乏力诊治与管理专家共识(2024)

中国老年医学学会; 全科未分化疾病专家协作组

doi:10.16766/j.cnki.issn.1674-4152.003658

乏力诊治与管理专家共识(2024)

doi: 10.16766/j.cnki.issn.1674-4152.003658

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: R442.9
计量
- 文章访问数: 86
- HTML全文浏览量: 36
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2024-04-12

摘要

摘要: 乏力是一种常见健康问题，长期乏力将影响患者的生命质量，并对其家庭和社会造成较大的医疗经济负担。本共识以乏力的诊治与管理为导向，阐述了乏力的定义、流行概况、病因与发病机制，针对其诊断进行了全面综述，包括详细问诊、体格检查、评估、诊断思维导图，针对其治疗从治疗原则、治疗方案和治疗措施展开了详细阐述，并针对管理提出了详细的建议包括管理、随访、转诊、三级预防、健康教育，以指导全科医生对乏力患者进行长程管理，提升其生命质量，减轻患者家庭与社会的经济负担。
- 乏力 /
- 诊治 /
- 管理
利益冲突 无

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图 1 乏力诊断思维导图

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图 2 乏力患者的管理流程

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表 1 乏力的RICE问诊

问诊内容	提示信息
1.患者本次就诊的主要原因(Reason)是什么？	明确乏力的特点和伴随症状
2.患者认为自己出了什么问题(Idea)？	进一步探寻乏力背后的可能原因
3.患者担忧(Concern)什么？	倾听患者内心的真实需求
4.患者期望(Expectation)医生可以帮助他做些什么？	了解患者对诊疗方面的意见，做到医患共同决策

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表 2 乏力的预警征

预警症状	严重原因
1.发热、盗汗	细菌感染、淋巴瘤、隐匿性肿瘤
2.发热、淋巴结肿大	HIV感染、隐匿性脓肿、淋巴瘤、梅毒、既往感染
3.体重减轻	恶性肿瘤、HIV感染
4.呼吸急促	心力衰竭、心律失常、慢性阻塞性肺疾病、贫血
5.心悸	心律失常、甲状腺危象
6.胸痛	冠状动脉、主动脉、肺动脉疾病
7.皮疹、多关节肿痛，关节畸形，或伴晨僵	皮肌炎、类风湿性关节炎、系统性红斑狼疮
8.瘀点瘀斑	白血病、再生障碍性贫血、脾功能亢进
9.背痛、弥漫性骨痛	癌转移、多发性骨髓瘤
10.腹痛、腹泻、便血	消化道肿瘤、腹腔内恶性肿瘤、肠系膜缺血
11.黄疸	肝炎、胰腺癌、胆管系统疾病、肝硬化、溶血性贫血
12.复视、咀嚼或构音困难	重症肌无力、急性脑血管意外、多发性硬化、多发性肌炎、吉兰巴雷综合征
13.睡眠障碍、情绪低落	抑郁症
14.老年人近期发病	恶性肿瘤、肺炎、贫血、心律失常、肾衰竭

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表 3 乏力筛查评估量表

序号	名称	用途说明
1	多维疲劳量表(the multidimensional fatigue inventory-20，MFI-20)	该量表不仅可对受试者进行全方面疲劳的评定，而且也可以根据需要将其中的某个维度单独抽出来进行评定，同时该量表简单、易懂，适用人群广泛，对总体疲劳的评定更有意义。
2	简明疲劳量表(brief fatigue inventory，BFI)	一个多维度量表，包括疲乏的严重程度和对生活带来的影响；适用人群广泛，简单、易懂。
3	Piper疲乏调查量表(revised Piper fatigue scale，PFS-R)	该量表包含4个维度，共22个条目和5个开放式的问题。4个维度，包括行为疲乏、情绪疲乏、感觉疲乏、认知疲乏。各维度总分除以条目数为维度得分，所有条目的平均分为总表的得分。各条目和维度的得分范围为0~10分，分数越高，表示疲乏的程度越严重。分数的评估分为4个等级，适用人群广泛，对评估乏力严重程度有重要意义。

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