陣發(fā)性交感神經(jīng)興奮課件

PSH李祥全1精選WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：陣發(fā)性SympatheticHyperactivity：交感活性增高2精選WHATISPSH交感神經(jīng)副交感神經(jīng)3精選WHATISPSH交感神經(jīng)興奮是一種應激反應，起到一定的機體保護作用4精選WHATISPSH交感興奮時可有以下變化：心率加快胃腸道血管收縮呼吸增快汗腺分泌瞳孔擴大糖原分解膀胱逼尿肌松弛、括約肌收縮肌張力升高！準備戰(zhàn)斗！5精選WHATISPSH6精選WHATISPSH平衡是機體正常的生理需求交感VS副交感7精選WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttime8精選WHATISPSH9精選WHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactors10精選WHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecosts11精選WHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystonia12精選ReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseases13精選MechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccurs14精選DiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizures15精選DiagnosticWorkupsCFS-AM量表特點得分臨床癥狀同時發(fā)生1突發(fā)性1輕微刺激引起癥狀發(fā)作1發(fā)作癥狀持續(xù)≥3天1腦損傷持續(xù)大于≥周1其他治療后癥狀無緩解1藥物可緩解交感神經(jīng)癥狀1發(fā)作≥2次/d1無副交感興奮表現(xiàn)1排除其他原因1獲得性腦損傷病史1不可能(＜8分)，可能(8～16分)，很可能(＞17分)16精選ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；17精選ManagementClonidine(可樂定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonist18精選ManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴噴?。篴nalogofGABA19精選ManagementBromocriptine（溴隱亭）:syntheticdopamineagonistthatstimulatesdopaminetype2receptorsandantagonizestype1receptorsinthehypothalamusandtheneostriatumofthebrainDantrolene（丹曲林）:decreasesmusclecontractionbydirectlyinterferingwithcalciumionreleasefromthesarcoplasmicreticulumwithinskeletalmusclecells.20精選ManagementPropranolol（普萘洛爾）:β-BlockersMorphine（嗎啡）:μ-opioidreceptoragonist;startingwithintravenouslydministeredmorphineandthenswitchingtoascheduledoralrouteofadministrationofmorphineoroxycod