臨床醫(yī)學英語翻譯.doc

學習資料收集于網(wǎng)絡，僅供參考臨床醫(yī)學英語翻譯Chapter 1 Patient-Physician Interaction Page 1第一章 醫(yī)患溝通 第頁The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. proceed 進行、開展 reasoning 推論、推理 clinical reasoning 診斷 clinical decision 確定治療方案 making decision 做出決定醫(yī)患溝通在臨床診斷和治療決策的許多階段中進行著。The interaction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.elucidation 說明、闡明 inquire 詢問、調查 evaluation 評估、評價這種溝通開始于病人訴說或所關注問題，然后通過詢問、評估不斷精確地確定這些問題。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 egration 綜合 consultation 磋商、會診 這個過程通常需要細致的病史詢問和體格檢查，進行診斷性化驗，綜合臨床發(fā)現(xiàn)和化驗結果，理解分析擬行治療過程中的風險和療效，并與病人及家屬反復磋商以形成治療方案Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so that benefit is maximized,while respecting individual variations among different patientsrespecting 注意到、關系、說到 evidence-based medicine 循證醫(yī)學 醫(yī)生們越來越容易查閱不斷增長的循證醫(yī)學文獻來指導這個過程，使得療效最大化，但要考慮到不同病人中個體差異是存在的。The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicineavailability可利用性， 可得到 randomize 隨機的 cookbook 食譜，烹調書 approach 接近 越來越多的可用于指導臨床診斷與治療的隨機試驗資料不應變成“烹調書”醫(yī)學。Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.Evidence 證據(jù)，跡象 guideline指導方針 emphasize 強調 因為隨機試驗獲得的現(xiàn)象和思路是著重于特征性病人的求證過程。Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional. substantial clinical 真實的，實在的 individual 個體 occasional 偶爾的，特殊的實際的臨床判斷需要確定這些現(xiàn)象和思路能否應用于某個病人個體，并能找出例外。Even more judgment is required in the many situations in which evidence is absent or inconclusive.inconclusive 不確定性，非決定性許多情況下，臨床表現(xiàn)缺乏或不典型，需要考慮更多的判斷。Evidence also must be tempered by patients preferences, although it is a physicians responsibility to emphasize when presenting alternative options to the patient. temper 脾氣，調音 preference 偏愛 emphasize 強調，詳述，闡明 presenting 提出 alternative 可選擇的，二選一病人還會根據(jù)自己的傾向調節(jié)著臨床癥狀，但醫(yī)生有責任通過選擇性問題搞清事實。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 堅持、固執(zhí) regimen 養(yǎng)生法、食物療法enhance 提高、加強 rationale 基本原理假如病人也懂得醫(yī)生問題的基本原理和表現(xiàn)，有特殊生活方式病人的固執(zhí)容易被強化。To care for a patient as an individual, the physician must understand the patient as a person. care for 喜歡、照料 為了把病人作為一個個體進行治療(為了個體化的照料病人)，醫(yī)生必須理解病人是一個人（不是一群人）。This fundamental precept of doctoring includes an understanding of the patients social situation, family issues,financial concerns, and preferences for different types of care and outcomes, ranging from maximum prolongation of life to the relief of pain and suffering. fundamental 基本的，根本的 precept 訓戒 doctoring 行醫(yī) prolongation 延長 這個最基本的行醫(yī)原則包括了解病人的社會地位，家庭問題，資金狀況以及對不同治療方法、不同治療結果的選擇，從最大限度地延長生命到臨時緩解疼痛和折磨。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 欣賞、感謝、評價 appropriate 適當?shù)摹⑶‘數(shù)?假如醫(yī)生沒有正確理解和定位這個問題，醫(yī)學就不可能恰當?shù)貞糜谂R床，甚至一個知識最淵博的醫(yī)生也不能取得理想的治療結果。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 意識到，知道 questionable 可疑的、成問題的、不可靠的 reliability 可靠、可信賴的 甚至，當醫(yī)生越來越容易知道新發(fā)現(xiàn)的同時，病人也能夠通過各種資源得到他們的信息，當然，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 選擇，替代 complementary 補充的、相配的 prescribe 規(guī)定、指定、開處方 替代療法和輔助療法的應用不斷增加就是病人對常規(guī)療法經(jīng)常不滿意的一個例子。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 approachessubstitute 代替、代用 rely on 依賴、信任 醫(yī)生對未證實的療法應該保持開放的思想，但是，如果這些療法可能帶來任何程度的潛在風險，醫(yī)生都必須細致地告知病人，包括可能需要用已證實的常規(guī)療法去替代的風險。It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options that either may considercrucial 嚴酷的、決定性的 either 兩者任一對醫(yī)生來說，對病人及家屬開誠布公地介紹所有能考慮的治療選擇，是極及關鍵的。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 廣闊的、大量的 醫(yī)生不是生存在真空中的，而是復雜而龐大的醫(yī)療和公共健康體系中的一部分。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 足夠的、恰當?shù)?在未發(fā)達時代，甚至當今在一些發(fā)展中國家，基本衛(wèi)生、清潔飲用水和最低營養(yǎng)保障是促進健康減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 采納、采用 epidemic 流行、傳染 而在發(fā)達國家中，健康的生活方式包括合理飲食和適當鍛煉，是減少肥胖、冠心病和糖尿病盛行的基礎。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、違禁的 collectively 全體地、共同地 produce 生產、創(chuàng)造公共健康干預如進行疫苗接種、減少損傷、減少吸煙、減少吸毒、減少酗酒等措施共同產生的健康效果幾乎比可想象的任何其它健康干預措施都要好。Chapter 5 Clinical Preventive Services Page 11 第五章 臨床預防服務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 咨詢immunization 使免除screening 遮敝，屏敝、選拔susceptibility 對敏感臨床預防服務包括對疾病的咨詢、防疫、篩查以及通過治療性的生活習慣改變和藥物治療來減少易感性。Preventive service often are classified as primary, secondary, or tertiary. tertiary 第三，第三紀tertiary industry 第三產業(yè)臨床預防服務常分為一級預防、二級預防和三級預防。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 解決impede 妨礙overt 公開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.一級預防是直接針對疾病或損傷發(fā)生前的預防，而二級預防是解決疾病或損傷發(fā)生后的早期發(fā)現(xiàn)和早期治療，以防止臨床疾病的進一步發(fā)展。In contrast, tertiary prevention refers to rehabilitative activities after the onset of disease to minimize complications and disability.rehabilitative 可修復的，康復disability 殘疾，病殘對比之下，三級預防是指疾病發(fā)生后的康復治療，以減少并發(fā)癥和病殘。Because of considerable overlap, distinguishing among these phases of prevention may be confusing. overlap 互搭，重疊，錯疊，交叉distinguishing 區(qū)別，區(qū)分，特征，特色因為（三級預防之間）有相當大的交叉，這些預防階段的區(qū)分可能有些混淆。Detecting and treating hypertension could be considered secondary prevention of hypertensive cardiovascular disease but primary prevention of heart failure and stroke. hypertensive cardiovascular disease 高血壓性心血管疾病發(fā)現(xiàn)和治療高血壓可以認為是對高血壓性心血管疾病的二級預防，但也可是對心力衰竭和中風的一級預防。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，認為continuum 統(tǒng)一體,一致性predisposing factors 易感因素along 沿著，前行modification 修改，變性premature 過早，過早發(fā)生，夭折，草率長期一貫地減少易感因素可能是防止疾病、避免早死早殘最好的預防。The sooner the prevention, the more likely unnecessary illness, disability, and premature death can be avoided. unnecessary 不必要的，多余的預防得越早，越不易發(fā)生不必要的疾病，病殘和早死就能夠避免。Increasing emphasis has been placed on preventing risk factors themselves.emphasis 重點，強調越來越多的重點已經(jīng)集中到對危險因素本身的預防。The term primordial prevention has been introduced for this concept.primordial 基本的，原始的，初生的，初發(fā)的 術語-根源預防（病因預防）已經(jīng)引進了這個概念。Indiscriminate screening for risk factors or disease without adequate advice and follow-up serves no useful purpose.indiscriminate 無差別的，不加區(qū)別的advice 忠告，勸告 沒有引導和隨訪的毫無選擇地遠離危險因素或疾病是沒有實用價值的預防。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 無限的，基礎深厚的，運用廣泛的uniform 一致的，統(tǒng)一的，制服protocol 規(guī)章制度，草案，協(xié)議ethnic 民族的，種族的，有民族特色的interval 間隔，區(qū)間 定期體檢逐漸從一年一度的、全面的、統(tǒng)一的規(guī)定項目改進成以恰當?shù)闹芷趯μ囟挲g、性別和種群的特殊疾病或危險因素有目的地預防、發(fā)現(xiàn)和治療。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 特遣部隊distinguish 區(qū)別，辨認，使顯著 substantially 非常，本質上，大體上 美國預防服務特別局的最近建議是基于全面的回顧性研究，這些研究選出了易于證明有效、確實是利大于弊的預防措施。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 衛(wèi)生保健guideline 指導方針，準則interface 接口，界面，聯(lián)系衛(wèi)生保健系統(tǒng)的改進和國家疾病控制政策的完善使人們更重視健康促進、疾病預防，以及接受醫(yī)療人員為主的公共衛(wèi)生系統(tǒng)的保健服務。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, 從方面說來，從角度來講cost-effectiveness 成本效益醫(yī)生應該以有無需要預防的角度考慮每一種疾病，包括可能發(fā)生的副作用和付出代價是否值得。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、觀念一個對臨床決策有用的理念是需要治療的病人數(shù)量決定一個不利因素是否要預防，這是基于絕對風險的下降。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，互為倒數(shù)的 ，倒數(shù)這個數(shù)量是以效能為基礎的，是對特定時期內對照組和治療組之間發(fā)生率差異的倒數(shù)進行的統(tǒng)計。Ample evidence connects identifiable and often preventable factors to the morbidity and mortality associated with major health problems.ample 足夠的，大量的identifiable 可以確認的大量的試驗證據(jù)找出了可確認的又?？深A防的與主要健康問題相關的發(fā)病和死亡因素。About half of all deaths, morbidity, and disability can be attributed to such nongenetic factors.nongenetic 非遺傳性的約一半死亡、發(fā)病和病殘與這些非遺傳性因素有關。Many lifestyle changes benefit multiple systems and disorders.許多生活習慣改變有利于多個系統(tǒng)和紊亂的改善。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 骨質疏松癥美國五分之一的死亡估計與吸煙有關，飲食習慣可能影響心血管疾病，糖尿病、骨質疏松癥和癌癥的發(fā)生。Other important personal behavior factors influencing health include physical activity, alcohol intake, illicit drug use, sexual practices, and exposure to environmental toxins.其它影響健康的重要個人行為因素有鍛煉、飲酒、吸毒、性行為以及環(huán)境毒物的接觸。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 rmative 提供信息的 candidate 候選人polymorphisms 多態(tài)性 traits 特質，屬性nucleotide 核苷酸 攜帶信息DNA多態(tài)性（例如，單核苷酸多態(tài)性）的認識和候選基因的進一步闡明允許我們發(fā)現(xiàn)易感人群和可能采取的措施，以預防這些有害基因特性的表達。Several common misconceptions impede preventive health care.impede 妨礙，阻礙好幾種錯誤觀念妨礙了預防保健。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 可遺傳的，可繼承的許多人認為有很強遺傳性的疾病是無法改變的，但是對疾病的易感性經(jīng)常需要多種基因和環(huán)境因素的相互作用才能表達。In addition, chronic diseases are multifactorial, so other factors can be changed to compensate for an elevated genetic risk.multifactorial 多因子的compensate 補償， 彌補，賠償 另外，慢性疾病是多因素的，所以，可以改變其它因素來彌補高基因風險。Although gene therapy holds much promise, preventive measures currently offer the best possibilities for limiting gene expression and avoiding mise 承諾，諾言，希望，前途雖然基因療法有著很大的希望，但目前的最有可能提供的預防措施是限制基因表達來避免疾病。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 順利地，好意地，親切地對老年人預防無用的觀念排除了在預防上本應極為受益的許多人，因為老年病人一般有更高患病風險，并且一直對預防措施極為支持、反應積極。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 預期壽命并且，老年人的預期壽命經(jīng)常是低估的，現(xiàn)在將到75歲的老人可以預期平均再活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頁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 orbidities 并存病 subclinical 亞臨床的同樣的疾病，老年病人在許多方面與青中年病人是有區(qū)別的，其中之一是并存病多、亞臨床疾病多。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 同時發(fā)生作為高發(fā)疾病的結果，并存?。▋蓚€或更多的疾病在同一個體同時發(fā)生）也是常見的。Of people age 65 and older, 50% have two or more chronic disease, and these diseases can confer additive risk of adverse outcomes, such as mortality. confer 授予、給予 additive 附加的、附屬物65歲以上的老年人中，50%患有兩種以上的慢性疾病，這些疾病能夠增加不良預后的風險，如死亡的風險。In some patients, cognitive impairment may mask the symptoms of important conditions. cognitive 認知的、認識的 impairment 損害 mask 口罩、假面具、掩飾在一些病人中，認知損害可以掩蓋重要病情的癥狀。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 中風 peptic ulcer 消化性潰瘍對一種疾病的治療可能會加重另一種疾病，例如，對有消化性潰瘍病史的病人使用阿斯匹林預防中風。The risk for becoming disabled or dependent also increases with the number of diseases present. disabled 殘廢的、有缺陷的 dependent 依靠的、依賴的病殘或生活不能自理的發(fā)生率也隨著并存的疾病數(shù)而增高。Specific pairs of diseases can increase synergistically the risk of disability. synergistic 協(xié)同的特殊的成對疾病可以協(xié)同增加病殘的風險。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 關節(jié)炎 odd 奇數(shù)的、單個的18%的老年人同時患有關節(jié)炎和心臟病，雖然每個疾病可以增加34倍的病殘率，但兩個疾病同時存在，可使病殘率提高到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 可能性老年與青中年的第二個差異是更容易出現(xiàn)非典型的癥狀和體癥。Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom. pneumonia 肺炎 mentation 精神作用、心理活動 primary 初始的、首要的、主要的肺炎和中風時可出現(xiàn)非特異性意識變化作為主要癥狀。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、靜止的 proportion 成比例的、相稱的同樣地，隱匿性心肌梗塞發(fā)生頻度隨著年齡的增大而增加，這些病人相應地頻發(fā)精神狀態(tài)改變、眩暈、虛弱而不是典型的胸痛癥狀。As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases than generally would be considered in middle-aged adults.spectrum 譜、光譜因此，老年病人的診斷應考慮更廣泛的疾病譜，要超過通常對中年病人所考慮的范圍。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、原來 frailty 脆弱、虛弱、意志薄弱tolerance 寬容、忍耐、耐受主要出現(xiàn)在老年人的第三個情況是衰弱，衰弱被認為屬于衰竭綜合癥，它有許多癥狀和體征，包括肌肉萎縮、體重下降、虛弱、運動耐受差、動作慢、身體活動少。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 估計、評價、看法 indicate 指出、表時、象征、適應征一些人估計7%的65歲以上社區(qū)老人和25%的85歲以上社區(qū)老人這些癥狀全部出現(xiàn)。 Many institutionalized older adults also are frail.institutionalized 使成公共團體、將收容在公共設施里frail 身體虛弱的、易損壞的、意志薄弱的許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 易受傷、易受責難衰弱是對各種壓力耐受下降、易于損害的一種狀態(tài)，從急性感染、損傷到住院治療，都可以發(fā)現(xiàn)一些老人不能耐受侵入性診療措施。The syndrome of frailty is associated with high risk of falls, needs for hospitalization, disability, and mortality. fall 跌倒、下降 frail 身體虛弱的、易損壞的、意志薄弱的衰弱癥狀與高病倒率、高住院率、高病殘率、高死亡率是密切相關的。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、構成要素 sarcopenia 肌減少（癥）、與年齡相關的骨骼肌質量下降衰弱早期征象中的一個主要變化是肌減少癥，或者說隨年齡增長的肌肉減少，它發(fā)生在1324%的6570歲的老人，60%的80歲以上的老人。 It is likely that dysregulation of multiple physiologic systems, including inflammation, hormonal status, and glucose metabolism, underlies the syndrome, wi