Neuroleptic malignant maʻi pale i kapaʻia ...

Neuroleptic malignant maʻi pale o ka pohihihi, a fraught me ka hopena no ke ola o kāna hana, kena ae la ia eʻai ana o psychotropic ai ', pakahi aku la ia neuroleptics o i nā pūʻulu o phenothiazines, thioxanthenes a me butirofenonov. NMS ke hoʻonāukiuki i ka hoʻohana 'ana o na mea paahana, e like me amphetamine, "Amoksalin" "Fluoxetine", "desipramine", "phenelzine" cocaine a "metoclopramide".

kumu

Pahiki kumumea ho okumu i neuroleptic maʻi pale paha e:

• aaieieno? o ai 'hooloihiia waiū;
• vysokopotentnyh hoʻohana o nā kālā;
• ana i na NMS ai ai 'pu me anticholinergic ai';
• antidepressants;
• ea mehana;
• Electroconvulsive lapaau a me kiʻekiʻe humidity.

Aggravation o ka maʻi hiki i kumu pololei attributable i ka physiological maikaʻiʻana o ka hoʻomanawanui. I ka poe nā:

• dehydration;
• psychomotor stimulation;
• alcoholism;
• noʻonoʻo retardation ;
• ka postpartum au;
• intercurrent nā mea palahēhē;
• hemahema o ka hao;
• physical exhaustion;
• traumatic lolo eha;
• thyroid dysfunction.

State o incoherence, kūpuna, 'ehaʻeha o uunu nui, kane keka - a pau i kēia pū kō i neuroleptic malignant maʻi pale. ZNR symptoms hiki e muli o kona kulana okoa - mai hoʻololi iki i ka tangible.

Easyʻano o ka

Neuroleptic malignant maʻi pale wehewehe aku ma ka hahai ana i nāʻikepili: mehana e subfebrile ana somatovegetativnye liʻiliʻi hewa (ke koko, ka lāʻau ikiʻai i loko o ka 150 / 90-110 / 70 mm o Hg, tachycardia - mai i 100 kui iho oe a no minuke ..) E like me ka maikai me abnormalities ma ka keʻena hoʻokolohuaʻikepili (mahuahua ESR i 18-30 mm o / h, i ka haahaa helu o lymphocytes - mai ka 15 a hiki i 19%). No kāna hana o ka homeostasis a me ka ulu ana hemodynamic. Psychopathological moku'āina ua hana oneiric-catatonic paha affective delusional ho'āhewa wale.

Ka awelika degere o

Ka mea i kekahi kanaka mea maʻi neuroleptic malignant maʻi pale lōpū, hōʻikeʻia e ke kēia mau hoailona:

• hōʻike somatovegetativnye kāna hana (asthma me tachycardia i 120 kui iho oe a no minuke);
• wela (38-39 degere);
• mea hou i loko o keʻena hoʻokolohuaʻikepili (ESR maoli i 35-50 mm o / h, a me ka leukocytosis - i 10J109 / l, i ka nui o ka leukocytes emi i 10-15%);
• mahuahua creatine phosphokinase pae a me ka tranzaminaza koko;
• A uku hōʻike hypokalemia a me ka hypovolemia.

Psychopathological kāna hana wehewehe aku ma ke ano o ko amentivnopodobnoy a me oneiric degere. Catatonic symptoms hoike aku immobility negativism, mahuahua alapine (frequency) (i loko o ke ahiahi) hihia o ka mea ukiuki loa nervousness, ka hele a me ka olelo ana, oia stereotype.

eiiieaena kaʻina

Ma ke kāʻei kua o ka hyperthermia kānāwai neuroleptic malignant maʻi pale. Symptoms o ka oi loa ano, oia hoi:

• listen somatovegetativnye hoʻolako 'ole' (. dyspnea i 30 breaths no 1 minuke, tachycardia hiki 120-140 kui iho oe a no minuke);
• hoonui i ka wai a me ka electrolyte kāna hana;
• hoomahuahua ae la lakou hemodynamic ka haunaele.

Ka nui loli ano 'akomi i loko o keʻena hoʻokolohua huahelu. ESR maoli he 40-70 mm o / h Leucocytes - i 12J109 / l, hoemiia ka helu o lymphocytes ia 3-10%, me ka nui loa maoli ka degere o ka creatine, alanine a me ka asparagine transaminase i loko o ke koko. Clouding ka manao ke hiki mai comatose, a me soporous amential kapuwaʻi. Nanea ana, negativism, chaotic mea ukiuki loa, lethargy, me ka emi ma ka Muscle leo, a, ma ka pakahi aku la ia kaumaha hihia, a me ka loa immobility me ka areflexia - a pau neuroleptic malignant maʻi pale.

lapaʻau

Kakahiaka nui ka hōʻoiaʻana o ka maʻi o ke kumu nui wahi. Ka mea i kekahi kanaka mea maʻi neuroleptic malignant maʻi pale i hōʻike muscular hoʻopilikia, tachycardia, kuni, hypertension, sweating akomi i ma hope o ka loaa ana neuroleptics, dysphagia.

Ka mua mea au i e hana i kekahi kauka, pela no ka mea, ua kāpaeʻia neuroleptics a me nā neurotoxic ai '. I koi kākoʻo kaʻina hana, e lawe mai ia i ka mahana, a e mai no ka nele o ka loli. pono e alii iho la oia mai Electrolyte imbalances. Koi 'ia e lawe mai akahele ka mālamaʻana o naehana hanu nui oihana, hiki ke wawahiia hou i ka hana o ka i ka wā ho okumu i kaumaha muscular rigidity a me ka helplessness e expectorate bronchial secretion.

Oe Pono e akahele kanaka hoʻoponoponoʻaʻa puʻuwai kuleana pili i. Eia naʻe,ʻaʻohe mea hōʻike i ka osmotic kaawale hōʻeleu i hou mai NMS, wale ia ke kōkua i ke kākoʻo o kaʻaʻa puʻuwai hana. Ua Ua pinepine koi 'ia e paka i ka Inc i loko o ka' okoʻa hoʻokāʻoi lapaau.

ka lapaʻauʻia

Malama ia no elike neuroleptic malignant maʻi pale lapaʻauʻia mea pono i ka luna 'hihia. No keia mea, Muscle relaxants ( "Dantrolene") ole dopamine agonists ( "Amantadine" a me ka "bromocriptine"). Ua hoemiia make nei mai i loko o ka hoʻohanaʻana i nāʻano o nā ai '. Nā māhele ĸokoĸa ana nä pane wiwo ole, akā, no ka "Bromocriptine" 'ana i kūpono i ho'ākāka' ia i loko o nā kumu i loko o dala mai 2,5 a hiki i 5 mg 3 manawa i ka lā hōʻike waha.

Dopamine agonists, pakahi aku la ia i loko o nui'āpana, e kāhea psychosis a me ka luaʻi, a me ka mea hiki ia me ka nui loa worsen i ka moku'āina o ke ola ana o ka hoʻomanawanui neuroleptic malignant maʻi pale. Direct kekahi hana naʻaupō Muscle relaxant hoʻohana i nā māhele o ka 10 mg / kg. Manao o kona hoʻohana - hoemi Muscle rigidity, e like me ka pūnao o skeletal Muscle, he mahuahua i mea he kuleana no ka hyperthermia. "Dantrolene" i kekahi hepatotoxicity e hoʻonāukiuki hepatitis, a hiki i ka make ma muli o ke ake ole. A laila, ma laila e e ole kumu e hoʻomau i ka hana neuroleptic malignant maʻi pale.

NMS ua eliminated no hoi ma kekahi hui malu pu ana o ka dopamine a "dantrolene" agonists. Anticholinergic ai ' i hoʻomano hoʻohana no ka iapaau ana o ka pseudoparkinsonism, kena ae la ia e antipsychotic ai', mai i nui hualoaʻa, eia hoi, hiki hou loko thermoregulation.

Aia ka he IeAIIeXIAaIEN ma ka hopena o ka "carbamazepine" ua nui nā mea maʻi hōʻike i kokololio mea hoʻonāwaliwali maoli nō o ka hoike NSA. Eia naʻe, aole mea i ike loea ikepili ma ka laulā o ka pono o benzodiazepines no ka iapaau ana o keia maʻi pale. Naʻe, i ka wa a ke ano? Ienoai aa, mau ai 'paha e pono e emi i ka mea ukiuki loa no nā mea maʻi me neuroleptic malignant maʻi pale.

hyperthermia

Ka maʻi hiki ke loaʻa ka hola koke no 100 tysyach anesthesia hoʻohana depolarizing Muscle relaxants ( "Miorelaksina", "ditilina" a me ka "listenon"), e like me inhalation anesthetics, mai waena halogen hydrocarbons ( "methoxyflurane", "Ftorogana" a me ka "Halothane") . Hyperthermia akaka i loko o nā mea maʻi me ka kiʻekiʻe susceptibility i mau ai ', i correlated me ka hoʻolako' ole 'o ka kalipuna pūnao ma Muscle nuipa a. I ka hopena o ka generalized Muscle twitching, a me kekahi manawa Muscle maʻi, a ua hanaʻia e like me ka hopena o ke alahula mau dala o ka wela, kino mahana instantaneously 42 degere ihoiho. Neuroleptic Malignant maʻi pale ke kumu no ka make i loko o 20-30% o ka hihia.

ambulance

Ma ka loaʻaʻana o ka hoʻokēʻai-ulu hyperthermia Pono e lawe ka luna i oleloia ai 'e hooki aku. No ka mea, anesthetic ai ', mai hoʻonāukiuki maʻi, hiki ke hōʻike' barbiturates "pancuronium", "Tubocurarine" a me ka nitrous'okesaside. Just ka mea, e ke hoʻohana ', ina he pono, i ka palena manawa o ka anesthesia malama.

No ka mea, o ka pahiki o ke kahua o ka ventricular fibrillation ua kakau prophylactic "Phenobarbital" a me ka "Procainamide" pākōlea dosages. Ua mea i pono, e hoomakaukau i ke anuanu maila kaʻina hana, e kau i luna nui ipu koko ipu me ka wai huihui a me ka hau. Ua pono koke normalize ha lewa, inject paʻakai hydrogencarbonate / ma (400 ml o 3% pāʻoihana). Ma pilikia hoopii, e waiho i ka manaʻo o ka resuscitation. Hospitalization - keia mea o ka mua loa, e hana ina diagnosed neuroleptic malignant maʻi pale.

Outlook

Makana i loko o ka mōʻaukala o NSA mea mau maoli ka likelihood o ia i ka noho ana o ka haumāna pele a me ka paakiki papa i ka maʻamau malaise. A, kāna hana ka pukaʻana i loko o kēia maʻi pale e kokoke loa piliwaiwai lolo 'ole me ka kumumea, e pili ana i ka poe a me' ē aʻe neurological kāna hana. No laila, i mea neuroleptic malignant maʻi pale? He He maʻi i me ka nui loa impairs he kanaka ka ola, a me ka hiki ke alakai i ka make.