PSH1

PSH1WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：陣發(fā)性SympatheticHyperactivity：交感活性增高2WHATISPSHPSH：ParoxysmalSymWHATISPSH交感神經(jīng)副交感神經(jīng)3WHATISPSH交感神經(jīng)副交感神經(jīng)3WHATISPSH交感神經(jīng)興奮是一種應(yīng)激反應(yīng)，起到一定的機(jī)體保護(hù)作用4WHATISPSH交感神經(jīng)興奮是一種應(yīng)激反應(yīng)，起到一定的WHATISPSH交感興奮時(shí)可有以下變化：心率加快胃腸道血管收縮呼吸增快汗腺分泌瞳孔擴(kuò)大糖原分解膀胱逼尿肌松弛、括約肌收縮肌張力升高！準(zhǔn)備戰(zhàn)斗！5WHATISPSH交感興奮時(shí)可有以下變化：！準(zhǔn)備戰(zhàn)斗！5WHATISPSH6WHATISPSH6WHATISPSH平衡是機(jī)體正常的生理需求交感VS副交感7WHATISPSH平衡是機(jī)體正常的生理需求交感VS副交感WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttime8WHATISPSHPSH：8WHATISPSH9WHATISPSH9WHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactors10WHATISPSHcharacteristic：10WHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecosts11WHATISPSHcharacteristic：11WHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystonia12WHATISPSHPSHoccursinstageReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseases13ReasonforPSHCausedby13MechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccurs14MechanismsUnknown14DiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizures15DiagnosticWorkupsExclusiondiDiagnosticWorkupsCFS-AM量表特點(diǎn)得分臨床癥狀同時(shí)發(fā)生1突發(fā)性1輕微刺激引起癥狀發(fā)作1發(fā)作癥狀持續(xù)≥3天1腦損傷持續(xù)大于≥周1其他治療后癥狀無緩解1藥物可緩解交感神經(jīng)癥狀1發(fā)作≥2次/d1無副交感興奮表現(xiàn)1排除其他原因1獲得性腦損傷病史1不可能(＜8分)，可能(8～16分)，很可能(＞17分)16DiagnosticWorkupsCFS-AM量表特點(diǎn)得分ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；17ManagementnodirecttreatmentManagementClonidine(可樂定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonist18ManagementClonidine(可樂定)：presyManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴噴?。篴nalogofGABA19ManagementBaclofen（巴氯芬）:structManagementBromocriptine（溴隱亭）:syntheticdopamineagonistthatstimulatesdopaminetype2receptorsandantagonizestype1receptorsinthehypothalamusandtheneostriatumofthebrainDantrolene（丹曲林）:decreasesmusclecontractionbydirectlyinterferingwithcalciumionreleasefromthesarcoplasmicreticulumwithinskeletalmusclecells.20ManagementBromocriptine（溴隱亭）:sManagementPropranolol（普萘洛爾）:β-BlockersMorphine（嗎啡）:μ-opioidreceptoragonist;startingwithintravenouslydministeredmorphineandthenswitchingtoascheduledoralrouteofadministrationofmorphineoroxycodone21ManagementPropranolol（普萘洛爾）:β22寫在最后成功的基礎(chǔ)在于好的學(xué)習(xí)習(xí)慣Thefoundationofsuccessliesingoodhabits22寫在最后成功的基礎(chǔ)在于好的學(xué)習(xí)習(xí)慣謝謝聆聽·學(xué)習(xí)就是為了達(dá)到一定目的而努力去干,是為一個(gè)目標(biāo)去戰(zhàn)勝各種困難的過程,這個(gè)過程會充滿壓力、痛苦和挫折LearningIsToAchieveACertainGoalAndWorkHard,IsAProcessToOvercomeVariousDifficultiesForAGoal謝謝聆聽LearningIsToAchieveACPSH24

PSH1WHATISPSHPSH：ParoxysmalSympatheticHyperactivityParoxysmal：陣發(fā)性SympatheticHyperactivity：交感活性增高25WHATISPSHPSH：ParoxysmalSymWHATISPSH交感神經(jīng)副交感神經(jīng)26WHATISPSH交感神經(jīng)副交感神經(jīng)3WHATISPSH交感神經(jīng)興奮是一種應(yīng)激反應(yīng)，起到一定的機(jī)體保護(hù)作用27WHATISPSH交感神經(jīng)興奮是一種應(yīng)激反應(yīng)，起到一定的WHATISPSH交感興奮時(shí)可有以下變化：心率加快胃腸道血管收縮呼吸增快汗腺分泌瞳孔擴(kuò)大糖原分解膀胱逼尿肌松弛、括約肌收縮肌張力升高！準(zhǔn)備戰(zhàn)斗！28WHATISPSH交感興奮時(shí)可有以下變化：！準(zhǔn)備戰(zhàn)斗！5WHATISPSH29WHATISPSH6WHATISPSH平衡是機(jī)體正常的生理需求交感VS副交感30WHATISPSH平衡是機(jī)體正常的生理需求交感VS副交感WHATISPSHPSH：unbalancedsympatheticsurgescausinghyperthermiadiaphoresistachycardiahypertensiontachypneadystonicposturingdevelopabruptlyandlastforashorttime31WHATISPSHPSH：8WHATISPSH32WHATISPSH9WHATISPSHcharacteristic：Thefirstepisodeoccurredonaverage5.9±3.7daysafterbraininjuryThedurationofeachepisodewasonaverage31min(range,15–50min)anditsfrequencywasonaverage5.6/day(range,3―8/day)Only20%ofpatientswhowerefollowedupat12monthsafterinjuryshowedcontinuedsignsofPSHYoungerageandmalegenderhavebeencitedasriskfactors33WHATISPSHcharacteristic：10WHATISPSHcharacteristic：Increasesindopamine,adrenaline,andnoradrenalinelevelsduringtheepisodeshavebeenreportedPatientswhoexperiencePSHhaveworseGlasgowOutcomeScalescoresandworsefunctionalindependentmeasuresthantheirounterpartslongerICUstays,longerhospitalstay,moremechanicalventilationdays,moreinfectiousepisodes,moretracheostomy,andhigherhealthcarecosts34WHATISPSHcharacteristic：11WHATISPSHPSHoccursinstages：asymptomaticduetosedation;onsetofsymptomclusters;declineinposturinganddystonia35WHATISPSHPSHoccursinstageReasonforPSHCausedbyTBIsubarachnoidhemorrhageencephalitistumorshydrocephalusotherdiseases36ReasonforPSHCausedby13MechanismsUnknownfunctionalorstructuraldisconnectionlesionsinthemesencephaloncausedisruptionsinrelayfromthemedulla/hypothalamusexcitatory–inhibitoryratio(EIR)modeldysfunctionofthediencephalic-brainsetminhibitorycenterthatnormallycontrolsafferentstimulusprocessinginthespinalcordoccurs37MechanismsUnknown14DiagnosticWorkupsExclusiondiagnosisInfectionsandsepsisshouldberuledoutinpatientswithfeverandtachycardiaOpiatewithdrawalfromprolongedsedationshouldbeaddressedEEGtoruleoutseizures38DiagnosticWorkupsExclusiondiDiagnosticWorkupsCFS-AM量表特點(diǎn)得分臨床癥狀同時(shí)發(fā)生1突發(fā)性1輕微刺激引起癥狀發(fā)作1發(fā)作癥狀持續(xù)≥3天1腦損傷持續(xù)大于≥周1其他治療后癥狀無緩解1藥物可緩解交感神經(jīng)癥狀1發(fā)作≥2次/d1無副交感興奮表現(xiàn)1排除其他原因1獲得性腦損傷病史1不可能(＜8分)，可能(8～16分)，很可能(＞17分)39DiagnosticWorkupsCFS-AM量表特點(diǎn)得分ManagementnodirecttreatmentoptionsareavailablecontrolofsymptomsMedicaltreatmentsforPSHincludeα2-agonists,β-blockers,benzodiazepines,dopamineagonists,opioids,GABAergicagents,antrolene,andgabapentin；40ManagementnodirecttreatmentManagementClonidine(可樂定)：presynapticα2-receptoragonistwhichreducescentralsympatheticoutflowfromthehypothalamusandventrolateralmedullaDexmedetomidine（右美托咪定）:anintravenoussedativeandthefirstandonlycurrentlyapprovedintravenousα2-agonist41ManagementClonidine(可樂定)：presyManagementBaclofen（巴氯芬）:structuralanalogoftheinhibitoryneurotransmitterγ-minobutyricacid(GABA),indicatedfortreatmentofspasticityandtoimprovemobilityGabapentin（加巴噴?。篴nalogofGABA42ManagementBaclofen（巴氯芬）:structManagementBromocriptine（溴隱亭）:syntheticd