Neuroleptic akaipa urwere inonzi ...

Neuroleptic akaipa chirwere haiwanzowaniki uye hwakazara nemigumisiro upenyu wenyonganyonga kunokonzerwa yaunodya pamusoro psychotropic zvinodhaka, kunyanya neuroleptics kuva mapoka phenothiazines, thioxanthenes uye butirofenonov. NMS kungakonzera kushandiswa munowanika amphetamine, "Amoksalin" "Fluoxetine", "desipramine", "phenelzine" kokeini kana "metoclopramide".

zvikonzero

Fungidziro zvinoita vanoumba neuroleptic chirwere angava:

• Vanotarisira zvinodhaka mazhinji ekisiposha;
• vysokopotentnyh kushandiswa mari;
• kushandisa kuti NMS tinazvo zvinodhaka pamwe chete anticholinergic zvinodhaka;
• antidepressants;
• mhepo tembiricha;
• Electroconvulsive kurapwa uye yakakwirira mwando.

Kusembura zvirwere zvinogona kukonzera zvikonzero pamusana kune vasiri zvakanaka murwere zvakananga. To avo vanosanganisira:

• kupera muviri;
• psychomotor dzishande;
• kudhakwa;
• mupfungwa retardation ;
• ari postpartum kumwedzi;
• intercurrent noutachiona;
• kushaya simbi;
• panyama kuneta;
• dzechimwe Kukuvara uropi;
• thyroid dysfunction.

State of incoherence, vakwegura, kufunganya mupfungwa, vanhurume - izvi zvose zvakare kunowedzera neuroleptic akaipa syndrome. ZNR Zviratidzo zvinogona akasiyana zvikuru - kubva muduku kusvikira zvaioneka.

Easy-siyana

Neuroleptic akaipa chirwere inozivikanwa nokutevera zvairatidza: tembiricha inokwira kuna subfebrile kuitika somatovegetativnye zvikanganiso zviduku (BP kupomba mukati 150 / 90-110 / 70 mm HG, tachycardia - kusvika anorova 100 paminiti ..) Kana uyewo abnormalities mu murabhoritari Data (yakawedzera ESR kusvika 18-30 mm / h, rakadzika nhamba lymphocytes - kubva 15 kusvika 19%). No kusagadzikana homeostasis uye hemodynamic kukura. Psychopathological mamiriro aumbwa oneiric-catatonic kana kuvhiringidzika delusional kurwisa.

The avhareji mwero

Chokwadi chokuti munhu anorwara neuroleptic akaipa chirwere mwero, zvinoratidzwa anotevera zviratidzo:

• akaratidza somatovegetativnye zvirwere (asima pamwe tachycardia kuti anorova 120 paminiti);
• Fivha (38-39 madhigirii);
• kuchinja mu murabhoritari Data (ESR kunowedzera kusvika 35-50 mm / h, uye leukocytosis - kukwira 10J109 / L, nhamba yemabhuku leukocytes zvinoderedza kusvika 10-15%);
• yakawedzera creatine phosphokinase mumatunhu uye tranzaminaza ropa;
• A mwero kwakaratidza hypokalemia uye hypovolemia.

Psychopathological nepfungwa inozivikanwa vorudzii manzwiro amentivnopodobnoy uye oneiric dhigirii. Catatonic zviratidzo akaratidza kutadza kufamba negativism, vakawedzera kakawanda (manheru) Muzviitiko kuzvinetsa kutya, kufamba uye kutaura kufanana nevechiduku.

kunzwisisa muitiro

On pakanyorwa hyperthermia zvingaitika neuroleptic akaipa syndrome. Zviratidzo zvikuru kare, okuti:

• yakakura somatovegetativnye kukundikana (. dyspnea kuti mweya 30 paminiti 1 miniti, tachycardia vanosvika 120-140 anorova paminiti);
• kuwedzera mvura uye electrolyte zvirwere;
• yakawedzera hemodynamic vachivavhiringidza.

Mukuru kuchinja unhu dzakaonekwa mu murabhoritari nemifananidzo. ESR chinowedzera 40-70 mm / h Leucocytes - kukwira 12J109 / L, kwakaderedza nhamba lymphocytes kuti 3-10%, yekudyidzana kunowedzera ukuru creatine, alanine uye asparagine transaminase muropa. Dzisavhiringidza mupfungwa kunogona kusvika kumusoro comatose, uye soporous amential matanho. Ndivete negativism, runobva nokushatiriswa lethargy, pamwe vasanyanye tsandanyama matauriro uye, mune kunyanya zvakakomba nyaya, uye Mhedziso kutadza kufamba pamwe areflexia - zvose neuroleptic akaipa syndrome.

mabatiro

Early kuziva chirwere ndiyo pfungwa huru. Chokwadi chokuti munhu ari kurwara neuroleptic akaipa chirwere zvingaratidza tsandanyama Zvinetso, tachycardia, fivha, BP, vangadikitira dzakaonekwa paakaudzwa neuroleptics, dysphagia.

Chaunotanga kuita chiremba, saka kusaenda neuroleptics uye zvimwe zvinodhaka neurotoxic. Uyewo zvinoda achitsigira nzira kuti tiuye pasi tembiricha uye anoumba kuti kushaya mvura mvura. Electrolyte imbalances inofanira warambidzwa. Kunodiwa kuti vaite kungwarira kuongorora kuti kufema anokosha, kushanda rinogona kuputswa zvakare kana dzichiumbwa chakakomba tsandanyama Rigidity uye asingabatsiri kuti expectorate Árbol secretion.

Unofanira kunyatsofunga kuongorora renal ushande. Zvisinei, hapana uchapupu hwokuti osmotic kuparadzana Inowedzera kunaya NMS, anongoti chinogona kubatsira kubatsirwa renal basa. Chinowanzoonekwa kunodiwa kubudisa kurapa ari ezvinhu kunowedzera kurapwa.

mishonga

Munokuridzirwa neuroleptic akaipa chirwere mishonga iri vanodiwa dzakaoma kunzwisisa. Nokuti chinangwa ichi, tsandanyama relaxants ( "Dantrolene") kana dopamine agonists ( "Amantadine" uye "bromocriptine"). Rufu akanga aderedzwa kushandisa zvose marudzi zvinodhaka. Mishonga siyana pachena, asi kuti "Bromocriptine" Unyanzvi vanotsanangurwa ari manyuko muhuwandu kubva 2.5 5 MG 3 kanomwe pazuva nomuromo.

Dopamine agonists, kunyanya migove makuru, kungakonzera psychosis kana kurutsa, uye anokwanisa yekudyidzana achiipa mamiriro utano murwere neuroleptic akaipa syndrome. Direct nokuita tsandanyama relaxant wakashandiswa mishonga 10 MG / makirogiramu. Chinangwa kushandiswa kwayo - achidzikisa tsandanyama Rigidity, uyewo muviri pamusoro skeletal tsandanyama, kuwedzera kuri pamwe anokonzera hyperthermia. "Dantrolene" akasiyana hepatotoxicity anogona kutsamwisa kuzvimba chiropa uye kunyange rufu nokuda chiropa kutadza. Uye ipapo achava chikonzero tichibata neuroleptic akaipa syndrome.

NMS uyewo panobviswa nokuda mubatanidzwa dopamine uye "dantrolene" agonists. zvinodhaka Anticholinergic dzinoshandiswa nevakawanda nekuda kurapa pseudoparkinsonism kukonzerwa antipsychotic zvinodhaka, regai kupa zvinokosha zvabuda, uyezve, aigona zvakare kanganisa thermoregulation.

Pane MASHOKO EZVAKAITIKA pamusoro matambudziko "carbamazepine" kuti varwere vakawanda vakaratidza akurumidze kwakaderera ari NSA yechipupuriro. Zvisinei, hapana akavimbika mashoko pamusoro kubudirira kushandiswa benzodiazepines kuti mishonga urwere ichi. Zvisinei, kana mamiriro inovandudzika, mishonga iyi inogona kubatsira kuderedza kutsamwa pavarwere vane neuroleptic akaipa syndrome.

hyperthermia

The chirwere chinogona kuwanikwa anenge kamwe pa 100 tysyach yokutindivadza kushandisa depolarizing tsandanyama relaxants ( "Miorelaksina", "ditilina" uye "listenon"), uyewo inhalation dzokutindivadza pakati halogen Mahydrocarbon ( "methoxyflurane", "Ftorogana" uye "Halothane") . Hyperthermia anooneka varwere dzakakwirira susceptibility nezvinodhaka izvi, izvo correlated pamwe kukundikana calcium muviri ari kwetsandanyama. Zvinoguma generalized tsandanyama twitching, uye dzimwe nguva tsandanyama chirwere, iyo yakaumbwa somugumisiro pakaitwa kupisa, tembiricha muviri panguva kunosvika madhigirii 42. Neuroleptic nyanyisa Syndrome kunokonzera rufu muna 20-30% nyaya.

amburenzi

Pamusoro kuonekwa munhu kukura nokukurumidza hyperthermia vanofanira kurega kutora yekunwa mishonga. Nekuti rufimbi zvinodhaka, musanetsa chirwere, vangazivikanwa barbiturates "pancuronium", "Tubocurarine" uye nitrous oxide. Just vanofanira kushandiswa, kana zvakakodzera, kuti kuwedzerwa yokutindivadza hanya.

Nokuti ndingangokuvara paumbwe ventricular fibrillation rinonyoreswa prophylactic "Phenobarbital" uye "Procainamide" kuchirapa dosages. Zvinokoshawo kuti agadzirire kutonhora nzira, achiisa pamusoro guru ropa midziyo mudziyo nemvura inotonhora kana chando. Zvinoda pakarepo normalize kufema mhepo, baya jekiseni yavaibvisa hydrogencarbonate / mu (400 ml 3% mhinduro). Muzviitiko ngozi, izvozvo yakarumbidza Implementation kuti nokumutswa. Muchipatara - ichi ndicho chinhu chokutanga kuita kana chirwere neuroleptic akaipa syndrome.

mataridzikiro

Present munhoroondo NSA anogara kunowedzera mukana wokuti vagumirwe kuerera yechipiri uye zvakaoma kosi yemamiriro zvakawanda zvive. Uyezve, zvinetso zvichiitika chirwere ichi vari dzinenge kumbobvira vadarika uropi chivako pasina zvikasawanirwa, kusika avo kana zvimwe chetsinga zvirwere. Saka chii neuroleptic akaipa chirwere? Ihosha kuti yekudyidzana kunokanganisa upenyu hwomunhu, uye kunyange zvingaita kuti rufu.