臨床醫(yī)學(xué)英語

1、臨床醫(yī)學(xué)英語Chapter 1 Patient-Physician InteractionPage 1第一章醫(yī)患溝通第頁The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. proceed 進行、開展 reasoning 推論、推理clinical reasoning 診斷clinical decision 確定治療方案making decision 做出決定醫(yī)患溝通在臨床診斷和治療決策的許多時期進行著。The interaction b

2、egins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.elucidation 說明、闡明inquire 詢問、調(diào)查evaluation 評估、評價這種溝通開始于病人主訴或所關(guān)注問題的闡明，然后通過交流、評估不斷精確地確定這些問題。The process commonly requires a careful history or physical examinat

3、ion, ordering of diagnostic tests, integration of clinical findings with the test results, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future egration 綜合 consultation 磋商、會診這個過程通常需要細致的詢問病史和體格檢查，開具診

4、斷性化驗醫(yī)囑，綜合臨床發(fā)現(xiàn)和化驗結(jié)果，理解分析擬行治療過程中的風(fēng)險和療效，然后與病人及家屬反復(fù)磋商以完善治療方案Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so that benefit is maximized,while respecting individual variations among different patientsrespecting 注意到、關(guān)系、說到evidence-based medicine 循證醫(yī)

5、學(xué)盡管考慮到不同病人中個體差異是存在的，但醫(yī)生們越來越容易查閱不斷增長的循證醫(yī)學(xué)文獻來指導(dǎo)這個過程，使得療效最大化。The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicineavailability可利用性，可得到randomize 隨機的cookbook 食譜，烹調(diào)書approach 接近但是，不斷增加的可用于指導(dǎo)臨床診斷與治療的隨機試驗資料不應(yīng)當(dāng)作“烹調(diào)書”使用。Ev

6、idence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.Evidence 證據(jù)，跡象 guideline指導(dǎo)方針emphasize 強調(diào)那些隨機試驗獲得的臨床表現(xiàn)和診斷思路是側(cè)重于求證具有某些特征病人而來的。Substantial clinical judgment is required to determine whether the evidence and guidelines apply to in

7、dividual patients and to recognize the occasional. substantial clinical 真實的，實在的individual 個體occasional 偶爾的，特殊的實際的臨床判斷需要確定這些臨床表現(xiàn)和診斷依據(jù)標(biāo)準(zhǔn)是否能應(yīng)用于普通病人的個體，并能找出例外。Even more judgment is required in the many situations in which evidence is absent or inconclusive.inconclusive 不確定性，非決定性在許多情況下，臨床表現(xiàn)缺乏或不典型，甚至需要考慮得

8、更多。Evidence also must be tempered by patients preferences, although it is a physicians responsibility to emphasize when presenting alternative options to the patient. temper 脾氣，調(diào)音preference 偏愛presenting 提出alternative 可選擇的，二選一雖然醫(yī)生喜歡提出選擇性問題讓病人回答，但病人肯定會根據(jù)自己的傾向調(diào)節(jié)臨床癥狀。The adherence of a patient to a spec

9、ific regimen is likely to be enhanced if the patient also understands the rationale and evidence behind the recommended option.adherence 堅持、固執(zhí)regimen 養(yǎng)生法、食物療法enhance 提高、加強rationale 基本原理假如還懂得所提供問題的基本原理和表現(xiàn)，有特殊生活方法病人的固執(zhí)容易強化這種傾向To care for a patient as an individual, the physician must understand the pa

10、tient as a person. care for 喜歡、照料為了把病人作為一個個體進行治療，醫(yī)生必須理解病人是一個人（不是一群人）。This fundamental precept of doctoring includes an understanding of the patients social situation, family issues,financial concerns, and preferences for different types of care and outcomes, ranging from maximum prolongation of life

11、 to the relief of pain and suffering. precept 訓(xùn)戒 doctoring 行醫(yī)prolongation 延長這個最基本的行醫(yī)原則包括了解病人的社會地位，家庭問題，資金狀況以及正確理解病人對不同治療方法、不同治療結(jié)果的選擇，從最大限度地延長生命到臨時緩解疼痛和癥狀。Even as physicians become increasingly aware of new discoveries, patients can obtain their own information from a variety of sources, some of whic

12、h are of questionable reliability.questionable 可疑的、成問題的、不可靠的reliability 可靠、可信賴的甚至，當(dāng)醫(yī)生越來越容易知道新發(fā)現(xiàn)的同時，病人也能夠通過各種途徑得到他們的信息，某些信息是不可靠的。The increasing use of alternative and complementary therapies is an example of patients frequent dissatisfaction with prescribed medical therapy.alternative 選擇，替代complement

13、ary 補充的、相配的prescribe 規(guī)定、指定、開處方不斷增加的替代療法和輔助療法的應(yīng)用就是病人對常規(guī)療法經(jīng)常不滿意的一個例子。Physicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven appr

14、oachessubstitute 代替、代用rely on 依賴、信任醫(yī)生對新療法應(yīng)該保持開放的思想，但是，如果這些療法具有任何程度的潛在風(fēng)險，都必須細致地告知病人，包括可能需要用已證實的常規(guī)療法去替代的風(fēng)險。It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options that either may considercrucial 嚴(yán)酷的、決定性的 either 兩者任一對醫(yī)生來說，對病人及家屬開誠布公地介紹所有可

15、考慮的治療選擇，是非常重要的。The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medical care and pubic health.vacuum 真空 extensive 廣闊的、大量的醫(yī)生不是生存在真空中，而是作為一個復(fù)雜而龐大的醫(yī)療和公共健康體系中的一部分。In premodern times and even today in some developing countries, basic hygiene, clean wate

16、r, and adequate nutrition have been the most important ways to promote health and reduce disease.adequate 足夠的、恰當(dāng)?shù)脑谖窗l(fā)達時代，甚至當(dāng)今在一些發(fā)展中國家，基本衛(wèi)生條件、清潔飲用水和最低營養(yǎng)保障是促進健康的最重要方法。In developed countries, the adoption of healthy lifestyles, including better diet and appropriate exercise, are cornorstones to reducing

17、 the epidemics of obesity, coronary disease, and diabetes.adoption 采納、采用epidemic 流行、傳染在發(fā)達國家中，健康的生活方式包括良好飲食和適當(dāng)鍛煉，是減少肥胖、冠心病和糖尿病的基礎(chǔ)。Public health interventions to provide immunizations and to reduce injuries and the use of tobacco, illicit drugs, and excess alcohol collectively can produce more health

18、benefit than nearly any other imaginable health intervention.illicit 非法的、違禁的collectively 全體地、共同地produce 生產(chǎn)、創(chuàng)造公共健康干預(yù)如進行疫苗接種、減少損傷、減少吸煙、減少吸毒、減少酗酒等措施共同產(chǎn)生的健康效果比幾乎可想象的任何其它健康干預(yù)措施都要好得多。Chapter Vital signsPage 15第六章生命體征第頁A nurse or assistant often obtains the vital signs.護士或護士助手經(jīng)?？傻玫缴w征Traditionally the vit

19、al signs include pulse rate, blood pressure, respiratory rate, and body temperature.傳統(tǒng)的生命體征包括脈搏（率）、血壓、呼吸（頻率）和體溫。More recently, advocates of various causes have advocated for a “fifth vital sign”. advocate 提倡、主張最近，人們以多種理由提出 “第五生命體征”的建議。The most cogent of these “new” vital signs is the patients quanti

20、tative assessment of pain.cogent 今人信服的，切實的，有力的這些“新”的生命體征中，最今人信服的是病人疼痛的定量評判。The pulse should be recorded as not just the rate but also the rhythm. 脈搏不僅要記錄頻率，而且要記錄節(jié)律。Physicians may prefer to initiate the examination by holding the patients hand while palpating the pulse.initiate 開始，創(chuàng)始醫(yī)生喜歡握住病人的手，觸摸脈搏，開

21、始檢查。This nonthreatening initial contact with the patient allows the physician to determine whether the patient has a regular or irregular rhythm. 這個對病人無威脅性的最初接觸讓醫(yī)生確定了脈搏是否具有節(jié)律性。When the blood pressure is abnormal, many physicians repeat the measurement.當(dāng)測得的血壓不正常，許多醫(yī)生重復(fù)這個測量。The instrument error that c

22、ontributes to the greatest variability is the cuff size of the sphygmomanometer. variability 變化，易變性sphygmomanometer 血壓計變異性中占比例最大的設(shè)備誤差是血壓計袖套的大小。Many adults require a large-size adult cuff; using a narrow cuff can alter systolic/diastolic blood pressure by -8 to +10/+2 to +8mmHg. mmHg: millimeter of m

23、ercury許多成人需用大號的成人袖套，如果使用窄袖套能夠影響收縮壓-810mmHg ，舒張壓28mmHg。The appearance of repetitive sounds (Korotkoff sounds, phase 1) constitutes the systolic pressure. constitute 構(gòu)成，設(shè)立，指定重復(fù)脈搏音（Korotkoff 音，第相）的出現(xiàn)定為收縮壓。After the cuff is inflated about the palpated pressure, the Korotkoff sounds muffle and disappear

24、as pressure is released (phase 5).inflate 充氣、膨脹muffle 含糊不清當(dāng)袖套充氣壓力約在可觸摸脈搏壓力的2030mmHg上方，Korotkoff音變鈍，當(dāng)壓力釋放，Korotkoff音消失（第相）。The level at which the sounds disappear is the diastolic pressure.聲音消失的水平就是舒張壓The American Heart Association recommends that each measure should be rounded upward to the nearest

25、2mmHgbe round up to the nearest whole number取最近的整數(shù)美國心臟病協(xié)會建議每次測量取最近的mmHg整數(shù)。The respiratory rate should be assessed at the same time the patient is observed to determine whether there is any respiratory discomfort (dyspnea).dyspnea 呼吸困難測量呼吸頻率的同時要觀察病人以確定是否存在呼吸困難。The subjective sensation of dyspnea is c

26、aused by an increased work of breathing. subjective 主觀的呼吸困難的主觀感覺是由于呼吸功增加起的。The examiner should decide whether patients have tachypnea (a rapid rate of breathing) or hypopnea (a slow or shallow rate of breathing).tachypnea 呼吸急促hypopnea 呼吸減弱檢查者要確定病人是否存在呼吸急促（呼吸頻率快）或呼吸減弱（呼吸頻率慢或淺）Tachpnea is not always a

27、ssociated with hyperventilation, which is defined by increased alvealar ventilation resulting in a lower arterial carbon dioxide level. hyperventilation 換氣過度resulting in 導(dǎo)致、引起呼吸急促不是都伴有過度換氣，過度換氣的定義是肺泡通氣量增高引起動脈血二氧化碳水平降低。In the evaluation of patients suspected of having pneumonia, examiners agree on th

28、e presence of tachypnea only 63% of the time.agree on 對取得一致意見對一組疑為肺炎患者的評估中，檢查者認為當(dāng)時呼吸急促的出現(xiàn)率僅為63%。The body temperature of adults usually is measured with an oral electric thermometer.成人體溫通常用口腔電子體溫計測定。These thermometers correlate well with the traditional mercury thermometer and are safer to use.mercur

29、y 汞這種體溫計與傳統(tǒng)的汞體溫計高度相關(guān)，使用安全。Rectal thermometers reliably record temperatures 0.4 higher than oral thermometers.直腸體溫計可靠地記錄了高于口表0.4的溫度。By comparison, newer tympanic thermometers may vary too much compared with oral thermometers (-1.2 to +1.6 versus the oral temperature) to be reliable among hospitalized

30、 patients.tympanic 鼓膜的、鼓室的too much to be 太以致于不相比較，新型的鼓式體溫計相對口表可能誤差太大（與口表相差-1.21.6度），不宜用于住院病人。Chapter 8 Why Geriatric Patients Are DifferentPage 20第八章老年病人的特殊性第20頁Older patients differ from young or middle-aged adults with the same disease in many ways, one of which is the frequent occurrence of comor

31、bidities and of subclinical orbidities 并存病subclinical 亞臨床的同樣的疾病，年齡大的病人在許多方面與青中年病人是有區(qū)別的，其中之一是并存病多和亞臨床疾病多。As a function of the high prevalence of disease, comorbidity (or the co-occurrence of two or more diseases in the same individual) is also common. prevalence 流行、普遍co-occurrence 同時發(fā)生作為高發(fā)

32、疾病的結(jié)果，并存?。▋蓚€或更多的疾病在同一個體同時發(fā)生）也是多見的。Of people age 65 and older, 50% have two or more chronic disease, and these diseases can confer additive risk of adverse outcomes, such as mortality. confer 授予、給予additive 附加的、附屬物65歲以上的老年中，50%患有兩種以上的慢性疾病，這些疾病能夠增加不利預(yù)后的風(fēng)險，如死亡率。In some patients, cognitive impairment may

33、 mask the symptoms of important conditions. cognitive 認知的、認識的impairment 損害mask 口罩、假面具、掩飾在一些病人中，認知損害可以掩蓋重要病情的癥狀。Treatment for one disease may affect another adversely, as in the use of aspirin to prevent stroke in individuals with a history of peptic ulcer disease. stroke 中風(fēng)peptic ulcer 消化性潰瘍對一種疾病的治療

34、可能加重另一種疾病，例如，對有消化性潰瘍病史的病人使用阿斯匹林預(yù)防中風(fēng)。The risk for becoming disabled or dependent also increases with the number of diseases present. disabled 殘廢的、有缺陷的dependent 依靠的、依賴的病殘或生活不能自理發(fā)生的風(fēng)險也隨著并存的疾病數(shù)而增高。Specific pairs of diseases can increase synergistically the risk of disability. synergistic 協(xié)同的特殊的成對疾病可以協(xié)同增

35、加病殘的風(fēng)險。Arthritis and heart disease coexist in 18% of older adults; although the odds of developing disability are increased by three-fold to four-fold with either disease alone, the risk of disability increases 14-fold if both are present. arthritis 關(guān)節(jié)炎有18%的老年人同時患有關(guān)節(jié)炎和心臟病，雖然每個疾病可以增加34倍的病殘率，但兩個疾病同時存在

36、，可使病殘率提高14倍。A second way in which older adults differ from younger adults is the greater likelihood that their diseases present with nonspecific symptoms and signs. likelihood 可能性老年與青中年的第二個差異是更容易出現(xiàn)非典型的癥狀和體癥。Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom

37、. pneumonia 肺炎mentation 精神作用、心理活動primary 初始的、首要的、主要的肺炎和中風(fēng)時可出現(xiàn)非典型意識變化作為主要的癥狀。Similarly, the frequency of silent myocardial infarction increases with increasing age, as does the proportion of patients who present with a change in mental status, dizziness, or weakness rather than typical chest pain. si

38、lent 沉默的、靜止的proportion 成比例的、相稱的同樣地，隱匿性心肌梗塞發(fā)生頻度隨著年齡的增大而增加，這些病人相應(yīng)地頻發(fā)精神狀態(tài)改變、眩暈、虛弱而不是典型的胸痛癥狀。As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases than generally would be considered in middle-aged adults.spectrum 譜、光譜因此，老年病人的診斷應(yīng)考慮更廣泛的疾病譜，要超過通常對中年病人所考慮的范圍

39、。A third condition that is found primarily in older adults is frailty, frailty is thought to be a wasting syndrome that presents with multiple symptoms and signs, including reduced muscle mass, weight loss, weakness, poor exercise tolerance, slowed motor performance, and low physical activity. prima

40、rily 起初、首先、原來frailty 脆弱、虛弱、意志薄弱tolerance 寬容、忍耐、耐受主要出現(xiàn)在老年人的第三個情況是衰弱，衰弱被認為屬于衰竭綜合癥，它有許多癥狀和體征中，包括肌肉萎縮、體重下降、虛弱、運動耐受差、動作慢、身體活動少。Some estimates indicate that the full syndrome is found in 7% of community-dwelling people age 65 and older, and in 25%of community-dwelling people age 85 and older. estimate 估計、

41、評價、看法indicate 指出、表時、象征、適應(yīng)征一些人估計7%的65歲以上社區(qū)老人和25%的85歲以上社區(qū)老人上述癥狀全部出現(xiàn)。 Many institutionalized older adults also are frail.institutionalized 使成公共團體、將收容在公共設(shè)施里frail 身體虛弱的、易損壞的、意志薄弱的許多老人院里的老人也是衰弱的。Frailty is a state of decreased reserve and increased vulnerability to all kinds of stress, from acute infectio

42、n or injury to hospitalization, and may identify individuals who cannot tolerate invasive therapies. reserve 保存、克制vulnerability 易受傷、易受責(zé)難衰弱是對各種壓力耐受下降、損害增加的一種狀態(tài)，從急性感染、損傷到住院治療，都可以發(fā)現(xiàn)一些人不能忍受侵入性診療措施。The syndrome of frailty is associated with high risk of falls, needs for hospitalization, disability, and m

43、ortality. fall 跌倒、下降frail 身體虛弱的、易損壞的、意志薄弱的衰弱的癥狀與易于病倒、需要住院治療、病殘、死亡的高風(fēng)險是相關(guān)的。There is early evidence that a core component of frailty is sarcopenia, or loss of muscle mass associated with aging, which occurs in 13 to 24% of persons age 65 to 70 and in 60% of persons age 80 and older. component 成分、構(gòu)成要素s

44、arcopenia 肌減少（癥）、與年齡相關(guān)的骨骼肌質(zhì)量下降衰弱一個主要成分的早期表現(xiàn)是肌肉減少，或說隨年齡增長的肌肉減少，它發(fā)生在1324%的6570歲的老人，60%的80歲以上的老人。 It is likely that dysregulation of multiple physiologic systems, including inflammation, hormonal status, and glucose metabolism, underlies the syndrome, with resulting decreased ability to maintain homeos

45、tasis in the face of stress. dysregulation 失調(diào)homeostasis 內(nèi)環(huán)境穩(wěn)定多種生理系統(tǒng)易于失調(diào) ，包括炎癥、激素狀態(tài)、糖的代謝，結(jié)果是在壓力面前保持內(nèi)環(huán)境的穩(wěn)定的能力下降。Subclinical disease (e.g., atherosclerosis), end-stage chronic disease (e.g., heart failure), or a combination of comorbid diseases may precipitate the syndrome. atherosclerosis 動脈粥樣硬化亞臨床疾病

46、(如動脈粥樣硬化), 晚期慢性疾病(如心力衰竭），或多種疾病并存可共同形成癥狀。Evidence from randomized, controlled trials shows that resistance exercise, with or without nutritional supplements, and home-based physical therapy can increase lean body mass and strength in even the frailest older adults. 隨機對照試驗的跡象顯示無論有無營養(yǎng)支持和家庭身體療法，即使是最虛弱的老

47、年人，對抗運動能夠增加瘦弱軀體的質(zhì)量和力量。This evidence suggests that earlier stages of frailty may be remediable, although end-stage frailty likely presages death.remediable 可挽回的presage 預(yù)兆、預(yù)示這個結(jié)果提示早期衰弱是可挽回的，盡管末期衰弱常提示死亡。 Fourth, cognitive impairment increases in prominence as people age. prominence 突出、顯著第四，人們變老時認知損害顯著增

48、加。Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls, immobilization, dependency, institutionalization, and mortality. immobilization 活動能力減少institutionalization 制度化、專門照料認知損害是大量不利結(jié)果的風(fēng)險因子，包括摔倒、活動能力下降、不能自理、需住老人院護理、死亡。 Cognitive impairment complicates diagnosis a

49、nd requires additional care giving to ensure safety.認知損害使診斷復(fù)雜，為保證安全需要更多的照料。 Finally, a serious and common outcome of chronic diseases of aging is physical disability, defined as having difficulty or being dependent on others for the conduct of essential or personally meaningful activities of life, f

50、rom basic self-care (e.g., bathing or toileting) to tasks required to live independently (e.g., shopping, preparing meals, or paying bills) to a full range of activities considered to be productive and/or personally meaningful.最后，老年人慢性病嚴(yán)重又常見的結(jié)果是身體能力不足，描述為個人最基本的或有意義的日?；顒佑欣щy或不得不依靠別人幫助指導(dǎo)，從基本的自理（如洗澡或如廁）

51、到獨立生活需要的各種任務(wù)（如購物、做飯、支付各種賬單），到具有集體和或個人意義的所有活動。Of older adults, 40% report difficulty with tasks requiring mobility, and difficulty with mobility predicts the future development of difficulty in instrumental activities of daily living (IADL; household management tasks) and activities of daily living (

52、ADL; basic self-care tasks). 在老年人中， 40%對需要運動的任務(wù)有困難，運動困難提示將來開展日常工具鍛煉（IADL；家庭護理項目）和目常鍛煉（ADL；基本自理項目）的困難。 In persons age 65 and other, difficulty with IADL is reported by 20%, and difficulty with ADL is reported by 11%; for both, the prevalence increases with age.prevalence 流行大于65歲的老人或其它人，IADL困難報導(dǎo)為20%，A

53、DL困難報導(dǎo)為11%；隨年齡增加兩個都困難成為普遍現(xiàn)象。People who have difficulty with tasks of IADL and ADL are at high risk of becoming dependent. IADL和ADL困難的人處于不能自理演變的高風(fēng)險中。 Of persons older than age 65, 5% reside in nursing homes, largely as a result of dependency in IADL and/or ADL secondary to severe disease. reside 居住nu

54、rsing home 療養(yǎng)院小于65歲的老人中，5%住在療養(yǎng)院里，大多數(shù)是嚴(yán)重疾病后依賴IADL和ADL的結(jié)果。Generally, woman live more years with disability, whereas men who become similarly disabled are more likely to die at a younger age.一般來說，同樣的能力不足，男性常死得更年輕，女性比男性能多活幾年。 Although physical disability is primarily a result of chronic diseases and ger

55、iatric conditions, its onset and severity are modified by other factors, including treatments that control the underlying diseases, physical activity, nutrition, and smoking. Primarily 首先、起初、主要、根本onset 進攻、有力的開始、發(fā)作雖然身體能力不足是慢性疾病和年老狀態(tài)的一個主要結(jié)果，它的發(fā)生和嚴(yán)重程度被其它因素影響著，包括基礎(chǔ)疾病的治療和控制、身體鍛煉、營養(yǎng)和吸煙。 Many intervention

56、trials indicate that disability can be prevented or its severity decreased; one trial showed improvements in functioning with resistance and aerobic exercise in older adults with osteoarthritis of the bic exercise 有氧運動osteoarthritis 骨關(guān)節(jié)炎許多干預(yù)試驗揭示能力不足可預(yù)防或減輕；一個試驗顯示膝骨關(guān)節(jié)炎老年人用對抗運動和有氧運動改善功能。Chapte

57、r 13 Tissue EngineeringPage 36第十三章組織工程第36頁The loss or failure of an organ or tissue is devastating. devastating 毀滅性的器官、組織的喪失或衰竭是毀滅性的。Current treatment methods include transplantation of organs, surgical reconstruction, use of mechanical devices, or supplementation of metabolic products. device 裝置現(xiàn)有的治療方法有器官移植、外科重建、機械裝置的應(yīng)用以及代謝性產(chǎn)品的補充治療。However, the ultimate goal of transplantation should reside in the ability to restore living cells to maintain or even enhance existing tissue function. reside 居住、屬于、存在于移植的最終目的應(yīng)該基于重建活細胞群以維持甚至增進現(xiàn)有組織的功能。