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《“医学无法解释的症状”临床实践中国专家共识》

[The Chinese expert consensus on clinical practice of "medically unexplained symptoms"].

出版信息

Zhonghua Nei Ke Za Zhi. 2017 Feb 1;56(2):150-156. doi: 10.3760/cma.j.issn.0578-1426.2017.02.017.

Abstract

"Medically unexplained symptoms" (MUS) are commonly seen in all clinical specialties. The preliminary investigations in China show a prevalence of MUS in 4.15%-18.2% of clinical patients. Based on international and national guidelines and the most advanced studies, a Chinese expert consensus on clinical practice of MUS is reached through three rounds of discussion seminars by 25 experts from various specialties including psychiatry, internal medicine, surgery, gynecology-obstetrics, otorhinolar-yngology and traditional Chinese medicine. Clinical doctors should be alert of patients whose discomfort complaints cannot be explained by organic conditions after thorough physical examination and necessary laboratory tests. MUS should be recognized as early as possible so as to avoid complicating iatrogenic factors. A full bio-psycho-social evaluation of the patient is the basic structure of understanding MUS patients. In clinical practice, a trustful doctor-patient relationship is the first step of successful treatment. Then after a reasonable clinical evaluation, explain to the patient that it is a harmless functional symptom, communicate with the patient and reach an acceptable therapeutic goal, help the patient understand the symptoms in a psycho-somatic aspect and rebuild confidence of getting back to normal life. Patients with mild symptoms can be treated by doctors in various specialties, from whom the patient seeks help. Patients with severe symptoms need multi-disciplinary care including specific psychotherapy. Pharmaceutical treatment includes symptom alleviating drugs and antidepressants. In clinical care of patients with "MUS" , a full bio-psycho-social evaluation, a good doctor-patient relationship, a treatment plan according to the severity of symptoms, and a multi-disciplinary cooperation should be noted and practiced.

摘要

“医学上无法解释的症状”(MUS)在所有临床专科中都很常见。中国的初步调查显示,临床患者中MUS的患病率为4.15%-18.2%。基于国际和国内指南以及最前沿的研究,来自精神病学、内科、外科、妇产科、耳鼻喉科和中医等多个专科的25位专家通过三轮讨论研讨会达成了关于MUS临床实践的中国专家共识。临床医生应对经过全面体格检查和必要实验室检查后仍无法用器质性疾病解释其不适主诉的患者保持警惕。应尽早识别MUS,以避免医源性因素复杂化。对患者进行全面的生物-心理-社会评估是理解MUS患者的基本框架。在临床实践中,建立信任的医患关系是成功治疗的第一步。然后,经过合理的临床评估,向患者解释这是一种无害的功能性症状,与患者沟通并达成可接受的治疗目标,帮助患者从身心方面理解症状,重建回归正常生活的信心。症状较轻的患者可由其寻求帮助的各专科医生进行治疗。症状严重的患者需要包括特定心理治疗在内的多学科护理。药物治疗包括缓解症状的药物和抗抑郁药。在“MUS”患者的临床护理中,应注意并践行全面的生物-心理-社会评估、良好的医患关系、根据症状严重程度制定的治疗方案以及多学科合作。

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