Neuroleptic bolaeang lefu bitsoa ...

Neuroleptic bolaeang syndrome, ke ka seoelo le tletse lintho tse ngata ka liphello tsa bophelo oa ho hloka taolo le bakoang ke ho noa lithethefatsi psychotropic, haholo-holo neuroleptics bao e leng lihlopha tsa phenothiazines, thioxanthenes le butirofenonov. NMS ka qholotsa ho sebelisa lisebelisoa tse kang se entsoeng ka amphetamine, "Amoksalin" "Fluoxetine", "desipramine", "phenelzine" k'hok'heine kapa "metoclopramide".

mabaka a

Kgonego lintlha eaba ba etsa lefu neuroleptic e ka ba o reng:

• tsamaiso ea lithethefatsi nako e telele ho pepesehela;
• vysokopotentnyh tšebeliso ea chelete;
• ho sebelisa ho NMS ea nang lithethefatsi hammoho le lithethefatsi anticholinergic;
• antidepressants;
• moea mocheso;
• kalafo Electroconvulsive le mongobo le phahameng.

Aggravation tsa mafu a ka etsa hore le mabaka a ho toba attributable ho fisioloji boiketlo ba mokuli. Ho ba kenyeletsa:

• dehydration;
• psychomotor tlhotlheletso;
• lemalla joala;
• kholofalo kelello ;
• nako postpartum;
• tsoaetsanang intercurrent;
• ho hloka ea tšepe;
• 'meleng mokhathala;
• sithabetsang boko ntsa kotsi;
• thyroid ho se sebetse.

State of incoherence, ea seng a hōlile, ea maikutlo ho tšoenyeha, ho kopanela liphate e motona - tsohle ena hape phaella ka ho re ho lefu neuroleptic bolaeang. ZNR matšoao a ka ba e fapaneng haholo - go tswa go tse sa reng letho ho bonahalang.

Bonolo fapaneng

Neuroleptic bolaeang syndrome, tšoauoa ka tse latelang ho bonahala: mocheso e hlaha ho subfebrile etsahala somatovegetativnye liphoso tse nyenyane (khatello ea mali pulse length hara 150 / 90-110 / 70 limilimithara Hg, tachycardia - ho fihlela ho otla 100 ka motsotso ..) Joalokaha hammoho le tsela e sa tloaelehang ka ho ya data laboratori ea (eketsehileng ESR ho 18-30 limilimithara / H, le tlaase nomoro ya lymphocytes - ho tloha ho 15 ho 19%). Ha ho bothata ea homeostasis le kgolo ya hemodynamic. boemo Psychopathological Ho thehoa oneiric-catatonic kapa afeketifi litlhaselo tsa delusional.

Tekanyo karolelano ea

'Nete ea hore motho a kulang neuroleptic bolaeang syndrome, e leka-lekaneng, o ile a bontša ka lipontšo tse latelang:

• di behilwe mafu somatovegetativnye (asma le tachycardia ho otla 120 ka motsotso);
• feberu (38-39 likhato);
• liphetoho tse khōlō ya data laboratori ea (ESR eketsa ho 35-50 limilimithara / H, le leukocytosis - ho fihlela 10J109 / k, lenane la leukocytes decreases ho 10-15%);
• eketseha maemo creatine phosphokinase le mali tranzaminaza;
• A a inyenyefatsa a senola hypokalemia le hypovolemia.

mafu a Psychopathological tšoauoa ka mofuta oa maikutlo a amentivnopodobnoy le lengolo la oneiric. matšoao a Catatonic bonahatsa immobility negativism, e ile ea eketseha maqhubu (mantsiboea) maemo a ho teneha ho tšoha, mokhatlo oa le puo e stereotype.

rarahaneng

Ka semelo sa hyperthermia ka 'na la hlaha neuroleptic bolaeang lefu. Matšoao a se matla ho feta, e leng:

• Amplified hlōleha somatovegetativnye (. dyspnea ho breaths 30 ka motsotso 1, tachycardia fihle otla 120-140 ka motsotso);
• eketsa mafu a metsi le electrolyte;
• eketseha hemodynamic meferefere.

Moholo ka ho fetisisa phetoho litšobotsi tse lemoha ka lipalo laboratoring. ESR eketsa ho 40-70 limilimithara / H Leucocytes - ho fihlela 12J109 / k, fokolitse palo ea lymphocytes ho 3-10%, haholo eketsa tekanyo ea ho creatine, alanine le asparagine transaminase maling. Clouding kelello ka fihla ho fihlela comatose, le soporous mehato amential. Stupor, negativism, pherekano motseng ho teneha, lethargy, le ea fokotseha ka mesifa molumo 'me, mabakeng a haholo-holo ka lintho tse tebileng,' me immobility feletseng le areflexia - tsohle neuroleptic bolaeang lefu.

kalafo

boitsebiso ba pele ba lefu lena le ke ntlha e khōlō. 'nete ea hore motho a kula neuroleptic bolaeang syndrome,' na a bontša mesifa tsitsipano, tachycardia, feberu, kgatelelo ya madi, ho fufuleloa lemoha ka mor'a ho amohela neuroleptics, dysphagia.

Ntho ea pele eo u lokelang ho se etsa ngaka, kahoo, ho hlakotsoe neuroleptics le lithethefatsi tse ling neurotoxic. Hape hloka tshehetso ditsela tsa ho tlisa fatše mocheso le etsang bakeng sa ho haella ha mokelikeli. Electrolyte lekalekane tlameha ho etsa qeto ea ho tsoa. Hlokahalang ho phetha go baya leitlho hloko mesebetsi matšoafo bohlokoa, ho sebetsa ha e ka robehile hape ha eaba ba etsa e le tse tebileng mesifa se tenyetsehe le ho hloka thuso ho expectorate bronchial secretion.

U lokela ho ka hloko hlahloba mosebetsi renal. Leha ho le joalo, ha ho na bopaki ba hore ho arohana osmotic eketsa hlaphoheloa NMS feela e ka thusa ho tšehetsoa ke mosebetsi renal. Hangata e lokela ho hlahisa phekolo ka bophirima ntlafatsoa kalafo.

meriana

Tsoara neuroleptic bolaeang syndrome, meriana e lakatsehang maemong a rarahaneng. Bakeng sa morero ona, relaxants mesifa ( "Dantrolene") kapa dopamine agonists ( "Amantadine" le "bromocriptine"). Ea batho ba shoang ile fokotswa ka tshebediso ya mefuta bobeli ba lithethefatsi. Tekanyetso fapana ka bolokolohi, empa bakeng sa "Bromocriptine" dithekeniki li hlalositsoe ka mehloli e ka tekanyo e ho tloha 2,5 ho 5 mg, 3 linako tse ling ka letsatsi ka molomo.

Dopamine agonists, haholo-holo ka likarolo tse ling tse khōlō, e ka mo lakalisa psychosis kapa ho hlatsa, 'me le khona ho haholo mpefala boemo ba bophelo bo botle ba ho ba le mamello neuroleptic syndrome, tse kotsi. Ka ho toba ka liketso tsa mesifa e phutholohe sebelisoa ka tekanyetso ea 10 mg, / lik'hilograma. Morero oa ho sebelisa - fokotsa mesifa se tenyetsehe, hammoho le ea metabolism a mesifa ya marapo, e leng keketseho e karolo e 'ngoe le boikarabelo ba ho hyperthermia. "Dantrolene" fapane hepatotoxicity le ka qholotsa lefu la sebete esita le lefu ka lebaka la ho hlōleha ha sebete. 'Me joale ho tla ba le ha ho na le lebaka la ho tsoela pele ho tšoara neuroleptic bolaeang lefu.

NMS hape e felisoa ke motswako wa dopamine le "dantrolene" agonists. lithethefatsi Anticholinergic ba ho pharaletseng sebelisoa bakeng sa ho phekoloa pseudoparkinsonism bakoang ke lithethefatsi antipsychotic, u se ke ua fana ka le liphello tse bohlokoa, ho feta moo, ka ho eketsehileng senya thermoregulation.

Ho na le ke update lam ka tshusumetso ya "carbamazepine" hore bakuli ba bangata ba ile ba bontša ka fokolisang e potlakileng ea bopaki NSA. Leha ho le joalo, ha ho na ya data ka tšeptjoang ka ho atleha ha tšebeliso ea benzodiazepines bakeng sa kalafo ya lefu lena. Leha ho le joalo, ha boemo ba ho ntlafatsa, lithethefatsi tsena li ka 'na ba le thuso ho fokotsa ho hlohlona ka bakuli ba nang le neuroleptic bolaeang lefu.

hyperthermia

Lefu lena le ka fumanoa hoo e ka bang hang ka 100 tysyach thethebatso sebelisa depolarizing relaxants mesifa ( "Miorelaksina", "ditilina" le "listenon"), hammoho le inhalation thethefatsang har'a hydrocarbons halogen ( "methoxyflurane", "Ftorogana" le "Halothane") . Hyperthermia hlaha ka bakuli ba susceptibility phahameng ho lithethefatsi tsena li ka, eo correlated le ho hlōleha ha oa metabolism k'halsiamo ka mesifa boima. Phello ke generalized mesifa twitching, le ka linako tse ling ke lefu mesifa, e leng e thehoa ka lebaka la palo e ngata haholo ea mocheso, mocheso oa 'mele mbalakaka fihla likhatong tse 42. Neuroleptic bolaeang Syndrome bakang lefu ka 20-30% ea linyeoe.

ambulense

Holim 'a ba bonoa a hyperthermia potlako hōla lokela ho ba khaotse ho ho nka lithethefatsi tse boletsoeng ka holimo. Hobane lithethefatsi thethefatsa, u se ke ua qholotsa lefu, ka ho tsejoa barbiturates "pancuronium", "Tubocurarine" le nitrous oxide e. Feela ba lokela ho sebelisoa ha ho hlokahala, e leng katoloso ea tlhokomelo thethebatso.

Hobane kgonego ya sebopeho sa fibrillation ventricular e ngolisitsoeng prophylactic "Phenobarbital" le "Procainamide" dosages phekolo. Ho boetse ho hlokahala hore ho lokisetsa ea ka mokhoa o Cooling, tsamaisa fetang kgolo methapo ea mali setshelo ka metsi a batang kapa leqhoa. Ho hloka hore hang-hang normalize hema moea, a nkente ka sodium hydrogencarbonate / ka (400 di ml 3% tharollo). Maemong a kotsi, ho kgothaletswa ho kenngwa tshebetsong ha resuscitation. Bookelong - ena ke ntho ea pele eo ho etsa ha fumanoa hore o tšoeroe neuroleptic bolaeang lefu.

pono

Joale historing ea NSA ke kamehla ho eketsa monyetla oa boemo joalo tsa phallo mahareng le 'nete hore thata atileng malaise. Ho feta moo, mafu a hlahella ka lefu lena ba hoo e ka bang mohla hlokomolohile sebopeho boko ntle mosaletsa sa, ho bōpa tseo kapa mafu a mang methapo ea kutlo. Ho joalo le ka seo neuroleptic bolaeang lefu? Ke lefu le hore haholo sitisa bophelo ba motho, 'me esita le ho ka etsa hore lefu.