ObjectiveTo study the feasibility of using propofol and remifentanil for reduction of shoulder joint dislocation in the conscious elderly patients, and compare its efficacy with brachial plexus block anesthesia. MethodsSeventy elderly patients (American Sociaty of Anesthesiologist physical statusⅠ-Ⅱ) who underwent shoulder dislocation reduction in our hospital between August 2011 and December 2013 were randomly divided into two groups, each group having 35 cases. Patients in group A received brachial plexus nerve block anesthesia downlink gimmick reset, while patients in group B received the use of remifentanil-propofol and lidocaine compound liquid intravenous drop infusion for anesthesia downlink manipulative reduction. After successful anesthesia, two groups of patients were treated with traction and foot pedal method (Hippocrates) to reset. We observed the two groups of patients in the process of reduction, and recorded their hemodynamic changes, reset time, discharge time, postoperative satisfaction, intra-operative memory, breathing forgotten (breathing interval was longer than 15 seconds) and visual analogue scale (VAS) scores, and then comparison was made between the two groups. ResultsPatients in both the two groups successfully completed manipulative reduction. Compared with group A, patients in group B had more stable hemodynamic indexes during the process of reduction, shorter reduction time, better anesthesia effect and higher postoperative satisfaction degree, and the differences were statistically significant (P<0.05). There was no significant difference in terms of time of leaving the operation room between the two groups (P>0.05). VAS score was higher in group A than that in group B (P<0.05). The occurrence of intra-operative memory amnesia and breathing forgotten phenomenon existed in part of the patients after operation in group B, but they did not occur in patients in group A. ConclusionRemifentanyl propofol-lidocaine compound fluid can be safely used in conscious elderly patients for shoulder joint dislocation reconstructive surgery, and it functions quickly with complete analgesia and stable hemodynamic indexes.
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.