儿茶酚胺相关的毛细血管渗漏ppt课件.pptVIP

Avoid Stress and hyperventilation as they both may induce vasoconstriction of the penumbra zone severe head injury 降低机体的应激反应/内源性儿茶酚胺释放: 在颅脑创伤病人还未转入ICU之前，就应主动的给予镇静镇痛的治疗（安定类药物 + 阿片类药物），以有效的降低机体的应激反应。 转入ICU之后，进一步的降低机体的应激反应，以及体内的儿茶酚胺的释放，给予咪唑安定 + 芬太尼 + ?1受体阻断剂美托洛尔 + ?2受体激动剂可乐定。 降低脑毛细血管的静水压+ 抗应激： ?1受体拮抗剂美托洛尔+ 中枢性的?2激动剂可乐定 维持CPP 50?60 mm Hg (metoprolol + clonidine) NORDSTROM, C.H., REINSTRUP, P., XU, W., et al.(2003). Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 98, 809-814. 主要内容： Case Report 内源性儿茶酚胺释放/毛细血管渗漏 Lund Concept之精髓 Dexmedetomidine + Beta-blocker J Trauma. 2007;62:26–35 Conclusions: Beta-blocker exposure was associated with a significant reduction in mortality in patients with severe TBI. This reduction in mortality is even more impressive, considering that the BB(+) group was older, more severely injured, and had lower predicted survival. NICU救治年龄?55岁的重型颅脑创伤，给予β1受体阻剂的治疗，死亡率从60%降致28%。 Kenji Inaba, et al. Beta-Blockers in isolated blunt head injury. J Am Coll Surg 2008; 206: 432-38. (metoprolol + clonidine)可以减轻血肿周围的水肿。 Pharmacologic Management of Paroxysmal Sympathetic Hyperactivity After Brain Injury 治疗： β-blockers + α2- agonists + morphine + baclofen + gabapentin 急性发作期：morphine + short-acting benzodiazepines A balance between control of symptoms without over sedation is the goal. Curr Neurol Neurosci Rep.2013V13N8 :370 J Neurosci Nurs.2016V48N2 :82-9 调查3000例患者（创伤、脓毒症、心梗、心脏骤停后综合征）， 发现具有共同的病理生理改变—内皮损伤 sympatho-adrenal hyperactivation Endotheliopathy capillary leakage (endothelial cell and glycocalyx damage) 内皮损伤的程度与儿茶酚胺的浓度成正比！ 毛细血管渗漏和凝血功能紊乱是内皮损伤最终结果！ Endogenous heparinization due to the shedding of the glycocalyx （syndecan-1） 内皮损伤的治疗： Xu L, et al. Chemical sympathectomy attenuates inflammation, glycocalyx shedding and coagulation disorders in rats with acute traumatic coagulopathy. Blood Coagul Fibrinolysis. 2015;26:152–60. Chat