以乏力为表现的未分化疾病全科诊疗思路

朱佳宏; 刘颖; 任菁菁

doi:10.16766/j.cnki.issn.1674-4152.002926

以乏力为表现的未分化疾病全科诊疗思路

doi: 10.16766/j.cnki.issn.1674-4152.002926

浙江大学医学院附属第一医院全科医学科，浙江杭州 310003

基金项目:

国家自然科学基金项目 72274169

详细信息

通讯作者:
任菁菁，E-mail：3204092@zju.edu.cn

中图分类号: R499 R441
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- 被引次数: 0
出版历程
- 收稿日期: 2022-11-07
- 网络出版日期: 2023-05-31

Diagnosis and treatment of medically unspecified disease manifested by fatigue: A general practice perspective

Department of General Practice, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China

摘要

摘要: 据统计，以乏力为主诉就诊的患者占全科门诊的10%~20%，是全科门诊常见的主诉之一。调查发现综合性医院全科线下门诊的未分化疾病患者中以乏力为主诉就诊的患者占据首位。亦有研究表明，乏力可对患者的生活质量产生较大影响，其严重程度与死亡率相关。乏力作为一种常见的未分化疾病，无明显特异性，既可以是人体的正常生理反应，也可能是各种疾病的表现之一。通常将乏力分为生理性乏力与病理性乏力，病理性乏力的病因繁多，可涉及各系统，处于疾病的未分化阶段，故以乏力为表现的未分化疾病的评估与治疗均有一定难度。乏力作为患者主观感受，难以评估，除详细地询问病史与体格检查，全科医生还需利用相关评估量表客观地评估患者的乏力程度。然而，目前尚无以乏力为表现的未分化疾病评估量表。对于以乏力为表现的未分化疾病患者，全科医生的处理包括对症治疗(包括非药物治疗与药物治疗)与长期随访，以减轻症状、缓解情绪及降低日常功能损害。全科医生如何为乏力患者提供连续性服务、帮助部分乏力患者与症状共存、寻找有效的干预措施及治疗方法，尚待进一步研究。本文论述了以乏力为表现的未分化疾病全科诊疗思路，浅析其不足之处，以期为全科医生识别及连续性管理乏力患者提供帮助。
- 全科医学 /
- 未分化疾病 /
- 乏力 /
- 诊疗思路
Abstract: Fatigue is a main reason for 10%-20% of all consultations with the general outpatient service. A survey showed that fatigue was the most common complaint among patients with medically unspecified diseases in offline general practice clinics in general hospitals. Also, a study found that fatigue could have a significant impact on patients' quality of life, and its severity was associated with mortality. As a common medically unspecified diseases, fatigue has no obvious specificity. It can not only be a normal physiological reaction of the human body, but also can be one of the manifestations of various diseases. Fatigue can be divided into physiological fatigue and pathological fatigue. Its etiology can be various and involve every system. It is difficult to evaluate and treat medically unspecified disease characterized by fatigue. Because of the subjective feeling, it is hard for general practitioners to evaluate the degree of fatigue. In addition to detailed history and physical examination, general practitioners need to objectively assess the degree of fatigue by using some assessment scales. However, there is no assessment scale for medically unspecified disease characterized by fatigue. The management of patients with medically unspecified disease characterized by fatigue includes symptomatic treatment (both non-pharmacological and pharmacological) and long-term follow-up to alleviate symptoms, relieve mood and reduce impairment in daily functioning. Further research is needed on how to provide a continuum of services for patients with fatigue, help some patients to live with their symptoms, and find effective interventions and treatments. We reviewed the literature on the general diagnosis and treatment of medically unspecified disease manifested by fatigue, hoping to help general practitioners with standardized diagnosis and continued management of the patient with fatigue.
- General practice /
- Medically unspecified disease /
- Fatigue /
- Diagnosis and treatment ideas

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图 1 乏力的诊疗思路

Figure 1. Diagnosis and treatment ideas of fatigue

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表 1 乏力的常见病因

Table 1. Common causes of fatigue

疾病分类	常见病因
肿瘤	乳腺癌，结直肠癌
精神疾病	抑郁症，躯体形式障碍，焦虑症，睡眠障碍
血液系统疾病	贫血，白血病
内分泌/代谢性疾病	甲状腺功能异常，Addison综合征，糖尿病，慢性肾病，慢性肝病
感染性疾病	病毒性感染，单核细胞增多症，贾第虫感染，结核病，新型冠状病毒感染
免疫系统疾病	纤维肌痛，系统性红斑狼疮，干燥综合征，类风湿关节炎
神经系统疾病	多发性硬化症
药物和其他物质	抗抑郁药和抗组胺药，苯二氮䓬类药物，抗精神病药物，降压药，阿片类药物，抗帕金森病药物，干扰素，抗病毒药物，细胞抑制剂，酒精
其他	慢性非感染性疾病，损害睡眠的疾病，缺乏运动，社会因素

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