麻醉专业英语.doc

. 可编辑修改1 麻醉专业英语 CHAPTER 1 FLUID, ELECTROLYTE AND ACID-BASE BALANCE.2 CHAPTER 2 INTRAVENOUS ANESTHESIA4 CHAPTER 3 INHALATIONAL ANESTHETIC AGENTS9 CHAPTER 4 MONITORING DURING ANESTHESIA11 CHAPTER 5 RESPIRATORY PHYSIOLOGY.13 CHAPTER 6 CARDIOVASCULAR PHYSIOLOGY18 CHAPTER 7 PHYSIOLOGY OF THE NS.22 CHAPTER 8 LOCAL ANESTHESIA AGENTS AND LOCAL ANESTHESIA.26 CHAPTER 9 NEUROMUSCULAR BLOCKING AGENTS28 CHAPTER 10 INTRATHECAL ANESTHESIA30 CHAPTER 11 ANESTHESIA FOR CARDIAC SURGERY32 CHAPTER 12 NEUROSURGICAL ANESTHESIA.34 CHAPTER 13 ANESTHESIA FOR ABMORMAL SURGERY.37 CHAPTER 14 PAEDIATRIC ANESTHESIA AND INTENSIVE CARE39 CHAPTER 15 ANESTHESIA FOR GYNECOLOGICAL AND OBSTETRIC SURGERY.45 CHAPTER 16 ANESTHETIC MANAGEMENT OF ELDERLY PATIENTS48 CHAPTER 17 POSTOPERATIVE PAIN50 CHAPTER 18 MANAGEMENT OF CHRONIC PAIN54 . 可编辑修改2 Chapter 1 Fluid, Electrolyte and Acid-Base Balance 1. The clinical manifestations of volume depletion are low blood pressure, narrow pulse pressure, tachycardia, poor skin turgor, and dry mucous membranes. The history may suggest the reason for volume depletion. 翻译： 血容量不足的临床表现包括低血压，脉压狭窄，心动过缓，轻度皮 肤水肿以及粘膜干燥。 病史的询问可能提示病因。 2. Combined water and electrolyte depletion may occur from gastrointestinal losses due to nasogastric suction, enteric fistulas, enterostomies, or diarrhea. Other causes are excessive diuretic therapy, adrenal insufficiency, profuse sweating, burns, and body fluid sequestration following trauma or surgery. 翻译： 水合并电解质的不足可以由肠道的丢失引起，其中包括鼻饲管的引 流， 肠瘘，肠造口术以及腹泻。 其他原因还包括，过度的利尿药治疗，肾上 腺功能不足，过度出汗，烧伤，以及创伤和手术造成的体液丢失。 3. Antidiuretic hormone, released during anesthesia and surgical stress, promotes water conservation by the kidneys. Renal vasoconstriction and increased aldosterone activity reduce sodium excretion. 翻译：麻醉期间以及手术刺激时分泌的抗利尿激素会加强肾脏的保水能力。 同时，肾血管的收缩和醛固酮的活动增强也会减少钠的分泌。 4. Hyponatremia in severe hyperglycemia results from the osmotic effects of the elevated glucose concentration, which draws water from the intracellular apace to dilute ECF sodium. 翻译：高糖血症时的低钠血症是由升高的血糖浓度的渗透作用造成的，也 . 可编辑修改3 就是说，过高的血糖浓度会迅速地将细胞内的水转移到血浆中对钠进行稀释。 5. With extracellular acidosis, a large proportion of the excess hydrogen is buffered intracellularly by an exchange of intracellular K+ for extracellular H+, this movement of K+ may produce dangerous hyperkalemia. 翻译：在胞外酸中毒时，很大一部分的胞外氢离子会和胞内的钾离子进行 交换，以此来对过多的氢离子进行缓冲，钾离子的这种运动可能会导致危险的 高钾血症。 6. The electrocardiographic changes are the most helpful indicators of the severity of hyperkalemia. Early changes include peaking of the T waves, widening of the QRS complex and depression of the ST segment. 翻译：心电描记图上的变化是评估高钾严重程度的最灵敏指标。早期的变 化包括 T 波高尖，QRS 波的增宽以及 ST 段的下移。 7. The clinical manifestation of hypokalemia relate to neuromuscular function: Decreased muscle contractility and muscle cell potential develop, and in extreme cases death may result from paralysis of muscles of respiration. 翻译：低钾血症的临床症状涉及神经肌肉的功能，包括：肌肉的收缩能力 减弱，肌细胞的电位升高，在极少数病例中还会由于呼吸肌的瘫痪导致死亡。 8. Acute respirtory acidosis occurs when respiration suddenly becomes inadequate, CO2 accumulates in the blood and hydrogenion concentration increases. This occurs most often in acute airway obstruction, aspiration, respiratory arrest, certain pulmonary infections, and pulmonary edema with impaired gas exchange. 翻译：急性呼吸性酸中毒的病因包括：突然的呼吸不足，血中 CO2 的堆积 . 可编辑修改4 以及氢离子浓度的升高。这种酸中毒最常见于急性呼吸道梗阻，误吸，呼吸暂 停，某些肺部感染以及肺水肿时合并换气不足等情况。 9. Metabolic acidosis is caused by increased production of hydrogen ion from metabolic or other causes from excessive bicarbonate losses. In either case, the plasma bicarbonate concentration is decreased, producing an increase in hydrogen ion concentration. 翻译：代谢性酸中毒的病因包括：代谢产生的氢离子增多或者是，其他原 因造成的碳酸氢盐丢失过多。两种情况下均是碳酸氢盐的浓度降低，从而导致 氢离子的浓度升高。 10.Volume deficit is best estimated of the basis of acute changes in weight or from clinical estimates, the clinician should remember that deficits less than 5% of body water will not be detectable and that loss of 15% of body water will be associated with srvere circulatory compromise. 翻译： 评估容量不足的两项最好的指标：一. 有体重急剧变化的根据； 二. 根据临床评估。临床医生要始终记住：不足 5%的水分丢失不能被监测出，而 15%的水分缺失将会造成严重的循环障碍。 Chapter 2 Intravenous Anesthesia 11.A widely accepted theory of anesthetic action is that both iv and inhalational anesthetics exert their primary sedative and hypnotic effects through an interaction with the inhibitory g-aminobutyric acid(GABA) neurotransmitter system. 翻译：关于麻醉药的作用机制，目前被广泛接受的理论是：无论是静脉还 . 可编辑修改5 是吸入性麻醉药，都是通过和抑制性的 GABA 中枢传递系统相互作用来发挥它 们主要的镇静和催眠效应。 12.Benzodiazepines bind to specific receptor sites that are part of the GABAa receptor complex. The binding of benzodiazepines to their receptor site increases the efficiency of the coupling between the GABA receptor and the chloride ion channal. The degree of modulation of the GABA-receptor function is limited, which explains the “celling effect” produced by benzodiazepines with respect to CNS depression. 翻译：苯二氮卓类与 GABAa 受体复合物上相应的结合位点相结合，提高了 GABA 受体和氯离子通道偶联的效率。而 GABA 受体的调节能力是有限的，这 就解释了为什么苯二氮卓类对中枢神经系统的抑制作用会产生“封顶效应” 。 13.Ketamine produces a functional dissociation between the thalamocortical and limbic system, a state that has been termed “dissociative” anesthesia. Ketamine depresses neuronal function in the cerebral cortex and thalamus, while simultaneously activating the limbic system. 翻译：氯胺酮会产生一种被称为“分离麻醉”的状态，也就是丘脑皮质和 边缘系统的功能分离。氯胺酮会在抑制大脑皮层和丘脑神经元功能的同时激活 边缘系统。 14.When a drug infusion is administered without a loading dose, 3-5 times the t1/2BETA value may be required to reach a “steady-state” plasma concentration. The steady-state concentration obtained during an anesthetic infusion depends on the rate of drug administration and its clearance rate. 翻译：当某种药物在给药时没有给予负荷剂量，则它将需要 3 到 5 倍的消 . 可编辑修改6 除半衰期才能达到血浆稳态浓度。麻醉期间能达到的稳态浓度取决于给药速度 和药物的消除速率。 15.The context-sensitive half-time is defined as the time necessary for the effect-compartment concentration to decrease by 50% in relation to the duration of the infusion. The context-sensitive half-time becomes particularly important in determining recovery after variable-length infusion of sedative-hypnotic drugs. 翻译：情境相关半衰期是指输药时程不同时效应室的浓度下降一半所需的 相应时间。这种半衰期在决定某些可变时程的镇静催眠药输注后的恢复显得尤 为重要。 16.When steady-state plasma concentrations are achieved, it can be presumed that the plasma concentration is in equilibrium with the effect-site concentration. Under these circumstances, it is possible to describe the relationship between drug and effect using a concentration-effect curve. 翻译：当血浆中的药物浓度达到稳态浓度时，可以认为效应处的浓度和血 浆中的药物浓度已经达到了平衡，在这种情况下，用浓度-效应曲线描述药物剂 量和效应的关系成为可能。 17.Barbiturates cause dose-dependent respiratory depression. However, bronchospasm or laryngospasm following induction with thiopental is usually the result of airway manipulation in “lightly” anesthetized patients. 翻译：巴比妥类会引起剂量依赖性的呼吸抑制作用。但是，硫喷妥钠诱导 后产生的支气管痉挛和喉痉挛却通常是由浅麻醉过程中的气道操作引起的。 18.Propofol is rapidly and extensively metabolized to inactive, water-soluble . 可编辑修改7 sulfate and glucuronic acid metabolites, which are eliminated by the kidneys. Propofols clearance rate(1.5-2.2 L/Min) exceeds hepatic blood flow, suggesting that an extrahepatic route of elimination(lung) also contributes to its clearance. 翻译：丙泊酚被迅速而广泛地代谢为没有活性的，水溶性的硫酸盐和葡萄 醛酸等产物，这些代谢产物都由肾脏清除。 丙泊酚的清除率（1.5-2.2L/min）超 过了肝脏的血流量，这就提示了还存在另外一条肝外清除途径（即肺的清除） 。 19.All benzodiazepines have anxiolytic, amnestic, sedative, hypnotic,anticonvulsant, and spinally mediated muscle relaxant properties. Benzodiazepines differ in potency and efficacy with regard to their distinctive pharmacologic properties. 翻译：所有的苯二氮卓类药物均具有抗焦虑，致遗忘，镇静，催眠，抗惊 厥，以及由脊髓介导的肌松作用等特性，此类药物的效价强度和效能会由于各 自不同的药理特性而各不相同。 20.Etomidate is associated with a high incidence of postoperative nausea and emesis when used in combination with opioids for short outpatient procedure. In addition, the increased mortality in critically ill patients sedated with an etomidate infusion has been attibuted to its inhibitory effect on cortisol synthesis. 翻译：当和阿片类联合用于门诊病人的短小手术时，依托咪酯的术后恶心 和呕吐发病率会较高。此外，在那些用依托咪酯输注进行镇静的危重病人中显 示的高死亡率已经被归咎为它对糖皮质激素合成的抑制作用。 21.Katemine produces dose-dependent CNS depression leading to a so-called dissociative anesthetic state characterized by profound analgesia and amnesia, even . 可编辑修改8 though patients may be conscious and maintain protective reflexes. 翻译：氯胺酮产生的剂量依赖性的中枢神经系统的抑制作用会产生一种被 称为分离麻醉的状态，这种状态的特征是：即使病人的意识清醒并且保持保护 性反射，但是他们的痛觉和记忆却是完全缺失的。 22.An important consideration in the use of katemine anesthesia relates to the high incidence of psychomimetic reaction(namely, hallucination, nightmares, altered short-term memory and cognition) during the early recovery period. 翻译：使用氯胺酮麻醉时需要着重考虑术后恢复早期拟精神症状的高发病 率，这些症状包括幻觉，噩梦，以及短期的记忆和认知改变。 23.Morphine produces its major theraputic as well as adverse effects in the central nervous system( brain and spinal cord) and the gastrointestinal system, but other system are also affected. CNS effects include analgesia, sedation, changes in affect, respiratory depression, nausea and vomitting, pruritus, and changes in pupil size. 翻译：吗啡主要是在神经系统（脑和脊髓）和胃肠道系统发挥它的治疗作 用和副作用，但同时其他系统也会受累。中枢神经系统效应包括痛觉缺失，镇 静，呼吸抑制，恶心呕吐，瘙痒以及瞳孔大小的改变。 24.Patients who are critically ill(e.g. patients with severe trauma or cardiac disease) can be expected to have high sympathetic tone, and thus may experience hypertention in response to doses of morphine which would not normally produce hemodynamic instability. 翻译：有严重创伤或心脏病的危重病人通常交感神经的紧张度都比较高， . 可编辑修改9 所以这些病人可能会由于吗啡的剂量而出现高血压，而通常情况下吗啡是不会 引起血流动力状态的不稳定的。 25.Nausea and vomitting are among the most distressing side effects of morphine and its derivatives. The incidence of opioid-induced nausea appears to be similar irrespective of the route of administration. Morphine causes dose-dependent nausea and vomitting, but the physiology and neuropharmacology of opioid-induced nausea and vomitting are complex. 翻译：恶心呕吐是吗啡和它的衍生物的最痛苦的副作用之一。阿片类诱导 产生的恶心不会因给药途径的不同而发生改变。吗啡会诱发一种剂量依赖性的 恶心呕吐，但是阿片类诱发的恶心呕吐的具体生理和神经药理机制则比较复杂。 26.High doses of fentanyl significantly blunt the “stress response” (e.g. hemodynamic and hormonal responses to surgical stimuli) while producing only minimal cardiovascular depression. 翻译：大剂量的芬太尼会显著抑制应激反应，例如对手术刺激所产生的血 流动力学反应和激素反应都会受到抑制而只会产生最轻微的心血管系统的抑制。 Chapter 3 Inhalational Anesthetic Agents 27.MAC is the minimum alveolar concentration of an anesthetic at 1 atmosphere absolute that prevents movement of 50% of the population to a standard stimulus. It has gained widespread acceptance as an index of anesthetic potency as it is . 可编辑修改10 measured. 翻译：MAC 是指在一个标准大气压下，能阻止 50%受试对象对一个标准刺 激的体动反应的肺泡内麻醉药的最小浓度，在被测量证实后，它作为一种衡量 麻醉药的效价强度的指标已被广泛接受。 28.Halothane causes a dose-dependent decrease in mucociliary function which may persist for several hours after anesthesia. This may contribute to postoperative sputum retention. 翻译：氟烷会对粘液纤毛的功能产生一种剂量依赖性的抑制作用，而这种 作用可能会一直持续到术后几个小时，这样就可能导致术后的痰液滞留。 29.The second type of hepatic dysfunction is extremely uncommon and takes the form of severe jaundice, progressing to fulminating hepatic necrosis. The mortality of this condition is quite high and varies between 30-70%. The incidence of type 2 is extremely low. 翻译：第二种类型的肝功能障碍极其罕见，通常是以严重黄疸的形式出现 并发展为暴发性肝坏死。一旦发生上述情况，则死亡率相当高，波动于 30-70% 之间。但是 2 型的发病率极低。 30.Enfulurane anesthesia is associated with a much smaller incidence of arrhythmias than halothane and much less sensitization of the myocardium to catecholamines, either endogenous or exogenous. 翻译：使用恩氟烷麻醉时出现心律失常的几率比氟烷时要低得多，且心肌 对儿茶酚胺的敏感性，无论是内源性的还是外源性的，也要低得多。 31.Isoflurane is the least(with exception of desflurane )soluble of the modern . 可编辑修改11 inhalational agents and thus alveolar concentrations equilibrate more rapidly. However, the rate of induction is limited by the pungency of the vapor. 翻译：异氟烷在目前使用的吸入麻醉药中是最不易溶解的（地氟烷除外） ， 这样它的肺泡浓度可以更快达到平衡。但是，诱导的速度却是要受到气体的刺 激性的限制的。 32.Nitrous oxide is a weak anesthetic whose MAC is 105%. Its used usually in combination with other agents。 Because of the low solubility, a change in alveolar ventilation has less effect on the rate of uptake than occurs with the more soluble agents such as halothane and ether. 翻译：一氧化二氮（即笑气）是一种低效麻醉剂，它的 MAC 达到了 105%，通常和其他药物联合使用。由于一氧化二氮的溶解度较低，所以和那些 比它溶解度大的药物如氟烷，乙醚相比，肺泡通气量的改变对它的摄取率影响 更小。 Chapter 4 Monitoring During Anesthesia 33.Maintenance of perfusion of vital organs is one of the principal tasks of the anesthetist during surgery. Adequate perfusion is dependent on adequate venous return to the heart, cardiac performance and arterial pressure. Adequacy of cardiac output and circulating blood volume may be inferred indirectly from observation of the variables: peripheral pulse, arterial oxygen saturation, peripheral perfusion, urine production, arterial prssure. 翻译：保持重要器官的灌流是麻醉医生在术中的主要职责之一，而充足的 . 可编辑修改12 灌流则依赖于足够的静脉回心血量，心脏的性能和动脉血压。心输出量和循环 血量是否充足则可以通过对以下指标的观测间接反映，包括：外周脉搏，动脉 氧饱和度，外周灌流，尿量以及动脉血压。 34.Advantages: Pulse oximeters are simple to use, non-invasive and require no warm-up. They provide an overall assessment of the integrity of all the systems involved in delivering oxygen to the tissues: oxygen supply to the patients; oxygen uptake by the lungs; oxygen delivery to the tissues via the circulatory system. 翻译：优点：脉搏血氧测量操作简单，无创且不需要预热时间，对向组织 供氧的各系统的完整性，这项指标则可以提供比较全面的评估。 35.Measurement of CVP is useful in situations similar to those warranting direct measurement of arterial pressure. The surface marking of the right atrium, is the true zero reference point. The normal range of values is 0-6cm H2O in the spontaneously breathing patients. Measurement of CVP is a valuable aid to blood and fluid replacement. 翻译：和在那些需要测量动脉血压相似的情况下一样，中心静脉压的测量 也很有意义。右心房的表层标志才是真正的零基准线。CVP 的正常值在自主呼 吸的病人是 0-6cmH2O，其测量对血液和体液的补充是一项很有价值的辅助措施。 36.Whichever route is chosen, meticulous attention to antisepsis is necessary. The tip of the catheter should lie above the level of the pericardium to minimize the risk of erosion through the wall of right atrium. 翻译：无论采取哪种途径，都要格外重视消毒的重要性。导管的尖端不应 . 可编辑修改13 超过心包膜水平，这样才能尽可能减小导管磨蚀右心房壁的危险性。 37.Losses of up to 10% of blood volume are tolerated well and may be replaced by an approprite volume of crystalloid solution. Blood loss in excess of 15% of blood volume during surgery should be replaced by blood. 翻译：10%以内的血容量丢失可以被机体很好地代偿，且这部分缺失可以 由适量的晶体液补充。但如果术中血容量的丢失高达 15%，此时则需要对病人 进行补血。 38.Estimation of fluid losses includes measurement of blood loss on swabs and drapes, fluid collection in suction jars and an allowance for evaporative loss. Fluid input and output must be measured as accurately as possible in babies and children. 翻译：对液体丢失的评估包括：对棉签，围巾上血量丢失的测量，吸引器 中的液体收集量，同时还要考虑到蒸发的丢失量。在婴幼儿和儿童病人的手术 中，液体的输入和输出要尽可能精确。 Chapter 5 Respiratory Physiology 39.The principal purpose of the respiratory system is the exchange of oxygen and carbon dioxide between the blood and respired gas. It has secondary roles in the control of acid base balance, the metabolism of hormones and the removal of compounds and particulate matter, taking advantages of its position as the only organ which receives the entire cardiac output. 翻译： 呼吸系统的主要功能是进行血液和吸入气体中的氧气和二氧化碳的 交换。同时由于它有利的生理解剖位置，作为可以接受全部心输出量的唯一器 . 可编辑修改14 官，还发挥着调节酸碱代谢的平衡，激素的代谢以及化合物和一些微粒的清除 等次要生理作用。 40.The lung surface area is about the size of a tennis court, and so this point of intersection with the external environment is huge. This is both an advantage and a disadvantage. 翻译：肺的表面积大约有一个网球场大小，因此这个和外环境相联系的场 所就显得相当巨大， 而这样既有利也有弊。 41.Therefore, the lungs are also a site of defense. The defense system exists at two levels. The first is to deal with inhaled particles. Depending upon their size, particles are either swept out of the airways entrapped in mucous or digested by macrophage. 翻译：如此说来，肺同时也扮演着机体防线的作用，它的防御作用体现在 两个水平。第一个是对吸入的颗粒的处理：由于颗粒大小的不同，那些黏附在 黏膜表面的颗粒会被直接清除出呼吸道，而有些则被巨噬细胞吞噬。 42.The lungs are a reservior of blood that can be mobilized during times of reduced volume. Approxiamtely 20% of the total blood volume resides in the pulmonary vasculature normally, but this volume can increase or decrease depending upon the output of the left ventricle. 翻译：肺脏扮演着储血库的角色，而其中的血液在机体循环血量减少时可 以被调动出来。通常情况下，机体大约 20%的总血容量储存在肺的血管网内， 但是这一储存量会随着左心室输出量的变化而产生相应的增加或减少。 43.Air is through into the body through the conducting airway. This begins . 可编辑修改15 with the trachea, which divideds into bronchi and subdivides multiple times into bronchioles. The conducting airways warm and humidify the inspired air but not a site of gas exchange. 翻译：空气是通过传导气道进入体内的，这一过程起始于气管，气管再分 支为支气管，再经过很多级的分支成为细支气管。传导气道的作用是对吸入气 体进行加热和湿化，但是没有气体交换功能。 44.The blood supply of the conducting airways provides the heat and moisture to warm and humidify the inspired air. It also provides for all the nutrient repuirments to lung tissue. 翻译：传导气道的血液供应不仅保证了对吸入气体进行加热和湿化所需的 热量和湿度，还提供了肺组织所需的营养物质。 45.Oxygen diffuses from the terminal bronchioles, through the respiratory bronchioles and alveolar sacs into the alveoli. It then diffuses across the alveolar epithelium, basement membranes, capillary endothelium, plasma and red cell membrane before combining with hemoglobin. Carbon dioxide diffuses in the reverse direction. 翻译：氧气的扩散途径如下：终末细支气管呼吸性细支气管肺泡囊 肺泡，到达肺泡后再依次穿过肺泡内皮细胞，基底膜，毛细血管内皮细胞等结 构进入血浆，最后穿过红细胞膜与血红蛋白结合。二氧化碳则按相反的方向扩 散。 46.Respiration is modified by many other factors, particularly from higher centers in the brain including the cortex. The pattern of respiration is modulated by . 可编辑修改16 speech and ingestion of food and drink. The anticipation of exercise as well as the activity itself increases respiration. 翻译：呼吸会受到很多其他因素的调节，特别是来自脑的高级中枢包括大 脑皮层的控制。呼吸模式会因说话或摄食水和食物等活动而发生相应的调整。 活动，甚至是对活动的期待也可以增强呼吸。 47.If the PaCO2 is kept constant, ?changes exponentially with PaO2. The response is linear when oxygenation is expressed as oxyhaemoglobin saturation(SaO2). The response is much greater if PaCO2 increases at the same time. 翻译：如果将 PaCO2 的值保持恒定，则？将随着动脉氧分压呈指数型 变化。当用氧合血红蛋白的饱和度来表示氧合的情况时，则两者的关系曲线呈 线性变化，当二氧化碳的动脉分压也同时增加时反应会更显著。 48.The total volume of the respiratory system(total lung capacity, TLC)when fully expanded by voluntary effort is about 3-6 litres in the average adult and is ralated more to height than weight. 翻译：在一个普通成人，呼吸系统的总容量（即肺总量）可以通过自主努 力完全扩张而达到 3-6 升，与体重相比，身高因素对肺总量的影响更大。 49.The closing capacity(CC) is that volume of the lung where small airways in the dependent parts of the lung begin to collapse during expiration. Normal