浙江省住院医师临床医学英语讲义2

    Record the severity of pain and functional impairment with a measure simple enough for repeated use. Extensive work in many diseases has shown that changes on a scale of 0 to 10 for pain intensity are valid and sensitive for detecting meaningful relief. Pain-related functional limitations can be assessed either by using the patient's choice of important activities or by asking the patient how much, on a scale of 0 to 10, pain has interfered with domains such as general activity, mood, walking, work, relations with other people, sleep, and enjoyment of life. 
记录的严重疼痛和功能障碍与测量简单的重复使用。在许多疾病的广泛努力显示变化进行打分,分值范围为0到10对于疼痛强度检测是有效的,有意义的敏感救济。疼痛相关的功能受限的可评估或者通过使用病人的选择的重要活动或问病人多少,进行打分,分值范围为0到10,疼痛干扰等领域一般活动,心情,散步,工作,与他人的关系、睡眠、和快乐的生活。
    Evaluate the psychological state of the patient. Unrecognized depression and anxiety disorders are common in patients with chronic pain. Patients readily tell the clinician about these if asked, and these mood disorders are readily treatable. Assess the presence of suicidal thoughts and the pain's effect on the patient's sexual activities. It is often helpful to ask patients how they are coping in the face of the pain or what keeps them from giving up because these responses identify sources of strength on which the clinician can build.
评估病人的心理状态。未知的抑郁和焦虑疾病患者通常都有慢性疼痛。随时告诉医生病人对这些如果问,这些情感障碍消声匿迹。评估自杀想法的存在和痛苦的影响,对病人的性活动。这是问患者通常有用,他们是如何应对面对痛苦或什么使他们放弃,因为这些响应识别力量的源泉,是临床医生可以建造。
    Develop a series of diagnosis-based hypotheses. Because pain may result from disease at the pain site or be referred from other parts of the body, it may be helpful to list all the possibilities for the site of origin, particularly when the pain has been resistant to therapy. Persistent rib pain in a patient with metastatic cancer despite radiation therapy to the lesion in that rib would raise the possibility of referred pain from thoracic epidural tumor, which can be imaged and treated. For each potential site of the lesion, the list of the common disease processes in that area can be considered. 
开发了系列diagnosis-based假说。因为疼痛可能由于疾病或转介疼痛部位从身体的其他部分,它可以帮助列出了所有的可能性,特别是当鼠蹊部位的疼痛一直抵抗治疗。持续的肋骨疼痛患者放射治疗癌性,尽管在那根肋骨病变的可能性会提高从胸硬膜外肿瘤转移痛,可不能成像和对待。为每一个潜在网站的病变、中常见的疾病过程在这个区域可以被考虑。
    Personally review the diagnostic procedures. In the re-evaluation of difficult pain diagnoses, it is remarkable how often lesions had been missed previously on imaging procedures, particularly when the radiologist was not given a specific diagnostic hypothesis. 
个人评论诊断程序。在艰难的痛苦再诊断,值得注意的是多久以前病变失去对成像程序,特别是当该放疗师没有给出一个具体的诊断的假设。
    In patients with multiple chronic symptoms that are unexplained despite a full diagnostic evaluation, consider the possibility of multisomatoform disorder. This more recently proposed diagnosis, which applies to one tenth of primary care visits, is defined by the presence of three bothersome and unexplained complaints, some of which have troubled the patient on most days in the previous 2 years. Depending on the presenting complaint or the clinician's specialty, many of these patients are said to have fibromyalgia, chronic fatigue, irritable bowel syndrome, idiopathic low back pain, or chronic tension-type headaches, but most of these patients have multisystem complaints. Laboratory studies suggest that generalized amplification of symptoms by the central nervous system is common in these patients. Recognition of multisomatoform disorder alerts the clinician to look closely for depressive or panic disorders, whose prevalence is high in these patients; to treat with antidepressants or cognitive-behavioral treatment, shown to reduce symptoms; and to limit elaborate diagnostic testing or potentially hazardous medical treatments. 
多种慢性症状患者是无法解释的充分的诊断评价,尽管考虑一下这种可能性的multisomatoform紊乱。这更最近提出的诊断,并适用于十分之一的初级保健访问,被定义为三个罗嗦的存在和不明原因的投诉,其中一些已经困扰的病人在大多数的日子前2年。根据目前的投诉或临床医生的专业,很多患者被认为的战斗能力。识别紊乱警报临床医师仔细看为抑郁或惊恐障碍,其发生率为;高在这些患者中治疗与抗抑郁药或认知行为治疗,减少症状表现,诊断测试或限制精心有潜在危险的医学治疗
    Reassess the patient's response to pain therapy. The principles of analgesic treatment are simple, but dose requirements and adverse effects vary widely. A daily phone call until the patient's treatment has been optimized is often the key to successful treatment.
评估病人的痛反应的治疗。止痛治疗的原则很简单,但是剂量要求和副作用大相径庭。日常电话,直到病人的治疗进行了优化往往是成功治疗的关键。

Chapter 54 Benefit of Early enteral feeding versus parenteral nutrition
本篇篇名为早期肠内与肠外营养的优点比较。病人的营养供给是必需的，但选择的途径可以有所不同，如肠内营养或肠外营养。比较而言，这两种营养均比较安全。本篇主要对一些病人的早期营养与肠外营养进行比较，结果提示，早期场内营养在降低感染和减少住院时间等方面有优势。
It is often said that enteral nutrition is safer and more efficacious than the parenteral route.
人们通常认为肠内营养比肠外营养更安全,更有效.但这一观点并没有在早期的动物实验和临床研究中得到承认
However a preliminary note of caution is raised from observations in experimental animals, which concluded that outcomes of enteral and parentaeral nutrition were equivalent when animals with catheter sepsis were eliminated.
但是动物实验观察得到的初部结果告诉我们当导管脓毒症消除以后，肠内和肠外营养结果是类似的。
Numerous studies have shown that it is safe to feed the gut in the immediate postoperative period and that this practice does not place the integrity of intestinal anastomoses at risk.
为数众多的研究标明术后即刻的肠内营养是安全的，同时对肠吻合口也不会带来风险。
Early feeding has been studied primarily in two patient populations: those who have undergone gastrointestinal surgery and in traumatically injured or critically ill persons.
早期进食实验最初是在两组实验病人中进行：一组是为胃肠术后病人，另一组为创伤或危重病人。
A recent meta-analysis reviewed 11 prospective, randomized, controlled trails that compared the practice of early enteral feeding to maintaining patients NPO after elective gastrointestinal surgery.
最近的一项meta分析对11个随机分组前瞻性研究来对照择期胃肠术后早期肠内营养与禁食病人。
This analysis of 837 patients concluded that there is no clear advantage to keeping patients NPO postoperatively and that early feeding may be of benefit in decreasing infections and shortening postoperative length of stay. 对837位病人的研究标明术后禁食病人（比早期肠内营养)没有明显益处，而且早期进食可以降低感染率，缩短住院时间。
However, a closer evaluation of this data reveals that the length of stay was reduced only by 0.84 day, and although there was an increase in “any type of infection” in the NPO group, when considered individually, there was no difference in the incidence of anastomotic dehiscence, wound infections, pneumonia, intra-abdominal abscess, or mortality.
但是，另一项相近的研究认为禁食组病人虽然住院时间缩短了0.84天，但“感染”发生率提高了，个别进行分析的结果表明，吻和口瘘，切口感染，肺炎，腹内脓肿及死亡率（两组间)没有差别。
In 2001 Marik and Zaloga performed a meta-analysis of 15 randomized, controlled trails involving 753 subjects that compared early with delayed enteral nutrition in critically ill surgical patients. Early enteral nutrition was associated with a significantly lower incidence of infection (relative risk reduction of 0.45) and reduced length of hospital stay (2.2 days less).
2001年 Marik 和Zaloga 对15组753例危重外科病人进行了meta分析以比较早期和晚期肠内营养的疗效。早期肠内营养组感染发生率明显较低（相对风险降低0.45)，住院日也有减少（少2.2天)。
There were no differences in noninfectious complications or in mortality. The authors concluded that early initiation of enteral feeding was beneficial, but this result must be interpreted with caution because of substantial heterogeneity between studies. 
非感染性并发症和死亡率无明显差别。作者认为早期肠内营养是有益的，但是考虑到研究中的差异性，这个结果需要谨慎对待
The studies that compared enteral and parenteral nutrition in the trauma population, as discussed earlier, concluded that enteral was superior because of an attenuated inflammatory response and a decrease in septic morbidity.
    Attenuated衰减，减弱
    Inflammatory炎症性
    septic morbidity
败血症发病率由于感染率和败血症发病率低，正如先前所进行的创伤病人有关肠内和肠外营养的结果得出，肠内营养超过肠外营养。
When these studies are examined more closely, it is clear that patients who were fed enterally usually received significantly less calories than those fed parenterally.
经过严密的研究发现肠内营养的病人吸收的热量明显少于肠外营养病人。
This discrepancy of “relative overfeeding” in the TPN groups in many instances led to hyperglycemia, presumably predisposing patients to immune dysfunction and nosocomial infection.
Discrepancy不一致，偏差  Hyperglycemia高血糖症
nosocomial infection院内感染  Predispose成为因素
TPN组相对营养过度使许多病人产生高血糖症，据推测可以导致免疫功能下降和院内感染。
Thus, poor glucose control alone may account for the observed differences in outcome.
    account for说明，解释
因此，血糖控制不佳可以解释说观察到的结果的差异。
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.
    Contemporary当代的，同代的
    Equivalent相当的，相等的
当代的研究发现，如果肠外营养经过改进避免高血糖的可能，给予与肠内营养相似的蛋白质和热量，两组之间的预后差异不大。
Enteral nutrition also can endanger patient safety in unique ways.
     Endanger使危险，危及
     Unique独特的
肠内营养也可以危及病人的安危。
Deaths in persons receiving enteral nutrition are often due to aspiration, for example when gastric motility suddenly is impaired with the onset of sepsis
     Aspiration误吸
     gastric motility
肠内营养病人的死亡常常是由于误吸，如由于败血症的发生说导致的胃能动性的损伤。
One death from aspiration is equivalent to the mortality over 2 to 3 years of well-operated parenteral nutrition program, despite the danger of catheter sepsis, which in well-operated units is now less than 1% to 3%.
     equivalent 相当的，相等的 catheter sepsis导管脓毒症
除了导管脓毒症的危险以外，通常在管理良好的单位发病率低于1％至3％，误吸的死亡率与实行了2－3年良好管理的肠外营养病人相当。

2014年新疆自治区住院医师规范化培训招生简章

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