以患者为中心的口苦诊疗策略与实践框架

孙俊生; 吴敬燊; 黄玮欣; 刘旭; 任菁菁; 姚丁烨

doi:10.16766/j.cnki.issn.1674-4152.004387

以患者为中心的口苦诊疗策略与实践框架

doi: 10.16766/j.cnki.issn.1674-4152.004387

孙俊生^{1, 2},
吴敬燊¹,
黄玮欣¹,
刘旭¹,
任菁菁³,
姚丁烨^{1, 2, ,}

1.
广州中医药大学深圳临床医学院，广东深圳 518116
2.
深圳市龙岗中心医院全科医学科，广东深圳 518116
3.
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

广东省本科高校教学质量与教学改革工程项目粤教高函〔2023〕4号

广东省本科高校教学质量与教学改革工程项目粤教高函〔2024〕30号

广州中医药大学教学质量与教学改革工程项目广中医校办[2024]278号

深圳市龙岗区医学重点学科建设经费资助项目 2024-2027

详细信息

通讯作者:
姚丁烨，E-mail: 349296973@qq.com

中图分类号: R249 R579.9
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- 文章访问数: 6
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出版历程
- 收稿日期: 2025-04-16
- 网络出版日期: 2026-04-11

Patient-centered diagnostic and therapeutic framework for bitter taste in general practice

1.
Shenzhen Clinical College of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518116, China

摘要

摘要: 目的构建以患者为中心的口苦诊疗策略与实践框架，为全科医生提供规范化的诊疗思路。方法通过系统性文献检索，深入探讨口苦的分类、病因，整合中西医认识，结合SOAP记录法，针对基层构建RAPRIOP管理模式并探讨多学科协作诊疗路径。结果口苦从临床特征分为一过性与持续性两类，从病因学分为器质性与非器质性两类。诊疗中通过SOAP记录法整合生物-心理-社会多维度信息：结合生物学病史采集与BATHE问诊法获取主观资料(S)，通过重点与系统查体结合辅助检查及量表评估获取客观资料(O)，综合评估病因、急危重症及严重程度(A)，并以RAPRIOP管理模式制定计划(P)，涵盖重塑信心、建议、处方、转诊、检查、观察、预防7个环节。同时构建“全科医学为核心、专科协作为支撑、中西医结合为特色”的多学科诊疗模式，辅以三级预防体系，形成系统化诊疗框架。结论 SOAP记录法可系统整合生物-心理-社会多维度信息，为精准评估口苦提供结构化支撑；RAPRIOP管理模式则能有序落实全流程干预措施。
- 口苦 /
- 未分化疾病 /
- 以患者为中心 /
- 全科医学 /
- 多学科协作 /
- 诊疗框架
Abstract: Objective To develop a patient-centered diagnostic and therapeutic strategy and practice framework for bitter taste, with the aim of providing general practitioners with a standardized approach for diagnosis. Methods A systematic literature review was conducted to explore the classification and etiology of bitter taste in the mouth. This review integrated the understanding from both traditional Chinese medicine and Western medicine. The SOAP documentation method, was employed in combination with the RAPRIOP management model, which was developed for primary care. This resulted in the exploration of multidisciplinary collaborative diagnostic and treatment pathways. Results Bitter taste in the mouth is classified into transient and persistent types based on clinical characteristics, and into organic and non-organic types based on etiology. In clinical practice, bio-psycho-social multi-dimensional information is integrated using the SOAP documentation method. Subjective data (S) are obtained through the collection of a patient ' s biological history, combined with the BATHE interview method. Objective data (O) are acquired via a combination of focused and systematic physical examinations, ancillary tests, and scale assessments. Etiology acute/critical conditions, and severity are comprehensively evaluated (A); and a plan (P) is developed using the RAPRIOP management model, encompassing seven elements: rebuilding confidence, recommendations, prescriptions, referrals, examinations, observation, and prevention. Moreover, a multidisciplinary diagnostic and treatment model centered on general practice, supported by specialty collaboration, and characterized by the integration of traditional Chinese and Western medicine is constructed. This is complemented by a three-tier prevention system, forming a systematic diagnostic and treatment framework. Conclusion The SOAP documentation method systematically integrates bio-psycho-social multi-dimensional information, providing structured support for the precise assessment of bitter taste in the mouth; the RAPRIOP management model can orderly implement full-process intervention measures.
- Bitter taste /
- Medically unexplained physical symptoms /
- Patient-centered /
- General practice /
- Multidisciplinary collaboration /
- Diagnostic framework

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图 1 口苦的全科诊疗思路

Figure 1. Clinical approach to bitter taste in general practice

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表 1 口苦常见病因

Table 1. Common causes of bitter taste in the mouth

疾病类型	分类	常见病因
器质性疾病	消化系统疾病	慢性胆囊炎、胆囊结石、胆汁反流性胃炎、肝病、胃食管反流病、消化性溃疡^[10]、功能性消化不良、慢性胃炎^[6]、幽门螺杆菌感染
	口腔颌面系统疾病	牙周炎、龋病^[11]、口腔卫生不良、口腔鳞状细胞癌、灼口综合征^{[9, 12]}、咽喉部疾病
	内分泌系统疾病	糖尿病^[13]、甲状腺功能异常
	神经系统疾病	舌咽神经、鼓索和嗅神经等神经损伤^[1]
	其他全身性疾病	干燥综合征^[14]、慢性肾脏病^[15]、恶性肿瘤^[16]
非器质性疾病	精神心理疾病	抑郁症^{[9, 17]}、精神分裂症^[18]
	药物因素	许多药物具有苦味^[19]。泼尼松龙、奎宁^[20]、洛匹那韦利托那韦^[21]、替诺福韦艾拉酚胺^[22]
	生活方式因素	不良情绪因素、不健康的生活习惯^[23]

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表 2 口苦常见病因的治疗方案

Table 2. Treatment plans for common causes of a bitter taste in the mouth

病因	干预方案
慢性病毒性肝炎^[35]	积极进行相关疫苗接种、抗病毒治疗及其他治疗等
胃食管反流病^[36]	基础治疗、药物治疗、难治性病例可考虑内镜治疗(如内镜下射频消融术)或外科手术(如腹腔镜下胃底折叠术)
龋病^[31]	全生命周期的个性化龋病管理策略，结合益生菌调控口腔微生态，智能防龋材料靶向抑制致龋菌及中药天然成分促进牙再矿化
口腔癌^[32]	手术切除联合化疗是主要的治疗策略
灼口综合征^[33-34]	消除局部刺激因素，药物治疗(氯硝西泮、度洛西汀等)，低能量激光治疗，心理认知治疗；中医治疗以健脾益气、滋阴降火为主，配合针灸、舌针等特色疗法
口腔干燥症^[35]	积极治疗原发病，去除诱发因素，采用人工唾液替代疗法，免疫调节治疗
内分泌疾病	糖尿病(血糖监测、饮食、运动、药物、教育等五维管理)
其他系统性疾病	抑郁症(药物-心理联合干预)^[36]、干燥综合征(应保持健康作息与运动，戒烟限酒；定期检查口腔，做好日常护理；依唾液流率分级，轻用对症法，中加免疫调节剂，重联用激素与抑制剂)^[32]

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