Diabetic-retinopathy糖尿病視網(wǎng)膜病變英文

1、The normal structure of the eyeballTerms角膜：corneaCorne/o-,Cornea角膜，Megacornea大角膜，Microcornea小角膜，Kerat/o-,Keratitis角膜炎，Keratomalacia角膜軟化癥鞏膜：scleraScler/o-,Scleritis鞏膜炎，Episcleritis表層鞏膜炎，Episclera鞏膜上層（epi-，beyond something）,epidermis表皮，上皮Epidermal表皮的，外皮的虹膜:iris , Irid/o-,Iridotomy虹膜切開術(shù)，iridectomy虹膜切除術(shù)

2、，iridocyclitis虹膜睫狀體炎睫狀體：ciliary body脈絡(luò)膜:choroid , Choroid/o-,choroidal脈絡(luò)膜的，choroidoretinitis脈絡(luò)膜視網(wǎng)膜炎視網(wǎng)膜：retin/oretinitis視網(wǎng)膜炎，retinopathy視網(wǎng)膜病變,diabetic retinopathy糖尿病視網(wǎng)膜病變 瞳孔:pupil ,Pupill/o-,pupillomotor瞳孔運動的，pupillometer瞳孔計玻璃體:vitreous , Vitre/o-,vitreous玻璃體的,Vitrectomy玻璃體切除術(shù),Vitreretinal玻璃體視網(wǎng)膜的,Vit

3、reretinopathy玻璃體視網(wǎng)膜病變晶狀體：lens視盤：optic disk黃斑:macular視神經(jīng)：optic nerve中央凹:FoveaDiabetic retinopathyDefinition Causes Symptoms Risk factors Tests and diagnosis When to seek medical advice Complications Treatments and drugs Prevention Diabetic retinopathy DefinitionDiabetic retinopathy is a complication

4、of diabetes that results from damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). causeDiabetic retinopathy can happen to anyone who has type 1 diabetes or type 2 diabetes. Causes When you have diabetes, your body doesnt use sugar (glucose) properly. CausesIf y

5、our blood sugar level is too high, your natural lens may swell which can blur your vision. CausesEventually, too much sugar in your blood can damage the tiny blood vessels (capillaries毛細(xì)血管) that nourish the retina. This can result in diabetic retinopathy.capillary ,Capill/o- , n.& adj.毛細(xì)管(的)Capillar

6、itis毛細(xì)管炎Symptoms At first, diabetic retinopathy may cause no symptoms or only mild vision problems.Symptoms You can have diabetic retinopathy and not know it. In fact, symptoms are unusual in the early stages of diabetic retinopathy. Symptoms Eventually, however, diabetic retinopathy can result in b

7、lindness. In China ,diabetic retinopathy is a leading cause of blindness in adults. symptomsIn fact, up to 45 percent of adults diagnosed with diabetes in China have some degree of diabetic retinopathy, according to the National Eye Institute. symptomsAnd the longer you have diabetes, the more likel

8、y you are to develop diabetic retinopathy. SymptomsDiabetic retinopathy usually affects both eyes. SymptomsAs the condition progresses, diabetic retinopathy symptoms may include: A) Spots floating in your vision B) Blurred vision C)Dark streaks or a red film that blocks your vision D) Poor night vis

9、ion E) Vision lossDiabetic retinopathy is usually classified as early or advanced.Early diabetic retinopathy. Nonproliferative diabetic retinopathy (NPDR) is the most common type of diabetic retinopathy. It can be described as mild, moderate or severe. NPDR : (Non Prolifertive Dibetic Retinopthy) 非增

10、殖性糖尿病視網(wǎng)膜病變When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges（凸起） protrude（伸入） from the vessel walls, sometimes leaking or oozing fluid and blood into the retina. These bulges are called microaneurysms. Microaneurysms : 微動脈瘤，微血管瘤In the early stages of diabetic retin

11、opathy, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the vessel walls, sometimes leaking or oozing fluid and blood into the retina. As diabetic retinopathy progresses, new blood vessels may grow and threaten your vision. As the condition progresses, the smaller ves

12、sels may close entirely and the larger retinal veins may begin to dilate（擴大） and become irregular in diameter（直徑）. Nerve fibers in the retina may begin to swell. Sometimes the central part of the retina (macula) begins to swell, too. This is known as macular edema. Macula : 黃斑M(jìn)acular edema ：黃斑水腫term

13、sExtensive ：廣泛的，大量的Intraretinal microvascular abnormalitis （IRMA）視網(wǎng)膜內(nèi)微血管異常Intraretinal : 視網(wǎng)膜內(nèi)部的Microvascular ：微血管的Cotton wool spots : 棉絨斑Hemorrhage ：出血Roots that means blood：Hemo- ，hema- ,hem-, haemo- ,haema- ,haem-rrhage ,出血，流血Gastrointestinalrrhage 消化道出血Advanced diabetic retinopathy. Proliferative

14、 diabetic retinopathy (PDR) is the most severe type of diabetic retinopathy. When you have PDR, abnormal blood vessels grow in the retina. Sometimes the new blood vessels grow or leak into the vitreous (the clear, jelly-like substance that fills the center of your eye ). 玻璃體:vitreous ，Vitre/o-,vitre

15、ous玻璃體的,Vitrectomy玻璃體切除術(shù),Jelly-like :膠狀的Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach（脫離） from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure may build up in the eyeball. This can

16、damage the optic nerve . (The nerve that carries images from your eye to your brain ). Peripheral : 外圍的，不重要的Peri- ，外圍的，周圍的Perinatal 圍產(chǎn)期的，出生前后的Periportal 門靜脈周的，Periarteritis 動脈周圍炎，periappendicitis 闌尾周炎Exudative maculopathy : 滲出性黃斑病變Hard exudates :硬滲出物Hard exudates and hemorrhages lateral to macula ：單

17、側(cè)性黃斑硬性滲出和出血 Lateral :側(cè)部的Apparent ：明顯的Quadrant ：象限，四分之一圓Prominent ：顯著的Risk factors Diabetic retinopathy can happen to anyone who has diabetes. The risk is highest if you: Risk factorsHave poor control of your blood sugar levelHave high blood pressureHave high cholesterolAre pregnantAre black or Hispa

18、nicSmokeHispanic ：西班牙人Cholesterol ：膽固醇Risk factorsThe longer you have diabetes, the greater your risk of developing diabetic retinopathy. When to seek medical advice Early detection of diabetic retinopathy is the best way to prevent vision loss:（a）If you have diabetes, see your eye doctor for a year

19、ly dilated eye exam（擴瞳檢查） even if your vision seems fine.（b）If you become pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy. (c)Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy（模糊或有斑點）. Compl

20、icationsThe abnormal growth of new blood vessels in the retina can lead to serious vision problems: Vitreous hemorrhage. The new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye（vitreous）. Retinal detachment（視網(wǎng)膜脫離）. This may cause blurred vision, spots f

21、loating in your vision or severe vision loss.Glaucoma. The new blood vessels may interfere with the normal flow of fluid out of the eye and cause pressure in the eye to build up. Blindness. Eventually, diabetic retinopathy can lead to complete vision loss. Glaucoma ：青光眼Tests and diagnosisDiabetic re

22、tinopathy is best diagnosed with a dilated eye exam. During the exam, your eye doctor will look for: Abnormal blood vesselsSwelling, blood or fatty deposits in the retina Damage to the nerve tissueGrowth of new blood vessels and scar tissueBleeding in the vitreousRetinal detachmentTests and diagnosi

23、sAs part of the eye exam, your doctor may do a retinal photography test called fluorescein angiography. Your doctor also may request an optical coherence tomography (OCT) exam. Fundus fluorescein angiography (FFA)熒光素眼底血管造影術(shù)Fundus 眼底，基底，宮底，F(xiàn)luorescein 熒光素，angiography 血管造影術(shù)Fundus hemorrhage 眼底出血Optica

24、l coherence tomography （OCT）光學(xué)相干斷層掃描Coherence 連續(xù)性，相關(guān)性，一致性Tomography ：X線斷層攝影術(shù)=laminographyTreatments Treatment for diabetic retinopathy depends on the type of diabetic retinopathy you have, its severity and how well it may respond to specific treatments. Early diabetic retinopathy If you have nonprol

25、iferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your retina to determine if you need laser treatment.Advanced diabetic retinopathyIf you have proliferative diabetic retinopathy, youll need prompt surgical treatment. Sometimes surge

26、ry is recommended for severe nonproliferative diabetic retinopathy, too.Depending on the specific problems with your retina, options may include: Treatments and drugs laser treatmentsurgical treatment. VirtectomyPrevention Remember, diabetes doesnt necessarily doom you to poor vision. Taking an acti

27、ve role in diabetes management can go a long way toward preventing complications.Doom 宣告厄運 PreventionMake a commitment to managing your diabetes.Monitor your blood sugar level.Ask your doctor about a glycated hemoglobin test.Glycated hemoglobin test 糖化血紅蛋白檢測Glycated 糖化的，hemoglobin血紅蛋白=haemoglobinPre

28、ventionKeep your blood pressure and cholesterol under control.Quit smoking. Take stress seriously. Pay attention to vision changes.Want more information?Go to these websites:英文：(1)American Academy of Ophthalmology /(2)Canadian Ophthalmological Society http:/www.eyesite.ca/(3)National eye institute /

29、(4)免費網(wǎng)上檢索Medline數(shù)據(jù)庫 /healthgate/MEDLINE/search.shtml (5)美國國立醫(yī)學(xué)圖書館 /PubMed/中文：中國眼科醫(yī)學(xué)信息網(wǎng) /眼底病論壇 /index.htm中文醫(yī)網(wǎng)-文獻(xiàn)檢索 /doctor/search/qkjs.htm醫(yī)網(wǎng)導(dǎo)航-文獻(xiàn)檢索 /orange98/navigate.htm國家圖書館文獻(xiàn)提供中心 /dcylb The End兒童常見意外傷害概述意外傷害是指無意或無目的造成的損傷和死亡，包括交通事故、溺水、中毒、墜落、窒息、燒傷、燙傷、動物咬傷等。近年來，我國兒童意外傷害的發(fā)生率和死亡率呈上升趨勢，已成為0-14歲兒童死亡和致殘的主

30、要原因。燒（燙）傷燒（燙）傷是小兒經(jīng)常遇到的傷害，多發(fā)生于5歲以下的小兒，嬰幼兒約占半數(shù)以上。日常生活中以燙傷多見，火焰燒傷其次，少數(shù)為化學(xué)灼傷或電灼傷。燒燙傷多發(fā)生在裸露部位，如頭面部，四肢，臀部等。小兒皮膚薄而嫩，同等熱力在其身上造成的損傷比成人重。小兒身體小,受傷面積相對比成人大。嬰兒細(xì)胞外液量按體重比成人大1倍，因此嬰兒燒傷后易發(fā)生低血容量性休克和酸堿平衡失調(diào)及電解質(zhì)紊亂。嬰兒對感染的抵抗力低，創(chuàng)面容易被大小便污染，而發(fā)生敗血癥等合并癥。在燒傷48小時后，創(chuàng)面滲出停止而開始回吸收，若輸液過多，易發(fā)生充血性心力衰竭，肺水腫而使病情惡化。 診斷部位深度面積例如：頭面部淺5%燒（燙）傷組織的

31、分層表皮 ：生發(fā)層真皮 ：乳頭層 網(wǎng)狀層皮下組織筋膜肌肉骨骼 身體各部位體表面積所占比例的估算 身體部位 成人 小兒 頭 頸 發(fā) 部 3 9+ (12-年齡） 面 部 3 9X1 (9%) 頸 部 3 雙上肢 雙上臂 7 雙前臂 6 9X2 (18%) 9X2 雙 手 5 軀 干 軀干前 13 軀干后 13 9X3 (27%) 9X3 會 陰 1 雙下肢 雙 臀 5 雙大腿 21 9X5 1 (46%) 9X5 1 (12 年齡) 雙小腿 13 雙 足 7燒傷深度的分度鑒別要點分度 深度 病理 臨床表現(xiàn) 愈合過程一度（紅斑） 達(dá)表皮角質(zhì)層、 局部血管充血、 輕度紅、腫、熱、痛、感覺過敏 23天

32、痊愈、無瘢痕 生發(fā)層建在 擴張、滲出 表皮干燥、無水泡二度 淺二度 達(dá)真皮淺層、部分 血漿滲出、積于 劇痛、感覺過敏、有水泡、 約2周痊愈、不遺留瘢痕（水泡） 生發(fā)層建在 表皮和真皮之間 泡皮剝脫后可見創(chuàng)面均勻 、 可有色素沉著 發(fā)紅、潮濕、水腫明顯 深二度 達(dá)真皮深層、有 局部組織壞死、 感覺較遲鈍，可有或無水泡， 約34周愈合，有瘢痕 皮膚附件殘存 皮下層滲出明顯 基底蒼白、間有紅色斑點、創(chuàng)面 潮濕；拔毛時痛、毛根有正常解 剖結(jié)構(gòu)。數(shù)天后若無感染，可出 現(xiàn)網(wǎng)狀栓塞血管三度（焦痂） 達(dá)皮膚全層、有時 皮膚壞死、蛋白 皮膚感覺消失，無彈性、無水泡， 經(jīng)24周后焦痂脫落，形成 可深達(dá)皮下組織、

33、凝固、形成焦痂 如皮革狀、蠟白、焦黃或碳化； 肉芽創(chuàng)面，小面積創(chuàng)面可由 肌肉和骨骼 拔毛不痛。數(shù)天后若無感染，可出 周圍上皮匍行而愈合，遺 現(xiàn)樹枝樣栓塞血管 留瘢痕；稍大面積者，需要 植皮方能愈合 治療原則：把好三關(guān)一、創(chuàng)面關(guān)二、休克關(guān)三、感染關(guān).一、創(chuàng)面關(guān)1、清創(chuàng)盡快爭取在嚴(yán)密消毒下進(jìn)行清創(chuàng)術(shù)。方法是：頭、面、會陰部燒傷，先剃除毛發(fā)，用生理鹽水沖洗，去除脫落的表皮，用碘伏消毒創(chuàng)面。小的水泡讓其自行吸收，水泡完整而較大者用無菌注射器在低位抽吸。水泡已破但清潔，泡皮未移位者，不必移除，原位覆蓋。水泡已破且有明顯污染或泡皮已剝脫者，則予剪除。早期創(chuàng)面可以用碘伏或1%的磺胺嘧啶銀覆蓋。 2、創(chuàng)面處理

34、（1）包扎療法四肢和軀干的燒傷可采用此療法。主要目的是使創(chuàng)面得到充分引流，隔絕外源病原菌并保護創(chuàng)面。一般用碘伏紗布或者外涂濕潤燒傷膏，外加棉墊與繃帶環(huán)形包扎。12天打開更換一次，若有感染跡象，則應(yīng)打開，根據(jù)具體情況進(jìn)行相應(yīng)處理。（2）暴露療法頭、面部燒傷可采用此療法。主要外用藥物有：碘伏、濕潤燒傷膏、 1%的磺胺嘧啶銀。二、休克關(guān)1、鎮(zhèn)痛、鎮(zhèn)靜2、補液：每1%面積每千克體重需膠體溶液1ml，電解質(zhì)溶液1ml（即生理鹽水與0.167mol/L乳酸鈉的2：1溶液），膠體溶液以血漿、低分子右旋糖酐或羥乙基淀粉為主。如果較廣較深的燒傷輸入全血是必須的，全血與血漿的比例按1：2計算。例如：某患兒2歲，體

35、重12Kg,胸背部、腹部淺-深燒傷面積20%，補液計算方法：2012=240ml，總液體量即240ml膠體+240ml晶體+基礎(chǔ)需要量（60-200）12ml。其中基礎(chǔ)需要量宜用1/5張液體（即5%葡萄糖4份和生理鹽水1份）。第1個24小時的總量的一半應(yīng)在8小時內(nèi)輸入（840ml)，第2個24小時的繼續(xù)損失量應(yīng)為第1天的半量，其代謝過程日需要量仍與第1天差不多。輸液過程中嚴(yán)密觀察心率、呼吸、血壓和尿量，若患兒顏色恢復(fù)正常，心跳有力，血壓升到90/60mmHg，尿量增多為休克恢復(fù)的標(biāo)志。三、感染關(guān)燒傷感染的危害性燒傷感染最常見的并發(fā)癥，死亡病例的70%與燒傷感染有關(guān)預(yù)防感染救治的主攻目標(biāo) 一、防治感染的總體方略（一）抓好三重點休克期復(fù)蘇良好開端早期創(chuàng)面處理奠定治療基礎(chǔ)營養(yǎng)支持扶植