【原】涨姿势|处方中的Rx、sig、bid、tid、iv这些是怎么来的？

孔较瘦 2021-01-13

展开全文

前不久来了一批新的轮转学生，手写处方自然是他们都要经历的过程之一。吗啡等精一处方多次重写的情况屡见不鲜。
偶尔有一次，我提问写处方的同学：医嘱中的Rx、sig、bid、tid、iv这些简写是怎么来的？各自又代表什么意思？
这个问题似乎过于简单，既然是简写，当然是复杂英文词汇的缩写！
但当我们随便拿出一个简写，似乎又没有人可以准确说出他们的英文原词，就连英文词汇量极为丰富的同学，也无一例外。
医学在传承中，有许多根深蒂固的习惯，本着拿来主义的方式和不求甚解的态度，似乎这些也都不影响日常工作。
凡事都怕深究，我们医疗小组内也经常会搞一些『涨姿势』的讨论，今天本着娱人娱己的态度，我们来熟悉一下这些最熟悉的陌生人：医嘱及处方中的简写词。
本公众号还会定期更新一些临床疑难、危重病例，偶尔还会有吐槽秀。若您喜欢我的文章，欢迎您点击上方蓝色字体『孔较瘦』添加关注，您还可以长按文末二维码识别并且添加。

一

我们在临床中使用的医学词汇，多数来自于西方医学。虽然英国通过发展殖民地，将英文推广成为国际通用语言，但不是所有的简写都是来自于英文，相当一部分来自拉丁文、希腊文。与之类似的还有物理学、化学中的缩写和符号。

拉丁文是二千多年前居住在亚平宁半岛罗马地区拉丁民族的语言，后来这个民族征服了欧洲大部分地区和中东一部分，建立了罗马帝国，拉丁语就成为整个罗马帝国的官方语言。

随着历史的发展和推进罗马帝国解体了，形成了很多独立国家，这些各自独立的国家在拉丁文基础上结合本地区的方言又组成了各国自己的语言，如法国、意大利、西班牙、葡萄牙、罗马尼亚等国的语言有很多近似之处，常称拉丁语系，就是这个原因。

拉丁语原本是意大利中部拉提姆地方（Latium，意大利语为Lazio）的方言，后来则因为发源于此地的罗马帝国势力扩张而将拉丁语广泛流传于帝国境内，并定拉丁文为官方语言。而基督教普遍流传于欧洲后，拉丁语更加深其影响力，从欧洲中世纪至20世纪初叶的罗马天主教为公用语，学术上论文也大多数由拉丁语写成。

现在虽然只有梵蒂冈尚在使用拉丁语，但是一些学术的词汇或文章例如生物分类法的命名规则等尚使用拉丁语。

在一些文学巨匠的手里，拉丁语被证明在表现精确性、逻辑和庄重等方面为其他语言所不及。尽管在中世纪以后，拉丁语已不在欧洲通用，但它却是法语、意大利语、西班牙语等主要欧洲语言的基础。希腊语是印欧语系中保存下来的最古的语种，它与拉丁语关系十分亲近。

二

医学词汇严重依赖希腊语和拉丁语，相当一部分医学词汇在拼写上甚至都无任何变动。

古希腊语有一些特征：它的词汇可以由词素来构成；通过一个词形式的变化，可表达各种不同的语法概念。据说一个古希腊语的动词有500多个形式，每一形式变化都表示时间、方式等方面的变化。

欧洲医学里的解刨学词汇，药理词汇等等都是拉丁语，所以医学生要选修拉丁语的，事实上，普遍欧洲的学生在高中时就修过拉丁语。

来自拉丁语的医学词汇相当多。许多表示人体部位的词，如cerebrum(大脑)，pelvis(骨盆)，cornea(角膜)，humerus(肱骨)，表示细微解剖部位的词，如ala(翼)，plexus(丛)，plica(皱襞)，fossa(窝)I表示功能，状态的rigor(寒战)，stupor(昏迷)，nausea(恶心)，tonus(紧张)等就直接来自拉丁语。

据统计，约有1000个左右的拉丁语医学词已成为医学英语词汇的一部分，而以变化词尾等方式受英语同化的拉丁语词就更多，如；inflammation(发炎)，inspection(视诊)，laceration(裂伤)(原词以—tio结尾)Iimmunity(免疫)，heredity(遗传)，obesity(肥胖)(原词以—itas结尾)'ligament(韧带)，pigment(色素)，medica—ment(药物)(原词以—mentum结尾)等。，直接来自希腊语的医学词要少些。thorax(胸)，iris(虹膜)，metra(子宫)，colon(结肠)等解剖名称，和stenosis(狭窄)，stasis(停滞)，ptosis(下垂)，ectopia(异位)等表示功能、状态的词就是这方面的例子。

三

医嘱和处方中的简写在现代医学领域中，应用十分广泛。大家尤其需要注意的是，这些词汇多数不是英文缩写。

以常用的处方简写为例：

bid(原文bis in die)每日二次；
tid(原文ter in die)每日三次；
qid(qualer in die)每日四次；
sig（原文signa, signetur）使用方法；
Rx（原文recipe）是一种处方的符号；
NS【英文normal saline (0.9%)】生理盐水

就我个人感觉, 学一点拉丁语至少对英语词汇的理解和记忆有很大帮助, 对语法分析的理解也更加深刻. 其他拉丁语后裔语言(现代罗曼语族), 比如法西意语, 上手学起来就很快, 没有太大的陌生感, 就算不学也能直接识得不少词。

这些简写并非全球通用，部分简写是在美国等地方不允许使用的。第五部分的附表向大家提供了医学中常用缩写词汇的拉文原文、希腊文、英文及可能混淆的意义；欢迎大家批评指正。

四

当然，掌握了这些其实并没有什么直接的卵用，既涨不了工资，也涨不了颜值。但我认为，人生的很多乐趣和广度恰恰来自于这些『无用』的知识。

我们经常谈论自己光辉灿烂的历史，无数的国学讲座也遍地开花。但实际上，在历史上有许多文明毁于天灾人祸，或许有过更为辉煌的成就，但是最完整的保存，最系统的研究，都聚焦希腊和罗马。因为西方文明率先而彻底地转型，几乎成了现代文明在事实意义上的等同；希腊和罗马，相比于没有“子孙”的其他遗存，自然地位非凡。

我们只有在更开阔的天空下，在比较的视野中，才有可能掌握真正反观自身的学问。比如我们思考为什么是希腊罗马，而不是其他文明，最终孕育了冲破诸多不可能而走入工业化、信息化的现代的西方文明？

我们总是抱怨找不到研究的方向，思考的去处，其实眼皮子底下就有很多『灯下黑』的学问值得去学习，难道不是吗？

五附表

缩写或符号	拉丁文/希腊文	对应英文	可能与之混淆的缩写
a.d.	auris dextra	right ear	A single-storey "a" can be mistaken as an "o" which could read "o.d.", meaning right eye
a.l., a.s.	auris laeva, auris sinistra	left ear	"a" can be mistaken as an "o" which could read "o.s." or "o.l", meaning left eye
a.u.	auris utraque	both ears	"a" can be mistaken as an "o" which could read "o.u.", meaning both eyes
b.i.d., b.d.	bis in die	twice daily	AMA style avoids use of this abbreviation (spell out "twice a day")
b.t.		bedtime	mistaken for "b.i.d", meaning twice daily
c.c.	cum cibo	with food [or] cubic centimetre	mistaken for "U", meaning units; also has an ambiguous meaning; use "mL" or "milliliters" (1 cm³ = 1 mL)
D, d.	die [or] dosis	days [or] doses	ambiguous meaning, write out "days" or "doses"
DC, dc, D/C, disc		discontinue [or] discharge	ambiguous meaning
DTO		deodorized tincture of opium	can easily be confused with "diluted tincture of opium," which is 1/25th the strength of deodorized tincture of opium; deaths have resulted due to massive morphine overdose.Compare laudanum and paregoric.
h.s.	hora somni (at the hour of sleep)	at bedtime [or] half-strength	ambiguous (2 meanings, easily conflated); spell out
IBW		ideal body weight (for dosing based on clearanceestimation)
IJ, inj.	injectio	injection	mistaken for "IV", meaning intravenously
i.m., IM		intramuscular
IN		intranasal	mistaken for "IM", meaning intramuscular, or "IV", meaning intravenously
IT		intrathecal	mistaken for other abbreviations; spell out
IU		international unit	mistaken for "IV" or "10", spell out "international unit"
i.v., IV		intravenous
i.v.p., IVP		intravenous push
MgSO4		magnesium sulfate	may be confused with "MSO4", spell out "magnesium sulfate"
min.	minimum [or] minim [or] minutum	minimum [or] minim [or] minute
mit., mitt.	mitte	send
mL		millilitre
MS		morphine sulfate or magnesium sulfate	can mean either morphine sulfate or magnesium sulfate, spell out either
MSO4		morphine sulfate	may be confused with "MgSO4", spell out "morphine sulfate"
NPO, n.p.o.	nil per os	nothing by mouth	AMA style avoids use of this abbreviation (spell out "nothing by mouth")
NS		normal saline (0.9%)
1/2NS		half-normal saline (0.45%)
o.d.	oculus dexter	right eye	"o" can be mistaken as an "a" which could read "a.d.", meaning right ear, confusion with "omni die"
o.s.	oculus sinister	left eye	"o" can be mistaken as an "a" which could read "a.s.", meaning left ear
o.u.	oculus uterque	both eyes	"o" can be mistaken as an "a" which could read "a.u.", meaning both ears
p.o.	per os	by mouth or orally	AMA style avoids use of this abbreviation (spell out "orally")
q	quaque	every, per
q.1 h, q.1°	quaque 1 hora	every 1 hour (can replace "1" with other numbers)
q4PM		at 4 pm (can replace "4" with other numbers)	mistaken to mean every 4 hours
q.a.d.	quaque alternis die	every other day
q.a.m.	quaque die ante meridiem	every morning (every day before noon)
q.d./q.1.d.	quaque die	every day	mistaken for "QOD" or "qds," spell out "every day" or "daily". AMA style avoids use of this abbreviation (spell out "every day")
q.d.a.m.	quaque die ante meridiem	once daily in the morning
q.d.p.m.	quaque die post meridiem	once daily in the evening
q.d.s.	quater die sumendus	4 times a day	can be mistaken for "qd" (every day)
q.p.m.	quaque die post meridiem	every evening (every day after noon)
q.h.	quaque hora	every hour
q.h.s.	quaque hora somni	every night at bedtime	can be mistaken as "q.h.r." (every hour)
q.i.d.	quater in die	4 times a day	can be mistaken for "qd" or "qod," write out "4 times a day". AMA style avoids use of this abbreviation (spell out "4 times a day")
q.l.	quantum libet	as much as is requisite
q.n.	quaque nocte	every night	can be mistaken as "q.h." (every hour)
q.o.d.	quaque altera die	every other day	mistaken for "QD," spell out "every other day". AMA style avoids use of this abbreviation (spell out "every other day")
q.q.	quaque	every; each
q.q.h.	quater quaque hora	every 4 hours
q.s.	quantum sufficiat (subjunctive), quantum sufficit (indicative)	as much as suffices; a sufficient quantity
q.v.	quantum volueris [or] quod vide	at will [or] which see
QWK		every week
rep., rept.	repetatur	repeats
RL, R/L		Ringer's lactate
Rx, Rx, RX,℞	recipe	take (often effectively a noun meaning "prescription"—medical prescription or prescription drug)
rep.	repetatur	let it be repeated
s.	signa	write (write on the label)
s.a.	secundum artem	according to the art (accepted practice or best practice)
SC		subcutaneous	"SC" can be mistaken for "SL," meaning sublingual. See also SQ
sem.	semen	seed
s.i.d.	semel in die	once a day	used exclusively in veterinary medicine
sig.	signa, signetur	write (write on the label)
s	sine	without (usually written with a bar on top of the "s")
sing.	singulorum	of each
SL, s.l.	sub lingua	sublingually, under the tongue
SOB		shortness of breath
sol.	solutio	solution
s.o.s., si op. sit	si opus sit	if there is a need
s.s., SS	semisse	one-half [or] sliding scale	mistaken for "55" or "1/2"
SSI		sliding scale insulin or sliding scale regular insulin	mistaken to mean "strong solution of iodine" or "selective serotonin reuptake inhibitor". See also SSRI
SQ		subcutaneously	"SQ" can be mistaken for "5Q" meaning "5 every dose". See also SC
st.	stet	let it stand (for example, for settling)
stat	statim	immediately
SubQ		subcutaneously
sum.	sumat [or] sumendum	let him take [or] let it be taken
t.d.s., TDS	ter die sumendum	3 times a day
t.i.d., t.d.	ter in die	3 times a day	AMA style avoids use of this abbreviation (spell out "3 times a day")
tinct.	tinctura	tincture
t.i.w.		3 times a week	mistaken for "twice a week"
U		unit	mistaken for a "4", "0" or "cc", spell out "unit"
μg		microgram	mistaken for "mg", meaning milligram
@		at	mistaken for "2"; spell out "at"
>		greater than	mistaken for a "7"
<		less than	mistaken for an "L"