阵发性交感神经兴奋ppt课件

1、PSH李祥全WHAT IS PSHPSH ：Paroxysmal Sympathetic HyperactivityuParoxysmal：阵发性uSympathetic Hyperactivity：交感活性增高WHAT IS PSHWHAT IS PSH交感神经兴奋是一种应激反应，起到一定的机体保护作用WHAT IS PSH交感兴奋时可有以下变化：u心率加快u胃肠道血管收缩u呼吸增快u汗腺分泌u瞳孔扩大u糖原分解u膀胱逼尿肌松弛、括约肌收缩u肌张力升高WHAT IS PSHWHAT IS PSH平衡是机体正常的生理需求WHAT IS PSHPSH：uunbalanced sympatheti

2、c surges causing1. hyperthermia2. diaphoresis3. tachycardia4. hypertension5. tachypnea6. dystonic posturingu develop abruptly and last for a short time交感发作.mp4WHAT IS PSHWHAT IS PSHcharacteristic：uThe first episode occurred on average 5.93.7 days after brain injuryuThe duration of each episode was o

3、n average 31 min (range,1550 min) and its frequency was on average 5.6/day (range,38/day)uOnly 20 % of patients who were followed up at 12 months after injury showed continued signs of PSHuYounger age and male gender have been cited as risk factorsWHAT IS PSHcharacteristic：uIncreases in dopamine, ad

4、renaline, and noradrenaline levels during the episodes have been reporteduPatients who experience PSH have worse Glasgow Outcome Scale scores and worse functional independent measures than their ounterpartsu longer ICU stays, longer hospital stay, more mechanical ventilation days, more infectious ep

5、isodes,more tracheostomy, and higher healthcare costs WHAT IS PSHPSH occurs in stages：1. asymptomatic due to sedation;2. onset of symptom clusters;3. decline in posturing and dystoniaReason for PSHCaused byuTBIusubarachnoid hemorrhageenucephalitisutumorsuhydrocephalusuother diseasesMechanismsUnknown

6、ufunctional or structural disconnection lesions in the mesencephalon cause disruptions in relay from the medulla/hypothalamusuexcitatoryinhibitory ratio (EIR) model dysfunction of the diencephalic-brainsetm inhibitory center that normally controls afferent stimulus processing in the spinal cord occu

7、rsDiagnostic WorkupsExclusion diagnosisuInfections and sepsis should be ruled out in patients with fever and tachycardiauOpiate withdrawal from prolonged sedation should be addresseduEEG to rule out seizuresDiagnostic WorkupsCFS-AM量表量表特点特点得得分分临床症状同时发生1突发性1轻微刺激引起症状发作1发作症状持续3天1脑损伤持续大于周1其他治疗后症状无缓解1药物可缓

8、解交感神经症状1发作2次/d1无副交感兴奋表现1排除其他原因1获得性脑损伤病史1不可能不可能( 8 分分) ， 可能可能( 8 16 分分) ， 很可能很可能( 17 分分)Managementno direct treatment options are availablecontrol of symptomsMedical treatments for PSH include 2-agonists, -blockers, benzodiazepines, dopamine agonists, opioids, GABAergic agents, antrolene, and gabapen

9、tin；ManagementClonidine(可乐定)：presynaptic 2-receptor agonist which reduces central sympathetic outflow from the hypothalamus and ventrolateral medullaDexmedetomidine（右美托咪定）:an intravenous sedative and the first and only currently approved intravenous 2-agonistManagementBaclofen（巴氯芬）:structural analog

10、 of the inhibitory neurotransmitter -minobutyric acid (GABA),indicated for treatment of spasticity and to improve mobilityGabapentin（加巴喷丁）：analog of GABAManagementBromocriptine（溴隐亭）:synthetic dopamine agonist that stimulates dopamine type 2 receptors and antagonizes type 1 receptors in the hypothala

11、mus and the neostriatum of the brainDantrolene（丹曲林）:decreases muscle contraction by directly interfering with calcium ion release from the sarcoplasmic reticulum within skeletal muscle cells.ManagementPropranolol（普萘洛尔）: -Blockers Morphine（吗啡）: -opioid receptor agonist;starting with intravenously dministered morphine and then switching to a scheduled oral route of administration of morphine or o