世界上伟大的医生(第八期)

2021-12-23 16:41:20 广州仁医医疗 15

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本期仁医医疗特别邀请到马尔堡大学医学院肺病学系肺康复教授、Schön Klinik贝希特斯加登康复医院肺病科主任Prof. Koczulla做专题访问。他是全德国唯一一位肺康复教授,也是德国肺康复科研研究所创始人以及联邦德国教育与科研司新冠肺炎及预后康复项目专组成员。本次采访中,Prof. Koczulla对新冠疫情何时结束、新冠肺炎患者的康复治疗等热点话题发表了独特的看法。


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01


您是何时决定从医的呢?又为什么专攻肺康复呢?

Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in Pulmonary Rehabilitation?


成为一名医生是我从小的梦想。我的大学生活在柏林开始,随后我还去了美国、荷兰求学。刚开始我学习的是内科,我对肺病学也很有兴趣。而且我从小就对科学感兴趣,大学也是如此。大学期间,初次接触肺病学的时候,我得到很多机会从事我喜爱的科研工作,所以后来我就留在了肺病科。

至于为什么我后来专攻肺康复,是因为我从事了许多重症监护的工作。这里的康复中心有别于传统,它会接诊很多危重症病人,所以在这里我学到了很多关于重症监护的知识。我们接诊了众多移植前后的病人。当然现在更多的是接诊新冠肺炎患者。

Doing or being a medical doctor was my dream since childhood times. I started university time in Berlin, and I went to the US and also to the Netherlands. First, I started with a kind of internal medicine, and pulmonology was just that I was very interested in. I saw a lot of patients suffering from pulmonary problems. I was always, since childhood and since starting university career, I was interested in science. In the university where I did my first pulmonology education, I had the opportunity to do a lot of scientific work, so I stayed with the pulmonology. You ask me why I then went to the rehab part. I did a lot of intensive care medicine. The rehab here is something which is not the classical rehab. That means rehab here has more severe patients, and the intensive care education just had me taken up. Here we see a lot of transplant patients, we see a lot of patients before transplant. At the moment, we see a lot of Covid patients.



02


您的早年经历如何塑造你的成就?

How did your early youth experience shape your success?


我想分享一个童年的故事。小时候我的眼睛受过伤,是医生让我重见光明恢复视觉,那时我就被医生这个职业深深吸引了。从那次受伤中恢复过来后我就对医学很着迷,这也是鼓励我进入医学领域的原因之一。

There is a nice story. When I was a little boy, I injured my eye. I was fascinated by the doctors who had me just to keep the opportunity to see and to have that sense of seeing. So I recovered from that injury and I was fascinated by medicine. I think that's one of the parts which inspired me to come to the field of medicine.



03


您职业生涯中是否有对您来说很重要的导师,他们教会您什么,是如何启发您的呢?

Who have been you greatest influences? What have they taught you and how have they inspired you?


医学院的老师们对我影响很大。在我医学生涯中,对我影响最大的人是Claus Vogelmeier教授,他是一名慢性阻塞性肺部疾病专家,在我医学生涯中担任着父亲般的角色。一些杰出的医学教育家对我也影响深远,比如来自休斯敦的心脏外科医生Denton A. Cooley教授,还有我在荷兰求学期间遇到的Klaus Rabe教授、Pieter Hiemstra教授以及Peter Sterk教授。

There were some teachers that influenced me of course at medical school. But the person who influenced me most during my medical career was Claus Vogelmeier. He is a specialist in chronic obstructive pulmonary diseases. He was kind of my father figure in medicine. But there were also some really prominent educators, like Denton A. Cooley from the heart surgery in Houston, Klaus Rabe, Pieter Hiemstra and Peter Sterk where they were the influences during my time at the Netherlands.



04


肺康复系的正教授很少见,您在马尔堡大学获得此头衔时有何感想?

There are not many W3 professors in Pulmonary Rehabilitation. How did you feel when you obtain the professorship at the University of Marburg?


作为德国唯一的肺康复系教授是一份极大的荣誉。当然这份荣誉也意味着重大的建设责任。我们迫切需要推动这一领域的前进,我也甘愿投身于这个领域的建设与发展。回顾过去四年,看到我们取得如此多的成就,我感到非常开心。

It is a big honor to be the only professor for Pulmonary Medicine in Germany. And of course it is also a position that has a lot of responsibility for future structures. There's also the demand of developing something which helps to bring the field forwards. So I like to structure that, I like to develop that. It is just a nice feeling to see that we’ve achieved quite a lot in the last 4 years.



05

您如何平衡行政、临床、科研、教学工作及个人生活?

How do you balance the personal life, administration, clinical practice, research activities and lecturing?


在日常工作中,我会接诊很多病人也经常到病房巡视病人。出诊是我工作的一个重要部分。有时很难平衡教学和临床工作。平时我们会在医院举办讲座周,让学生们参与一周的教学讲座。我也会出差到马尔堡和萨尔茨堡开展讲座。

科学研究也是我日常工作的一部分,我们会核查病人能否入组参与科研项目。我们科室有多个并行的临床研究。我们还有特殊设定,让病人留院至少三周,以便收集更多的科研数据。这些是我们能在医院同时开展多个研究的原因。在基础科学方面,我们与马尔堡大学有合作,那边的同事会帮助我们收集科研数据。

I see a lot of patients, and I am doing rounds quite often. I also have a major parts in the diagnostics. The balance between the lectures and the clinical setting, it's sometimes difficult. So we have some lecture weeks here. That means we have the students here for a week. I also travel for the lectures in Marburg and in Salzburg. The research is part of the daily business. We will check every patient if he/she can be part in a specific study. We have a lot of parallel running clinical studies in our department. We have a special setting that the patients stay here for at least three weeks that gives you a lot of opportunities for scientific questions. That's the reason why we run so many studies here. For the basic science, we have the collaboration with the Marburg where I have some employees that help to answer that scientific questions.



06

能否请您分享一个您认为最富有挑战性、最令您印象深刻的病例?

Could you please share one case that you think as the most challenging and impressive one?


在呼吸科,我们接待过许多危重症病人,遇到过很多富有挑战性的病例。在过去的几周里,我遇到最具挑战性的病人是一位新冠肺炎康复患者。这名患者刚转入我们科室时,自身情况非常糟糕。但是最后他能够自己走上飞机楼梯并回到他自己的国家。

We have a lot of challenging cases, since we see a lot of severe patients in pulmonary medicine. But one of the most challenging in the last couple of weeks was a patient suffering from post-Covid. He came in a really bad shape, but later was able to enter the stairway of the plane himself and went back to his home country.



07


您作为多个领先的呼吸领域学会的活跃成员,这对您的职业生涯有何帮助?

You have been an active member of a number of leading organizations or societies in the field of pulmonology; how has this helped to shape your career?


我认为通过加入学会,可极大帮助你在临床和科学研究方面发展人际关系网络。通过这些人际关系网络可助你成功,提高你的工作质量。建立人际关系网络是必要的,例如加入一些科学学会。

I think the networking based on society context or in the society is a major part of developing network systems for clinical and for scientific questions. It is increasing your success, increasing the quality of your work by using these systems. So I think it's mandatory to have that kind of networking, for example, joining some societies.



08


新冠肺炎疫情现在是医疗领域最大挑战之一,您认为这对您所在领域有何影响?

The COVID-19 pandemic is one of the biggest challenges facing modern healthcare. What impact do you see this having on the field of Pulmonary Rehabilitation?


你说得对,新冠肺炎疫情是一个大挑战。但通过应对新冠疫情,加强了呼吸科各亚专科之间的联系,各科室之间的知识共享与交流也增多了。在新冠疫情期间,呼吸科领域的地位也发生了变化。各种会议和政治决策中必须要有呼吸科医生的参与,呼吸科医生为政治家们提供了很多医学建议。新冠疫情期间,呼吸科和整个医学领域的地位都有所提高了。

You're completely right. The pandemic was challenging. But by just coping the pandemic again, the networking between the pulmonary departments increased. I have the impression that there was a lot of exchange of knowledge. It was possible also from the standing of the field of pulmonology that changed during the pandemic. It was mandatory to have respiratory physicians included in the conferences and the political decision making. There was a lot of advising also for the politicians by respiratory physicians. So I think that our position and the great field of medicine increased during the pandemic.


09

您认为新冠疫情何时会结束?

When do you think the Covid-19 pandemic will end?


对于这个问题,我准备了一个东西。你知道它是什么吗?这是一个水晶球,女巫会从水晶球中看到她想要的答案。但说真的,其实我不知道疫情何时会结束。

我认为在接下来几个月,特别是在冬季,疫情仍在肆虐。众所周知,气溶胶在湿度高的环境以及低温的冬季会带来更大的危险。我预测疫情可能在明年春天有所缓解。目前,德国受感染的病人数量仍在增加,感染数量几乎和去年同期持平,而且大部分新冠病毒感染的病人未接种疫苗。德国开始为特定的病人进行第三针疫苗接种。但在过去的几周里,感染人数仍在上升。我预测新冠疫情后的问题也将持续至少几个月。因为一些症状需要很长一段时间才能痊愈,这意味着未来几周乃至几个月后都要面对新冠疫情后的问题。预计明年我们也会接诊很多新冠康复后的患者。可能到明年春天,急性感染病人数量会有所下降,但我推测新冠疫情后的问题将至少持续到明年年底。

For that question, I've prepared something. Do you know what it is? It's a crystal ball, and you know all the witches try to get something out of the crystal balls to read something inside. But no kidding, I do not know. I think for sure some months, the pandemic, especially during winter time, will let us suffer, because we know that the aerosols during a higher humidity state and during the winter times, are bigger dangers. So I would guess that it probably decreases in spring. At the moment, in Germany, the numbers of infected patients increase. We are nearly as high as last year during that time. We see a lot of infected patients which were not vaccinated. We started the third vaccination for specific patients, but at the moment, the numbers have increased during the last couple of weeks. I would guess that the post-Covid problems will just be present for at least a couple of months, since we know that symptoms can be cured over a long time period. That means over weeks, over months in the post-Covid field, I would guess that the next year also will bring us a lot of patients suffering from post-Covid. So I would guess that the acute infection goes down, let's say, at spring; and the post-Covid problems will maintain to at least on the end of the next year.



10


在新冠肺炎患者出院后的康复阶段,您认为他们应该注意什么才可完全康复或避免二次感染?

In order to fully regain their health and to avoid reinfection, what advice would you give to those Covid-19 patients during their recovery phase?


首先,我认为需要制定个性化的康复方案。医生需要了解病人的所有症状。病人可能有很多需求。当然我们会观察他们的症状。我的首要建议是制定个性化的康复方案。这就意味着除了诊断,如果在康复治疗阶段医生对药物治疗无法提供很多建议,那么就需要寻求更多针对新冠康复后患者用药的医学循证,更深入了解该疾病的病理。

对于非药物治疗部分,确实物理康复治疗起到一定的成效,但也需个性化的康复方案。医生要先了解病人能做什么,能做到什么程度以及病人能恢复到什么程度。相比之前,我们对功能障碍患者的康复治疗的进展会更慢,这是一个很大的区别。同时要记住,疲劳、慢性疲劳综合征也是一个问题。要把一切因素都考虑周全。所以我的建议是基于对病人整体的诊断,或者说基于病人症状的复杂性为病人制定个性化的康复治疗方案。

I think, first of all, we need a personalized approach. That means we just have to get all the symptoms of the patients. We have learned that they can require a lot. Of course, we see patterns. But my first advice is a personalized approach. That means besides the diagnostics, and if you turn into therapy, and we do not have a lot of advice and evidence for the pharmaceutical therapies. Just to get more evidence based medicine in the pharmaceutical part of the post-Covid treatment. We need to understand better the physiology and part of the physiology of the disease.

For the non-pharmaceutical part, we know that rehab bring some success, but also there we need a personalized approach. That means we have to check what can the patient, what does the patient able to do, where we can get him? And where we can bring him? For that, we start more slowly than before we started for those patients who are deconditioned. So I think that's a major difference. You have to keep in mind that also the fatigue or the chronic fatigue syndrome can be a problem. Just taking it all together. My advice is to make a very individualized plan for the patient, a therapy plan based on the broad diagnostic which probably is based on the symptom complex of patients.



11


世界卫生组织在全球十大死因中列出了四种肺部疾病。对此您有何看法?国际合作对这种现象可以提供什么帮助?

The World Health Organization (WHO) lists four lung diseases among the top ten causes of death. What’s your opinion on this and how can international collaboration contribute to this issue?


到目前为止,我认为呼吸科医生在医学领域的地位没有得到充分表现。我们知道,比如肺部感染和慢性阻塞性肺疾病(COPD)在未来几年里都在增加,正如你提到的,成为全球十大死因之一。现在我们需要的是发展科学合作和增强预防工作。例如我们必须通过控制香烟、大麻和电子烟来预防COPD,同时也要解决环境污染问题。这样就有希望在未来的几代人里减少肺部疾病。我认为预防、合作和科学方案以及药物输送管理可改善这一现状。

I think that the respiratory physicians, and the rank of the respiratory physicians in the field of medicine is underrepresented so far. Just based on what you just cited, that means, we know, for example, pulmonary infections and the COPD that increase over the next couple of years, and will become one of these, as you mentioned, leading causes of death. For that time, we need the scientific networking and we need the prevention. That's very important. For example, in the field of COPD we have to prevent by limiting cigarette, smoking and also vaping, but also the environmental problems that we have to decrease. Then we can hope that for the future generations, perhaps these diseases can be decreased. I think, preventing, networking and scientific approaches to become better and the field of drug delivery should be a major point.



12



对于想要从事肺康复的人,您有什么建议?

What advice would you give to someone hoping to start a career in Pulmonary Rehabilitation?


我的建议是全面学习肺康复知识。从我的经历来说,肺康复学习是从重症监护室(ICU)开始的,另一方面就是从预防开始。从事肺康复的人要接受全面的教育。对我而言,在ICU学到的经验、操作规范和重症监护医学是首要的,因为我要治疗危急重症病人。再者,把大学学习的课堂知识、临床和科研方法结合非常重要。你会发现进入了一个非常有趣、富有挑战性但又让你非常着迷的医学领域。我非常热爱肺康复这一领域,也希望你能成为我们的一份子。


I think just to cover the whole range of pulmonary rehab. For me, pulmonary rehab starts at the ICU and also on the other side, starts in the prevention. You should be broad educated. The ICU experience and the specification and intensive care medicine was ahead for me just to cover that part of the very severe disease patients. For me, it is also very important to combine always the 3 columns. The university education, including the lecturing, the clinical approach and the scientific approach. These three parts should be taken together, and that gives you a very interesting, a very demanding, but also a very fascinating field of medicine. I like that quite a lot and so I can recommend to be part of that rehab society.



13



假如您不从医的话,您会从事什么行业?

What would you have been if you had not been a medical doctor?


我母亲曾经希望我成为一名演员。我以前会花一些时间在剧院练习表演,并在学校的剧院里扮演一些小角色。

My mother wanted me to become an actor. So I spent some time in active practicing in theater and acting little roles in the school theatre.



14


除了医学外,您还有什么兴趣爱好?

What are your hobbies outside of practicing medicine?


我喜欢文化艺术方面的东西。比如戏剧、电影。我对音乐也很感兴趣,喜欢听音乐。我还喜欢踢足球、打网球、双板滑雪、单板滑雪,以及各项山上运动。

I'm interested in cultural stuff. That means theater, cinema. I'm very interested in music, I like listening to music quite a lot. I also like soccer playing, tennis playing, and skiing, snowboarding, so all the things you can do in the mountains.



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