阵发性交感神经兴奋课件.pptx

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1、PSH,李祥全,1,.,WHAT IS PSH,PSH：Paroxysmal Sympathetic HyperactivityParoxysmal：阵发性Sympathetic Hyperactivity：交感活性增高,2,.,WHAT IS PSH,交感神经,副交感神经,3,.,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,4,.,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！,5,.,WHAT IS PSH,6,.,WHAT IS PSH,平衡是机体正常

2、的生理需求,交感VS副交感,7,.,WHAT IS PSH,PSH：unbalanced sympathetic surges causinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonic posturing develop abruptly and last for a short time,8,.,WHAT IS PSH,9,.,WHAT IS PSH,characteristic：The first episode occurred on average 5.93.7 days after brain inj

3、uryThe 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 factors,10,.,WHAT IS PSH,char

4、acteristic：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 ventil

5、ation days,more infectious episodes,more tracheostomy,and higher healthcare costs,11,.,WHAT IS PSH,PSH occurs in stages：asymptomatic due to sedation;onset of symptom clusters;decline in posturing and dystonia,12,.,Reason for PSH,Caused byTBIsubarachnoid hemorrhageencephalitistumorshydrocephalusother

6、 diseases,13,.,Mechanisms,Unknownfunctional 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 proces

7、sing in the spinal cord occurs,14,.,Diagnostic Workups,Exclusion diagnosisInfections and sepsis should be ruled out in patients with fever and tachycardiaOpiate withdrawal from prolonged sedation should be addressedEEG to rule out seizures,15,.,Diagnostic Workups,CFS-AM量表,不可能(8 分)，可能(8 16 分)，很可能(17

8、分),16,.,Management,no direct treatment options are availablecontrol of symptomsMedical treatments for PSH include 2-agonists,-blockers,benzodiazepines,dopamine agonists,opioids,GABAergic agents,antrolene,and gabapentin；,17,.,Management,Clonidine(可乐定)：presynaptic 2-receptor agonist which reduces cent

9、ral 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-agonist,18,.,Management,Baclofen（巴氯芬）:structural analog of the inhibitory neurotransmitter-minobutyric acid(GABA),indicated fo

10、r treatment of spasticity and to improve mobilityGabapentin（加巴喷丁）：analog of GABA,19,.,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 brainDantrolene（丹曲林）:decreases musc

11、le contraction by directly interfering with calcium ion release from the sarcoplasmic reticulum within skeletal muscle cells.,20,.,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,21,.,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;,22,.,