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--> 00:01.848\n嗯，\n\n00:01.848 --> 00:04.172\n今天我们大家一起学习一下，\n\n00:04.322 --> 00:04.723\n嗯，\n\n00:04.973 --> 00:10.272\n关于儿童真菌性鼻窦炎的有关方面的诊断。\n\n00:10.373 --> 00:10.748\n嗯，\n\n00:10.748 --> 00:11.923\n鉴别诊断，\n\n00:11.923 --> 00:12.772\n治疗，\n\n00:12.873 --> 00:15.173\n临床症状和预后。\n\n00:17.305 --> 00:17.504\n嗯，\n\n00:17.704 --> 00:23.280\n儿童真菌性鼻窦炎的临床症状因类型，\n\n00:23.280 --> 00:29.930\n它有非侵袭性和侵袭性的病情严重程度不同而有所差异。\n\n00:29.930 --> 00:32.755\n以下说一下详细的分类和表现。\n\n00:34.472 --> 00:34.923\n那我吧。\n\n00:36.333 --> 00:36.933\n我个裤头。\n\n00:38.736 --> 00:38.936\n嗯，\n\n00:39.085 --> 00:42.186\n第一个是非侵袭性真菌性鼻窦炎，\n\n00:42.236 --> 00:43.835\n这是个常见的类型。\n\n00:43.835 --> 00:47.511\n它的特点是真菌在鼻窦内定植，\n\n00:47.511 --> 00:49.936\n不侵犯粘膜及周围组织，\n\n00:49.936 --> 00:52.811\n多见于免疫力正常的儿童。\n\n00:52.811 --> 00:56.736\n他的鼻部局部症状有鼻塞，\n\n00:57.285 --> 01:00.085\n可以是单侧或者双侧鼻塞，\n\n01:00.085 --> 01:03.686\n程度可轻可重而逐渐加重。\n\n01:04.655 --> 01:04.755\n嗯，\n\n01:04.755 --> 01:09.405\n还有一个就是流涕常为脓粘脓性的鼻涕量较多。\n\n01:09.456 --> 01:11.905\n部分患儿患儿呢，\n\n01:11.905 --> 01:13.856\n鼻涕中可以带有血，\n\n01:14.106 --> 01:17.180\n尤其是真菌球性球，\n\n01:17.180 --> 01:20.456\n真菌球形的这个类型若。\n\n01:21.408 --> 01:23.658\n鼻窦内有真菌团块，\n\n01:24.308 --> 01:24.683\n嗯，\n\n01:24.683 --> 01:29.708\n可能擤出豆渣样或者干酪样的分泌物啊。\n\n01:29.708 --> 01:30.808\n这干这里面呢，\n\n01:30.808 --> 01:34.158\n会含有真菌菌丝和坏死组织。\n\n01:35.041 --> 01:35.241\n嗯。\n\n01:37.408 --> 01:37.734\n然后呢，\n\n01:37.734 --> 01:40.384\n他还有一个症状就是鼻塞，\n\n01:40.384 --> 01:43.308\n会夜间症状可能会加重，\n\n01:43.308 --> 01:46.058\n它会影响孩子的睡眠质量，\n\n01:46.259 --> 01:46.609\n嗯，\n\n01:46.609 --> 01:47.283\n导致呢，\n\n01:47.283 --> 01:49.808\n辗转反侧或者频繁的醒来，\n\n01:50.109 --> 01:50.509\n嗯。\n\n01:52.582 --> 01:52.656\n嗯，\n\n01:52.656 --> 01:56.707\n还有一个症状就是它的会嗅觉减退，\n\n01:56.707 --> 02:02.832\n因鼻窦引流不畅或者真菌代谢产物刺激可出现嗅觉下降。\n\n02:03.681 --> 02:04.082\n嗯，\n\n02:04.832 --> 02:07.632\n还有一个是面部及全身的表现，\n\n02:07.632 --> 02:09.832\n它可以面部闷胀感，\n\n02:10.182 --> 02:14.432\n患侧面颊眼眶或者额头轻微胀痛，\n\n02:14.832 --> 02:17.606\n按压时可能有压痛啊，\n\n02:17.606 --> 02:19.682\n还有会有全身的症状，\n\n02:19.832 --> 02:20.606\n通常呢，\n\n02:20.606 --> 02:22.632\n没有发热或者仅有低热。\n\n02:22.923 --> 02:25.572\n部分患儿可能因长期鼻塞呢，\n\n02:25.572 --> 02:26.423\n影响睡眠，\n\n02:26.473 --> 02:27.923\n出现精神不振，\n\n02:28.223 --> 02:29.623\n注意力不集中。\n\n02:30.173 --> 02:31.723\n嗯，\n\n02:31.772 --> 02:32.873\n按照分型呢，\n\n02:32.873 --> 02:37.072\n还有一种叫侵蚀侵袭性的真菌性鼻窦炎，\n\n02:37.223 --> 02:37.623\n嗯，\n\n02:37.822 --> 02:40.723\n这个比较是这个型类型呢，\n\n02:40.723 --> 02:41.397\n比较罕见，\n\n02:41.397 --> 02:49.673\n但是风险也要危险性要比侵袭性的非侵袭性的要要大得多。\n\n02:49.772 --> 02:50.897\n它的特点呢，\n\n02:50.897 --> 02:52.623\n是真菌侵。\n\n02:52.820 --> 02:55.520\n侵犯鼻粘膜、血管及周围神经，\n\n02:55.970 --> 02:56.345\n嗯，\n\n02:56.345 --> 02:57.720\n进展迅速，\n\n02:57.871 --> 03:00.095\n多见于免疫缺陷的儿童，\n\n03:00.095 --> 03:04.770\n如白血病、糖尿病控制不佳、长期使用激素等。\n\n03:06.630 --> 03:06.755\n嗯，\n\n03:06.755 --> 03:07.804\n它的表现呢？\n\n03:07.804 --> 03:10.580\n急进急性进展的鼻窦炎。\n\n03:11.796 --> 03:11.972\n嗯，\n\n03:11.972 --> 03:14.272\n急性进展的鼻部症状是这样，\n\n03:14.272 --> 03:15.397\n鼻塞出血。\n\n03:16.097 --> 03:16.496\n嗯，\n\n03:16.546 --> 03:17.972\n鼻塞迅速加重，\n\n03:17.972 --> 03:19.947\n鼻粘膜可见溃疡坏死，\n\n03:19.947 --> 03:23.947\n常伴反复鼻出血或者血性分泌物。\n\n03:25.496 --> 03:25.697\n嗯。\n\n03:26.744 --> 03:27.895\n他鼻腔内有异物，\n\n03:27.994 --> 03:29.945\n它是因为组织坏死，\n\n03:30.145 --> 03:31.445\n可以出现恶臭，\n\n03:32.145 --> 03:32.820\n然后呢，\n\n03:32.820 --> 03:35.244\n会有周围组织受累表现。\n\n03:35.544 --> 03:35.919\n嗯，\n\n03:35.919 --> 03:39.494\n主要表现为眼眼部眼部症状呢，\n\n03:39.494 --> 03:41.645\n是眼眶肿胀疼痛，\n\n03:41.645 --> 03:42.895\n眼睑下垂，\n\n03:43.095 --> 03:45.744\n眼球突出或者活动受限，\n\n03:46.345 --> 03:50.494\n这都是因为真菌侵犯眶内组织引起。\n\n03:50.744 --> 03:53.470\n还有一个是视力下降，\n\n03:53.470 --> 03:56.845\n它会有复视甚至失眠。\n\n03:56.970 --> 04:00.070\n这是因为累积了视神经和眼动脉，\n\n04:00.770 --> 04:01.171\n嗯，\n\n04:01.671 --> 04:04.570\n另外就是会有面部皮肤的改变，\n\n04:04.820 --> 04:06.820\n患侧面部肿胀，\n\n04:06.820 --> 04:09.746\n皮肤发紫或出现坏死斑，\n\n04:09.746 --> 04:10.921\n触痛明显，\n\n04:11.470 --> 04:11.871\n嗯。\n\n04:13.421 --> 04:13.621\n嗯。\n\n04:14.746 --> 04:16.746\n还会有一个神经系统的症状，\n\n04:16.746 --> 04:18.696\n它表现为头痛剧烈，\n\n04:18.795 --> 04:20.696\n若真菌侵入颅内，\n\n04:20.696 --> 04:24.045\n可出现呕吐、抽搐、意识障碍等，\n\n04:24.395 --> 04:25.996\n从而危及生命。\n\n04:26.696 --> 04:27.971\n这个类型呢，\n\n04:27.971 --> 04:28.346\n嗯。\n\n04:29.613 --> 04:34.162\n真菌性鼻窦炎它的全身症状表现比较严重，\n\n04:34.312 --> 04:37.162\n它可以有持续的高热、寒颤，\n\n04:37.213 --> 04:38.463\n精神萎靡，\n\n04:38.863 --> 04:40.312\n食欲极差，\n\n04:40.412 --> 04:41.988\n病情进展迅速，\n\n04:41.988 --> 04:44.062\n可引发感染性休克。\n\n04:45.807 --> 04:46.131\n嗯，\n\n04:46.131 --> 04:47.256\n下面再说一说，\n\n04:47.256 --> 04:50.457\n就是不同年龄段的儿童的特殊表现。\n\n04:53.295 --> 04:53.471\n然后，\n\n04:53.471 --> 04:55.770\n婴幼儿他是小于3岁的时候呢，\n\n04:55.770 --> 04:57.596\n他不会表达不适，\n\n04:57.596 --> 05:03.996\n可能表现为烦躁、哭闹、拒食、睡眠不安、频繁用手揉鼻或者抓面部，\n\n05:04.196 --> 05:07.295\n鼻腔分泌物增多且不易清理。\n\n05:07.645 --> 05:08.071\n然后，\n\n05:08.071 --> 05:09.571\n到学龄期儿童的时候，\n\n05:09.571 --> 05:10.645\n可主诉头痛，\n\n05:10.795 --> 05:14.196\n多为额部或者颞颞部隐痛，\n\n05:14.446 --> 05:18.821\n可有头晕或者因鼻塞用口呼吸导致打鼾，\n\n05:18.821 --> 05:20.846\n咽部干痛。\n\n05:21.941 --> 05:22.140\n嗯。\n\n05:22.907 --> 05:23.131\n嗯，\n\n05:23.131 --> 05:27.707\n我们这里要根据症状来来警惕它的危险信号。\n\n05:28.157 --> 05:28.557\n嗯，\n\n05:28.606 --> 05:33.006\n它危险信号常常提示有侵袭性的可能，\n\n05:33.106 --> 05:36.131\n一个就是鼻涕带血且持续不止，\n\n05:36.131 --> 05:38.856\n或出现黑色褐色分泌物。\n\n05:39.307 --> 05:39.707\n嗯，\n\n05:39.957 --> 05:45.307\n还有是单侧面部肿胀疼痛剧烈或伴眼部红肿，\n\n05:45.307 --> 05:46.506\n视力异常。\n\n05:47.852 --> 05:48.477\n免疫缺陷，\n\n05:48.477 --> 05:49.653\n缺陷儿童呢，\n\n05:49.953 --> 05:50.352\n嗯，\n\n05:50.953 --> 05:55.028\n就是长期患病或者使用免疫抑制剂的儿童啊，\n\n05:55.028 --> 05:56.553\n出现鼻窦炎症状，\n\n05:56.703 --> 05:58.153\n并快速加重。\n\n05:59.407 --> 06:01.231\n另外一个症状就全身症状，\n\n06:01.231 --> 06:02.756\n就是一个高热不退，\n\n06:02.756 --> 06:04.557\n伴有精神状态极差，\n\n06:05.006 --> 06:06.557\n甚至意识模糊。\n\n06:08.005 --> 06:09.005\n这是危险信号，\n\n06:09.005 --> 06:10.105\n要及时就医。\n\n06:12.559 --> 06:12.760\n嗯，\n\n06:12.809 --> 06:15.209\n说一下那个及时就医的重要性，\n\n06:15.209 --> 06:17.160\n儿童真菌性鼻窦炎呢，\n\n06:17.160 --> 06:19.959\n尤其是侵袭性可能危及生命。\n\n06:20.059 --> 06:22.209\n若孩子出现上述症状呢，\n\n06:22.410 --> 06:24.260\n尤其是伴随危险信号，\n\n06:24.260 --> 06:28.160\n需尽快至耳鼻喉科就诊，\n\n06:28.209 --> 06:32.010\n完善鼻内腔鼻内镜检查，\n\n06:32.010 --> 06:35.109\n鼻窦CT及真菌病原学检查。\n\n06:35.947 --> 06:36.197\n嗯，\n\n06:36.197 --> 06:39.722\n可以做分泌物的涂片、组织活检等等，\n\n06:39.722 --> 06:40.898\n避免延误。\n\n06:42.369 --> 06:42.820\n质量。\n\n06:45.089 --> 06:47.589\n虽然真菌性的鼻窦炎相对少见，\n\n06:47.589 --> 06:50.464\n但是它的临床表现更为复杂，\n\n06:50.464 --> 06:55.214\n危险性也也也更加更加的大，\n\n06:55.214 --> 07:03.790\n下面说一下就是真儿童真菌性的鼻窦炎与其他鼻窦炎的鉴别，\n\n07:04.089 --> 07:06.940\n一个就是与细菌性鼻窦炎的鉴别，\n\n07:07.140 --> 07:08.989\n它的鉴别点在是。\n\n07:12.286 --> 07:14.085\n细菌性的鼻窦炎呢？\n\n07:16.510 --> 07:17.610\n根据一个病史来，\n\n07:18.161 --> 07:18.561\n嗯，\n\n07:18.811 --> 07:20.561\n那个真菌性鼻窦炎呢，\n\n07:20.561 --> 07:21.460\n它病程较长，\n\n07:21.460 --> 07:24.411\n多为单侧免疫正常儿童多见。\n\n07:24.760 --> 07:25.161\n嗯，\n\n07:25.561 --> 07:27.510\n细菌性鼻窦炎呢，\n\n07:27.811 --> 07:30.661\n急性发作都有上呼吸道感染病史，\n\n07:31.161 --> 07:34.061\n慢性常反复发作。\n\n07:35.578 --> 07:37.727\n还有一个根据分泌物特点来，\n\n07:38.278 --> 07:39.602\n真菌性鼻窦炎呢，\n\n07:39.602 --> 07:42.227\n它是分泌物是粘脓涕，\n\n07:42.377 --> 07:44.528\n带血或者干酪样分泌物。\n\n07:44.828 --> 07:46.653\n而细菌性鼻窦炎呢，\n\n07:46.653 --> 07:47.828\n它是脓性涕，\n\n07:47.928 --> 07:49.578\n急性发作时量多，\n\n07:49.578 --> 07:50.928\n色黄或者绿。\n\n07:51.967 --> 07:52.166\n嗯，\n\n07:52.316 --> 07:59.117\n从另外一个从鼻窦CT来鉴别真菌性鼻窦炎呢，\n\n07:59.117 --> 08:00.967\n窦内可见高密度影。\n\n08:01.117 --> 08:01.441\n嗯，\n\n08:01.441 --> 08:03.316\n这是因为有真菌团块，\n\n08:03.416 --> 08:05.666\n钙化粘膜增厚引起。\n\n08:05.967 --> 08:07.717\n而细菌性鼻窦炎呢，\n\n08:07.717 --> 08:09.867\n它鼻腔粘膜的均匀增厚，\n\n08:09.867 --> 08:11.066\n无钙化灶。\n\n08:11.907 --> 08:13.657\n实验室检查来鉴别的话，\n\n08:13.657 --> 08:15.006\n真菌性鼻窦炎呢，\n\n08:15.006 --> 08:19.881\n它分泌物图片可见真菌菌丝培养有真菌增长。\n\n08:20.032 --> 08:22.606\n而细菌性的鼻窦炎呢，\n\n08:22.606 --> 08:24.332\n它是细菌培养阳性，\n\n08:24.582 --> 08:28.282\n可以是肺炎链球菌、流感嗜血杆菌等。\n\n08:29.372 --> 08:29.472\n嗯，\n\n08:29.472 --> 08:31.472\n治疗反应来鉴别的话，\n\n08:31.472 --> 08:34.148\n肝真菌性鼻窦炎呢，\n\n08:34.148 --> 08:37.973\n规范的抗真菌药物或者手术效果显著。\n\n08:38.523 --> 08:38.922\n嗯，\n\n08:38.973 --> 08:40.922\n而细菌性鼻窦炎，\n\n08:40.922 --> 08:42.872\n它是抗生素治疗有限。\n\n08:43.760 --> 08:44.861\n有有有效。\n\n08:47.648 --> 08:48.922\n要特别注意的呢，\n\n08:48.922 --> 08:51.872\n是侵袭性的真菌性鼻窦炎，\n\n08:51.872 --> 08:57.223\n需与急性细菌性鼻窦炎伴眶周蜂窝织炎鉴别，\n\n08:57.322 --> 08:59.848\n后者多有高热、局部红肿热痛，\n\n08:59.848 --> 09:04.973\n但无组织坏死、血管侵袭及免疫缺陷病史病史。\n\n09:06.289 --> 09:06.439\n嗯，\n\n09:06.439 --> 09:06.989\n第二个，\n\n09:06.989 --> 09:11.614\n我们要与变态性的真菌性鼻窦炎鉴别。\n\n09:11.614 --> 09:12.888\n它们有共同点，\n\n09:13.039 --> 09:16.239\n均与过敏相感相关，\n\n09:16.239 --> 09:17.689\n可伴鼻息肉，\n\n09:17.789 --> 09:20.388\n眶鼻窦内粘液滞留。\n\n09:21.442 --> 09:21.642\n嗯。\n\n09:24.291 --> 09:26.067\n鉴别点一个是过敏史，\n\n09:26.216 --> 09:29.841\n变态性真菌性鼻窦炎常有明确的过敏史，\n\n09:29.841 --> 09:31.716\n如哮喘过敏性鼻炎，\n\n09:32.117 --> 09:34.591\n而非侵袭性的真菌性鼻窦炎呢，\n\n09:34.591 --> 09:37.216\n它过敏史不是太典型，\n\n09:37.216 --> 09:40.142\n从分泌物来特点来鉴别呢，\n\n09:40.142 --> 09:43.716\n就是变态性真菌性鼻窦炎呢，\n\n09:43.716 --> 09:48.117\n可可见大量嗜酸性粒细胞粘液。\n\n09:50.242 --> 09:55.591\n黄脓色的胶冻状而非侵袭性的真菌性鼻窦炎，\n\n09:55.591 --> 09:59.242\n它的分泌物是干酪样的或者带血分泌物。\n\n10:00.104 --> 10:00.203\n嗯，\n\n10:00.203 --> 10:02.754\n从真菌作用来分明呢，\n\n10:02.754 --> 10:07.254\n就是真菌作用变应原引起免疫反应，\n\n10:07.254 --> 10:10.879\n无侵袭性而非侵袭性真菌性鼻窦炎呢，\n\n10:10.879 --> 10:17.203\n它真菌定植或形成球菌无过敏阻导实验室检查呢。\n\n10:17.453 --> 10:22.254\n变态性真菌性鼻窦炎是血清IGE显著升高，\n\n10:22.354 --> 10:24.604\n分泌物嗜酸性粒细胞增多，\n\n10:24.804 --> 10:29.903\n而非侵袭性真菌性鼻窦炎它是IGE正常的或者轻度增高。\n\n10:30.346 --> 10:31.997\n真菌菌丝可见。\n\n10:33.455 --> 10:33.656\n嗯，\n\n10:33.906 --> 10:35.356\n治疗上鉴别，\n\n10:35.656 --> 10:36.056\n嗯，\n\n10:36.455 --> 10:41.705\n变态性真菌性鼻窦炎常用激素加抗过敏手术清除粘液，\n\n10:41.806 --> 10:49.656\n而非侵袭性真菌性鼻窦炎用手术清除真菌团块加抗真菌药物治疗。\n\n10:50.296 --> 10:50.497\n嗯，\n\n10:51.046 --> 10:55.146\n还有我们必须与鼻腔鼻窦肿物鉴别。\n\n10:55.546 --> 10:55.872\n嗯，\n\n10:55.872 --> 10:57.247\n需警惕疾病，\n\n10:57.247 --> 11:03.947\n就横纹肌肉瘤、鼻腔恶性淋巴瘤和尤文肉瘤等鉴别的鉴别点在于，\n\n11:03.947 --> 11:06.146\n一个是病情的进展啊，\n\n11:06.146 --> 11:08.096\n真菌性鼻窦炎进展。\n\n11:08.846 --> 11:13.995\n急性伴组织坏死而鼻腔鼻窦肿瘤呢，\n\n11:14.046 --> 11:15.096\n缓慢进场，\n\n11:15.096 --> 11:17.046\n早期以鼻塞出血为主。\n\n11:17.096 --> 11:18.620\n影像学呢，\n\n11:18.620 --> 11:21.971\n真菌性鼻窦炎可见窦壁骨质破坏，\n\n11:21.971 --> 11:25.445\n常为侵袭性真菌性侵蚀所致。\n\n11:25.445 --> 11:28.020\n而鼻腔鼻窦肿瘤呢，\n\n11:28.020 --> 11:30.020\n它存在不规则骨质破坏，\n\n11:30.020 --> 11:32.645\n软组织肿肿瘤占位。\n\n11:32.945 --> 11:36.245\n实验室检查来鉴别就是真菌性鼻窦炎。\n\n11:36.245 --> 11:38.945\n活检可见真菌菌丝及血管清。\n\n11:39.460 --> 11:44.809\n而鼻腔鼻窦肿瘤可见病理确诊肿瘤细胞，\n\n11:45.559 --> 11:47.635\n全身情况来说，\n\n11:47.635 --> 11:51.760\n真菌性鼻窦炎是有一般特别是侵袭性的，\n\n11:51.760 --> 11:53.859\n可有免疫缺缺陷病史，\n\n11:53.859 --> 11:55.359\n伴感染中毒症状，\n\n11:55.359 --> 11:56.359\n高热休克。\n\n11:58.869 --> 12:00.318\n而肿瘤这块呢，\n\n12:00.318 --> 12:02.318\n可伴有贫血、消瘦，\n\n12:02.369 --> 12:05.119\n而无真菌感染证据，\n\n12:05.619 --> 12:06.018\n嗯。\n\n12:07.138 --> 12:09.888\n还有就是与鼻异物继发感染鉴别，\n\n12:09.888 --> 12:11.088\n一个好发年龄呢，\n\n12:11.088 --> 12:12.812\n多见于3岁以下婴幼儿，\n\n12:12.812 --> 12:14.038\n有单侧鼻塞。\n\n12:15.150 --> 12:16.650\n流脓涕伴臭味。\n\n12:17.476 --> 12:17.577\n嗯，\n\n12:17.577 --> 12:19.327\n一个病史应该知道，\n\n12:19.327 --> 12:23.226\n一个一个鼻腔异物肯定是有异物塞入史的。\n\n12:23.226 --> 12:27.726\n而真菌性鼻窦炎就没有这个明确的异物史啊。\n\n12:28.544 --> 12:29.494\n症状特点呢，\n\n12:29.494 --> 12:31.669\n就真菌性鼻窦炎可伴有头痛，\n\n12:31.669 --> 12:32.494\n面部肿胀，\n\n12:32.695 --> 12:33.969\n而鼻腔异物呢，\n\n12:33.969 --> 12:36.344\n可见可有单侧鼻塞，\n\n12:36.344 --> 12:37.419\n流涕出血，\n\n12:37.419 --> 12:38.594\n取出异物后呢，\n\n12:38.594 --> 12:39.695\n症状就缓解。\n\n12:39.794 --> 12:40.844\n影像学呢，\n\n12:41.145 --> 12:43.395\n鼻窦内可见软组织或钙化。\n\n12:44.750 --> 12:45.125\n还有，\n\n12:45.125 --> 12:45.500\n嗯，\n\n12:45.901 --> 12:47.101\n鼻腔异物呢，\n\n12:47.401 --> 12:48.825\n鼻窦无明显异常，\n\n12:48.825 --> 12:50.051\n异物影像呢，\n\n12:50.450 --> 12:52.950\n没有异物影像一般都在鼻腔内，\n\n12:52.950 --> 12:54.500\n不会在鼻窦里面。\n\n12:55.403 --> 12:57.778\n鼻内镜检查，\n\n12:57.778 --> 13:00.778\n真菌性鼻窦炎可见真菌团块，\n\n13:00.778 --> 13:02.403\n粘膜充血、溃疡。\n\n13:04.140 --> 13:04.340\n嗯。\n\n13:05.023 --> 13:06.023\n而鼻腔异物呢，\n\n13:06.023 --> 13:08.573\n直接可以窥见异物啊。\n\n13:13.960 --> 13:14.161\n嗯，\n\n13:14.161 --> 13:16.036\n鉴别诊断的流程建议呢，\n\n13:16.036 --> 13:17.710\n要详细病史的采集，\n\n13:18.111 --> 13:19.935\n还有一个鼻内镜的检查，\n\n13:19.935 --> 13:21.236\n影像学的检查，\n\n13:21.236 --> 13:23.111\n实验室诊断啊。\n\n13:24.791 --> 13:25.791\n就这里要注意一点，\n\n13:25.791 --> 13:28.466\n就是非侵袭性真菌性鼻窦炎呢，\n\n13:28.466 --> 13:32.741\n必须与慢性细菌性鼻窦炎、变态性鼻窦炎仔细区分，\n\n13:32.890 --> 13:34.890\n避免过度使用抗菌素。\n\n13:34.940 --> 13:38.390\n还有一个侵袭性真菌性鼻窦炎是急性。\n\n13:40.052 --> 13:41.528\n是急症侵袭性的，\n\n13:41.528 --> 13:44.427\n需与肿瘤其他感染性级别相鉴别，\n\n13:44.427 --> 13:45.278\n一旦怀疑，\n\n13:45.278 --> 13:48.203\n需尽早启动抗真菌治疗。\n\n13:49.578 --> 13:50.528\n以及手术字。\n\n13:51.697 --> 13:52.047\n干预。\n\n13:52.945 --> 13:56.570\n儿童单侧鼻窦伴出血坏死或者免疫缺陷时，\n\n13:56.570 --> 13:57.596\n去高度真菌，\n\n13:57.745 --> 13:59.745\n高度怀疑真菌性鼻窦炎。\n\n13:59.945 --> 14:00.346\n嗯，\n\n14:01.046 --> 14:01.445\n好，\n\n14:02.145 --> 14:04.195\n我们再看一下它的治疗。\n\n14:05.005 --> 14:05.205\n嗯，\n\n14:06.255 --> 14:07.054\n就一般。\n\n14:08.682 --> 14:09.783\n我们会有那个。\n\n14:11.625 --> 14:14.101\n抗真菌治疗和手术治疗两两种。\n\n14:14.200 --> 14:19.950\n非侵袭性的核心治疗是手术清除病灶加术后辅助治疗，\n\n14:19.950 --> 14:22.250\n目标是彻底清除真菌团块，\n\n14:22.301 --> 14:23.401\n减少复发。\n\n14:23.401 --> 14:29.801\n而侵袭性的核心治疗是紧急抗真菌药物加急诊手术清创，\n\n14:30.151 --> 14:32.026\n目标是控制感染扩散，\n\n14:32.026 --> 14:33.000\n挽救生命。\n\n14:36.604 --> 14:36.679\n嗯，\n\n14:36.679 --> 14:39.004\n这里我说一下那个抗真菌的药啊，\n\n14:39.254 --> 14:41.379\n一个就是首选，\n\n14:41.379 --> 14:42.804\n如果是曲霉的话，\n\n14:42.804 --> 14:45.504\n是首选药物是氟利康唑，\n\n14:45.604 --> 14:49.153\n可以静脉或者口服序贯啊。\n\n14:49.153 --> 14:52.203\n毛霉的话可以用两性霉素鼻脂体，\n\n14:52.854 --> 14:56.604\n然后也可以用泊沙康唑艾沙康唑。\n\n14:57.330 --> 14:57.405\n嗯，\n\n14:57.405 --> 14:59.780\n其他可以根据药名来选择，\n\n14:59.780 --> 15:03.179\n如氟康唑、洗白菌素等。\n\n15:03.380 --> 15:03.705\n嗯，\n\n15:03.705 --> 15:05.880\n手术就是一个急性的清创，\n\n15:05.880 --> 15:09.780\n彻底切除坏死组织及健康出血边缘，\n\n15:09.979 --> 15:12.330\n避免颅内和眶内扩散，\n\n15:12.380 --> 15:13.729\n这个是很要紧的。\n\n15:13.729 --> 15:16.304\n术后要持持续清创，\n\n15:16.304 --> 15:17.580\n根据感染范围，\n\n15:17.830 --> 15:19.780\n可能需要多次手术。\n\n15:19.780 --> 15:21.580\n还有一个就是免疫支持，\n\n15:21.880 --> 15:24.155\n如果有免疫缺陷的患者，\n\n15:24.155 --> 15:25.979\n侵袭性的真菌性鼻窦炎，\n\n15:25.979 --> 15:27.530\n我们就要用免疫。\n\n15:27.575 --> 15:28.474\n支持要纠，\n\n15:28.825 --> 15:29.849\n如果有糖尿病，\n\n15:29.849 --> 15:30.750\n纠正糖尿病，\n\n15:30.750 --> 15:33.974\n中性粒细胞减少的基础疾病等都要纠正。\n\n15:34.768 --> 15:35.018\n嗯。\n\n15:37.523 --> 15:39.273\n儿童用药关键注意事项，\n\n15:39.273 --> 15:41.223\n一个是氟利康唑，\n\n15:41.223 --> 15:43.922\n需要监测血药浓度啊。\n\n15:44.273 --> 15:45.372\n两性霉素呢，\n\n15:45.372 --> 15:46.822\n要监测肝肾功能。\n\n15:47.458 --> 15:48.132\n要注意低钾。\n\n15:48.132 --> 15:48.708\n低镁。\n\n15:50.552 --> 15:52.651\n禁忌药物就是氟胞嘧啶，\n\n15:52.651 --> 15:57.552\n儿童是不可以用那个氟胞嘧啶来来来抗真菌治疗，\n\n15:57.552 --> 16:00.401\n因为儿童骨髓抑制风险高，\n\n16:00.401 --> 16:02.101\n需避免单用啊。\n\n16:02.101 --> 16:03.177\n氟利康唑也是的，\n\n16:03.177 --> 16:05.351\n严重肝功能不全者慎用。\n\n16:06.875 --> 16:09.924\n然后我们随访就是一个影像学的评估，\n\n16:09.974 --> 16:10.825\n每两周。\n\n16:12.127 --> 16:14.478\n要复查CT、磁共振，\n\n16:14.627 --> 16:16.127\n直至病灶稳定，\n\n16:16.478 --> 16:18.028\n这是侵袭性的感染，\n\n16:18.028 --> 16:19.028\n非侵袭感染，\n\n16:19.028 --> 16:21.028\n术后3个月复查鼻窦CT，\n\n16:21.228 --> 16:22.627\n还有一个实验室检查，\n\n16:22.627 --> 16:23.552\n就刚才说过了，\n\n16:23.552 --> 16:25.278\n要监测肝功能、肾功能。\n\n16:26.901 --> 16:27.375\n还要注意，\n\n16:27.375 --> 16:31.700\n复发预警就是一个持续的鼻塞、流涕、眶内肿胀，\n\n16:31.750 --> 16:33.625\n需立即就诊。\n\n16:33.625 --> 16:34.526\n预防措施，\n\n16:34.526 --> 16:40.301\n措施就是高危患儿、血液肿瘤、长期激素免疫抑制剂使用的患儿一定要。\n\n16:41.385 --> 16:42.135\n高度警惕，\n\n16:42.184 --> 16:44.184\n如有症状鼻塞出血，\n\n16:44.184 --> 16:45.984\n面部肿胀要及时就医。\n\n16:45.984 --> 16:46.734\n高热啊，\n\n16:46.734 --> 16:47.635\n这样子的。\n\n16:47.885 --> 16:49.984\n还有就是一个环境的控制，\n\n16:49.984 --> 16:51.434\n避免潮湿环境，\n\n16:51.534 --> 16:53.534\n减少真菌孢子暴露。\n\n16:55.057 --> 16:55.333\n嗯，\n\n16:55.333 --> 16:56.533\n关键提醒就是，\n\n16:56.533 --> 16:59.057\n侵蚀性感染死亡率高达50%，\n\n16:59.107 --> 17:02.757\n需耳鼻喉科、感染科、血液科多科协作。\n\n17:04.139 --> 17:05.213\n另外一个重要点，\n\n17:05.213 --> 17:09.614\n关键点就是早期手术清创是改善预后的关键，\n\n17:09.614 --> 17:12.889\n延迟治疗可能导致颅内感染或者失明。\n\n17:14.227 --> 17:18.126\n还有一个就是避免滥用广谱抗菌素糖鼻子煎素。\n\n17:19.017 --> 17:22.368\n因为广谱抗菌素菌群失调会引起真菌的。\n\n17:23.350 --> 17:23.551\n嗯，\n\n17:23.651 --> 17:25.426\n感染还有一个糖皮激素，\n\n17:25.426 --> 17:26.551\n长期应用也会。\n\n17:27.805 --> 17:28.005\n嗯，\n\n17:28.155 --> 17:30.829\n如果疑似侵袭性感染，\n\n17:30.829 --> 17:38.755\n需立即转诊有儿童耳鼻喉科和感染科经验的综合医院。\n\n17:40.081 --> 17:42.031\n今天我们就学习到这里。\n\n","v0247cg10004d60s1viljht1n9j2b3f0",1065,545,"2026-01-24 21:47:04","儿童真菌性鼻窦炎症状及治疗方案 - 专业指南与有效疗法  ","儿童真菌性鼻窦炎, 鼻窦炎症状, 真菌感染治疗, 儿童鼻窦炎用药, 鼻塞流脓鼻涕, 抗真菌药物, 鼻窦炎手术  ","本文详细介绍儿童真菌性鼻窦炎的典型症状（如鼻塞、脓涕、头痛等）、诊断方法及治疗方案，包括抗真菌药物选择、手术干预及家庭护理建议，帮助家长及时识别并科学应对。","2026-02-11 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