Lou Jau-Shin, Weiss Michael D, Carter Gregory T
Oregon Health and Science University, Portland, USA.
Am J Hosp Palliat Care. 2010 Mar;27(2):145-57. doi: 10.1177/1049909109358420.
Fatigue is a common and potentially debilitating symptom of neuromuscular disease (NMD). Studies show that patients with NMD subjectively report increased levels of fatigue. Laboratory testing has demonstrated that patients with NMD show objective physiological signs of increased fatigue, with both central and peripheral components. To date, no treatment has been proven to be truly effective through evidence-based medicine. Thus, the clinician must use a multimodality approach to treating fatigue in patients with NMD. Management interventions are generally based on a sequential approach including treatment of comorbid factors, with the goal of maximizing physical and psychological functioning. This might include low-intensity exercise training, cognitive therapy, treatment of associated depression, correction of risk factors such as obesity, poor nutrition, and inactivity (deconditioning). Optimizing cardiopulmonary function is also critical and measures such as noninvasive, positive pressure ventilation may reduce fatigue in patients with NMD. Novel medications such as modafinil, a nonamphetamine stimulant, may be a helpful pharmacological treatment. Nutraceutical agents, such as creatine monohydrate, coenzyme Q10 (CoQ10), and alpha-lipoic acid, may also improve neuromuscular function and reduce fatigue.
疲劳是神经肌肉疾病（NMD）常见且可能使人衰弱的症状。研究表明，NMD患者主观报告疲劳程度增加。实验室检测已证明，NMD患者表现出疲劳增加的客观生理迹象，包括中枢和外周因素。迄今为止，尚无经循证医学证明真正有效的治疗方法。因此，临床医生必须采用多模式方法来治疗NMD患者的疲劳。管理干预措施通常基于一种循序渐进的方法，包括治疗合并症因素，目标是使身体和心理功能最大化。这可能包括低强度运动训练、认知疗法、治疗相关的抑郁症、纠正肥胖、营养不良和缺乏运动（身体机能下降）等风险因素。优化心肺功能也至关重要，诸如无创正压通气等措施可能会减轻NMD患者的疲劳。新型药物如莫达非尼（一种非苯丙胺类兴奋剂）可能是一种有效的药物治疗方法。营养补充剂，如肌酸一水合物、辅酶Q10（CoQ10）和α-硫辛酸，也可能改善神经肌肉功能并减轻疲劳。
