外科臨床英語翻譯對照:休克(3)

Symptoms and Signs

癥狀體征

Lethargy, confusion, and somnolence are common. The hands and feet are pale, cool, clammy, and often cyanotic, as are the earlobes, nose, and nail beds. Capillary filling time is prolonged, and except in distributive shock, the skin appears grayish or dusky and moist. Overt diaphoresis may occur. Peripheral pulses are weak and typically rapid; often, only femoral or carotid pulses are palpable. Tachypnea and hyperventilation may be present. BP tends to be low (< 90 mm Hg systolic) or unobtainable; direct measurement by intra-arterial catheter, if done, often gives higher and more accurate values. Urine output is low.

常見癥狀有倦怠、意識模糊和瞌睡；手足蒼白、發(fā)冷、冷濕、常常伴有發(fā)紺，耳葉、鼻子和指甲床也是如此。毛細血管充盈時間延長，除分布性休克外，還可出現(xiàn)皮膚淺灰或灰黑潮濕癥狀。出汗明顯。周圍脈搏細速，通常只可捫及股或頸動脈�？赡芎粑�急促和換氣過度。血壓低（收縮壓＜90mm Hg)或測不到。但動脈直接插管所測得的血壓明顯較高較準確。排尿量少。

Distributive shock produces similar symptoms, except the skin may appear warm or flushed, especially during sepsis. The pulse may be bounding rather than weak. In septic shock, fever, usually preceded by chills, is generally present. Some patients with anaphylactic shock have urticaria or wheezing.醫(yī)學(xué)全在線www.med126.com

分布性休克癥狀類似，但皮膚溫暖或潮紅，尤其是敗血癥期間。脈搏洪大而不弱。敗血癥性休克通常先出現(xiàn)寒戰(zhàn)，然后發(fā)燒。有些過敏性休克病人會有蕁麻疹或喘鳴。

Numerous other symptoms (eg, chest pain, dyspnea, abdominal pain) may occur due to the underlying disease or secondary organ failure.

由于潛在疾病或繼發(fā)性器官衰竭，還可出現(xiàn)其他多種癥狀（如胸痛、呼吸困難腹痛等)。

Diagnosis

診斷

Diagnosis is mostly clinical, based on evidence of insufficient tissue perfusion (obtundation, oliguria, peripheral cyanosis) and signs of compensatory mechanisms (tachycardia, tachypnea, diaphoresis). Specific criteria include obtundation, heart rate > 100, respiratory rate > 22, hypotension (systolic BP < 90 mm Hg) or a 30 mm Hg fall in baseline BP, and urine output < 0.5 mL/kg/h. Laboratory findings that support the diagnosis include lactate > 3 mmol/L, base deficit < −5 mEq/L, and Paco2 < 32 mm Hg. However, none of these findings alone is diagnostic, and each is evaluated in the overall clinical context, including physical signs. Recently, measurement of sublingual PCO2 has been introduced as a noninvasive and rapid measurement of the severity of shock.

診斷以臨床診斷為主，可根據(jù)組織灌注不足（遲鈍、少、周圍發(fā)紺)和代償機制方面的一些癥狀（心動過速、呼吸急促、出冷汗)作出診斷。特殊標準包括遲鈍、心率＞100、呼吸率＞22、低血壓（收縮壓＜90 mm Hg)或比基線血壓低30 mm Hg，排尿量＜0.5 mL/kg/h.。支持診斷的化驗結(jié)果包括乳酸鹽＞3 mmol/L，　堿缺失＜−5 mEq/L，Paco2＜mm Hg。不過，單項檢驗結(jié)果都不能作為診斷依據(jù)，每項檢驗結(jié)果都應(yīng)結(jié)合總的臨床情況加以評價，包括身體癥狀。最近，有一種無創(chuàng)性快速檢測手段，即舌下PCO2測定法，已被引進用于測定休克的嚴重程度。

Diagnosis of cause: Recognizing the underlying cause of shock is more important than categorizing the type. Often, the cause is obvious or can be recognized quickly by history and physical examination, aided by simple testing.醫(yī)學(xué)全在線gydjdsj.org.cn

病因診斷：確定休克的潛在病因比給休克分類更重要。病因常常是明顯的，可以通過病史及體格檢查快速識別，并用簡單的檢驗加以確診。

Chest pain (with or without dyspnea) suggests MI, aortic dissection, or pulmonary embolism. A systolic murmur may indicate ventricular septal rupture or mitral insufficiency from acute MI. A diastolic murmur may indicate aortic regurgitation from aortic dissection involving the aortic root. Cardiac tamponade is suggested by jugular venous distention, muffled heart sounds, and a paradoxical pulse. Pulmonary embolism severe enough to produce shock typically produces decreased O2 saturation and occurs more often in special settings, including prolonged bed rest and after a surgical procedure. Tests include ECG, troponin I, chest x-ray, ABG measurements, lung scan, helical CT, and/or echocardiography.

胸痛（伴或無呼吸困難)提示心肌梗死、主動脈破裂或肺栓塞。收縮期雜音表明室中隔破裂或急性心肌梗死引起的二尖瓣閉鎖不全。舒張期雜音表明因主動脈破裂而引起的主動脈返流，累及主動脈根部。頸靜脈怒張、心音低沉、及奇脈提示心包填塞。嚴重的肺動脈栓塞產(chǎn)生典型的休克，可導(dǎo)致氧飽和度下降，某些情況下及術(shù)后較為常見，包括臥床休息時候延長。診斷檢查包括ECG、肌鈣蛋白I、胸透、ABG、肺部掃描、螺旋式計算機體層造影和或超聲心動圖等。

Abdominal or back pain or a tender abdomen suggests pancreatitis, ruptured abdominal aortic aneurysm, peritonitis, and, in women of childbearing age, ruptured ectopic pregnancy. A pulsatile midline mass suggests ruptured abdominal aortic aneurysm. A tender adnexal mass suggests ectopic pregnancy. Testing typically includes abdominal CT (if the patient is unstable, bedside ultrasound can be helpful), CBC, amylase, and lipase, and, for women of childbearing age, urine pregnancy test.

腹痛或背痛或腹部觸痛提示胰腺炎、腹主動脈瘤破裂、腹膜炎和育齡期婦女的異位妊娠破裂。正中線搏動性腫塊提示腹主動脈瘤破裂。附件觸痛腫塊提示異位妊娠。主要生化檢查包括腹部CT（如病人狀態(tài)不穩(wěn)，床邊超聲檢查有助于診斷)、CBC、淀粉酶檢查和脂酶檢查等，育齡期婦女則應(yīng)再作尿妊娠試驗。

Fever, chills, and focal signs of infection suggest septic shock, particularly in immunocompromised patients. Isolated fever, contingent on history and clinical settings, may point to heat stroke. Tests include chest x-ray; urinalysis; CBC; and cultures of wounds, blood, urine, and other relevant body fluids.

發(fā)燒、寒戰(zhàn)和局部感染癥狀提示敗血癥性休克，特別是免疫代償病人。無病史及臨床突發(fā)性單純發(fā)燒可指向熱性休克，檢查包括胸透、尿分析、CBC及傷口、血液、尿液及其他相關(guān)體液的培養(yǎng)。

In a few patients, the cause is occult. Patients with no focal signs or symptoms indicative of cause should have ECG, cardiac enzymes, chest x-ray, and ABG. If results of these tests are normal, the most likely causes include drug overdose, occult infection (including toxic shock), and obstructive shock.

有些病人的病因不易發(fā)現(xiàn)。病人沒有出現(xiàn)顯示病因的局部性或癥狀體征時就應(yīng)作ECG、心酶、胸透和ABG檢查。如檢查結(jié)果正常，最可能的原因包括藥物過量、隱匿性感染（包括中毒性休克)和阻塞性休克。

Ancillary testing: If not already obtained, ECG, chest x-ray, CBC, serum electrolytes, BUN, creatinine, PT, PTT, liver function tests, and fibrinogen and fibrin split products are done to monitor patient status and serve as a baseline. If the patient's volume status is difficult to determine, monitoring of central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) may be useful. CVP < 5 mm Hg (< 7 cm H2O) or PAOP < 8 mm Hg may indicate hypovolemia, although CVP may be greater in hypovolemic patients with preexisting pulmonary hypertension.

輔助檢查：如未曾獲得檢查結(jié)果，則ECG、胸透、CBC、血清電解質(zhì)分析、BUN、肌酑、PT、PTT、肝功檢查、纖維蛋白素原和纖維蛋白裂解產(chǎn)物等都可用以檢測病人狀況并充當(dāng)對照標準。如難以確定病人容量狀況，檢測中心靜脈壓（CVP)或肺動脈閉塞壓（PAOP)可能有用。CVP < 5 mm Hg (< 7 cm H2O)或PAOP < 8 mm Hg可能提示血容量不足，雖然原先患有肺動脈高血壓的低血容量性病人的CVP也可能較高。