Neuroleptic phem syndrome hu ua ...

Neuroleptic phem syndrome yog ib tug tsis tshua muaj thiab fraught nrog txim rau lub neej ntawm teeb meem tshwm sim los ntawm tsawg ntawm cov psychotropic tshuaj, tshwj xeeb yog neuroleptics teej tug mus rau pawg ntawm phenothiazines, thioxanthenes thiab butirofenonov. NMS yuav ntxias cov kev siv cov cuab yeej xws li amphetamine, "Amoksalin" "Fluoxetine", "desipramine", "phenelzine" yeeb los yog "metoclopramide".

yog vim li cas

Muaj tseeb yam txoj kev neuroleptic syndrome tej zaum yuav:

• koom haum saib xyuas ntawm cov tshuaj ntev raug;
• vysokopotentnyh siv ntawm cov nyiaj;
• thov mus rau lub NMS muaj tshuaj ua ke nrog anticholinergic tshuaj;
• antidepressants;
• huab cua kub;
• Electroconvulsive kev kho mob thiab cov pwm.

Aggravation ntawm cov kab mob yuav ua rau yog vim li cas ncaj qha attributable mus rau lub physiological zoo ntawm tus neeg mob. Rau cov neeg muaj xws li:

• lub cev qhuav dej;
• psychomotor stimulation;
• alcoholism;
• hlwb ruamqauj ;
• lub postpartum lub sij hawm;
• intercurrent kab mob;
• tsis muaj hlau;
• lub cev qaug;
• puas hlwb raug mob;
• thyroid kawg.

State of incoherence, cov neeg laus, lub siab lub ntsws ntxhov siab vim, txiv neej nrog txiv neej pw - tag nrho cov no kuj ntxiv rau neuroleptic phem syndrome. ZNR cov tsos mob yuav ua tau txawv heev - los ntawm me rau tangible.

Ib qho yooj yim ntau yam ntawm

Neuroleptic phem syndrome yus muaj los ntawm cov nram qab no indications: kub nce mus rau subfebrile tshwm sim somatovegetativnye me me faults (ntshav siab mem tes tsis pub dhau lub 150 / 90-110 / 70 mm Hg, tachycardia - mus txog rau 100 beats per minute ..) Raws li zoo raws li kev txawv txav nyob rau hauv laboratory cov ntaub ntawv (ntau zog ESR rau 18-30 hli / h, qhov uas tsis muaj tus naj npawb ntawm lymphocytes - los ntawm 15 mus rau 19%). Tsis mob ntawm homeostasis thiab hemodynamic txoj kev loj hlob. Psychopathological lub xeev yog tsim Oneiric-catatonic los yog affective delusional tawm tsam.

Qhov nruab nrab degree ntawm

Lub fact tias ib tug neeg yog mob neuroleptic phem syndrome ntsis, qhia los ntawm cov nram qab no tshwm sim:

• tso tawm kom pom somatovegetativnye mob (asthma nrog tachycardia mus rau 120 beats per minute);
• kub ib ce (38-39 degrees);
• tseem ceeb hloov nyob rau hauv laboratory cov ntaub ntawv (ESR tsub kom mus 35-50 hli / h, thiab leukocytosis - txog 10J109 / l, kom muaj nuj nqis ntawm leukocytes txo rau 10-15%);
• nce creatine phosphokinase ntau ntau thiab tranzaminaza ntshav;
• Ib tug coj qhia hypokalemia thiab hypovolemia.

Psychopathological mob tsiag ntawv los ntawm hom ntawm txoj kev xav amentivnopodobnoy thiab Oneiric degree. Catatonic cov tsos mob manifested immobility negativism, nce zaus (nyob rau hauv lub yav tsaus ntuj) tus neeg mob ntawm voos nervousness, zog thiab hais lus stereotype.

complex txheej txheem

Nyob rau hauv keeb kwm yav dhau ntawm hyperthermia zaum yuav tshwm sim neuroleptic phem syndrome. Cov tsos mob ntawm loj dua twb, namely:

• amplified somatovegetativnye failures (. dyspnea mus rau 30 pa ib 1 feeb, tachycardia mus txog 120-140 yeej ib feeb);
• kom dej electrolyte mob;
• nce hemodynamic teeb.

Qhov loj tshaj kev hloov yam ntxwv kuaj nyob rau hauv laboratory nuj nqis. ESR tsub kom mus 40-70 hli / h Leucocytes - txog 12J109 / l, txo tus naj npawb ntawm lymphocytes rau 3-10%, ho tsub kom cov neeg kawm ntawv ntawm creatine, alanine thiab asparagine transaminase nyob rau hauv cov ntshav. Clouding lub siab yuav mus txog li raw, thiab soporous amential kauj ruam. Stupor, negativism, chaotic voos, nkees, nrog ib tug txo nyob rau hauv cov nqaij laus thiab, nyob rau hauv tshwj xeeb yog yam uas txhaum loj, thiab tsis immobility nrog areflexia - tag nrho cov neuroleptic phem syndrome.

kev kho mob

Early qhia kom paub txog tus kab mob no yog lub ntsiab point. Lub fact tias ib tug neeg yog mob neuroleptic phem syndrome tej zaum yuav qhia npag nro, tachycardia, ua npaws, kub siab, tawm hws kuaj tom qab tau txais neuroleptics, dysphagia.

Tus thawj yam uas koj yuav tau ua ib tug kws kho mob, ces nws muab tso tseg neuroleptics thiab lwm yam neurotoxic tshuaj. Tsis tas li ntawd yuav tsum tau txhawb cov txheej txheem coj qhov kub thiab ua rau cov tsis muaj kua. Ntsha imbalances yuav tsum tau txiav txim tawm. Yuav tsum tau mus nqa tawm ceev faj xyuas ntawm kev ua pa tseem ceeb heev functions, lub lag luam uas yuav tawg dua thaum txoj kev loj npag rigidity thiab helplessness rau expectorate bronchial secretion.

Koj yuav tsum ua tib zoo saib xyuas lub raum muaj nuj nqi. Txawm li cas los, yog tsis muaj pov thawj hais tias tus osmotic sib cais accelerates recovering los ntawm NMS, tsuas nws muaj peev xwm pab tau cov kev pab txhawb nqa ntawm lub raum ua hauj lwm. Nws yog feem ntau yuav tsum tau mus ua ib tug kho nyob rau hauv ib qhov kho kom zoo kev kho mob.

tshuaj

Treat neuroleptic phem syndrome tshuaj yog ntshaw nyob rau hauv txoj mob. Rau lub hom phiaj no, nqaij hnaiv ( "Dantrolene") los yog dopamine agonists ( "Amantadine" thiab "bromocriptine"). Lub neej no twb txo nyob rau hauv kev siv ntawm ob qho tib si hom tshuaj. Koob txawv dawb do, tiam sis rau "Bromocriptine" hom kev kawm yog tau piav nyob rau hauv lub qhov chaw nyob rau hauv cov nqi los ntawm 2.5 mus 5 mg 3 lub sij hawm ib hnub twg hais lus.

Dopamine agonists, tshwj xeeb yog nyob rau hauv loj hlob, tej zaum yuav ua psychosis los yog ntuav, thiab yog tau ho paug lub xeev kev kho mob ntawm tus neeg mob neuroleptic phem syndrome. Direct acting nqaij relaxant siv nrog koob tshuaj ntawm 10 mg / kg. Lub hom phiaj ntawm txoj kev siv - txo nqaij rigidity, raws li zoo raws li lub metabolism ntawm skeletal leeg, ib qho kev nce uas yog tej lub luag hauj lwm rau hyperthermia. "Dantrolene" txawv hepatotoxicity yuav ntxias tus kab mob siab thiab tuag taus thiab vim rau lub siab tsis ua hauj lwm. Thiab ces yuav muaj tsis muaj yog vim li cas mus ntxiv los kho neuroleptic phem syndrome.

NMS kuj yog tshem tawm los ntawm ib tug ua ke ntawm dopamine thiab "dantrolene" agonists. Anticholinergic tshuaj yog lug siv rau cov kev kho mob ntawm pseudoparkinsonism tshwm sim los ntawm antipsychotic tshuaj, tsis txhob muab teeb meem loj tau, Ntxiv, yuav ntxiv cuam tshuam thermoregulation.

Muaj yog ib qho kev hloov tshiab rau tej yam uas "carbamazepine" hais tias muaj ntau cov neeg mob pom ib tug ceev ceev weakening ntawm lub NSA zaj lus tim khawv. Txawm li cas los, yog tsis muaj txhim khu kev qha cov ntaub ntawv nyob rau hauv cov hauj lwm zoo ntawm kev siv cov benzodiazepines rau cov kev kho mob ntawm no syndrome. Txawm li cas los, thaum tus mob pab, cov tshuaj tej zaum yuav pab tau kom txo lub voos nyob rau hauv cov neeg mob muaj neuroleptic phem syndrome.

hyperthermia

Tus kab mob muaj peev xwm yuav nrhiav tau kwv yees li ib zaug tauj ib 100 tysyach tshuaj loog siv depolarizing nqaij hnaiv ( "Miorelaksina", "ditilina" thiab "listenon"), raws li zoo raws li nqus tau pa anesthetics los ntawm cov halogen hydrocarbons ( "methoxyflurane", "Ftorogana" thiab "Halothane") . Hyperthermia tshwm nyob rau hauv cov neeg mob uas muaj nyhav rau cov tshuaj, uas correlated nrog failures ntawm calcium metabolism hauv cov nqaij loj. Cov no ib tug generalized nqaij laim, thiab tej zaum kuj nqaij kab mob, uas yog tsim nyob rau raws li ib tug tshwm sim ntawm loj nyiaj ntawm tshav kub, lub cev kub instantaneously nce mus txog 42 degrees. Neuroleptic phem Syndrome ua tuag nyob rau hauv 20-30% ntawm cov neeg.

tsheb thauj neeg mob

Thaum nrhiav kom tau ntawm ib tug ceev ceev-loj hlob hyperthermia yuav tsum tsis txhob noj cov saum toj no hais cov tshuaj. Vim hais tias kev ua kom loog tshuaj, tsis txhob ntxias tus kab mob, yuav tsum tau qhia barbiturates "pancuronium", "Tubocurarine" thiab cov pa roj nitrous oxide. Cia li lawv yuav tsum tau siv, Yog hais tias tsim nyog, lub extension ntawm tshuaj loog mob.

Vim hais tias qhov tshwm sim ntawm tsim ntawm ventricular fibrillation yog sau npe prophylactic "Phenobarbital" thiab "Procainamide" kho noj tshuaj npaum cas. Nws tseem yog tsim nyog los npaj lub txias sai, muab tshaj loj cov hlab ntsha thawv nrog dej txias los yog dej khov. Nws yuav tsum tau sai li sai tau normalize ua pa cua, hno sodium hydrogencarbonate / nyob rau hauv (400 ml ntawm 3% cov kua). Nyob rau hauv txaus ntshai mob, nws pom zoo rau qhov kev siv ntawm resuscitation. Pw tsev kho mob - qhov no yog thawj zaug uas yuav ua li cas yog tias koj paub hais tias neuroleptic phem syndrome.

outlook

Tam sim no nyob rau hauv lub keeb kwm ntawm NSA yog yeej ib txwm tsub kom qhov yuav ntawm xws li ib tug lub xeev ntawm cov theem nrab txaus thiab yooj yim kawg lub prevailing malaise. Ntxiv mus, kev ntshawv siab tawm nyob rau hauv no syndrome yog yuav luag tsis bypassed lub hlwb tsis muaj ib tug kab, tsim cov los yog lwm yam neurological ntshawv siab. Yog li ntawd yog dab tsi neuroleptic phem syndrome? Nws yog ib tug kab mob uas ho impairs ib tug neeg lub neej, thiab txawm yuav ua tau kom tuag.