干货 | 医患对话精听 | Acratia and Palpitation 乏力伴心悸
摘要: Acratia and palpitation(乏力伴心悸)是甲状腺功能亢进症(甲亢)的常见症状,尤其在高龄孕妇中需特别关注。该对话展示了医生如何通过系统问诊评估患者当前症状、妊娠状态及既往病史,以判断病情控制情况。
- 甲亢患者在怀孕期间需密切监测甲状腺功能,因药物使用和妊娠本身可能相互影响。
- 乏力、心悸、怕热、体重变化等是甲亢典型症状,但个体表现可能随时间或治疗而改变。
- 医患沟通中,医生通过结构化问诊(如症状、饮食、排便、情绪、家族关系等)全面评估患者状况。
- 患者自述症状变化(如“以前怕热,现在不明显”)对判断疾病活动性具有重要参考价值。
- 既往流产史与当前妊娠状态提示甲亢管理对生殖健康的重要性。
小白老师说:今天医患对话精听的主题是Acratia and Palpitation,患者是患有甲亢的高龄孕妇。可能的生词我已经给大家注好了中文。很多实用的句型值得模仿。参加医博英语考试的童鞋们可以好好琢磨一下这个长对话有哪些可能的考点。OK,请点击下方条形框播放语音。
Acratia and Palpitation 乏力伴心悸
WOMAN, AGED 35 (女性,35岁)
D=Doctor, P=Patient
D: I see from notes you came to us a year ago with an overactive thyroid gland(甲状腺功能亢进).
P: Yes, and I had a miscarriage(流产) in May and I’m now pregnant again.
D: When is your baby due?(什么时候分娩?/ 预产期是什么时候?)
P: Roughly 10th July.
D: Have you been taking pills for your gland?
P: I stopped taking them about six months ago.
D: How are you at the moment?
P: I keep feeling queer and my doctor suggested I had a check-up.
D: Tell me what symptoms you have. Do you ever faint?
P: No, but I feel faint. I feel hot and weak when I’m travelling.
D: Do you actually flush(面颊潮红) or sweat?
P: No. Not as before.
D: Any other symptoms? Have you been gaining weight?
P: Yes, I didn’t realize I was pregnant.
D: How is your appetite?
P: Good.
D: Are your bowels regular?
P: Yes.
D: Do you go more than once a day?
P: No.
D: They are quite well-formed, are they?
P: Yes.
D: How are your nerves? Are you jittery(神经过敏), fidgety(烦躁不安)?
P: No.
D: Do the family get on your nerves? (家里有人惹你生气吗?)
P: Not now.
D: Were your eyes always prominent(突出的)?
P: Yes.
D: Are you particularly bothered by the weather?(你特别受天气影响吗?)
P: No. I used to be before.
D: You suffer from palpitations(心悸)?
P: Yes, but I’ve had them since I was a child.
D: In yourself, you feel different?
P: Oh, yes.
常见问题
甲亢患者怀孕期间可以停用抗甲状腺药物吗?
一般不建议自行停药。是否调整药物需由内分泌科与产科医生共同评估,权衡母体与胎儿风险。
乏力伴心悸一定是甲亢吗?
不一定。虽然这是甲亢常见症状,但也可能由贫血、心律失常、焦虑或其他内分泌疾病引起,需结合检查综合判断。
医生问‘家里有人惹你生气吗’有什么临床意义?
甲亢患者常伴有情绪易激惹、烦躁,此问题用于评估神经系统受累情况,是甲亢问诊的典型内容。
为什么医生要问排便次数和性状?
甲亢可导致肠蠕动加快,引起腹泻或大便次数增多;规律且成形的大便提示当前胃肠道症状不明显。
参考资料
妊娠期甲状腺疾病诊治指南(中国)
中华医学会内分泌学分会发布,指导甲亢患者妊娠期管理
Hyperthyroidism and Pregnancy
↗美国内分泌学会关于甲亢与妊娠的患者教育资料