目的：探讨醒脑静注射液联合纳络酮注射液在急性安定中毒治疗中的疗效。方法：本研究采用醒脑静注射液联合纳络酮注射液治疗急性安定中毒55例并与单纯纳络酮治疗的51例进行对照。106例患者均经静脉血毒物测定为安定中毒；来诊时均有意识障碍，平均年龄（30.35±7.95）合并酒精中毒及其他疾病20例，常规给予洗胃、补液、利尿促排泄、纠正电解质失衡、吸氧及抗感染等对症处理。结果：醒脑静注射液治疗组与对照组患者比较，神志恢复时间(h),治疗组(1.73±0.98)显著短于对照组(3.22±1.38)(P＜0.01)；同组患者就诊时与清醒后的神志、呼吸、血压、心率及瞳孔等临床指标比较差异有显著性(P＜0.05)。结论:醒脑静注射液与纳络酮联合应用，治疗急性安定中毒与对照组比较起效快、疗效确定，临床应用安全可靠。
ObjectiveTo investigate the risk factors affecting the 28-day neurological outcome after admission of patients with sepsis complicated with consciousness disorder, create a simple scoring system, and evaluate its predictive value for the poor neurological outcome.MethodsWe retrospectively collected and analyzed the demographic data, clinical data, 28-day survival status and neurologic outcome of patients with sepsis complicated with disturbance of consciousness admitted to the Emergency Department of West China Hospital of Sichuan University between June 1st, 2017 and May 31st, 2018. Independent risk factors for the 28-day neurologic outcome of patients with disturbance of consciousness were obtained through univariate analyses and multiple logistic regression analysis, and then the continuous variables of risk factors were converted to binary variables according to the cut-off values from receiver operating characteristic (ROC) curve analysis, a simple scoring system was established and it’s predictive value for 28-day neurological outcome of patients with sepsis complicated with consciousness disorder was assessed.ResultsA total of 149 patients with sepsis complicated with consciousness disorder were included in this study, including 103 males (69.1%) and 46 females (30.9%), with an average age of (58.2±18.6) years old. There were 72 patients (48.3%) with poor outcome of neurological function on Day 28 after admission. Multiple logistic regression analysis revealed that total bile acid [odds ratio (OR)=1.040, 95% confidence interval (CI) (1.004, 1.077), P=0.027], blood ammonia [OR=1.014, 95%CI (1.001, 1.027), P=0.030], pulmonary infection [OR=3.255, 95%CI (1.401, 7.566), P=0.006], and Glasgow Coma Score (GCS) [OR=0.837, 95%CI (0.739, 0.949), P=0.005] were independent influencing factors for the poor neurological function in patients with sepsis complicated with consciousness disorder on Day 28 after admission. The area under the ROC curve predicting the 28-day poor neurological function was 0.754 [95%CI (0.676, 0.832)], and the sensitivity and specificity were 79.2% and 63.6%, respectively.ConclusionFor emergency patients with sepsis complicated with consciousness disorder, a simple scoring system based on early GCS, pulmonary infection, serum ammonia, and total bile acid has a favorable predictive value for short-term neurological function.
In recent years, with the great breakthroughs in the treatment of brain injury, neurological dysfunction and other serious diseases, more and more patients have been referred to disorders of consciousness (DOC). In clinical work, accurate assessment of DOC is critical to its treatment, and how to assess the level of consciousness and prognosis of patients after treatment has become a hot research topic in recent years. The model of consciousness loss and recovery is an ideal tool to understand the neural mechanism of consciousness, but clinical trials are easily restricted by many factors such as ethics, so animal models are often used as preclinical basic experiments, while non-human primates (NHP) are closely related to humans and are ideal models for studying human diseases. Currently, there are many tests to assess the level of consciousness of NHP, and there are different methods, all of which have certain advantages and limitations. This article reviews the current literature on the current status of the NHP consciousness scale assessment tool, and find that the assessment of NHP consciousness is mainly divided into stimulus response-based assessment after anesthesia experiments, behavioral task completion-based assessment after stimulus-reward experiments, and comprehensive multi-indicator assessment of NHP consciousness level. Therefore, this article provides an overview of the current status of each NHP consciousness scale assessment tool and its advantages and disadvantages in order to provide new thoughts on assessing consciousness from the perspective of animal models in the hope of finding a more appropriate assessment tool.
Prolonged disorders of consciousness (pDOC) are pathological conditions of alterations in consciousness caused by various severe brain injuries, profoundly affecting patients’ life ability and leading to a huge burden for both the family and society. Exploring the mechanisms underlying pDOC and accurately assessing the level of consciousness in the patients with pDOC provide the basis of developing therapeutic strategies. Research of non-invasive functional neuroimaging technologies, such as functional magnetic resonance (fMRI) and scalp electroencephalography (EEG), have demonstrated that the generation, maintenance and disorders of consciousness involve functions of multiple cortical and subcortical brain regions, and their networks. Invasive intracranial neuroelectrophysiological technique can directly record the electrical activity of subcortical or cortical neurons with high signal-to-noise ratio and spatial resolution, which has unique advantages and important significance for further revealing the brain function and disease mechanism of pDOC. Here we reviewed the current progress of pDOC research based on two intracranial electrophysiological signals, spikes reflecting single-unit activity and field potential reflecting multi-unit activities, and then discussed the current challenges and gave an outlook on future development, hoping to promote the study of pathophysiological mechanisms related to pDOC and provide guides for the future clinical diagnosis and therapy of pDOC.