医药类英语翻译

医药类英语翻译以下AGuidetoIntensiveCareUnitICU指南ThisintroductoryguidetothecriticalcareenvironmentdescribestheICUandthecaregiverswhostaffit;thepatientsandhowtheyareadmitted,monitored,andtreated;andsomeofthemonlife-supportequipment.ItincludesastrategyforpresentingyourpatienttoyourteamandpreparesyoufortheethicalissuesthatmightconfrontyouintheICU.Theguidealsodescribessomeofthecareerpathsthatculminateinleadershippositionsincriticalcaremedicine.危重病护理环境指南介绍了重症监护室及室内护理人员，病人与病人入院、监护和治疗方式，及某些惯用的生命支持设备等内容。指南还涉及如何向ICU小组介绍病人和如何作好应对ICU可能碰到的职业道德问题的心理准备，并对危重病人护理医学中提高领导职位的职业发展途径进行了描述。ICUTYPESICU种类Thehospitalyouareintodayisdifferentfromthehospitalyourattendingphysicianclaimedashisorherenvironment.Lengthsofstayaredown,patientacuityisrising,andcriticalcareunitsareproliferating.Althoughthehealthcaresystemischanging,hospitalswillalwaysneedanareatocarefortheirsickestpatients--acriticalcarecenter.Theneedfortheseunitsisgrowingaspatientsatalle_tremesoflifethemostprematureinfants,adultswithcardiovasculardisease,theseverelyinjuredaregrowing,bothinabsolutenumbersandinproportiontothegeneralpopulation.Citizensofdevelopednationsaroundtheworldareliving--andstayingactive--intotheninthandtenthdecadesoflife.Whentheybeeill,theyoftenrequireaggressiveinterventiontostabilizetheirdelicatephysiologicbalancesotheycanheal.你今天所在的医院与你主治医生所说的那种环境已大不相似。病人住院时间缩短、病人规定提高、危重护理病房不停增多。即使健康护理系统正在不停发生变化，但医院将始终需要有一种护理最病重的病人的区域一种危重病护理中心。由于处在生命极端状态病人的增多，如早产儿、成人心血管疾病患者和重伤病人等，无论是按绝对数字还是按总人口比率计算，对这些病房的需求也在增加。发达国家人口正进入到人生的90和100岁。一旦生病，他们就经常需要采用入侵性方法使他们那脆弱的生理平衡得以稳定，使疾病得以治愈。Theinterventionsrequiredtomanagelife-threateningillnessesgenerallyincludebothcoresupports--intensivenursingcareandcardiopulmonarymonitoring--aswellassupportsfocusedonthepatientsparticularillness.WhilenearlyallICUsarecapableofprovidingaspectrumofcare,manyhavedevelopedafocusedareaofe_cellence:careofcriticallyillandinjuredchildreninthepediatricICU（PICU）;adultcardiacdiseasesinthecoronarycareunit（CCU）;perioperativecare,traumacare,andcareofmultipleorgandysfunctioninthesurgicalICU（SICU）;careofneurologicalandneurosurgicalpatientsintheneuroscienceICU;andsoon.Manyteachinghospitalsalsohavegradedcriticalcarecenterssuchasintermediatecareunitsandtelemetryunitswherepatientswhorequiremorethanwardcarecanbenefitfromspecificmonitoringandintervention.威胁生命的疾病的解决方法涉及核心支持重症护理和心肺监护及以病人特定疾病为重点的支持方法。尽管几乎全部的ICU都能够提供整套的护理，但诸多ICU都有自己重点关注的强项：儿科ICU（PICU）危重病及受伤小朋友的护理；冠心病监护室的成人心脏病护理；外科ICU（SICU）的围手术期护理、外伤护理和多个器官功效障碍的护理等；神经科ICU的神经和神经外科病人护理；等等。诸多教学医院也有不同等级的危重病护理中心，如过渡监护治疗病房和远程治疗病房等。需要病房外护理的病人能够从远程治疗特殊的监护和介入中受益。TheICUTeamICU小组Themorethingsgetbusy,themoreyouwillappreciatethateachteammemberintheICUhasaspecificrole.Theteamleaderisaphysician.Studentstypicallyareassignedtotraininintensivecareunitswheretheteamleaderisanintensivistphysicianwhohasreceivedadvancedtrainingintheartandscienceofcriticalcaremedicine.InNorthAmerica,addedqualificationsincriticalcaremedicineareobtainedafterboardcertificationinaprimaryspecialtysuchaspediatrics,internalmedicine,surgery,oranesthesiology.Manycountrieshaveestablishedcriticalcaremedicineasanindependentspecialty.Irrespectiveofthetrainingpathway,yourteamleaderembracesthephilosophyofcriticalcaremedicine,namelythataphysician-led,multidisciplinaryteamcanprovideoptimalcaretothecriticallyillpatient.事情越忙，你就越能体会每个ICU组员所起的特殊作用。ICU小组长是一位医生。在指定的医学生实习重症监护室里，ICU组长普通是一种重症专科医生，他在危重病人护理医学方面受过高级培训。在北美地区，额外的危重病护理医学资格是在其有了基本的专科证书---如儿科、内科、外科或麻醉科等专科资格证书---后获得的。诸多国家已将危重病护理医学设为一种独立的专业科室。不管组长接受的是何种途径的培训，他都会掌握危重病护理医学的基本原理，也就是说，一种由医生领导的多学科小组能够向危重病人提供最佳的护理。ThetermmultidisciplinaryrefersnotonlytootherphysicianswhomayparticipateasconsultantsorcoattendingsintheICU,butalsototheotherhealthcareprofessionalswhoworksidebyside,aroundtheclockintheICU.Themostnumerousofthesearethecriticalcarenurses,manyofwhomalsohaveadvancedtrainingandcertificationincriticalcareandarerecognizedasCCRNs.Somehaveachievedevengreaterrecognitionandresponsibility.Theyaretheacutecarenursepractitionersandclinicalnursespecialistswhoplementthephysicianstaffinestablishingplans,writingorders,anddirectingmanagement.PhysicianassistantsalsoprovidecareintheICU.多学科一词并不仅仅是指以会诊医师或合作主治医师身份加入ICU的其它医生，它同时也指在ICU内并肩工作24小时的其它卫生保健专业人员，人数最多的是重症监护护士。这些护士多数在重症护理方面受过高级培训，并获得对应的证书，是公认的重症监护注册护士。有些护士所获得的承认不尽于此，他们的职责也更重大。他们是急症护理医生和临床护理专家，也能够制订计划、写医嘱和指导治疗，是医生的补充。医生助理也提供ICU护理。Respiratorytherapistsaree_pertsinmanyformsofpulmonarydiagnosisandintervention.Inadditiontooperatingthemechanicalventilator,therapistsoftenobtainandanalyzearterialbloodforbloodgasesandtestpatientsbreathingstrengthbyobtainingforcedvitalcapacity,negativeinspiratorypressure,andotherparameters.Insomehospitals,respiratorytherapistsperformendotrachealintubationinadditiontosupportingventilationwithbag-and-maskdevices.TheICUteamtypicallyincludesapharmacistwhohelpsyoureviewmedicationprofilesanddetermineifyourpatientispredisposedtosideeffectsordruginteractions.ThepharmacistwillhelpyoucalculateclearanceratesfrommeasureddruglevelsandplandosingschedulesformanyofthemedicationsusedintheICU.呼吸治疗师是多个肺病诊疗和治疗的专家，除了使用机械呼吸机外，这些治疗师经常获取并分析动脉血气，通过用力肺活量、负压吸气及其它参数测试病人的呼吸力。在某些医院，呼吸治疗师除了用袋-面罩装置支持通气外也施行气管内插管。一种典型的ICU小组都有一种药剂师，他协助护士评定药品性质，拟定病人与否会诱发副作用或药品互相作用。药剂师根据测得的药品浓度协助你计算药品去除率，为ICU使用的多个药品计划给药方案。Theteamalsotypicallyincludessomeonewhoisane_pertinnutritionsupportsuchasadietitianwhohasadvancedtraininginenteral（gut）andparenteral（intravenous）nutritionalsupportstrategiesandpitfalls.OtherimportantmembersoftheICUteamarethemedicalsocialworker,whoprovidesongoingpsychosocialassessmentsandsupport;representativesofthechaplaincystaff,whoareavailableoncalltoofferspiritualsupporttopatients,families,andICUstaffmembers;andaunitsecretary,whomanagesadministrativetaskssuchasreception,telemunications,andchartmaintenance.Inaddition,theICUstaffgenerallyincludesmanyothertraineeswhoaretheretolearnwithyousuchasfellows,residents,nursingstudents,anddieteticsstudents.典型的ICU小组还会涉及一位营养专家，如在肠道和非肠道（静脉内）营养支持办法及缺点方面受过高级培训的营养师等。ICU小组其它重要组员有医务社会工作者，他为病人提供不停的心理社会评定和支持；牧师代表，能够随时招他为病人、家眷和ICU组员提供精神上的协助；以及一位病房秘书，解决某些行政性工作，如接待、联系及图表保管。另外，ICU组员普通涉及其它诸多在此学习的实习人员，犹如行、居民、护生及营养学学生等。ThePatientsICU病人Patientsareadmittedtotheintensivecareuniteitherbecausetheyrequirehigh-intensitymonitoringandlifesupportbyspeciallytrainedhealthcareprovidersorbecausetheyrequirehigh-intensitynursingcarethatcannotbeprovidedonageneralmedicalorsurgicalward.Asnotedpreviously,surgicalpatientsareadmittedtothesurgicalintensivecareunitandmedicalpatientstothemedicalorcoronaryintensivecareunits.Manysurgicalpatientsareadmittedwithmedicalproblemssuchaspneumoniaorsepsis.病人进入ICU，不是由于需要由通过特殊训练的健康护理人员进行高强度监护和生命支持，就是由于他们所需要的高强度护理是其它变通内科或外科病房所无法提供的。如前所述，外科病人进入外科ICU，内科病人进入内科或冠状病ICU。许多外科病人住进来时都会有内科疾病，如肺炎、浓毒症等。PatientsetotheICUfromseveralareas:lOperatingroom（OR）orpost-anesthesiacareunit（PACU）--Surgicalpatientswhorequireinvasivemonitoring,mechanicalventilation,orresuscitationaftersurgerymaybetransporteddirectlytotheICUfromtheORorthePACUafteraperiodofobservation.Suchdirecttransportisconsideredatransferfromonecriticalcareareatoanother.Therefore,theirICUmanagementisacontinuationofcarethattheyreceivedfromtheanesthesiologyteamintheoperatingroomorPACU.ICU病人来自下例科室：手术室（OR）或麻醉后监护病房（RACU）术后需要侵入性监测、机械通气或复苏的病人在通过一段观察后能够直接从手术室或麻醉后监护病房送到ICU，这种直接运输方式也就是由一种危重病护理区转到另一种危重病护理区，因此，其ICU解决只是OR或PACU麻醉小组护理的继续。lEmergentcarecenter（ECC）oremergencyroom--Medical,surgical,trauma,orburnpatientscanbeadmittedtotheICUfromtheECCoremergencyroom.Thesepatientstypicallyundergoaseriesofdiagnostictestspriortotheirtransfer,andtheetiologyoftheirillnessmayormaynotbeknownbythetimetheyetotheICU.Theyareadmittedtomanagetheiracuteillness.急诊护理中心（ECC）或急诊室内科、外科、创伤或灼伤病人能够由ECC或急诊室收住ICU。这些病人在转来之前普通都做过一系列的诊疗检查，到ICU时，其病因可能已经懂得，也可能还不懂得。他们住进ICU是由于有急病要解决。lMedicalorsurgicalward--PatientsmaybeadmittedtotheICUfromageneralmedicalorsurgicalward.Thesearepatientswhowereinitiallystablebutwhodevelopedrespiratorydistress,lowbloodpressure,shock,cardiopulmonaryarrest,orotherphysiologicinstabilitiesontheward.Theyrequireaggressiveresuscitation,treatment,andinvasivemonitoringandaretransferredtotheICUforcloserobservation,morefrequentmeasurementofvitalsigns,invasivemonitoring,ormechanicalventilation.内科或外科病房病人能够从普通内科或外科病房收住ICU。这些病人开始时的病情都很稳定，但在病房时发生了呼吸窘迫、低血压、休克、心肺停止或其它的生理不稳定状况，需要超常规的复苏、治疗和侵入性监护，转到ICU进行更亲密的观察、增加生命体征测量、采用侵入性监护或进行机械通气。lOtherfacilities--Patientsmayalsobetransferredfromanotherfacilitythatdoesnothavetheresourcestoprovidethelevelortypeofcaretheyrequire.其它机构病人也能够从另一种机构转到这里，由于该机构没法提供所需的护理。monReasonsforAdmissiontotheICU:lRespiratorypromise--Patientswithrespiratorydistress,manifestedeitherasaninabilitytoo_ygenateoraninabilitytoventilate,aretransferredtotheICUforsupplementalo_ygenandmechanicalventilation.Etiologiesofrespiratorydistressarenumerousandincludepneumonia,acuterespiratorydistresssyndrome,pulmonaryembolism,ande_acerbationsofchronicobstructivelungdisease.ICU入院常见因素呼吸系统损伤呼吸窘迫病人可体现为无法氧合或通气不能，转到ICU就是为了补充氧气、机械通气。呼吸窘迫病因诸多，涉及肺炎、急性呼吸窘迫综合症、肺栓塞和慢性阻塞性肺部疾病等。lHemodynamicpromise--Patientswithhemodynamicinstabilityareadmittedformanagementofarrhythmias,hypotension,orhypertension.Patientswithhypotensionaretypicallyresuscitatedwithfluidormedications（e.g.,vasopressorsorinotropes）toincreasevasculartone.Ifapredeterminedminimalmeanbloodpressurecannotbemaintained,orifthepatienthassignsofinadequateo_ygendeliverytothetissues（i.e.,alteredmentalstatus,decreasedurineoutput,coolskin,andlacticacidosis）,apulmonaryarterycatheter（PAC）maybeinsertedtomonitorcardiacoutput.MeasurementsobtainedfromthePACaidtheclinicianindeciding,fore_le,whethertotreatthepatientwithmorefluidstoimprovepreloadthefillingpressureoftheleftventricle--ortoinitiateinotropestoimprovecontractility.Intheseinstances,anarterialcatheterisofteninsertedtomonitorsystemicbloodpressurecontinuously.Patientswithseverehypertensionaregenerallymanagedwithtitratableintravenousmedications.血液动力学功效损伤血液动力学功效不稳病人收住ICU以解决心律失常、低血压或高血压。低血压病人重要是通过液体或药品进行复苏（如血管升压类药品或收缩性药品），增加血管张力。如果无法保持预定的最低平均血压，如果病人出现组织供氧局限性症状（如精神状态变化、排尿量减少、皮肤发冷和乳酸性酸中毒），就可能需要施行肺动脉导管（PAC）以监测心排血量。PAC测量成果能够协助临床医生作出决定，如与否需要增加输液改善前负荷即左室充盈压或使用收缩性药品以提高收缩性。在上术状况中，经常要通过插入动脉导管来持续监测体循环血压。有严重高血压的病人普通采用可滴定静脉给药法进行解决。lMyocardialischemiaorinfarction--Patientswithinadequateo_ygendeliverytotheirmyocardiumareadmittedforthemanagementofanginaandmyocardialinfarction.Theymayrequiretitrationofnitroglycerin,betablockers,andmorphine.Eachmedicationcanresultinfurtherplicationssuchashypotension,decreasedheartrate,bronchospasm,ordecreasedrespiratorydrive,respectively.Thesepatientsareoftencandidatesforthrombolyticagentsandcardiaccatheterization.Thegoalofadmission,toreverseischemiaandminimizemyocardialinjury,requiresclosemonitoringandrapidintervention.心肌缺血或梗死心肌供氧局限性病人入院解决心绞痛或心肌梗死。这些病人可能需要甘油滴定、-制止剂或吗啡。每种药品都可能造成进一步的并发症，如低血压、心率减慢、支气管痉挛或呼吸动力削弱等。这些病人经常是血栓溶解剂和心导管插管的使用对象。收治目的是逆转心肌缺血减少心肌损伤，这需要亲密的监护，并快速采用方法。lNeurologicalpromise--PatientswithalterationsinmentalstatusareadmittedtotheICUforfrequentneurologicchecks.Iftheirconditiondeteriorates,theymayneedtohaveanendotrachealtubeplacedtoprotecttheirairway.神经损伤精神状态变化病人住进ICU进行频繁的神经检查。如果病情恶化，就可能需要放置气管内插管以保护气道。lGastrointestinal--Patientswithlife-threateninggastrointestinalbleedingareadmittedtotreathypotensionwithIVfluids,bloodandbloodproducts.DiagnostictestssuchasendoscopywilllikelybeperformedtolocateandtreatthesourceofbleedinginunstablepatientsintheICU.胃肠出现危及性命的胃肠出血病人住进ICU，通过IV输液、全血或血液制品治疗低血压。有可能在ICU通过内窥镜之类的诊疗检查来定位和治疗不稳定病人的出血。lRenalandmetabolic--Patientsmaybeadmittedfortreatmentoftheplicationsofrenalfailure,includingacidosis,volumeoverload,andelectrolyteabnormalities.Moreoften,patientsdeveloprenalfailureintheICUsecondarytohypotensionandsepsis.Treatmentwithcarefulattentiontoacid-basebalance,electrolytes,andvolumestatusisprovidedintheICU.Othermetaboliccrises,suchashypercalcemia,unrelatedtorenalfailure,mayresultinapatientsadmissiontotheICU.肾和代谢问题病人入院也可能是为了治疗肾衰引发的多个并发症，涉及酸中毒、容量过分负荷、电解质异常等。更常见的状况是，病人在ICU时因低血压和脓毒症而继发肾衰。ICU治疗时应亲密注意酸碱平衡、电解质和容积状况。其它代谢性危象如高钙血症等，尽管与肾衰无关，但也可能造成病人收住ICUlPostoperative--TherearemanyreasonsforadmittingpatientstotheICU.Theymaystillbeonaventilator,ortheymayhaveotherinvasivemonitoring.TheymayhaveahistoryofcoronaryarterydiseaseandthereforebeatriskforaperioperativeMI.Theymayhavehade_tensivebleedingandrequirefrequentobservation.Theymayhavehadane_tensivesurgicalprocedure,includingopen-heartsurgery,organtransplantation,vascularsurgery,orgeneralabdominalsurgery.EachsurgicalinterventionhasspecificperioperativeissuesthatrequireobservationandtreatmentintheICU.Patientswithtrauma,orthopedicinjuries,ande_tensivethermalinjuriesarealsoadmittedtoICUs.术后诸多因素能够使病人住进ICU。他们可能仍在使用呼吸机，也可能是在接受其它入侵性监测。他们可能有冠状动脉疾病史，因此有围手术期心肌梗死危险。病人也可能有大出血，需要亲密观察。病人可能接受过大型外科手术，如开胸手术、器管移植、血管手术、或腹部手术。每次手术都有特定的围手术期问题需要在ICU进行观察和治疗。创伤、骨伤和大面积热损伤病人也会收住ICU。TransportingthePatienttotheICUOnceitisclearthatapatientrequiresmanagementintheintensivecareunit,theICUpersonnelshouldbenotified.Anattending,fellow,orresidentshouldcalltheICUchargenurseandindicatethepatientsname,illness,reasonfortransfertotheICU,andimmediateplansfortreatment.AlertingthestaffintheICUpriortopatienttransportallowsthemtoprepareforthepatientsarrival.AdvancemunicationwiththeICUphysicianensuresthattheappropriatesupportisavailablewhenthepatientarrives.Itisessentialthattheappropriatepersonnel,equipment,andmonitorsareavailableforalltransferstotheICU.运输病人到ICU一旦明确病人需要由ICU解决，就应告知ICU医护人员。由主治医师、普通医生或住院医师呼喊ICU主管护师，搞清病人的姓名、疾病、转室因素，立刻制订治疗计划。在病人送到前提示ICU工作人员能够使他们为病人到来作好准备。事先与ICU医师沟通可确保病人达成时得到适宜的支持。使转到ICU的全部病人都有适宜的人手、器械和监护，这一点极为重要。TheEquipment设备Thevastarrayoftechnologypresentinanaveragepatientsroomcanbeoverwhelming.Eventhebedshavebeeincrediblyple_,costingtensofthousandsofdollarsandrequiringdetailedoperatinginstructions.Itisstressfulenoughjusttobeintheroomofapatientwhoiscriticallyill,letalonetocopewiththean_ietythattheequipmentmightalarmormalfunctionandrequireanintervention.Inreality,themachinesintheICUhavemanyfail-safebackupsystemssothatmechanicalfailureisrare.Furthermore,devicesthatrequiremoresupervisionareusuallyacpaniedbyanindividualwithe_pertise,suchasacardiactechnicianforanintra-aorticballoonpumporahemodialysistechnicianforahemodialysismachine.Respiratorytherapistsareinclosepro_imitytopatientsroomsandintervenequicklyifamechanicalventilatoralarmsormalfunctions.Thebestwaytoresolvean_ietyistobeefamiliarwithallofthedifferentdevices.普通病人病房里的技术多得使人晕头转向，连床铺也复杂得令人难以置信，不仅要花数万美元，还要有具体的操作阐明。在危重病人病房里就已够紧张的了，更不用说还要应付器械告警或故障需要解决这样令人焦虑的事。在现实中，ICU机器都有诸多故障保险备份系统，因此，出现机械故障的可能性很小。并且，需要监督的装置普通都由专业人员看着，如由心脏科技师负责主动脉内气囊泵或血透技师负责血液透析机等。呼吸治疗师离病人房间很近，一旦机械呼吸机告警或故障，他能够很快进行解决。减轻焦虑的最佳办法是熟悉多个装置。BedsidemonitorsAllpatientsareconnectedtoabedsidemonitorwhosescreendisplaysseveralparameters.ChannelsIandIItypicallydisplaytwoEKGleadsprovidingcontinuousmonitoringofthepatientsheartrhythm.ThepatientsbloodpressureisdisplayedeithercontinuouslyfromacatheterinthepatientsarterialsystemorintermittentlyfromanautomaticallyinflatingbloodpressurecuffonchannelIII.Thearteriallineallowsbeat-to-beatmeasurementofbloodpressure.AnA-lineisalsoinsertedinpatientswhorequirenumerousarterialbloodgasesinordertoavoidrepeatedpunctures.床边监测仪全部病人都接有一种床边监测仪，它能够显示多个参数。其中通道I、II重要显示两台EKG导联仪，对病人心律进行持续监测。病人血压监测有持续和间断两种，前者通过病人动脉系统插管监测，后者通过通道III自动充气血压袖带监测。动脉插管能够测量每一搏动的血压状况，它能够用于需要大量动脉血气的病人，避免重复穿刺。Patientsmayhaveacentralvenouscatheterplacedinthesuperiorvenacavathroughtheinternaljugularorsubclavianvein.Acentralvenouscatheterallowsmeasurementofcentralvenouspressure（CVP）.TheCVPservesasanestimateofthepatientsvolumestatus.Centrallinesarealsousedtorapidlyinfusefluidandtoadministersubstancesthatcannotbeinfusedintoaperipheralveinsuchashypertonicparenteralfluidsandmedicationssuchasvasopressors.病人也能够经由颈内静脉或锁骨下静脉放置上腔静脉中心静脉插管，测定中心静脉压（CVP），由此预计病人的容积状态。中心静脉插管也可用于快速输液和给药。某些周边静脉难以输入的药品或液体，如高渗非肠道液体、血管升压类药品等，都能够通过该插管输入。Whenmoredataaboutapatientshemodynamicphysiologyisrequired,apulmonaryarterycathetercanbeinsertedandadvancedthroughtherightventricleintothepulmonaryartery.ThePACallowscontinuousdisplayofpulmonaryarterypressure,andvariablessuchascardiacoutputandpulmonaryarteryocclusionpressure,orwedgepressure,canbeintermittentlyobtained.Thewedgepressureisameasurementthatreflectsthepatientspreload.Thecatheterisusedtodiagnoseandmanagehemodynamicinstability.如需要更多的病人血液动力生理学资料，就能够施行肺动脉插管（PAC），经由右室插入肺动脉。PAC能够持续显示肺动脉压及其它多个变量，如心排血量，也能够间断性显示肺动脉闭塞压或楔压。楔压反映了病人的前负荷状况，插管用于诊疗和解决血液动力学的不稳定性。Therespiratoryrateandthepulseo_imeterreading,whichindicatesthepatientso_ygensaturation,arealsodisplayedonthemonitor.Thepulseo_imeterisanoninvasivemonitorattachedtothepatientsfingerorearlobetomeasureo_ygensaturationcontinuously.Bedsidemonitorscanbesettoalarmforbradycardiaortachycardia,hypotensionorhypertension,tachypnea,and/oro_y