阵发性交感神经兴奋ppt课件(1).pptx

PSH李祥全WHAT IS PSHPSH：Paroxysmal Sympathetic HyperactivityParoxysmal：阵发性Sympathetic Hyperactivity：交感活性增高WHAT IS PSHWHAT IS PSH交感神经兴奋是一种应激反应，起到一定的机体保护作用WHAT IS PSH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WHAT IS PSHWHAT IS PSH平衡是机体正常的生理需求WHAT IS PSHPSH：unbalanced sympathetic surges causing1.hyperthermia2.diaphoresis3.tachycardia4.hypertension5.tachypnea6.dystonic posturing develop abruptly and last for a short timeWHAT IS PSHWHAT IS PSHcharacteristic：The first episode occurred 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 been cited as risk factorsWHAT 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 longer ICU stays,longer hospital stay,more mechanical ventilation days,more infectious episodes,more tracheostomy,and higher healthcare costs WHAT IS PSHPSH occurs in stages：1.asymptomatic due to sedation;2.onset of symptom clusters;3.decline in posturing and dystoniaReason for PSHCaused byTBIsubarachnoid hemorrhageencephalitistumorshydrocephalusother diseasesMechanismsUnknownfunctional or structural disconnection lesions in the mesencephalon cause disruptions in relay from the medulla/hypothalamusexcitatoryinhibitory ratio(EIR)modeldysfunction of the diencephalic-brainsetm inhibitory center that normally controls afferent stimulus processing in the spinal cord occursDiagnostic WorkupsExclusion diagnosisInfections and sepsis should be ruled out in patients with fever and tachycardiaOpiate withdrawal from prolonged sedation should be addressedEEG to rule out seizuresDiagnostic WorkupsCFS-AM量量表表特点特点得得分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不可能不可能(8 分分)，可能可能(8 16 分分)，很可能很可能(17 分分)Managementno direct treatment options are availablecontrol of symptomsMedical treatments for PSH include 2-agonists,-blockers,benzodiazepines,dopamine agonists,opioids,GABAergic agents,antrolene,and gabapentin；ManagementClonidine(可乐定)：presynaptic 2-receptor agonist which reduces central sympathetic outflow from the hypothalamus and ventrolateral medullaDexmedetomidine（右美托咪定）:an intravenous sedative and the first and only currently approved intravenous 2-agonistManagementBaclofen（巴氯芬）:structural analog of the inhibitory neurotransmitter-minobutyric acid(GABA),indicated for treatment of spasticity and to improve mobilityGabapentin（加巴喷丁）：analog of GABAManagementBromocriptine（溴隐亭）: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.ManagementPropranolol（普萘洛尔）:-Blockers Morphine（吗啡）:-opioid receptor agonist;starting with intravenously dministered morphine and then switching to a scheduled oral route of administration of morphine or oxycodoneManagementBenzodiazepines（苯二氮卓类）:Short-acting benzodiazepines are preferable for patients early in the course,longer-acting agents to decrease the bouts of hyperactivity;