神经危重症并发阵发性交感神经过度兴奋综合征的临床特点观察

Cfinical characteristics of paroxysmal sympathetic hyperactivity with severe neurological diseases

目的观察神经危重症并发阵发性交感神经过度兴奋综合征（PSH）患者的临床资料，了解PSH的发病特点及诊疗过程。方法选取自2013年12月至2014年6月在贵州省人民医院神经ICU住院治疗的神经危重症患者84例，按是否伴发PSH分为PSH组（n=101和对照组（n=74）。记录2组患者年龄、性别、GCS评分及急性生理与慢性健康-Ⅱ（APACHE-Ⅱ）评分、临床特点、影像学资料、ICU住院时间、总住院日、气管插管或切开时间、机械通气时间及预后等指标。结果2组患者性别、年龄、GCS评分及APACHEⅡ评分对比差异无统计学意义（P〉0．05）。对比2组原发病：脑梗死发生率在PSH组明显低于对照组，差异有统计学意义（P〈0．05）；对比2组影像学结果：脑室周围及脑室系统病变在PSH组明显低于对照组，差异有统计学意义（P〈0．05）。β受体阻滞剂和多巴胺受体激动剂联合治疗PSH有效。PSH组患者平均住院日、ICU住院日、死亡率、气管切开人数、机械通气时间均高于对照组，差异有统计学意义（P〈0．05）。结论PSH在脑梗死患者中少见．脑深部白质损伤患者更容易伴发PSH；PSH是神经危重症患者的严重并发症，可增加住院时间及死亡率。

Objective To observe the clinical data of neurological critical illness with paroxysmal sympathetic hyperactivity （PSH）, and to understand the characteristics and diagnosis/treatment of PSH. Methods Eighty-four critically ill patients, admitted to our hospital from December 2013 to June 2014, were chosen in our study; 10 PSH patients were chosen as research group and the remaining 74 patients without PSH were served as controls. Age, gender, Glasgow coma scale （GCS） scores, acute physiology and chronic health evaluation （APACHE）-II scores, clinical characteristics, imaging features, EEG, hospitalization time in ICU, hospital stay, time of tracheal intubation or tracheotomy, mechanical ventilation time and prognosis in the two groups were recorded respectively. Results No significant differences were noted in gender, age, GCS scores or APACHE-II scores in both groups （P〉0.05）. The patients with primary diseases of cerebral infarction had significantly lower rate of PSH than those without primary diseases of cerebral infarction （P〈0.05）; patients with periventricular and intraventricular lesions were more frequently accompanied with PSH than those without periventricular and intraventrieular lesions, with significant difference （P〈0.05）. The combination of beta blockers and dopamine receptor agonists was an effective treatment for PSH. The average hospitalization days, hospitalization days at ICU, mortality, number of incision of trachea, mechanical ventilation time of PSH group were significantly higher than those of control group （P〈0.05）. Conclusions PSH occurs rarely in cerebral infarction patients; patients with deep brain white matter injury are more prone to PSH. PSH is the serious complication in neurological critical illness patients, which increases the length of hospital stay and mortality rate.