WEBVTT00:00:07.560 --> 00:00:08.200大家好00:00:08.200 --> 00:00:10.940我是上海市普陀区中心医院00:00:11.120 --> 00:00:12.800急诊内科的主治医生00:00:12.800 --> 00:00:14.060我叫邵周俊00:00:14.960 --> 00:00:15.440今天00:00:15.440 --> 00:00:18.920我和大家分享一下肺部真菌病00:00:18.920 --> 00:00:22.140基础认知以症状表现00:00:24.680 --> 00:00:28.420我们来了解一下肺部真菌病的定义00:00:30.160 --> 00:00:31.400肺部真菌病00:00:31.400 --> 00:00:35.140是指由真菌引起的肺部感染性疾病00:00:36.880 --> 00:00:38.180在医学领域00:00:38.200 --> 00:00:40.620当真菌侵入人体肺部00:00:40.680 --> 00:00:43.900并在肺部组织中生长繁殖00:00:44.040 --> 00:00:45.720引发炎症反应00:00:45.720 --> 00:00:50.080对肺部的正常结构和功能造成破坏00:00:50.080 --> 00:00:53.180时被定义为肺部的真菌病00:00:53.760 --> 00:00:56.100例如在临床诊断中00:00:56.200 --> 00:00:58.940若通过痰液培养等检查00:00:59.040 --> 00:01:00.740发现特定真菌00:01:00.800 --> 00:01:04.580同时患者伴有发热咳嗽咳痰等00:01:05.880 --> 00:01:07.620肺部感染症状00:01:07.640 --> 00:01:11.180结合影像学显示肺部有异常病变00:01:11.480 --> 00:01:14.060即可依据相关诊断标准00:01:14.120 --> 00:01:16.220确诊为肺部真菌病00:01:18.480 --> 00:01:20.460肺部真菌病的地理00:01:22.640 --> 00:01:24.840与其他肺部疾病的区别00:01:24.840 --> 00:01:25.640鉴定00:01:25.960 --> 00:01:29.180肺部真菌病与常见的细菌性肺炎00:01:29.280 --> 00:01:30.900病毒性肺炎等00:01:30.960 --> 00:01:33.760在病症状和治疗方法上00:01:33.760 --> 00:01:35.500都有明显的区别00:01:36.080 --> 00:01:38.840细菌性肺炎多由细菌感染引起00:01:38.840 --> 00:01:40.100疾病较急00:01:40.240 --> 00:01:43.340高热咳脓产等症状较为突出00:01:43.560 --> 00:01:46.620病毒性肺炎则由病毒入侵导致00:01:46.760 --> 00:01:48.800症状可能相对较轻00:01:48.800 --> 00:01:50.900以干咳乏力等为主00:01:51.120 --> 00:01:54.760而肺部真菌病的症状相对不典型00:01:54.760 --> 00:01:56.400病程可能较长00:01:56.400 --> 00:01:58.680治疗上使用抗真菌药物00:01:58.680 --> 00:02:01.860而非针对细菌或病毒的药物00:02:02.280 --> 00:02:04.460比如在实际临床中00:02:04.560 --> 00:02:07.400曾有患者起初氨细菌性肺炎00:02:07.400 --> 00:02:08.860治疗效果不佳00:02:09.440 --> 00:02:12.660经进一步检查确诊为肺部真菌病00:02:12.800 --> 00:02:16.220调整治疗方案后病情才得到改善00:02:18.800 --> 00:02:21.100肺部真菌的常见种类00:02:22.560 --> 00:02:23.820念珠菌属00:02:24.160 --> 00:02:24.720念珠菌00:02:24.720 --> 00:02:27.780是肺部真菌中较为常见的一类00:02:27.840 --> 00:02:30.460其中白色念珠菌最为多见00:02:30.480 --> 00:02:33.080它广泛存在于自然界00:02:33.080 --> 00:02:34.820以及人体的口腔00:02:34.960 --> 00:02:36.940胃肠道阴道等部位00:02:37.480 --> 00:02:39.660当人体免疫力下降时00:02:39.680 --> 00:02:42.260如长期使用广谱抗菌素00:02:42.720 --> 00:02:43.680糖皮质激素00:02:43.680 --> 00:02:46.980或者患有艾滋病的免疫缺陷疾病时00:02:47.040 --> 00:02:49.880白色念珠菌就可能大量繁殖00:02:49.880 --> 00:02:51.120并侵入肺部00:02:51.120 --> 00:02:52.220引发感染00:02:52.400 --> 00:02:55.620据统计在医院获得性肺部感染中00:02:55.640 --> 00:02:56.760念珠菌感染00:02:56.760 --> 00:02:59.820约占百分之十到百分之二十00:03:00.040 --> 00:03:01.960例如有一位长期住院00:03:01.960 --> 00:03:05.820且接受多种抗菌素治疗的老年患者00:03:05.840 --> 00:03:09.060后期出现发热咳嗽加重等症状00:03:09.160 --> 00:03:10.280经检查发现00:03:10.280 --> 00:03:13.220是白色念珠菌引起的肺部感染00:03:15.720 --> 00:03:16.840肺部真菌呢00:03:16.840 --> 00:03:20.340常见种类有曲霉曲霉属00:03:20.800 --> 00:03:23.560曲霉属真菌在环境中分布广泛00:03:23.560 --> 00:03:26.660常见的有烟曲霉黄曲霉等00:03:26.920 --> 00:03:28.700曲霉容易在潮湿00:03:28.720 --> 00:03:31.020通风不良的环境中生长00:03:31.080 --> 00:03:33.740如发霉的谷物污染等00:03:33.960 --> 00:03:36.540当人们吸入含有曲霉菌00:03:36.880 --> 00:03:38.400孢子的空气后00:03:38.400 --> 00:03:39.980在一定条件下00:03:40.080 --> 00:03:42.620孢子可在肺部发芽生长00:03:42.720 --> 00:03:44.620导致肺部曲霉病00:03:44.680 --> 00:03:48.800在一些从事农业园艺工作的人群中00:03:48.800 --> 00:03:52.360由于接触曲霉孢子的机会较多00:03:52.360 --> 00:03:54.220发病风险相对较高00:03:54.640 --> 00:03:55.680有研究表明00:03:55.680 --> 00:03:58.060在某些特定职业环境中00:03:58.160 --> 00:03:59.600曲霉感染的发病率00:03:59.600 --> 00:04:02.060可达到百分之五到百分之十00:04:03.920 --> 00:04:07.660肺部真菌的常见种类还有引球菌属00:04:07.840 --> 00:04:11.100引球菌主要存在于土壤和个缝中00:04:11.200 --> 00:04:12.240新型引球菌00:04:12.240 --> 00:04:15.380是引起肺部引球菌病的主要病原菌00:04:15.600 --> 00:04:18.540它可通过呼吸道进入人体肺部00:04:18.720 --> 00:04:19.960大多数情况下00:04:19.960 --> 00:04:22.800人体免疫系统能够控制感染00:04:22.800 --> 00:04:26.000但对于免疫功能低下的人群00:04:26.000 --> 00:04:27.920如器官移植受者00:04:27.920 --> 00:04:30.580长期使用免疫制剂的患者等00:04:30.760 --> 00:04:33.420隐球菌可能在肺部大量繁殖00:04:33.480 --> 00:04:35.480进而扩散至全身00:04:35.480 --> 00:04:37.140在艾滋病患者中00:04:37.160 --> 00:04:38.120隐球菌感染00:04:38.120 --> 00:04:40.500是常见的机会性感染之一00:04:40.640 --> 00:04:42.200约有百分之十到百分之00:04:42.200 --> 00:04:43.900二十的艾滋病患者00:04:44.000 --> 00:04:46.140会并发肺部隐球菌病00:04:48.080 --> 00:04:50.260肺部真菌病的发病机制00:04:50.760 --> 00:04:52.460真菌的入侵途径00:04:52.840 --> 00:04:55.920真菌主要通过呼吸道吸入的方式00:04:55.920 --> 00:04:57.060进入肺部00:04:57.480 --> 00:04:59.220在日常生活中00:04:59.440 --> 00:05:02.900空气中存在的大量的真菌孢子00:05:03.360 --> 00:05:04.800当人们呼吸时00:05:04.800 --> 00:05:08.100这些孢子可随空气进入呼吸道00:05:08.520 --> 00:05:09.320例如00:05:09.360 --> 00:05:13.740在建筑工地农业生产等环境中00:05:13.840 --> 00:05:17.260空气中的真菌孢子浓度相对较高00:05:17.760 --> 00:05:21.160人们在此环境中长时间活动肌肉00:05:21.160 --> 00:05:23.340孢子的几率就会增加00:05:23.560 --> 00:05:25.920此外一些医疗操作00:05:25.920 --> 00:05:28.700如气管插管机械通气等00:05:28.760 --> 00:05:32.420也可能为真菌入侵肺部侵创造条件00:05:32.800 --> 00:05:34.260有研究发现00:05:34.400 --> 00:05:36.200在接受机械通气00:05:36.200 --> 00:05:39.540超过四十八小时的患者中00:05:39.640 --> 00:05:43.540肺部真菌感染的风险明显升高00:05:44.720 --> 00:05:47.100肺部真菌病的发病机制00:05:47.800 --> 00:05:51.660人体免疫反应与真菌的相互作用00:05:52.080 --> 00:05:53.400人体的免疫系统00:05:53.400 --> 00:05:56.860在抵御真菌入侵中起着关键作用00:05:57.000 --> 00:05:59.140当真菌侵入肺部后00:05:59.280 --> 00:06:00.800免疫系统会启动00:06:00.800 --> 00:06:03.180一系列的免疫防御机制00:06:03.240 --> 00:06:07.280如巨噬细胞会吞吞噬真菌孢子00:06:07.280 --> 00:06:09.880中性粒细胞会释放抗菌物质00:06:09.880 --> 00:06:11.380来杀灭真菌00:06:12.960 --> 00:06:15.220然而在某些情况下00:06:15.600 --> 00:06:17.160真菌能够逃避00:06:17.160 --> 00:06:19.360或抑制人体的免疫反应00:06:19.360 --> 00:06:22.980例如一些真菌可以产生特定的00:06:23.600 --> 00:06:25.340特殊的酶或毒素00:06:25.720 --> 00:06:27.700破坏人体的免疫细胞00:06:27.840 --> 00:06:30.580或者改变自身的免疫结构00:06:33.320 --> 00:06:36.820如患有恶性肿瘤糖尿病等慢性疾病00:06:38.160 --> 00:06:41.300免疫功系统的功能受到抑制00:06:41.320 --> 00:06:44.320真菌就更容易在肺部大量繁殖00:06:44.320 --> 00:06:45.540引发疾病00:06:46.400 --> 00:06:49.040据统计患有糖尿病的患者00:06:49.040 --> 00:06:51.160发生肺部真菌病的风险00:06:51.160 --> 00:06:53.940是正常人的两到三倍00:06:55.640 --> 00:06:58.380肺部真菌病的发发病机制00:06:59.000 --> 00:07:00.660影响发病的因素00:07:01.520 --> 00:07:03.820多种因素会影响肺病00:07:03.880 --> 00:07:06.840肺部真菌病的发病年龄是一个00:07:06.840 --> 00:07:08.020重要的因素00:07:08.400 --> 00:07:09.000老年人00:07:09.000 --> 00:07:11.940和儿童的免疫系统相对较弱00:07:12.120 --> 00:07:13.980更容易感染真菌00:07:14.040 --> 00:07:17.420例如老年人由于身体机能下降00:07:17.480 --> 00:07:20.340呼吸道黏膜的防御功能减弱00:07:20.440 --> 00:07:23.500肺部清除病原体的能力降低00:07:23.800 --> 00:07:26.700因此肺部真菌病的发病率较高00:07:26.840 --> 00:07:29.080此外长期吸烟酗酒00:07:29.080 --> 00:07:32.460也会损害呼吸道的正常结构和功能00:07:32.520 --> 00:07:35.140破坏肺部的防御屏障00:07:35.640 --> 00:07:37.680增加感染真菌的风险00:07:37.680 --> 00:07:39.060有研究表明00:07:39.080 --> 00:07:42.540长期吸烟者患肺部真菌病的几率00:07:42.800 --> 00:07:45.700比不吸烟者高出约百分之五十00:07:45.760 --> 00:07:47.880同时环境因素00:07:47.880 --> 00:07:51.180如长期处于潮湿阴暗的环境中00:07:51.240 --> 00:07:54.740也有利于真菌的生长和传播00:07:54.840 --> 00:07:57.620从而增加发病的可能性00:08:00.120 --> 00:08:01.180点真菌00:08:01.480 --> 00:08:04.620肺真菌病的典型临床症状有哪些呢00:08:05.000 --> 00:08:06.380首先是发热00:08:06.720 --> 00:08:10.180发热是肺部真菌病常见的症状之一00:08:10.720 --> 00:08:14.380多数患者会出现不同程度的发热00:08:14.960 --> 00:08:16.120体温可波动00:08:16.120 --> 00:08:16.720在00:08:16.720 --> 00:08:19.760三十七点五摄氏度到三十九摄氏度00:08:19.760 --> 00:08:22.680之间部分严重感染的患者00:08:22.680 --> 00:08:26.100体温可能超过三十九度00:08:27.120 --> 00:08:28.720发热的热型多样00:08:28.720 --> 00:08:30.740可能是持续性的发热00:08:30.760 --> 00:08:32.980也可能是间歇性的发热00:08:33.080 --> 00:08:33.880例如00:08:33.880 --> 00:08:37.700一位肺部念菌念珠菌感染的患者00:08:37.760 --> 00:08:39.580持续发热一周左右00:08:39.960 --> 00:08:42.120体温一直在三十八摄氏度00:08:42.120 --> 00:08:44.460到三十八点五摄氏度徘徊00:08:44.760 --> 00:08:48.460使用普通退烧药后体温可暂时下降00:08:48.480 --> 00:08:50.620但不久后又会回升00:08:50.720 --> 00:08:54.060发热会导致患者身体代谢加快00:08:54.480 --> 00:08:55.880消耗大量的能量00:08:55.880 --> 00:08:58.820引起乏力疲倦等不适00:08:59.320 --> 00:09:02.620从而影响患者的日常生活工作00:09:09.880 --> 00:09:12.580肺真菌病的典型症状还有咳嗽00:09:13.080 --> 00:09:13.520咳嗽00:09:13.520 --> 00:09:16.740在肺部真菌病患者中也较为普遍00:09:17.520 --> 00:09:20.460咳嗽的程度和性质因人而异00:09:20.960 --> 00:09:23.820有的患者表现为轻度的干咳00:09:24.080 --> 00:09:28.500有的则剧烈咳嗽并伴有大量的痰液00:09:28.600 --> 00:09:29.800一般来说00:09:29.800 --> 00:09:32.260早期可能以干咳为主00:09:32.480 --> 00:09:34.160随着病情的进展00:09:34.160 --> 00:09:36.700痰液会逐渐增多00:09:36.800 --> 00:09:39.500例如肺部曲霉病患者00:09:39.800 --> 00:09:42.100呼起可能只是偶尔干咳00:09:42.160 --> 00:09:45.400但是随着曲霉菌在肺部的繁殖00:09:45.400 --> 00:09:46.900和炎症的加重00:09:47.000 --> 00:09:48.620咳嗽会变得频繁00:09:49.040 --> 00:09:52.060且可出在痰液可能带有血渍00:09:52.440 --> 00:09:52.880咳嗽00:09:52.880 --> 00:09:55.720不仅会给患者带来身体上的不适00:09:55.720 --> 00:09:58.340还可能影响患者的睡眠质量00:09:58.680 --> 00:10:00.160长期的剧烈咳嗽00:10:00.160 --> 00:10:03.620甚至可能导致胸部肌肉的疼痛00:10:07.800 --> 00:10:09.080咳痰咳痰00:10:09.080 --> 00:10:12.460也是肺部真菌病的典型症状之一00:10:12.920 --> 00:10:14.480痰液的性质和颜色00:10:14.480 --> 00:10:17.780因真菌种类的不同而有所差异00:10:17.840 --> 00:10:19.080念珠菌感染时00:10:19.080 --> 00:10:21.860痰液可能呈一个白色粘稠状00:10:22.080 --> 00:10:23.700有时像胶冻状00:10:24.640 --> 00:10:25.680曲霉感染的00:10:25.680 --> 00:10:28.460痰液可能带有黄色或绿色00:10:29.600 --> 00:10:31.380质地较为浓稠00:10:32.240 --> 00:10:33.120部分患者00:10:33.120 --> 00:10:36.700还可能咳出类似豆腐渣样的物质00:10:37.360 --> 00:10:41.060例如曾有一一位曲霉患者00:10:41.400 --> 00:10:44.700霉菌感染的患者和出的痰液中00:10:44.720 --> 00:10:46.780带有黄色的块状物00:10:46.880 --> 00:10:51.180经检查确定为曲霉的菌丝团00:10:52.960 --> 00:10:55.400和痰不会不畅00:10:55.400 --> 00:10:58.340可以导致痰液在肺部的积聚00:10:58.400 --> 00:11:00.100进一步加重感染00:11:00.200 --> 00:11:04.300从而影响肺部的气体交换功能00:11:05.480 --> 00:11:08.500不同真菌治病的症状差异00:11:09.240 --> 00:11:12.440念珠菌治病症状的特点00:11:12.440 --> 00:11:15.100念珠菌引起的肺部真菌病00:11:15.320 --> 00:11:17.600除了上述典型症状外00:11:17.600 --> 00:11:20.060还可能有一些特殊表现00:11:20.520 --> 00:11:23.860患者的咳嗽可能相对较轻00:11:25.000 --> 00:11:27.100但咳痰较为明显00:11:27.600 --> 00:11:30.100念珠菌引起的肺部真菌病00:11:30.320 --> 00:11:33.800它的痰液多为白色粘液样00:11:33.800 --> 00:11:35.620有时可以拉丝00:11:37.040 --> 00:11:38.200部分患者00:11:38.200 --> 00:11:41.420还可能出现口腔粘膜的病变00:11:42.200 --> 00:11:45.820如口腔内可见白色的斑膜00:11:45.840 --> 00:11:46.900这是由于00:11:47.120 --> 00:11:50.380念珠菌在口腔粘膜大量繁殖00:11:51.120 --> 00:11:52.060导致的00:11:52.520 --> 00:11:55.540在一些免疫力极度低下的患者中00:11:55.840 --> 00:11:59.640念珠菌的感染可能扩散迅速导致00:11:59.640 --> 00:12:03.980呼吸急促胸痛呼吸衰竭等严重症状00:12:04.120 --> 00:12:04.920例如00:12:05.360 --> 00:12:07.100一位患有白血病00:12:07.280 --> 00:12:09.940且长期接受化疗的患者00:12:10.520 --> 00:12:11.960感染念珠菌后00:12:11.960 --> 00:12:14.100不仅肺部症状加重00:12:14.120 --> 00:12:17.600还出现了口腔黏膜广泛的白色斑膜00:12:17.600 --> 00:12:19.180伴有疼痛00:12:19.320 --> 00:12:20.700影响进食00:12:21.760 --> 00:12:24.800曲霉致病症状特点00:12:24.800 --> 00:12:27.300曲霉导致的肺部真菌病00:12:27.760 --> 00:12:30.300咳嗽症状往往较为突出00:12:30.480 --> 00:12:32.060且咳嗽剧烈00:12:32.120 --> 00:12:34.660有时呈刺激性咳嗽00:12:35.440 --> 00:12:38.060咳嗽中常带有血丝00:12:38.160 --> 00:12:39.000这是因为00:12:39.000 --> 00:12:42.380霉菌的菌丝容易侵犯肺部血管00:12:42.600 --> 00:12:44.860导致血管破裂出血00:12:45.360 --> 00:12:48.020患者还可能出现胸痛症状00:12:48.440 --> 00:12:50.020疼痛程度不一00:12:50.120 --> 00:12:53.340可为隐痛钝痛或刺痛00:12:53.880 --> 00:12:57.080这与曲霉在肺部引起的炎症00:12:57.080 --> 00:12:58.700刺激胸膜有关00:12:58.920 --> 00:12:59.400此外00:12:59.400 --> 00:13:03.420部分曲霉病患者可能出现排血症状00:13:03.960 --> 00:13:04.800严重程度00:13:04.800 --> 00:13:08.460从痰痰中带血到大量排血不等00:13:08.960 --> 00:13:09.760比如00:13:10.040 --> 00:13:13.340有一位从事粮食储存工作的患者00:13:13.440 --> 00:13:15.220感染烟曲霉后00:13:15.320 --> 00:13:17.300咳嗽频繁且剧烈00:13:18.320 --> 00:13:20.860痰中经常带有血丝00:13:20.920 --> 00:13:22.660随着病情的进展00:13:23.240 --> 00:13:24.900出现了少量苔藓00:13:25.840 --> 00:13:27.860经过肺部ct检查00:13:28.160 --> 00:13:31.820发现肺部有典型的曲霉感染病灶00:13:33.400 --> 00:13:35.740隐球菌致病症状特点00:13:36.080 --> 00:13:39.980肺部隐球菌病的症状相对较为隐匿00:13:40.440 --> 00:13:43.460部分患者可能没有明显的症状00:13:43.680 --> 00:13:46.780仅在体检中发现肺部有病变00:13:46.880 --> 00:13:48.200有症状的患者00:13:48.200 --> 00:13:51.620主要表现为低热咳嗽咳痰00:13:51.760 --> 00:13:54.140痰液一般为白色稀薄牙00:13:54.280 --> 00:13:56.620与念珠菌一曲霉感染不同00:13:56.680 --> 00:13:58.680引球菌感染引起的胸痛00:13:58.680 --> 00:14:00.380症状相对较少00:14:00.600 --> 00:14:02.960然而当当隐球菌感染00:14:02.960 --> 00:14:05.340扩散至中枢神经系统时00:14:05.440 --> 00:14:07.700患者会出现头痛头晕00:14:07.800 --> 00:14:10.780恶心呕吐等神经系统的症状00:14:11.360 --> 00:14:13.420经检查发现时00:14:16.360 --> 00:14:18.360例如一位艾滋病患者00:14:18.360 --> 00:14:21.580最初仅表现为轻微的咳嗽低热00:14:21.760 --> 00:14:23.060未引起重视00:14:23.120 --> 00:14:26.580后来逐渐出现头痛视力模糊等症状00:14:26.600 --> 00:14:27.200经检查00:14:27.200 --> 00:14:29.120发现是肺部隐球菌病00:14:29.120 --> 00:14:31.260合并中枢神经系统感染00:14:33.400 --> 00:14:34.200呼吸困难00:14:34.200 --> 00:14:37.100随着肺部真菌病病情的进展00:14:37.120 --> 00:14:40.120部分患者会出现呼吸困难的症状00:14:40.120 --> 00:14:42.440这是由于肺部的炎症和病变00:14:42.440 --> 00:14:44.200影响了气体交换功能00:14:44.200 --> 00:14:46.100导致氧气的摄入不足00:14:46.480 --> 00:14:48.900呼吸困难的程度可轻可重00:14:48.960 --> 00:14:51.780轻者可能在活动后出现气促00:14:51.880 --> 00:14:53.360重者即使在休息时00:14:53.360 --> 00:14:55.240也会感到呼吸费力00:14:55.240 --> 00:14:57.740甚至出现端坐呼吸00:14:58.280 --> 00:15:00.380或使用辅助呼吸设备00:15:00.880 --> 00:15:01.200例如00:15:01.200 --> 00:15:04.220一位患有严重肺部曲霉病的患者00:15:04.240 --> 00:15:06.960由于肺部广泛的炎症和纤维化00:15:06.960 --> 00:15:09.240日常活动如穿衣洗漱等00:15:09.240 --> 00:15:11.140都会感到明显的气促00:15:11.240 --> 00:15:14.460后期甚至需要长期吸氧来维持呼吸00:15:14.760 --> 00:15:15.360呼吸困难00:15:15.360 --> 00:15:17.820会严重影响患者的生活质量00:15:17.840 --> 00:15:19.680限制患者的活动范围00:15:19.680 --> 00:15:22.000导致患者心理压力增大00:15:22.000 --> 00:15:24.220产生焦虑抑郁等情绪00:15:25.320 --> 00:15:26.200胸痛胸痛00:15:26.200 --> 00:15:27.600也是肺部真菌病00:15:27.600 --> 00:15:29.700可能伴随的症状之一00:15:29.880 --> 00:15:32.360胸痛的原因主要是肺部炎症刺激00:15:32.360 --> 00:15:33.160胸膜00:15:33.800 --> 00:15:35.300胸痛的性质多样00:15:35.800 --> 00:15:38.320可为刺痛钝痛或隐痛00:15:38.320 --> 00:15:39.820疼痛因人而异00:15:40.000 --> 00:15:42.600部分患者在咳嗽或深呼吸时00:15:42.600 --> 00:15:43.820胸痛会加重00:15:43.840 --> 00:15:46.940这会导致患者不敢用力呼吸和咳嗽00:15:47.080 --> 00:15:48.560从而影响痰液的排出00:15:48.560 --> 00:15:49.940加重肺部感染00:15:52.680 --> 00:15:56.160例如一位肺部念珠菌感染的患者00:15:56.160 --> 00:15:59.160随着病情发展出现了胸痛症状00:15:59.160 --> 00:16:00.640疼痛为刺痛感00:16:00.640 --> 00:16:03.300尤其是在深呼吸时疼痛加重00:16:03.320 --> 00:16:05.320这使得患者呼吸浅快00:16:05.320 --> 00:16:07.920进一步影响了肺部的交换00:16:07.920 --> 00:16:10.100延长了疾病的治疗周期00:16:10.360 --> 00:16:12.040今天我的分享到此结束00:16:12.040 --> 00:16:12.940谢谢大家