神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件

第九章急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)(acuteinflammatorydemyelinatingpolyneuropathies,AIDP)神經(jīng)康復(fù)學(第1版)第九章急性炎癥性脫髓鞘性1本章重點1.Guillain-Bare綜合征的臨床表現(xiàn)、輔助檢查、診斷2.Guillain-Barre綜合征常見的康復(fù)問題和主要的康復(fù)評定3.Guillain-Barre綜合征的康復(fù)治療本章重點2急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病Acuteinflammatorydemyelinatingpolyneuropathies,AIDPGuillain-Bare綜合征(GBS)「概念」口急性&亞急性特發(fā)性多發(fā)性神經(jīng)病口可能與感染有關(guān)&免疫機制參與急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病3流行病學GBS年發(fā)病率0.6~1.9/10萬,男性略多歐美國家雙峰發(fā)病年齡(16~25&45-60歲)我國青壯年&兒童多見◆有地區(qū)&季節(jié)流行趨勢流行病學4病因&發(fā)病機制GBS確切病因不清冷與空腸彎曲菌(campylobacterjejun,CJ感染有關(guān)☆可能與巨細胞病毒(CMV)EB病毒肺炎支原體乙型肝炎病毒(HBV八HIV感染有關(guān)病因&發(fā)病機制5病因&發(fā)病機制分子模擬(molecularmimicry)機制σ病原體某些組分與周圍神經(jīng)組分相似□機體免疫系統(tǒng)發(fā)生錯誤識別產(chǎn)生自身免疫性T細胞和自身Ab→對周圍神經(jīng)免疫應(yīng)答→脫髓鞘病因&發(fā)病機制6臨床表現(xiàn)四肢弛緩性癱&呼吸肌麻痹

病前1~4周多有胃腸道\呼吸道感染&疫苗接種史◆急性&亞急性起病

四肢對稱性弛緩性癱,自雙下肢開始,近端較重◆數(shù)日~2周達高峰

危重者1~2d完全性四肢癱,呼吸肌&吞咽肌麻痹,危及生命數(shù)d內(nèi)對稱性癱自下肢→上肢,腱反射減低&消失,可累及腦神經(jīng)臨床表現(xiàn)7臨床表現(xiàn)2肢體感覺障礙σ感覺異常(燒灼麻木\刺痛\不適感感覺缺失較少見(手套襪子形分布)振動覺&關(guān)節(jié)運動覺通常保存神經(jīng)根刺激征一少數(shù)病例出現(xiàn)Kernig征LAsegue征臨床表現(xiàn)8臨床表現(xiàn)腦神經(jīng)麻痹常見雙側(cè)面癱其次是球麻痹可為首發(fā)癥狀臨床表現(xiàn)9臨床表現(xiàn)自主神經(jīng)紊亂癥狀竇性心動過速&心律失常體位性低血壓&高血壓出汗增多&皮膚潮紅*手足腫脹&營養(yǎng)障礙肺功能受損暫時性尿潴留*麻痹型腸梗阻臨床表現(xiàn)10神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件11神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件12神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件13神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件14神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件15神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件16神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件17神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件18神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件19神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件20神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件21神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件22神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件23神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件24神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件25神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件26神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件27神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件28神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件29神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件30神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件31神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件32神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件33神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件34神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件35神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件36神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件37神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件38神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件39神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件40神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件41第九章急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)(acuteinflammatorydemyelinatingpolyneuropathies,AIDP)神經(jīng)康復(fù)學(第1版)第九章急性炎癥性脫髓鞘性42本章重點1.Guillain-Bare綜合征的臨床表現(xiàn)、輔助檢查、診斷2.Guillain-Barre綜合征常見的康復(fù)問題和主要的康復(fù)評定3.Guillain-Barre綜合征的康復(fù)治療本章重點43急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病Acuteinflammatorydemyelinatingpolyneuropathies,AIDPGuillain-Bare綜合征(GBS)「概念」口急性&亞急性特發(fā)性多發(fā)性神經(jīng)病口可能與感染有關(guān)&免疫機制參與急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病44流行病學GBS年發(fā)病率0.6~1.9/10萬,男性略多歐美國家雙峰發(fā)病年齡(16~25&45-60歲)我國青壯年&兒童多見◆有地區(qū)&季節(jié)流行趨勢流行病學45病因&發(fā)病機制GBS確切病因不清冷與空腸彎曲菌(campylobacterjejun,CJ感染有關(guān)☆可能與巨細胞病毒(CMV)EB病毒肺炎支原體乙型肝炎病毒(HBV八HIV感染有關(guān)病因&發(fā)病機制46病因&發(fā)病機制分子模擬(molecularmimicry)機制σ病原體某些組分與周圍神經(jīng)組分相似□機體免疫系統(tǒng)發(fā)生錯誤識別產(chǎn)生自身免疫性T細胞和自身Ab→對周圍神經(jīng)免疫應(yīng)答→脫髓鞘病因&發(fā)病機制47臨床表現(xiàn)四肢弛緩性癱&呼吸肌麻痹

病前1~4周多有胃腸道\呼吸道感染&疫苗接種史◆急性&亞急性起病

四肢對稱性弛緩性癱,自雙下肢開始,近端較重◆數(shù)日~2周達高峰

危重者1~2d完全性四肢癱,呼吸肌&吞咽肌麻痹,危及生命數(shù)d內(nèi)對稱性癱自下肢→上肢,腱反射減低&消失,可累及腦神經(jīng)臨床表現(xiàn)48臨床表現(xiàn)2肢體感覺障礙σ感覺異常(燒灼麻木\刺痛\不適感感覺缺失較少見(手套襪子形分布)振動覺&關(guān)節(jié)運動覺通常保存神經(jīng)根刺激征一少數(shù)病例出現(xiàn)Kernig征LAsegue征臨床表現(xiàn)49臨床表現(xiàn)腦神經(jīng)麻痹常見雙側(cè)面癱其次是球麻痹可為首發(fā)癥狀臨床表現(xiàn)50臨床表現(xiàn)自主神經(jīng)紊亂癥狀竇性心動過速&心律失常體位性低血壓&高血壓出汗增多&皮膚潮紅*手足腫脹&營養(yǎng)障礙肺功能受損暫時性尿潴留*麻痹型腸梗阻臨床表現(xiàn)51神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件52神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件53神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件54神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件55神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件56神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件57神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件58神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件59神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件60神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件61神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件62神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件63神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件64神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件65神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件66神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件67神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件68神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件69神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件70神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件71神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件72神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件73神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件74神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性多發(fā)性神經(jīng)病的康復(fù)課件75神經(jīng)康復(fù)學9-急性炎癥性脫髓鞘性