临床医学英语翻译.pdf

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1、临床医学英语翻译Chapter 1Patient-Physician Interaction第一章医患沟通第页Page 1The patient-physician interaction proceeds through many phases of clinicalreasoning anddecision making.proceed进行、开展clinical decision确定治疗方案reasoning 推论、推理clinical reasoning诊断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

2、with an elucidation of complaints or concerns,followed by inquiries orevaluation 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 commonlyrequires a careful historyor physical examination,ordering of

3、diagnostic tests,integration of clinical findings with the test results,understanding of the risks andbenefits of the possible courses of action,and careful consultation with the patient and family todevelop future plans.integration 综合consultation磋商、会诊进行诊断性化验，综合临床发现和化验这个过程通常需要细致的病史询问和体格检查，结果，理解分析拟行治

4、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 guidethe process so that benefit is maximized,patientsrespecting注意到、关系、说到要考虑到不同病人中个体差异是存在的。The increasing availabilityof randomized trials to guide the approach to diagnosis andtherapy

5、 should not be equated withavailabilityapproach 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。可 利 用 性，可 得 到“cookbook”medicinerandomize随 机 的cookbook食 谱，烹 调 书evidence-based medicine 循证医学使得疗效最大化，但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，while respecting individual variations among differentEvidence and the guidelines that

6、 are derived from it emphasize proven approaches forpatients 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 clinicaljudgment is required to determine whether the evidence and guidelinesapply to individual patients and to recognize the occ

7、asional.1substantial 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 orinconclusive.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 patientsp referenc

8、es,although it is a physicianresponsibility 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 th

9、e patient alsounderstands the rationale and evidence behind the recommended option.adherence 坚持、固执enhance 提高、加强regimen养生法、食物疗法rationale 基本原理 s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

10、疗人（不是一群人）。This fundamental precept of doctoringincludes an understanding of the patientsocsialsituation,familyissues,financialconcerns,and preferences for different types of care andoutcomes,ranging from maximum prolongation of life to the relief of pain and suffering.fundamental基本的，根本的precept训戒doct

11、oring 行医prolongation延长家庭问题，资金状况以及对不同治疗这个最基本的行医原则包括了解病人的社会地位，(为了个体化的照料病人)，医生必须理解病人是一个方法、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 cannotbe applied appropriately,and even the most knowledgeable physician fails to achieve approp

12、riateoutcomes.appreciate 欣赏、感谢、评价appropriate 适当的、恰当的医学就不可能恰当地应用于临床，甚至一个知假如医生没有正确理解和定位这个问题，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 theirown information from a variety of sources,some of which are of questionable reliability.aware of靠、可信赖

13、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，意识到，知道questionable 可疑的、成问题的、不可靠的reliability可2当然，某些信息是不可靠的。The increasing use of alternative and complementary therapies is an example of patientsfrequent dissatisfaction with prescribed medical therapy.alternative 选择，替代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。Phys

14、icians should keep an open mind regarding unproven options but must advise theirpatients carefully if such options may carry any degree of potential risks,including the risk thatthey may relied on to substitute for proven approachessubstitute 代替、代用rely on 依赖、信任但是，如果这些疗法可能带来任何程度的潜医生对未证实的疗法应该保持开放的思想，c

15、omplementary 补充的、相配的prescribe 规定、指定、开处在风险，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 regardingthe full range of options that either may considercrucial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 do

16、es not exist in a vacuum but rather as part of a complicated and extensivesystem 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

17、most important ways to promote health and reduce disease.adequate 足够的、恰当的在未发达时代，甚至当今在一些发展中国家，基本卫生、清洁饮用水和最低营养保障是促进健康减少疾病的最重要措施。Indeveloped countries,the adoptionofhealthylifestyles,includingbetterdiet andappropriate exercise,are cornorstones to reducing the epidemics of obesity,coronary disease,anddi

18、abetes.adoption 采纳、采用尿病盛行的基础。Public health interventions to provide immunizations and to reduce injuries and the use oftobacco,illicit drugs,and excess alcohol collectively can produce more health benefit than nearlyany other imaginable health intervention.illicit非法的、违禁的collectively全体地、共同地produce 生产

19、、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。epidemic 流行、传染是减少肥胖、冠心病和糖而在发达国家中，健康的生活方式包括合理饮食和适当锻炼，3Chapter 5Clinical Preventive Services第五章临床预防服务Page 11Clinical preventive services include counseling,immunization,screening tests,and reductionofthe susceptibilityto disease byin

20、terventionssuch as therapeutic lifestylechanges andpharmacotherapy.counseling咨询immunizationscreeningsusceptibility疗来减少易感性。Preventive service often are classified as primary,secondary,or tertiary.tertiary第三，第三纪第三产业tertiary industry使免除遮敝，屏敝、选拔对敏感防疫、筛查以及通过治疗性的生活习惯改变和药物治临床预防服务包括对疾病的咨询、临床预防服务常分为一级预防、二级预防

21、和三级预防。Primary prevention is directed towardpreventing disease or injurybefore it develops,whereas secondary prevention deals with early detection and treatment to impede the progress ofovert disease.deal withimpedeovert解决妨碍公开Primary prevention is directed towardpreventing disease or injurybefore it

22、develops,whereas secondary prevention deals with early detection and treatment to impede the progress ofovert disease.一级预防是直接针对疾病或损伤发生前的预防，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 tominimize complications and disability.re

23、habilitative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 beconfusing.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。而二级预防是解决疾病或损伤发生后的Detectingandtreatinghypertensioncouldbecons

24、ideredsecondarypreventionof4hypertensive 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，和中风的一级预防。Prevention may be perceived best along a continuum from modificationof predisposingfactors,to preventi

25、ng 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 likelyunnecessary illness,disability,and prematuredeath can be avoided.

26、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。但也可是对心力衰竭Indiscriminate

27、screening for risk factors or disease without adequate advice and follow-upserves 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 protocolto an approach that targets the prevention,d

28、etection,and treatment of specific diseases or riskfactors 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

29、、发现和治疗。5Currentrecommendations bythe U.S.Preventive Services Task Force are based onsystematic evidence reviews that distinguish procedures likelyto prove effectiveand to havesubstantially 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，效、

30、确实是利大于弊的预防措施。这些研究选出了易于证明有Changes inthe healthcare system andthe developmentof nationalguidelinesformanagement 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gu

31、ideline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、及接受医疗人员为主的公共卫生系统的保健服务。疾病预防，以Physicians should consider each disorder in terms of the potential for prevention,includingthe 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

32、需要预防的角度考虑每一种疾病，否值得。包括可能发生的副作用和付出代价是A concept useful for clinical decision making is the number of patients needed to treat toprevent 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，基于绝对风险的下。降这是This number is based on efficacy and is cal

33、culated as the reciprocal of the difference in eventrates 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 identifiableand often preventable factors to the morbidityandmortality assoc

34、iated 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。6About half of all deaths,morbidity,and disabilitycan be attributed to such nongeneticfactors.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

35、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,andcancer.osteoporosis骨质疏松症美国五分之一的死亡估计与吸烟有关，松症和癌症的发生。饮食习惯可能影响心血管疾病，糖尿病、骨质疏Other importantpersonal b

36、ehavior factors influencinghealth includephysical 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。TheidentificationofinformativeDNApolymorphisms(e.g.,singlenucleotidepolymorphisms)and further elucidationof candidate

37、 genes allow for detection of susceptibleindividuals and possible institution of measures to prevent the expression of these harmful genetictraits.informative提供信息的polymorphisms多态性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 imped

38、e preventive health care.impede妨碍，阻碍好几种错误观念妨碍了预防保健。candidate 候选人traits特质，属性Manybelieve that diseases witha strong heritable component cannot be altered,butsusceptibility to disease often requires the interaction of multiple genes and environmental factorsfor expression.heritable 可遗传的，可继承的许多人认为有很强遗传性

39、的疾病是无法改变的，和环境因素的相互作用才能表达。In addition,chronicdiseases are multifactorial,so other factorscan be changed tocompensate for an elevated genetic risk.multifactorial多因子的但是对疾病的易感性经常需要多种基因7compensate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 current

40、ly offer the bestpossibilities 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 benefitmost from prevention because elderly patients generally have a greate

41、r absolute risk of disease andhave been shown to adhere and respond favorably to preventive measures.favorably顺利地，好意地，亲切地因为老年病人一般有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，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 age75 now can expect to live

42、 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，现在将到年多。75 岁的老人可以预期平均再活11Chapter 8Why Geriatric Patients Are Different老年病人的特殊性第 20 页Page 20第八章Older patients differ from young or middle-aged adults with the same disease in many ways,one of which is the frequent occurrence of comorbi

43、dities and of subclinical orbidities临床疾病多。As a function of the high prevalence of disease,comorbidity(or the co-occurrence of two ormore 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。Of people age 65 and older,50%have two or more

44、 chronic disease,and these diseases canconfer 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。并存病subclinical亚临床的其中之一是并存病多、亚同样的疾病，老年病人在许多方面与青中年病人是有区别的，In some patients,cognitive impairment may mask the symptoms of importa

45、nt conditions.8cognitive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,asstroke in individuals with a history of peptic ulcer disease.stroke中风peptic ulcer消化性溃疡例如，对有消化性溃疡病史的病人使用阿斯对一种疾病的治疗可能会加重另一种疾病，匹林预防中风。The risk for becoming disabled or

46、 dependent also increases withthe number of diseasespresent.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

47、 odds of developingdisability are increased by three-fold to four-fold with either disease alone,the risk of disabilityincreases 14-fold if both are present.arthritis关节炎odd奇数的、单个的虽然每个疾病可以增加34 倍的病残率，但两14 倍。18%的老年人同时患有关节炎和心脏病，个疾病同时存在，可使病残率提高到in the use of aspirin to preventA second way in which older

48、adults differ from younger adults is the greater likelihood thattheir 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 primarysymptom.pneumonia 肺炎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。Simil

49、arly,the frequency of silent myocardial infarction increases with increasing age,as doesthe proportionof patients who present with a change in mental status,dizziness,or weaknessrather than typical chest pain.silent沉默的、静止的proportion成比例的、相称的这些病人相应地频发精神状同样地，隐匿性心肌梗塞发生频度随着年龄的增大而增加，态改变、眩晕、虚弱而不是典型的胸痛症状。me

50、ntation 精神作用、心理活动primary 初始的、首要的、主As a result,the diagnostic evaluation of geriatric patients must consider a wider spectrum of9diseases 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 adult