临床带教与英文查房 | 慢性阻塞性肺病（一）

**小白老师说：**Bedside teaching is seen as one of the most important modalities in teaching a variety of skills for the medical profession, which greatly improves certain clinical diagnostic skills in medical students and residents.

临床带教和英文查房的内容很受欢迎，很多朋友留言希望能有语音。小白老师特意录了音频，方便大家跟读学习。

点击这里播放音频**▼**

Chronic Obstructive Pulmonary Disease

Chief Resident: Your attention, please. The teaching ward round by Chief physician Professor Clark now begins. Firstly, let’s have the case presented by Dr. Grey.

住院总医师：请各位注意了，主任医师 Clark 教授的教学查房现在开始，首先由实习医师 Grey 医生汇报病史。

Intern (Dr. Grey): This 70-year-old man was admitted because of a one-week history of breathlessness and cough with purulent sputum.

实习医师：病人，男性，70 岁，因气急、咳嗽、咳痰 1 周入院。

He had always been coughing with sputum during the past thirty years and tended to getting worse over recent five years, with breathlessness developing.

病人近 30 年来一直有咳嗽、咳痰，近5年来有所加重，伴气急。

The symptoms were usually aggravated by cold weather or alternations of seasons, while tended to ease when the weather was getting warm. Almost every year he had to suffer for one to three months. He was continuously using salbutamol inhalation which did relieve the symptoms most of the time.

症状通常于天气寒冷时或季节更替时发作，天气回暖后好转。几乎每年都有发作，持续1～3个月。病人一直使用沙丁硫醇吸入治疗，症状多能缓解。

One week before admission, he caught a cold and suffered a relapse thereafter. Meanwhile, he had large volumes of purulent sputum and wheezed after moderate movement. He inhaled salbutamol as usual, but it didn’t work this time. So he came. The patient has a smoking history of 100 pack years. And his family history was unremarkable. Mainly that’s all.

入院前 1 周，病人感冒后症状又有发作，伴咯大量脓痰，动则气急。吸入沙丁胺醇后症状无缓解。为求进一步诊治，入我院。病人有吸烟史，100 包每年，家族史无特殊。汇报完毕。

Chief physician: Your presentation is quite clear. Were there any significant physical findings, Dr. Grey?

主任医师：你的汇报很清楚。查体有什么有意义的发现吗?

Intern (Dr. Grey): Yes. We examined the patient carefully and found signs of lung disease, including bucket-like-chest and rhonchi. But there was no cyanosis in the lips and no edema of the legs.

实习医师：我们仔细检查了病人，发现一些肺部体征，包括桶状胸和肺部干啰音。无口唇发绀和双下肢水肿。

The laboratory tests reported that PaO₂ was 10 kPa and PaCO₂ was 5 kPa. However, WBC count was 9.9 X 10⁹/L, and the neutrophils were 90%. A previous pulmonary function examination showed that the forced expiratory volume in 1 second ( FEV1 ) was 1.5 liters and FEV1/forced vital capacity (FVC) was 50%.

实验室检查报告：PaO₂ 10 kPa，PaCO₂，5kPa；白细胞计数 9.9×10⁹/L，中性粒细胞 90%。病人过去的肺功能检查示第1秒用力呼气量（FEVI）是 1.5 L，第 1 秒用力呼气量/用力肺活量（FEV1/FVC）是 50%。

Chief Physician: When was the pulmonary function done?

主任医师：肺功能是什么时候做的?

Intern (Dr. Grey): ( Looking through the chart ) Er… 6 months ago.

实习医师：*（翻看病历）*嗯，6个月前。

Chief physician: How was his condition at that time? I mean whether he was sick or instability?

主任医师：当时病人的情况怎么样? 也就是说当时他是在发作期还是稳定期?

Intern (Dr. Grey): Sorry, I failed to ask it.

实习医师：不好意思，我没有问。

Chief physician: Never mind, but be more careful next time.

主任医师：没关系，不过下次要问仔细了。

Intern (Dr. Grey): Got it, Professor.

实习医师：我知道了，教授。

Chief Physician: Did he have a fever?

主任医师：病人发热吗?

Intern (Dr. Grey): No.

实习医师：不发热。

Chief Physician: Well, since we have learned about the history, it’s the very time to visit the patient.

主任医师：好，既然我们已经了解了病史，现在该去看看病人了。

Chief Resident: OK. Let’s go to the ward.

住院总医师：好，那就去病房吧。