医学英语

《临床医学英语》

【题型】词组中译英、英译中10个，段落英译中八选五段alternative and complementary therapies 补充和替代疗法nutrition营养

healthy lifestyles健康生活方式

immunizations免疫接种

systolic收缩期的

diastolic舒张期的

respiratory呼吸(作用)的。

dyspnea气急／呼吸困难

tachypnea呼吸急促

hypopnea呼吸减弱

comorbidity并存病

subclinical disease无明显临床症状的疾病

adverse outcomes不利结果

peptic ulcer消化性溃疡

arthritis关节炎

myocardial infarction心肌梗死

spectrum of diseases疾病谱

weight loss减肥

atherosclerosis动脉粥样硬化

chronic disease(e.g.,heart failure)心力衰竭

physical therapy理疗

bioartificial liver生物人工肝

autologous cells自体细胞

growth factors生长因子

lower gastrointestinal tracts上消化道和下消化道premenopausal women绝经前妇女

biopsy活检

inflammatory bowel disease炎性肠病

angiography血管造影

capsule enteroscopy胶囊小肠镜

asthma哮喘

chronic bronchitis支气管炎

emphysema肺气肿

hypoxia低氧＼缺氧

pulmonary emboli栓子

lung compliance肺顺应性

diabetic nephropathy糖尿病性肾病

life expectancy预期寿命

nephropathy肾病

hyperglycemia高血糖＼高血糖症

microalbuminuria微量白蛋白尿

primary tumor原发肿瘤

etiology病因学

advanced cancer晚期肿瘤

preterm labor未足月产

epidemic influenza流感

imaging test影像学

acute cholecystitis 急性胆囊炎

gallstones胆结石

endoscopic ultrasonography内窥镜超声检查

pancreatic tumors胰腺肿瘤

preoperative staging术前分期

chronic pancreatitis慢性胰腺炎

arrhythmia心率失常

coronary artery disease冠脉疾病

myocarditis心肌炎

hypertrophic cardiomyopathy肥厚性心肌病

vetntricular tachycardia室性心动过速

idiopathic dilated cardiomyopathy特发性扩张型心肌病

gastrointestinal perforation胃肠穿孔

celiotomy剖腹术

immunosuppression免疫抑制

intestinal anastomoses肠吻合术

elective gastrointestinal surgery择期手术

postoperatively术后的

wound infections切口感染

intra-abdominal abscess 腹腔脓肿

nosocomial infection院内感染

aspiration误吸

1.第一课P1 The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. The interaction begins with an elucidation of complaints or concerns, followed by inquires or evaluation to address these concerns in increasingly precise ways. The process commonly requires a careful history or physical examination, ordering of diagnostic tests, integration of clinical findings with the test result, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future plans. 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.

医患沟通贯穿于临床推论和临床决策的各个阶段。医患沟通始于主诉的阐述或关心的表达，并以越来越精确的方式，通过学问或评估得以继续。这一过程通常需要仔细的病史(采集)和体格检查,安排诊断性实验,并使实验结果与临床发现一体化,以及对可能所采取行动的风险和好处的理解，与病人及其家庭之间细致的商讨以产生将来的计划。医生越来越（趋于）访问日益增多的循证医学文献去指导这个过程，以使取得最大的收益，同时对于不同的病

人充分考虑个体的不同变化。

2.第八课P22 Fourth, cognitive impairment increases in prominence as people age. Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls, immobilization, dependency, institutionalization, and mortality. Cognitive impairment complicates diagnosis and requires additional care giving to ensure safety.

第四，认知的损害，随着人们年龄的增长日益显著。认知的损害是很多的不良结果的危险因素，包括衰弱，不能活动，不能自理，？，死亡率，认知的损害诊断复杂，需要额外的关爱以确保安全。

3.第二十一课P62 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. 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. No therapeutic maneuvers are possible with the device. 以种新的可以可视化整个胃肠粘膜的装置，包括一个不可消化的胶囊里的相机，这个相机把相片转化至附着于腹部的接受器上，定位与识别图像的位置。胶囊小肠镜的诊断意义尚不明确，但这种方法可以看到以前进不去的小肠的肠段。用这种装置目前不能治疗。

4.第二十二课P64 An increased drive to ventilate may also cause dyspnea. Such stimuli include hypoxia, usually when arterial oxygen tensions are less than 60 mmHg, and stimuli from inflamed lung parenchyma, as occur in bacterial pneumonia or alveolitis and that drive the respiratory centers of the brain. These stimuli often lower the resting carbon dioxide pressure (Pco2) to less than the normal level of 40mmHg and cause dyspnea, especially on mild exertion.过度通气也可以导致呼吸困难。兴奋呼吸中枢的刺激因素有动脉氧分压低于60mmHg时的低氧以及细菌性肺炎或肺泡炎时肺实质产生的炎性产物。这些刺激因素常常使静息时的二氧化碳分压降至40mmHg的正常水平以下而导致呼吸困难，在轻微活动时更加明显。

5.第二十三课P68 After several years, most diabetic patients exhibit diffuse glomerulosclerosis, although a minority have pathognomonic Kimmelsteil-Wilson nodular lesions. 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 (>300mg/day) begins approximately 15 years after diagnosis. Soon after, following a variable period on the order of 3 to 5 years, the GFR begins a relentless decline (>=10ml/min/year), which is eventually reflected by an increase in serum creatinine. The appearance of massive proteinuria and the nephrotio syndrome is common in this context and often heralds progression to ESRD. Once the serum creatinine rises (reflecting an approximately 50% decline in GFR), ESRD develops in most patients within 10 years. This course is highly variable, however, particularly in type 2 dieabetics, who may exhibit moderate proteinuria for several years without a substantial deterioration of renal function. A simple but useful method of monitoring rogression

to renal failure is to plot the reciprocal of the serum creatinine as a function of time. This technique allows better assessment of both therapeutic interventions and the time when renal replacement therapy will become necessary.

几年以后，大多数糖尿病患者出现弥漫性肾小球硬化症，而少数患者出现特异性K-W结节损害。尽管病变进展持续贯穿疾病始终，少数患者肾小球硬化广泛足以引起ESRD的发展，在这些情况下，糖尿病肾病诊断后15年患者开始出现明显的白蛋白尿（大于等于300mg/天）。不久，大约3到5年的可逆期过后，肾小球滤过率开始不停下降（大于等于10ml/分钟/年），最终表现为血清肌酐的上升，在这种情况下，通常大量蛋白尿和肾病综合症开始出现，并宣告肾病已经进入到ＥＳＲＤ．一旦血清肌酐上升（反映肾小球滤过率大约降低５０％），大部分患者在１０年内发展成为ＥＳＲＤ．这个过程是极具可变性的，然而，尤其在２型糖尿病患者，他们可能表现为持续好几年的中等量蛋白尿而肾功能不恶化．一个简单但有用的监测肾功能衰竭进展的方法是绘制血清肌酐倒数和时间的函数曲线．这个技术能更好的评估治疗干预的效果和需要进行肾移植的时间．

6.第二十五课P76 Clinical and Pathologic Evaluation

Since all patients with cancer of unknown primary site have advanced disease, therapeutic nihilism has been common. However, it is now evident that heterogeneous group contains subsets of patients with widely diverse prognoses; some cancers are highly responsive to treatment, and some patients may have a substantial chance of achieving longterm survival with appropriate treatment. The initial clinical and pathologic evaluation should therefore focus on identifying a primary site when possible and on identifying patients for whom specific treatment is indicated.

临床和病理评估．由于所有原发灶不明肿瘤患者都会到疾病晚期，姑息治疗就变得很普遍．然而，现在很显然的是这些特殊病人有很多不同的结局．有些癌症对治疗高度敏感，这使得有些病人通过适当治疗可能存活很长时间．因此最初的临床和病理评估应该集中于在可能的情况下识别原发灶以及识别那些需要特殊治疗的病人．

7.第二十六课P78 In the management of the pregnant trauma patient, the critical point is that resuscitation of the fetus is accomplished by resuscitation of the mother. Therefore, the initial evaluation and treatment of the pregnant injured patient is identical to that of the nonpregnant injured patient. Rapid assessment of the maternal airway, breathing, and circulation and ensuring an adequate airway avoids maternal and fetal hypoxia. In the later stages of pregnancy, as already described, uterine compression of the vena cava may result in hypotension from diminished venous return, so the pregnant trauma patient should be placed in left lateral decubitus position. If spinal cord injury is suspected, the patient may be secured to a backboard and then tilted to the left. The increased blood volume associated with tilted to the left. The increased blood volume associated with pregnancy has important implications in the trauma patient. Signs of blood loss such as tachycardia and hypotension may be delayed until the patient loses nearly 30% of her blood volume. As a result, the fetus may be experiencing hypoperfusion long before the mother manifests any signs. Early and rapid fluid resuscitation should be administered even in the pregnant patient who is normotensive.

在处理孕期创伤病人时，关键点是胎儿的复苏能够通过母亲的复苏来实现．因此，孕期创

伤病人最初的评估和治疗跟非孕期受伤病人是一样的．对孕妇气道、呼吸和循环的快速评估并确保足够的通气能够避免母婴低氧血症。在妊娠晚期，如被描述的那样，子宫压迫腔静脉使静脉回流减少可导致低血压，所以孕期创伤病人应该置于左侧卧位。如果怀疑脊髓受损，那么应该把病人固定在脊骨矫正板上后再向左侧倾斜。妊娠期血容量增加在外伤病人中是一个重要暗示。失血体征比如心动过速和低血压直到病人失血量达到全血的30%才会出现。这样一来，胎儿可能在母亲出现任何征象之前很久就已经处于低灌注状态了，补液复苏甚至在血压正常的妊娠病人中也应尽早和尽快地执行。

8.第二十八课P83 Postoperative surgical complications represent one of the most frustrating and difficult occurrences experienced by surgeons who do a significant volume of surgery. Regardless of how technically gifted, bright, and capable a surgeon is, surgical complications are a virtually guaranteed aspect of life. The cost of surgical complications in the United States today runs into millions of dollars and is associated with lost work productivity, disruption of normal family life, and unanticipated stress to employers and society in general. Frequently, the functional results of the operation are compromised by complications; in some cases, the patient never recovers to the preoperative level of function. The most significant and difficult part of complications is the suffering borne by the patient who enters the hospital anticipating an uneventful operation but is left suffering and compromised by the complication.

无论一个外科医生如何有天赋、如何聪明、如何有能力，在其生涯中外科并发症其实是不可避免的一个方面，在美国外科并发症所引起的费用已达到数以百万计，并引起劳动生产力的损失，扰乱正常的家庭生活，对雇主和社会带来预想不到的压力。由于手术并发症，手术后功能恢复大打折扣，有些病例其功能永远不能恢复到术前水平。（发生）并发症的最重要和最困难的方面是遭受痛苦的病人，他（她）进入医院是期待做一个顺利的手术，但却（被迫）处于遭受痛苦和受并发症侵害的境地。

9.第三十课P88

Epidemics occur almost exclusively during the winter months in temperate areas, but influenza activity may continue year-round in the tropics. Outbreaks may occur in tour groups (land or ship) and in facilities during summer months, particularly after the appearance of a drift variant. Regional differences in the time and magnitude of occurrence of influenza outbreaks are common. During epidemics, the overall attack rates typically average 5 to 20% in adults. Attack rates of 40 to 50% are not uncommon in closed populations, including those in hospitals and nursing homes, and in certain highly susceptible age group. Two different strains within a single subtype, two different influenza A subtypes (H1N1 and H3N2),or both influenza A and B viruses may cocirculate. In addition, stimultaneous outbreaks of influenza A and respiratory syncytial viruses have been found. Strains circulating at the end of one season’s epidemic are sometimes responsible for the next season’s outbreak (the so-called herald wave phenomenon). Furthermore, ther than the association of influenza outbreaks with colder seasons, the factors that allow an pidemic to develop or those responsible for the tapering off of an epidemic when only some susceptible persons have been infected are unknown.

温带地区流感几乎都发生在冬天的几个月，但在热带地区流感活动却常年不断。流感爆发可能发生在夏季的旅行团和设施建筑里，尤其在漂移变异出现以后。流感爆发流行的发生

在时间和数量上的地区差异是很常见的。在流行期间，成人的总发病率通常是5-20%。在人口密集地方包括医院和小型医院以及某一高度易感人群中，发病率达40-50%也不罕见。单一亚型内的两个不同菌种之间，A型流感病毒的两个不同亚型（H1N1和H3N2）之间，以及A型流感病毒和B型流感病毒之间均可以互相转染。另外，我们也已经发现A型流感病毒和呼吸道合孢病毒同时爆发。某一季节疾病流行末期传播的菌种有时对下个季节的疾病爆发有一定的影响（所谓先驱波现象）。此外，除了流感爆发跟寒冷季节有关外，流行病的诱发因素或者那些引起流行病逐渐减少至只有少数几个易感者发生感染的因素均不得而知。

10.第三十五课P102 How should the choice between CT or ultrasonography be made in a patient who presents with acute abdominal pain? More specifically, when is it appropriate to move directly to CT? In general, if the pain is not biliary in character, is not localized to the right upper quadrant, or occurs in an obese patient, CT is preferred because it often reveals previously unsuspected abnormalities. At least three other imaging choices exist:(1)no imaging study; (2)a plain radiographic series of the abdomen (technically and economically similar to the chest radiograph but generally not as useful);and (3)MRI of the abdomen or pelvis (usually reserved for more complex situations or after failure to diagnose with other methods).Other than identifying free intraperitoneal air(perforated viscus), gas patterns of bowel obstruction, and radiodense ureteral calculi, the traditional abdominal series, although the least expensive test, is considered generally inferior to CT and has been large replaced by CT. A current-generation multislice helical CT scanner can generate 5-mm sections of the entire abdomen and intravenous contrast material to opacify (and identify) loops of bowel and vascular structures.

对急性腹痛病人来说，超声波检查和CT检查该怎么选择呢？更具体地说就是什么时候把病人直接送去做CT更合适？一般来说，如果疼痛性质不像在胆囊，不定位在右上腹，或者发生在肥胖病人上，CT更可取，因为它常常可以发现先前未知的异常。至少还存在三种其他成像方式可选择：（1）（2）腹部扫描系列（技术上和经济上与胸片相似，但通常不够有用）；（3）腹部或骨盆MRI（通常在更复杂的情况或用其它方法无法诊断的时候才用）。除了能识别腹部游离气体（内脏穿孔），肠梗阻的气体形态和输尿管结石的密度增高影，尽管传统的腹部扫描系列是最廉价的试验，但它通常比CT差，而且大部分被CT所取代。现代多层螺旋CT扫描可以在一秒钟那产生腹部和骨盆的每5mm一层的截面。口服或静脉给予造影剂对XX（而且识别）肠袢和血管结构很有用的．

11.第四十一课P118 In assessing prognosis and planning a treatment strategy, it is useful to classify SCD as either primary (without a clear trigger) or secondary. A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes are associated with recurrent rates of less than 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; proarrhythmis secondary to antiarrhythmics, tricyclics, and antihistamines; or substance abuse with drugs such as cocaine and amphetamines. Therapy is directed toward removing or treating the acute precipitant. 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.

在评估预后和计划治疗时，对SCD分为原发性（没有明显诱因）或继发性是有益的。原发性SCD的I年内有10-30％的复发率，但多数继发性SCD的1年复发率不到2％。由继发性室速导致明确可逆转的SCD，常由下列原因引起；冠脉痉挛相关的短暂缺血，利尿剂引起的低钾血症、继发于肾功能衰竭的高钾血症、血管紧张与转换酶抑制剂/前列腺抑制剂、保钾利尿剂、抗心率失常药引起的致心律失常作用、三环类抗抑郁药、抗组胺药，或者可卡因、苯异丙胺等药物的滥用等。治疗上应针对去除或处理这些引起急性事件（的诱因）。在缺少早期心梗表现的急性缺血相关的SCD常常与下列情况相关，严重的冠脉近端的阻塞性疾病，左室功能正常，正常均值信号心电图，以及电生理检查中的不可诱导性（不能诱导出室速）。

12.第四十五课P131 Some patients with clear finding of the acute abdomen may be treated without surgical operation. For example, patients with perforated duodenal ulcer who seek attention late in the course of their disease after they have been sick for several days may be treated best by careful supportive care including nasogastric suction, intravenous fluids, and pain relief. Certain patients with empyema of the gallbladder, especially those with other serious concomitant illnesses, can be treated by percutaneous drainage of the infected gallbladder and careful supportive care rather than with cholecystectomy.

有些腹痛原因明确的病人也可以进行非手术治疗。举个例子，有些穿孔性十二指肠溃疡患者，在发病几天以后才寻求治疗，那时最佳的治疗就是细心的支持护理包括胃肠减压、静脉补液和减轻疼痛。某些胆囊积脓尤其是那些有合并症的病人，可以通过对感染胆囊经皮穿刺引流和细心的支持护理来治疗，不必采取胆囊切除术。

13.第五十四课P159 The studies that compared enteral and parenteral nutrition in the trauma population, as discussed earlier, concluded that enteral nutrition was superior because of an attenuated inflammatory response and a decrease in septic morbidity. When these studies are examined more closely, it is clear that patients who were fed parenterally. This discrepancy of “relative overfeeding” in the TPN groups in many instances led to hyperglycemia, presumably predisposing patients to immune dysfunction and nosocomial infection. Thus, poor glucose control alone may account for the observed differences in outcome. In more contemporary studies where feeds are carefully advanced in a manner that avoids hyperglycemia and groups are fed equivalent protein and calories, there appears to be little difference in clinical outcome between enteral and parenteral routes of feeding. Enteral nutrition also can endanger patient safety in unique ways. Deaths in persons receiving enteral nutrition are often due to aspiration, for example when gastric motility suddenly is equivalent to the mortality over 2 to 3 years of a well-operated parenteral nutrition program, despite the danger of catheter sepsis, which in well-operated units is now less than 1% to 3%.

如早些时候讨论的，肿瘤病人肠内营养和肠外营养的比较研究得出肠内营养在减少炎症应答和降低脓毒血症的发生率上是优于后者的。更进一步地审查这些研究时我们发现肠内营养的病人比肠外营养的得到更少的更有效的卡路里。全胃肠外营养组“相对进食过多”的差异在很多情况下导致了高血糖，推测这些病人由于免疫功能不全和院内感染而被预先处

理。因此，单个简单的葡萄糖控制就会使观察结果发生改变。在更多的同期研究中，预先仔细地准备避免高血糖的饮食并给以等量的蛋白质和卡路里，肠内营养和肠外营养组之间几乎没有临床结果的差别，肠内营养也会在特别的方面危及病人的安全。接受肠内营养的病人其死亡主要在于误吸，比如败血症使得病人的胃运动功能突然受损时就会发生。尽管有导管相关败血症的危险，置管很好的肠外营养程序中超过2到3年才发生一例误吸死亡，而现在有了良好的装置其发生率更是降低至1-3％。