《医学英语》五年制教学课件
医学英语五年制教学课件,医学英语,医学,英语,五年制,教学,课件
LOGOChapter14TheHeartMedicalTerminology吉林大学中日联医院吉林大学中日联医院心脏外科心脏外科林柏松林柏松Basicintroduction42000-2003医学博士医学博士12352004-2008李玉林教授博士后李玉林教授博士后李玉林教授博士后李玉林教授博士后2004.12副教授、硕士导师副教授、硕士导师1987-1992医学本科(毕业后留科)医学本科(毕业后留科)1995-1998医学硕士医学硕士Basicintroduction9678102012.11印度克拉拉邦总医院心脏外科印度克拉拉邦总医院心脏外科2013.05心脏外科副主任心脏外科副主任2013.09吉林省政府咨询专家吉林省政府咨询专家2010.09教授、主任医师教授、主任医师2006.1-2007.7国家公派德国心脏中心国家公派德国心脏中心LOGO True wisdom consists not only in seeing what is before your eyes,but in foreseeing what is to come.Terence,Aldelphi,1.386.(Act III,Scene 3)真正的智慧是不仅看到你眼前所看到真正的智慧是不仅看到你眼前所看到的的,而且要预见将要发生的。而且要预见将要发生的。泰伦斯,泰伦斯,阿德菲阿德菲,1.386.(第三幕,第三场)(第三幕,第三场)BloodPressureAssessmentssmntvThePrinciplesprnsplvBloodpressurecanbemeasureddirectlywithanintra-arterial,intr:tiril catheterkt orindirectlywithasphygmomanometer,sfgmomnmt.Thesphygmomanometerconsistsofaninflatablenfletbl rubberbladderwithinaclothcover,arubberbulb橡皮袋toinflatethebladder,andamanometermnmt tomeasurethepressureinthebladder.BloodPressureAssessmentssmntvassessment英英sesmnt美美ssmntn.评定;估价vprinciples英英prnsplz美美prnsplzn.原则;法则;信念(principle的复数);本源v.向灌输原则(principle的第三人称单数形式)vintra-arterial,intr:tiriln.动脉内的vcatheter英英kt美美ktn.医导管;导尿管;尿液管vsphygmomanometer英英,sfgmmnmt美美,sfgmomnmtn.内科血压计vsphygmous脉搏的脉搏的sphygmo-与脉有关的BloodPressureAssessmentssmntvinflatable英英nfletb()l美美nfletbladj.膨胀的,可充气的;得意的vrubber英英rb美美rbn.橡胶;橡皮;合成橡胶;按摩师adj.橡胶制成的vt.涂橡胶于;用橡胶制造vi.扭转脖子看;好奇地引颈而望n.(Rubber)人名;(西)鲁韦尔vbulb英英blb美美blbn.电灯泡;鳞茎;球状物vi.生球茎;膨胀成球状vinflate英英nflet美美nfletvt.使充气;使通货膨胀vi.膨胀;充气vmanometer英英mnmt美美mnmtn.压力计;流测压计;血压计BloodPressureAssessmentssmntvThePrinciplesprnsplvBloodpressurecanbemeasureddirectlywithanintra-arterial,intr:tiril catheterkt orindirectlywithasphygmomanometer,sfgmomnmt.Thesphygmomanometerconsistsofaninflatablenfletbl rubberbladderwithinaclothcover,arubberbulb橡皮袋toinflatethebladder,andamanometermnmt tomeasurethepressureinthebladder.BloodPressureAssessmentssmntvIndirectmeasurementmmntofbloodpressureinvolvesnvlvtheauscultatory:sklttridetectiondtknoftheappearanceanddisappearanceoftheKorotkoffsounds柯氏音柯氏音overthecompressedkmprstartery.Korotkoffsoundsarelow-pitchedlupittsoundsoriginatingridineitiinthevesselthatarerelatedtoturbulencetbjlnsproducedbypartiallyprlioccludinganarterywithabloodpressurecuff.BloodPressureAssessmentssmntvauscultatory:sklttriadj.听诊的vauscultatorygap听诊无音间隙vdetection英英dtek()n美美dtknn.侦查,探测;发觉,发现;察觉vKorotkoffSounds低沈的冲击声、低沈的冲击声、柯氏音柯氏音vcompressed英英kmprest美美kmprstadj.被压缩的;扁平的vlow-pitched英英lupittadj.低调的;低沉的;倾斜缓的vturbulence英英tbjl()ns美美tbjlnsn.骚乱,动荡;流湍流;狂暴BloodPressureAssessmentssmntv听诊间隙听诊间隙(柯氏第1音出现后又很快消失继而会重新出现并最终消失为柯氏第5音,即在收缩压与舒张压之间出现一段无声期,可能由上肢静脉充盈及动脉前向血流较少所致,老年人及伴终末靶器官损害的高血压患者较易出现,可能系动脉内压力波动的反映),收缩压应在出现柯氏第一音时读取,而不是是声音再次出现时。12岁儿童、妊娠妇女、严重贫血、甲状腺功能亢进、主动脉瓣关闭不全及柯氏音不消失者,以柯氏音第4期(变音)定为舒张压,注意在记录时标明。BloodPressureAssessmentssmntv俄国学者柯洛特柯夫(Korotokoff)发现,用臂带绑扎上臂并加压,将肱动脉血管压瘪,然后再减压,随着外压力的降低,从臂带内的听诊器中可以听到血流重新冲开血管后发出与脉搏同步的摩擦、冲击音。1905年,柯氏报告了他的这一发现。由于这一发现的重要性,以后即命名这种摩擦、冲击音为柯氏音。v柯氏描述了柯氏音可以分为五期(也称时相),即弹响音、杂音、拍击音、捂音和消失音的共同性特点。他提出,把能听到的弹响音第一声时对应的外压力作为收缩压,与心脏收缩在肱动脉内形成的最高血液内压力相当;消失音(儿童取拍击音向捂音转变时的“变音”)时记为舒张压,与心脏舒张在肱动脉内形成的最低血液内压力相当。BloodPressureAssessmentssmntvIndirectmeasurementmmntofbloodpressureinvolvesnvlvtheauscultatory:sklttridetectiondtknoftheappearanceanddisappearanceoftheKorotkoffsounds柯氏音柯氏音overthecompressedkmprstartery.Korotkoffsoundsarelow-pitchedlupittsoundsoriginatingridineitiinthevesselthatarerelatedtoturbulencetbjlnsproducedbypartiallyprlioccludinganarterywithabloodpressurecuff.BloodPressureAssessmentssmntvSeveralphasesfesizoccurinsequencesikwnsastheoccludingpressuredrops压力下降.Phase1occurswhentheoccludingpressurefallstothesystolicsstlkbloodpressure.Thetappingtpsoundsareclearandgraduallyincreaseinintensityastheoccludingpressurefalls.Phase2occursatapressureabout10to15mmHglowerthanthatinphase1andconsistsoftappingsoundsfollowedbymurmurs.BloodPressureAssessmentssmntvphase英英fez美美fezn.相;阶段;天位相vt.使定相;逐步执行vi.逐步前进复数fesizvocclude英英klud美美kludvt.使闭塞;封闭;挡住vi.咬合vsequence英英sikw()ns美美sikwnsn.数计序列;顺序;续发事件vt.按顺序排好vinsequence依次,逐一vsystolic英英sstlk美美sstlkadj.心脏收缩的vtappingtpn.冶出钢;开孔;出渣;轻敲声v.轻敲(tap的ing形式);轻拍vmmHgabbr.毫米汞柱(millimetre(s)ofmercury)(液压单位)vmercurymkjrin.化汞,水银天水星,温度表,精神,元气BloodPressureAssessmentssmntvSeveralphasesfesizoccurinsequencesikwnsastheoccludingpressuredrops压力下降.Phase1occurswhentheoccludingpressurefallstothesystolicsstlkbloodpressure.Thetappingtpsoundsareclearandgraduallyincreaseinintensityastheoccludingpressurefalls.Phase2occursatapressureabout10to15mmHglowerthanthatinphase1andconsistsoftappingsoundsfollowedbymurmurs.BloodPressureAssessmentssmntvPhase3occurswhentheoccludingpressurefallsenoughtoallowalargeamountofvolumetocrossthepartiallyoccludedartery.Thesoundsaresimilartothesoundsofphase2,exceptthatonlythetappingsoundsareheard.Phase4istheabruptbrptmufflingmflianddecreasedintensityofthesoundsasthepressureapproachesprotthediastolic,dastlkbloodpressure.Phase5isthecompletedisappearance,dsprnsofthesounds.Thevesselisnolongercompressedbytheoccludingcuff.Turbulenttbjlntflowisnolongerpresent.BloodPressureAssessmentssmntvabrupt英英brpt美美brptadj.生硬的;突然的;唐突的;陡峭的vmufflingv.消声(muffle的ing形式)vmuffle英英mf()l美美mflvt.蒙住;裹住;抑制;发低沉的声音n.低沉的声音;消声器;包裹物(如头巾,围巾等);唇鼻部vapproach英英prt美美protn.方法;途径;接近vt.接近;着手处理vi.靠近vdiastolic英英,dastlk美美,dastlkadj.心脏舒张的vdisappearance英英dsprns美美,dsprnsn.消失;不见vturbulentflow流湍流;流紊流vturbulent英英tbjl()nt美美tbjlntadj.骚乱的,混乱的;狂暴的;吵闹的;激流的,湍流的BloodPressureAssessmentssmntvPhase3occurswhentheoccludingpressurefallsenoughtoallowalargeamountofvolumetocrossthepartiallyoccludedartery.Thesoundsaresimilartothesoundsofphase2,exceptthatonlythetappingsoundsareheard.Phase4istheabruptbrptmufflingmflianddecreasedintensityofthesoundsasthepressureapproachesprotthediastolic,dastlkbloodpressure.Phase5isthecompletedisappearance,dsprnsofthesounds.Thevesselisnolongercompressedbytheoccludingcuff.Turbulenttbjlntflowisnolongerpresent.BloodPressureAssessmentssmntvThenormalbloodpressureforadultsdltisupto140mmHgsystolicandupto85mmHgdiastolic.Forthediastolicbloodpressurereading,thepointofdisappearanceoftheKorotkoffsoundsisprobablymoreaccuratekjrtthanthepointofmufflingmfli.However,ifthepointofdisappearanceismorethan10mmHglowerthanthepointofmuffling,thepointofmufflingisprobablymoreaccurate.BloodPressureAssessmentssmntvadult英英dlt;dlt美美dltadj.成年的;成熟的n.成年人vaccurate英英kjrt美美kjrtadj.精确的vmufflingv.消声(muffle的ing形式)BloodPressureAssessmentssmntvThenormalbloodpressureforadultsdltisupto140mmHgsystolicandupto85mmHgdiastolic.Forthediastolicbloodpressurereading,thepointofdisappearanceoftheKorotkoffsoundsisprobablymoreaccuratekjrtthanthepointofmufflingmfli.However,ifthepointofdisappearanceismorethan10mmHglowerthanthepointofmuffling,thepointofmufflingisprobablymoreaccurate.BloodPressureAssessmentssmntvRecordingboththepointofmufflinganddisappearancefrequentlyfrikwntlihelpsincommunicationk,mjunken.Abloodpressuremightberecordedas125/75-65:thesystolicbloodpressureis125;thepointofmufflingis75;thepointofdisappearanceis65(thediastolicbloodpressure).BloodPressureAssessmentssmntvfrequently英英frikw()ntl美美frikwntliadv.频繁地,经常地;时常,屡次vcommunication英英kmjunke()n美美k,mjunkenn.通讯,通信通信;交流BloodPressureAssessmentssmntvRecordingboththepointofmufflinganddisappearancefrequentlyfrikwntlihelpsincommunicationk,mjunken.Abloodpressuremightberecordedas125/75-65:thesystolicbloodpressureis125;thepointofmufflingis75;thepointofdisappearanceis65(thediastolicbloodpressure).BloodPressureAssessmentssmntvBloodpressureshouldberecordedonlytothenearest5mmHgbecausethereisa3mmHglimitofaccuracyforallsphygmomanometers,sfgmomnmt.Inaddition,normalbloodpressurechangesoccurfrommomenttomoment,andmeasuringtolessthan5mmHgprovidesafalseflssensesnsofaccuracykjrsi.BloodPressureAssessmentssmntvfalse英英fls;fls美美flsadj.错误的;虚伪的;伪造的adv.欺诈地vsense英英sens美美snsn.感觉,官能;观念;道理;理智vt.感觉到;检测vaccuracy英英kjrs美美kjrsin.数精确度,准确性BloodPressureAssessmentssmntvBloodpressureshouldberecordedonlytothenearest5mmHgbecausethereisa3mmHglimitofaccuracyforallsphygmomanometers,sfgmomnmt.Inaddition,normalbloodpressurechangesoccurfrommomenttomoment,andmeasuringtolessthan5mmHgprovidesafalseflssensesnsofaccuracykjrsi.BloodPressureAssessmentssmntvThesizeofthecuffisimportantfortheaccuratedeterminationd,tmnenofbloodpressure.Itisrecommended,rkmndthatthecuffkfbesnuglysngliappliedpladaroundthearm,withitslowestedge1inchabovetheantecubital,ntikju:bitlfossafs.Thecuffshouldbeapproximatelyprksmtli20%widerthanthediameteroftheextremitykstrmti.Thebladdershouldoverlieovlaitheartery.Theuseofacuffthatistoosmallforalargearmresultsinanerroneouslyirunislihighreadingofbloodpressure.BloodPressureAssessmentssmntvdetermination英英d,tmne()n美美d,tmnenn.决心;果断vrecommended英英美美,rkmndadj.被推荐的v.推荐,介绍;建议(recommend的过去分词)vitisrecommendedthat有人推荐vsnuglysngliadv.舒适地;隐蔽地;贴身地;紧密地vapplied英英plad美美pladadj.应用的;实用的v.应用;实施(apply的过去分词);敷上vantecubital,ntikju:bitladj.解剖肘前的vfossafsn.解剖凹;小窝BloodPressureAssessmentssmntvapproximately英英prksmtl美美prksmtliadv.大约,近似地;近于vextremity英英kstremt;ek-美美kstrmtin.极端;绝境;非常手段;手足voverlie英英vla美美ovlaivt.躺在上面;覆在上面;压在(婴儿、幼仔)身上使之窒息而死verroneouslyirunisliadv.错误地;不正确BloodPressureAssessmentssmntvThesizeofthecuffisimportantfortheaccuratedeterminationd,tmnenofbloodpressure.Itisrecommended,rkmndthatthecuffkfbesnuglysngliappliedpladaroundthearm,withitslowestedge1inchabovetheantecubital,ntikju:bitlfossafs.Thecuffshouldbeapproximatelyprksmtli20%widerthanthediameteroftheextremitykstrmti.Thebladdershouldoverlieovlaitheartery.Theuseofacuffthatistoosmallforalargearmresultsinanerroneouslyirunislihighreadingofbloodpressure.BloodPressureAssessmentssmntvAnothercauseoffalselyf:lslielevatedelvetdbloodpressurereadingsislackofsupportofthepatientsarm.Toobtainanaccuratemeasurement,thecuffmustbeatheartlevel.Ifthearmisnotsupported,thepatientisperformingisometricexercise,whichraisestherecordedpressure.BloodPressureAssessmentssmntvfalselyf:lsliadv.错误地;虚伪地;不实地velevated英英elvetd美美lvetdadj.提高的;高尚的;严肃的;欢欣的v.提高;抬起;振奋;提拔(elevate的过去分词)n.高架铁路visometric英英as()metrk美美asmtrkadj.数等距的;等角的;等轴的;等体积的n.等容线visometricexercise等长练习;静力训练BloodPressureAssessmentssmntvAnothercauseoffalselyf:lslielevatedelvetdbloodpressurereadingsislackofsupportofthepatientsarm.Toobtainanaccuratemeasurement,thecuffmustbeatheartlevel.Ifthearmisnotsupported,thepatientisperformingisometricexercise,whichraisestherecordedpressure.BloodPressureAssessmentssmntvIncontrast,excessiveksesv;pressureonthediaphragmdafrmofthestethoscopestskopproducesaspuriouslyspjrslilowerreadingofthediastolicbloodpressurewithoutanysignificantsnfkntalteration,ltrenofsystolicpressure.Ifthearmisheldcorrectly,noskinindentations,ltrenshouldoccur.BloodPressureAssessmentssmntvexcessive英英ksesv;ek-美美ksesv;adj.过多的,极度的;过分的vexcessivepressure剩余压力;过度压力vdiaphragm英英dafrm美美dafrmn.隔膜;快门,摄光圈;横隔膜;隔板vstethoscope英英steskp美美stskopvt.用听诊器诊断n.临床听诊器vspuriouslyspjrsliadv.伪造地;不合逻辑地;虚假地vsignificant英英sgnfk()nt美美snfkntadj.重大的;有效的;有意义的;值得注意的;意味深长的n.象征;有意义的事物valteration英英ltre()n;l-美美,ltrenn.修改,改变;变更BloodPressureAssessmentssmntvIncontrast,excessiveksesv;pressureonthediaphragmdafrmofthestethoscopestskopproducesaspuriouslyspjrslilowerreadingofthediastolicbloodpressurewithoutanysignificantsnfkntalteration,ltrenofsystolicpressure.Ifthearmisheldcorrectly,noskinindentations,ltrenshouldoccur.BloodPressureAssessmentssmntvTheauscultatory:sklttrigapisthesilencethatoccursbetweenthedisappearanceoftheKorotkoffsoundsaftertheinitialappearanceandtheirreappearanceatalowerpressure.Theauscultatorygapispresentwhenthereisadecreasedbloodflowtotheextremitieskstrmti,asisfoundinhypertensionandinaorticertkstenosisstnoss.Itsclinicalimportanceliesinthefactthatthesystolicbloodpressuremaybemistakenforthelowerbloodpressure,thepointofreappearance.BloodPressureAssessmentssmntvauscultatory:sklttriadj.听诊的vauscultatorygap听诊无音间隙vaortic英英etk美美ertkadj.大动脉的vstenosis英英stnss美美stnossn.(器官)病理狭窄v听诊间隙听诊间隙(柯氏第1音出现后又很快消失继而会重新出现并最终消失为柯氏第5音,即在收缩压与舒张压之间出现一段无声期,可能由上肢静脉充盈及动脉前向血流较少所致,老年人及伴终末靶器官损害的高血压患者较易出现,可能系动脉内压力波动的反映),收缩压应在出现柯氏第一音时读取,而不是是声音再次出现时。BloodPressureAssessmentssmntvTheauscultatory:sklttrigapisthesilencethatoccursbetweenthedisappearanceoftheKorotkoffsoundsaftertheinitialappearanceandtheirreappearanceatalowerpressure.Theauscultatorygapispresentwhenthereisadecreasedbloodflowtotheextremitieskstrmti,asisfoundinhypertensionandinaorticertkstenosisstnoss.Itsclinicalimportanceliesinthefactthatthesystolicbloodpressuremaybemistakenforthelowerbloodpressure,thepointofreappearance.BloodPressureAssessmentssmntvDetermineBloodPressurebyPalpationplpetvBloodpressureassessmentisperformedwiththepatientlyingcomfortablyinthesupinesupanposition.Thecuffbladderiscenteredsntdovertherightbrachialbreklartery.Ifthearmisobese()bis,alargeadultorthighacuffshouldbeused.Thearmshouldbeslightlyslatliflexedflksd,anditshouldbesupportedatapproximatelyprksmtlitheleveloftheheart.BloodPressureAssessmentssmntvpalpationplpetn.触诊;扪诊vsupine英英s(j)upan美美supanadj.仰卧的;懒散的;掌心向上的;向后靠的vcentered英英美美sntdadj.居中的;有圆心的v.集中;居中(center的过去式和过去分词形式)vbrachial英英brekl美美brekladj.臂的,臂状的vobese英英()bis美美obisadj.肥胖的,过胖的vthigh英英a美美an.大腿,股vslightly英英slatl美美slatliadv.些微地,轻微地;纤细地vflex英英fleks美美flksvt.折曲;使收缩vi.弯曲;收缩n.屈曲;电线;松紧带adj.弹性工作制的vapproximately英英prksmtl美美prksmtliadv.大约,近似地;近于BloodPressureAssessmentssmntvDetermineBloodPressurebyPalpationplpetvBloodpressureassessmentisperformedwiththepatientlyingcomfortablyinthesupinesupanposition.Thecuffbladderiscenteredsntdovertherightbrachialbreklartery.Ifthearmisobese()bis,alargeadultorthighacuffshouldbeused.Thearmshouldbeslightlyslatliflexedflksd,anditshouldbesupportedatapproximatelyprksmtlitheleveloftheheart.BloodPressureAssessmentssmntvTodeterminethesystolicbloodpressureadequatelydikwitliandtoexcludeanerrorasaresultofanauscultatorygap,bloodpressureisfirstassessedsestbypalpation.Inthisprocedureprsid,therightbrachialbreklorrightradialredlarteryispalpatedwhilethecuffisinflatedabovethepressurerequiredtoobliteratebltretthepulsepls.BloodPressureAssessmentssmntvadequatelydikwitliadv.充分地;足够地;适当地vassessedsestv.对进行评估(assess过去时形式)vprocedure英英prsid美美prsidn.程序,手续;步骤vradial英英redl美美redladj.半径的;放射状的;光线的;光线状的n.射线,光线vradialartery解剖桡动脉;桡骨动脉vobliterate英英bltret美美bltretvt.消灭;涂去;冲刷;忘掉vpulse英英pls美美plsn.电子脉冲;脉搏vt.使跳动vi.跳动,脉跳BloodPressureAssessmentssmntvTodeterminethesystolicbloodpressureadequatelydikwitliandtoexcludeanerrorasaresultofanauscultatorygap,bloodpressureisfirstassessedsestbypalpation.Inthisprocedureprsid,therightbrachialbreklorrightradialredlarteryispalpatedwhilethecuffisinflatedabovethepressurerequiredtoobliteratebltretthepulsepls.BloodPressureAssessmentssmntvTheadjustabledstblscrewisopenedslowlyfordeflationdflen.Thesystolicpressureisidentifiedbythereappearanceofthebrachialpulse.Assoonasthepulseisfelt,theadjustablescrewisopenedforrapiddeflation.ThisassessmentisdemonstrateddmnstretidinFigure14-20.BloodPressureAssessmentssmntvadjustable美美dstbladj.可调节的vadjustablescrew可调螺钉vdeflation英英dfle()n美美dflenn.通货紧缩;放气vdemonstrate英英demnstret美美dmnstretvt.证明;展示;论证vi.示威BloodPressureAssessmentssmntvTheadjustabledstblscrewisopenedslowlyfordeflationdflen.Thesystolicpressureisidentifiedbythereappearanceofthebrachialpulse.Assoonasthepulseisfelt,theadjustablescrewisopenedforrapiddeflation.ThisassessmentisdemonstrateddmnstretidinFigure14-20.LOGO
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