:10:23.120 --> 00:10:25.320咽痛无咳嗽咳痰00:10:25.320 --> 00:10:26.520无呕吐腹泻00:10:26.520 --> 00:10:28.400无血尿精神欠佳00:10:28.400 --> 00:10:32.420饮食差在当地门诊输液治疗3天00:10:32.520 --> 00:10:34.380患儿应反复发热00:10:34.520 --> 00:10:36.840现体温39度无00:10:36.840 --> 00:10:39.720寒颤口服口服布洛芬混悬液00:10:39.720 --> 00:10:43.580后来儿科以发热原因待查收入院00:10:43.800 --> 00:10:48.720血常规是白细胞13.9乘以10的9次方00:10:48.720 --> 00:10:51.760每升淋巴64.5%00:10:51.760 --> 00:10:54.100中心率29.3%00:10:55.400 --> 00:10:58.260红细胞血红蛋白血小板基本正常00:10:58.400 --> 00:11:00.420诊断为上呼吸道感染00:11:00.920 --> 00:11:03.360按照安全经济有效原则00:11:03.360 --> 00:11:06.820给予抗感染退热对症支持治疗00:11:07.800 --> 00:11:09.060治疗与转归00:11:09.240 --> 00:11:11.940经抗感染及对症支持治疗00:11:12.040 --> 00:11:13.700患儿偶有咳嗽00:11:13.800 --> 00:11:15.320无咳痰喘息00:11:15.320 --> 00:11:18.340无发热精神饮食一般00:11:18.440 --> 00:11:19.980口唇无发干00:11:20.200 --> 00:11:21.080咽无充血00:11:21.080 --> 00:11:22.620扁桃体无肿大00:11:22.720 --> 00:11:24.040双肺呼吸阴清00:11:24.040 --> 00:11:25.400未闻及干湿00:11:25.400 --> 00:11:27.560罗音心律齐00:11:27.560 --> 00:11:28.360心阴有力00:11:28.360 --> 00:11:30.540心弦曲未闻及杂音00:11:30.600 --> 00:11:32.480服软肝脾胃下胃00:11:32.480 --> 00:11:35.420胃处及四肢肌张力正常00:11:35.440 --> 00:11:37.320上呼吸道感染已治愈00:11:37.320 --> 00:11:38.260可出院00:11:39.240 --> 00:11:42.660经抗啊案例二经抗感染及对症治疗00:11:42.680 --> 00:11:43.960患儿偶有咳嗽00:11:43.960 --> 00:11:45.520无咳痰喘息00:11:45.520 --> 00:11:47.860无发热精神饮食一般00:11:48.000 --> 00:11:49.160口唇无发干00:11:49.160 --> 00:11:50.240咽无充血00:11:50.240 --> 00:11:51.660扁桃体无肿大00:11:51.680 --> 00:11:53.200双肺呼吸音清00:11:53.200 --> 00:11:54.240未闻及干湿00:11:54.240 --> 00:11:58.100落阴心律其心阴有力00:11:58.200 --> 00:12:00.300心前区未闻及杂音00:12:00.320 --> 00:12:01.680服软肝脾肋下00:12:01.680 --> 00:12:04.540胃处及四肢肌张力正常00:12:04.680 --> 00:12:06.400上呼吸道感染已治愈00:12:06.400 --> 00:12:07.300可出院00:12:08.240 --> 00:12:10.500呃最新的研究进展00:12:11.960 --> 00:12:15.920病原学研究新型病毒的发现近年来00:12:15.920 --> 00:12:18.500随着分子生物学技术的发展00:12:18.560 --> 00:12:22.080一些新型呼吸道病毒被陆续发现00:12:22.080 --> 00:12:26.020如人偏肺病毒博卡病毒等等00:12:26.560 --> 00:12:27.720这些新型病毒00:12:27.720 --> 00:12:30.200在急性上呼吸道感染中的作用00:12:30.200 --> 00:12:32.000逐渐受到关注00:12:32.000 --> 00:12:32.880研究发现00:12:32.880 --> 00:12:36.400它们可引起类似普通感冒的症状00:12:36.400 --> 00:12:38.580具且具有一定的流行性00:12:39.080 --> 00:12:40.900病原体耐药性研究00:12:41.040 --> 00:12:42.960细菌性上呼吸道感染中00:12:42.960 --> 00:12:43.920肺炎链球菌00:12:43.920 --> 00:12:45.840流感嗜血杆菌等00:12:45.840 --> 00:12:49.080常见病原体的耐药性问题00:12:49.080 --> 00:12:50.260日益突出00:12:50.280 --> 00:12:53.400耐药机制主要包括呃00:12:53.400 --> 00:12:55.360细菌产生酶类00:12:55.360 --> 00:12:57.240破坏抗生素改00:12:57.240 --> 00:12:59.380变细胞靶位结构00:12:59.440 --> 00:13:03.460减少细细菌细胞膜通透性等00:13:03.760 --> 00:13:05.880微生物主研主学00:13:05.880 --> 00:13:10.560研究人体呼吸道微生物组00:13:10.560 --> 00:13:12.820是一个复杂的生态环境00:13:12.880 --> 00:13:15.940正常情况下维持着一定的平衡00:13:16.080 --> 00:13:17.220研究发现00:13:17.280 --> 00:13:19.200急性上呼吸道感染时00:13:19.200 --> 00:13:21.760呼吸道微生物组的结构和功能00:13:21.760 --> 00:13:22.900发生改变00:13:22.960 --> 00:13:24.740有益菌数量减少00:13:25.040 --> 00:13:26.940友善菌数量增多00:13:26.960 --> 00:13:30.860这种失衡有害菌数量增多00:13:31.480 --> 00:13:32.240这种失衡00:13:32.240 --> 00:13:34.940可能与感染的发生和发展有关00:13:36.800 --> 00:13:41.540诊快速诊断技术研究快速诊断技术00:13:43.120 --> 00:13:45.460核酸检测技术不断进步00:13:45.560 --> 00:13:47.220如实时荧光00:13:47.280 --> 00:13:51.400定量PCR等温扩增技术等00:13:51.400 --> 00:13:55.460可快速准确的检测出病原体的核酸00:13:55.560 --> 00:13:57.220缩短了诊断时间00:13:57.320 --> 00:14:00.460抗原检测技术也在不断发展00:14:00.480 --> 00:14:02.540如免疫承息法00:14:02.920 --> 00:14:04.900美联免疫吸附试验等00:14:05.000 --> 00:14:09.000具有操作简便结果快速的特点00:14:09.000 --> 00:14:12.920适用于基层医疗机构和现场00:14:12.920 --> 00:14:14.140快速筛查00:14:14.760 --> 00:14:16.540多重病原体检测00:14:16.600 --> 00:14:18.360由于急性上呼吸道感染00:14:18.360 --> 00:14:22.500可能由多种病原体混合感染引起00:14:22.520 --> 00:14:26.720因此多种多重病原体检测技术00:14:26.720 --> 00:14:27.900应运而生00:14:28.080 --> 00:14:32.340如呼吸道病原体多重核酸检测芯片00:14:32.360 --> 00:14:34.700可同时检测出多种病毒00:14:34.760 --> 00:14:37.420细菌和支原体等病原体00:14:38.760 --> 00:14:42.300提高了诊断的准确性和全面性00:14:43.280 --> 00:14:44.620影像学技术00:14:44.680 --> 00:14:46.040高分辨率CT00:14:46.040 --> 00:14:48.740磁共振成像等影像学技术00:14:48.840 --> 00:14:51.320在急性上呼吸道感染的诊断中00:14:51.320 --> 00:14:53.260也发挥着重要作用00:14:53.960 --> 00:14:57.520他们可更清晰地显示鼻窦00:14:57.520 --> 00:15:01.560咽部喉部等部位的病变情况00:15:01.560 --> 00:15:04.940有助于早期发现并发症00:15:05.400 --> 00:15:07.300如鼻窦炎咽炎等00:15:08.120 --> 00:15:11.820治疗策略研究新型抗病毒药物00:15:13.480 --> 00:15:14.160呃00:15:14.160 --> 00:15:17.480随着对病毒结构和功能的深入了解00:15:17.480 --> 00:15:20.820一些新型抗病毒药物不断研发出来00:15:21.000 --> 00:15:24.760如针对流感病毒的神经氨酸酶抑00:15:24.760 --> 00:15:27.520制剂奥司他韦帕拉米韦等00:15:27.520 --> 00:15:30.300可有效抑制病毒的复制和传播00:15:30.640 --> 00:15:32.380对呼吸道合胞病毒00:15:32.400 --> 00:15:35.200一般伪磷雾化吸入可治疗00:15:35.200 --> 00:15:36.280可缓解症状00:15:36.280 --> 00:15:37.460缩短病程00:15:37.800 --> 00:15:39.260免疫调节治疗00:15:39.840 --> 00:15:42.460是近年来研究的热点之一00:15:42.480 --> 00:15:45.800通过免疫调节机体的免疫功能00:15:45.800 --> 00:15:48.420增强机体对病原体的清除力00:15:48.520 --> 00:15:51.980如使用干扰素胸腺肽等免疫调节剂00:15:52.280 --> 00:15:54.580可提高机体的抗病毒能力00:15:54.600 --> 00:15:56.880对于免疫功能低下的患者00:15:56.880 --> 00:15:59.040可适当使用免疫球蛋白等00:15:59.040 --> 00:16:00.980进行免疫治疗00:16:01.320 --> 00:16:02.460中医药治疗00:16:02.840 --> 00:16:03.360中医药00:16:03.360 --> 00:16:06.000在急性上呼吸道感染的治疗中00:16:06.000 --> 00:16:07.280具有独特的优势00:16:07.280 --> 00:16:10.560许多中药具有清热解毒疏风解表00:16:10.560 --> 00:16:12.300止咳化痰等功效00:16:12.520 --> 00:16:15.900如银翘散桑菊饮等经典方剂00:16:16.440 --> 00:16:20.060以及连花清瘟板蓝根颗粒等中成药00:16:20.120 --> 00:16:23.020在临床应用中取得了良好的疗效00:16:23.680 --> 00:16:26.940挑战临床挑战以应对策略00:16:28.240 --> 00:16:32.000临床桥段有以下三个方面第一个00:16:32.000 --> 00:16:33.580病原体的复杂性00:16:33.720 --> 00:16:35.960临床症状的多样性00:16:35.960 --> 00:16:37.940患者群体的特殊性00:16:38.400 --> 00:16:41.080应对策略主要是规范00:16:41.080 --> 00:16:42.860规范诊断流程00:16:42.960 --> 00:16:44.760建立完善的诊断流程00:16:44.760 --> 00:16:46.200结合病史体征00:16:46.200 --> 00:16:47.280实验室检查00:16:47.280 --> 00:16:49.820影像学检查等多方面信息00:16:49.960 --> 00:16:51.500进行综合判断00:16:51.800 --> 00:16:53.120对于疑似病例00:16:53.120 --> 00:16:55.120及时进行病原学检测00:16:55.120 --> 00:16:56.620明确病原体00:16:56.640 --> 00:16:58.340为治疗提供依据00:16:58.920 --> 00:17:00.540个体化治疗方案00:17:00.760 --> 00:17:02.600根据患者的具体情况00:17:02.600 --> 00:17:05.080制定个体化的治疗方案00:17:05.080 --> 00:17:07.580包括药物选择剂量调整00:17:07.800 --> 00:17:08.980疗程确定等00:17:09.000 --> 00:17:12.220对重症患者加强监护及支持治疗00:17:12.320 --> 00:17:13.980及时调整治疗方案00:17:14.080 --> 00:17:17.600对轻症患者注重对症治疗和护理00:17:17.600 --> 00:17:18.740促进康复00:17:19.279 --> 00:17:21.159多学科协作00:17:21.159 --> 00:17:23.119急性上呼吸道感染的诊治00:17:23.119 --> 00:17:25.079需要多学科的协作00:17:25.079 --> 00:17:28.539如呼吸科感染科儿科老年科等00:17:28.559 --> 00:17:30.480加强学科间的00:17:30.480 --> 00:17:31.900沟通与合作00:17:32.000 --> 00:17:35.380共同探讨疾病的诊断和治疗方案00:17:35.440 --> 00:17:37.460提高诊疗水平00:17:37.880 --> 00:17:39.780预防与控制策略00:17:40.200 --> 00:17:41.820个人预防措施00:17:41.920 --> 00:17:44.520呃主要是增强个人卫生意识00:17:44.520 --> 00:17:46.100加强个人防护00:17:46.200 --> 00:17:47.780提高自身免疫力00:17:48.480 --> 00:17:52.120社区预防措施开展健康教育00:17:52.120 --> 00:17:53.740加强环境消毒00:17:53.760 --> 00:17:55.160建立监测预警00:17:55.160 --> 00:17:58.220机室医疗机构防控措施00:17:58.400 --> 00:18:00.620呃一个是加强患者管理00:18:00.760 --> 00:18:04.120严格执行医院感防控制度00:18:04.120 --> 00:18:06.660提高医务人员的防控意识00:18:07.200 --> 00:18:11.480未来展望研究方向包括病原体研究00:18:11.480 --> 00:18:14.500诊断技术研究治疗策略研究00:18:15.440 --> 00:18:17.220预防与控制策略00:18:17.400 --> 00:18:20.800呃包括公共卫生体系建设00:18:20.800 --> 00:18:22.660疫苗研发与接种00:18:22.760 --> 00:18:24.780健康教育与促进00:18:25.480 --> 00:18:29.120参考文献主要是哦00:18:29.120 --> 00:18:30.100谢谢大家