第四节 既往史

一、既往史（past history）主要内容

1．预防接种 [history of preventive inoculation]及传染病史。

2．药物及其他过敏史。

3．手术、外伤史及输血史。

4．过去健康状况及疾病的系统回顾。

二、系统回顾（review of systems）

呼吸系统：咳嗽、咳痰、呼吸困难、胸痛、盗汗、发热 [respiratory system:cough, sputum, short of breath, chest pain, night sweeting, fever]

循环系统：心悸、胸痛、气促、咳嗽和咯血、水肿、晕厥、头晕 [circulatory system:palpitation, chest pain, short of breath, cough and hemoptysis, edema, syncope, dizziness]

消化系统：嗳气、返酸、腹胀、腹痛、腹泻、恶心和呕吐 [alimentary system:belching, sour regurgitation, abdominal distension, abd.pain, diarrhea, nausea and vomiting]

泌尿系统：排尿困难、尿频和尿急、尿痛、腹痛、水肿 [urinary system:difficulty in micturition, frequency and urgency of micturition, painful micturition, abdominal pain, edema]

造血系统：乏力、头晕、心悸、出血 [hematopoietic system:fatigue, dizziness, palpitation, bleeding]

内分泌系统：心悸、怕热、多汗、烦渴、水肿、手抖、消瘦和肥胖 [endocrine system:palpitation, heat intolerance, excessive sweeting, polydipsia, edema, hand tremble, wasting and obesity]

神经系统：头痛、晕厥、头晕和眩晕、失眠、偏瘫、失语 [nervous system:headache, coma, dizziness and vertigo, insomnia, hemiplegia, aphasia]

运动系统：关节痛、麻木、跛行、瘫痪 [motor system:joint pain, numbness, claudication, paralysis]

三、常用英语表述方法

1．无药物（食物）过敏史 [no past history of allergy to drugs（food）]

2．有青霉素过敏史 [have allergic history of penicilin]

3．有肺结核接触史 [there was contact history of lung tuberculosis]

4.2000年6月因急性阑尾切除术 [Appendectomy was done in June,2000 due to acute appendicitis]

5．健康状况佳（差）[health state was good（bad）]

6．既往体健 [be well（healthy）before]

7．否认既往心、肺疾病史 [deny any history of prior heart and lung disease]

8.10岁时（20年前）曾患过…… [suffered from...at age 10（20 years ago）]

9．易患…… [be liable（subj ect, apt）to...]

10．不详 [not in detail（not quite clear）]

11．外伤史 [trauma history]

12．预防接种史 [history of preventive inoculation]

13．他曾患…… [He has experienced...]

14．患者长期患……年，采用……治疗 [The patient had a lengthy history of...for... years treated with...]

15．她曾因……住院 [She has documented...]

16．在过去……年，她曾患…… [Within the past...years, she has had...]

17．本次入院前……年，她曾患……病一段时间 [...year prior to this presentation, she had an brief episode of...]

18．她叙述有……年……病史，但否认…… [She describes a...year history of..., but denies...]

19．患者曾患……病……时间 [the patient underwent...for...of...]

20．既往史包括…… [Previous medical history included...]

21．现服用……药物 [Present medications include...]

22．否认吸烟，吸毒史，偶尔饮酒 [Gives a negative history for smoking, drug, and only occasional alcohol use.]

23．家族史中，祖父患阿耳茨海默氏病 [Family history includes a grandfather with Alzheimer's disease.]

24．患者母亲死于…… [The patient's mother died of...]

25．家族中父亲曾患……疾病，未患……疾病 [Family history was positive for...and ...（disease）in his father, negative for...（disease）.]

26．家族史中无……病史 [Family history revealed no history of...]

27．她已婚、育2子 [She is married with two children.]

28．患者曾吸烟每天……包，但已于……年前戒掉 [The patient smoked...packs a day in the past but quit completely...years ago.]

29．他吸烟……年，每天半包，偶尔少量饮酒 [He smoked one half pack of cigarettes per day for...years, and he occasionally drank alcohol in moderation.]

30．不吸烟，嗜酒 [Does not smoke and is a social drinker.]