成人尿路感染

第七单元 Text A 成人尿路感染 尿路感染是一个严重的健康问题，每年影响数百万人。 泌尿道Infections of the urinary tract are the second most common type of infection in the body.感染是人体第二大最常见类型的感染。每年因Urinary tract infections (UTIs) account for about 8.3 million doctor visits each year.* Women are especially prone to UTIs for reasons that are not yet well understood.尿路感染（UTIs ）就医的人数约为830万人。妇女尤其容易感染UTIs，但原因尚不清楚。20％的女性会患尿路感染20会感染会患尿路感染 会。UTIs in men are not as common as in women but can be very serious when they do occ男子的发病率不如女性高，但一旦发病会很严重。 * Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1999–2000. Vital and Health StatisticsThe urinary system consists of the kidneys, ureters, bladder, and urethra.泌尿系统由肾脏﹑输尿管﹑膀胱和尿道组成。系统中The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back.关键要素是肾脏，位于背部中间肋骨下方的一对深紫色器官。 The kidneys remove excess liquid and wastes from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce a hormone that aids the formation of red blood cells.肾脏以尿液的形式消除血液中过剩的液体和废物，保持血液中盐和其它物质相对的稳定和平衡，产生促使红血球生成的激素。称为Narrow tubes called ureters carry urine from the kidneys to the bladder, a sack-like organ in the lower abdomen.输尿管的窄管把尿液从肾脏导到膀胱，一个位于下腹袋子状的器官。 Urine is stored in the bladder and emptied through the urethra.尿液储存在膀胱里并通过尿道排空。 The average adult passes about a quart and a half of urine each day.成人平均每天排尿量为1.5夸脱（大约1500毫升）。 但尿量不尽相同The amount of urine varies, depending on the fluids and foods a person consumes.但尿量，这取决于人消耗的食物和水。 The volume formed at night is about half that formed in the daytim夜间形成的尿量只有白天的一半左右。 [ Top ] What are the causes of UTI?尿路感染的原因 Normally, urine is sterile.尿液通常是无菌的，一般不含细菌、病毒和真菌，但含有液体、盐和废物。 有An infection occurs when tiny organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply.有有有些微生物，通常是从消化道进入的细菌，聚集在尿道，并开始繁殖，就会引发感染。 The urethra is the tube that carries urine from the bladder to outside the body.尿道是将尿液从膀胱排除体外的管道。 Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon.大部分感染是由大肠杆菌引起的，通常生活在结肠。 In many cases, bacteria first travel to the urethra.通常情况下，细菌首先进入尿道。 When bacteria multiply, an infection can occur.当细菌繁殖，感染就可能发生。 如果An infection limited to the urethra is called urethritis.感染只限于尿道，就是尿道炎。 If bacteria move to the bladder and multiply, a bladder infection, called cystitis, results.如果细菌转移到膀胱并且繁殖，引起膀胱感染，则是膀胱炎。 If the infection is not treated promptly, bacteria may then travel further up the ureters to multiply and infect the kidneys.如果感染不及时治疗，细菌可能进一步进入输尿管繁殖导致肾脏感染。 A kidney infection is called pyelonephritis.肾脏感染是所谓的肾盂肾炎。 称为Microorganisms called Chlamydia and Mycoplasma may also cause UTIs in both men and women, but these infections tend to remain limited to the urethra and reproductive system.衣原体和支原体的微生物也可能导致男性和妇女的尿路感染，但这些感染往往只限于尿道和生殖系统。 与欲与大肠杆菌不同， 衣原体和支原体可通过性传播。 The urinary system is structured in a way that helps ward off infection.泌尿系统的结构有助于抵御感染。 The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash bacteria out of the body.输尿管和膀胱，防止尿液回流到肾脏而且从膀胱流出的尿液有助于清除体内的细菌。 In men, the prostate gland produces secretions that slow bacterial growth.男性的前列腺产生的分泌物使细菌生长缓慢；In both sexes, immune defenses also prevent infection.男性和男性和女性的免疫系统都可以防止感染。 But despite these safeguards, infections still occur.尽管如此，感染仍会发生。 Who is at risk?危险人群 Some people are more prone to getting a UTI than others.有些人比其他人更容易得尿路感染。 Any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone, for example) sets the stage for an infection.任何阻碍尿液流动的尿道异常（例如，肾结石）都有可能诱发感染。 An enlarged prostate gland also can slow the flow of urine, thus raising the risk of infection.前列腺肥大也可以使尿液流动缓慢，增大感染风险。 常见的感染源是置放于尿道和膀胱里的导尿管。不能排尿的或病情严重而丧失一时的患者，常长期需要插导尿管。A common source of infection is catheters, or tubes, placed in the urethra and bladder.Some people, especially the elderly or those with nervous system disorders who lose bladder control, may need a catheter for life.有些人，特别是老人或那些因神经系统疾病导致膀胱功能失控的病人，可能终生要靠插导管生活。 Bacteria on the catheter can infect the bladder, so hospital staff take special care to keep the catheter clean and remove it as soon as possible.导尿管上的细菌可能感染膀胱，因此医务人员均特别注意保持导管清洁并尽早拔掉尿导管。 因为免疫系统的变化，People with diabetes have a higher risk of a UTI because of changes in the immune system.糖尿病患者得尿路感染的风险较高。 Any other disorder that suppresses the immune system raises the risk of a urinary infection.任何其它抑制免疫系统的病变都会加剧这种风险。 先天性尿道异常的UTIs may occur in infants, both boys and girls, who are born with abnormalities of the urinary tract, which sometimes need to be corrected with surgery.婴儿，不分性别，也会患尿路感染，有时需要手术。 UTIs are more rare in boys and young men.尿路感染在男孩和青年男子中较罕见。 但是In adult women, though, the rate of UTIs gradually increases with age.在成年妇女中，尿路感染发病率逐渐随着年龄增长。 Scientists are not sure why women have more urinary infections than men.科学家尚不明确为什么妇女患泌尿系感染多于男性。 One factor may be that a woman's urethra is short, allowing bacteria quick access to the bladder.其中一个因素可能是女性尿道短，使细菌快速进入膀胱。 Also, a woman's urethral opening is near sources of bacteria from the anus and vagina.此外，女性的尿道口离肛门和阴道的细菌源很近。 For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear.对许多妇女，性交可能引发感染，虽然这种情况的原因尚不明确。 According to several studies, women who use a diaphragm are more likely to develop a UTI than women who use other forms of birth control.研究表明，使用子宫帽节育的妇女比采用其它措施节制生育的女性更容易得尿道炎。 Recently, researchers found that women whose partners use a condom with spermicidal foam also tend to have growth of E.最近，研究人员发现，配偶使用保险套与杀精泡沫也往往coli bacteria in the vagina.使大肠杆菌进入女性阴道。 What are the symptoms of UTI?尿路感染的症状 Not everyone with a UTI has symptoms, but most people get at least some symptoms.不是每个患有尿路感染的人都有症状，但大部分人至少有某些症状，尿频或排尿时膀胱或尿道灼痛。It is not unusual to feel bad all over—tired, shaky, washed out—and to feel pain even when not urinating.人们往往感觉疲倦、虚弱、面色苍白，甚至在不排尿时也觉得疼痛，也是常见情况。 Often women feel an uncomfortable pressure above the pubic bone, and some men experience a fullness in the rectum.妇女往往觉得耻骨部位不舒服的压迫感，有些男人觉得直肠涨气。有尿路It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed.患有患有尿路尿路感染患者主诉，尽管有排尿感，只有少量的尿液排出。The urine itself may look milky or cloudy, even reddish if blood is present.尿液混浊状，甚至血尿。Normally, a UTI does not cause fever if it is in the bladder or urethra.通常，膀胱或尿道感染不会引起发烧。 A fever may mean that the infection has reached the kidneys.发烧可能意味着感染已达到了肾脏。Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting.肾脏感染的其它症状包括背部或肋骨侧下方疼痛、恶心或呕吐等。 In children, symptoms of a urinary infection may be overlooked or attributed to another disorder.儿童尿路感染的症状可能被忽略或归咎于其它疾病。当儿童或婴儿急躁、食欲不振、原因不明的发热而且持续不退、腹泻、萎靡不振，应考虑患有尿路感染。与Unlike adults, children are more likely to have fever and no other symptom成人不同，儿童更有可能发烧而且没有其它症状。 This can happen to both boys and girls.男孩和女孩都有可能如此。 如果孩子出现这些症状，尤其是尿出现变化，应及时就医The child should be seen by a doctor if there are any questions about these symptoms, especially a change in the child's urinary pattern.如果。 How is UTI diagnosed?尿路感染如何诊断？ To find out whether you have a UTI, your doctor will test a sample of urine for pus and bacteria.要了解是否患有尿路感染，医生将提取尿液样本测试尿脓和细菌。 You will be asked to give a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample of urine in a sterile container.您要清洗外阴以便提交一个“干净”的尿液样本并把收集的尿液样本装在无菌容器里。This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results.这种方法收集尿液，有助于防止生殖器官周围的细菌进入样本而影响检测结果。Usually, the sample is sent to a laboratory, although some doctors' offices are equipped to do the testing.虽然有些医生办公室都配备做这样测试的仪器，但通常情况下，样本要送实验室。 In the urinalysis test, the urine is examined for white and red blood cells and bacteria.尿液检验检查尿液中白细胞、红细胞和细菌。Then the bacteria are grown in a culture and tested against different antibiotics to see which drug best destroys the bacteria.然后进行细菌培养，用不同的抗生素做对抗实验，看看哪种药物能最有效地杀死细菌。This last step is called a sensitivity test.这最后一步就是药效敏感性试验。 Some microbes, like Chlamydia and Mycoplasma , can be detected only with special bacterial cultures.一些微生物，如衣原体和支原体，只有通过特殊的细菌培养才可检测到。当患者有UIT症状液中有尿路感染，医生会怀疑是患有尿路感染的一种。但普通的细菌培养不能发现任何细菌。 如果When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor may order some tests to determine if your system is normal.如果如果感染没有因治疗消除，而且发现感染由同一菌株的细菌引起的，医生可能会要求做一些检测，以确定患者的系统是否是正常。One of these tests is an intravenous pyelogram, which gives x-ray images of the bladder, kidneys, and ureters.这些测试之一就是静脉肾盂造影，通过X射线照出膀胱、肾脏和输尿管的图像。将注入静脉，拍下一组X光照片An opaque dye visible on x-ray film is injected into a vein, and a series of x rays is taken. XX。照照片展现了泌尿道的轮廓，即使是很小的变化也能检测出来。 If you have recurrent infections, your doctor also may recommend an ultrasound exam, which gives pictures from the echo patterns of soundwaves bounced back from internal organs.如果经常感染，医生会推荐超声波检验，通过内部器官反弹超声波的回声成像。 Another useful test is cystoscopy.另一种有效的测试是膀胱镜检查。A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see inside the bladder from the urethra膀胱镜是一种由空心管﹑几个镜片和光源组成的器械，使医生可从尿道检查膀胱。 How is UTI treated?尿路感染的治疗 UTIs are treated with antibacterial drugs.抗菌药物可治疗尿路感染。患者病史和尿检结果决定用药种类和治疗期限。 The sensitivity test is especially useful in helping the doctor select the most effective drug.敏感性测试在帮助医生选择最有效的药物方面是特别有用的。 The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin).最常用于治疗常规感染的药物是甲氧苄氨嘧啶（ trimpex ） 、甲氧苄啶/磺胺甲基异恶唑（ bactrim ， septra ，科特林）、阿莫西林（ amoxil ， trimox ， wymox ）、呋喃妥因（ macrodantin ，呋喃坦啶）和氨苄西林（ omnipen ， polycillin ， principen ， totacillin ）。 A class of drugs called quinolones includes four drugs approved in recent years for treating UTI.喹诺酮类药物，即四种在近年来获得批准用于治疗尿路感染药物是它们是氧氟沙星（ floxin ）、诺氟沙星（ noroxin ）、环丙沙星（ cipro ）和曲伐沙星（ trovan ）。 通常情况下，如果没有并发阻塞或其它疾病，Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or other disorder.通通常尿路感染 1或2天的治疗就可以治愈。Still, many doctors ask their patients to take antibiotics for a week or two to ensure that the infection has been cured.但是，许多医生要求病人服用抗生素一至两周时间，以确保治愈。Single-dose treatment is not recommended for some groups of patients, for example, those who have delayed treatment or have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate infections.单剂量治疗不适宜用于某些患者群体，例如延误治疗或有肾脏感染迹象的患者、有糖尿病的患者或结构异常的病人、或有前列腺炎的男性。Longer treatment is also needed by patients with infections caused by Mycoplasma or Chlamydia , which are usually treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycyclin由支原体、衣原体感染的患者需要更长时间的治疗，常用药物是四环素、甲氧苄啶/磺胺甲基异恶唑（TMP/SMZ）或强力霉素。随访尿检随访尿检帮助确认尿路感染是否治愈。疗程完整很重要，因为症状可能会在感染完全清除之前消失。 严重的Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own.肾脏感染患者需要住院，直至消除水肿并可独立服药。Kidney infections generally require several weeks of antibiotic treatment.肾脏感染通常需要几个星期抗生素治疗。Researchers at the University of Washington found that 2-week therapy with TMP/SMZ was as effective as 6 weeks of treatment with the same drug in women with kidney infections that did not involve an obstruction or nervous system disorder.华盛顿大学的研究人员发现， 服用甲氧苄啶/磺胺甲基异恶唑疗法2周与6周治疗女性脑梗塞或中枢神经系统紊乱的肾脏感染是一样有效的。In such cases, kidney infections rarely lead to kidney damage or kidney failure unless they go untreated.在这种情况下，肾脏感染很少导致肾损害或肾功能衰竭，除非未经任何治疗。 Various drugs are available to relieve the pain of a UTI.缓解尿路感染疼痛的药物有很多。 A heating pad may also help.加热垫也有作用。Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria.大部分医生建议多喝水，以利于清洁尿路中的细菌。治疗期间，最好不喝咖啡﹑酒﹑忌辛辣食物。And one of the best things a smoker can do for his or her bladder is to quit smoking.吸烟者要戒烟以保护膀胱。众所周知，Smoking is the major known cause of bladder cancer.吸烟是诱发膀胱癌的主要原因。 Is there a vaccine to prevent recurrent UTIs?有疫苗可预防尿路感染？ In the future, scientists may develop a vaccine that can prevent UTIs from coming back.将来，科学家可能发明一种可以防止尿路感染复发的疫苗。 Researchers in different studies have found that children and women who tend to get UTIs repeatedly are likely to lack proteins called immunoglobulins, which fight infection.研究人员在不同的研究中发现，反复得尿路感染的妇女和儿童往往缺乏能对抗感染的一种蛋白质，即免疫球蛋白。不不感染的妇女和儿童的生殖器官和泌尿道有正常水平的免疫球蛋白。 Early tests indicate that a vaccine helps patients build up their own natural infection-fighting powers.早期试验表明，疫苗可以帮助病人建立自身对抗感染能力。在免疫过程中死亡的细菌不会引起感染;相反，会迅速使身体产生抗体，对抗存活的细菌。 Researchers are testing injected and oral vaccines to see which works best.研究人员正在测试注射和口服疫苗，看看哪种最好。 Another method being considered for women is to apply the vaccine directly as a suppository in the vagina.另一种正在考虑对适用于妇女的方法是将疫苗栓剂直接作用在阴道。