Study on the characteristics, etiology, diagnosis and treatment of fatigue patients in general practice wards of general hospitals
-
摘要:
目的 分析综合医院全科病房以“乏力待查”收治患者的临床特征、病因分布及诊疗转归情况，为提升全科医生对该类未分化疾病的诊治与管理能力提供参考。 方法 采用回顾性研究方法，选取2022年10月31日—2024年12月31日浙江大学医学院附属第一医院全科医学科病房收治的289例“乏力待查”患者作为研究对象。收集其人口学资料、疾病诱因、伴随症状、最终病因诊断及治疗方案等，并对数据进行统计分析。 结果 289例患者中，女性175例（60.55%）、男性114例（39.45%），年龄为（56.37±12.28）岁。最常见的诱因为睡眠不足（139例，48.10%）与营养相关问题（93例，32.18%）。病因构成前3位依次为精神心理障碍（97例，33.56%）、消化系统疾病（70例，24.22%）及内分泌系统疾病（62例，21.45%）。诊疗转归方面，106例（36.68%）患者在全科病房内明确了治疗方案；82例（28.37%）需转诊至专科进一步治疗；101例（34.95%）患者未能明确治疗方案。 结论 综合医院全科病房乏力待查患者以中老年女性居多，睡眠不足与营养问题是其主要诱因，精神心理障碍、消化系统及内分泌系统疾病是前3位病因。全科医生需着力提升对常见病因的鉴别诊断、共病管理、心理评估与干预以及多学科协作转诊能力，以改善患者诊疗结局。 Abstract:Objective To analyze the clinical characteristics, etiology, and diagnosis-treatment outcomes of patients admitted with "fatigue of unknown origin" in the general practice ward of a general hospital, and to provide references for enhancing the diagnostic and management capabilities of general practitioners. Methods A retrospective study was conducted on 289 patients with "fatigue of unknown origin" as the primary diagnosis in the General Practice Ward of the First Affiliated Hospital of Zhejiang University School of Medicine from October 31, 2022, to December 31, 2024. Data on demographics, predisposing factors, accompanying symptoms, final etiological diagnoses, and treatment outcomes were collected and statistically analyzed. Results Among the 289 patients, 175 (60.55%) were female and 114 (39.45%) were male, with a mean age of (56.37±12.28) years. The most common predisposing factors were sleep deprivation (139 cases, 48.10%) and nutritional issues (93 cases, 32.18%). The top three etiological categories were mental disorders (97 cases, 33.56%), digestive system diseases (70 cases, 24.22%), and endocrine system diseases (62 cases, 21.45%). Regarding treatment outcomes, a definitive plan was established within the general practice ward for 106 patients (36.68%), 82 patients (28.37%) required referral to specialists, and no definitive plan was established for 101 patients (34.95%). Conclusion Patients with fatigue of unknown origin in the general practice ward of a general hospital are predominantly middle-aged and elderly females. Sleep deprivation and nutritional issues are the main predisposing factors, while mental disorders, digestive, and endocrine system diseases are the leading causes. General practitioners need to enhance competencies in differential diagnosis, comorbidity management, psychological assessment and intervention, and multidisciplinary collaboration and referral to improve patient outcomes. -
Key words:
- General practice /
- General hospital /
- Fatigue /
- Medically unspecified disease
-
表 1 289例乏力待查患者基本情况
Table 1. Basic information of 289 patients with unexplained fatigue
项目 例数(%) 性别 男性 114(39.45) 女性 175(60.55) 年龄(岁) 20以下 3(1.04) 20~34 11(3.81) 35~49 63(21.80) 50~64 140(48.44) 65及以上 72(24.91) 住院时间(d) 1~3 134(46.37) 4~6 120(41.52) 7~9 33(11.42) 10~12 2(0.69) 是否以乏力为第一就诊原因 是 250(86.51) 否 39(13.49) 起病情况 急 18(6.23) 慢 271(93.77) 病程 长(6个月以上) 151(52.25) 短(6个月以内) 138(47.75) 乏力发作规律 有 41(14.19) 无 248(85.81) 
下载: 导出CSV
表 2 乏力待查患者伴随症状分布
Table 2. Distribution of accompanying symptoms in patients with fatigue of unknown origin
伴随症状 例数(%) 睡眠障碍 129(44.64) 肢体无力 111(38.41) 胸闷 91(31.49) 头晕 90(31.14) 体重下降 76(26.30) 关节痛 60(20.76) 腹痛 37(12.80) 咳痰 27(9.34) 心悸 22(7.61) 咳嗽 22(7.61) 盗汗 21(7.27) 背痛 19(6.57) 水肿 16(5.54) 口干 12(4.15) 胸痛 9(3.11) 气促 8(2.77) 打鼾 2(0.69) 皮肤改变 2(0.69) 口渴 2(0.69)
下载: 导出CSV
表 3 不同特征乏力待查患者治疗方案分类比较(例)
Table 3. Comparison of treatment plans for patients with undetermined specific conditions (cases)
项目 例数 全科已明确治疗方案(n=106) 转诊专科进一步治疗(n=82) 治疗方案未明确(n=101) χ2值 P值 性别 1.128 0.569 男性 114 40 30 44 女性 175 66 52 57 年龄(岁) 7.700 0.463 20以下 3 0 0 3 20~34 11 3 4 4 35~49 63 25 16 22 50~64 140 50 39 51 65及以上 72 28 23 21 住院时间(d) 14.317 0.026 1~3 134 43 32 59 4~6 120 49 34 37 7~9 33 13 15 5 10~12 2 1 1 0 是否以乏力为第一就诊原因 2.365 0.307 是 250 96 69 85 否 39 10 13 16 起病情况 1.821 0.402 急 18 9 5 4 慢 271 97 77 97 病程 0.695 0.706 长(6个月以上) 151 52 44 55 短(6个月以内) 138 54 38 46 乏力发作规律 4.573 0.102 有 41 17 6 18 无 248 89 76 83
下载: 导出CSV
-
[1] 朱佳宏, 刘颖, 任菁菁. 以乏力为表现的未分化疾病全科诊疗思路[J]. 中华全科医学, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926Zhu J H, Liu Y, Ren J J. General practice diagnosis and treatment ideas for undifferentiated diseases manifested as fatigue[J]. Chinese Journal of General Practice, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926 [2] MILOVANOVIC B, MARKOVIC N, PETROVIC M, et al. Assessment of autonomic nervous system function in patients with chronic fatigue syndrome and post-COVID-19 syndrome presenting with recurrent syncope[J]. J Clin Med, 2025, 14(3): 811. DOI: 10.3390/jcm14030811. [3] HASHIMOTO K, TAKEUCHI T, MURASAKI M, et al. Psychosomatic symptoms related to exacerbation of fatigue in patients with medically unexplained symptoms[J]. J Gen Fam Med, 2023, 24(1): 24-29. doi: 10.1002/jgf2.582 [4] MAISEL P, BAUM E, DONNER-BANZHOFF N. Fatigue as the chief complaint: epidemiology, causes, diagnosis, and treatment[J]. Dtsch Arztebl Int, 2021, 118(33-34): 566-576. [5] ARIANE G, AUDREY L, JOHANNA S, et al. Improving general practitioners' approaches to functional somatic syndromes: a pilot training program with a focus on compassion and communication[J]. BMC Med Educ, 2025, 25(1): 87. DOI: 10.1186/s12909-025-06580-4. [6] 中国老年医学学会, 全科未分化疾病专家协作组. 乏力诊治与管理专家共识(2024)[J]. 中华全科医学, 2024, 22(9): 1453-1462. doi: 10.16766/j.cnki.issn.1674-4152.003658Chinese Geriatrics Society, Expert Collaboration Group on Undifferentiated Diseases in General Practice. Expert consensus on the diagnosis and management of fatigue (2024)[J]. Chinese Journal of General Practice, 2024, 22(9): 1453-1462. doi: 10.16766/j.cnki.issn.1674-4152.003658 [7] 吴静怡, 任菁菁, 刘颖, 等. 综合医院亚专长全科医师发展现状的调查研究[J]. 中华全科医学, 2023, 21(10): 1789-1792. doi: 10.16766/j.cnki.issn.1674-4152.003225Wu J Y, Ren J J, Liu Y, et al. Investigation on the development status of general practitioners with sub-specialty in general hospitals[J]. Chinese Journal of General Practice, 2023, 21(10): 1789-1792. doi: 10.16766/j.cnki.issn.1674-4152.003225 [8] 殷培, 任菁菁. 国内外亚专长全科医师培养对比分析[J]. 江苏预防医学, 2023, 34(2): 231-234.Yin P, Ren J J. Comparative analysis of the cultivation of general practitioners with sub-specialty at home and abroad[J]. Jiangsu Journal of Preventive Medicine, 2023, 34(2): 231-234. [9] 叶青, 陈明敏, 任菁菁. 基层全科医师发展精神卫生亚专长的必要性及路径探索[J]. 中国全科医学, 2025, 28(16): 1950-1954, 1960.Ye Q, Chen M M, Ren J J. The necessity and path exploration of primary care general practitioners developing mental health sub-specialties[J]. Chinese General Practice, 2025, 28(16): 1950-1954, 1960. [10] 张雷, 盛锡楠, 李洁. 临床诊疗决策中的伦理问题与共同决策之道[J]. 医学与哲学, 2024, 45(24): 8-11.Zhang L, Sheng X N, Li J. Ethical issues in clinical decision-making and the path of shared decision-making[J]. Medicine & Philosophy, 2024, 45(24): 8-11. [11] 陈曦, 胡欢婷, 黄丹丹, 等. 冠心病患者健康行为决策辅助工具的构建研究[J]. 中华护理教育, 2024, 21(12): 1496-1503.Chen X, Hu H T, Huang D D, et al. Development of a health behavior decision aid tool for patients with coronary heart disease[J]. Chinese Journal of Nursing Education, 2024, 21(12): 1496-1503. [12] CHENG A L, HERMAN E, ABRAMOFF B, et al. Multidisciplinary collaborative guidance on the assessment and treatment of patients with long COVID: a compendium statement[J]. PM R, 2025, 17(6): 684-708. doi: 10.1002/pmrj.13397 [13] TAYLOR H, ALHASAN S, SALEEM M, et al. Influence of menstrual cycle and hormonal contraceptive use on MS symptom fluctuations: a pilot study[J]. Mult Scler Relat Disord, 2023, 77: 104864. DOI: 10.1016/j.msard.2023.104864. [14] 吴小林, 贺丹, 龚红霞, 等. 叙事医学认知培训对医护人员叙事医学认知度和门诊患者就医体验的影响[J]. 广西医学, 2022, 44(14): 1685-1689.Wu X L, He D, Gong H X, et al. Effect of narrative medicine cognitive training on medical staff's awareness of narrative medicine and outpatient patients' medical experience[J]. Guangxi Medical Journal, 2022, 44(14): 1685-1689. [15] 朱向伟, 卢根娣. 叙事教学法在临床护理伦理培训中的应用进展[J]. 中国医学伦理学, 2025, 38(6): 704-711.Zhu XW, Lu G D. Application progress of narrative teaching method in clinical nursing ethics training[J]. Chinese Medical Ethics, 2025, 38(6): 704-711. [16] CAROLLO C, EVOLA S, SORCE A, et al. Mission and one-year experience of a kidney-heart outpatient service: a patient-centered management model[J]. J Clin Med, 2025, 14(6): 2102. DOI: 10.3390/jcm14062102. [17] MOSER R P, TRIVEDI N, MURRAY A, et al. Patient-centered communication (PCC) scale: psychometric analysis and validation of a health survey measure[J]. PLoS One, 2022, 17(12): e0279725. DOI: 10.1371/journal.pone.0279725.
点击查看大图
表(3)
计量
- 文章访问数: 6
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0
