阵发性交感神经兴奋ppt课件

dysfunction of the diencephalic-brainsetm
inhibitory center that normally controls
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Exclusion diagnosis Infections and sepsis should be ruled out in
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
李祥全
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PSH ：Paroxysmal Sympathetic Hyperactivity Paroxysmal：阵发性 Sympathetic Hyperactivity：交感活性增高
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交感神经兴奋是一种应激反应，起到一定的机体保护作用
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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
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平衡是机体正常的生理需求
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PSH：
unbalanced sympathetic surges causing
1. hyperthermia
2. diaphoresis
3. tachycardia 4. hypertension
交感发作.mp4
5. tachypnea
6. dystonic posturing
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轻微刺激引起症状发作 1
发作症状持续≥3天
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脑损伤持续大于≥周
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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
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无副交感兴奋表现
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排除其他原因
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获得性脑损伤病史
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不可能( ＜ 8 分) ， 可能( 8 ～ 16 分) ， 很可能( ＞ 17 分)
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no direct treatment options are available control of symptoms Medical treatments for PSH include α2-
agonists, β-blockers, benzodiazepines, dopamine agonists, opioids, GABAergic agents, antrolene, and gabapentin；
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Clonidine(可乐定)：presynaptic α2-receptor agonist which reduces central sympathetic outflow from the hypothalamus and ventrolateral medulla
(range,15–50 min) and its frequency was on average 5.6/day (range,3―8/day) Only 20 % of patients who were followed up at 12 months after injury showed continued signs of PSH Younger age and male gender have been cited as risk factors
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characteristic： Increases in dopamine, adrenaline, and noradrenaline
levels during the episodes have been reported Patients who experience PSH have worse Glasgow
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Unknown
functional or structural disconnection
lesions in the mesencephalon cause
disruptions in relay from the
medulla/hypothalamus
excitatory–inhibitory ratio (EIR) model
patients with fever and tachycardia Opiate withdrawal from prolonged sedation
should be addressed EEG to rule out seizures
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CFS-AM量 表
ቤተ መጻሕፍቲ ባይዱ
特点
得
分
临床症状同时发生
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突发性
Dexmedetomidine（右美托咪定）:an intravenous sedative and the first and only currently approved intravenous α2-agonist
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Baclofen（巴氯芬）:structural analog of the inhibitory neurotransmitter γ-minobutyric acid (GABA),indicated for treatment of spasticity and to improve mobility
develop abruptly and last for a short time
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characteristic： The first episode occurred on average 5.9±3.7 days after
brain injury The duration of each episode was on average 31 min
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PSH occurs in stages： 1. asymptomatic due to sedation; 2. onset of symptom clusters; 3. decline in posturing and dystonia
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Caused by TBI subarachnoid hemorrhageen cephalitis tumors hydrocephalus other diseases