Can Fam Physician. 2019 Feb;65(2):107-108.
I recently saw in my office a patient whom I had initially diagnosed with anorexia nervosa 6 months earlier and she was continuing to lose weight. Her physical examination findings in the office revealed a blood pressure of 85/55 mm Hg and a heart rate of 55 beats/min at rest. Should patients such as this one be sent to the hospital for inpatient monitoring and treatment? There is a lack of clear evidence-based guidelines for hospital admission of adolescents with anorexia nervosa, resulting in a high degree of variation in practices among physicians. Clinical judgment based on expert opinion seems to be the main driver of the decision to admit for inpatient care. Acceptable indications for a patient's admission include the following: weight is less than 75% of ideal body weight, temperature is lower than 35.5°C (95.9°F), heart rate is less than 45 beats/min, systolic blood pressure level is lower than 80 mm Hg, orthostatic change in pulse is higher than 20 beats/min, or orthostatic change in blood pressure is greater than 10 mm Hg. Consultation with an adolescent medicine specialist is highly recommended for adolescents with these vital signs.
我最近在我的办公室看到一位患者，我在 6 个月前最初诊断她患有神经性厌食症，她仍在继续减重。她在办公室的体检结果显示，血压为 85/55mmHg，心率在休息时为 55 次/分钟。像这样的患者是否应该住院进行监测和治疗？由于缺乏针对神经性厌食症青少年住院治疗的明确循证指南，导致医生之间的做法存在很大差异。基于专家意见的临床判断似乎是决定住院治疗的主要驱动因素。患者入院的可接受指征包括以下内容：体重低于理想体重的 75%，体温低于 35.5°C（95.9°F），心率低于 45 次/分钟，收缩压低于 80mmHg，直立位脉搏变化高于 20 次/分钟，或直立位血压变化大于 10mmHg。对于有这些生命体征的青少年，强烈建议咨询青少年医学专家。
