阵发性交感神经兴奋ppt课件.pptx

Click to edit Master text styles,#,Click to edit Master title style,PSH,李祥全,WHAT IS PSH,PSH,：Paroxysmal Sympathetic Hyperactivity,Paroxysmal,：阵发性,Sympathetic Hyperactivity,：交感活性增高,WHAT IS PSH,交感神经,副交感神经,WHAT 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,！准备战斗！,WHAT IS PSH,WHAT IS PSH,平衡是机体正常的生理需求,交感,VS,副交感,WHAT IS PSH,PSH,：,unbalanced sympathetic surges,causing,hyperthermia,diaphoresis,tachycardia,hypertension,tachypnea,dystonic posturing,develop abruptly and last for a short time,WHAT IS PSH,WHAT IS PSH,characteristic,：,The,first episode occurred on average 5.93.7 days after brain injury,The 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 PS,H,Younger age and male gender have been cited as risk factors,WHAT IS PSH,characteristic,：,Increases in dopamine,adrenaline,and noradrenaline levels during the episodes have been reported,Patients 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 PSH,PSH occurs in stages,：,asymptomatic due to sedation;,onset of symptom clusters;,decline in posturing and dystonia,Reason for PSH,Caused by,TBI,subarachnoid hemorrhageen,cephalitis,tumors,hydrocephalus,other diseases,Mechanisms,Unknown,functional or structural disconnection,lesions in the mesencephalon cause disruptions in relay from the medulla/hypothalamus,excitatoryinhibitory ratio(EIR)model,dysfunction of the diencephalic-brainsetm inhibitory center that normally controls afferent stimulus processing in the spinal cord occurs,Diagnostic Workups,Exclusion diagnosis,Infections and sepsis should be ruled out in patients with fever and tachycardia,Opiate withdrawal from prolonged sedation should be addressed,EEG to rule out seizures,Diagnostic Workups,CFS-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,/d,1,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),Management,no direct treatment options are available,control of symptoms,Medical treatments for PSH include 2-agonists,-blockers,b,enzodiazepines,dopamine agonists,opioids,GABAergic agents,antrolene,and gabapentin；,Management,Clonidine,(,可乐定,),：presynaptic 2-receptor agonist which reduces central,s,ympathetic outflow from the hypothalamus and ventrolateral medulla,Dexmedetomidine,（右美托咪定）,:an intravenous sedative and the first and only currently approved intravenous 2-agonist,Management,Baclofen（巴氯芬）,:structural analog of the inhibitory neurotransmitter-minobutyric acid(GABA),indicated for treatment of spasticity and to improve mobility,Gabapentin,（加巴喷丁）,：,analog of GABA,Management,Bromocriptine,（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 brain,Dantrolene,（丹曲林）,:decreases muscle contraction by directly interfering with calcium ion release from the sarcoplasmic reticulum within skeletal muscle cells.,Management,Propranolol,（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 oxycodone,Management,Benzodiazepines,（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;,