阵发性交感神经兴奋ppt课件

longer ICU stays, longer hospital stay, more mechanical
ventilation days, more infectious episodes,more tracheostomy, and
higher healthcare costs
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WHAT IS PSH
〉 PSH occurs in stages： 1. asymptomatic due to sedation; 2. onset of symptom clusters; 3. decline in posturing and dystonia
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Reason for PSH
〉 Caused by TBI subarachnoid hemorrhageen cephalitis tumors hydrocephalus other diseases
〉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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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！
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WHAT IS PSH
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WHAT IS PSH
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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
交感VS副交感
平衡是机体正常的生理需求
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WHAT IS PSH
〉 PSH： unbalanced sympathetic surges causing 1. hyperthermia 2. diaphoresis 3. tachycardia 4. hypertension 5. tachypnea 6. dystonic posturing develop abruptly and last for a short time
tachycardia Opiate withdrawal from prolonged sedation should be addressed EEG to rule out seizures
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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
benzodiazepines, dopamine agonists, opioids, GABAergic agents, antrolene, and gabapentin；
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)
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Management
〉 no direct treatment options are available 〉 control of symptoms 〉 Medical treatments for PSH include α2-agonists, β-blockers,
PSH
李祥全
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WHAT IS PSH
〉PSH ：Paroxysmal Sympathetic Hyperactivity Paroxysmal：阵发性 Sympathetic Hyperactivity：交感活性增高
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WHAT IS PSH
交感神经百度文库
副交感神经
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WHAT IS PSH
controls afferent stimulus processing in the spinal cord occurs
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Diagnostic Workups
〉 Exclusion diagnosis Infections and sepsis should be ruled out in patients with fever and
交感发作.mp4
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WHAT IS PSH
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WHAT IS PSH
〉 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 (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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Mechanisms
〉 Unknown functional or structural disconnection lesions in the mesencephalon cause disruptions in relay from the
medulla/hypothalamus excitatory–inhibitory ratio (EIR) model dysfunction of the diencephalic-brainsetm inhibitory center that normally