導言
臨床常像在風雨中點燈。醫師端詳著抹片上一片狼藉的紅血球碎片，彷彿看見微血管裡發生的戰爭；病房外，家屬的腳步徘徊，等一個好消息。語言是我們理解世界的工具，醫學更是如此：幾個關鍵字，能把抽象的機轉變成可操作的行動，帶著孩子一步步走出風暴。
精讀與文法解析
A. “The smear showed schistocytes, confirming microangiopathic hemolysis.” — 分詞片語 confirming… 表結果補充，相當於 which confirmed… 的濃縮版；讓句子更簡潔也更有力。 — 技巧：把「證據→結論」用現在分詞連接，是科學英文常見的節奏。
B. “Platelets were low, but coagulation studies were largely normal.”
— 對比連接詞 but；largely 作程度副詞，「大致、基本上」— 在醫療敘述裡很實用，避免過度絕對。
— 複數名詞 studies 指多項檢驗；語氣客觀。
C. “This pattern argued against DIC and pointed toward HUS.”
— argue against / point toward 是兩個很學術的動詞片語：前者「不支持／排除」，後者「指向」。 — and 連接兩個動作，形成「排除—指向」的邏輯鏈。
D. “We avoided antibiotics and antidiarrheals, focusing instead on careful fluids and renal support.”
— avoid + V-ing「避免做……」；focusing instead on… 用分詞片語 + instead 強調「改以……為重」。 — 平行結構：antibiotics and antidiarrheals；careful fluids and renal support。
E. “If atypical HUS was suspected, plasma exchange or complement blockade would be considered.”
— 假設語氣 If… was suspected（學術寫作常見「客觀被動」）；would be considered「將會被考慮」— 委婉而專業。 — 或然語氣有距離感，合乎醫學寫作的審慎。
F. “Day by day, urine output improved; the numbers followed.”
— 片語 day by day「一天天地」；分號連接兩獨立子句，第二句是第一句的「自然結果」。 — the numbers 指檢驗數值，屬以物指代（metonymy）— 科普敘事的常見手法。
單字與片語
- schistocyte (n.) 裂片紅血球
— Syn: fragmented RBC — Ex: Numerous schistocytes were seen on the peripheral smear. - coagulation studies (n.) 凝血檢查
— Syn: clotting tests — Ex: Coagulation studies remained within normal limits. - argue against (phr.v.) 不支持／與……相左
— Syn: militate against — Ex: The findings argue against DIC. - point toward (phr.v.) 指向
— Syn: indicate, suggest — Ex: The triad points toward HUS. - antidiarrheal (n./adj.) 止瀉藥；止瀉的
— Syn: antiperistaltic agent — Ex: Antidiarrheals were withheld to avoid complications. - renal support (n.) 腎臟支持性治療
— Syn: kidney support — Ex: The team provided renal support with dialysis. - plasma exchange (n.) 血漿置換
— Syn: plasmapheresis — Ex: Plasma exchange can help in atypical HUS. - complement blockade (n.) 補體抑制
— Syn: complement inhibition — Ex: Complement blockade targets the underlying pathway. - urine output (n.) 尿量
— Syn: urinary volume — Ex: Increasing urine output signaled recovery.
相近或同義表達與差異
• confirm vs. support — confirm「證實」語氣較強；support「支持」較保留。寫作時可先用 support，證據更完整時升級為 confirm。 • avoid vs. withhold — avoid 強調「不去做」；withhold 強調「暫時先不給／保留」。臨床用語常說 withhold antibiotics（先不給）。 • argue against vs. rule out — argue against 是「與之不符」但非百分之百排除；rule out 才是「排除」。考試與寫作要注意強度差。 • improve vs. recover — improve「改善」是過程；recover「恢復」是結果。敘事上多用 improve 逐日更新，最後才說 recover。
易混淆比較
• DIC vs. HUS — 兩者都會「出血瘀青＋血小板低」，差別在：DIC 多有「凝血異常（PT, aPTT 明顯延長）」；HUS 則常「凝血多正常」，且兼有溶血線索（LDH 高、haptoglobin 低、schistocytes）。 — 例：If labs are largely normal in coagulation but hemolysis is evident, that argues against DIC and points toward HUS.
• antibiotic use in STEC
— 某些細菌性腹瀉給抗生素可能增加毒素釋放風險；因此敘述常見 avoided antibiotics。 — 例：They avoided antibiotics, focusing on hydration and monitoring.
• transfuse platelets or not?
— 在沒有嚴重出血時，HUS 不常主動輸血小板，避免加劇微血管阻塞；此處語言可寫：Platelets were withheld unless bleeding occurred.（unless 子句限定條件，清楚好用。）
小結
把抽象的病理拉回病房，靠的就是幾個「會說話」的句型：分詞片語承接結論（confirming…）、argue against／point toward 組出邏輯鏈、avoid／withhold 展現治療取向，再用 would be considered 保持醫學寫作的謹慎距離。理解這些語感，就能把化驗單讀成故事，把故事換成行動。到這裡，我們完成了三部曲：從歷史偵探（第 1 篇）、到兩線合流（第 2 篇）、再到臨床決策語言（第 3 篇）。恭喜你收束線索，也學會了把英語當成手術刀，俐落而溫柔。
