臨床醫(yī)學(xué)英語翻譯

臨床醫(yī)學(xué)英語翻譯臨床醫(yī)學(xué)英語翻譯臨床醫(yī)學(xué)英語翻譯資料僅供參考文件編號：2022年4月臨床醫(yī)學(xué)英語翻譯版本號：A修改號：1頁次：1.0審核：批準:發(fā)布日期：臨床醫(yī)學(xué)英語翻譯Chapter1Patient-PhysicianInteractionPage1第一章醫(yī)患溝通第１頁Tceed進行、開展reasoning推論、推理clinicalreasoning診斷clinicaldecision確定治療方案makingdecision做出決定醫(yī)患溝通在臨床診斷和治療決策的許多階段中進行著。Theinteractionbeginswithanelucidationofcomplaintsorconcerns,followedbyinquiriesorevaluationtoaddresstheseconcernsinincreasinglypreciseways.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訴說或所關(guān)注問題，然后通過詢問、評估不斷精確地確定這些問題。Theprocesscommonlyrequiresacarefulhistoryorphysicalexamination,orderingofdiagnostictests,integrationofclinicalfindingswiththetestresults,understandingoftherisksandbenefitsofthepossiblecoursesofaction,andcarefulconsultationwiththepatientandfamilytodevelopfutureegration綜合consultation磋商、會診這個過程通常需要細致的病史詢問和體格檢查，進行診斷性化驗，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，并與病人及家屬反復(fù)磋商以形成治療方案Physiciansincreasinglycancallonagrowingliteratureofevidence-basedmedicinetoguidetheprocesssothatbenefitismaximized,whilerespectingindividualvariationsamongdifferentpatientsrespecting注意到、關(guān)系、說到evidence-basedmedicine循證醫(yī)學(xué)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，但要考慮到不同病人中個體差異是存在的。Theincreasingavailabilityofrandomizedtrialstoguidetheapproachtodiagnosisandtherapyshouldnotbeequatedwith“cookbook”medicineavailability可利用性，可得到randomize隨機的cookbook食譜，烹調(diào)書approach接近越來越多的可用于指導(dǎo)臨床診斷與治療的隨機試驗資料不應(yīng)變成“烹調(diào)書”醫(yī)學(xué)。Evidenceandtheguidelinesthatarederivedfromitemphasizeprovenapproachesforpatientswithspecificcharacteristics.Evidence證據(jù)，跡象guideline指導(dǎo)方針emphasize強調(diào)因為隨機試驗獲得的現(xiàn)象和思路是著重于特征性病人的求證過程。Substantialclinicaljudgmentisrequiredtodeterminewhethertheevidenceandguidelinesapplytoindividualpatientsandtorecognizetheoccasional.substantialclinical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現(xiàn)象和思路能否應(yīng)用于某個病人個體，并能找出例外。Evenmorejudgmentisrequiredinthemanysituationsinwhichevidenceisabsentorinconclusive.inconclusive不確定性，非決定性許多情況下，臨床表現(xiàn)缺乏或不典型，需要考慮更多的判斷。Evidencealsomustbetemperedbypatients’preferences,althoughitisaphysician’sresponsibilitytoemphasizewhenpresentingalternativeoptionstothepatient.temper脾氣，調(diào)音preference偏愛emphasize強調(diào)，詳述，闡明presenting提出alternative可選擇的，二選一病人還會根據(jù)自己的傾向調(diào)節(jié)著臨床癥狀，但醫(yī)生有責任通過選擇性問題搞清事實。Theadherenceofapatienttoaspecificregimenislikelytobeenhancedifthepatientalsounderstandstherationaleandevidencebehindtherecommendedoption.adherence堅持、固執(zhí)regimen養(yǎng)生法、食物療法enhance提高、加強rationale基本原理假如病人也懂得醫(yī)生問題的基本原理和表現(xiàn)，有特殊生活方式病人的固執(zhí)容易被強化。Tocareforapatientasanindividual,thephysicianmustunderstandthepatientasaperson.carefor喜歡、照料為了把病人作為一個個體進行治療(為了個體化的照料病人)，醫(yī)生必須理解病人是一個人（不是一群人）。Thisfundamentalpreceptofdoctoringincludesanunderstandingofthepatient’ssocialsituation,familyissues,financialconcerns,andpreferencesfordifferenttypesofcareandoutcomes,rangingfrommaximumprolongationoflifetothereliefofpainandsuffering.fundamental基本的，根本的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折磨。Ifthephysiciandoesnotappreciateandaddresstheseissues,thescienceofmedicinecannotbeappliedappropriately,andeventhemostknowledgeablephysicianfailstoachieveappropriateoutcomes.appreciate欣賞、感謝、評價appropriate適當?shù)?、恰當?shù)募偃玑t(yī)生沒有正確理解和定位這個問題，醫(yī)學(xué)就不可能恰當?shù)貞?yīng)用于臨床，甚至一個知識最淵博的醫(yī)生也不能取得理想的治療結(jié)果。Evenasphysiciansbecomeincreasinglyawareofnewdiscoveries,patientscanobtaintheirowninformationfromavarietyofsources,someofwhichareofquestionablereliability.awareof意識到，知道questionable可疑的、成問題的、不可靠的reliability可靠、可信賴的甚至，當醫(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資源得到他們的信息，當然，某些信息是不可靠的。Theincreasinguseofalternativeandcomplementarytherapiesisanexampleofpatients’frequentdissatisfactionwithprescribedmedicaltherapy.alternative選擇，替代complementary補充的、相配的prescribe規(guī)定、指定、開處方替代療法和輔助療法的應(yīng)用不斷增加就是病人對常規(guī)療法經(jīng)常不滿意的一個例子。Physiciansshouldkeepanopenmindregardingunprovenoptionsbutmustadvisetheirpatientscarefullyifsuchoptionsmaycarryanydegreeofpotentialrisks,includingtheriskthattheymayreliedontosubstituteforprovenapproachessubstitute代替、代用relyon依賴、信任醫(yī)生對未證實的療法應(yīng)該保持開放的思想，但是，如果這些療法可能帶來任何程度的潛在風(fēng)險，醫(yī)生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。Itiscrucialforthephysiciantohaveanopendialoguewiththepatientandfamilyregardingthefullrangeofoptionsthateithermayconsidercrucial嚴酷的、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能考慮的治療選擇，是極及關(guān)鍵的。Thephysiciandoesnotexistinavacuumbutratheraspartofacomplicatedandextensivesystemofmedicalcareandpubichealth.vacuum真空extensive廣闊的、大量的醫(yī)生不是生存在真空中的，而是復(fù)雜而龐大的醫(yī)療和公共健康體系中的一部分。Inpremoderntimesandeventodayinsomedevelopingcountries,basichygiene,cleanwater,andadequatenutritionhavebeenthemostimportantwaystopromotehealthandreducedisease.adequate足夠的、恰當?shù)脑谖窗l(fā)達時代，甚至當今在一些發(fā)展中國家，基本衛(wèi)生、清潔飲用水和最低營養(yǎng)保障是促進健康減少疾病的最重要措施。Indevelopedcountries,theadoptionofhealthylifestyles,includingbetterdietandappropriateexercise,arecornorstonestoreducingtheepidemicsofobesity,coronarydisease,anddiabetes.adoption采納、采用epidemic流行、傳染而在發(fā)達國家中，健康的生活方式包括合理飲食和適當鍛煉，是減少肥胖、冠心病和糖尿病盛行的基礎(chǔ)。Publichealthinterventionstoprovideimmunizationsandtoreduceinjuriesandtheuseoftobacco,illicitdrugs,andexcessalcoholcollectivelycanproducemorehealthbenefitthannearlyanyotherimaginablehealthintervention.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)生的健康效果幾乎比可想象的任何其它健康干預(yù)措施都要好。Chapter5ClinicalPreventiveServicesPage11第五章臨床預(yù)防服務(wù)Clinicalpreventiveservicesincludecounseling,immunization,screeningtests,andreductionofthesusceptibilitytodiseasebyinterventionssuchastherapeuticlifestylechangesandpharmacotherapy.counseling咨詢immunization使免除screening遮敝，屏敝、選拔susceptibility對敏感臨床預(yù)防服務(wù)包括對疾病的咨詢、防疫、篩查以及通過治療性的生活習(xí)慣改變和藥物治療來減少易感性。Preventiveserviceoftenareclassifiedasprimary,secondary,ortertiary.tertiary第三，第三紀tertiaryindustry第三產(chǎn)業(yè)臨床預(yù)防服務(wù)常分為一級預(yù)防、二級預(yù)防和三級預(yù)防。Primarypreventionisdirectedtowardpreventingdiseaseorinjurybeforeitdevelops,whereassecondarypreventiondealswithearlydetectionandtreatmenttoimpedetheprogressofovertdisease.dealwith解決impede妨礙overt公開Primarypreventionisdirectedtowardpreventingdiseaseorinjurybeforeitdevelops,whereassecondarypreventiondealswithearlydetectionandtreatmenttoimpedetheprogressofovertdisease.一級預(yù)防是直接針對疾病或損傷發(fā)生前的預(yù)防，而二級預(yù)防是解決疾病或損傷發(fā)生后的早期發(fā)現(xiàn)和早期治療，以防止臨床疾病的進一步發(fā)展。Incontrast,tertiarypreventionreferstorehabilitativeactivitiesaftertheonsetofdiseasetominimizecomplicationsanddisability.rehabilitative可修復(fù)的，康復(fù)disability殘疾，病殘對比之下，三級預(yù)防是指疾病發(fā)生后的康復(fù)治療，以減少并發(fā)癥和病殘。Becauseofconsiderableoverlap,distinguishingamongthesephasesofpreventionmaybeconfusing.overlap互搭，重疊，錯疊，交叉distinguishing區(qū)別，區(qū)分，特征，特色因為（三級預(yù)防之間）有相當大的交叉，這些預(yù)防階段的區(qū)分可能有些混淆。Detectingandtreatinghypertensioncouldbeconsideredsecondarypreventionofhypertensivecardiovasculardiseasebutprimarypreventionofheartfailureandstroke.hypertensivecardiovasculardisease高血壓性心血管疾病發(fā)現(xiàn)和治療高血壓可以認為是對高血壓性心血管疾病的二級預(yù)防，但也可是對心力衰竭和中風(fēng)的一級預(yù)防。Preventionmaybeperceivedbestalongacontinuumfrommodificationofpredisposingfactors,topreventingadisease,toavoidingprematuredeathanddisability.perceive感知，認為continuum統(tǒng)一體,一致性predisposingfactors易感因素along沿著，前行modification修改，變性premature過早，過早發(fā)生，夭折，草率長期一貫地減少易感因素可能是防止疾病、避免早死早殘最好的預(yù)防。Thesoonertheprevention,themorelikelyunnecessaryillness,disability,andprematuredeathcanbeavoided.unnecessary不必要的，多余的預(yù)防得越早，越不易發(fā)生不必要的疾病，病殘和早死就能夠避免。Increasingemphasishasbeenplacedonpreventingriskfactorsthemselves.emphasis重點，強調(diào)越來越多的重點已經(jīng)集中到對危險因素本身的預(yù)防。Thetermprimordialpreventionhasbeenintroducedforthisconcept.primordial基本的，原始的，初生的，初發(fā)的術(shù)語根源預(yù)防（病因預(yù)防）已經(jīng)引進了這個概念。Indiscriminatescreeningforriskfactorsordiseasewithoutadequateadviceandfollow-upservesnousefulpurpose.indiscriminate無差別的，不加區(qū)別的advice忠告，勸告沒有引導(dǎo)和隨訪的毫無選擇地遠離危險因素或疾病是沒有實用價值的預(yù)防。Theperiodichealthexaminationhasevolvedfromanannual,broad-based,uniformprotocoltoanapproachthattargetstheprevention,detection,andtreatmentofspecificdiseasesorriskfactorsforparticularage,gender,andethnicgroupsatappropriateintervals.periodic周期的，定期的broad-based無限的，基礎(chǔ)深厚的，運用廣泛的uniform一致的，統(tǒng)一的，制服protocol規(guī)章制度，草案，協(xié)議ethnic民族的，種族的，有民族特色的interval間隔，區(qū)間定期體檢逐漸從一年一度的、全面的、統(tǒng)一的規(guī)定項目改進成以恰當?shù)闹芷趯μ囟挲g、性別和種群的特殊疾病或危險因素有目的地預(yù)防、發(fā)現(xiàn)和治療。CurrentrecommendationsbytheU.S.PreventiveServicesTaskForcearebasedonsystematicevidencereviewsthatdistinguishprocedureslikelytoproveeffectiveandtohavesubstantiallymorebenefitthanharm.TaskForce特遣部隊distinguish區(qū)別，辨認，使顯著substantially非常，本質(zhì)上，大體上美國預(yù)防服務(wù)特別局的最近建議是基于全面的回顧性研究，這些研究選出了易于證明有效、確實是利大于弊的預(yù)防措施。Changesinthehealthcaresystemandthedevelopmentofnationalguidelinesformanagementofdiseasearelikelytodrawgreaterattentiontohealthpromotion,diseaseprevention,andtheinterfaceofphysician-basedmedicalcarewiththepublichealthcaresystem.healthcare衛(wèi)生保健guideline指導(dǎo)方針，準則interface接口，界面，聯(lián)系衛(wèi)生保健系統(tǒng)的改進和國家疾病控制政策的完善使人們更重視健康促進、疾病預(yù)防，以及接受醫(yī)療人員為主的公共衛(wèi)生系統(tǒng)的保健服務(wù)。Physiciansshouldconsidereachdisorderintermsofthepotentialforprevention,ermsof就…而言,從…方面說來，從…角度來講cost-effectiveness成本效益醫(yī)生應(yīng)該以有無需要預(yù)防的角度考慮每一種疾病，包括可能發(fā)生的副作用和付出代價是否值得。Aconceptusefulforclinicaldecisionmakingisthenumberofpatientsneededtotreattopreventoneadverseevent,whichisbasedonabsoluteriskreduction.concept概念、看法、觀念一個對臨床決策有用的理念是需要治療的病人數(shù)量決定一個不利因素是否要預(yù)防，這是基于絕對風(fēng)險的下降。Thisnumberisbasedonefficacyandiscalculatedasthereciprocalofthedifferenceineventratesbetweencontrolandtreatmentgroupsforaspecifiedperiod.efficacy效力，效能，有效性reciprocal相互的，互為倒數(shù)的，倒數(shù)這個數(shù)量是以效能為基礎(chǔ)的，是對特定時期內(nèi)對照組和治療組之間發(fā)生率差異的倒數(shù)進行的統(tǒng)計。Ampleevidenceconnectsidentifiableandoftenpreventablefactorstothemorbidityandmortalityassociatedwithmajorhealthproblems.ample足夠的，大量的identifiable可以確認的大量的試驗證據(jù)找出了可確認的又?？深A(yù)防的與主要健康問題相關(guān)的發(fā)病和死亡因素。Abouthalfofalldeaths,morbidity,anddisabilitycanbeattributedtosuchnongeneticfactors.nongenetic非遺傳性的約一半死亡、發(fā)病和病殘與這些非遺傳性因素有關(guān)。Manylifestylechangesbenefitmultiplesystemsanddisorders.許多生活習(xí)慣改變有利于多個系統(tǒng)和紊亂的改善。CigarettesmokinghasbeenestimatedtocontributetooneinfivedeathsintheUnitedStates;dietaryhabitsmayaffecttheoccurrenceofcardiovasculardisease,diabetes,osteoporosis,andcancer.osteoporosis骨質(zhì)疏松癥美國五分之一的死亡估計與吸煙有關(guān)，飲食習(xí)慣可能影響心血管疾病，糖尿病、骨質(zhì)疏松癥和癌癥的發(fā)生。Otherimportantpersonalbehaviorfactorsinfluencinghealthincludephysicalactivity,alcoholintake,illicitdruguse,sexualpractices,andexposuretoenvironmentaltoxins.其它影響健康的重要個人行為因素有鍛煉、飲酒、吸毒、性行為以及環(huán)境毒物的接觸。TheidentificationofinformativeDNApolymorphisms(e.g.,singlenucleotidepolymorphisms)andfurtherelucidationofcandidategenesallowfordetectionofsusceptibleindividualsandpossibleinstitutionofmeasurestopreventtheexpressionoftheseharmfulgeneticrmative提供信息的candidate候選人polymorphisms多態(tài)性traits特質(zhì)，屬性nucleotide核苷酸攜帶信息DNA多態(tài)性（例如，單核苷酸多態(tài)性）的認識和候選基因的進一步闡明允許我們發(fā)現(xiàn)易感人群和可能采取的措施，以預(yù)防這些有害基因特性的表達。Severalcommonmisconceptionsimpedepreventivehealthcare.impede妨礙，阻礙好幾種錯誤觀念妨礙了預(yù)防保健。Manybelievethatdiseaseswithastrongheritablecomponentcannotbealtered,butsusceptibilitytodiseaseoftenrequirestheinteractionofmultiplegenesandenvironmentalfactorsforexpression.heritable可遺傳的，可繼承的許多人認為有很強遺傳性的疾病是無法改變的，但是對疾病的易感性經(jīng)常需要多種基因和環(huán)境因素的相互作用才能表達。Inaddition,chronicdiseasesaremultifactorial,sootherfactorscanbechangedtocompensateforanelevatedgeneticrisk.multifactorial多因子的compensate補償，彌補，賠償另外，慢性疾病是多因素的，所以，可以改變其它因素來彌補高基因風(fēng)險。Althoughgenetherapyholdsmuchpromise,preventivemeasurescurrentlyofferthebestpossibilitiesforlimitinggeneexpressionandavoidingmise承諾，諾言，希望，前途雖然基因療法有著很大的希望，但目前的最有可能提供的預(yù)防措施是限制基因表達來避免疾病。Thenotionthatpreventionislessusefulinolderpersonsexcludesmanywhowouldbenefitmostfrompreventionbecauseelderlypatientsgenerallyhaveagreaterabsoluteriskofdiseaseandhavebeenshowntoadhereandrespondfavorablytopreventivemeasures.favorably順利地，好意地，親切地對老年人預(yù)防無用的觀念排除了在預(yù)防上本應(yīng)極為受益的許多人，因為老年病人一般有更高患病風(fēng)險，并且一直對預(yù)防措施極為支持、反應(yīng)積極。Also,lifeexpectancyfrequentlyisunderestimatedintheelderly;individualswhoreachage75nowcanexpecttoliveanaverageof11moreyears.lifeexpectancy預(yù)期壽命并且，老年人的預(yù)期壽命經(jīng)常是低估的，現(xiàn)在將到75歲的老人可以預(yù)期平均再活11年多。Chapter8WhyGeriatricPatientsAreDifferentPage20第八章老年病人的特殊性第20頁Olderpatientsdifferfromyoungormiddle-agedadultswiththesamediseaseinmanyways,oneofwhichisthefrequentoccurrenceofcomorbiditiesandofsubclinicalorbidities并存病subclinical亞臨床的同樣的疾病，老年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、亞臨床疾病多。Asafunctionofthehighprevalenceofdisease,comorbidity(ortheco-occurrenceoftwoormorediseasesinthesameindividual)isalsocommon.prevalence流行、普遍co-occurrence同時發(fā)生作為高發(fā)疾病的結(jié)果，并存病（兩個或更多的疾病在同一個體同時發(fā)生）也是常見的。Ofpeopleage65andolder,50%havetwoormorechronicdisease,andthesediseasescanconferadditiveriskofadverseoutcomes,suchasmortality.confer授予、給予additive附加的、附屬物65歲以上的老年人中，50%患有兩種以上的慢性疾病，這些疾病能夠增加不良預(yù)后的風(fēng)險，如死亡的風(fēng)險。Insomepatients,cognitiveimpairmentmaymaskthesymptomsofimportantconditions.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。Treatmentforonediseasemayaffectanotheradversely,asintheuseofaspirintopreventstrokeinindividualswithahistoryofpepticulcerdisease.stroke中風(fēng)pepticulcer消化性潰瘍對一種疾病的治療可能會加重另一種疾病，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)。Theriskforbecomingdisabledordependentalsoincreaseswiththenumberofdiseasespresent.disabled殘廢的、有缺陷的dependent依靠的、依賴的病殘或生活不能自理的發(fā)生率也隨著并存的疾病數(shù)而增高。Specificpairsofdiseasescanincreasesynergisticallytheriskofdisability.synergistic協(xié)同的特殊的成對疾病可以協(xié)同增加病殘的風(fēng)險。Arthritisandheartdiseasecoexistin18%ofolderadults;althoughtheoddsofdevelopingdisabilityareincreasedbythree-foldtofour-foldwitheitherdiseasealone,theriskofdisabilityincreases14-foldifbotharepresent.arthritis關(guān)節(jié)炎odd奇數(shù)的、單個的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3~4倍的病殘率，但兩個疾病同時存在，可使病殘率提高到14倍。Asecondwayinwhicholderadultsdifferfromyoungeradultsisthegreaterlikelihoodthattheirdiseasespresentwithnonspecificsymptomsandsigns.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。Pneumoniaandstrokemaypresentwithnonspecificchangesinmentationastheprimarysymptom.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)非特異性意識變化作為主要癥狀。Similarly,thefrequencyofsilentmyocardialinfarctionincreaseswithincreasingage,asdoestheproportionofpatientswhopresentwithachangeinmentalstatus,dizziness,orweaknessratherthantypicalchestpain.silent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。Asaresult,thediagnosticevaluationofgeriatricpatientsmustconsiderawiderspectrumofdiseasesthangenerallywouldbeconsideredinmiddle-agedadults.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。Athirdconditionthatisfoundprimarilyinolderadultsisfrailty,frailtyisthoughttobeawastingsyndromethatpresentswithmultiplesymptomsandsigns,includingreducedmusclemass,weightloss,weakness,poorexercisetolerance,slowedmotorperformance,andlowphysicalactivity.primarily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，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。Someestimatesindicatethatthefullsyndromeisfoundin7%ofcommunity-dwellingpeopleage65andolder,andin25%ofcommunity-dwellingpeopleage85andolder.estimate估計、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)老人這些癥狀全部出現(xiàn)。Manyinstitutionalizedolderadultsalsoarefrail.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。Frailtyisastateofdecreasedreserveandincreasedvulnerabilitytoallkindsofstress,fromacuteinfectionorinjurytohospitalization,andmayidentifyindividualswhocannottolerateinvasivetherapies.reserve保存、克制vulnerability易受傷、易受責難衰弱是對各種壓力耐受下降、易于損害的一種狀態(tài)，從急性感染、損傷到住院治療，都可以發(fā)現(xiàn)一些老人不能耐受侵入性診療措施。Thesyndromeoffrailtyisassociatedwithhighriskoffalls,needsforhospitalization,disability,andmortality.fall跌倒、下降frail身體虛弱的、易損壞的、意志薄弱的衰弱癥狀與高病倒率、高住院率、高病殘率、高死亡率是密切相關(guān)的。Thereisearlyevidencethatacorecomponentoffrailtyissarcopenia,orlossofmusclemassassociatedwithaging,whichoccursin13to24%ofpersonsage65to70andin60%ponent成分、構(gòu)成要素sarcopenia肌減少（癥）、與年齡相關(guān)的骨骼肌質(zhì)量下降衰弱早期征象中的一個主要變化是肌減少癥，或者說隨年齡增長的肌肉減少，它發(fā)生在13~24%的65~70歲的老人，60%的80歲以上的老人。Itislikelythatdysregulationofmultiplephysiologicsystems,includinginflammation,hormonalstatus,andglucosemetabolism,underliesthesyndrome,withresultingdecreasedabilitytomaintainhomeostasisinthefaceofstress.dysregulation失調(diào)homeostasis內(nèi)環(huán)境穩(wěn)定（衰弱時）多種生理系統(tǒng)易于失調(diào)，包括炎癥反應(yīng)、激素調(diào)節(jié)、葡萄糖代謝，在癥狀的背后，伴隨的結(jié)果是在壓力面前保持內(nèi)環(huán)境穩(wěn)定的能力下降。Subclinicaldisease(e.g.,atherosclerosis),end-stagechronicdisease(e.g.,heartfailure),oracombinationofcomorbiddiseasesmayprecipitatethesyndrome.atherosclerosis動脈粥樣硬化precipitate沉淀，促成亞臨床疾病(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。Evidencefromrandomized,controlledtrialsshowsthatresistanceexercise,withorwithoutnutritionalsupplements,andhome-basedphysicaltherapycanincreaseleanbodymassandstrengthineventhefrailestolderadults.隨機對照試驗的結(jié)果顯示無論有無營養(yǎng)支持和家庭運動療法，即使是最虛弱的老年人，對抗運動能夠增加瘦弱軀體的質(zhì)量和力量。Thisevidencesuggeststhatearlierstagesoffrailtymayberemediable,althoughend-stagefrailtylikelypresagesdeath.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，盡管末期衰弱常預(yù)示著死亡。Fourth,minence突出、顯著第四，人們變老時認知損害顯著增加。Cognitiveimpairmentisariskfactorforawiderangeofadverseoutcomes,includingfalls,immobilization,dependency,institutionalization,andmortality.immobilization活動能力減少institutionalization制度化、專門照料認知損害是大量不良預(yù)后的風(fēng)險因子，包括摔倒、活動能力下降、生活不能自理、需住老人院護理、死亡。Cognitiveimpairmentcomplicatesdiagnosisandrequiresadditionalcaregivingtoensuresafety.認知損害使診斷復(fù)雜，為保證安全需要更多的照料。Finally,aseriousandcommonoutcomeofchronicdiseasesofagingisphysicaldisability,definedashavingdifficultyorbeingdependentonothersfortheconductofessentialorpersonallymeaningfulactivitiesoflife,frombasicself-care(e.g.,bathingortoileting)totasksrequiredtoliveindependently(e.g.,shopping,preparingmeals,orpayingbills)toafullrangeofactivitiesconsideredtobeproductiveand/orpersonallymeaningful.最后，老年人慢性疾病嚴重又常見的結(jié)果是身體能力喪失，描述為個人最基本的或必須的日?；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）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。Ofolderadults,40%reportdifficultywithtasksrequiringmobility,anddifficultywithmobilitypredictsthefuturedevelopmentofdifficultyininstrumentalactivitiesofdailyliving(IADL;householdmanagementtasks)andactivitiesofdailyliving(ADL;basicself-caretasks).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；家務(wù)自理項目）和目常鍛煉（ADL；基本自理項目）的困難。Inpersonsage65andother,difficultywithIADLisreportedby20%,anddifficultywithADLisreportedby11%;forboth,theprevalenceincreaseswithage.prevalence流行大于65歲的老人或其它人，IADL困難報導(dǎo)為20%，ADL困難報導(dǎo)為11%；隨年齡增加兩個都困難成為普遍現(xiàn)象。PeoplewhohavedifficultywithtasksofIADLandADLareathighriskofbecomingdependent.IADL和ADL困難的人處于生活不能自理演變的高風(fēng)險中。Ofpersonsolderthanage65,5%resideinnursinghomes,largelyasaresultofdependencyinIADLand/orADLsecondarytoseveredisease.reside居住nursinghome療養(yǎng)院大于65歲的老人中，5%住在療養(yǎng)院里，大多數(shù)是嚴重疾病后依賴IADL和ADL的結(jié)果。Generally,womanlivemoreyearswithdisability,whereasmenwhobecomesimilarlydisabledaremorelikelytodieatayoungerage.一般來說，同樣的能力喪失，男性常死得更年輕，女性比男性能多活幾年。Althoughphysicaldisabilityisprimarilyaresultofchronicdiseasesandgeriatricconditions,itsonsetandseverityaremodifiedbyotherfactors,includingtreatmentsthatcontroltheunderlyingdiseases,physicalactivity,nutrition,andsmoking.primarily首先、起初、主要、、根本onset進攻、有力的開始、發(fā)作雖然身體能力喪失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。Manyinterventiontrialsindicatethatdisabilitycanbepreventedoritsseveritydecreased;onetrialshowedimprovementsinfunctioningwithresistanceandaerobicexerciseinolderadultswithosteoarthritisofthebicexercise有氧運動osteoarthritis骨關(guān)節(jié)炎許多干預(yù)試驗揭示能力喪失可預(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了功能。OccultandObscureGastrointestinalBleedingPage60occult神秘的、秘密的、隱蔽的obscure黑暗的、模糊的、隱匿的隱匿性和來源不明性胃腸道出血第60頁Occultbleedingisdefinedasthedetectionofasymptomaticbloodlossfromthegastrointestinaltract,generallybyroutinefecaloccultbloodtesting(FOBT)orthepresenceofirondeficiencyanemia.fecal排泄物、殘渣隱匿性出血指的是無癥狀性胃腸道出血，一般通過常規(guī)的大便隱血試驗（FOBT）或存在著缺鐵性貧血而發(fā)現(xiàn)。Obscuregastrointestinalbleedingisdefinedasbleedingofunknownoriginthatpersistsorrecursafteranegativeinitialendoscopicevaluationofboththeupperandlowergastrointestinaltracts.initial開始的、最初的evaluation評價來源不明性胃腸出血是指首次上、下消化管內(nèi)窺鏡檢查都陰性、原發(fā)部位不明的持續(xù)性或反復(fù)性出血。Bothoftheseentitiesmaybepresentationsofrecurrentorchronicbleeding.entity實體、存在、本質(zhì)presentation提出、表現(xiàn)、存在兩者都可能表現(xiàn)為反復(fù)的或慢性的出血。Theinitialapproachtoevidenceofoccultgastrointestinalbloodlossshouldbeendoscopicevaluation.對隱匿性胃腸道出血，應(yīng)該使用內(nèi)窺鏡進行早期檢查。InthesettingofanisolatedpositiveFOBT,colonoscopyisindicatedasthefirsttest.colonoscopy結(jié)腸鏡只有單純大便隱血試驗陽性的情況下，結(jié)腸鏡作為首選的檢查方法是適合的。Theyieldofcolonoscopyinthesepatientsisapproximately2%forcancerand30%foroneormorecolonicpolyps.yield產(chǎn)出、結(jié)出、產(chǎn)生這些病人結(jié)腸鏡的結(jié)果大約2%是癌癥，30%是單發(fā)或多發(fā)的結(jié)腸息肉。Theinitialapproachtoapatientwithirondeficiencyanemiadependsonthepresenceofsymptomsreferabletoeithertheupperorlowergastrointestinaltract.referable可認為與...有關(guān)的、可參考的缺鐵性貧血病人的早期檢查方法要根據(jù)存在的癥狀是與上消化道相關(guān)還是與下消化道相關(guān)而決定。Regardlessofthefindingsontheinitialupperorlowerendoscopicexamination,allpatientsshouldhavebothupperandlowerendoscopybecausethecomplementaryendoscopicexaminationhasayieldof6%evenifthefirstonewasplementary補充的、互補的positive確定的、絕對的、真實的無論首次上消化道或下消化道內(nèi)窺鏡檢查會有何發(fā)現(xiàn)，所有病人兩個檢查都應(yīng)該做，因為互補的內(nèi)窺鏡檢查有6%的再發(fā)現(xiàn)，即使第一個檢查是陽性的。Forpremenopausalwomen,apositiveFOBTrequiresfullevaluation,asdoesirondeficiencyanemia.premenopausal絕經(jīng)前的對絕經(jīng)前婦女，大便隱血試驗陽性需要全面分析，缺鐵性貧血也一樣。Bariumradiographsoftheupperandlowergastrointestinaltracthavelimitedutilityinthesettingofoccultbleedingbecauseoftheirinabilitytobiopsyortreatlesionsthatareidentified.utility實用、效用、通用隱匿性出血時，上、下消化道的鋇劑造影應(yīng)用有限，因為它們不能活檢或治療發(fā)現(xiàn)的病損。Theevaluationofobscuregastrointestinalbleedingisoftenfrustratingfrustrating令人泄氣的、令人沮喪的原因不明性胃腸道出血的診斷常常令人沮喪。Angiodysplasiaisthemostcommoncauseinmostrecentseries.Angiodysplasia血管發(fā)育畸形血管發(fā)育畸形是最近病例統(tǒng)計中最常見的病因。Initialendoscopicexaminationshouldfocusonanysymptomsreportedbythepatient.focus聚焦、集中、明確首次內(nèi)窺鏡檢查要關(guān)注病人訴說的任何癥狀。Potentialcausativeagents,suchasNSAIDsandaspirin,shouldbediscontinued.causative成為原因的NSAIDs非甾體類抗炎鎮(zhèn)痛藥non-steroidalantiinflammatorydrugs能成為潛在病因的藥物，如非甾體類抗炎鎮(zhèn)痛藥和阿斯匹林，都應(yīng)該停用。Disordersassociatedwithbleeding,suchashereditaryhemorrhagictelangiectasia(Osler-Weber-Rendusyndrome),inflammatoryboweldisease,orableedingdiathesisshouldbeconsidered.telangiectasia毛細血管擴張diathesis素質(zhì)伴有出血的疾病，像遺傳性出血性毛細血管擴張癥（Osler-Weber-Rendu綜合癥）、炎性腸疾病、或出血性體質(zhì)應(yīng)該加以考慮。Arepeatendoscopicevaluationmaybeappropriate,becauseapproximatelyonethirdofcasesrevealacauseofbleedingoverlookedduringtheinitialendoscopy.內(nèi)窺鏡重復(fù)檢查可能是需要的，因為接近三分之一病例查出了首次內(nèi)窺鏡漏掉的出血病原灶。Whenupperendoscopyandcolonoscopyarebothunrevealing,evaluationofthesmallbowelisindicated.當上消化道內(nèi)窺鏡和結(jié)腸鏡均無發(fā)現(xiàn)時，應(yīng)該對小腸進行檢查。Radiographicevaluationofthesmallbowelisnoninvasivebutrelativelyinsensitive,withalessthan6%yieldfromsmallbowelfollow-throughanda10to21%yieldfromenteroclysis.insensitive感覺遲鈍的follow-through持久的貫徹，持續(xù)enteroclysis小腸造影小腸X線檢查是非侵入性的，但相對不靈敏，小腸全片不到6%有發(fā)現(xiàn)，小腸造影10～21％有結(jié)果。Bycomparison,thediagnosticyieldofendoscopicenteroscopyofthesmallbowelinobscuregastrointestinalbleedingis38to75%.enteroscopy腸鏡檢查相比較，對來源不明性胃腸道出血小腸內(nèi)窺鏡的診斷結(jié)果是38～75%。Traditionalvideoendoscopescanevaluateonlytheproximalsmallbowel(≤150cm),whereaslongerscopes,whicharepassedthoughtheentiresmallbowelandthenwithdrawnwhilevisualizingthemucosa(sondeenteroscopy),arelimitedintheirabilitytovisualizetheentiremucosaandcannotbeusedtoperformdiagnosticortherapeuticximal最接近的、近側(cè)的visualize使看得見，想像sonde探空火箭、探子、探針傳統(tǒng)的電視內(nèi)窺鏡只能檢查近端小腸(≤150cm)，然而能通過整個小腸邊退邊看腸粘膜的更長內(nèi)鏡，也不能看到整個腸粘膜，不能作為常規(guī)的診斷或治療手段。Whenendoscopicevaluationdoesnotdetectthecauseofbloodloss,radiographicproceduressuchasscintigraphyandangiographyshouldbeconsidered.scintigraphy閃爍顯像當內(nèi)窺鏡檢查不能發(fā)現(xiàn)出血病因，像閃爍造影和血管造影等影像學(xué)手段應(yīng)該考慮。Provocativeangiographyusingheparinorthrombolyticagentshasbeensuggestedbysomeauthorities,butthisapproachhasthepotentialriskofprecipitatingmajorvocative刺激的、挑拔的、氣人的precipitating使突然發(fā)生、促使雖然使用肝素或溶栓藥的刺激性血管造影被某些專家推薦，但這種方法有促發(fā)大出血的潛在風(fēng)險。Inthefaceofcontinuedbloodlossandnoidentifiedetiology,intraoperativeendoscopymayprovidesimultaneousdiagnosisandtherapy.simultaneous同時發(fā)生的、同時存在的碰到進行性出血又診斷不明，術(shù)中應(yīng)用腸鏡可以同時進行診斷和治療。Duringtheprocedure,thesurgeonplicatesthebowelovertheendoscope.plicate有褶的;有皺襞的操作時，外科醫(yī)生把小腸套到內(nèi)窺鏡上。Asthescopeiswithdrawn,endoscopicfindingscanbeidentifiedforsurgicalresectionortreatment.內(nèi)鏡退出時，內(nèi)鏡的發(fā)現(xiàn)可以決定是外科切除或保守治療。Theyieldofthisprocedureexceeds70%.這個措施70%以上有結(jié)果。Insomeclinicalsituations,thesiteofbleedingcannotbeidentified,andthepatientrequireslong-termtransfusiontherapy.long-term長期的transfusion輸血某些臨床病例，出血部位無法找到，病人而要長期輸血治療。Anewdeviceforvisualizingtheentiregastrointestinalmucosaconsistsofasmallcamerainaningestablecapsulethattransmitsimagestoreceiversattachedtothepatient’sabdomenandmappedtoidentifythelocationoftheimage.ingestable能咽下、能吸收camera照相機、電視攝像機一種新的裝置能顯示全部胃腸粘膜，這種裝置由一顆裝有小型攝像機并并能咽下的膠囊組成，它將（數(shù)字）影像信號傳到附著在病人腹部的接收器，并繪制出圖像來識別影像的位置。Thediagnosticyieldofcapsule