1、二、1、炎症： inflammation 2、内脏的： Viscreal 3、预计，预测： estimate 4、子宫破裂： Uterine rupture5、死亡数、死亡率：mortality 6、缺氧：Hypoxia7、并发症： complication 8、流行性感冒：Epidemic influence9、常规的，一般的：regular 10、腹膜炎：Peritonitis 11、冠心病：coronary disease 12、生长因子：Growth factor13、免疫接种：immunization 14、胰腺炎：pencreatitis15、心电图：electrocardiogr
2、am 16、脊髓：spinal cord17、移植：transplantation 18、心源性猝死：sudden cardic disease19、低氧：hypoxemia 20、干细胞：stem cell三、1、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 treat
3、ment 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 o
4、f 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 with pregnancy has important implications in the trauma patient.Sign
5、s 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 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
6、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很久之前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。2、Postoperative surgical comp
7、lications 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 complica
8、tions 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
9、,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
10、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。3、Epidemics occur almost exclusively during the winter months in temperate areas,but influenza activi
11、ty 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 outbreaks are common.During expidemics,the overall attack rates typically average 5 to 20% in adults.Attack
12、 rates of 40 to 50% are not uncommon in closed populations,including those in hospitals and nursing homes,and in certain highly susceptible age groups.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
13、addition,simultaneous outbreaks of influenza A and respiratory syncytial viruses have been found. Strains circulating at the end of one seasons outbreak (the so-called herald wave phenomenon).Furthermore,other than the association of influenza outbreaks with colder seasons,the factors that allow an
14、epidemic 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
15、%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。4、How should the chice between CT or ultrasonography be made in a patient who prese
16、nts 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,an obese patient,CT is preferred because it often reveals imaging choices exist: (1)no imaging study;(2) a plain radiographic series of the abdomen (techni
17、cally 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 b
18、owel obstruction,and radiodense ureteral calculi,the traditional abdominal series,although the least expensive test,is considered generally inferior to CT and has been largely replaced by CT. A current-generation multislice helical CT scanner can generate 5-mm sections of the entire abdomen and plvi
19、s in about 1 minute.It is helpful to use oral 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
20、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5、Some patients with clear findings of the acute badomen may be treated without surgical oper
21、ation. 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 empye
22、ma 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。
23、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。6、The loss or failure of an organ or tissue is devastating. Current treatment methods include transplantation of organs, surgical reconstruction, use of mechanical devices, or supplementation of metabolic products. However, the ultimate goal of
24、 transplantation should reside in the ability to restore living cells to maintain or even enhance existing tissue function. This is emerging through the process of tissue engineering. Initial discoveries in engineered tissues were made in the mid-1980s with skin-based products. By developing replace
25、ment tissues that remain intact with bioactive properties after implantation, tissue engineering could provide an alternative to transplantation and other forms of reconstruction. The potential impact of this field is endless, offering unique solutions to the medical field for tissue and organ repla
26、cement. 一个器官或组织的缺失或功能衰竭是致命的。现在的治疗方法包括器官移植、手术重建、使用机械设备或补充代谢产品。然而，移植的的最终目标应该放在能够恢复活细胞来维持或甚至增强存活组织的功能。这个目标贯穿组织工程出现的过程。人造组织是以皮肤产品开始在 1980 年代中期时出现。通过生产移植后能保持生物活性的替代品，能保持由于疾病或创伤所致的组织或器官生理功能及结构完整，组织工程能够提供移植和其他形式重建的替代品。皮肤替代产品是最先进的，现在在世界范围的市场上有几种伤口治疗的组织工程材料供应。这个领域的潜在影响是没有止境的，提供医疗领域中组织和器官移植的各种独特的产品。7、Traditio
27、nally the vital signs include pulse rate, blood pressure, respiratory rate, and body temperature. The pulse should be recorded as not just the rate but also the rhythm. Physicians may prefer to initiate the examination by holding the patients hand while touching the pulse. This nonthreatening initia
28、l contact with the patient allows the physician to determine whether the patient has a regular or irregular rhythm. The respiratory rate should be assessed at the same time the patient is observed to determine whether there is any respiratory discomfort. The body temperature of adults usually is mea
29、sured with an oral electric thermometer. These thermometers correlate well with the traditional mercury thermometers and are safer to use. Rectal thermometers reliably record temperatures 0.4 higher than oral thermometers.传统的生命体征包括脉率、血压、呼吸频率和体温。脉率不只是记录其速率还要记录其节律。医生可能喜欢握着病人的手同时触压脉率来开始检查。这种非侵害性的与病人开始接
30、触使得医生能够确定病人脉率是否规律或不规律。在每一次测量呼吸频率同时要观察判定病人是否有任何呼吸不畅（呼吸困难） 。成年人的体温通常用电子温度计测得的。这些体温计和传统的水银温度计（精确度）非常一致且使用更安全。直肠温度计（测得的温度）要比口腔温度计（测得的温度）可靠地高出 0.4。8、Old patients differ from young or middle-aged adults with the same disease in many ways, one of which is the frequent occurrence of co-occurrence of two or
31、more diseases and of subclinical disease. As a function of the high prevalence of disease, the co-occurrence of two or more diseases in the same individual is also common. Of people age 65 and older, 50% have two or more chronic diseases, and these diseases can confer additive risk of adverse outcom
32、es, such as mortality. 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. The risk for becoming disabled or dependent also increase with the number of diseases present. Specific pairs of diseases c
33、an increase synergistically the risk of disability.患有同一种病的老人和青年人及中年人在许多方面表现不同，其中之一是老年病人经常同时伴有并存病和亚临床的疾病。由于高发病的原因，一个人身上同时患有 2 种或更多的疾病是很常见的。65 岁及年龄更大的老年人，50%的人患有 2 种或 2 种以上的慢性病，而这些疾病会共同造成不良后果的另外风险，比如死亡。治疗（其中）一种病可能对其另一种病产生不良影响，比如有消化性溃疡病史的病人用阿司匹林来预防发生中风。并存病数量越多导致瘫痪和不能自理的风险越高，一些特殊配对的疾病会相互促进，使瘫痪的可能性增大。9、S
34、hortness 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. The cause of dyspnea may be pulmonary disease, circulatory disease, or both. It is the physicians responsibility to define the causative mechani
35、sms of shortness of breath so that diagnostic techniques and therapies can be directed appropriately. The main mechanism of the symptom of dyspnea is increased mechanical work of breathing, usually brought on by increased airway resistance as occurs in asthma, chronic bronchitis. The increased mecha
36、nical work done on the lungs to overcome obstruction to airflow is perceived as an increased effort to breathe and produces the symptom of dyspnea.“气促” “感觉无法吸到足够的空气” “呼吸很累” 这些都是病人用来描述呼吸困难症状的词语。呼吸困难的原因可以是肺部疾病,循坏系统疾病或者两者都有。是医生的职责去确定气促产生的机制，然后才能正确指导运用诊断技术和治疗。气促症状常见的机制是呼吸用力增加，通常是由于气道阻力增加所致，比如发生在哮喘,慢性支气管
37、炎和肺气肿，或者是由于肺的顺应性下降所致，比如发生在肺间质纤维化反应。在后者，呼吸时需要用更大的力来产生更高的胸膜腔负压使空气进入肺.。在肺上增加的机械做功是用以克服气道阻力或降低的肺顺应性，呼吸时用力增加被察觉就产生呼吸困难的症状。10、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 gastro
38、intestinal tracts. 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. Regardless of either the findings on the initial upper or lower endoscopic examination, all patients should have both up
39、per and lower endoscopy because the complementary endoscopic examination has a yield of 6% even if the first one was positive. For premenopausal women, a positive fecal occult blood testing (FOBT) requires full evaluation, as does iron deficiency anemia. Barium radiograghs of the upper and lower gas
40、trointestinal tract have limited utility in occult bleeding because of their inability to biopsy or treat lesions that are identified.隐匿出血是指从胃肠道无症状的失血，通常通过大便潜血试验（FOBT）检测出或是出现缺铁性贫血。来源不明的胃肠道出血是指经过首次上消化道和下消化道内窥镜检查后没有发现出血部位的不明来源的持续出血或多次出血。这两种情况可能都表示有慢性出血或多次出血。缺铁性贫血的首选检查方法取决于出现的症状提示是上消化道还是下消化道。不管首次上消化道或下
41、消化道内窥镜检查发现，所有的病人都应该进行上下消化道的内窥镜检查，因为这两种互补的内窥镜检查可以有 6%的新发现，哪怕首次的检查是阳性的。对绝经前妇女，一次的 FOBT 阳性结果应该全面评估，缺铁性贫血也应如此。在隐匿出血的背景下上下消化道的钡剂放射影像检查的用处有限，因为它们无法对发现的损伤进行活检和治疗。在孕妇创伤的处理过程中，胎儿复苏的关键是通过对母亲的复苏实现的。因此对孕期创伤病人最初进行的评估和处理与非孕期创伤病人一样。迅速采取措施通畅气道，吸氧和建立循环通道以确保气道通畅避免堵塞进而出现母婴低氧现象。在怀孕晚期，正如所描述的那样，子宫压迫腔静脉使静脉血液回流减少而引起低血压，因此孕
42、期创伤的病人应该采取左侧卧位。如果怀疑有脊柱损伤的孕期创伤病人应将其固定到靠板再左侧倾斜。失血体征比如心动过速和低血压直到病人出血已经达到全身血容量的 30%才会出现。这样一来，胎儿已经经历很长时间按的低氧，所以补液复苏措施甚至在孕妇血压正常的妊娠病人中也应尽早、尽快进行。外科术后并发症使是那些手术经验丰富的外科医生也很犯难、感到困惑的。无论他技巧多好，多有天分、多么聪明，能干的一个外科医生，其外壳生涯中术后并发症不可避免的一个方面。在美国外科术后并发症所引起的费用达数百万，并引起劳动生产力的损失，影响家庭的正常生活，给雇主和社会带来无法想象的压力。手术并发症的存在是手术的功效大打折扣；在很多
43、案例中，病人根本不能回到数千健康功能。最重要、最困难的是那些病人遭受病痛折磨的病人，最初入院手术时期望能做一个顺利的手术，但被迫处于遭受痛苦和并发症的境地。流行性感冒在温带地区通常发生在冬天的几个月时间里，而在热带地区则全面都可以发生。大爆发通常在夏天时发生在旅游团队和建筑工地，尤其是在飘逸便已出现以后。流行性感冒的发生的差异在时间和数量上也是很常见的。在流行性感冒理性期间所有感染的人中成人的发病率通常在 5%到 20%。感染率达到 40%到 50%在那些范围较局限的地区，比如小型医院、疗养院和那些高危人群聚集的地方是很常见的。同一亚型的两个不同的菌株之间，A 型病毒的 两个不同亚型之间 (H
44、1N1 and H3N2)，或者 A、B 两种病毒之间可以相互感染。此外，A 型流感病毒和呼吸道合胞病毒通常可以起感染。某一个季度的流感爆发末期传播的菌株的存留往往可以英气下一集的爆发（这就是所谓的先驱波效应） 。除了流感的爆发于寒冷季节有关外，其他是流感发张的因素或者那些事感染者减少到只有几个仪式感染病人的原因都还不清楚。有一些已经明确发现急性腹痛病因的病人可以不经外科手术治疗。例如，那些有穿孔性十二指肠溃疡的平时没有注意的病人往往在溃疡已经发生很多天后才开始注意自己的身体不适，尤其应该采取细心呵护支持治疗，包括肠内营养、肠外输液和镇痛。病变部位明确如胆囊炎的病人，尤其是那些出现其他严重病症
45、的人，通过经皮穿刺治疗和关心支持治疗不手术切除更好。传统的生命体征包括脉率，血压，呼吸频率和体温。脉率不仅仅是记录次数还有节律。医生通常喜欢握着病人的手同时侧脉率来开始检查。这种废侵害性的检查方式是医生能够同时判断病人的脉率是有节律的还是紊乱的。病人的呼吸频率也可以同时测得，并且根据病人的表现判断他是否有同呼吸困难。成人的体温通常是用口腔电子体温计测得的。这种体温计具有传统体温计的准确性而且更加安全。肛温及测得的体温则比口腔体温计测得的 温度高 0.4 摄氏度。老年人于年轻人、中年人即使是换同一种疾病仍有很多的不同点，其中之一就是老老年人通常可存在可伴或不伴一两桶疾病或者亚临床疾病。一种高发病
46、率的功能性疾病，在同一个兵身上同时伴发两种或以上的疾病是很常见的。那些 65 岁或者年龄更大的病人，50%以上的病人有两种及以上慢性并发疾病，而这些疾病往往会增加想不良结果转变的概率，比如死亡率。对一种疾病的治疗可以是另一种疾病的不良预后，比如那些长期用阿司匹林预防中风的病人可能会引起胃溃疡疾病。随着共存疾病的数量愈来愈多发生残疾和艺考生活的的风险也逐渐增加。特殊相伴的疾病将会增加相应记得致残风险。气促，感觉空气不够，用力呼吸都是用来描述病人呼吸困难症状的词汇。引起呼吸困难的原因可以是肺部疾病、循环疾病也可以两着都有。医生的责任就是运用诊断性技巧寻找引起气促的原因及机制，选择适当的治疗方案。产生呼吸困难症状的主要机制是由于呼吸做工的增加，通常由肺气肿、慢性支气管炎等引起的气道阻力增加。肺部为可以气流阻力增加的做工量是影响呼吸，产生呼吸困难症状的主要因素。
