陣發(fā)性交感神經(jīng)興奮ppt課件(PPT 22頁)

1、PSH李祥全1.第1頁，共22頁。WHAT IS PSHPSH ：Paroxysmal Sympathetic HyperactivityParoxysmal：陣發(fā)性Sympathetic Hyperactivity：交感活性增高2.第2頁，共22頁。WHAT IS PSH交感神經(jīng)副交感神經(jīng)3.第3頁，共22頁。WHAT IS PSH交感神經(jīng)興奮是一種應(yīng)激反應(yīng)，起到一定的機(jī)體保護(hù)作用4.第4頁，共22頁。WHAT IS PSH交感興奮時(shí)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(kuò)大糖原分解膀胱逼尿肌松弛、括約肌收縮肌張力升高！準(zhǔn)備戰(zhàn)斗！5.第5頁，共22頁。WHAT IS PSH

2、6.第6頁，共22頁。WHAT IS PSH平衡是機(jī)體正常的生理需求交感VS副交感7.第7頁，共22頁。WHAT IS PSHPSH：unbalanced sympathetic surges causinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonic posturing develop abruptly and last for a short time8.第8頁，共22頁。WHAT IS PSH9.第9頁，共22頁。WHAT IS PSHcharacteristic：The first episode occ

3、urred on average 5.93.7 days after brain injuryThe duration of each episode was on average 31 min (range,1550 min) and its frequency was on average 5.6/day (range,38/day)Only 20 % of patients who were followed up at 12 months after injury showed continued signs of PSHYounger age and male gender have

4、 been cited as risk factors10.第10頁，共22頁。WHAT IS PSHcharacteristic：Increases in dopamine, adrenaline, and noradrenaline levels during the episodes have been reportedPatients who experience PSH have worse Glasgow Outcome Scale scores and worse functional independent measures than their ounterparts lon

5、ger ICU stays, longer hospital stay, more mechanical ventilation days, more infectious episodes,more tracheostomy, and higher healthcare costs 11.第11頁，共22頁。WHAT IS PSHPSH occurs in stages：asymptomatic due to sedation;onset of symptom clusters;decline in posturing and dystonia12.第12頁，共22頁。Reason for

6、PSHCaused byTBIsubarachnoid hemorrhageencephalitistumorshydrocephalusother diseases13.第13頁，共22頁。MechanismsUnknownfunctional or structural disconnection lesions in the mesencephalon cause disruptions in relay from the medulla/hypothalamusexcitatoryinhibitory ratio (EIR) modeldysfunction of the dience

7、phalic-brainsetm inhibitory center that normally controls afferent stimulus processing in the spinal cord occurs14.第14頁，共22頁。Diagnostic WorkupsExclusion diagnosisInfections and sepsis should be ruled out in patients with fever and tachycardiaOpiate withdrawal from prolonged sedation should be addres

8、sedEEG to rule out seizures15.第15頁，共22頁。Diagnostic WorkupsCFS-AM量表特點(diǎn)得分臨床癥狀同時(shí)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.第16頁，共22頁。Managementno direct treatment options are availablecontrol of symptomsMedical treatm

9、ents for PSH include 2-agonists, -blockers, benzodiazepines, dopamine agonists, opioids, GABAergic agents, antrolene, and gabapentin；17.第17頁，共22頁。ManagementClonidine(可樂定)：presynaptic 2-receptor agonist which reduces central sympathetic outflow from the hypothalamus and ventrolateral medullaDexmedeto

10、midine（右美托咪定）:an intravenous sedative and the first and only currently approved intravenous 2-agonist18.第18頁，共22頁。ManagementBaclofen（巴氯芬）:structural analog of the inhibitory neurotransmitter -minobutyric acid (GABA),indicated for treatment of spasticity and to improve mobilityGabapentin（加巴噴?。篴nalog

11、 of GABA19.第19頁，共22頁。ManagementBromocriptine（溴隱亭）:synthetic dopamine agonist that stimulates dopamine type 2 receptors and antagonizes type 1 receptors in the hypothalamus 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.20.第20頁，共22頁。ManagementPropranolol（普萘洛爾）: -Blockers Morphine（嗎啡）: -opioid receptor agonist;starting with intravenously dministered morphine and then switching to a scheduled oral route of administration of morphine or oxycodone21.第21頁