临床医学英语翻译

临床医学英语翻译临床医学英语翻译临床医学英语翻译资料仅供参考文件编号：2022年4月临床医学英语翻译版本号：A修改号：1页次：1.0审核：批准:发布日期：临床医学英语翻译Chapter1Patient-PhysicianInteractionPage1第一章医患沟通第１页Tceed进行、开展reasoning推论、推理clinicalreasoning诊断clinicaldecision确定治疗方案makingdecision做出决定医患沟通在临床诊断和治疗决策的许多阶段中进行着。Theinteractionbeginswithanelucidationofcomplaintsorconcerns,followedbyinquiriesorevaluationtoaddresstheseconcernsinincreasinglypreciseways.elucidation说明、阐明inquire询问、调查evaluation评估、评价这种沟通开始于病人诉说或所关注问题，然后通过询问、评估不断精确地确定这些问题。Theprocesscommonlyrequiresacarefulhistoryorphysicalexamination,orderingofdiagnostictests,integrationofclinicalfindingswiththetestresults,understandingoftherisksandbenefitsofthepossiblecoursesofaction,andcarefulconsultationwiththepatientandfamilytodevelopfutureegration综合consultation磋商、会诊这个过程通常需要细致的病史询问和体格检查，进行诊断性化验，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，并与病人及家属反复磋商以形成治疗方案Physiciansincreasinglycancallonagrowingliteratureofevidence-basedmedicinetoguidetheprocesssothatbenefitismaximized,whilerespectingindividualvariationsamongdifferentpatientsrespecting注意到、关系、说到evidence-basedmedicine循证医学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，但要考虑到不同病人中个体差异是存在的。Theincreasingavailabilityofrandomizedtrialstoguidetheapproachtodiagnosisandtherapyshouldnotbeequatedwith“cookbook”medicineavailability可利用性，可得到randomize随机的cookbook食谱，烹调书approach接近越来越多的可用于指导临床诊断与治疗的随机试验资料不应变成“烹调书”医学。Evidenceandtheguidelinesthatarederivedfromitemphasizeprovenapproachesforpatientswithspecificcharacteristics.Evidence证据，迹象guideline指导方针emphasize强调因为随机试验获得的现象和思路是着重于特征性病人的求证过程。Substantialclinicaljudgmentisrequiredtodeterminewhethertheevidenceandguidelinesapplytoindividualpatientsandtorecognizetheoccasional.substantialclinical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现象和思路能否应用于某个病人个体，并能找出例外。Evenmorejudgmentisrequiredinthemanysituationsinwhichevidenceisabsentorinconclusive.inconclusive不确定性，非决定性许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。Evidencealsomustbetemperedbypatients’preferences,althoughitisaphysician’sresponsibilitytoemphasizewhenpresentingalternativeoptionstothepatient.temper脾气，调音preference偏爱emphasize强调，详述，阐明presenting提出alternative可选择的，二选一病人还会根据自己的倾向调节着临床症状，但医生有责任通过选择性问题搞清事实。Theadherenceofapatienttoaspecificregimenislikelytobeenhancedifthepatientalsounderstandstherationaleandevidencebehindtherecommendedoption.adherence坚持、固执regimen养生法、食物疗法enhance提高、加强rationale基本原理假如病人也懂得医生问题的基本原理和表现，有特殊生活方式病人的固执容易被强化。Tocareforapatientasanindividual,thephysicianmustunderstandthepatientasaperson.carefor喜欢、照料为了把病人作为一个个体进行治疗(为了个体化的照料病人)，医生必须理解病人是一个人（不是一群人）。Thisfundamentalpreceptofdoctoringincludesanunderstandingofthepatient’ssocialsituation,familyissues,financialconcerns,andpreferencesfordifferenttypesofcareandoutcomes,rangingfrommaximumprolongationoflifetothereliefofpainandsuffering.fundamental基本的，根本的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折磨。Ifthephysiciandoesnotappreciateandaddresstheseissues,thescienceofmedicinecannotbeappliedappropriately,andeventhemostknowledgeablephysicianfailstoachieveappropriateoutcomes.appreciate欣赏、感谢、评价appropriate适当的、恰当的假如医生没有正确理解和定位这个问题，医学就不可能恰当地应用于临床，甚至一个知识最渊博的医生也不能取得理想的治疗结果。Evenasphysiciansbecomeincreasinglyawareofnewdiscoveries,patientscanobtaintheirowninformationfromavarietyofsources,someofwhichareofquestionablereliability.awareof意识到，知道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资源得到他们的信息，当然，某些信息是不可靠的。Theincreasinguseofalternativeandcomplementarytherapiesisanexampleofpatients’frequentdissatisfactionwithprescribedmedicaltherapy.alternative选择，替代complementary补充的、相配的prescribe规定、指定、开处方替代疗法和辅助疗法的应用不断增加就是病人对常规疗法经常不满意的一个例子。Physiciansshouldkeepanopenmindregardingunprovenoptionsbutmustadvisetheirpatientscarefullyifsuchoptionsmaycarryanydegreeofpotentialrisks,includingtheriskthattheymayreliedontosubstituteforprovenapproachessubstitute代替、代用relyon依赖、信任医生对未证实的疗法应该保持开放的思想，但是，如果这些疗法可能带来任何程度的潜在风险，医生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。Itiscrucialforthephysiciantohaveanopendialoguewiththepatientandfamilyregardingthefullrangeofoptionsthateithermayconsidercrucial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能考虑的治疗选择，是极及关键的。Thephysiciandoesnotexistinavacuumbutratheraspartofacomplicatedandextensivesystemofmedicalcareandpubichealth.vacuum真空extensive广阔的、大量的医生不是生存在真空中的，而是复杂而庞大的医疗和公共健康体系中的一部分。Inpremoderntimesandeventodayinsomedevelopingcountries,basichygiene,cleanwater,andadequatenutritionhavebeenthemostimportantwaystopromotehealthandreducedisease.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、清洁饮用水和最低营养保障是促进健康减少疾病的最重要措施。Indevelopedcountries,theadoptionofhealthylifestyles,includingbetterdietandappropriateexercise,arecornorstonestoreducingtheepidemicsofobesity,coronarydisease,anddiabetes.adoption采纳、采用epidemic流行、传染而在发达国家中，健康的生活方式包括合理饮食和适当锻炼，是减少肥胖、冠心病和糖尿病盛行的基础。Publichealthinterventionstoprovideimmunizationsandtoreduceinjuriesandtheuseoftobacco,illicitdrugs,andexcessalcoholcollectivelycanproducemorehealthbenefitthannearlyanyotherimaginablehealthintervention.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几乎比可想象的任何其它健康干预措施都要好。Chapter5ClinicalPreventiveServicesPage11第五章临床预防服务Clinicalpreventiveservicesincludecounseling,immunization,screeningtests,andreductionofthesusceptibilitytodiseasebyinterventionssuchastherapeuticlifestylechangesandpharmacotherapy.counseling咨询immunization使免除screening遮敝，屏敝、选拔susceptibility对敏感临床预防服务包括对疾病的咨询、防疫、筛查以及通过治疗性的生活习惯改变和药物治疗来减少易感性。Preventiveserviceoftenareclassifiedasprimary,secondary,ortertiary.tertiary第三，第三纪tertiaryindustry第三产业临床预防服务常分为一级预防、二级预防和三级预防。Primarypreventionisdirectedtowardpreventingdiseaseorinjurybeforeitdevelops,whereassecondarypreventiondealswithearlydetectionandtreatmenttoimpedetheprogressofovertdisease.dealwith解决impede妨碍overt公开Primarypreventionisdirectedtowardpreventingdiseaseorinjurybeforeitdevelops,whereassecondarypreventiondealswithearlydetectionandtreatmenttoimpedetheprogressofovertdisease.一级预防是直接针对疾病或损伤发生前的预防，而二级预防是解决疾病或损伤发生后的早期发现和早期治疗，以防止临床疾病的进一步发展。Incontrast,tertiarypreventionreferstorehabilitativeactivitiesaftertheonsetofdiseasetominimizecomplicationsanddisability.rehabilitative可修复的，康复disability残疾，病残对比之下，三级预防是指疾病发生后的康复治疗，以减少并发症和病残。Becauseofconsiderableoverlap,distinguishingamongthesephasesofpreventionmaybeconfusing.overlap互搭，重叠，错叠，交叉distinguishing区别，区分，特征，特色因为（三级预防之间）有相当大的交叉，这些预防阶段的区分可能有些混淆。Detectingandtreatinghypertensioncouldbeconsideredsecondarypreventionofhypertensivecardiovasculardiseasebutprimarypreventionofheartfailureandstroke.hypertensivecardiovasculardisease高血压性心血管疾病发现和治疗高血压可以认为是对高血压性心血管疾病的二级预防，但也可是对心力衰竭和中风的一级预防。Preventionmaybeperceivedbestalongacontinuumfrommodificationofpredisposingfactors,topreventingadisease,toavoidingprematuredeathanddisability.perceive感知，认为continuum统一体,一致性predisposingfactors易感因素along沿着，前行modification修改，变性premature过早，过早发生，夭折，草率长期一贯地减少易感因素可能是防止疾病、避免早死早残最好的预防。Thesoonertheprevention,themorelikelyunnecessaryillness,disability,andprematuredeathcanbeavoided.unnecessary不必要的，多余的预防得越早，越不易发生不必要的疾病，病残和早死就能够避免。Increasingemphasishasbeenplacedonpreventingriskfactorsthemselves.emphasis重点，强调越来越多的重点已经集中到对危险因素本身的预防。Thetermprimordialpreventionhasbeenintroducedforthisconcept.primordial基本的，原始的，初生的，初发的术语根源预防（病因预防）已经引进了这个概念。Indiscriminatescreeningforriskfactorsordiseasewithoutadequateadviceandfollow-upservesnousefulpurpose.indiscriminate无差别的，不加区别的advice忠告，劝告没有引导和随访的毫无选择地远离危险因素或疾病是没有实用价值的预防。Theperiodichealthexaminationhasevolvedfromanannual,broad-based,uniformprotocoltoanapproachthattargetstheprevention,detection,andtreatmentofspecificdiseasesorriskfactorsforparticularage,gender,andethnicgroupsatappropriateintervals.periodic周期的，定期的broad-based无限的，基础深厚的，运用广泛的uniform一致的，统一的，制服protocol规章制度，草案，协议ethnic民族的，种族的，有民族特色的interval间隔，区间定期体检逐渐从一年一度的、全面的、统一的规定项目改进成以恰当的周期对特定年龄、性别和种群的特殊疾病或危险因素有目的地预防、发现和治疗。CurrentrecommendationsbytheU.S.PreventiveServicesTaskForcearebasedonsystematicevidencereviewsthatdistinguishprocedureslikelytoproveeffectiveandtohavesubstantiallymorebenefitthanharm.TaskForce特遣部队distinguish区别，辨认，使显著substantially非常，本质上，大体上美国预防服务特别局的最近建议是基于全面的回顾性研究，这些研究选出了易于证明有效、确实是利大于弊的预防措施。Changesinthehealthcaresystemandthedevelopmentofnationalguidelinesformanagementofdiseasearelikelytodrawgreaterattentiontohealthpromotion,diseaseprevention,andtheinterfaceofphysician-basedmedicalcarewiththepublichealthcaresystem.healthcare卫生保健guideline指导方针，准则interface接口，界面，联系卫生保健系统的改进和国家疾病控制政策的完善使人们更重视健康促进、疾病预防，以及接受医疗人员为主的公共卫生系统的保健服务。Physiciansshouldconsidereachdisorderintermsofthepotentialforprevention,ermsof就…而言,从…方面说来，从…角度来讲cost-effectiveness成本效益医生应该以有无需要预防的角度考虑每一种疾病，包括可能发生的副作用和付出代价是否值得。Aconceptusefulforclinicaldecisionmakingisthenumberofpatientsneededtotreattopreventoneadverseevent,whichisbasedonabsoluteriskreduction.concept概念、看法、观念一个对临床决策有用的理念是需要治疗的病人数量决定一个不利因素是否要预防，这是基于绝对风险的下降。Thisnumberisbasedonefficacyandiscalculatedasthereciprocalofthedifferenceineventratesbetweencontrolandtreatmentgroupsforaspecifiedperiod.efficacy效力，效能，有效性reciprocal相互的，互为倒数的，倒数这个数量是以效能为基础的，是对特定时期内对照组和治疗组之间发生率差异的倒数进行的统计。Ampleevidenceconnectsidentifiableandoftenpreventablefactorstothemorbidityandmortalityassociatedwithmajorhealthproblems.ample足够的，大量的identifiable可以确认的大量的试验证据找出了可确认的又常可预防的与主要健康问题相关的发病和死亡因素。Abouthalfofalldeaths,morbidity,anddisabilitycanbeattributedtosuchnongeneticfactors.nongenetic非遗传性的约一半死亡、发病和病残与这些非遗传性因素有关。Manylifestylechangesbenefitmultiplesystemsanddisorders.许多生活习惯改变有利于多个系统和紊乱的改善。CigarettesmokinghasbeenestimatedtocontributetooneinfivedeathsintheUnitedStates;dietaryhabitsmayaffecttheoccurrenceofcardiovasculardisease,diabetes,osteoporosis,andcancer.osteoporosis骨质疏松症美国五分之一的死亡估计与吸烟有关，饮食习惯可能影响心血管疾病，糖尿病、骨质疏松症和癌症的发生。Otherimportantpersonalbehaviorfactorsinfluencinghealthincludephysicalactivity,alcoholintake,illicitdruguse,sexualpractices,andexposuretoenvironmentaltoxins.其它影响健康的重要个人行为因素有锻炼、饮酒、吸毒、性行为以及环境毒物的接触。TheidentificationofinformativeDNApolymorphisms(e.g.,singlenucleotidepolymorphisms)andfurtherelucidationofcandidategenesallowfordetectionofsusceptibleindividualsandpossibleinstitutionofmeasurestopreventtheexpressionoftheseharmfulgeneticrmative提供信息的candidate候选人polymorphisms多态性traits特质，属性nucleotide核苷酸携带信息DNA多态性（例如，单核苷酸多态性）的认识和候选基因的进一步阐明允许我们发现易感人群和可能采取的措施，以预防这些有害基因特性的表达。Severalcommonmisconceptionsimpedepreventivehealthcare.impede妨碍，阻碍好几种错误观念妨碍了预防保健。Manybelievethatdiseaseswithastrongheritablecomponentcannotbealtered,butsusceptibilitytodiseaseoftenrequirestheinteractionofmultiplegenesandenvironmentalfactorsforexpression.heritable可遗传的，可继承的许多人认为有很强遗传性的疾病是无法改变的，但是对疾病的易感性经常需要多种基因和环境因素的相互作用才能表达。Inaddition,chronicdiseasesaremultifactorial,sootherfactorscanbechangedtocompensateforanelevatedgeneticrisk.multifactorial多因子的compensate补偿，弥补，赔偿另外，慢性疾病是多因素的，所以，可以改变其它因素来弥补高基因风险。Althoughgenetherapyholdsmuchpromise,preventivemeasurescurrentlyofferthebestpossibilitiesforlimitinggeneexpressionandavoidingmise承诺，诺言，希望，前途虽然基因疗法有着很大的希望，但目前的最有可能提供的预防措施是限制基因表达来避免疾病。Thenotionthatpreventionislessusefulinolderpersonsexcludesmanywhowouldbenefitmostfrompreventionbecauseelderlypatientsgenerallyhaveagreaterabsoluteriskofdiseaseandhavebeenshowntoadhereandrespondfavorablytopreventivemeasures.favorably顺利地，好意地，亲切地对老年人预防无用的观念排除了在预防上本应极为受益的许多人，因为老年病人一般有更高患病风险，并且一直对预防措施极为支持、反应积极。Also,lifeexpectancyfrequentlyisunderestimatedintheelderly;individualswhoreachage75nowcanexpecttoliveanaverageof11moreyears.lifeexpectancy预期寿命并且，老年人的预期寿命经常是低估的，现在将到75岁的老人可以预期平均再活11年多。Chapter8WhyGeriatricPatientsAreDifferentPage20第八章老年病人的特殊性第20页Olderpatientsdifferfromyoungormiddle-agedadultswiththesamediseaseinmanyways,oneofwhichisthefrequentoccurrenceofcomorbiditiesandofsubclinicalorbidities并存病subclinical亚临床的同样的疾病，老年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、亚临床疾病多。Asafunctionofthehighprevalenceofdisease,comorbidity(ortheco-occurrenceoftwoormorediseasesinthesameindividual)isalsocommon.prevalence流行、普遍co-occurrence同时发生作为高发疾病的结果，并存病（两个或更多的疾病在同一个体同时发生）也是常见的。Ofpeopleage65andolder,50%havetwoormorechronicdisease,andthesediseasescanconferadditiveriskofadverseoutcomes,suchasmortality.confer授予、给予additive附加的、附属物65岁以上的老年人中，50%患有两种以上的慢性疾病，这些疾病能够增加不良预后的风险，如死亡的风险。Insomepatients,cognitiveimpairmentmaymaskthesymptomsofimportantconditions.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。Treatmentforonediseasemayaffectanotheradversely,asintheuseofaspirintopreventstrokeinindividualswithahistoryofpepticulcerdisease.stroke中风pepticulcer消化性溃疡对一种疾病的治疗可能会加重另一种疾病，例如，对有消化性溃疡病史的病人使用阿斯匹林预防中风。Theriskforbecomingdisabledordependentalsoincreaseswiththenumberofdiseasespresent.disabled残废的、有缺陷的dependent依靠的、依赖的病残或生活不能自理的发生率也随着并存的疾病数而增高。Specificpairsofdiseasescanincreasesynergisticallytheriskofdisability.synergistic协同的特殊的成对疾病可以协同增加病残的风险。Arthritisandheartdiseasecoexistin18%ofolderadults;althoughtheoddsofdevelopingdisabilityareincreasedbythree-foldtofour-foldwitheitherdiseasealone,theriskofdisabilityincreases14-foldifbotharepresent.arthritis关节炎odd奇数的、单个的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3~4倍的病残率，但两个疾病同时存在，可使病残率提高到14倍。Asecondwayinwhicholderadultsdifferfromyoungeradultsisthegreaterlikelihoodthattheirdiseasespresentwithnonspecificsymptomsandsigns.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。Pneumoniaandstrokemaypresentwithnonspecificchangesinmentationastheprimarysymptom.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特异性意识变化作为主要症状。Similarly,thefrequencyofsilentmyocardialinfarctionincreaseswithincreasingage,asdoestheproportionofpatientswhopresentwithachangeinmentalstatus,dizziness,orweaknessratherthantypicalchestpain.silent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。Asaresult,thediagnosticevaluationofgeriatricpatientsmustconsiderawiderspectrumofdiseasesthangenerallywouldbeconsideredinmiddle-agedadults.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。Athirdconditionthatisfoundprimarilyinolderadultsisfrailty,frailtyisthoughttobeawastingsyndromethatpresentswithmultiplesymptomsandsigns,includingreducedmusclemass,weightloss,weakness,poorexercisetolerance,slowedmotorperformance,andlowphysicalactivity.primarily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，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。Someestimatesindicatethatthefullsyndromeisfoundin7%ofcommunity-dwellingpeopleage65andolder,andin25%ofcommunity-dwellingpeopleage85andolder.estimate估计、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岁以上社区老人这些症状全部出现。Manyinstitutionalizedolderadultsalsoarefrail.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。Frailtyisastateofdecreasedreserveandincreasedvulnerabilitytoallkindsofstress,fromacuteinfectionorinjurytohospitalization,andmayidentifyindividualswhocannottolerateinvasivetherapies.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、易于损害的一种状态，从急性感染、损伤到住院治疗，都可以发现一些老人不能耐受侵入性诊疗措施。Thesyndromeoffrailtyisassociatedwithhighriskoffalls,needsforhospitalization,disability,andmortality.fall跌倒、下降frail身体虚弱的、易损坏的、意志薄弱的衰弱症状与高病倒率、高住院率、高病残率、高死亡率是密切相关的。Thereisearlyevidencethatacorecomponentoffrailtyissarcopenia,orlossofmusclemassassociatedwithaging,whichoccursin13to24%ofpersonsage65to70andin60%ponent成分、构成要素sarcopenia肌减少（症）、与年龄相关的骨骼肌质量下降衰弱早期征象中的一个主要变化是肌减少症，或者说随年龄增长的肌肉减少，它发生在13~24%的65~70岁的老人，60%的80岁以上的老人。Itislikelythatdysregulationofmultiplephysiologicsystems,includinginflammation,hormonalstatus,andglucosemetabolism,underliesthesyndrome,withresultingdecreasedabilitytomaintainhomeostasisinthefaceofstress.dysregulation失调homeostasis内环境稳定（衰弱时）多种生理系统易于失调，包括炎症反应、激素调节、葡萄糖代谢，在症状的背后，伴随的结果是在压力面前保持内环境稳定的能力下降。Subclinicaldisease(e.g.,atherosclerosis),end-stagechronicdisease(e.g.,heartfailure),oracombinationofcomorbiddiseasesmayprecipitatethesyndrome.atherosclerosis动脉粥样硬化precipitate沉淀，促成亚临床疾病(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。Evidencefromrandomized,controlledtrialsshowsthatresistanceexercise,withorwithoutnutritionalsupplements,andhome-basedphysicaltherapycanincreaseleanbodymassandstrengthineventhefrailestolderadults.随机对照试验的结果显示无论有无营养支持和家庭运动疗法，即使是最虚弱的老年人，对抗运动能够增加瘦弱躯体的质量和力量。Thisevidencesuggeststhatearlierstagesoffrailtymayberemediable,althoughend-stagefrailtylikelypresagesdeath.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，尽管末期衰弱常预示着死亡。Fourth,minence突出、显著第四，人们变老时认知损害显著增加。Cognitiveimpairmentisariskfactorforawiderangeofadverseoutcomes,includingfalls,immobilization,dependency,institutionalization,andmortality.immobilization活动能力减少institutionalization制度化、专门照料认知损害是大量不良预后的风险因子，包括摔倒、活动能力下降、生活不能自理、需住老人院护理、死亡。Cognitiveimpairmentcomplicatesdiagnosisandrequiresadditionalcaregivingtoensuresafety.认知损害使诊断复杂，为保证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，老年人慢性疾病严重又常见的结果是身体能力丧失，描述为个人最基本的或必须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）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。Ofolderadults,40%reportdifficultywithtasksrequiringmobility,anddifficultywithmobilitypredictsthefuturedevelopmentofdifficultyininstrumentalactivitiesofdailyliving(IADL;householdmanagementtasks)andactivitiesofdailyliving(ADL;basicself-caretasks).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；家务自理项目）和目常锻炼（ADL；基本自理项目）的困难。Inpersonsage65andother,difficultywithIADLisreportedby20%,anddifficultywithADLisreportedby11%;forboth,theprevalenceincreaseswithage.prevalence流行大于65岁的老人或其它人，IADL困难报导为20%，ADL困难报导为11%；随年龄增加两个都困难成为普遍现象。PeoplewhohavedifficultywithtasksofIADLandADLareathighriskofbecomingdependent.IADL和ADL困难的人处于生活不能自理演变的高风险中。Ofpersonsolderthanage65,5%resideinnursinghomes,largelyasaresultofdependencyinIADLand/orADLsecondarytoseveredisease.reside居住nursinghome疗养院大于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,womanlivemoreyearswithdisability,whereasmenwhobecomesimilarlydisabledaremorelikelytodieatayoungerage.一般来说，同样的能力丧失，男性常死得更年轻，女性比男性能多活几年。Althoughphysicaldisabilityisprimarilyaresultofchronicdiseasesandgeriatricconditions,itsonsetandseverityaremodifiedbyotherfactors,includingtreatmentsthatcontroltheunderlyingdiseases,physicalactivity,nutrition,andsmoking.primarily首先、起初、主要、、根本onset进攻、有力的开始、发作虽然身体能力丧失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。Manyinterventiontrialsindicatethatdisabilitycanbepreventedoritsseveritydecreased;onetrialshowedimprovementsinfunctioningwithresistanceandaerobicexerciseinolderadultswithosteoarthritisofthebicexercise有氧运动osteoarthritis骨关节炎许多干预试验揭示能力丧失可预防或减轻；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了功能。OccultandObscureGastrointestinalBleedingPage60occult神秘的、秘密的、隐蔽的obscure黑暗的、模糊的、隐匿的隐匿性和来源不明性胃肠道出血第60页Occultbleedingisdefinedasthedetectionofasymptomaticbloodlossfromthegastrointestinaltract,generallybyroutinefecaloccultbloodtesting(FOBT)orthepresenceofirondeficiencyanemia.fecal排泄物、残渣隐匿性出血指的是无症状性胃肠道出血，一般通过常规的大便隐血试验（FOBT）或存在着缺铁性贫血而发现。Obscuregastrointestinalbleedingisdefinedasbleedingofunknownoriginthatpersistsorrecursafteranegativeinitialendoscopicevaluationofboththeupperandlowergastrointestinaltracts.initial开始的、最初的evaluation评价来源不明性胃肠出血是指首次上、下消化管内窥镜检查都阴性、原发部位不明的持续性或反复性出血。Bothoftheseentitiesmaybepresentationsofrecurrentorchronicbleeding.entity实体、存在、本质presentation提出、表现、存在两者都可能表现为反复的或慢性的出血。Theinitialapproachtoevidenceofoccultgastrointestinalbloodlossshouldbeendoscopicevaluation.对隐匿性胃肠道出血，应该使用内窥镜进行早期检查。InthesettingofanisolatedpositiveFOBT,colonoscopyisindicatedasthefirsttest.colonoscopy结肠镜只有单纯大便隐血试验阳性的情况下，结肠镜作为首选的检查方法是适合的。Theyieldofcolonoscopyinthesepatientsisapproximately2%forcancerand30%foroneormorecolonicpolyps.yield产出、结出、产生这些病人结肠镜的结果大约2%是癌症，30%是单发或多发的结肠息肉。Theinitialapproachtoapatientwithirondeficiencyanemiadependsonthepresenceofsymptomsreferabletoeithertheupperorlowergastrointestinaltract.referable可认为与...有关的、可参考的缺铁性贫血病人的早期检查方法要根据存在的症状是与上消化道相关还是与下消化道相关而决定。Regardlessofthefindingsontheinitialupperorlowerendoscopicexamination,allpatientsshouldhavebothupperandlowerendoscopybecausethecomplementaryendoscopicexaminationhasayieldof6%evenifthefirstonewasplementary补充的、互补的positive确定的、绝对的、真实的无论首次上消化道或下消化道内窥镜检查会有何发现，所有病人两个检查都应该做，因为互补的内窥镜检查有6%的再发现，即使第一个检查是阳性的。Forpremenopausalwomen,apositiveFOBTrequiresfullevaluation,asdoesirondeficiencyanemia.premenopausal绝经前的对绝经前妇女，大便隐血试验阳性需要全面分析，缺铁性贫血也一样。Bariumradiographsoftheupperandlowergastrointestinaltracthavelimitedutilityinthesettingofoccultbleedingbecauseoftheirinabilitytobiopsyortreatlesionsthatareidentified.utility实用、效用、通用隐匿性出血时，上、下消化道的钡剂造影应用有限，因为它们不能活检或治疗发现的病损。Theevaluationofobscuregastrointestinalbleedingisoftenfrustratingfrustrating令人泄气的、令人沮丧的原因不明性胃肠道出血的诊断常常令人沮丧。Angiodysplasiaisthemostcommoncauseinmostrecentseries.Angiodysplasia血管发育畸形血管发育畸形是最近病例统计中最常见的病因。Initialendoscopicexaminationshouldfocusonanysymptomsreportedbythepatient.focus聚焦、集中、明确首次内窥镜检查要关注病人诉说的任何症状。Potentialcausativeagents,suchasNSAIDsandaspirin,shouldbediscontinued.causative成为原因的NSAIDs非甾体类抗炎镇痛药non-steroidalantiinflammatorydrugs能成为潜在病因的药物，如非甾体类抗炎镇痛药和阿斯匹林，都应该停用。Disordersassociatedwithbleeding,suchashereditaryhemorrhagictelangiectasia(Osler-Weber-Rendusyndrome),inflammatoryboweldisease,orableedingdiathesisshouldbeconsidered.telangiectasia毛细血管扩张diathesis素质伴有出血的疾病，像遗传性出血性毛细血管扩张症（Osler-Weber-Rendu综合症）、炎性肠疾病、或出血性体质应该加以考虑。Arepeatendoscopicevaluationmaybeappropriate,becauseapproximatelyonethirdofcasesrevealacauseofbleedingoverlookedduringtheinitialendoscopy.内窥镜重复检查可能是需要的，因为接近三分之一病例查出了首次内窥镜漏掉的出血病原灶。Whenupperendoscopyandcolonoscopyarebothunrevealing,evaluationofthesmallbowelisindicated.当上消化道内窥镜和结肠镜均无发现时，应该对小肠进行检查。Radiographicevaluationofthesmallbowelisnoninvasivebutrelativelyinsensitive,withalessthan6%yieldfromsmallbowelfollow-throughanda10to21%yieldfromenteroclysis.insensitive感觉迟钝的follow-through持久的贯彻，持续enteroclysis小肠造影小肠X线检查是非侵入性的，但相对不灵敏，小肠全片不到6%有发现，小肠造影10～21％有结果。Bycomparison,thediagnosticyieldofendoscopicenteroscopyofthesmallbowelinobscuregastrointestinalbleedingis38to75%.enteroscopy肠镜检查相比较，对来源不明性胃肠道出血小肠内窥镜的诊断结果是38～75%。Traditionalvideoendoscopescanevaluateonlytheproximalsmallbowel(≤150cm),whereaslongerscopes,whicharepassedthoughtheentiresmallbowelandthenwithdrawnwhilevisualizingthemucosa(sondeenteroscopy),arelimitedintheirabilitytovisualizetheentiremucosaandcannotbeusedtoperformdiagnosticortherapeuticximal最接近的、近侧的visualize使看得见，想像sonde探空火箭、探子、探针传统的电视内窥镜只能检查近端小肠(≤150cm)，然而能通过整个小肠边退边看肠粘膜的更长内镜，也不能看到整个肠粘膜，不能作为常规的诊断或治疗手段。Whenendoscopicevaluationdoesnotdetectthecauseofbloodloss,radiographicproceduressuchasscintigraphyandangiographyshouldbeconsidered.scintigraphy闪烁显像当内窥镜检查不能发现出血病因，像闪烁造影和血管造影等影像学手段应该考虑。Provocativeangiographyusingheparinorthrombolyticagentshasbeensuggestedbysomeauthorities,butthisapproachhasthepotentialriskofprecipitatingmajorvocative刺激的、挑拔的、气人的precipitating使突然发生、促使虽然使用肝素或溶栓药的刺激性血管造影被某些专家推荐，但这种方法有促发大出血的潜在风险。Inthefaceofcontinuedbloodlossandnoidentifiedetiology,intraoperativeendoscopymayprovidesimultaneousdiagnosisandtherapy.simultaneous同时发生的、同时存在的碰到进行性出血又诊断不明，术中应用肠镜可以同时进行诊断和治疗。Duringtheprocedure,thesurgeonplicatesthebowelovertheendoscope.plicate有褶的;有皱襞的操作时，外科医生把小肠套到内窥镜上。Asthescopeiswithdrawn,endoscopicfindingscanbeidentifiedforsurgicalresectionortreatment.内镜退出时，内镜的发现可以决定是外科切除或保守治疗。Theyieldofthisprocedureexceeds70%.这个措施70%以上有结果。Insomeclinicalsituations,thesiteofbleedingcannotbeidentified,andthepatientrequireslong-termtransfusiontherapy.long-term长期的transfusion输血某些临床病例，出血部位无法找到，病人而要长期输血治疗。Anewdeviceforvisualizingtheentiregastrointestinalmucosaconsistsofasmallcamerainaningestablecapsulethattransmitsimagestoreceiversattachedtothepatient’sabdomenandmappedtoidentifythelocationoftheimage.ingestable能咽下、能吸收camera照相机、电视摄像机一种新的装置能显示全部胃肠粘膜，这种装置由一颗装有小型摄像机并并能咽下的胶囊组成，它将（数字）影像信号传到附着在病人腹部的接收器，并绘制出图像来识别影像的位置。Thediagnosticyieldofcapsule