陣發(fā)性交感神經(jīng)興奮

陣發(fā)性交感神經(jīng)興奮WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：陣發(fā)性SympatheticHyperactivity：交感活性增高WHATISPSH交感神經(jīng)副交感神經(jīng)WHATISPSH交感神經(jīng)興奮是一種應激反應，起到一定的機體保護作用WHATISPSH交感興奮時可有以下變化：心率加快胃腸道血管收縮呼吸增快汗腺分泌瞳孔擴大糖原分解膀胱逼尿肌松弛、括約肌收縮肌張力升高！準備戰(zhàn)斗！WHATISPSHWHATISPSH平衡是機體正常的生理需求交感VS副交感WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttimeWHATISPSHWHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactorsWHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecostsWHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystoniaReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseasesMechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccursDiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizuresDiagnosticWorkupsCFS-AM量表特點得分臨床癥狀同時發(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)ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；ManagementClonidine(可樂定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonistManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴噴?。篴nalogofGABAManagementBromocriptine（溴隱亭）:syntheticdopamineagonistthatstimulatesdopaminetype2receptorsandantagonizestype1receptorsinthehypothalamusandtheneostriatumofthebrainDantrolene（丹曲林）:decreasesmusclecontractionbydirectlyinterferingwithcalciumionreleasefromthesarcoplasmicreticulumwithinskeletalmusclecells.ManagementPropranolol（普萘洛爾）:β-BlockersMorphine（嗎啡）:μ-opioidreceptoragonist;startingwithintravenouslydministeredmorphineandthenswitchingtoascheduledoralrouteofadministrationofmorphineor