PSH-AM量表可用于重度颅脑损伤所致阵发性交感神经过度兴奋综合征的诊断
PSH-AM scale can be used in the diagnosis of paroxysmal sympathetic hyperactivity syndrome caused by severe brain injury

唐璐.PSH-AM量表可用于重度颅脑损伤所致阵发性交感神经过度兴奋综合征的诊断[J].内科急危重症杂志,2021,27(4):

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DOI：10.11768/nkjwzzzz20210408

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基金项目:湖南省自然基金（No：2020JJ8101）

作者	单位	E-mail
唐璐	长沙市第一医院	tanhong1968@qq.com

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中文摘要:

目的：探讨重度颅脑损伤所致阵发性交感神经过度兴奋（PSH）患者的临床特点、诊断及治疗方案。方法：选择长沙市第一医院神经内科重症监护室2016年5月-2018年10月收治的获得性脑损伤患者259例，使用阵发性交感神经过度兴奋评分量表（PSH-AM）评估，其中5例患者合并PSH，分析其年龄、性别、病程、临床表现及辅助检查资料。结果：5例（男4，女1）患者，年龄17~63岁，其中原发病为脑干梗死2例、脑干出血1例、结核性脑膜脑炎1例，松果体生殖细胞瘤术后1例。5例患者均行脑电图检查，未见癫痫波；神经影像学检查提示脑干受累；抗癫痫治疗无效，苯二氮卓类、β受体阻滞剂和多巴胺受体激动剂联合应用对PSH有较好疗效。4例完全控制，1例死亡。结论：重度颅脑损伤可致PSH，PSH-AM可作为诊断PSH的工具，抗癫痫治疗对PSH无效。

英文摘要:

Objective: To explore the clinical characteristics, diagnosis and treatment strategy of patients with paroxysmal sympathetic hyperactivity (PSH) caused by severe brain injury (SBI). Methods: A total of 259 patients with acquired brain injury who were admitted to the Department of Neurology Intensive Care Unit of Changsha First Hospital from May 2016 to October 2018 were selected. All patients were assessed by the Paroxysmal sympathetic hyperactivity-Assessment measure (PSH-AM) scale. A total of 5 cases of SBI were complicated with PSH, and age, sex, etiology, clinical symptom, and laboratory examinations were analyzed. Results: Among 5 cases of SBI with PSH, 4 cases were males and one was female; Their ages ranged from 17 to 63 years old. The primary disease was brainstem infarction in 2 cases, brainstem hemorrhage in 1 case, tuberculous meningoencephalitis in 1 case, and pineal germ cell tumor after surgery in 1 case. All 5 patients were given electroencephalogram examination, and no epileptic waves were observed. The neuroimaging examination showed that brainstem injury existed. Anti-epileptic treatment was ineffective. The combined use of benzodiazepines, β-receptor blockers and dopamine receptor agonists obtained a good effectiveness on PSH. Four cases were completely controlled and one case died. Conclusions: SBI can lead to PSH. PSH-AM can be a useful diagnostic tool for PSH. Antiepileptic therapy for PSH is ineffective.