糖皮质激素利与弊教材课程.ppt

* 硬膜外腔镜看见疤痕 * 无菌性炎症，如缺血性组织损伤等。在各种急性炎症的早期，应用糖皮质激素可减轻炎症早期的渗出、水肿、毛细血管扩张、白细胞浸润和吞噬等反应，从而改善炎症早期出现的红、肿、热、痛等临床症状；在炎症后期，应用糖皮质激素可抑制毛细血管和成纤维细胞的增生，抑制胶原蛋白、粘多糖的合成及肉芽组织增生，从而防止炎症后期的粘连和瘢痕形成，减轻炎症的后遗症。但必须注意，炎症反应是机体的一种防御功能，炎症后期的反应也是组织修复的重要过程，故糖皮质激素在抑制炎症、减轻症状的同时，也降低了机体的防御和修复功能，可导致感染扩散和延缓创口愈合 * Entry through upper respiratory tract 10–21?day incubation Travels to regional lymph nodes, liver and spleen (primary viraemia) Travels to skin/mucous membranes: vesicular rash (secondary viraemia) Replication in epidermal cells, entry into nerve endings and transport to dorsal root ganglia (DRG) where it establishes latency in sensory neurones Reactivation in DRG → infection of nerves and dermatome → herpes zoster10,11 * 4?Guide to assessing severity of acute zoster pain and neurological dysfunction Symptom/sign in affected or surrounding dermatomesBedside test*PainUse numeric rating scale (0–10) or visual analogue scale to score background and exacerbations of pain.Primary sensory loss or attenuation (cool, warm, light touch, pinprick, vibration)Map and record sensory deficit.Evoked pain and dysaesthesia?Allodynia (pain due to a stimulus that does not normally provoke pain, eg, light touch21)Use cotton wool to brush the skin and map out any abnormal sensation.Hyperalgesia (an increased response to a stimulus which is normally painful21)Apply firm (static) pressure with thumb and/or apply punctate pressure with toothpick and/or apply heated/cooled metal object.Hyperpathia (an abnormally painful reaction to a stimulus which is normally painful; often a repetitive stimulus21)Apply toothpick repetitively for 30?seconds and monitor for increased spread and severity of pain.* Also assess level of disability (impact on sleep, mood and activities of daily living) caused by pain and/or neurological dysfunction. ? Dysaesthesia is an unpleasant abnormal sensation that can be spontaneous or evoked. Special cases of dysaesthesia include hyperalgesia and allodynia.21 * Pain persisting beyond the crusting of