阵发性交感神经兴奋课件

PSH1

PSH1WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：阵发性SympatheticHyperactivity：交感活性增高2WHATISPSHPSH：ParoxysmalSymWHATISPSH交感神经副交感神经3WHATISPSH交感神经副交感神经3WHATISPSH交感神经兴奋是一种应激反应，起到一定的机体保护作用4WHATISPSH交感神经兴奋是一种应激反应，起到一定的WHATISPSH交感兴奋时可有以下变化：心率加快胃肠道血管收缩呼吸增快汗腺分泌瞳孔扩大糖原分解膀胱逼尿肌松弛、括约肌收缩肌张力升高！准备战斗！5WHATISPSH交感兴奋时可有以下变化：！准备战斗！5WHATISPSH6WHATISPSH6WHATISPSH平衡是机体正常的生理需求交感VS副交感7WHATISPSH平衡是机体正常的生理需求交感VS副交感WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttime8WHATISPSHPSH：8WHATISPSH9WHATISPSH9WHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactors10WHATISPSHcharacteristic：10WHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecosts11WHATISPSHcharacteristic：11WHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystonia12WHATISPSHPSHoccursinstageReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseases13ReasonforPSHCausedby13MechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccurs14MechanismsUnknown14DiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizures15DiagnosticWorkupsExclusiondiDiagnosticWorkupsCFS-AM量表特点得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(＜8分)，可能(8～16分)，很可能(＞17分)16DiagnosticWorkupsCFS-AM量表特点得分ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；17ManagementnodirecttreatmentManagementClonidine(可乐定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonist18ManagementClonidine(可乐定)：presyManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴喷丁）：analogofGABA19ManagementBaclofen（巴氯芬）:structManagementBromocriptine（溴隐亭）:syntheticdopamineagonistthatstimulatesdopaminetype2receptorsandantagonizestype1receptorsinthehypothalamusandtheneostriatumofthebrainDantrolene（丹曲林）:decreasesmusclecontractionbydirectlyinterferingwithcalciumionreleasefromthesarcoplasmicreticulumwithinskeletalmusclecells.20ManagementBromocriptine（溴隐亭）:sManagementPropranolol（普萘洛尔）:β-BlockersMorphine（吗啡）:μ-opioidreceptoragonist;startingwithintravenouslydministeredmorphineandthenswitchingtoascheduledoralrouteofadministrationofmorphineoroxycodone21ManagementPropranolol（普萘洛尔）:β22写在最后成功的基础在于好的学习习惯Thefoundationofsuccessliesingoodhabits22写在最后成功的基础在于好的学习习惯谢谢聆听·学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折LearningIsToAchieveACertainGoalAndWorkHard,IsAProcessToOvercomeVariousDifficultiesForAGoal谢谢聆听LearningIsToAchieveACPSH24

PSH1WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：阵发性SympatheticHyperactivity：交感活性增高25WHATISPSHPSH：ParoxysmalSymWHATISPSH交感神经副交感神经26WHATISPSH交感神经副交感神经3WHATISPSH交感神经兴奋是一种应激反应，起到一定的机体保护作用27WHATISPSH交感神经兴奋是一种应激反应，起到一定的WHATISPSH交感兴奋时可有以下变化：心率加快胃肠道血管收缩呼吸增快汗腺分泌瞳孔扩大糖原分解膀胱逼尿肌松弛、括约肌收缩肌张力升高！准备战斗！28WHATISPSH交感兴奋时可有以下变化：！准备战斗！5WHATISPSH29WHATISPSH6WHATISPSH平衡是机体正常的生理需求交感VS副交感30WHATISPSH平衡是机体正常的生理需求交感VS副交感WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttime31WHATISPSHPSH：8WHATISPSH32WHATISPSH9WHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactors33WHATISPSHcharacteristic：10WHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecosts34WHATISPSHcharacteristic：11WHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystonia35WHATISPSHPSHoccursinstageReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseases36ReasonforPSHCausedby13MechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccurs37MechanismsUnknown14DiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizures38DiagnosticWorkupsExclusiondiDiagnosticWorkupsCFS-AM量表特点得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(＜8分)，可能(8～16分)，很可能(＞17分)39DiagnosticWorkupsCFS-AM量表特点得分ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；40ManagementnodirecttreatmentManagementClonidine(可乐定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonist41ManagementClonidine(可乐定)：presyManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴喷丁）：analogofGABA42ManagementBaclofen（巴氯芬）:structManagementBromocriptine（溴隐亭）:syntheticd