WEBVTT00:00:01.320 --> 00:00:02.960嗯各位朋友大家好00:00:02.960 --> 00:00:04.240我是这个00:00:04.240 --> 00:00:06.800上海市第一人民医院耳耳鼻喉科00:00:06.800 --> 00:00:07.860陈立晓医生00:00:08.240 --> 00:00:10.480那么今天我给大家呃00:00:10.480 --> 00:00:13.500讲解一下咽炎的症状和治疗方法00:00:16.440 --> 00:00:18.440那么将从以下6点进行00:00:18.440 --> 00:00:20.160给大家详细的介绍00:00:20.160 --> 00:00:22.940第一个是咽炎的基本概念和分类00:00:23.120 --> 00:00:23.880第二个00:00:23.880 --> 00:00:27.340是这个咽炎的典型症状的识别00:00:27.400 --> 00:00:30.900还有第三点是诊断方法和幅度检查00:00:31.200 --> 00:00:33.520第四点是药物的治疗方案的介绍00:00:33.520 --> 00:00:34.680第五个是00:00:34.680 --> 00:00:37.100非药物的一个治疗手段推荐00:00:37.440 --> 00:00:40.340第六点是预防措施和康复建议00:00:41.280 --> 00:00:42.520那么首先是第一点00:00:42.520 --> 00:00:44.420咽炎的基本概念和分类00:00:46.000 --> 00:00:46.800呃00:00:48.600 --> 00:00:50.700而咽炎的定义和发病原因00:00:50.760 --> 00:00:52.080那么咽炎的定义呢00:00:52.080 --> 00:00:52.840顾名思义00:00:52.840 --> 00:00:55.180就是咽部的一个非特异性炎症00:00:55.320 --> 00:00:56.400对咽部黏膜00:00:56.400 --> 00:00:58.980及黏膜下组织的急性或慢性炎症00:00:59.600 --> 00:01:00.560发病原因的话00:01:00.560 --> 00:01:03.100主要是由病毒或细菌感染引起00:01:03.200 --> 00:01:05.000也可因这个环境因素00:01:05.000 --> 00:01:05.920像干燥00:01:05.920 --> 00:01:08.980吸烟或者身体免疫力下降而发病00:01:10.680 --> 00:01:13.540那么如何区分急性还是慢性咽炎呢00:01:14.040 --> 00:01:16.240首先就从发病时间来看00:01:16.240 --> 00:01:18.040急性咽炎呢起病急00:01:18.040 --> 00:01:20.840病程短慢性咽炎呢病程长00:01:20.840 --> 00:01:21.560症状顽固00:01:21.560 --> 00:01:22.500难以治愈00:01:22.600 --> 00:01:25.220通常呢是要3个月以上00:01:25.280 --> 00:01:28.720急性咽炎反复发作3个月以上呃00:01:28.720 --> 00:01:31.260即可诊断为慢性咽炎00:01:31.640 --> 00:01:32.880那么症状表现呢00:01:32.880 --> 00:01:35.280急性咽炎主要分为咽部的干燥00:01:35.280 --> 00:01:36.620灼热疼痛00:01:36.840 --> 00:01:38.640呃吞咽疼痛明显00:01:38.640 --> 00:01:39.120然后00:01:39.120 --> 00:01:41.640慢性咽炎的表现为咽部的异物感00:01:41.640 --> 00:01:43.060痒感干燥感00:01:43.280 --> 00:01:46.580患者常咳出咽内的一个咽咽00:01:48.000 --> 00:01:49.600在病理变化方面呢00:01:49.600 --> 00:01:52.240急性咽炎的咽部黏膜充血肿胀00:01:52.240 --> 00:01:54.080咽淋巴结呃组织呢00:01:54.080 --> 00:01:56.160可肿大慢性咽炎的比00:01:56.160 --> 00:01:56.920主要表现为00:01:56.920 --> 00:01:58.940咽部黏膜的一个慢性充血00:01:59.160 --> 00:02:00.960黏膜和黏膜下结缔组织增00:02:00.960 --> 00:02:03.300生黏液腺的一个分泌增多00:02:05.800 --> 00:02:07.860易感人群呢和危险因素00:02:09.240 --> 00:02:10.720那么易感人群呢00:02:10.720 --> 00:02:11.880相对急性咽炎呢00:02:11.880 --> 00:02:14.940多见于冬春季的一个交替00:02:15.160 --> 00:02:17.220慢性咽炎则常见于成年人00:02:17.240 --> 00:02:18.500且病情较长00:02:18.600 --> 00:02:20.040像一些抽烟的患者00:02:20.040 --> 00:02:21.400或者长期熬夜的患者00:02:21.400 --> 00:02:22.780身体抵抗力下降00:02:22.800 --> 00:02:24.540这些都会反复出现的00:02:24.960 --> 00:02:26.280呃危险因素呢00:02:26.280 --> 00:02:27.760像抽烟喝酒00:02:27.760 --> 00:02:28.740空气污染00:02:28.800 --> 00:02:30.180身体抵抗力下降00:02:30.240 --> 00:02:32.240邻近器官炎症等因素00:02:32.240 --> 00:02:34.780均可增加炎症的一个发病风险00:02:37.000 --> 00:02:39.180咽炎的典型症状有哪些呢00:02:42.040 --> 00:02:43.400咽部的不适表现呢00:02:43.400 --> 00:02:44.920主要有以下几个方面00:02:44.920 --> 00:02:46.380第一个干燥感00:02:46.680 --> 00:02:48.920患者呢常感受到咽部的干燥00:02:48.920 --> 00:02:50.880尤其在吞咽或者说话时00:02:50.880 --> 00:02:52.260能够更加明显00:02:52.640 --> 00:02:53.900第二个是疼痛感00:02:55.360 --> 00:02:57.560咽部疼痛是咽部的一个常见症状00:02:57.560 --> 00:03:00.380尤其是急性咽炎中表现为尤为突出00:03:00.560 --> 00:03:02.380疼痛呢可放射至耳部00:03:02.920 --> 00:03:04.300异物感患者呢00:03:04.360 --> 00:03:05.960他经常会感受到了00:03:05.960 --> 00:03:07.660喉咙像是有东西一样00:03:07.720 --> 00:03:08.600像是有痰00:03:08.600 --> 00:03:09.720但是咳又咳不出00:03:09.720 --> 00:03:11.020咽又咽不下去00:03:11.240 --> 00:03:13.340嗯还有一个是灼热感00:03:13.440 --> 00:03:14.880他可出现灼热感00:03:14.880 --> 00:03:16.900尤其在进食啊或饮水时00:03:16.920 --> 00:03:18.220症状更加明显00:03:18.320 --> 00:03:21.000像有一些这个石冠反流啊等00:03:21.000 --> 00:03:22.220这种都会引起00:03:24.080 --> 00:03:25.120那么他的咳嗽呢00:03:25.120 --> 00:03:26.820主要一个刺激性咳嗽00:03:27.000 --> 00:03:28.880他因刺激性干咳00:03:28.880 --> 00:03:29.960通常呢是没有痰00:03:29.960 --> 00:03:31.860会有少量的白色粘液痰00:03:32.440 --> 00:03:32.960第二个呢00:03:32.960 --> 00:03:34.660就是说阵发性咳嗽00:03:34.760 --> 00:03:37.540它主要是这个阵发性发作00:03:37.600 --> 00:03:39.400尤其在说话或吸气时00:03:39.400 --> 00:03:41.180症状是明显加重的00:03:41.200 --> 00:03:42.960就是不能长期讲话00:03:42.960 --> 00:03:43.880呃00:03:43.880 --> 00:03:46.920长句就是讲几句话都可能要咳一下00:03:46.920 --> 00:03:48.780要不然他会感觉到不舒服00:03:50.280 --> 00:03:52.080那么咳嗽和吞咽的关系呢00:03:52.080 --> 00:03:54.420患者在吞咽食物或者唾液时00:03:54.520 --> 00:03:56.940常因刺激咽部而引起咳嗽00:04:00.200 --> 00:04:01.340伴随的症状00:04:01.720 --> 00:04:02.040那么00:04:02.040 --> 00:04:04.400急性咽炎和慢性咽炎伴随的症状呢00:04:04.400 --> 00:04:05.460是不一样的00:04:05.560 --> 00:04:06.840呃像发热00:04:06.840 --> 00:04:08.040急性咽炎患者00:04:08.040 --> 00:04:09.680他可能出现发热的症状00:04:09.680 --> 00:04:11.320通常伴有全身的不适啊00:04:11.320 --> 00:04:14.080头痛像一些上呼吸道感染00:04:14.080 --> 00:04:15.080他就首发一00:04:15.080 --> 00:04:17.440呃一部分人可能会首发这个咽部00:04:17.440 --> 00:04:19.620或者鼻咽部等情况00:04:19.800 --> 00:04:20.700声音嘶哑00:04:20.840 --> 00:04:22.160就是咽炎症状00:04:22.160 --> 00:04:24.320比较严重的他反复咳嗽啊00:04:24.320 --> 00:04:26.880或者说这种抵抗力下降啊00:04:26.880 --> 00:04:28.960呃长长期大量讲话00:04:28.960 --> 00:04:30.940他就会出现这种声带受累00:04:31.000 --> 00:04:33.060出现声带受累发炎00:04:33.280 --> 00:04:35.420出现声音嘶哑或者发音困难00:04:35.880 --> 00:04:36.860吞咽困难00:04:37.080 --> 00:04:39.240吞咽部吞咽疼痛时呢00:04:39.240 --> 00:04:40.760患者可出现吞咽困难00:04:40.760 --> 00:04:43.220影响正常的进食和饮水00:04:43.640 --> 00:04:44.600耳朵疼痛00:04:44.600 --> 00:04:46.720正如前面所说的咽炎呢00:04:46.720 --> 00:04:49.120它能通过咽鼓管引起耳部的疼痛00:04:49.120 --> 00:04:51.340尤其在吞咽时症状更加明显00:04:51.680 --> 00:04:53.660嗯这个就是在这00:04:53.920 --> 00:04:57.760嗯慢性不愈的患者中能够表现出来00:04:57.760 --> 00:04:58.560这样00:04:59.000 --> 00:05:01.780第三个就是诊断方法和辅助检查00:05:04.400 --> 00:05:05.160呃00:05:05.160 --> 00:05:07.520临床医生初步诊断有哪些依据呢00:05:07.520 --> 00:05:09.540第一个就是患者的症状00:05:09.840 --> 00:05:12.620那么患者多是干燥灼热疼痛00:05:12.680 --> 00:05:13.520吞咽时呢00:05:13.520 --> 00:05:14.500疼痛加重00:05:14.560 --> 00:05:16.260咽部分泌物呢比较多00:05:16.480 --> 00:05:18.700呃一般呢都是以白色痰为主00:05:19.760 --> 00:05:20.200第二个00:05:20.200 --> 00:05:21.580就是咽部的体征00:05:21.920 --> 00:05:23.760咽部我们可以看到呢00:05:23.760 --> 00:05:25.560当我们用压舌板观察的时候00:05:25.560 --> 00:05:28.420可以看到他咽部有充血肿胀00:05:28.680 --> 00:05:30.720以及咽后壁的滤泡增生啊00:05:30.720 --> 00:05:33.380或者说咽厕所红肿等这些情况00:05:33.880 --> 00:05:38.080那么病史和临床表现他表现呢00:05:38.080 --> 00:05:39.040急性咽炎呢00:05:39.040 --> 00:05:41.520他通常由上呼吸道感染病史合并00:05:41.520 --> 00:05:43.580出现这种急性咽炎的情况00:05:43.640 --> 00:05:45.720而慢性咽炎他的病程较长00:05:45.720 --> 00:05:47.500症状呢就是反复发作00:05:50.760 --> 00:05:52.280编式检查的项目呢00:05:52.280 --> 00:05:53.940有哪些以及意义呢00:05:54.000 --> 00:05:55.760第一个我们常用的一个00:05:55.760 --> 00:05:58.580血常规还有呢就是烟丝子的培养00:05:58.840 --> 00:06:00.820另外一个就是抗体的检测00:06:01.200 --> 00:06:02.480那么检查白细胞计数00:06:02.480 --> 00:06:03.760和中性粒的比例呢00:06:03.760 --> 00:06:05.740能够判断是否存在感染00:06:06.160 --> 00:06:08.140第二个就是咽拭子的培养00:06:08.200 --> 00:06:09.720检查咽部致病菌00:06:09.720 --> 00:06:12.900有助于检查这个咽部的病原体类型00:06:13.040 --> 00:06:14.900第三个就是抗体检查00:06:15.160 --> 00:06:17.560检测患者体内特异性抗体00:06:17.560 --> 00:06:20.460有助于检测判断咽炎的一个类型00:06:21.360 --> 00:06:22.520影像学检查呢00:06:22.520 --> 00:06:25.740在这个诊断中呢也是比较重要的00:06:28.520 --> 00:06:30.220第一个就是喉镜检查00:06:31.040 --> 00:06:33.720呃喉镜呢能够观察到整个喉腔00:06:33.720 --> 00:06:35.720咽腔的一个情况呃00:06:35.720 --> 00:06:37.460像咽部粘膜性病变00:06:37.640 --> 00:06:39.780评估严重的范围及程度00:06:39.800 --> 00:06:42.500能够为治疗呢提供这个依据00:06:42.680 --> 00:06:44.620还有一个就是影像学检查00:06:45.040 --> 00:06:46.000像x线00:06:46.000 --> 00:06:49.180CT可排出的咽部的一个周围脓肿00:06:49.200 --> 00:06:50.760扁桃体脓肿呃00:06:50.760 --> 00:06:52.240肿瘤病变呃00:06:52.240 --> 00:06:53.720像红外山岩癌啊00:06:53.720 --> 00:06:55.800或者说这个溃咽癌呃00:06:55.800 --> 00:06:58.660都能够很好的能够做出一个判断00:06:58.960 --> 00:06:59.320同时00:06:59.320 --> 00:07:01.620也有助于这个咽部的一个鉴别诊断00:07:03.640 --> 00:07:06.620第四个它就是一个药物方案00:07:06.680 --> 00:07:08.060治疗方案的介绍00:07:08.520 --> 00:07:10.580那么药物方案呢这些呢00:07:10.600 --> 00:07:12.080嗯在临床当中呢00:07:12.080 --> 00:07:14.120我们也知道这个用药呢00:07:14.120 --> 00:07:15.340也都是比较多00:07:15.640 --> 00:07:17.760主要是就是一个嗯00:07:17.760 --> 00:07:19.920缓解局部的一个疼痛啊00:07:19.920 --> 00:07:23.700灼热感和针对性这个病因进行治疗00:07:24.000 --> 00:07:24.940嗯00:07:25.440 --> 00:07:26.740呃像润喉片00:07:27.080 --> 00:07:28.180口腔喷雾剂00:07:28.320 --> 00:07:30.400西瓜霜啊这些之类的00:07:30.400 --> 00:07:32.440它能够快速的缓解咽部的疼痛00:07:32.440 --> 00:07:34.260灼热感或干燥的症状00:07:34.320 --> 00:07:36.760但需要注意频率和计量00:07:36.760 --> 00:07:39.420避免呢出现两个药物的依赖00:07:40.720 --> 00:07:41.360第二个呢00:07:41.360 --> 00:07:42.360就是漱口水00:07:42.360 --> 00:07:44.580它具有消毒杀菌的漱口水00:07:44.720 --> 00:07:45.800像温盐水啊00:07:45.800 --> 00:07:48.320不放氯己啶含漱液呃00:07:48.320 --> 00:07:49.900进口锌啊这些00:07:50.080 --> 00:07:52.400嗯它能够清除口腔和咽部00:07:52.400 --> 00:07:53.940减少细菌的滋生00:07:54.120 --> 00:07:55.800那么使用使用呢00:07:55.800 --> 00:07:57.580就像饭前饭后啊00:07:57.760 --> 00:08:00.940嗯主要是一个饭后的漱口00:08:01.000 --> 00:08:03.140嗯这个是比较好的00:08:03.240 --> 00:08:05.380还有一个局部涂抹药膏00:08:05.440 --> 00:08:06.720对于咽部滤泡增生00:08:06.720 --> 00:08:08.560或出血明显的患者呢00:08:08.560 --> 00:08:10.320也可以使用药膏涂抹00:08:10.320 --> 00:08:12.340能够减轻炎症和不适感00:08:12.760 --> 00:08:14.240但是怎么说呢00:08:14.240 --> 00:08:15.440在临床呃00:08:15.440 --> 00:08:16.760在临床操作当中呢00:08:16.760 --> 00:08:17.560可能这一点呢00:08:17.560 --> 00:08:18.600不是说是能够00:08:18.600 --> 00:08:21.340那么呃方便00:08:21.480 --> 00:08:23.520因为这个咽部的药物涂抹00:08:23.520 --> 00:08:24.320大部分呢00:08:24.320 --> 00:08:25.600他就是因为00:08:25.600 --> 00:08:27.480病人在不断的做吞咽动作00:08:27.480 --> 00:08:29.780保持这个口腔湿润的情况下00:08:29.920 --> 00:08:33.140他能够顺着这个睁眼动作00:08:33.160 --> 00:08:36.880嗯不能够在咽部呢长久的存留00:08:36.880 --> 00:08:37.920那么也限制了00:08:37.920 --> 00:08:40.580他在这个局部用药的情况00:08:40.640 --> 00:08:43.300那么像润喉片和这个口腔喷雾00:08:43.560 --> 00:08:45.000嗯这个喷雾制剂呢00:08:45.000 --> 00:08:45.820它能够00:08:45.840 --> 00:08:48.780还是能比起这个局部药膏的涂抹00:08:48.800 --> 00:08:50.680它能够更好的在口腔内00:08:50.680 --> 00:08:52.340也能够一个存留00:08:55.280 --> 00:08:58.440全身用药的原则和推荐全身用药呢00:08:58.440 --> 00:09:00.720这个都是需要根据患者的情况00:09:00.720 --> 00:09:02.240来进行呃00:09:02.240 --> 00:09:03.560用药的呃00:09:03.560 --> 00:09:07.040像这些有呃这个呃检验00:09:07.040 --> 00:09:09.620检验的一个结果嗯00:09:11.120 --> 00:09:11.960像查出来病00:09:11.960 --> 00:09:13.560如果是病毒性感染呢00:09:13.560 --> 00:09:15.060那么对于急性咽炎00:09:15.400 --> 00:09:16.720尤其是病毒性的00:09:16.720 --> 00:09:18.760那么尽早使用抗病毒药物00:09:18.760 --> 00:09:20.020像奥司他韦啊00:09:20.120 --> 00:09:21.040利巴韦林啊00:09:21.040 --> 00:09:22.840控制病情的发展啊00:09:22.840 --> 00:09:24.480那么就像嗯00:09:24.480 --> 00:09:25.440这段时间还好00:09:25.440 --> 00:09:28.160像我这个过年期间00:09:28.160 --> 00:09:29.620那么甲流乙流00:09:29.680 --> 00:09:32.120这个是比较流行的阶段的话00:09:32.120 --> 00:09:35.060那么临床中经常会碰到这种患者00:09:35.200 --> 00:09:38.580短期内出现一个急性的咽痛不舒服00:09:39.040 --> 00:09:39.200嗯00:09:39.200 --> 00:09:42.120他没有说有全身的其他感染的情况00:09:42.120 --> 00:09:43.160像发热啊00:09:43.160 --> 00:09:44.000喉咙痰啊00:09:44.000 --> 00:09:45.700或者说鼻塞脓鼻涕00:09:45.840 --> 00:09:47.820嗯之类的00:09:47.880 --> 00:09:50.280嗯会表现一个咽痛的症状00:09:50.280 --> 00:09:51.760那么在这个抽血化00:09:51.760 --> 00:09:52.580验的时候00:09:52.720 --> 00:09:54.680呃检查整个咽腔呢00:09:54.680 --> 00:09:56.020是一个慢性充00:09:56.160 --> 00:09:58.020是一个急性充血的状态00:09:58.080 --> 00:09:59.360呃抽血检查呢00:09:59.360 --> 00:10:01.120可能发现这个甲流或者乙流00:10:01.120 --> 00:10:02.060是阳性的00:10:02.200 --> 00:10:03.760那么针对这类病人的话00:10:03.760 --> 00:10:05.240我们使用这个奥司他韦00:10:05.240 --> 00:10:06.420或者利巴韦林00:10:06.480 --> 00:10:07.960呃使用奥司他韦呢00:10:07.960 --> 00:10:10.200他这个效果可可能会好一点00:10:10.200 --> 00:10:11.780再加辅助一些00:10:11.840 --> 00:10:14.480像这个嗯00:10:14.480 --> 00:10:15.640口腔喷雾啊00:10:15.640 --> 00:10:17.220然后这个含片00:10:17.320 --> 00:10:19.600以及这个针对慢性咽炎的00:10:19.600 --> 00:10:21.700呃一些清热解毒的药物00:10:22.840 --> 00:10:24.080那么抗生素类呢00:10:24.080 --> 00:10:25.780对于细菌引起的咽炎00:10:25.840 --> 00:10:28.240他应该根据呢00:10:28.240 --> 00:10:29.480药敏实验的结果00:10:29.480 --> 00:10:29.880进行00:10:29.880 --> 00:10:32.340那个敏感菌的一个抗生素的使用00:10:32.440 --> 00:10:33.360像青霉素00:10:33.360 --> 00:10:34.280头孢类的00:10:34.280 --> 00:10:35.600避免使用抗生素呢00:10:35.600 --> 00:10:36.540导致耐用00:10:36.640 --> 00:10:37.880那么这一点呢00:10:37.880 --> 00:10:38.800在临床当中呢00:10:38.800 --> 00:10:40.820使用呢也是相对受限的00:10:40.920 --> 00:10:42.320因为药敏实验的结果呢00:10:42.320 --> 00:10:43.440我们大家都知道00:10:43.440 --> 00:10:44.200嗯00:10:44.200 --> 00:10:45.380原始的培养00:10:45.520 --> 00:10:47.160嗯要有几天00:10:47.160 --> 00:10:49.020甚至一周或者更长时间00:10:49.080 --> 00:10:51.040那么它的结果出现00:10:51.040 --> 00:10:54.580呃就是等到结果出来00:10:55.320 --> 00:10:57.420它只能说是有一个00:10:57.600 --> 00:10:58.620嗯00:10:59.800 --> 00:11:01.680后期的一个判断作用00:11:01.680 --> 00:11:03.820但是对药物的指导作用00:11:04.080 --> 00:11:06.740早期呢可能是嗯00:11:07.000 --> 00:11:08.100作用不是那么大00:11:08.120 --> 00:11:09.960因为患者这个痛00:11:09.960 --> 00:11:10.880我们常规呢00:11:10.880 --> 00:11:13.420可能会根据患者在不过敏的情况下00:11:13.480 --> 00:11:15.000嗯如果出这个血糖00:11:15.000 --> 00:11:16.040血常规啊00:11:16.040 --> 00:11:17.880CRP啊或者降钙素啊00:11:17.880 --> 00:11:20.240等这些降钙素原这些情况00:11:20.240 --> 00:11:22.360那么它就会出现呃00:11:22.360 --> 00:11:23.320相应的指标00:11:23.320 --> 00:11:24.560如果有细菌性感染00:11:24.560 --> 00:11:26.540那我们把相应的抗生素00:11:26.600 --> 00:11:28.360呃根据经验性用药00:11:28.360 --> 00:11:29.740把抗生素给用上00:11:29.960 --> 00:11:32.040嗯可能等到他这个药品00:11:32.040 --> 00:11:33.040实验结果出来时候00:11:33.040 --> 00:11:34.700病人的症状已经好了00:11:34.840 --> 00:11:36.180嗯是这种情况00:11:36.240 --> 00:11:38.580那么还有一个清热解毒的中成药00:11:38.680 --> 00:11:40.000呃清热解毒性00:11:40.000 --> 00:11:42.160像这个清热解毒颗粒啊00:11:42.160 --> 00:11:43.420双黄连口服液00:11:43.480 --> 00:11:45.640它能够辅助治疗这个急性咽炎00:11:45.640 --> 00:11:47.580缓解咽痛咽干的症状00:11:47.960 --> 00:11:50.440嗯这些药呢在临床当中呢00:11:50.440 --> 00:11:52.400嗯使用的还是比较多的00:11:52.400 --> 00:11:54.500嗯特别是针对一些慢性咽炎00:11:57.040 --> 00:11:58.560那么中西药结合00:11:58.560 --> 00:12:01.140中西医结合治疗呢优势探讨00:12:01.760 --> 00:12:02.280中西00:12:02.280 --> 00:12:04.420中医呢有自己的特征点00:12:04.440 --> 00:12:05.400然后西医呢00:12:05.400 --> 00:12:08.940也有自己的呃呃明显的优势00:12:09.160 --> 00:12:10.820所以说两者能够结合00:12:10.920 --> 00:12:13.560是对这个急慢性咽炎的治疗呢00:12:13.560 --> 00:12:14.000嗯00:12:14.000 --> 00:12:17.060在五官科当中呢是一个很好的案例00:12:17.200 --> 00:12:20.200那么病因治疗和症状缓解相结合00:12:20.200 --> 00:12:21.000中医治疗呢00:12:21.000 --> 00:12:23.560它主要注重呢辨证湿症00:12:23.560 --> 00:12:26.260根据患者的体质和病情选用中药00:12:26.360 --> 00:12:27.900同时结合西药00:12:28.080 --> 00:12:30.700能够快速缓解症状的一个优势00:12:31.520 --> 00:12:33.340达到一个治疗的效果00:12:33.360 --> 00:12:35.160就是不仅治病症00:12:35.160 --> 00:12:36.820也能够治病根00:12:38.320 --> 00:12:40.720还有一个就是减少药物的副作用00:12:40.720 --> 00:12:42.200中药西用结合使用呢00:12:42.200 --> 00:12:43.440可相互的制约00:12:43.440 --> 00:12:44.980降低药物的副作用00:12:45.120 --> 00:12:46.660提高治疗的依从性00:12:46.960 --> 00:12:49.520能够同时呢能够缩短这个病程00:12:49.520 --> 00:12:50.540减少复发00:12:50.840 --> 00:12:52.640它能够各自发挥优势00:12:52.640 --> 00:12:53.480互补不足00:12:53.480 --> 00:12:54.640提高机体免疫力00:12:54.640 --> 00:12:55.980从而缩短病程00:12:56.040 --> 00:12:57.020减少复发00:12:57.920 --> 00:12:58.720第五00:12:58.960 --> 00:13:01.780他一个非药物治疗手段的推荐00:13:03.400 --> 00:13:06.160我们知道这个不良的生活习惯呢00:13:06.160 --> 00:13:08.300能够给患者呢00:13:08.320 --> 00:13:11.180针对咽炎呢带来比较大的影响00:13:11.280 --> 00:13:13.040那么改善生活质量00:13:13.040 --> 00:13:15.300是能够明显降低复发的风险00:13:15.800 --> 00:13:17.940像常见的一个戒烟戒酒00:13:18.040 --> 00:13:21.280它这些都是一个咽炎的重要诱因啊00:13:21.280 --> 00:13:23.160同时呢戒烟戒线酒呢00:13:23.160 --> 00:13:26.120它能够呃减少烟部的刺激00:13:26.120 --> 00:13:27.700降低咽部的复发率00:13:28.120 --> 00:13:29.620同时呢合理饮食00:13:29.640 --> 00:13:30.480保持清洁00:13:30.480 --> 00:13:33.100饮食呢避免辛辣酸冷等刺激00:13:33.160 --> 00:13:34.700呃食物的刺激00:13:34.720 --> 00:13:36.940有助于呢保护咽部的黏膜00:13:37.440 --> 00:13:39.420同时呢良好的作息规律00:13:39.440 --> 00:13:42.020充足的睡眠也有助于增强抵抗力00:13:42.240 --> 00:13:45.260免疫力减少这个咽部咽炎的发作00:13:46.160 --> 00:13:48.640嗯同时保持室内空气流通00:13:48.640 --> 00:13:51.020避免长时间在密闭环境中工作00:13:51.240 --> 00:13:53.080减少咽部的一个刺激00:13:53.080 --> 00:13:54.500也是比较关键的00:13:54.640 --> 00:13:57.240所以说就是一个全身性因素00:13:57.240 --> 00:13:58.080和局部的00:13:58.080 --> 00:14:00.700一个局部的刺激和全身的抵抗力00:14:00.720 --> 00:14:02.420这个都是比较关键的00:14:03.880 --> 00:14:05.540局部的物理治疗方法00:14:05.560 --> 00:14:07.040那么局部物理治疗呢00:14:07.040 --> 00:14:08.200像雾化吸入00:14:08.200 --> 00:14:09.360它能够将药物啊00:14:09.360 --> 00:14:12.200或生理盐水雾化后进入咽部00:14:12.200 --> 00:14:14.940可以起到这个润喉消炎止痛的作用00:14:15.320 --> 00:14:15.880第二个呢00:14:15.880 --> 00:14:17.080就是咽部的涂药00:14:17.080 --> 00:14:19.820使用药膏或药粉直接涂抹在咽部00:14:19.960 --> 00:14:22.660有助于减轻咽部的炎症或疼痛00:14:23.120 --> 00:14:25.500第三呢就是激光或微波治疗00:14:25.760 --> 00:14:27.840通过激光或微波的物理手段00:14:27.840 --> 00:14:29.420对咽部进行照射00:14:29.520 --> 00:14:30.960能够促进血液循环00:14:30.960 --> 00:14:33.180缓解这个咽部的一个炎症00:14:34.640 --> 00:14:36.460这个像滤泡性咽炎00:14:36.640 --> 00:14:37.560长期慢00:14:37.560 --> 00:14:39.820长期慢性滤泡性咽炎的患者00:14:39.960 --> 00:14:43.120呃可能有些甚至会引起焦虑啊00:14:43.120 --> 00:14:46.100等这个精神症状00:14:46.200 --> 00:14:48.760嗯把可能应用的局部00:14:48.760 --> 00:14:50.580或者全身性的用药呢00:14:50.640 --> 00:14:51.960呃使用上之后呢00:14:51.960 --> 00:14:54.000对患者的治疗治疗00:14:54.000 --> 00:14:57.320或者说心理方面的症状的减轻呢00:14:57.320 --> 00:14:59.900也是有比较好的一个结果的00:15:01.640 --> 00:15:04.040呃免疫调节在康复中的作用00:15:04.040 --> 00:15:06.480那么增强免疫力和锻炼身体00:15:06.480 --> 00:15:08.760以及咽咽部的免疫疗法呢00:15:08.760 --> 00:15:12.740这些在这个呃在康复当中00:15:13.200 --> 00:15:14.780它的作用也是比较明显的00:15:14.840 --> 00:15:17.380第一个就是免呃免疫增强剂00:15:17.560 --> 00:15:20.080呃如胸腺肽这个干扰素00:15:20.080 --> 00:15:22.000它能够提高身体的免疫力00:15:22.000 --> 00:15:24.060减少咽部咽炎的发作00:15:24.440 --> 00:15:24.920第二个呢00:15:24.920 --> 00:15:26.380就是说锻炼身体00:15:26.400 --> 00:15:27.920适当的运动锻炼00:15:27.920 --> 00:15:29.780可以增强身体的抵抗力00:15:29.840 --> 00:15:31.120提高咽部抵抗力00:15:31.120 --> 00:15:31.920同时减少00:15:31.920 --> 00:15:33.780呢咽部的咽炎的复发00:15:34.040 --> 00:15:36.260第三个呢就是咽部免疫疗法00:15:36.320 --> 00:15:38.680通过注射或含氟免疫调节剂00:15:38.680 --> 00:15:40.760直接作用于咽部黏膜00:15:40.760 --> 00:15:42.260提高咽部的免疫力00:15:44.080 --> 00:15:47.100第六点就是预防措施和康复措施00:15:47.360 --> 00:15:48.000针对以上00:15:48.000 --> 00:15:50.680我们对这个病的症状的了解00:15:50.680 --> 00:15:52.980病因诊断的辅助方法00:15:53.040 --> 00:15:54.240以及治疗00:15:54.240 --> 00:15:56.260和这个预防00:15:56.600 --> 00:15:59.740那么就和治疗的和康复那么00:16:02.120 --> 00:16:03.480我们就是说第六点00:16:03.480 --> 00:16:05.580它能预防孕妇和康复00:16:07.080 --> 00:16:08.160这类前面的诱因00:16:08.160 --> 00:16:09.200我们需要知道00:16:09.200 --> 00:16:11.160就是避免诱因复发00:16:11.160 --> 00:16:12.900能够减轻这个发作00:16:13.200 --> 00:16:15.440第一个避免长时间过度使用嗓子00:16:15.440 --> 00:16:16.880像教师呃00:16:16.880 --> 00:16:19.880歌手等职业人必注意嗓子的保护00:16:19.880 --> 00:16:22.460避免过度用嗓导致咽部的充血00:16:22.760 --> 00:16:24.740第二个就是戒酒戒烟00:16:24.800 --> 00:16:26.720烟酒对咽部的刺激的作用00:16:26.720 --> 00:16:28.820它是容易导致咽炎的发作的00:16:29.160 --> 00:16:30.700还有一个就是我们的环境00:16:30.840 --> 00:16:32.760嗯保持室内空气的湿润00:16:32.760 --> 00:16:34.980避免过干或潮湿的环境00:16:35.080 --> 00:16:37.100能够减少这个咽部的刺激00:16:37.720 --> 00:16:39.500同时呢对鼻炎00:16:39.640 --> 00:16:42.320鼻窦炎等口鼻疾病可诱发咽炎00:16:42.320 --> 00:16:43.740也需进行治疗00:16:43.880 --> 00:16:45.740像这个胃酸反流00:16:46.000 --> 00:16:48.120引起的一个咽湿管反流00:16:48.120 --> 00:16:50.820这个也是需要我们需要注意的00:16:52.320 --> 00:16:53.600那么增强免疫力00:16:53.600 --> 00:16:55.460提呃提高抵抗力00:16:55.520 --> 00:16:56.480就是第一个00:16:56.480 --> 00:16:57.460身体锻炼00:16:57.520 --> 00:16:58.360合理饮食00:16:58.360 --> 00:17:00.680规律作息和心理调节等00:17:00.680 --> 00:17:03.660全身和局部的一个呃00:17:04.240 --> 00:17:06.460一起多管齐下00:17:06.480 --> 00:17:09.320嗯减轻他的一个发作的症状00:17:09.320 --> 00:17:10.540和一个频率00:17:11.480 --> 00:17:12.560那么定期复查00:17:12.560 --> 00:17:13.760及时调整治疗方案00:17:13.760 --> 00:17:15.340这个也是比较关键的00:17:15.680 --> 00:17:18.700嗯主要是这一个遵医嘱的用药00:17:19.000 --> 00:17:20.560嗯定期复查呃00:17:20.560 --> 00:17:22.980检查炎症的一个病情变化00:17:23.040 --> 00:17:25.340嗯调整治疗方案00:17:25.360 --> 00:17:28.080还有一个就是关注症状的变化00:17:28.080 --> 00:17:29.920以免呢病情恶化00:17:29.920 --> 00:17:31.660还有一个就是并发症00:17:31.680 --> 00:17:32.520像他引起00:17:32.520 --> 00:17:33.600的一个中耳炎00:17:33.600 --> 00:17:36.120鼻窦炎等情况也需要密切的关注00:17:36.120 --> 00:17:37.140并及时治疗00:17:37.720 --> 00:17:39.500好谢谢各位老师