Neuroleptic syndrome ebulalayo ngokuthi ...

Neuroleptic syndrome abulalayo kuyinto ezingavamile futhi igcwele nemiphumela ngenxa yokuphila disorder kubangelwa edonsa izidakamizwa psychotropic, ikakhulukazi neuroleptics okuqondene amaqembu phenothiazines, thioxanthenes futhi butirofenonov. NMS kungaba avuse ukusetshenziswa amathuluzi anjenge-amphetamine, "Amoksalin" "Fluoxetine", "desipramine", "phenelzine" i-cocaine noma "metoclopramide".

izizathu

Okungenzeka izici ukwakha neuroleptic syndrome zingase kube:

• ukuphatha izidakamizwa nokunwetshiwe ukuchayeka;
• ukusetshenziswa vysokopotentnyh kwezimali;
• ngokufaka isicelo NMS banezimfanelo izidakamizwa kanye nezidakamizwa anticholinergic;
• antidepressant;
• lokushisa air;
• ukwelashwa Electroconvulsive kanye nomswakama eliphezulu.

Okubi kakhulu izifo kungabangela izizathu ngqo ezibangelwa bokuphila inhlalakahle isiguli. Ukuze labo zihlanganisa:

• amanzi emzimbeni;
• lengqondo ukushukuma;
• ukuluthwa utshwala;
• retardation engqondo ;
• kwesikhathi kwangemva kokubeletha;
• izifo intercurrent;
• yokuntuleka yensimbi;
• ukukhathala ngokomzimba;
• Kwenhlekelele okulimala ebuchosheni;
• yegilo ukungasebenzi.

Inkulumo Echaza Isimo Sezwe incoherence, abadala, ukukhathazeka okungokomzwelo, ubulili besilisa - konke lokhu lwenza neuroleptic syndrome ebulalayo. ZNR izimpawu kungaba okuhluke kakhulu - kusuka ezincane eziphathekayo.

ezihlukahlukene Easy

Neuroleptic syndrome abulalayo libhekene elandelayo izinkomba: izinga lokushisa likhuphuka ukuba subfebrile zenzeka somatovegetativnye amaphutha amancane (blood pressure ishayela ngaphakathi 150 / 90-110 / 70 mm HG, tachycardia - kuze kufinyelele amabhithi 100 ngomzuzu ..) Kanye kwezinso e idatha laboratory (kwenyuke ESR ukuze 18-30 mm / h, inani eliphansi lymphocyte - kusuka 15 kuya 19%). Ayikho iziyaluyalu homeostasis nokukhula hemodynamic. kwakhiwa isimo Psychopathological is ukuhlaselwa kokudumazeka oneiric-catatonic noma ngokomzwelo.

Izinga isilinganiso

Iqiniso lokuthi umuntu egula neuroleptic syndrome abulalayo ngokulinganisela, kuboniswa izimpawu ezilandelayo:

• ukuboniswa somatovegetativnye iziyaluyalu (isifuba somoya kanye tachycardia ku-120 ngomzuzu);
• imfiva (38-39 degrees);
• izinguquko eziphawulekayo idatha laboratory (ESR kwandisa ukuba 35-50 mm / h, futhi leukocytosis - up 10J109 / l, nenani leukocyte Sehlile 10-15%);
• anda amazinga creatine phosphokinase futhi tranzaminaza igazi;
• A nesizotha wembula hypokalemia futhi hypovolemia.

iziyaluyalu Psychopathological libhekene uhlobo imizwa amentivnopodobnoy futhi degree oneiric. izimpawu Catatonic wabonakaliswa baxhashazwe negativism, imvamisa anda (kusihlwa) Ezimweni yokucasuka ukwethuka, ukunyakaza futhi inkulumo ngemibono.

inqubo eyinkimbinkimbi

On isizinda komzimba kungenzeka neuroleptic syndrome ebulalayo. Izimpawu ezimbi kakhulu kakade, okuyilezi:

• iyakhula somatovegetativnye ukwehluleka (. dyspnea kuya ku-30 umoya ngomzuzu 1, tachycardia ukufinyelela 120-140 ngomzuzu);
• ukwandisa amanzi electrolyte iziyaluyalu;
• anda thuthuva hemodynamic.

Okukhulu kunakho ushintsho izici ezitholakele izibalo laboratory. ESR kwandisa ukuba 40-70 mm / h Leucocytes - up 12J109 / l, inciphise inani lama-lymphocyte ukuze 3-10%, kakhulu kwandisa degree of creatine, alanine futhi asparagine transaminase egazini. Ingaphazamisi ingqondo kungaba afinyelela comatose, futhi soporous izinyathelo amential. Stupor, negativism, ukucasuka senhlekelele, ukucobeka, nokungawuvivinyi ngokwanele imisipha iphimbo kanye, ezimweni ezibucayi ikakhulukazi, baxhashazwe ngokuphelele nge areflexia - konke syndrome neuroleptic ebulalayo.

ukwelashwa

ukusithola ngokushesha lesi sifo iphuzu eliyinhloko. Iqiniso lokuthi umuntu egula neuroleptic syndrome abulalayo kungase kubonise ukungezwani kwemisipha, tachycardia, imfiva, umfutho ophakeme wegazi, ukujuluka Kutholwe ngemuva kokuthola neuroleptics, dysphagia.

Into yokuqala okudingeka ukwenze udokotela, ngakho-ke kukhanselwe neuroleptics nezinye izidakamizwa Neurotoxic. Futhi zidinga izinqubo asekelayo ukuceka izinga lokushisa futhi wenze i-ukuntuleka uketshezi. Electrolyte ukungalingani kumele wawususa. Kuyadingeka ukuba afeze ukuqapha ngokucophelela imisebenzi zokuphefumula esibalulekile, ukusebenza ongatholakala ngobugebengu futhi uma ukwakha sina rigidity kwemisipha futhi singenamandla ukuze expectorate uketshezi bronchial.

Udinga ukuqapha ngokucophelela umsebenzi kwezinso. Nokho, abukho ubufakazi bokuthi ngokwahlukana osmotic ngesivinini esalulama NMS, umane kungaba ukusiza ekusekeleni umsebenzi kwezinso. Kuvame balindzeleke kwekutsi bakhicite yokwelapha ukwelashwa kulungiselelwa ukugqanyiswa.

imithi

Phatha neuroleptic abulalayo syndrome imithi efiselekayo ezimweni eziyinkimbinkimbi. Ngenxa yale njongo, imisipha relaxants ( "Dantrolene") noma Dopamine agonists ( "Amantadine" futhi "bromocriptine"). Nokufa incishisiwe ukusetshenziswa zombili izinhlobo izidakamizwa. Ukweqiwa ziyahlukahluka ngokukhululekile, kodwa "Bromocriptine" amasu zichazwe imithombo imali kusuka 2.5 kuya 5 mg 3 izikhathi ngosuku ngomlomo.

Dopamine agonists, ikakhulukazi izingxenye ezinkulu, kungase kubangele sengqondo noma ukuhlanza, futhi liyakwazi kakhulu isimo sibe sibi isimo sempilo isiguli neuroleptic syndrome ebulalayo. Direct oyibamba imisipha relaxant ukusetshenziswa ne esenikwe 10 mg / kg. Injongo yokusetshenziswa kwawo - ukunciphisa imisipha rigidity, kanye umzimba kwemisipha lwamathambo, ukwanda okuyinto necala for komzimba okukhulu. "Dantrolene" ihlukile hepatotoxicity angase avuse kwesibindi ngisho nokufa ngenxa yokwehluleka kwesibindi ukusebenza. Futhi ngaleso sikhathi kuyoba khona isizathu sokuqhubeka ukwelapha neuroleptic syndrome ebulalayo.

NMS futhi siqedwa by inhlanganisela Dopamine futhi "dantrolene" agonists. izidakamizwa Anticholinergic kabanzi ekwelapheni pseudoparkinsonism ebangelwa izidakamizwa antipsychotic, unganikezi kwaba nemiphumela emikhulu, ngaphezu kwalokho, ungekwazi ukuphazamisa thermoregulation.

Kukhona i update on umthelela "carbamazepine" ukuthi iziguli eziningi zabonisa kuyadamba okusheshayo wobufakazi NSA. Nokho, akukho idatha okunokwethenjelwa mayelana nokusebenza kahle ukusetshenziswa benzodiazepines ukwelapha lesi sifo. Nokho, lapho isimo ngcono, le mithi ingasiza ukwehlisa yokucasuka iziguli kokuba neuroleptic syndrome ebulalayo.

komzimba

Lesi sifo kungatholakala cishe kanye 100 tysyach izinzwa depolarizing imisipha relaxants ( "Miorelaksina", "ditilina" futhi "listenon"), kanye ephefumula imithi yokubulala izinzwa kusuka phakathi Halogen hydrocarbon ( "methoxyflurane", "Ftorogana" futhi "Halothane") . Komzimba okukhulu kubonakala in iziguli ezifweni okusezingeni eliphezulu kulezi izidakamizwa, okuyinto kuhlobene nezinga ukwehluleka kwe-calcium umzimba yemisipha. Imiphumela iba yinhlanganisela yokukhandleka generalized imisipha ukudikiza, futhi ngezinye izikhathi isifo esikhubaza imisipha, kwamiswa ngenxa esiningi ukushisa okuyinto, izinga eliphansi lokushisa komzimba ngokushesha sifinyelela 42 degrees. Neuroleptic Syndrome Ebulalayo kubangela ukufa e 20-30% of amacala.

ambulensi

Phezu ukuthola we komzimba elikhula kudingeka ayeke ukuthatha imithi eshiwo ngenhla. Ngenxa izidakamizwa izinzwa, barbiturates musa avuse isifo, kungathiwa "pancuronium", "Tubocurarine" futhi i-nitrous oxide. Vele kufanele isetshenziswe, uma kunesidingo, isandiso lokunakekela izinzwa.

Ngenxa ematfuba kumiswa ventricular fibrillation ibhalisiwe prophylactic "Phenobarbital" futhi "Procainamide" imithamo zokwelapha. Kuyadingeka ukulungiselela inqubo lwaluyophola, ukubeka phezu ezinkulu imithambo yegazi esitsheni ngamanzi abandayo noma iqhwa. Budinga ngokushesha kujwayeleke uphefumula umoya, bafake sodium hydrogencarbonate / e (400 ml 3% isixazululo). Ezimweni esiyingozi, Kunconywa ukuqaliswa yokusiza umuntu ukuba aphefumule. Esibhedlela - lena into yokuqala okumele uyenze uma kutholakala ukuthi uphethwe yini neuroleptic syndrome ebulalayo.

ukuba nombono ongafani ngeke

Yethula emlandweni NSA uhlale kwandisa amathuba simo ukugeleza yesibili futhi Yiqiniso nzima ukucobeka linqoba. Ngaphezu kwalokho, izinkinga abasafufusa kule syndrome acishe never indiva isakhiwo ubuchopho benganakwa, ukudala labo noma nezinye izifo zezinzwa. Ngakho-ke yini neuroleptic syndrome abulalayo? Yisifo ukuthi kakhulu kuthuntubeza ikhono lomuntu ukuphila komuntu, ngisho kungaholela ekufeni.