摘要
腰背痛是全科医学门诊中常见健康问题,严重影响患者生活质量,甚至导致全身残疾。本文通过全面回顾相关文献,探讨腰背痛在全科医学中的诊疗思路,旨在为全科医生提供规范、明确的诊疗方案,以提升临床诊疗服务质量。研究发现,全科医生在面对病因复杂的腰背痛诊疗上存在不足,特别是在缺乏高级检测设备的情况下易出现误诊和漏诊。因此,培养全科医生运用全科思维习惯,提升鉴别诊断技巧至关重要。本文推荐采用约翰·莫塔安全诊断策略,全面考虑可能的诊断、严重疾病、经常被遗漏的疾病、潜在隐藏的疾病和患者传达的信息。在治疗方面,全科管理策略涵盖了非药物管理、药物治疗、机会性预防、预防性照顾和随访等多个方面。特别是对于病程较长、难以完全治愈的腰背痛疾病,非药物治疗显得尤为重要。运动疗法、针刺疗法、脊柱推拿、按摩及体外冲击波等非药物疗法,以及中医药管理方法,都显示出良好的治疗效果。此外,本文还强调了预防性照顾的重要性,包括维持正确的姿势、加强工作保护、进行腰背锻炼和保持健康饮食等,这些措施不仅能够缓解腰背痛,还有助于预防其再次发作。定期随访则有助于监测病情变化、调整治疗方案、提供心理支持并促进医患沟通。综上,全科医生在处理腰背痛时,应采用全科诊疗思维,遵循生物-心理-社会医学模式,使用安全的诊断策略,进行全面评估,并制定合理的诊疗方案。同时,关注患者的心理健康,帮助他们树立积极的心态,提高生活质量,这对于腰背痛的治疗和管理至关重要。
Low back pain is a prevalent health concern in general medical settings that significantly impacts patients' quality of life and can lead to systemic disability.This article seeks to offer general practitioners standardized and clear diagnostic and treatment guidelines by conducting a comprehensive review of relevant literature and exploring the diagnos-tic and therapeutic approaches for low back pain in general practice medicine,with the goal of enhancing the quality of clinical services.The review reveals that general practitioners often encounter challenges in diagnosing and treating com-plex low back pain stemming from various causes,particularly when advanced diagnostic tools are unavailable,resulting in misdiagnoses and overlooked conditions.Therefore,it is imperative to train general practitioners to adopt a holistic ap-proach and enhance their differential diagnosis skills.The John Mortara safety diagnostic strategy is recommended as it considers a wide range of potential diagnoses,serious illnesses,commonly missed conditions,underlying disorders,and patient-specific information.Regarding treatment,general management strategies encompass non-pharmacological inter-ventions,medication therapy,preventive measures,proactive care,and follow-up appointments.Non-pharmacological treatments like exercise therapy,acupuncture,spinal manipulation,massage,extracorporeal shock wave therapy,and traditional Chinese medicine approaches have demonstrated positive outcomes in addressing chronic and challenging low back pain conditions.Furthermore,the article underscores the significance of preventive care,including maintaining proper posture,implementing workplace safety measures,engaging in low back exercises,and adopting a healthy diet.These measures not only alleviate low back pain but also help prevent its recurrence.Regular follow-up visits help monitor disease changes,adjust treatment plans,provide psychological support,and promote doctor-patient communication.In summary,general practitioners should adopt a holistic approach to diagnosis and treatment when dealing with low back pain,following the biological-psychological-social medical model.They should use safe diagnostic strategies,conduct comprehensive evaluations,and develop reasonable diagnosis and treatment plans.Additionally,attention should be given to patients' mental health to help them establish a positive attitude and improve their quality of life,which is crucial for the treatment and management of low back pain.
作者
许培裕
卢梓健
汤健鹏
姚丁烨
任菁菁
孙俊生
XU Peiyu;LU Zijian;TANG Jianpeng;YAO Dingye;REN Jingjing;SUN Junsheng(Department of General Practice,Longgang District Central Hospital of Shenzhen,Shenzhen,Guangdong 5181116,China;不详)
出处
《中华全科医学》
2024年第10期1631-1635,共5页
Chinese Journal of General Practice
基金
国家自然科学基金项目(72274169)
广东省本科高校教学质量与教学改革工程项目(粤教高函〔2023〕4号)
深圳市龙岗区医学学科建设经费资助。
关键词
全科医学
腰背痛
诊疗思路
General practice
Low back pain
Diagnosis and treatment ideas
作者简介
通信作者:孙俊生,E-mail:junshengsun@126.com。
