阵发性交感神经兴奋课件

PSH李祥全1精选WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：阵发性SympatheticHyperactivity：交感活性增高2精选WHATISPSH交感神经副交感神经3精选WHATISPSH交感神经兴奋是一种应激反应，起到一定的机体保护作用4精选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！5精选WHATISPSH6精选WHATISPSH平衡是机体正常的生理需求交感VS副交感7精选WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttime8精选WHATISPSH9精选WHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactors10精选WHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecosts11精选WHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystonia12精选ReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseases13精选MechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccurs14精选DiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizures15精选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(＜8分)，可能(8～16分)，很可能(＞17分)16精选ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；17精选ManagementClonidine(可乐定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonist18精选ManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴喷丁）：analogofGABA19精选ManagementBromocriptine（溴隐亭）:syntheticdopamineagonistthatstimulatesdopaminetype2receptorsandantagonizestype1receptorsinthehypothalamusandtheneostriatumofthebrainDantrolene（丹曲林）:decreasesmusclecontractionbydirectlyinterferingwithcalciumionreleasefromthesarcoplasmicreticulumwithinskeletalmusclecells.20精选ManagementPropranolol（普萘洛尔）:β-BlockersMorphine（吗啡）:μ-opioidreceptoragonist;startingwithintravenouslydministeredmorphineandthenswitchingtoascheduledoralrouteofadministrationofmorphineoroxycod