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,可能影响妊娠结局及母体健康。
- 甲亢患者在怀孕期间可能出现乏力、心悸等症状,需密切监测甲状腺功能。
- 既往有流产史的甲亢孕妇再次妊娠时,应重新评估是否需要药物干预。
- 医患对话中涉及系统性问诊技巧,包括对症状、体重、食欲、排便、情绪及眼部体征的全面询问。
- 部分甲亢典型症状(如怕热、烦躁、多汗)在孕期可能减轻或不典型,需结合病史综合判断。
- 心悸若为长期存在(如自幼年起),需鉴别是否与甲亢相关或其他心脏原因所致。
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
甲亢孕妇为什么会出现乏力和心悸?
甲亢导致代谢亢进,增加心脏负担并消耗能量,从而引发乏力和心悸,尤其在妊娠期更易显现。
甲亢患者怀孕后可以停用抗甲状腺药物吗?
不可自行停药。是否调整药物需由医生根据甲状腺功能、孕周及胎儿风险综合评估决定。
医患对话中医生为何反复询问症状变化?
通过对比症状前后变化(如潮红、怕热、烦躁是否减轻),帮助判断甲亢控制情况及是否与妊娠相互影响。
眼球突出一定是甲亢引起的吗?
虽然眼球突出(突眼)是Graves病的典型表现,但也有先天性或非甲亢原因,需结合甲状腺功能和其他检查判断。
参考资料
妊娠期甲状腺疾病诊治指南(中华医学会内分泌学分会)
提供甲亢在妊娠期的管理原则,包括药物使用与监测建议。
Hyperthyroidism in Pregnancy - American Thyroid Association
国际权威指南,涵盖甲亢对妊娠的影响及临床处理策略。