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目的探讨阵发性交感神经过度兴奋(PSH)的临床表现及诊治方法,提高对PSH的认识。方法回顾性分析2009年2月—2013年5月我院神经内、外科病房及外院高压氧中心诊治的5例PSH患者的临床表现、实验室检查及治疗等资料。结果 5例患者中男4例、女1例,年龄25~77岁,其中严重脑创伤2例、反复脑梗死1例、缺血缺氧性脑病1例、脑出血1例。5例患者主要以阵发性躁动、高热、瞳孔散大、心动过速、血压升高、多汗、呼吸急促、肌张力障碍或姿势异常为临床表现。首次发作距原发病时间为1~60 d,发作时间为数分钟至半小时,发作频率1~10次/d,未发现昼夜规律,吸痰和排便为其可能的诱因。影像学检查提示颅脑损伤部位分散于额叶、顶叶、枕叶、颞叶、丘脑、小脑及脑干。抗癫痫治疗疗效不佳。结论 PSH病因不一,临床表现多样,早期容易误诊,目前主要是对症治疗。
Objective To investigate the clinical manifestations and diagnosis and treatment of paroxysmal sympathetic over-hyperactivity (PSH) and to improve the understanding of PSH. Methods The clinical manifestations, laboratory tests and treatment of 5 PSH patients diagnosed and treated in our hospital from February 2009 to May 2013 were retrospectively analyzed. Results There were 4 males and 1 females in 5 patients, aged from 25 to 77 years, including 2 severe traumatic brain injury, 1 recurrent cerebral infarction, 1 hypoxic-ischemic encephalopathy and 1 cerebral hemorrhage. Five patients with paroxysmal agitation, fever, mydriasis, tachycardia, elevated blood pressure, hyperhidrosis, shortness of breath, dystonia or postural abnormalities as the clinical manifestations. The first attack from the original onset time of 1 ~ 60 d, the onset time of a few minutes to half an hour, the seizure frequency of 1 to 10 times / d, no day-night law, suction and defecation as its possible causes. Imaging studies suggest that brain injury sites scattered in the frontal lobe, parietal lobe, occipital lobe, temporal lobe, thalamus, cerebellum and brain stem. Anti-epileptic treatment ineffective. Conclusion The causes of PSH are different, the clinical manifestations are diverse, early misdiagnosis is the main symptomatic treatment.