急诊医学专业英语Word文件下载.docx
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急诊医学专业英语Word文件下载.docx
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英译汉:
EmergencyDiagnosisandAssessmentofICHandItsCauses
RapidrecognitionanddiagnosisofICHareessentialbecauseofitsfrequentlyrapidprogressionduringthefirstseveralhours.Theclassicclinicalpresentationincludestheonsetofasuddenfocalneurologicaldeficitwhilethepatientisactive,whichprogressesoverminutestohours.Thissmoothsymptomaticprogressionofafocaldeficitoverafewhoursisuncommoninischemicstrokeandrareinsubarachnoidhemorrhage.HeadacheismorecommonwithICHthanwithischemicstroke,althoughlesscommonthaninsubarachnoidhemorrhage.
VomitingismorecommonwithICHthanwitheitherischemicstrokeorsubarachnoidhemorrhage.Increasedbloodpressureandimpairedlevelofconsciousnessarecommon.However,clinicalpresentationalone,althoughhelpful,isinsufficienttoreliablydifferentiateICHfromotherstrokesubtypes.
TheearlyriskofneurologicaldeteriorationandcardiopulmonaryinstabilityinICHishigh.IdentificationofprognosticindicatorsduringthefirstseveralhoursisveryimportantforplanningthelevelofcareinpatientswithICH.ThevolumeofICHandgradeontheGlasgowComaScale(GCS)onadmissionarethemostpowerfulpredictorsofdeathby30days.Hydrocephaluswasanindependentindicatorof30-daydeathinanotherstudy.Conversely,corticallocation,mildneurologicaldysfunction,andlowfibrinogenlevelshavebeenassociatedwithgoodoutcomesinmediumtolargeICH.
BecauseofthedifficultyindifferentiatingICHfromischemicstrokebyclinicalmeasures,emergencymedicinepersonneltriageandtransportpatientswithICHandischemicstroketohospitalssimilarly.Asdescribedbelow,patientswithICHoftenhavegreaterneurologicalinstabilityandriskofveryearlyneurologicaldeteriorationthandopatientswithischemicstrokeandwillhaveagreaterneedforneurocriticalcare,monitoringofincreasedintracranialpressure(ICP),andevenneurosurgicalintervention.Thislevelofcaremayexceedthatavailableatsomehospitals,eventhosethatmeetthecriteriaforprimarystrokecenters.Thus,eachhospitalthatevaluatesandtreatsstrokepatientsshoulddeterminewhethertheinstitutionhastheinfrastructureandphysiciansupporttomanagepatientswithmoderate-sizedorlargeICHsorhasaplantotransferthesepatientstoatertiaryhospitalwiththeappropriateresources.
InitialclinicaldiagnosticevaluationofICHatthehospitalinvolvesassessmentofthepatient’spresentingsymptomsandassociatedactivitiesatonset,timeofstrokeonset,age,andotherriskfactors.Thepatientorwitnessesarequestionedabouttrauma;
hypertension;
priorischemicstroke,diabetesmellitus,smoking,useofalcoholandprescription,over-thecounter,orrecreationaldrugssuchascocaine;
useofwarfarinandaspirinorotherantithrombotictherapy;
andhematologicdisordersorothermedicaldisordersthatpredisposetobleeding,suchassevereliverdisease.
Thephysicalexaminationfocusesonlevelofconsciousnessanddegreeofneurologicaldeficitafterassessmentofairway,breathing,circulation,andvitalsigns.Inseveralretrospectivestudies,elevatedsystolicbloodpressure_160mmHgonadmissionhasbeenassociatedwithgrowthofthehematoma,butthishasnotbeendemonstratedinprospectivestudiesofICHgrowth.Fever_37.5°
Cthatpersistsfor_24hoursisfoundin83%ofpatientswithpooroutcomesandcorrelateswithventricularextensionofthehemorrhage.
Brainimagingisacrucialpartoftheemergentevaluation.Computedtomography(CT)andmagneticresonancescansshowequalabilitytoidentifythepresenceofacuteICH,itssizeandlocation,andhematomaenlargement.Deephemorrhagesinhypertensivepatientsareoftenduetohypertension,whereaslobarhemorrhagesinnonhypertensiveelderlypatientsareoftenduetocerebralamyloidangiopathy;
however,asubstantialnumberoflobarhemorrhagesinhypertensive
patientsmaybeduetohypertension,andbothdeepandsuperficialhemorrhagesmaybecausedbyvascularabnormalitiesandothernonhypertensivecauses.
CTmaybesuperioratdemonstratingassociatedventricularextension,whereasmagneticresonanceimaging(MRI)issuperioratdetectingunderlyingstructurallesionsanddelineatingtheamountofperihematomaledemaandherniation.ACTscanwithcontrastmayidentifyanassociatedaneurysm,arteriovenousmalformation,ortumor.CTangiographymayprovideadditionaldetailinpatientswithsuspectedaneurysmorarteriovenousmalformation.
CThasalsoclarifiedthenaturalhistoryofICH.OneprospectivestudyofspontaneousICHinthe
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