臨床英語(yǔ)英漢翻譯對(duì)照:暈厥1

Syncope(1)

暈厥(1)

James C. Chesnutt

Syncope is a common and concerning medical problem, which accounts for 3% of emergency room visits and up to 6% of hospital admissions. Although the cause of syncope can be life-threatening (e.g., ventricular tachycardia) and the result can be devastating (e.g., fractured hip), a definitive explanation for syncope is found less than one half of the time. Syncope recurrence is approximately 20% per year compared with an incidence of 2% for an initial episode of syncope.

暈厥是一種令人擔(dān)憂的常見(jiàn)病，占急診病例的3%，住院病例中可達(dá)6%。雖然暈厥的病因可能危及生命（如室性心動(dòng)過(guò)速)，并會(huì)產(chǎn)生嚴(yán)重后果（如髖部骨折)，但說(shuō)得清楚的暈厥卻不到一半。暈厥的復(fù)發(fā)率大約為20%年，初發(fā)率則為2%。

1. Approach.

1、診斷思路

Syncope is a brief loss of consciousness with collapse resulting from transient brain dysfunction based on decreased blood flow or neurologic insult. Syncope can be categorized based on the causative mechanism (See Table below). The most common causes are vasovagal (18%), arrhythmia (14%), neurologic (10%), orthostatic hypotension (8%), and situational (5%).

暈厥是暫時(shí)性意識(shí)喪失并跌倒，它是因?yàn)檠�流減少或神經(jīng)損傷而造成一過(guò)性大腦功能失調(diào)而引起的。根據(jù)誘發(fā)機(jī)制，暈厥可以分為幾類。從誘因看，最常見(jiàn)的有血管迷走神經(jīng)性（占18%)、心率不齊性（14%)、神經(jīng)性（10%)、直立性低血壓性（8%)和環(huán)境因素引起的暈厥（5%)。

Types of syncope with selected examples

暈厥分類及舉例

CARDIOGENIC SYNCOPE (CS)

1. Arrhythmia, including ventricular tachycardia, sick sinus syndrome, atrial fibrillation, atrioventricular block and others
2. Organic heart disease, including coronary artery disease congestive heart failure valvular disease, hypertrophic cardiomyopathy, and others.醫(yī)學(xué)全在線www.med126.com

心源性暈厥（CS)

1. 心律失常，包括室性心動(dòng)過(guò)速、病竇綜合癥、房性纖顫、房室傳導(dǎo)阻滯，其他。
2. 器質(zhì)性心臟病，包括冠狀動(dòng)脈疾病、充血性心力衰竭、心臟瓣膜疾病、肥厚性心肌病，其他。

NEUROGENIC SYNCOPE (NS)

1. Seizure disorder
2. Transient ischemic attack and stroke
3. Subclavian steal syndrome and others

神經(jīng)性暈厥（NS)

1. 癲癇。
2. 一過(guò)性腦缺血發(fā)作和腦卒中。
3. 鎖骨下動(dòng)脈竊血綜合征及其他。

NEUROCARDIOGENIC SYNCOME (NCS)

1. Vasovagal
2. carotid sinus hypersensitivity
3. Orthostatic hypotension
4. Dysautonomic
5. Postural orthostatic tachycardia syndrome
6. Situational, including micturition, cough, and others

神經(jīng)心源性暈厥（NCS)

1. 血管迷走神經(jīng)性。
2. 頸動(dòng)脈竇過(guò)敏。
3. 直立性低血壓。
4. 自主神經(jīng)功能紊亂。
5. 體位性心動(dòng)過(guò)速綜合癥。
6. 環(huán)境因素，包括排尿、咳嗽，其他。

UNCLASSIFIED SYNCOPE

1. Drugs
2. Alcohol
3. Psychogenic
4. Hypoglycemia
5. Pregnancy
6. Hypoxemia, dehydration, and others

未分類暈厥

1. 藥物。
2. 酒精。
3. 心理因素。
4. 低血糖。
5. 妊娠。
6. 低氧血癥，脫水及其他。

2. History

2、病史檢查

What are the symptoms or circumstances related to the syncope?

1. Dizziness preceding syncope is highly associated with a psychological cause (24%) versus syncope without preceding dizziness (5%). Dizziness with syncope can also be associated with arrhythmia.
2. Important history includes palpitation, duration of prodrome and recovery, and presence of postural or exertional symptoms.
3. Related environmental factors include heat, dehydration, and alcohol.

1. 與無(wú)頭暈性暈厥相比，頭暈后暈厥與精神性誘因關(guān)聯(lián)很大，前者占5%，后者則占24%。頭暈伴暈厥也與心律不齊有關(guān)。
2. 重要病史包括：心悸、前驅(qū)癥狀及恢復(fù)時(shí)間、以及體位性或勞力性癥狀。
3. 相關(guān)環(huán)境因素包括：高溫、脫水和酒精。

Which disease, risk factor, or family history is present?

1. Organic heart disease is associated with arrhythmia and increased risk of death.
2. Psychiatric illnesses most commonly associated with syncope are major depression (12.2%), alcoholism (9.2%), generalized anxiety disorder (8.6%), and panic disorder (4.3%). These correlate with a higher rate of recurrent syncope, younger age, and a more benign course.
3. Older age (>60 years) is more highly associated with arrhythmias, orthostatic hypotension, medication side-effects, and situational (e.g., micturition) syncope.
4. Ask about diabetes mellitus, neuropathy, anemia, and other chronic diseases.
5. Inquire about a family history of sudden death, hypertrophic cardiomyopathy, or other organic heart disease.

1. B. 疾病、危險(xiǎn)因素及家族史

1. 器質(zhì)性心臟病可伴隨心律不齊和死亡危險(xiǎn)增加。
2. 與暈厥最有關(guān)系的精神疾病包括嚴(yán)重的抑郁（12.2%)、酒精中毒（9.2%)、全身性焦慮（8.6%)和恐懼�。�4.3%)。上述疾病通常與較高的暈厥復(fù)發(fā)率、年幼和較為良性的病程有關(guān)。
3. 老齡病人（＞60歲)與心律不齊、直立性低血壓、藥物副作用和環(huán)境性（如排尿)暈厥關(guān)聯(lián)更大。
4. 詢問(wèn)糖尿病、神經(jīng)病、貧血和其他慢性病。
5. 查詢卒死、肥厚性心肌病及其他器質(zhì)性心臟病的家族史。

What medications does the patient take?

The most commonly implicated are antihypertensives and antidepressants. Others include antianginals, analgesics, and sedatives.

病人用藥

最常見(jiàn)的影響藥物有降壓藥和抗抑郁劑。其他藥物包括抗心絞痛藥、麻醉劑和鎮(zhèn)靜劑。