Chinese General Practice ›› 2024, Vol. 27 ›› Issue (05): 509-520.DOI: 10.12114/j.issn.1007-9572.2023.0728
Special Issue: 指南/共识最新文章合集
• Guidelines·Consensus • Previous Articles Next Articles
Received:
2023-08-10
Revised:
2023-10-25
Published:
2024-02-15
Online:
2023-11-21
Contact:
WANG Zhen, CHEN Jue
通讯作者:
王振, 陈珏
基金资助:
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2023.0728
推荐强度 | 证据级别 | 病因、治疗、预防 |
---|---|---|
A | 1a | 多个同质随机对照研究的系统综述 |
1b | 单个随机对照研究 | |
1c | "全或无"证据 | |
B | 2a | 同质性队列研究的系统综述 |
2b | 单一的队列研究(包括低质量的随机对照研究,如随访率<80%) | |
2c | 结局性研究 | |
3a | 同质性病例对照研究的系统综述 | |
3b | 单独的病例对照研究 | |
C | 4 | 病例系列 |
D | 5 | 没有严格评价的专家意见,或完全基于生理学和基础研究 |
Table 1 Grading criteria for clinical evidence and strength of recommendation by the Oxford Centre for Evidence-based Medicine
推荐强度 | 证据级别 | 病因、治疗、预防 |
---|---|---|
A | 1a | 多个同质随机对照研究的系统综述 |
1b | 单个随机对照研究 | |
1c | "全或无"证据 | |
B | 2a | 同质性队列研究的系统综述 |
2b | 单一的队列研究(包括低质量的随机对照研究,如随访率<80%) | |
2c | 结局性研究 | |
3a | 同质性病例对照研究的系统综述 | |
3b | 单独的病例对照研究 | |
C | 4 | 病例系列 |
D | 5 | 没有严格评价的专家意见,或完全基于生理学和基础研究 |
分类 | 躯体症状 |
---|---|
营养不良:与能量摄入不足有关的特征 | 在身高、体质量和体质量指数图表上与既往的生长轨迹有偏差 |
异常的生命体征:静息状态下心率或血压降低;直立时心率增加(>20次/min)或血压下降(<10 mmHg);体温过低 | |
情绪平淡或焦虑 | |
皮肤苍白、干燥;胡萝卜素血症(特别是手掌和脚底) | |
恶病质:面部消瘦,皮下脂肪减少,肌肉量减少 | |
毛发稀疏 | |
心脏杂音(1/3伴有左房室瓣脱垂),四肢冰凉,手足发绀 | |
左下腹粪便团块 | |
青春期发育的延迟:乳房小,阴道干燥;睾丸小 | |
与清除有关的特征 | 生命体征异常:直立时心率增加(>20次/min)或血压下降(<10 mmHg) |
牙釉质腐蚀、口角炎、上腭部划痕 | |
Russell's征(自我催吐导致指关节磨损或结茧) | |
唾液腺肿大(腮腺和下颌下腺) | |
上腹部压痛 | |
脊柱挫伤或擦伤(与过度运动或仰卧起坐有关) |
Table 2 Significant physical symptoms in adolescent AN patients
分类 | 躯体症状 |
---|---|
营养不良:与能量摄入不足有关的特征 | 在身高、体质量和体质量指数图表上与既往的生长轨迹有偏差 |
异常的生命体征:静息状态下心率或血压降低;直立时心率增加(>20次/min)或血压下降(<10 mmHg);体温过低 | |
情绪平淡或焦虑 | |
皮肤苍白、干燥;胡萝卜素血症(特别是手掌和脚底) | |
恶病质:面部消瘦,皮下脂肪减少,肌肉量减少 | |
毛发稀疏 | |
心脏杂音(1/3伴有左房室瓣脱垂),四肢冰凉,手足发绀 | |
左下腹粪便团块 | |
青春期发育的延迟:乳房小,阴道干燥;睾丸小 | |
与清除有关的特征 | 生命体征异常:直立时心率增加(>20次/min)或血压下降(<10 mmHg) |
牙釉质腐蚀、口角炎、上腭部划痕 | |
Russell's征(自我催吐导致指关节磨损或结茧) | |
唾液腺肿大(腮腺和下颌下腺) | |
上腹部压痛 | |
脊柱挫伤或擦伤(与过度运动或仰卧起坐有关) |
编号 | 条件 |
---|---|
1 | BMI≤相应年龄和性别青少年BMI中位数的75% |
2 | 脱水 |
3 | 电解质紊乱(低钾血症、低钠血症、低磷血症) |
4 | 心电图异常(如QTc延长) |
5 | 生理上的不稳定性: 严重心动过缓(日间心率<50次/min;夜间心率<45次/min) 低血压(<90/45 mmHg) 低体温(<35.6 ℃) 体位性脉搏增加(>20次/min)或体位性血压降低(收缩期>20 mmHg或舒张期>10 mmHg) |
6 | 生长发育受阻 |
7 | 门诊治疗失败 |
8 | 严重拒食 |
9 | 无法控制的暴饮暴食和清除行为 |
10 | 营养不良导致的急性并发症(晕厥、癫痫发作、心力衰竭、胰腺炎等) |
11 | 因共病其他精神障碍或躯体疾病导致无法门诊治疗(如严重抑郁、自杀意念、强迫性障碍、1型糖尿病) |
Table 3 Conditions for hospitalization of adolescent AN patients
编号 | 条件 |
---|---|
1 | BMI≤相应年龄和性别青少年BMI中位数的75% |
2 | 脱水 |
3 | 电解质紊乱(低钾血症、低钠血症、低磷血症) |
4 | 心电图异常(如QTc延长) |
5 | 生理上的不稳定性: 严重心动过缓(日间心率<50次/min;夜间心率<45次/min) 低血压(<90/45 mmHg) 低体温(<35.6 ℃) 体位性脉搏增加(>20次/min)或体位性血压降低(收缩期>20 mmHg或舒张期>10 mmHg) |
6 | 生长发育受阻 |
7 | 门诊治疗失败 |
8 | 严重拒食 |
9 | 无法控制的暴饮暴食和清除行为 |
10 | 营养不良导致的急性并发症(晕厥、癫痫发作、心力衰竭、胰腺炎等) |
11 | 因共病其他精神障碍或躯体疾病导致无法门诊治疗(如严重抑郁、自杀意念、强迫性障碍、1型糖尿病) |
心理治疗类型 | 治疗目标 | 推荐疗程 | 推荐强度/证据级别 |
---|---|---|---|
FT | 通过调整家庭的互动模式,使家庭系统具有更好的功能来支持个体康复,从而改善患者症状 | 1次/周,持续数月 | A/1b |
FBT | 通过赋能予父母负责青少年体质量恢复,逐步调整为适当控制、最终帮助青少年独立发展 | 6个月,20次访谈 | A/1a |
CBT-E | 聚焦于改变患者对于体质量体形的歪曲认知,纠正或改善异常的进食行为 | 4~6个月,20~40次访谈 | B/2a |
DBT | 通过一系列技巧训练,帮助患者认识自我,学会调整情绪,建立良好的人际关系以及学会承受生活中不可避免的痛苦 | 6个月,每周1次个体访谈和1次技能团体 | C/4 |
其他(PDT、 IPT等) | 帮助患者理解饮食行为症状背后的潜意识动机、冲突,或人际关系模式等,帮助患者发展更加灵活及具有适应性的应对方式 | 4~12个月,15~50次访谈不等 | D/5 |
Table 4 Recommendations for psychotherapy in adolescent AN patients
心理治疗类型 | 治疗目标 | 推荐疗程 | 推荐强度/证据级别 |
---|---|---|---|
FT | 通过调整家庭的互动模式,使家庭系统具有更好的功能来支持个体康复,从而改善患者症状 | 1次/周,持续数月 | A/1b |
FBT | 通过赋能予父母负责青少年体质量恢复,逐步调整为适当控制、最终帮助青少年独立发展 | 6个月,20次访谈 | A/1a |
CBT-E | 聚焦于改变患者对于体质量体形的歪曲认知,纠正或改善异常的进食行为 | 4~6个月,20~40次访谈 | B/2a |
DBT | 通过一系列技巧训练,帮助患者认识自我,学会调整情绪,建立良好的人际关系以及学会承受生活中不可避免的痛苦 | 6个月,每周1次个体访谈和1次技能团体 | C/4 |
其他(PDT、 IPT等) | 帮助患者理解饮食行为症状背后的潜意识动机、冲突,或人际关系模式等,帮助患者发展更加灵活及具有适应性的应对方式 | 4~12个月,15~50次访谈不等 | D/5 |
心理治疗类型 | 治疗目标 | 推荐疗程 | 推荐强度/证据级别 |
---|---|---|---|
CBT-E | 聚焦于改变患者对于体质量体形的歪曲认知,纠正或改善异常的进食行为 | 4~6个月,20~40次访谈 | A/1a |
PDT | 帮助患者理解饮食行为症状背后的潜意识动机、冲突、防御方式等,帮助患者发展更加灵活及具有适应性的应对方式 | 约1年,50次访谈 | B/2a |
DBT | 通过一系列技巧的训练,帮助患者认识自我,学会调整情绪,建立良好的人际关系以及学会承受生活中不可避免的痛苦 | 6个月,1次/周个体访谈和1次技能团体 | B/2b |
IPT | 聚焦于识别和改变导致进食问题发生、发展和持续的人际关系背景 | 4~5个月,15~20次访谈 | B/2b |
Table 5 Recommendations for psychotherapy in adult AN patients
心理治疗类型 | 治疗目标 | 推荐疗程 | 推荐强度/证据级别 |
---|---|---|---|
CBT-E | 聚焦于改变患者对于体质量体形的歪曲认知,纠正或改善异常的进食行为 | 4~6个月,20~40次访谈 | A/1a |
PDT | 帮助患者理解饮食行为症状背后的潜意识动机、冲突、防御方式等,帮助患者发展更加灵活及具有适应性的应对方式 | 约1年,50次访谈 | B/2a |
DBT | 通过一系列技巧的训练,帮助患者认识自我,学会调整情绪,建立良好的人际关系以及学会承受生活中不可避免的痛苦 | 6个月,1次/周个体访谈和1次技能团体 | B/2b |
IPT | 聚焦于识别和改变导致进食问题发生、发展和持续的人际关系背景 | 4~5个月,15~20次访谈 | B/2b |
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