Kornder Nele, Baum Erika, Maisel Peter, Lindner Nicole
Institut für Allgemeinmedizin, Philipps-Universität Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Deutschland.
Centrum für Allgemeinmedizin, Westfälische Wilhelms-Universität Münster, Münster, Deutschland.
ZFA (Stuttgart). 2023;99(3):127-132. doi: 10.1007/s44266-023-00045-z. Epub 2023 Apr 24.
Fatigue is one of the most common reasons for seeking medical counseling in the family medicine (FM), often entailing diagnostic uncertainty. Patients use terms describing emotional, cognitive, physical, and behavioral aspects. A number of biological, mental, and social causes may underlie the symptom of fatigue, often in combination. This guideline describes the procedures to be applied for primary undetermined symptomatology.
The experts involved conducted a systematic search using the terms for fatigue in the context of FM in PubMed, Cochrane Library and via manual search. Concerning related guidelines, the National Institute for Health and Care Excellence (NICE) guideline was used for myalgic encephalitis/chronic fatigue syndrome (ME/CFS). In a structured consensus process, broad approval of the core recommendations/background text of the revised guideline was attained.
1) Alongside gathering information concerning the symptom characteristics, the anamnesis aims to collect information about pre-existing health conditions, sleeping behavior, use of drugs and psychosocial factors. 2) Depression and anxiety as two common causes will be identified based on screening questions. The occurrence of post-exertional malaise (PEM) will be inquired. 3) The following basic diagnostics are recommended: physical examination, laboratory tests (blood glucose, full blood count, blood sedimentation/CRP, transaminases/γ-GT, TSH). 4) Further examinations should be conducted only in case of specific indications. 5) A biopsychosocial approach is to be adopted. 6) Behavioral therapy and symptom-oriented activating measures can improve fatigue in underlying diseases and undetermined fatigue. 7) In case of PEM, further ME/CFS criteria should be collected and patients have to be supervised accordingly.
疲劳是在家庭医学（FM）中寻求医疗咨询的最常见原因之一，常常导致诊断不确定性。患者使用描述情绪、认知、身体和行为方面的术语。疲劳症状可能有多种生物学、心理和社会原因，且这些原因常常相互交织。本指南描述了针对原发性未确诊症状应采用的程序。
相关专家在PubMed、Cochrane图书馆中使用与FM背景下的疲劳相关术语进行系统检索，并通过手工检索。关于相关指南，采用了英国国家卫生与临床优化研究所（NICE）关于肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）的指南。在一个结构化的共识过程中，修订指南的核心建议/背景文本获得了广泛认可。
1）除了收集有关症状特征的信息外，病史采集旨在收集有关既往健康状况、睡眠行为、药物使用和心理社会因素的信息。2）将根据筛查问题识别抑郁和焦虑这两种常见病因。询问运动后不适（PEM）的发生情况。3）建议进行以下基本诊断：体格检查、实验室检查（血糖、血常规、血沉/C反应蛋白、转氨酶/γ-谷氨酰转移酶、促甲状腺激素）。4）仅在有特定指征时才应进行进一步检查。5）应采用生物心理社会方法。6）行为疗法和以症状为导向的激活措施可改善基础疾病中的疲劳和未确诊的疲劳。7）对于PEM，应收集更多ME/CFS标准，并相应地对患者进行监测。
