临床医学英语翻译

2021年2月11日发(作者：依莲)

临床医学英语翻译

Chapter 1

Patient-Physician Interaction

Page 1

第一章

医患沟通

第１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阶段中进行着。

The interaction begins 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。

The

process

commonly

requires

a

careful

history

or

physical

examination,

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 plans.

integration

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

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

patients

respecting

注意到、关系、说到

evidence-based medicine

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。

The

increasing

availability

of

randomized

trials

to

guide

the

approach

to

diagnosis

and

therapy should not be equated with “cookbook” medicine

availability

可

利

用

性

，

< p>

可

得

到

randomize

随

机

的

cookbook

食

谱

，

烹

调

< br>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。

Evidence

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

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。

Substantial

clinical

judgment

is

required

to

determine

whether

the

evidence

and

guidelines

apply to individual patients and to recognize the occasional.

1

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 确定这些现象和思路能否应用于某个病人个体，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

许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。

Evidence

also

must

be

tempered

by

patients’

preferences,

although

it

is

a

physician’s

responsibility to emphasize when presenting alternative options to the patient.

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。

The adherence of a patient to a specific 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。

To care for a patient as an individual, the physician must understand the patient as a person.

care for

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

< p>
)

，医生必须理解病人是一个

人（不是一群人）< /p>

。

This

fundamental

precept

of

doctoring

includes

an

understanding

of

the

patient’s

social

situation,

family

issues,

financial

concerns,

and

preferences

for

different

types

of

care

and

outcomes, ranging from maximum prolongation of life to the relief of pain and suffering.

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。

If the physician does not appreciate and address these issues, the science of medicine cannot

be applied appropriately, and even the most knowledgeable physician fails to achieve appropriate

outcomes.

appreciate

欣赏、感谢、评价

appropriate

适当的、恰当的

< br>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。

Even as physicians become increasingly aware of new discoveries, patients can obtain their

own information from a variety of sources, some of which are of questionable reliability.

aware of

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，

2

当然，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

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。

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 approaches

substitute

代替、代用

rely on

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。

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 consider

crucial

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。

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的，而是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 water,

and adequate nutrition have been the most important ways to promote health and reduce disease.

adequate

足够的、恰当的

< br>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。

In

developed

countries,

the

adoption

of

healthy

lifestyles,

including

better

diet

and

appropriate exercise, are cornorstones to reducing the epidemics of obesity, coronary disease, and

diabetes.

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。

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 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

产生的健康效果几乎比可想 象的任何其它健康干预措施都要好。

3

Chapter 5

Clinical Preventive Services

Page 11

第五章

临床预防服务

Clinical preventive services include counseling, immunization, screening tests, and reduction

of

the

susceptibility

to

disease

by

interventions

such

as

therapeutic

lifestyle

changes

and

pharmacotherapy.

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。

Preventive service often are classified as primary, secondary, or tertiary.

tertiary

第三，第三纪

tertiary industry

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。

Primary

prevention

is

directed

toward

preventing

disease

or

injury

before

it

develops,

whereas secondary prevention deals with early detection and treatment to impede the progress of

overt disease.

deal with

解决

impede

妨碍

overt

公开

Primary

prevention

is

directed

toward

preventing

disease

or

injury

before

it

develops,

whereas secondary prevention deals with early detection and treatment to impede the progress of

overt disease.

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。

In contrast, tertiary prevention refers to rehabilitative activities after the onset of disease to

minimize complications and disability.

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。

Because

of

considerable

overlap,

distinguishing

among

these

phases

of

prevention

may

be

confusing.

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。

Detecting

and

treating

hypertension

could

be

considered

secondary

prevention

of

4

hypertensive cardiovascular disease but primary prevention of heart failure and stroke.

hypertensive cardiovascular disease

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

< br>和中风的一级预防。

Prevention

may

be

perceived

best

along

a

continuum

from

modification

of

predisposing

factors, to preventing a disease, to avoiding premature death and disability.

perceive

感知，认为

continuum

统一体

,

一致性

predisposing factors

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。

The

sooner

the

prevention,

the

more

likely

unnecessary

illness,

disability,

and

premature

death can be avoided.

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。

Increasing emphasis has been placed on preventing risk factors themselves.

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。

The term primordial prevention has been introduced for this concept.

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。

Indiscriminate

screening

for

risk

factors

or

disease

without

adequate

advice

and

follow-up

serves no useful purpose.

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。

The periodic health examination has evolved from an annual, broad- based, uniform protocol

to

an

approach

that

targets

the

prevention,

detection,

and

treatment

of

specific

diseases

or

risk

factors for particular age, gender, and ethnic groups at appropriate intervals.

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 。

5

Current

recommendations

by

the

U.S.

Preventive

Services

Task

Force

are

based

on

systematic

evidence

reviews

that

distinguish

procedures

likely

to

prove

effective

and

to

have

substantially more benefit than harm.

Task Force

特遣部队

distinguish

区别，辨认，使显著

substantially

非常，本质上，大体上

< p>
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。

Changes

in

the

health

care

system

and

the

development

of

national

guidelines

for

management of disease are likely to draw greater attention to health promotion, disease prevention,

and the interface of physician-based medical care with the public health care system.

health care

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。

Physicians should consider each disorder in terms of the potential for prevention, including

the possibility of adverse effects and cost-effectiveness.

in terms of

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。

A

concept

useful

for

clinical

decision

making

is

the

number

of

patients

needed

to

treat

to

prevent one adverse event, which is based on absolute risk reduction.

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。

This number is based on efficacy and is calculated as the reciprocal of the difference in event

rates between control and treatment groups for a specified period.

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。

Ample

evidence

connects

identifiable

and

often

preventable

factors

to

the

morbidity

and

mortality associated with major health problems.

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。

6

About

half

of

all

deaths,

morbidity,

and

disability

can

be

attributed

to

such

nongenetic

factors.

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。

Many lifestyle changes benefit multiple systems and disorders.

许多生活习惯改变有利于多个系统和紊乱的改善。

Cigarette smoking has been estimated to contribute to one in five deaths in the United States;

dietary

habits

may

affect

the

occurrence

of

cardiovascular

disease,

diabetes,

osteoporosis,

and

cancer.

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。

Other

important

personal

behavior

factors

influencing

health

include

physical

activity,

alcohol intake, illicit drug use, sexual practices, and exposure to environmental toxins.

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。

The

identification

of

informative

DNA

polymorphisms

(e.g.,

single

nucleotide

polymorphisms)

and

further

elucidation

of

candidate

genes

allow

for

detection

of

susceptible

individuals and possible institution of measures to prevent the expression of these harmful genetic

traits.

informative

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。

Several common misconceptions impede preventive health care.

impede

妨碍，阻碍

好几种错误观念妨碍了预防保健。

Many

believe

that

diseases

with

a

strong

heritable

component

cannot

be

altered,

but

susceptibility to disease often requires the interaction of multiple genes and environmental factors

for expression.

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

< br>和环境因素的相互作用才能表达。

In

addition,

chronic

diseases

are

multifactorial,

so

other

factors

can

be

changed

to

compensate for an elevated genetic risk.

multifactorial

多因子的

7

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。

Although

gene

therapy

holds

much

promise,

preventive

measures

currently

offer

the

best

possibilities for limiting gene expression and avoiding disease.

promise

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。

The notion that prevention is less useful in older persons excludes many who would benefit

most from prevention because elderly patients generally have a greater absolute risk of disease and

have been shown to adhere and respond favorably to preventive measures.

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, life expectancy frequently is underestimated in the elderly; individuals who reach age

75 now can expect to live an average of 11 more years.

life expectancy

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。

Chapter 8

Why Geriatric Patients Are Different

Page 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 comorbidities and of subclinical disease.

comorbidities

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。

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。< /p>

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。

In some patients, cognitive impairment may mask the symptoms of important conditions.

8

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< /p>

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的发生率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

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

< br>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。

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.

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, 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.

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。

As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of

9

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。

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.

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。

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、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。

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

infection

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、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。

The

syndrome

of

frailty

is

associated

with

high

risk

of

falls,

needs

for

hospitalization,

disability, and mortality.

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。

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

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

< br>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

10

to maintain homeostasis in the face of stress.

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。

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

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。

< p>

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。< /p>

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，尽管末期衰弱常预示着死亡。

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 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。

Cognitive

impairment

complicates

diagnosis

and

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, from 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，

老年人慢性疾病严重又常见的结果是身体能力丧失，

< br>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< /p>

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。

11

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 (ADL; basic self-care tasks).

在老年人中，

< /p>

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。

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

6 5

岁的老人或其它人，

IADL

困难报 导为

20%

，

ADL

< br>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< /p>

和

ADL

困难的人处于生活不能自理演变 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

nursing home

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

A DL

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，同样的能力丧失，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 geriatric 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。

Many

intervention

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 knee.

aerobic exercise

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< /p>

和有氧运动改善了功能。

Occult and Obscure Gastrointestinal Bleeding

Page 60

occult

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

12

Occult

bleeding

is

defined

as

the

detection

of

asymptomatic

blood

loss

from

the

gastrointestinal

tract,

generally

by

routine

fecal

occult

blood

testing

(FOBT)

or

the

presence

of

iron deficiency anemia.

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< /p>

（

FOBT

）

或存

在着缺铁性贫血而发现。

Obscure gastrointestinal

bleeding

is

defined

as

bleeding

of

unknown

origin

that

persists

or

recurs after a negative initial endoscopic evaluation of both the upper and lower gastrointestinal

tracts.

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。

Both of these entities may be presentations of recurrent or chronic bleeding.

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。

The initial approach to evidence of occult gastrointestinal blood loss should be endoscopic

evaluation.

对隐匿性胃肠道出血，应该使用内窥镜进行早期检查。

In the setting of an isolated positive FOBT, colonoscopy is indicated as the first test.

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。

The yield of colonoscopy in these patients is approximately 2% for cancer and 30% for one

or more colonic polyps.

yield

产出、结出、产生

这些病人结肠镜的结果大约

2%

是癌症，< /p>

30%

是单发或多发的结肠息肉。

The

initial

approach

to

a

patient

with

iron

deficiency

anemia

depends

on

the

presence

of

symptoms referable to either the upper or lower gastrointestinal tract.

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。

Regardless of the findings on the initial upper or lower endoscopic examination, all patients

should have both upper and lower endoscopy because the complementary endoscopic examination

has a yield of 6% even if the first one was positive.

complementary

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。

13

For premenopausal women, a positive FOBT requires full evaluation, as does iron deficiency

anemia.

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。

Barium

radiographs

of

the upper

and

lower

gastrointestinal

tract

have

limited

utility

in

the

setting of occult bleeding because of their inability to biopsy or treat lesions that are identified.

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。

< p>

The evaluation of obscure gastrointestinal bleeding is often frustrating

frustrating

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。

Angiodysplasia is the most common cause in most recent series.

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。

Initial endoscopic examination should focus on any symptoms reported by the patient.

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。

Potential causative agents, such as NSAIDs and aspirin, should be discontinued.

causative

成为原因的

NSAIDs

非甾体类抗炎镇痛药

non-steroidal antiinflammatory drugs

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。

Disorders

associated

with

bleeding,

such

as

hereditary

hemorrhagic

telangiectasia

(Osler-Weber- Rendu

syndrome),

inflammatory

bowel

disease,

or

a

bleeding

diathesis

should

be

considered.

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。

A repeat endoscopic evaluation may be appropriate, because approximately one third of cases

reveal a cause of bleeding overlooked during the initial endoscopy.

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。

When upper endoscopy and colonoscopy are both unrevealing, evaluation of the small bowel

is indicated.

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。

14

Radiographic evaluation of the small bowel is noninvasive but relatively insensitive, with a

less than 6% yield from small bowel follow-through and a 10 to 21% yield from enteroclysis.

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。

By comparison, the diagnostic yield of endoscopic enteroscopy of the small bowel in obscure

gastrointestinal bleeding is 38 to 75%.

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%

。

Traditional videoendoscopes can evaluate only the proximal small bowel (

≤

150cm), whereas

longer

scopes,

which

are

passed

though

the

entire

small

bowel

and

then

withdrawn

while

visualizing

the

mucosa

(sonde

enteroscopy),

are

limited

in

their

ability

to

visualize

the

entire

mucosa and cannot be used to perform diagnostic or therapeutic maneuvers.

proximal

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

(

≤

< p>
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。

When endoscopic evaluation does not detect the cause of blood loss, radiographic procedures

such as scintigraphy and angiography should be considered.

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。

Provocative angiography using heparin or thrombolytic agents has been suggested by some

authorities, but this approach has the potential risk of precipitating major bleeding.

provocative

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。

In the face of continued blood loss and no identified etiology, intraoperative endoscopy may

provide simultaneous diagnosis and therapy.

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。

During the procedure, the surgeon plicates the bowel over the endoscope.

plicate

有褶的

;

< p>
有皱襞的

操作时，外科医生把小肠套到内窥镜上。

As

the

scope

is

withdrawn,

endoscopic

findings

can

be

identified

for

surgical

resection

or

treatment.

内镜退出时，内镜的发现可以决定是外科切除或保守治疗。

15

The yield of this procedure exceeds 70%.

这个措施

70%

以上有结果 。

In some clinical situations, the site of bleeding cannot be identified, and the patient requires

long-term transfusion therapy.

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。

A new device for visualizing the entire gastrointestinal mucosa consists of a small camera in

an

ingestable

capsule

that

transmits

images

to

receivers

attached

to

the

patient’s

abdomen

and

mapped to identify the location of the image.

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

< br>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。

The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially

visualize segments of the small bowel that were previously inaccessible.

potentially

潜在的、可能的

inaccessible

达不到的、难接近的

胶囊小肠镜的诊 断效率现在还不清楚，

但是，

这种方法可能显示出以前难以接近 的小肠

肠管。

No therapeutic maneuvers are possible with the device.

但这个装置不可能有任何治疗性操作。

Chapter 23

Diabetic Nephropathy

Page 67

第二十三章

糖尿病肾病

第

67

页

End-stage renal disease (ESRD) from diabetic nephropathy is a major cause of morbidity and

mortality,

particularly

in

patients

with

type

1

diabetes,

affecting

30

to

35%

of

patients

in

the

United States.

nephropathy

肾病

< /p>

由糖尿病性肾病所发展的晚期肾病（

EARD

）是人类患病和死亡的一个主要原因，特别

是患有

1

型糖尿病的病人，在美国涉及

30~35%

的 病人。

Although

nephropathy

is

about

one

half

as

frequent

in

type

2

diabetics

(partially

due

to

a

shortened

life

expectancy),

type

2

diabetes

still

makes

up

the

vast

majority

of

diabetic

patients

seeking therapy for ESRD.

expectancy

期望、预期

make up

补足、编造、组成

尽管

2

型糖尿病的肾病发生率大约是

1

< br>型的一半（部分原因为预期寿命缩短）

，但

2

< p>
型

糖尿病仍然是需要治疗晚期肾病的糖尿病病人的绝大多数。

Overall,

diabetes

is

the

leading

cause

of

ESRD

in

the United

states,

accounting

for

more

than one third of cases.

16

overall

总体来说

accounting for

说明、证明、对

…

负责

总的来说，糖尿病是美国晚期肾病的首要病因，占三分之一以上。

< p>

Details

are

less

clear

in

patients

with

type

2

diabetes,

but

the

natural

history

of

diabetic

nephropathy in type 1 diabetes is well described.

2

< br>型糖尿病病人的演变细节不是很清楚，

但

1

型糖尿病肾病的自然病程已有充分的描述。

The

period

immediately

following

diagnosis

is

best

characterized

by

glomerular

hyperfiltration.

glomerular

肾小球的

hyperfiltration

超过滤

紧接诊断后的一段时期以肾小球超滤最具有特征。

During this time, there is renal hypertrophy, increased renal blood flow, increased glomerular

volume, and an increased transglomerular pressure gradient, all contributing to a rise in GFR.

hypertrophy

肥大

gradient

坡度、

梯度

GFR

glomerular filtration rate

肾小球

滤过率

在这段时间中，

有肾脏肥大、

肾血流增加、

< br>肾小球容积增大和肾小球两端的压力梯度增

加，这些都与肾小球滤过率升高有关。

Importantly, these changes depend at least in part on hyperglycemia, as they are diminished

by intensive diabetes treatment.

hyperglycemia

高血糖

intensive

加强的，密集的

重要的是，这些变化至少部分是依靠高血糖，因为通过有力的糖尿病治疗它们会消失。< /p>

Three to 5 years after diagnosis, early glomerular lesions appear, characterized by thickening

of glomerular basement membranes, mesangial matrix expansion, and arteriolosclerosis.

mesangial

肾小球系膜的

matrix

母体、基础

诊断后的

3~5

年，

早期的肾小球损害出现，

< br>以肾小球基底膜增厚、

系膜基底扩张和小动

脉硬化为特征 。

Albumin

excretion

remains

low

during

early

glomerular

changes;

however,

as

pathologic

changes

mount,

the

glomeruli

lose

their

functional

integrity,

resulting

in

glomerlar

filtration

defects and increased glomerular permeability.

albumin

白蛋白

mount

骑上、进行攻击

增长

integrity

完整、完善

defect

缺点、缺陷

permeability

渗透性

在肾小球变化的早期，白蛋白 排泄仍然较低，但是，随着病理变化加重，肾小球失去完

善的功能，引起肾小球滤过的缺 陷，肾小球渗透性增加。

Although

results

of

routine

tests

of

renal

function

(creatinine

and

urinalysis)

still

remain

normal, microalbuminuria (30 to 300 mg/day) appears.

< p>
尽管肾功能的常规化验（肌酐和尿检）结果还是正常，但微白蛋白尿（

30 ~300

毫克／

天）已经出现。

Systemic hypertension is also present at this time in more than 50% of cases.

在这个时期，

50%

以 上的病例还出现高血压。

17

After

several

years,

most

diabetic

patients

exhibit

diffuse

glomerulosclerosis,

although

a

minority have pathognomonic Kimmelsteil-wilson nodular lesions .

exhibit

展示、陈列

diffuse

扩散、传播

glomerulosclerosis

肾小球硬化症

pathognomonic

特异病征性的

数年以后，大多数糖尿 病病人显示广泛的肾小球硬化，尽管只有少数病人有特征性的

Kimmelsteil- wilson

小结。

Although pathologic changes continue to mount

throughout

the disease, glomerulosclerosis

extensive

enough

to

cause

ESRD

develops

in

a

minority

of

patients;

in

these

cases,

overt

albuminuria (>300 mg/day) begins approximatedly 15 years after diagnosis.

overt

明显的、公然的

虽然病理变化在整个 病程中是持续发展的，

但只有少部分病人的肾小球硬化范围大到足

以引起晚期肾病，这些病例中，明显的白蛋白尿（

>300mg/

天）大约在诊断后

15

年开始。

Soon

after,

following

a

variable

period

on

the

order

of

3

to

5

years,

the

GFR

begins

a

relentless

decline

(

≥

10

ml/min/year),

which

is

eventually

reflected

by

an

increase

in

serum

creatinine.

on the order of

属于

…

一类 的、与

…

相似的

relentless

残忍的、不留情面的

之后，接着一个 不确定的时期，约需

3~5

年，肾小球滤过率开始极度下降（≥

10

毫升

/

分

/

年）

，最终以血清肌酐浓度增高而表 现出来。

The appearance of massive proteinuria and the nephrotic syndrome is common in this context

and often heralds progression to ESRD.

nephrotic syndrome

肾病综合症

context

环境、背境、上下文

herald

传令、预示、预报

progression

进行、前进、进展

病变发展到这个程度，

出现大量蛋白尿和肾病综合症是常见的，

并且常预示着晚期肾病

的形成。

Once

the

serum

creatinine

rises

(reflecting

an

approximately

50%

decline

in

GFR),

ESRD

develops in most patients within 10 years.

potentially

潜在的、可能的

inaccessible

达不到的、难接近的

一旦血清肌酐浓 度增高

（反映肾小球滤过率约下降

50%

）

，

多数病人

10

< br>年内发展成晚期

肾病。

This

course

is

highly

variable,

houever,

particularly

in

type

2

diabetics,

who

may

exhibit

moderate proteinuria for several years without a substantial deterioration of renal function.

deterioration

变化、退化、恶化

但是，

< p>
这个过程是非常不确定的，

特别是

2

型糖尿病，

可以出现多年的中等蛋白尿而不

发生实质 性的肾功能恶化。

A simple but useful method of monitoring progression to renal failure is to plot the reciprocal

of the serum creatinine as a function of time.

plot

小块地皮、地基、用图标出、阴谋

reciprocal

相互的、倒数、互补

18

一个简单而实用的肾功能衰竭 进展的监测方法是用图表记录血清肌酐的倒数作为当时

的肾功能。

This technique allows better assesssment of both therapeutic interventions and the time when

renal replacement therapy will become necessary.

这个技术使治疗性干预和肾移植时机的判断更为准确。

Chapter 41

Diagnosis of Sudden Cardic Death(SCD)

Page 118

第四十一章

心源性猝死的诊断

第

118

页

SCD is death due to instantaneous, unanticipated circulatory collapse within 1 hour of initial

symptoms and is often, but not always, due to a cardiac arrhythmia.

instantaneous

瞬间的、即刻的、即时的

unanticipated

不曾预料到的

心源性猝死是指出现初始症状

1

小时内预料不到的循环衰竭 死亡，

常是，

但不全是心律

失常致。< /p>

More

than

70%

of

all

sudden

natural

deaths

have

a

cardiac

cause,

and

80%

of

these

are

attributable to coronary artery disease.

attributable

可归于┄的

70%

< br>以上的自然猝死有心脏的原因，心脏原因中

80%

跟冠状 动脉疾病有关。

In assessing prognosis and planning a treatment strategy, it is useful to classify SCD as either

primary (without a clear trigger) or secondary.

strategy

策略、战略

trigger

触发、引起

在估计预后和制定治疗方 案时，

将心源性猝死分为原发性

（无明确的诱发因素）

或继发

性是实用的。

A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes

are associated with recurrence rates of less than 2%.

episode

一段情节、插曲、有趣的事

associated with

联合

原发性发作的在

1

年内有

10~30%

的复发 率，而大多数继发性的复发率小于

2%

。

Identifiable reversible precipitants of secondary ventricular fibrillation (VF) include transient

ischemia

possibly

related

to

vasospasm;

hypokalemia

resulting

from

diuretics;

hyperkalemia

secondary to renal failure, angiotensin-converting enzyme inhibitors, prostaglandin inhibitors, or

potassium-sparing

diuretics;

proarrhythmia

secondary

to

antiarrhythmics,

tricyclics,

and

antihistamines; or substance abuse with drugs such as cocaine and amphetamines.

identifiable

可确认的

reversible

可逆的

precipitant

仓促的、突然的

transient

短暂的、瞬时的

hypokalemia

低钾血症

angiotensin- converting enzyme

血管紧张素转化酶

prostaglandin

前列腺素

sparing

节俭的、保守的

proarrhythmia

致心律失常作用

tricyclic

三环的、三环分子

antihistamine

抗组织胺类

abuse

滥用、陋习

amphetamine

安非他明、苯异丙胺

19

已知的可逆性继发性心室颤动 （

VF

）的发作包括可能是血管痉挛性的短暂缺血；利尿

剂引起的低钾血症；肾功能衰竭、血管紧张素转化酶抑制因子、前列腺素抑制因子、或保钾

利尿剂所致的高钾血症；

抗心律失常药、

三 环类药和抗组胺类药引起的心律失常；

或可卡因

或安非他明类药 物的滥用。

Therapy is directed toward removing or treating the acute precipitant.

removing

消除

治疗是直接消除或处理急性触发因素。

SCD

related

to

acute

ischemia

in

the

absence

of

prior

MI

often

is

associated

with

severe

proximal

occlusive

disease,

normal

left

ventricular

function,

normal

signal-averaged

ECG

,

and

noninducibility [absence of ventricular tachycardia (VT) ]during electrophysiologic study.

MI

myocardial infarction

心肌梗死

average

平均

inducibility

可诱导的

缺乏心肌梗死前兆的急性缺 血性心源性猝死经常与严重的近端梗阻性疾病有关，

这种病

人左 心室功能正常，

心电图信号普通无殊，

电生理研究时无法诱异室 速

（室性心动过速缺乏）

。

Most patients should undergo comprehensive evaluation of myocardial function and coronary

anatomy.

undergo

经历、忍受

comprehensive

全面的、广泛的、能充分理解的

大多 数病人应该进行全面的心肌功能评价和冠状动脉解剖结构检查。

Echocardiography

is

useful

for

excluding

hypertrophic

cardiomyopathy

and

valvular

heart

disease; magnetic resonance imaging, for diagnosing arrhythmogenic right ventricular dysplasia;

and

myocardial

biopsy,

for

identifying

infiltrative

diseases

such

as

myocarditis,

amyloidosis,

hemochromatosis, and sarcoidosis.

echocardiography

超声心动图

hypertrophic cardiomyopathy

肥厚性心肌病

magnetic resonance imaging

磁共振

dysplasia

发育异常、结构异常

infiltrative

渗透性的、浸润性的

amyloidosis

淀粉样变

hemochromatosis

血色素沉着

sarcoidosis

结节病

超声心动图对排除肥厚性心肌病和瓣膜性心脏病很有用；

磁共振 对有心律失常性右室发

育不良症的诊断很有用；

心肌活检对浸润 性疾病如心肌炎、

淀粉样变、

血色素沉着症和结节

病很有用。

Coronary angiography should be performed to assess for the presence of coronary occlusive

disease and to exclude coronary artery anomalies.

应该进行冠状动脉血管造影 评估冠脉阻塞性疾病的存在并排除冠脉的结构异常。

Myocardial

perfusion

scintigraphy

provides

complementary

data

for

assessing

ischemic

burden.

20

myocardial perfusion scintigraphy

心肌灌注闪烁照相术

心肌灌注闪烁照相术对缺血程度估计可提供辅助资料。

Left

ventricular

function

can

be

assessed

by

contrast

ventriculography,

radionuclide

ventriculography, or echocardiography.

ventriculography

心室造影术

radionuclide ventriculography

放射性核素心室显像术

通过对比心室 造影、同位素心室造影或超声心动图可以评价左心室功能。

Evaluation

of

SCD

survivors

also

includes

Holter

monitoring

and/or

electrophysiologic

testing.

Holter monitoring

动态心电图监护仪

对心源性猝死生还 者的测试还包括动态心电监护和

/

或电生理测试。

The

Electrophysiological

Study

Versus

Electrocardiographic

Monitoring

(ESVEM)

trial

showed, however, a 50% 2-year recurrence of ventricular tachyarrhythmias in patients in whom

antiarrhythnmic drugs successfully suppressed PVCs.

ventricular tachyarrhythmias

室性快速型心律失常

PVCs

premature ventricular contraction

室性早搏

但是，

电生理激发加动态心电监测试验显示，

用抗心律失常药物 成功控制的室性早搏病

人

2

年内

50%

复发快速型室性心律失常。

These data suggest a dissociation between PVC suppression and recurrence of VT; PVCs may

represent

a

marker

of

left

ventricular

dysfunction

rather

than

a

trigger

of

SCD,

or

the

arrhythmogenic substrate may change over time.

dissociation

分裂、分离

substrate

底层、底物、基础

这些资料提示室性 早搏的控制和室性心动过速的复发是无关的；

室早可能是代表左室功

能紊乱的一个信号，

而不是心源性猝死的触发因素，

或心律 不齐的基础病因可能因时间而改

变。

In

SCD

survivors,

sustained

monomorphic

ventricular

tachycardia

is

inducible

by

electrophysiologic

testing

in

40

to

50%

and

polymorphic

VT

in

10

to

20%;

in

30

to

50%,no

sustained arryhthmia is induced.

sustaine

持继不变、相同、维持

monomorphic

单一同态的、单形的

在心源性猝死生还者中，

40~50 %

电生理试验能诱导持续单一型室性心动过速，

10~20%< /p>

能诱导持续多型的室性心动过速，

30~50%

< br>不能诱导持续的节律异常。

In

patients

with

ischemic

heart

disease

and

left

ventricular

dysfunction,

inducibility

of

sustained VT carries a poor prognosis.

在伴有缺血性心脏病和左室功能不全的病人中，能诱导持续室性心动过速的预后不良。< /p>

A low ejection fraction is associated with a poor prognosis, however, regardless of whether

sustained

VT

is

inducible;

patients

with

an

ejection

fraction

of

30%

or

less

and

who

are

noninducible have a 25% arrythmia recurrence rate at 1 year, whereas noninducible patients with

an ejection fraction greater than 30 have a 10 to 15% recurrence rate.

21

ejection fraction

射血分数

但是，

不 良预后与低射血分数有关，

不管持续室性心动过速是否能诱导，

射血分数

30%

以下的不能诱导者

1< /p>

年时有

25%

的心律失常复发率，而射血 分数大于

30%

的不能诱导者只

有

10~15%

的复发率。

In patients with SCD and idiopathic dilated cardiomyopathy, sustained monomorphic VT is

rarely induced.

idiopathic

先天的、初发的、突发的

患有心源性猝死和先天性扩张性心肌病病人中，持续单一型室性心动过速几乎不能诱

导。

Neither the inability to induce VT nor the ability of drugs to suppress inducible polymorphic

VT or VF is a predictor of a favorable outcome.

administer

执行，实施

normotensive

血压正常

不能诱导室性心动过速不是，

用药物能控制的可诱导多形态的室早和室颤也不是良好预< /p>

后的信号。

?

Chapter 4 Palliative care and hospice of dying patients

临终病

人的姑息治疗和临 终关怀

?

State-of-the-art

end-of-life

care

is

synonymous

with

palliative

care,

a

term

describing

comprehensive (physical, psychosocial, and spiritual), interdisciplinary services that focus

on alleviating suffering and promoting quality of life for patients and their families facing

a life-threatening or terminal illness.

?

State-of-the- art

最高级的

?

end-of- life

终末期

?

Synonymous

同义的，同类的

?

Disciplinary

学科的

inter-

相互的

?

姑息性治疗是指终末期病人的临终 关怀，是一种全面多学科

(

生理、社会心理和精神

方面

)

交互的服务，旨在针对频临死亡或终末期病人 或家属以减轻病痛提高生活质

量。

?

The

term

palli

ative

literally

means

“to

clock”

and

can

be

used

derisively

to

describe

measures that merely cover up a problem, but the term has become widely accepted as a

description

of

approaches

to

providing

comfort

for

dying

persons

without

necessarily

modifying

the

underlying

medical

condition(e.g.,

reducing

pain

or

dyspnea

from

metastatic lung cancer without affecting the tumor burden).

?

Derisively

< p>
：嘲笑的，嘲弄的

?

从字面上理解，

< br>palliative

是指时钟，通常用来讽刺仅表面掩盖问题的措施，但该词< /p>

常被广泛地用来描述针对垂死病人采取的减轻痛苦，而不改变其基础疾病状态的方

22

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

法（如针对转移性肺癌采取镇痛和 减轻呼吸困难而不去影响肿瘤负荷）

Many aspects of palliative care, as with any specialty, are relevant to the general practice

of medicine and to all clinicians who tend to dying persons.

relevant to

有关的

姑息性治疗的特性通常与药物治疗和所有治疗临终病人的医生相关的。

Palliative care has a role in the earliest phases of a life-threatening illness but assumes a

more

prominent

or

even

dominant

role

in

the

final

3

to

6

months

of

common

terminal

conditions:

advanced

cancer,

heart

and

lung

failure,

end-stage

liver

and

renal

disease,

acquired immunodeficiency syndrome, and life-limiting neurologic diseases.

Prominent

显著的，突出的

姑息性治疗可以用于临终病人的早期治疗，但其最重要和突出 的使用是针对终末期

的最后

3

至

6

个月时间

:

如患有 晚期癌症、心肺衰竭、晚期肝肾疾病，艾滋病和致命

的神经系统疾病的病人。

< p>

Hospice programs offer a widely recognized form of palliative care in the United States.

Hospice in the United States refers to a specific, government- regulated form of end-of-life

care, first available under Medicare but then adopted by Medicaid and many third-party

insurers.

美国临终关怀计划提供了一系列经过广泛认可的姑息性治疗方案。美国的临终关怀

是指政府管理的专业性终末期治疗系统，初期在医疗机构治疗，尔后可转医疗互助

机构或第三方保险机构。

Hospice care typically is given at home or in a nursing home-less commonly in an acute

care hospital or specialized acute care unit-and is provided by an interdisciplinary team,

which

usually

includes

a

physician,

nurse,

social

worker,

chaplain,

volunteers,

bereavement coordinator, and home health aides, all of whom work with the primary care

physician, patient, and family.

Interdisciplinary

各学科的

Chaplain

牧师

Bereavement

丧亲

临终关怀通常是在（病人）住所或家庭护理中心进行，而不是 紧急医护医院或特殊

的急症监护病房，实施临终关怀的人员包括相关学科的团队，通常有 医生，护士，

社会工作者，牧师，自愿者，负责丧葬组织和家庭医生，这些人与初级护理 人员、

病人和家庭形成了临终关怀团队

Bereavement services are offered to the family for a year after the death.

丧亲服务可以延续至病人死后一年的时间。

Hospice regulation in the United States require that a patient agree to forgo measures with

curative intent and focus on comfort.

美国临终关怀的规定要求病人必须同意放弃治疗 意向，而关注（死前的）安慰。

Although

hospice

programs

vary

in

their

policies,

many

“aggressive”,

expensive

interventions,

such

as

surgery,

radiation

therapy,

total

parenteral

nutrition,

and

transfusions, tend to be excluded.

虽然临终关怀项目政策各异，但是一般不包括许多超常规的，昂贵治疗，如外科手

术，放射治疗，全胃肠营养和输血。

To

many

patients

and

families,

hospice

seems

to

signify

“giving

up”,

rather

than

being

viewed

as

a

model

of

compassionate

care

and

of

making

the

best

of

a

situation

with

23

limited options.

?

Compas sionate

同情，怜悯

?

对很多病人和家庭来说，

临终关怀更像一种

“放弃”

，而不是怜悯和在有 限选择最好

结果的手段。

?

Also, to be eligible for a Medicare-certified hospice program, the primary physician must

certify that the patient is likely to die within 6 months if the illness runs its usual course.

?

Eligible

合适的

?

同时需 要注意的是，一个经过医疗机构认可的临终关怀计划只适用于经初诊医生按

照疾病常规转 归确定，只有

6

个月以内的生存期的病人。

?

No penalties exist, however, for referring a patient too early to hospice, and physicians

generally use hospice care much later in the course of an illness than appropriate.

?

< /p>

但是，如果一个病人过早进行临终关怀，其损失是无法弥补的，因此临终关怀通常

比正常时机会推迟很多。

?

Another

option

is

palliative

care

in

inpatient

units,

which

are

furnished

in

a

homelike

fashion;

are

quieter

than

the

typical

noisy

hospice

ward;

are

decorated

with

personally

important

objects

from

each

patient;

and

typically

lack,

minimize,

or

obscure

hospital

paraphernalia.

?

Paraphernalia

个人用品

?

姑息治 疗最好的选择是在装修成家庭风格的住院病区进行以避免过多的嘈杂，通常

应使用病人个 人重要物品进行妆点，而尽量避免、减少过多的医院风格。

?

Patients

are

encouraged

to

wear

their

own

clothes,

pets

are

allowed,

and

families

(including

children)

have

unlimited

visiting

privileges

and

are

encouraged

to

stay

overnight and to cook there or bring food.

鼓励病人穿着自身衣服，允许携带宠物， 家庭成员（包括孩子）有无限制的探视特权，

鼓励他们夜间陪护，提供烹调设施或允许携 带食物。

?

Chapter 22

Shortness of Breath

?

“shortness

of

breath”,

“a

feeling

of

not

being

able

to

get

enough

air”,

and

“labored

breathing” are all terms used by patients to describe the symptom of dyspnea.

?

“

气促

”“

不能呼吸足够空气

”

和

“

用力呼吸

”

是病人描述呼吸困难症状时常用的词。

?

Dyspnea

呼吸困难

?

The cause of dyspnea may be pulmonary disease, circulatory disease, or both.

?

呼吸困难的原因可能是肺部疾病，循环系统疾病或者两者并存。

?

Pulmonary

肺的

?

Circulatory

循环

?

It

is

the

physician’s

responsibility

to

define

the

causative

mechanisms

of

shortness

of

breath so that diagnostic techniques and therapies can be directed appropriately.

?

医生应该明确气促的病因以便采用合适的诊断方法和治疗。

?

The most consistent correlate of the symptom of dyspnea is increased mechanical work of

breathing, usually brought on by increased airway resistance as occurs in asthma, chronic

bronchitis,

and

emphysema,

or

decreased

distensibility

of

the

lungs

as

occurs

in

interstitial fibrotic reactions.

24