可编辑
可编辑
本篇包括人卫第四版 Unit 3B ，Unit4A ，5A，8A，10A，12AB，
13A 等七篇课文
Unit 3 Text B The Other Side of Antibiotics
抗生素的另一面
Antibiotics have eliminated or controlled so many infectious diseases that virtually everyone has benefited from their use at one time or another. Even without such personal experience, however, one would have to be isolated indeed to be unaware of the virtues, real and speculative,
of these “ miracle
”drugs 1. The
American press, radio, and television have done a good job of reporting the truly
remarkable story of successes in the chemical war on germs. What s more, any shortcomings on their part have been more than made up for by the aggressive public relations activity of the pharmaceutical companies which manufacture and sell antibiotics.
抗生素可以消除或控制很多种感染疾病，以致几乎每人生病时都习惯于使用它而受益， 但是如果一个人没有这样的亲身经历， 他必定是离群索居才会不知道这些 “特效药物”或真 实或推测的优点。美国的出版物、电台或电视台用大量的篇幅报道了有关对细菌的化学战中 获得的这些显著功绩。而它的缺点却被生产和销售抗生素的制药公司通过公关活动掩藏了。
In comparison, the inadequacies and potential dangers of these remarkable drugs are much less widely known. And the lack of such knowledge can be bad, especially if it leads patients to pressure their doctors into prescribing antibiotics when such medication isn 't really needed, or leads them to switch doctors until they find one who is, so to speak, antibiotics-minded
2.
相比而言， 使用这些药物的危险性并不广为人知。
对这种知识的缺乏将更糟糕， 特别是 当患者要求医生开处方用抗生素而事实并不需要， 或患者频繁地更换医生直至找到一个同意 开抗生素处方的医生。
Because the good side of the antibiotics story is so very well-known, there seems more point here to a review of some of the immediate and long-range problems that can come from today
' s casual use of these drugs. It should be made
clear in advance that calamities from the use of antibiotics are rare in relation to the enormous amounts of the drugs administered. But the potential hazards, so little touched on generally, do need a clear statement.
因为抗生素的好的一面已广为人知， 今天抗生素的滥用导致短期或长期问题。
我们预先 应该知道与抗生素的巨大的使用量相比
,它产生危害的例子是少见的。
但是，尽管十分少见，
需要对这种潜在的危险作一个清楚的说明。
The antibiotics are not, strictly speaking, exclusively prescription drugs. A number of them are permitted in such over-the-counter products as nasal sprays, lozenges, troches, creams, and ointments. Even if these products do no harm there is no point whatsoever in using them. If you have an infection serious enough to warrant the launching of chemical warfare, you need much bigger doses of the antibiotics than any of the non-prescription products are allowed to contain.
严格来讲，抗生素并不全是处方药。许多抗生素被允许作为非处方药
（ 如鼻喷雾剂、键
剂、片剂、软膏和乳膏 ）,尽管它们没有危害，也不能随意地使用。如果你患了严重的感染， 你就得需要比非处方药所允许最大剂量更大剂量的抗生素了。
Over-the-counter products, however, account for only a small percentage of
total an tibiotics product ion .It is the prescripti on dosages that give people trouble.
然而，非处方药品只是整个抗生素类产品的一小部分,正是处方药物给人类带来了麻烦。
然而，非处方药品只是整个抗生素类产品的一小部分,
正是处方药物给人类带来了麻烦。
These drugs — even allowing
These drugs — even allowing
for the diverse
abilities of the many narrow
spectrum ones and the versatility of the broad-spectrum ones—
spectrum ones and the versatility of the broad-spectrum ones
—are not the cure-
alls they often are billed as being. There arewide gaps in their abilityto master
alls they often are billed as being. There are
wide gaps in their ability
to master
con tagious diseases. Such importa nt in fecti ons as mumps, measles, com mon colds, in flue nza, and in fectious hepatitis still await conq uest. All are virus infections and despite intense efforts, very little progress has bee n made in chemotherapy aga inst
viruses. Only small progress has been achieved against
fungi.
Many strains of
bacteria and fungi are n aturally resista nt to all curre ntly available an tibiotics and other chemotherapeutic drugs.
这些药物一即使允许最大能力，很多窄谱抗生素和广谱抗生素也并不是如宣传的那样治 疗百病。它们的能力与治疗传染性疾病间还存在很大的差距。如腮腺炎、麻疹、普通感冒、 流行性感冒和传染性肝炎等严重感染性疾病仍有待解决。
这些都是病毒感染，尽管做出了很
大的努力，但是在抗病毒的化疗药物的研究上几乎没有什么进展。
抗真菌药物的研究上只取
得一点小成就。很多细菌和真菌对现有的抗生素和其他化疗药物具有耐药性。
Some microorga ni sms origi nally sen sitive to the action of an tibiotics, especially staphylococcus, have developed resista nt stra ins. This acquired resista nee imposes on the long range value of the drugs a very importa nt limitati on, which is not adequately met by the freque nt in troduct ion of new an timicrobial age nts to combat the problem.
一些原来对抗生素敏感的细菌，特别是葡萄球菌现在也产生了耐药性，
这些获得的耐药
性对药物的长期使用产生重要的限制，频繁引人新的抗菌药物也不能完全解决这个问题。
It has been pretty well established that the increase in strains of bacteria resistant to an antibiotic correlates directly with the duration and extent of use of that antibiotic in a given location. In one hospital a survey showed that, before erythromycin had been widely used there, all strains of staphylococci taken from patients and personnel were sensitive to its action. When the hospital started extensive use of erythromycin, however, resistant staphylococcus strains began to appear.
现已经确定， 在一些地区， 抗生素广泛和长期的使用与细菌耐药性增加有直接的相互关 系。某医院调查显示， 在红霉素广泛使用以前， 所有从病人身上取出的葡萄球菌都对红霉素 敏感 .然而，自从医院开始广泛应用红霉素以来，耐药葡萄球菌菌株开始出现。
The development of bacterial resistance can be minimized by a more discriminating use of antibiotics, and the person taking the drug can help here. When an antibiotic must be used, the best way to prevent the development of resistance is to wipe out the infection as rapidly and thoroughly as possible. Ideally, this requires a bactericidal drug, which destroys, rather than a bacteriostatic drug, which inhibits. And the drug must be taken in adequate dosage for as long as is necessary to eradicate the infection completely. The doctor, of course, must choose the drug, but patients can help by being sure to take the full course of treatment recommended by the doctor, even though symptoms seem to disappear before all the pills are gone. In rare instances the emergence of resistance can be delayed or reduced by combinations of antibiotics. Treatment of tuberculosis
with
streptomycin alone results in a high degree of resistance, but if para-aminosalicylic acid or isoniazid is used with streptomycin the possibility that this complication will arise is greatly reduced.
更有区别的应用抗生素可以最大限度地抑制细菌耐药性的发展， 使用药物的病人可对此 有所帮助。
当必须使用一种抗生素时， 最好的避免耐药性方法就是尽快彻底地去除感染。
这 就需要用能杀死细菌的杀菌药， 而不是抑制细菌的抑菌药。
这种药物必须使用一定剂量， 并 且一定的时间以完全根除这种感染。
医生当然得选这种药， 但患者须遵医嘱、 使用足够的治 疗量，即使在药物吃完以前症状似乎已经消失。
少数情况下联合用药可以推迟或降低耐药性 的产生。
用链霉素单独治疗结核病会导致高度的耐药，
但如果链霉素联用对氨基水杨酸或异
烟肼将大大降低耐药性。
In hospital treatment of severe infections, the sensitivity of the infecting organism to appropriate antibiotics is determined in the laboratory before treatment is started. This enables the doctor to select the most effective drug or drugs; it determines whether the antibiotic is bactericidal or bacteriostatic for the germs at hand; and it suggests the amount needed to destroy the growth of the bacteria completely. In either hospital or home, aseptic measures can help to reduce the prevalence of resistant strains of germs by preventing cross infection and the resultant spreading of organisms.
在医院治疗严重感染时， 感染菌对抗生素的敏感性在治疗前已在实验室确定， 这样可以 使医生选择最有效的药物， 可以决定使用抑菌还是杀菌的抗生素， 并可对能完全破坏细菌生 长所需的用量给出建议。
无论在医院或是在家里， 无菌措施由于避免了交叉感染以及由此造 成的生物体传播，从而可以降低细菌耐药菌株的广泛流行。
Every one of the antibiotics is potentially dangerous for some people. Several serious reactions may result from their use. One is a severe, sometimes fatal, shock
like anaphylactic action, which may strike people who have become sensitized to
penicillin. Anaphylactic reaction happens less frequently and is less severe when the antibiotic is given by mouth. It is most apt to occur in people with a history of allergy, or a record of sensitivity to penicillin. Very small amounts of penicillin, even the traces which get into the milk of cows for a few days after they are treated with the antibiotic for mastitis, may be sufficient to sensitize; hence, the strong campaign by food and drug officials to keep such milk off the market.
对有些人来说任何一种抗生素都可能有潜在的危险。
一些严重的反应可能是由于它们的 应用产生的， 其中之一就是严重的有时甚至是致死性的过敏性休克， 对青霉素过敏的人使用 青霉素将很危险。
口服抗生素将使过敏频率降低或降低严重性。
青霉素过敏或有过敏史者更 容易发生。
奶牛使用抗生素治疗乳腺炎几天后， 其牛奶中带入的极其少量甚至痕量的青霉素 也可能足以引起过敏。所以食品药品监督官员采取强有力的措施防止这种牛奶进人市场。
To minimize the risk of anaphylactic shock in illnesses where injections of penicillin are the preferred treatment, a careful doctor will question the patient carefully about allergies and previous reactions. In case of doubt another antibiotic will be substituted, if feasible, or other precautionary measures will be taken before the injection is given.
当注射青霉素是首选治疗方案时， 为降低这种过敏性休克， 谨慎的医生会仔细询问病人 的过敏史及其反应。
如过敏史不清楚， 医生会用其他抗生素代替或注射前用其他方法检查其 是否过敏。
— such as
— such as
sore mouth, cramps, diarrhea, or anal itch
— which occur most frequently after use
of the tetracycline group but have also been encountered after use of penicillin and
streptomycin. These reactions
may result from
suppression
by the
antibiotic of
bacteria normally found in
the gastrointestinal
tract. With
their
competition
removed, antibiotic-resistant
staphylococci or
fungi, which
also
are normally
present, are free to flourish
and cause what
is called a super-infection. Such
infections can be extremely difficult to cure.
其他抗生素不良反应包括胃肠道不适，如口腔疼痛、痉挛、腹泻、肛门瘙痒，这种情况 在使用四环素类抗生素后经常发生， 在使用青霉素和链霉素后也会遇到。
这些反应可能是由 于使用的抗生素抑制了正常的胃肠道菌群引起的。
随着这种竞争的消除， 正常存在的葡萄球 菌或真菌耐药菌株自由繁殖并引起所谓的超感染，这种感染将更难治疗。
A few antibiotics have such toxic effects that their usefulness is strictly limited.
They include streptomycin and dihydro-streptomycin, which sometimes cause deafness, and chloramphenicol, which may injure the bone marrow. Drugs with such serious potential dangers as these should be used only if life is threatened and nothing else will work
有些抗生素有毒性作用， 使其应用受到了严格的限制。
这类抗生素包括会导致耳聋的链 霉素和双氢链霉素， 以及会产生骨髓损伤的氯霉素。
这些有严重危险的药物只有在生命受到 威胁或其他药物无效时才使用。
All the possible troubles that can result from antibiotic treatment should not
keep anyone from using one of these drugs when it is clearly indicated. Nor should
they discourage certain preventive uses of antibiotics which have proved extremely valuable.
由于有些抗生素疗效确切， 因此使用抗生素所带来的所有可能的麻烦也不能阻止任何人 用任何一种抗生素，对于被证明是有效的抗生素，人们不会不鼓励它们的使用。
翻译
另一种发现新的抗生素的高难度方法是合理药物设计， 即利用有关分子结构的知识 来进行全新的药品设计或改进。
Rational drug design is another more difficult method of new antibiotics discovery, that is to say, design or improve a brand new drug by using the knowledge of molecular structure.
制药工业在探索和开发新药的同时还要对抗现有抗生素不断増长的微生物耐药性， 这将是一条漫长的道路。
When pharmaceutical industry explores and develops a new drug, it fights against the microbial resistances to available antibiotics all the time. It is a very long way.
应该大力鼓励医生、 制药业以及公众态度的转变。
必须将抗生素视为一种应被谨慎 使用并且仅在真正必需时才使用的宝贵资源。
The change of doctors, pharmaceutical industry and the public attitudes should be encouraged greatly. The antibiotics must be viewed as a precious resource only used cautiously in real needs.
全世界都必须在医学教育的初期就进行关于抗生素的审慎使用及其耐药危险的灌 输，并且，这种教育还应贯穿于医学工作者的整个医疗生涯。
The cautious use of antibiotics and their hazardous resistances should be pumped into the medical students during their early medical education throughout the world. What's more, this education should penetrate through the medical worker's whole career.
制药工业必须停止推进非临床使用抗生素的生产，
并且， 它应该认识到， 它将从抗
生素的合理使用中获利，因此，应该对为此所作的各种尝试提供财务援助。
Pharmaceutical industry must stop producing the non-clinical antibiotics, and it may realize that it will benefit a lot from rational use of antibiotics. Hence, it should offer financial aids to all these attempts.
Unit 4 Text A The Scope of Pharmacology
药理学范畴
In its entirety, pharmacology embraces the knowledge of the history, source, physical and chemical properties, compounding, biochemical and physiological effects, mechanisms of action, absorption, distribution, biotransformation and excretion, and therapeutic and other uses of drugs. Since a drug is broadly defined as any chemical agent that affects living processes, the subject of pharmacology is obviously quite extensive.
总体来说， 药理学包括药物的以下诸方面内容 :历史背景、 来源、理化特性、 合成、生化 生理作用、作用机制、吸收、分布、生物转化和排泄以及治疗作用和其他作用。由于药物被 一般性定义为影响生命过程的化学物质，因而药理学范畴显然是极其广泛的。
For the physician and the medical student, however, the scope of pharmacology
is less expansive than indicated by the above definitions. The clinician is interested primarily in drugs that are useful in the prevention, diagnosis, and treatment of human disease, or in the prevention of pregnancy. His study of the pharmacology of these drugs can be reasonably limited to those aspects that provide the basis for their rational clinical use. Secondarily, the physician is also concerned with chemical agents that are not used in therapy but are commonly responsible for household and industrial poisoning as well as environmental pollution. His study of these substances is justifiably restricted to the general principles of prevention, recognition, and treatment of such toxicity or pollution. Finally, all physicians share in the responsibility to help resolve the continuing sociological problem of the abuse of drugs.
然而， 就医生和医学生生而言， 药理学范畴并没有上述定义那么广泛。
临床医生的主要 兴趣在于药物对人类疾病的预防、诊断及治疗
.或是在避孕方而所起的作用。因而他对这些
药物的药理学研究不仅仅周限于某些方面，只要能为其合理的临床用药提供理论根据就行。
其次， 医生也关注某些化学物质，这些物质虽然不用于治疗， 但通常与家庭中毒； 工业中毒 以及环境污染有关。
医生对这些物质的研究当然仅限于一般性了解。
对这类中毒或汚污染的 防范、诊断和治疗。
最后， 所有医生都应责无旁贷地为解决药品滥用所引起的社会问题而做 出自己的努力。
A brief consideration of its major subject areas will further clarify how the study
of pharmacology is best approached from the standpoint of the specific requirements and interests of the medical student and practitioner. At one time, it was essential for the physician to have a broad botanical knowledge, since he had
to select the proper plants from which to prepare his own crude medicinal preparations. However, fewer drugs are now obtained from natural sources, and, more importantly, most of these are highly purified or standardized and differ little from synthetic chemicals. Hence, the interests of the clinician in pharmacognosy are correspondingly limited. Nevertheless, scientific curiosity should stimulate the physician to learn something of the sources of drugs, and this knowledge often proves practically useful as well as interesting. He will find the history of drugs of similar value.
从医学生和从业医师的特別耑求和一般兴趣的角度来看， 什么才是药理学学习的最佳途 径呢？只要对其主要学科领域稍加研究便可知晓。
以前，医师必须拥有广泛的植物方而的知 识，因为他得挑选适当的植物， 且将其制备成简单的药物制剂。然而， 现在的药物已很少取 自于天然植物， 而且更为重要的是大多数天然药物已被高度提纯， 且与合成的化学药物无甚 区别， 所以，临床医生对生药学的兴趣也相应减弱。尽管如此，应该激励临床医生了解药物 的来源的科学好奇心， 这方面知识往往被证明不但有趣， 而且有用。
他将会发现了解药物的 历史同样具有价值。
The preparing, compounding, and dispensing of medicines at one time lay within the province of the physician, but this work is now delegated almost completely to the pharmacist
1. However, to write intelligent prescription orders, the
physician must have some knowledge of the physical and chemical properties of drugs and their available dosage forms, and he must have a basic familiarity with the practice of pharmacy. When the physician shirks his responsibility in this regard, he invariably fails to translate his knowledge of pharmacology and medicine into
prescription orders and medication best suited for the individual patient.
药物的制备、 合成与销售一度都是医生的职责， 但这项工作现在几乎全归药师了。
不过 临床医师要想开出合理的处方，必须对药物的理化性质及其现有剂型有所了解
,必须基本了
解药房业务。
若临床医师逃避这方面责任， 他肯定用不好药理学及药物知识， 从而难以开出 适合每位患者的最佳医疗处方。
I
Pharmacokinetics deals with the absorption, distribution, biotransformation, and excretion of drugs. These factors, coupled with dosage, determine the concentration of a drug at its sites of action and, hence, the intensity of its effects as a function of time. Many basic principles of biochemistry and enzymology and the physical and chemical principles that govern the active and passive transfer and the distribution of substances across biological membranes are readily applied to the understanding of this important aspect of pharmacology
2.
药物动力学涉及药物的吸收、 分布、 生物转化以及排泄等方面。
这些因素再加上剂量便 决定了药物在其作用点的浓度， 进而决定了其与时间成函数关系的药效强度。
在对药理学这 一重要方面的理解过程中， 常常运用到许多有关生物化学和酶学方面的基本原理和物理化学 方面的一些基本法则，而这些原理和法则决定着物质在生物膜之间的主动和被动转移及分 布。
The study of the biochemical and physiological effects of drugs and their mechanisms of action is termed as pharmacodynamics. It is an experimental medical science that dates back only to the later half of the nineteenth century. As a border science, pharmacodynamics borrows freely from both the subject matter and the experimental techniques of physiology, biochemistry, microbiology,
immunology, genetics, and pathology. It is unique mainly in that attention is focused on the characteristics of drugs. As the name implies, the subject is a dynamic one. The student who attempts merely to memorize the pharmacodynamic properties of drugs is foregoing one of the best opportunities for correlating the entire field of preclinical medicine. For example, the actions and effects of the saluretic agents can be fully understood only in terms of the basic principles of renal physiology and of the pathogenesis of edema. Conversely, no greater insight into normal and abnormal renal physiology can be gained than by the study of the pharmacodynamics of the saluretic agents.
对药物的生化生理作用及其作用机制的研究称为药效学。
这是一门实验医学， 其历史仅 可追溯到 19 世纪后半叶。作为边缘学科，药效学从生理学、生化学、微生物学、免疫学、 遗传学和病理学等诸多学科的主要理论和实验技术中吸取了大量内容。
该学科的独到之处主 要在于其关注的要点是药物的特征。
顾名思义， 该科目属于动态学科。
学生如果仅仅打算死 记硬背药物的药效学特性的话，那他将会丧失把整个临床前期医学连为—体的这一最佳机 会。例如 :利盐排泄剂的活性和效用只有在肾脏生理学和水肿发病机制的基本原理的基础上 才能完全理解。
换句话说， 只有通过对利盐排泄剂的药效学研究， 才能最深人地了解肾脏生 理学正常和异常两方面情况。
Another ramification of pharmacodynamics is the correlation of the actions and
effects of drugs with their chemical structures. Such structure-activity relationships
are an integral link in the analysis of drug action, and exploitation of these relationships among established therapeutic agents has often led to the development of better drugs. However, the
correlation of biological activity
with chemical structure is usually of interest to the physician only when it provides the basis for summarizing other pharmacological information.
药效学的另一分支是研究药物活性和效用与其化学结构的相互关系。
这种构效关系是分 析药物作用不可或缺的部分， 将这种关系应用于现有的治疗药物中往往会促使药品的更新换 代。然而， 只有当生物活性与化学结构的关联能够为总结其他药物学信息提供基础时， 临床 医师才会对此产生兴趣。
The physician is understandably interested mainly in the effects of drugs in man.
This emphasis on clinical pharmacology is justified, since the effects of drugs are
often characterized by significant interspecies variation, and since they may be further modified by disease. In addition, some drug effects, such as those on mood and behavior, can be adequately studied only in man. However, the pharmacological evaluation of drugs in man may be limited for technical, legal, and ethical reasons, and the choice of drugs must be based in part on their pharmacological evaluation in animals. Consequently, some knowledge of animal pharmacology and comparative pharmacology is helpful in deciding the extent to which claims for a
3
drug based upon studies in animals can be reasonably extrapolated to man
3.
临床医师的兴趣主要集中于药物对人体的疗效。
临床药理重视这一点是合理的， 因为药 物的作用往往因种属的明显差异而大相径庭， 并可能由于疾病的作用而发生进一步改而且有 些药物作用——诸如对情绪和行为的作用—只有通过人体才能得以充分研究，不过药物对 人体的药理学评价可能因技术、 法律及伦理道德方面的原因而受到限制， 对药物的选择在一 定程度上也只得以它们在动物身上所进行的药理学评价为基础。
因此， 动物药理学和比较药 理学方面的知识有助于确定以动物实验为基础的某种新药研制何时才可用于人体。
Pharmacotherapeutics deals with the use of drugs in the prevention and treatment of disease. Many drugs stimulate or depress biochemical or physiological function in man in a sufficiently reproducible manner to provide relief of symptoms or, ideally, to alter favorably the course of disease. Conversely, chemicotherapeutic agents are useful in therapy because they have only minimal effects on man but can destroy or eliminate parasites. Whether a drug is useful for therapy is crucially dependent upon its ability to produce its desired effects with only tolerable undesired effects. Thus, from the standpoint of the physician interested in the therapeutic uses of a drug, the selectivity of its effects is one of its most important characteristics. Drug therapy is rationally based upon the correlation of the actions and effects of drugs with the physiological, biochemical, microbiological, immunological, and behavioral aspects of disease. Pharmacodynamics provides one of the best opportunities for this correlation during the study of both the preclinical and the clinical medical sciences.
药物治疗学涉及如何在疾病防治中使用药物。
许多药物以强有力的可重现方式促进或抑 制着人体的生理生化功能， 进而使症状得以缓解或促使病程朝着令人满意的方向转变。
相反， 化疗药物的治病功能是因为其对人体作用很小但却能杀死或清除寄生生物。—种药物是否 可以用于治疗，关键取决于其能
