麻木诊治与管理专家共识（2025）

doi:10.12114/j.issn.1007-9572.2025.0522

摘要/Abstract

摘要： 麻木是临床常见问题，病因复杂，且缺乏系统性临床研究数据，不仅影响患者身心健康，也给社会带来较大的经济负担。本共识由全科医学、神经病学、老年医学等多学科专家共同撰写，通过梳理与整合近年来麻木领域国内外前沿循证医学研究结果，详细阐述了麻木的定义、分类、流行病学特征、病因与发病机制，全面总结了麻木的诊断方法（包括详细问诊、系统体格检查和辅助检查），具体论述了麻木的个体化治疗原则和治疗措施。本共识同时强调麻木的综合管理，涵盖筛查、随访、综合干预、健康教育、多学科诊疗支持、分级转诊等内容，并从临床实践、教育培训和科研创新等方面提出麻木诊治与管理的未来方向，旨在为规范开展麻木诊治和全程管理提供参考和指导。

关键词: 麻木, 诊断, 治疗, 管理, 多学科诊疗, 分级诊疗, 专家共识

Abstract:

Numbness is a common clinical problem with complex etiology and a lack of systematic clinical research data, affecting patients' physical and mental health and imposing an economic burden on society. This consensus was written by multidisciplinary experts including general practice, neurology, and geriatrics. By reviewing and integrating the cutting-edge domestic and international evidence-based medical research results in the field of numbness in recent years, it elaborates in detail on the definition, classification, epidemiology, etiology and pathogenesis, comprehensively summarizes the diagnostic methods of numbness, including detailed consultation, systematic physical examination, and auxiliary examination, and specifically expounds the individualized treatment principles and measures for numbness. The consensus also emphasizes the comprehensive community management of numbness, including screening, follow-up, comprehensive interventions, health education, multidisciplinary diagnostic support, and graded referral systems. Furthermore, it proposes future directions for the diagnosis, treatment, and management of numbness from the perspectives of clinical practice, education and training, and scientific research innovation. The ultimate aim is to provide guidance and support for the standardized diagnosis, treatment, and whole-process care of patients with numbness.

Key words: Numbness, Diagnosis, Therapy, Management, Multidisciplinary diagnosis and treatment, Grading diagnosis and treatment, Expert consensus

中图分类号:

R 256.69

海峡两岸医药卫生交流协会全科医学分会,浙江省医学会全科医学分会,浙江省数理医学学会全科未分化疾病专委会,等. 麻木诊治与管理专家共识（2025）[J]. 中国全科医学, 2026, 29(18): 2433-2449. DOI: 10.12114/j.issn.1007-9572.2025.0522.
General Practice Branch of Cross-straits Medicine Exchange Association,General Practice Branch of Zhejiang Medical Association,General Undifferentiated Disease Professional Committee of Zhejiang Society of Mathematical Medicine, et al. Expert Consensus on the Diagnosis, Treatment, and Management of Numbness (2025)[J]. Chinese General Practice, 2026, 29(18): 2433-2449. DOI: 10.12114/j.issn.1007-9572.2025.0522.

图/表 13

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病程类型	发病时间（周）	常见病因	核心处理原则
急性麻木	<4	脑血管病、创伤、急性感染/中毒等	紧急评估
亚急性麻木	4~12	吉兰-巴雷综合征、维生素B族缺乏等	及时干预
慢性麻木	>12	糖尿病周围神经病变、颈椎病等	长期管理

病程类型	发病时间（周）	常见病因	核心处理原则
急性麻木	<4	脑血管病、创伤、急性感染/中毒等	紧急评估
亚急性麻木	4~12	吉兰-巴雷综合征、维生素B族缺乏等	及时干预
慢性麻木	>12	糖尿病周围神经病变、颈椎病等	长期管理

分度	数字评分（分）	感觉受损症状及对日常生活的影响
轻度	1~3	感觉异常或感觉减退；对日常生活无影响
中度	4~7	感觉异常或感觉减退；对日常生活有轻微影响（如难以扣纽扣、拿餐具等）
重度	8~10	感觉丧失；对日常生活有明显影响（如行走困难、无法完成精细动作等）

分度	数字评分（分）	感觉受损症状及对日常生活的影响
轻度	1~3	感觉异常或感觉减退；对日常生活无影响
中度	4~7	感觉异常或感觉减退；对日常生活有轻微影响（如难以扣纽扣、拿餐具等）
重度	8~10	感觉丧失；对日常生活有明显影响（如行走困难、无法完成精细动作等）

系统	部位	症状	疾病
中枢神经系统	脑部疾病	突发起病的单侧麻木	缺血性或出血性脑血管病；炎症性疾病：感染性脑炎、脑脓肿、自身免疫性脑炎等；脱髓鞘性脑病：多发性硬化、视神经脊髓炎谱系疾病等；脑退行性疾病：多系统萎缩等
中枢神经系统	脊髓疾病	病灶平面以下的躯干及肢体麻木	血管性疾病：脊髓梗死、出血、血管畸形等；营养代谢性疾病：亚急性联合变性、铜缺乏性脊髓病等；自身免疫性疾病：副肿瘤性脊髓病、神经结节病等；感染性疾病：HIV感染、疱疹病毒感染性脊髓病等；受压性疾病：椎间盘压迫、肿瘤压迫等
周围神经系统	单神经病	损害神经支配区域内出现麻木症状	各种原因造成的卡压
	多发性单神经病	麻木分布范围累及2根及以上周围神经支配区域，多不对称	血管炎等风湿免疫系统疾病叠加周围神经病、感染性神经炎等
	多发性周围神经病	多以肢体远端为主，呈手套、袜套样分布	内分泌和代谢性疾病；免疫相关性周围神经病：吉兰-巴雷综合征、慢性炎性脱髓鞘性神经根神经病等；副肿瘤性周围神经病等；特殊药物等