- 期刊
Paroxysmal Sympathetic Hyperactivity: Two Case Reports
陣發性交感神經過度活化：兩則病例報告
摘要
陣發性交感神經過度活化（Paroxysmal sympathetic hyperactivity, PSH）是一種以陣發性的體溫增高、冒汗、躁動、肌肉張力異常、血壓變高、呼吸變快及心跳變快的症候群。絕大多數的病例報告都是在腦部損傷之後發生，只有少數病例沒有腦部損傷。明確的致病機轉到現在仍不清楚，大多數的病患對於嗎啡類、gabapentin、benzodiazepine、中樞作用α- 致效劑與β- 阻斷劑、bromocriptine 與脊髓腔內注射baclofen等藥物有效，而對一般抗癲癇藥物、抗生素或退燒藥效果較差，對陣發性交感神經過度活化的延遲診斷與處置可能會增加死亡率與罹病率，我們提出兩則病例報告並回顧陣發性交感神經過度活化相關文獻。正確的診斷與適當的處置能夠減少呼吸器使用天數與住院天數，甚至是預後，故對於加護病房內呈現體溫增高、肌肉張力異常、呼吸變快及心跳變快病人的鑑別診斷與處置是相當重要的。
並列摘要
Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by episodes of hyperthermia, diaphoresis, agitation, dystonia, and increased blood pressure (BP), respiratory rate (RR), and heart rate (HR). Most cases are found after brain injury, although a few cases have had no brain injury. The exact mechanism is still not clear, but PSH can be treated by opioids, gabapentin, benzodiazepines, centrally acting α-agonists, and β-antagonists, bromocriptine, and intrathecal baclofen, instead of anti-epileptics, antibiotics, or antipyretics, in most cases. Delayed diagnosis and management of PSH may increase morbidity and mortality. We present 2 cases and review the literature on PSH. Accurate diagnosis and appropriate treatment can reduce the number of ventilator days and shorten the hospital course, and even improve the clinical outcome. Therefore, the differential diagnosis and management of patients presenting with hyperthermia, dystonia, tachypnea, and tachycardia are very important in daily practice in the intensive care unit.