Neuroleptic malignant syndrome yog ib qho tsis tshua muaj thiab ua rau lub neej tsis zoo los ntawm kev siv cov tshuaj psychotropic, tshwj xeeb tshaj yog cov neuroleptics uas yog cov pab pawg ntawm phenothiazine, thioxanthenes thiab butyrophenones. Kev siv tshuaj xws li amphetamine, Amoxalin, Fluoxetine, Desipramine, Phenelzine, cocaine lossis Metoclopramide tuaj yeem ua rau NMS.
Yog vim li cas
Yam Tseem Ceeb rau kev tsim ntawm neuroleptic syndrome tuaj yeem yog:
- noj tshuaj ntev ntev;
- siv nyiaj ntau heev;
- siv NMS cov tshuaj nquag nrog rau cov tshuaj anticholinergic;
- tshuaj tiv thaiv kev nyuaj siab;
- cua kub;
- kev kho hluav taws xob thiab cov av noo siab.
Kev mob hnyav tuaj yeem tshwm sim los ntawm cov laj thawj ncaj qha cuam tshuam nrog kev noj qab haus huv ntawm tus neeg mob. Cov no suav nrog:
- dehydration;
- psychomotor irritation;
- yuav haus cawv;
- kev puas hlwb;
- postpartum;
- kis kab mob sib kis;
- hlau deficiency;
- lub cev qaug zog;
- mob hlwb raug mob;
- thyroid dysfunction.
Lub xeev ntawm incoherence, laus laus, kev xav nervousness, txiv neej pw - tag nrho cov no kuj exacerbates neuroleptic malignant syndrome. Cov tsos mob ntawm IDD tuaj yeem muaj txij li me me mus rau pom.
Kev txhim kho ntau yam yooj yim
Malignant neuroleptic syndrome yog tus cwj pwm los ntawm cov lus qhia hauv qab no: qhov kub nce mus rau cov lej subfebrile, me me somatovegetative tsis ua haujlwm (BP mem tes hauv 150/90-110/70 mm Hg, tachycardia - mus txog 100 neeg ntaus ib feeb), thiab tseem deviations nyob rau hauv lub chaw soj nstuam cov ntaub ntawv (nce ESR mus txog 18-30 mm / h, ib tug tsawg tus naj npawb ntawm lymphocytes - los ntawm 15 mus rau 19%). Tsis muaj teeb meem ntawm homeostasis thiab hemodynamic loj hlob. Lub xeev psychopathological yog tsim los ntawm oneiroid-catatonic los yog cuam tshuam-delusional tawm tsam.
Medium degree
Cov cim qhia hauv qab no qhia tias ib tus neeg mob muaj mob me me neuroleptic malignant syndrome:
- manifested somatovegetative disorders (asthma nrog tachycardia txog 120 neeg ntaus ib feeb);
- nce lub cev kub (txog 38-39 degrees);
- hloov pauv taunyob rau hauv cov ntaub ntawv kuaj (ESR nce mus rau 35-50 mm / h, thiab leukocytosis - mus txog 10J109 / l, cov leukocytes txo mus rau 10-15%);
- qib ntawm creatine phosphokinase thiab transaminase hauv cov ntshav nce;
- kuaj pom muaj hypokalemia thiab hypovolemia tau sau tseg.
Hom kev puas siab puas ntsws yog qhov ua txhaum ntawm kev xav ntawm kev xav thiab kev kawm qib siab. Catatonic cov tsos mob yog tshwm sim los ntawm immobility nrog negativism, nce (nyob rau hauv yav tsaus ntuj) ntawm cov neeg mob ntawm irritation nrog nervousness, lub cev muaj zog thiab hais lus stereotypes.
txheej txheem nyuaj
Tawm tsam keeb kwm ntawm hyperthermia, malignant neuroleptic syndrome kuj tuaj yeem tshwm sim. Cov tsos mob twb mob hnyav dua, xws li:
- somatovegetative tsis ua haujlwm tau nce ntxiv (ua pa luv txog 30 ua pa hauv 1 min., tachycardia nce mus txog 120-140 neeg ntaus ib feeb);
- dej thiab electrolyte tsis meej nce;
- hemodynamic cuam tshuam nce.
Qhov kev hloov pauv loj tshaj plaws hauv qhov zoo yog pom hauv cov lej kuaj. ESR nce mus rau 40-70 mm / h, leukocytes - mus txog 12J109 / l, cov lymphocytes txo mus rau 3-10%, qib ntawm creatine phosphokinase, aspartic thiab alanine transaminase hauv cov ntshav nce ntau. Kev tsis pom kev ntawm lub siab tuaj yeem ncav cuag coma, soporous thiab amental theem. loog loog, negativism, chaotic irritation, lethargy nrog ib tug txo nyob rau hauv cov leeg nqaij tone, thiab tshwj xeeb tshaj yog nyob rau hauv cov mob hnyav, kiag li immobility nrog areflexia - tag nrho cov no yog malignant neuroleptic syndrome.
Kev kho mob
Kev txheeb xyuas tus kab mob raws sijhawm yog lub ntsiab lus tseem ceeb. Qhov tseeb tias ib tug neeg muaj mob neuroleptic malignant syndrome tuaj yeem qhia tau los ntawm cov leeg nro, tachycardia, kub taub hau, kub siab, nce tawm hws pom tom qab noj tshuaj tiv thaiv kab mob, dysphagia.
Thawj yam uas kws kho mob yuav tsum ua yog nres tshuaj tiv thaiv kab mob thiab lwm yam tshuaj neurotoxic. Koj tseem yuav xav tau kev pab txhawb nqa kom txo qhov kub thiab ua kom tsis muaj dej. Electrolyte imbalance yuav tsum raug cais tawm. Nco ntsoov ua tib zoo saib xyuas kev ua pa ua pa, uas tuaj yeem cuam tshuam ntau zaus los ntawm kev tsim cov leeg nqaij nruj thiab tsis muaj kev pab kom hnoos li bronchial secretions.
Yuav tsum tau saib xyuas kev ua haujlwm ntawm lub raum. Txawm li cas los xij, tsis muaj pov thawj tias osmotic compartment accelerates post NMS rov qab, tsuas yog tias nws tuaj yeem pab txhawb lub raum ua haujlwm. Nws yog ib qho tsim nyog los ua kev kho mob hauv qhov chaw kho kom zoo dua qub.
Tshuaj Kho Mob
Nws yog qhov tsim nyog los kho tus mob neuroleptic malignant syndrome nrog cov tshuaj hauv cov xwm txheej nyuaj. Rau qhov no, cov leeg nqaij so (Dantrolene) lossis dopamine agonists (Amantadine thiab Bromocriptine) yog siv. Kev tuag txo qis nrog kev siv ob hom tshuaj. Cov koob tshuaj tau hloov pauv dawb, txawm li cas los xij, rau Bromocriptine, cov peev txheej piav qhia qhov ntau thiab tsawg ntawm 2, 5 thiab txog 5 mg 3 zaug hauv ib hnub.hnub hais lus.
Dopamine agonists, tshwj xeeb tshaj yog nyob rau hauv koob tshuaj loj, tuaj yeem ua rau muaj kev puas siab puas ntsws lossis ntuav, thiab qhov no tuaj yeem ua rau muaj kev noj qab haus huv ntawm tus neeg mob neuroleptic malignant syndrome. Ib qho kev ua haujlwm ncaj qha rau cov leeg nqaij so yog siv ntawm koob tshuaj tsawg li 10 mg / kg. Lub hom phiaj ntawm nws txoj kev siv yog los txo cov leeg nqaij rigidity, nrog rau cov leeg pob txha metabolism, qhov nce ntawm cov uas yog ib feem ntawm lub luag haujlwm rau hyperthermia. "Dantrolene" yog hepatotoxic, tuaj yeem ua rau mob siab thiab tuag taus vim lub siab tsis ua haujlwm. Thiab tom qab ntawd yuav tsis muaj qhov taw tes rau kev kho mob ntxiv ntawm neuroleptic malignant syndrome.
NMS kuj raug tshem tawm los ntawm kev sib xyaw ntawm dopamine agonists thiab Dantrolene. Anticholinergic tshuaj, dav siv los kho cov kab mob neuroleptic pseudoparkinsonism, tsis muab cov txiaj ntsig tseem ceeb, ntxiv rau, lawv tuaj yeem cuam tshuam ntxiv rau thermoregulation.
Muaj cov ntaub ntawv tsis ntev los no txog kev ua haujlwm ntawm "Carbamazepine", uas nyob rau hauv ntau tus neeg mob tau pom qhov tsis muaj zog ntawm cov lus qhia ntawm NMS. Txawm li cas los xij, tsis muaj cov ntaub ntawv txhim khu kev qha ntawm kev siv cov tshuaj benzodiazepines rau kev kho tus mob no. Txawm li cas los xij, thaum tus mob zoo tuaj, cov tshuaj no yuav pab tau kom txo tau qhov khaus ntawm cov neeg mob neuroleptic malignant syndrome.
Tus kab mob tuaj yeem kuaj pom kwv yees li ib zaug hauv 100,000 tshuaj loog siv depolarizing cov leeg nqaij so(Myorelaxin, Ditilin thiab Listenone), nrog rau kev nqus tshuaj loog los ntawm cov halogen-hloov cov hydrocarbons (Methoxyflurane, Fluorogan thiab Halothane). Hyperthermia tshwm sim hauv cov neeg mob uas muaj kev cuam tshuam rau cov tshuaj no, uas cuam tshuam nrog kev ua tsis tiav ntawm calcium metabolism hauv cov leeg nqaij. Qhov tshwm sim yog cov leeg nqaij twitching, thiab qee zaum cov leeg mob, vim tias muaj cov cua kub loj heev, lub cev kub tam sim ntawd nce mus txog 42 degrees. Neuroleptic Malignant Syndrome ua rau tuag hauv 20-30% ntawm cov neeg mob.
Ambulance
Thaum kuaj pom tus mob hyperthermia sai, tsis txhob noj cov tshuaj saum toj no. Ntawm cov tshuaj loog uas tsis provoke tus kab mob, barbiturates, Pancuronium, Tubocurarine thiab nitrous oxide tuaj yeem paub qhov txawv. Tsuas yog lawv yuav tsum tau siv thaum tsim nyog rau kev kho tshuaj loog.
Vim muaj qhov tshwm sim ntawm kev txhim kho ventricular arrhythmia, prophylactic siv "Phenobarbital" thiab "Procainamide" nyob rau hauv cov tshuaj kho ntau npaum li cas. Nws tseem yog ib qho tsim nyog los npaj cov txheej txheem txias los ntawm kev tso cov ntim dej txias lossis dej khov rau cov hlab ntsha loj. Nws yuav tsum tam sim ntawd normalize qhov nqus tau pa, txhaj tshuaj sodium bicarbonate intravenously (400 ml ntawm 3% tov). Nyob rau hauv cov xwm txheej txaus ntshai, kev siv cov kev ntsuas resuscitation raug pom zoo. Kev mus pw hauv tsev kho mob yog thawj qhov ua tau yog tias kuaj pom tus mob neuroleptic malignant.
Huab cua
Muaj keeb kwm ntawm NMS ib txwm ua rau muaj kev pheej hmoo ntawm kev kawm theem nrab ntawm cov xwm txheej zoo li no thiab ua rau muaj kev nyuaj siab ntawm kev mob hnyav. Tsis tas li ntawd, cov teeb meem uas tshwm sim hauv cov mob no yuav luag tsis dhau ntawm lub hlwb cov qauv yam tsis muaj kab, tsim qee yam kab mob neurological. Yog li dab tsi yog neuroleptic malignant syndrome? Qhov no yog ib yam kab mob uas ua rau tib neeg lub neej tsis zoo, thiab tuaj yeem ua rau tuag taus.
