阵发性交感神经兴奋教学文案

PSH李祥全第一页，共22页。WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：阵发性SympatheticHyperactivity：交感(jiāoɡǎn)活性增高第二页，共22页。WHATISPSH交感神经(jiāogǎn-shénjīng)副交感神经(jiāogǎn-shénjīng)第三页，共22页。WHATISPSH交感神经兴奋是一种应激反应，起到一定的机体(jītǐ)保护作用第四页，共22页。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(hànxiàn)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(zhǔnbèi)战斗！第五页，共22页。WHATISPSH第六页，共22页。WHATISPSH平衡是机体(jītǐ)正常的生理需求交感(jiāoɡǎn)VS副交感(jiāoɡǎn)第七页，共22页。WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttime第八页，共22页。WHATISPSH第九页，共22页。WHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactors第十页，共22页。WHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecosts第十一页，共22页。WHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystonia第十二页，共22页。ReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseases第十三页，共22页。MechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccurs第十四页，共22页。DiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizures第十五页，共22页。DiagnosticWorkupsCFS-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(kěnéng)(＜8分)，可能(kěnéng)(8～16分)，很可能(kěnéng)(＞17分)第十六页，共22页。ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；第十七页，共22页。ManagementClonidine(可乐(kělè)定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonist第十八页，共22页。ManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴喷丁）：analogofGABA第十九页，共22页。ManagementBromocriptine（溴隐亭）:syntheticdopamineagonistthatstimulatesdopaminetype2receptorsandantagonizestype1receptorsinthehypothalamusandtheneostriatumofthebrainDantrolene（丹曲林）:decreasesmusclecontractionbydirectlyinterferingwithcalciumionreleasefromthesarcoplasmicreticulumwithinskeletalmusclecells.第二十页，共22页。ManagementPropranolol（普萘洛尔）:β-BlockersMorphine（吗啡(mafēi)）:μ-opioidreceptoragonist;startingwithintravenouslydministeredmorphineandthenswitchingtoascheduledoralrouteofadministrationofmorphineoroxycod