Neuroleptic ebulalayo syndrome ebizwa ...

Neuroleptic ebulalayo syndrome yinto enqabileyo yaye naxa ingumbandela ozaliswe ziziphumo ngenxa yomphefumlo sifo okubangelwa ukutya iziyobisi psychotropic, ingakumbi neuroleptics ukubayinxalenye kumaqela phenothiazines, thioxanthenes kunye butirofenonov. NMS kungabangela ukusetyenziswa izixhobo ezifana amphetamine, "Amoksalin" "Fluoxetine", "desipramine", "phenelzine" cocaine okanye "metoclopramide".

izizathu

imiba kwenzeke bokwakha neuroleptic syndrome kungaba:

• ulawulo iziyobisi ndoyolula exposure;
• ukusetyenziswa vysokopotentnyh kwemali;
• isicelo ukuya NMS bako iziyobisi kunye namachiza anticholinergic;
• lakhula;
• lobushushu lomoya;
• unyango Electroconvulsive nokufuma eliphezulu.

Ukuqhubela kwezifo kunokubangela izizathu kungayanyaniswa ngqo kwimpilo-ntle komzimba malunga nesigulane eso. To ezo ziquka:

• emzimbeni;
• lengqondo kushukunyiswa;
• utshwala;
• ukukhubazeka engqondweni ;
• ixesha Kukudandatheka lo;
• izifo intercurrent;
• ukungabikho yentsimbi;
• ngokomzimba;
• nokulimala engqondweni ebuhlungu;
• ndlala kwekhono.

State of incoherence, abadala, ixhala ngokweemvakalelo, sex eyindoda - konke oku lwenza neuroleptic amabi syndrome. Iimpawu ZNR ukusetyenziswa kumxholo wawakhoakulula ezahlukeneyo - ukusuka ezingephi ukuya ephathekayo.

iintlobo Easy of

Neuroleptic ebulalayo syndrome luphawulwa zilandelayo zibonisa: ubushushu subfebrile kwenzeka somatovegetativnye iziphene ezincinane (igazi ukubetha xi ngaphakathi 150 / 90-110 / 70 mm HG, tachycardia - up to ibetha 100 ngomzuzu ..) Njengokuba kwakunye ezingaqhelekanga e data kwilebhu (ukwanda ESR ukuya 18-30 mm / h, inani eliphantsi lymphocyte - ukususela-15 ukuya kwi-19%). Akukho zifo of homeostasis kunye nokukhula hemodynamic. karhulumente Psychopathological ukhandwa ukuhlaselwa oneiric-catatonic okanye Uthando bazikhohlisa.

I-avareji degree of

Into yokuba umntu egula syndrome neuroleptic yingozi ngcathu, kuboniswe kule miqondiso ilandelayo:

• wabonisa somatovegetativnye ukuphazamiseka (asthma kunye tachycardia ukuba ibetha 120 ngomzuzu);
• fever (38-39 degrees);
• utshintsho olukhulu data elebhu (ESR kwandisa ukuya 35-50 mm / h, kunye leukocytosis - up 10J109 / l, ubungakanani leukocytes uyehla uye kuma-10-15%);
• kumanqanaba creatine phosphokinase negazi tranzaminaza;
• A athobekile kutyhilwa hypokalemia kunye hypovolemia.

izifo Psychopathological luphawulwa uhlobo iimvakalelo amentivnopodobnoy nezidanga oneiric. Iimpawu Catatonic walibonakalisa nokungakwazi negativism, qho (ngokuhlwa) amatyala aphazamiseke novalo, intshukumo kunye nentetho bazibandakanye.

yinkqubo entsonkothileyo

Ngomhla imvelaphi komzimba zingenzeka neuroleptic amabi syndrome. Iimpawu sele kakhulu ngakumbi, ezizezi:

• kukhulu ukusilela somatovegetativnye (. dyspnea ukuya Ukuphefumla 30 ngomzuzu 1, tachycardia ukufikelela ibetha 120-140 ngomzuzu);
• ukwandisa iingxaki zamanzi kunye electrolyte;
• ukwanda ukuphazamiseka hemodynamic.

Ezona mpawu kakhulu utshintsho labonwa amanani elebhu. ESR kwandisa ku 40-70 mm / h Leucocytes - up 12J109 / l, kunciphise inani lymphocyte kwi 3-10%, kuphula ngesidanga creatine, alanine kunye asparagine transaminase egazini. Clouding ingqondo unako ukufikelela phezulu amanyathelo comatose, kwaye soporous amential. Badengeka, negativism, nokurhawuzela umbhodamo, silale, kunye ukuncipha kwezihlunu kunye, kwiimeko kuyingozi kakhulu, kunye nokungakwazi ngokupheleleyo kunye areflexia - yonke neuroleptic amabi syndrome.

unyango

Ukuqatshelwa kwangoko esi sifo ingongoma eyintloko. Into yokuba umntu ongaphilanga neuroleptic amabi syndrome kunokubonisa imisipha, tachycardia, ifiva, lwegazi, ukubila ibhaqe emva kokufumana neuroleptics, dysphagia.

Into yokuqala kufuneka wenze ugqirha, ngoko irhoxisiwe neuroleptics kunye namanye amachiza neurotoxic. Kwakhona kufuna iinkqubo ezinika inkxaso ukuzisa phantsi lobushushu wandlule ngenxa yokunqongophala kwamanzi. ukungalingani Electrolyte kufuneka kwaba njalo. Ufuna ukwenza esweni ngenyameko imisebenzi yokuphefumla ebalulekileyo, ukusebenza apho kwaphulwa kwakhona xa kusenziwa ngqongqo kakhulu kwimisipha singenamandla ukuba expectorate secretion inyumoniya.

Kufuneka esweni ngenyameko umsebenzi kwezintso. Nangona kunjalo, akukho bungqina bokuba ukwahlukana osmotic ibalekisa isazama NMS, yinqakrzaze inokunceda inkxaso yomsebenzi kwezintso. Idla kufuneka avelise kwanonyango ndawo oluphuculweyo unyango.

amayeza

Siphathane neuroleptic amayeza syndrome angendawo enqwenelekayo kwiimeko ezinzima. Ukulungiselela le njongo, relaxants kwezihlunu ( "Dantrolene") okanye agonists dopamine ( "Amantadine" yaye "bromocriptine"). Mortality sicuthiwe kusetyenziswe zombini iindidi iziyobisi. Amathamo abafani ngokukhululekileyo, kodwa ubuchule "Bromocriptine" zichazwe kwi imithombo ngezixa ukusuka 2.5 ukuya kumaxesha 5 mg 3 ngosuku ngomlomo.

agonists Dopamine, ingakumbi iinxenye ezinkulu, kungabangela ukugula ngengqondo okanye ukugabha, kwaye uyakwazi mandundu kakhulu imeko yempilo yomguli neuroleptic amabi syndrome. Direct alunywe kwemisipha relaxant esetyenziswa kunye amathamo-10 mg / kg. Injongo ukusetyenziswa kwayo - ukunciphisa ngqongqo kwezihlunu, kwakunye nethe zihlunu skeletal, ukwanda leyo unenxaxheba komzimba. "Dantrolene" iyahluka hepatotoxicity ukuze bandiqumbise hepatitis kunye nokufa ngenxa ukusilela esibindini. Kwaye ngelo xesha kuya kubakho isizathu ukuqhubeka ukuphatha neuroleptic amabi syndrome.

NMS kwakhona iyapheliswa yi indibanisela dopamine kunye "dantrolene" agonists. iziyobisi Anticholinergic asetyenziswa ngokubanzi ekunyangeni pseudoparkinsonism okubangelwa ziziyobisi antipsychotic, musa ukunika iziphumo ezibalulekileyo, koko, enokuphazamisana ngakumbi thermoregulation.

Kukho uhlaziyo ngefuthe "carbamazepine 'ukuba izigulane ezininzi wabonisa buthathaka ngokukhawuleza yesingqino NSA. Nangona kunjalo, akukho ngedatha ethembekileyo kwi impumelelo yokusetyenziswa benzodiazepines ukuba unyango le sifo. Noko ke, xa imeko iphucuke, la machiza kunokuba luncedo ukunciphisa ukungavisisani izigulane ukuba neuroleptic amabi syndrome.

komzimba

Isifo inokufumaneka malunga kanye 100 zomzimba tysyach nganye usebenzisa depolarizing relaxants kwezihlunu ( "Miorelaksina", "ditilina" yaye "listenon"), kwakunye iintlungu inhalation phakathi hydrocarbon halogen ( "methoxyflurane", "Ftorogana" yaye "Halothane") . Komzimba ivela izigulane susceptibility eliphezulu ukuya kula machiza, leyo ngamazinga kunye lokungaphumeleli ngecalcium yokucolwa mass kwezihlunu. Ngenxa yoko ngokubanzi twitching kwezihlunu, yaye ngamanye amaxesha isifo sezihlunu, oluthi luqokelelane ngenxa omkhulu ubushushu, ubushushu bomzimba kweso kufika kumgomo we 42. Neuroleptic ebulalayo Syndrome ubangela ukufa 20-30% yamatyala.

ambulensi

Xa efumanise komzimba ngokukhawuleza sandayo kufuneka uyeke ukuthatha amachiza zikhankanywe ngasentla. Ngenxa yokuba iziyobisi iintlungu, barbiturates musani ukubacaphukisa izifo, ziyakwazi ukuchongeka "pancuronium", "Tubocurarine" kunye ne-nitric oxide. kufuneka zisetyenziswe nje, ukuba kuyimfuneko, ukwandiswa ukhathalelo zomzimba.

Kuba amathuba akuseko ventricular fibrillation ubhalisiwe umbala "Phenobarbital" yaye "Procainamide" iidosi zonyango. Kuyimfuneko ukuba kulungiselelwe inkqubo okupholisa, ebeka phezu ezinkulu imithambo yegazi container ngamanzi abandayo okanye umkhenkce. Kufuneka ngoko nangoko bunjani ukuphefumla umoya, bafake sodium hydrogencarbonate / kwi (400 ml-3% solution). Kwiimeko eziyingozi, bubulumko ukuphunyezwa yokurhaxwa. Esibhedlela - lo nto yokuqala ukuyenza xa wafunyaniswa neuroleptic amabi syndrome.

Outlook

Akhoyo kwimbali NSA usoloko kunyusa amathuba meko ezifika lesibini nekhondo ayingeni umkhuhlane ezikhoyo. Ngaphezu koko, ukuphazamiseka asakhasayo kulo syndrome phantse awusoze baphula Isakhiwo bubuchopho, azafunyanelwa ndawo, ukudala abo okanye ezinye izifo-luvo. Ngoko ke yintoni neuroleptic amabi syndrome? Sisifo okwenzeka kakhulu ebomini bomntu, kwaye kunokukhokelela ekufeni.