临床医学英语

1、临床医学英语Chapter 1 Patient-Physician InteractionPage 1第一章医患沟通第页The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. proceed 进行、开展 reasoning 推论、推理clinical reasoning 诊断clinical decision 确定治疗方案making decision 做出决定医患沟通在临床诊断和治疗决策的许多时期进行着。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 说明、阐明inquire 询问、调查evaluation 评估、评价这种沟通开始于病人主诉或所关注问题的阐明，然后通过交流、评估不断精确地确定这些问题。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 综合 consultation 磋商、会诊这个过程通常需要细致的询问病史和体格检查，开具诊

4、断性化验医嘱，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，然后与病人及家属反复磋商以完善治疗方案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、关系、说到evidence-based medicine 循证医

5、学尽管考虑到不同病人中个体差异是存在的，但医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化。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 随机的cookbook 食谱，烹调书approach 接近但是，不断增加的可用于指导临床诊断与治疗的随机试验资料不应当作“烹调书”使用。Ev

6、idence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.Evidence 证据，迹象 guideline指导方针emphasize 强调那些随机试验获得的临床表现和诊断思路是侧重于求证具有某些特征病人而来的。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 真实的，实在的individual 个体occasional 偶尔的，特殊的实际的临床判断需要确定这些临床表现和诊断依据标准是否能应用于普通病人的个体，并能找出例外。Even more judgment is required in the many situations in which evidence is absent or inconclusive.inconclusive 不确定性，非决定性在许多情况下，临床表现缺乏或不典型，甚至需要考虑得

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 脾气，调音preference 偏爱presenting 提出alternative 可选择的，二选一虽然医生喜欢提出选择性问题让病人回答，但病人肯定会根据自己的倾向调节临床症状。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 坚持、固执regimen 养生法、食物疗法enhance 提高、加强rationale 基本原理假如还懂得所提供问题的基本原理和表现，有特殊生活方法病人的固执容易强化这种倾向To care for a patient as an individual, the physician must understand the pa

10、tient as a person. care for 喜欢、照料为了把病人作为一个个体进行治疗，医生必须理解病人是一个人（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 训戒 doctoring 行医prolongation 延长这个最基本的行医原则包括了解病人的社会地位，家庭问题，资金状况以及正确理解病人对不同治疗方法、不同治疗结果的选择，从最大限度地延长生命到临时缓解疼痛和症状。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、成问题的、不可靠的reliability 可靠、可信赖的甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种途径得到他们的信息，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 选择，替代complement

13、ary 补充的、相配的prescribe 规定、指定、开处方不断增加的替代疗法和辅助疗法的应用就是病人对常规疗法经常不满意的一个例子。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 依赖、信任医生对新疗法应该保持开放的思想，但是，如果这些疗法具有任何程度的潜在风险，都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。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 严酷的、决定性的 either 两者任一对医生来说，对病人及家属开诚布公地介绍所有可

15、考虑的治疗选择，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 广阔的、大量的医生不是生存在真空中，而是作为一个复杂而庞大的医疗和公共健康体系中的一部分。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 足够的、恰当的在未发达时代，甚至当今在一些发展中国家，基本卫生条件、清洁饮用水和最低营养保障是促进健康的最重要方法。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 采纳、采用epidemic 流行、传染在发达国家中，健康的生活方式包括良好饮食和适当锻炼，是减少肥胖、冠心病和糖尿病的基础。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、违禁的collectively 全体地、共同地produce 生产、创造公共健康干预如进行疫苗接种、减少损伤、减少吸烟、减少吸毒、减少酗酒等措施共同产生的健康效果比几乎可想象的任何其它健康干预措施都要好得多。Chapter Vital signsPage 15第六章生命体征第页A nurse or assistant often obtains the vital signs.护士或护士助手经常可得到生命体征Traditionally the vit

19、al signs include pulse rate, blood pressure, respiratory rate, and body temperature.传统的生命体征包括脉搏（率）、血压、呼吸（频率）和体温。More recently, advocates of various causes have advocated for a “fifth vital sign”. advocate 提倡、主张最近，人们以多种理由提出 “第五生命体征”的建议。The most cogent of these “new” vital signs is the patients quanti

20、tative assessment of pain.cogent 今人信服的，切实的，有力的这些“新”的生命体征中，最今人信服的是病人疼痛的定量评判。The pulse should be recorded as not just the rate but also the rhythm. 脉搏不仅要记录频率，而且要记录节律。Physicians may prefer to initiate the examination by holding the patients hand while palpating the pulse.initiate 开始，创始医生喜欢握住病人的手，触摸脉搏，开

21、始检查。This nonthreatening initial contact with the patient allows the physician to determine whether the patient has a regular or irregular rhythm. 这个对病人无威胁性的最初接触让医生确定了脉搏是否具有节律性。When the blood pressure is abnormal, many physicians repeat the measurement.当测得的血压不正常，许多医生重复这个测量。The instrument error that c

22、ontributes to the greatest variability is the cuff size of the sphygmomanometer. variability 变化，易变性sphygmomanometer 血压计变异性中占比例最大的设备误差是血压计袖套的大小。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许多成人需用大号的成人袖套，如果使用窄袖套能够影响收缩压-810mmHg ，舒张压28mmHg。The appearance of repetitive sounds (Korotkoff sounds, phase 1) constitutes the systolic pressure. constitute 构成，设立，指定重复脉搏音（Korotkoff 音，第相）的出现定为收缩压。After the cuff is inflated about the palpated pressure, the Korotkoff sounds muffle and disappear

24、as pressure is released (phase 5).inflate 充气、膨胀muffle 含糊不清当袖套充气压力约在可触摸脉搏压力的2030mmHg上方，Korotkoff音变钝，当压力释放，Korotkoff音消失（第相）。The level at which the sounds disappear is the diastolic pressure.声音消失的水平就是舒张压The American Heart Association recommends that each measure should be rounded upward to the nearest

25、2mmHgbe round up to the nearest whole number取最近的整数美国心脏病协会建议每次测量取最近的mmHg整数。The respiratory rate should be assessed at the same time the patient is observed to determine whether there is any respiratory discomfort (dyspnea).dyspnea 呼吸困难测量呼吸频率的同时要观察病人以确定是否存在呼吸困难。The subjective sensation of dyspnea is c

26、aused by an increased work of breathing. subjective 主观的呼吸困难的主观感觉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 呼吸减弱检查者要确定病人是否存在呼吸急促（呼吸频率快）或呼吸减弱（呼吸频率慢或浅）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 换气过度resulting in 导致、引起呼吸急促不是都伴有过度换气，过度换气的定义是肺泡通气量增高引起动脉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 对取得一致意见对一组疑为肺炎患者的评估中，检查者认为当时呼吸急促的出现率仅为63%。The body temperature of adults usually is measured with an oral electric thermometer.成人体温通常用口腔电子体温计测定。These thermometers correlate well with the traditional mercury thermometer and are safer to use.mercur

29、y 汞这种体温计与传统的汞体温计高度相关，使用安全。Rectal thermometers reliably record temperatures 0.4 higher than oral thermometers.直肠体温计可靠地记录了高于口表0.4的温度。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 太以致于不相比较，新型的鼓式体温计相对口表可能误差太大（与口表相差-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页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 亚临床的同样的疾病，年龄大的病人在许多方面与青中年病人是有区别的，其中之一是并存病多和亚临床疾病多。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 同时发生作为高发

32、疾病的结果，并存病（两个或更多的疾病在同一个体同时发生）也是多见的。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、给予additive 附加的、附属物65岁以上的老年中，50%患有两种以上的慢性疾病，这些疾病能够增加不利预后的风险，如死亡率。In some patients, cognitive impairment may

33、 mask the symptoms of important conditions. cognitive 认知的、认识的impairment 损害mask 口罩、假面具、掩饰在一些病人中，认知损害可以掩盖重要病情的症状。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 中风peptic ulcer 消化性溃疡对一种疾病的治疗

34、可能加重另一种疾病，例如，对有消化性溃疡病史的病人使用阿斯匹林预防中风。The risk for becoming disabled or dependent also increases with the number of diseases present. disabled 残废的、有缺陷的dependent 依靠的、依赖的病残或生活不能自理发生的风险也随着并存的疾病数而增高。Specific pairs of diseases can increase synergistically the risk of disability. synergistic 协同的特殊的成对疾病可以协同增

35、加病残的风险。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 关节炎有18%的老年人同时患有关节炎和心脏病，虽然每个疾病可以增加34倍的病残率，但两个疾病同时存在

36、，可使病残率提高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 可能性老年与青中年的第二个差异是更容易出现非典型的症状和体症。Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom

37、. pneumonia 肺炎mentation 精神作用、心理活动primary 初始的、首要的、主要的肺炎和中风时可出现非典型意识变化作为主要的症状。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、静止的proportion 成比例的、相称的同样地，隐匿性心肌梗塞发生频度随着年龄的增大而增加，这些病人相应地频发精神状态改变、眩晕、虚弱而不是典型的胸痛症状。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 谱、光谱因此，老年病人的诊断应考虑更广泛的疾病谱，要超过通常对中年病人所考虑的范围

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、原来frailty 脆弱、虚弱、意志薄弱tolerance 宽容、忍耐、耐受主要出现在老年人的第三个情况是衰弱，衰弱被认为属于衰竭综合症，它有许多症状和体征中，包括肌肉萎缩、体重下降、虚弱、运动耐受差、动作慢、身体活动少。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 估计、

41、评价、看法indicate 指出、表时、象征、适应征一些人估计7%的65岁以上社区老人和25%的85岁以上社区老人上述症状全部出现。 Many institutionalized older adults also are frail.institutionalized 使成公共团体、将收容在公共设施里frail 身体虚弱的、易损坏的、意志薄弱的许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 易受伤、易受责难衰弱是对各种压力耐受下降、损害增加的一种状态，从急性感染、损伤到住院治疗，都可以发现一些人不能忍受侵入性诊疗措施。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 身体虚弱的、易损坏的、意志薄弱的衰弱的症状与易于病倒、需要住院治疗、病残、死亡的高风险是相关的。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、构成要素s

44、arcopenia 肌减少（症）、与年龄相关的骨骼肌质量下降衰弱一个主要成分的早期表现是肌肉减少，或说随年龄增长的肌肉减少，它发生在1324%的6570岁的老人，60%的80岁以上的老人。 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 失调homeostasis 内环境稳定多种生理系统易于失调 ，包括炎症、激素状态、糖的代谢，结果是在压力面前保持内环境的稳定的能力下降。Subclinical disease (e.g., atherosclerosis), end-stage chronic disease (e.g., heart failure), or a combination of comorbid diseases may precipitate the syndrome. atherosclerosis 动脉粥样硬化亚临床疾病

46、(如动脉粥样硬化), 晚期慢性疾病(如心力衰竭），或多种疾病并存可共同形成症状。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. 随机对照试验的迹象显示无论有无营养支持和家庭身体疗法，即使是最虚弱的老

47、年人，对抗运动能够增加瘦弱躯体的质量和力量。This evidence suggests that earlier stages of frailty may be remediable, although end-stage frailty likely presages death.remediable 可挽回的presage 预兆、预示这个结果提示早期衰弱是可挽回的，尽管末期衰弱常提示死亡。 Fourth, cognitive impairment increases in prominence as people age. prominence 突出、显著第四，人们变老时认知损害显著增

48、加。Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls, immobilization, dependency, institutionalization, and mortality. immobilization 活动能力减少institutionalization 制度化、专门照料认知损害是大量不利结果的风险因子，包括摔倒、活动能力下降、不能自理、需住老人院护理、死亡。 Cognitive impairment complicates diagnosis a

49、nd requires additional care giving to ensure safety.认知损害使诊断复杂，为保证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，老年人慢性病严重又常见的结果是身体能力不足，描述为个人最基本的或有意义的日常活动有困难或不得不依靠别人帮助指导，从基本的自理（如洗澡或如厕）

51、到独立生活需要的各种任务（如购物、做饭、支付各种账单），到具有集体和或个人意义的所有活动。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%对需要运动的任务有困难，运动困难提示将来开展日常工具锻炼（IADL；家庭护理项目）和目常锻炼（ADL；基本自理项目）的困难。 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岁的老人或其它人，IADL困难报导为20%，A

53、DL困难报导为11%；随年龄增加两个都困难成为普遍现象。People who have difficulty with tasks of IADL and ADL are at high risk of becoming dependent. IADL和ADL困难的人处于不能自理演变的高风险中。 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 疗养院小于65岁的老人中，5%住在疗养院里，大多数是严重疾病后依赖IADL和ADL的结果。Generally, woman live more years with disability, whereas men who become similarly disabled are more likely to die at a younger age.一般来说，同样的能力不足，男性常死得更年轻，女性比男性能多活几年。 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 进攻、有力的开始、发作虽然身体能力不足是慢性疾病和年老状态的一个主要结果，它的发生和严重程度被其它因素影响着，包括基础疾病的治疗和控制、身体锻炼、营养和吸烟。 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 有氧运动osteoarthritis 骨关节炎许多干预试验揭示能力不足可预防或减轻；一个试验显示膝骨关节炎老年人用对抗运动和有氧运动改善功能。Chapte

57、r 13 Tissue EngineeringPage 36第十三章组织工程第36页The loss or failure of an organ or tissue is devastating. devastating 毁灭性的器官、组织的丧失或衰竭是毁灭性的。Current treatment methods include transplantation of organs, surgical reconstruction, use of mechanical devices, or supplementation of metabolic products. device 装置现有的治疗方法有器官移植、外科重建、机械装置的应用以及代谢性产品的补充治疗。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、属于、存在于移植的最终目的应该基于重建活细胞群以维持甚至增进现有组织的功能。