Survey study of the etiology of non-traumatic altered consciousness in the Emergency Department at Suez Canal University Hospital in Egypt

BACKGROUND Disorders of consciousness including coma in non-trauma patients can be caused by a wide variety of pathologies affecting the central nervous system.They represent a frequent challenge in emergency medicine and are combined with a very high in-hospital mortality.Hence,early treatment of these patients is vital and increases the likelihood of a good outcome.AIM To identify the causes of altered consciousness presentation to the Emergency Department at Suez Canal University Hospital.METHODS This was a descriptive cross-sectional study conducted on 87 patients with acute non-traumatic disturbed level of consciousness(DLOC)at the Emergency Department.RESULTS The mean age of the studied patients was 60.5±13.6 years.Among them,60%were males and 40%were females.The most common cause of acute non-traumatic DLOC was systemic infection,such as sepsis and septic shock(25.3%),followed by respiratory causes(24.1%)and neurological causes(18.4%).CONCLUSION The most common cause of acute non-traumatic DLOC was systemic infections followed by respiratory and neurological causes.

Repetitive transcranial magnetic stimulation improves consciousness disturbance in stroke patients A quantitative electroencephalography spectral power analysis

Repetitive transcranial magnetic stimulation is a noninvasive treatment technique that can directly alter cortical excitability and improve cerebral functional activity in unconscious patients. To investigate the effects and the electrophysiological changes of repetitive transcranial magnetic stimulation cortical treatment, 10 stroke patients with non-severe brainstem lesions and with disturbance of consciousness were treated with repetitive transcranial magnetic stimulation. A quantitative electroencephalography spectral power analysis was also performed. The absolute power in the alpha band was increased immediately after the first repetitive transcranial magnetic stimulation treatment, and the energy was reduced in the delta band. The alpha band relative power values slightly decreased at 1 day post-treatment, then increased and reached a stable level at 2 weeks post-treatment. Glasgow Coma Score and JFK Coma Recovery Scale-Revised score were improved. Relative power value in the alpha band was positively related to Glasgow Coma Score and JFK Coma Recovery Scale-Revised score. These data suggest that repetitive transcranial magnetic stimulation is a noninvasive, safe, and effective treatment technology for improving brain functional activity and promoting awakening in unconscious stroke patients.

Patients with disturbances in consciousness as observed by clinical nurses: Analysis of nursing records

The objective of the present study was to discuss patients with disturbances in consciousness by analyzing nursing records. Observations from clinical nurses as well as patients’ responses about their care were selected from nursing records. Nursing records from one week of patient care were examined for patients who were unable to speak during hospitalization within a neuro-surgery ward of the hospital. Selected records were classified into the following eight categories: results from monitoring;results from observation;opening and moving the eyes to stimulus;movement of the limbs to stimulus;vocalization to stimulus;facial expression to stimulus;patient’s response to care;and miscellaneous. Patients comprised two groups. One group encompassed eight patients with Japan Coma Scale (JCS) II and the other was a group of eight patients with JCS III. When nurses use the JCS to assess patients with disturbances in consciousness, patients who awaken to stimulus are classified as JCS II, while those who do not are JCS III. The total nursing records selected for JCS II were 1551 and 1160 for JCS III. The category of “results from monitoring” was the most selected category within nursing records and accounted for 42.8% of the JCS III group, while “results from observation” accounted for 38.4% of the JCS II group. Furthermore, results indicated that the categories of “results from monitoring”, “results from observation”, and “movement of the limbs for stimulus” had peaked after two to three days, and then abruptly decreased. There were only a few records for the categories of “vocalization to stimulus” and “facial expression to stimulus”, both for the JCS II and the JCS III groups. Even though patients could not verbally indicate their intentions due to problems with consciousness, it is essential for nurses to pay careful attention to the details of patients’ reactions.

The Characteristic of Nurses’ Eye Movements during Observation of Patients with Disturbed Consciousness

Objective: The objective of this study was to clarify the characteristics of nurses’ eye movements during observation of patients with disturbed consciousness by comparing intuition ability, critical thinking, and clinical experience years. Methods: Participants were 19 nurses working on a neurosurgery ward in Japan and caring for patients with consciousness disturbance who were unable to speak. Ten novice nurses (24.8 ± 3.36 years old) and nine expert nurses (38.3 ± 5.77 years old) were compared. The observation scene, displayed on a computer screen, was a static image of a simulated patient in a resting state who had developed right putaminal hemorrhage. We showed the participants an information sheet about the simulated patient then used an eye tracking camera to analyze gaze points, gaze time, and gaze count during observation. The Kuroda Intrinsic Intuitive Ability Scale (KIIS) created by Kawahara and the Critical Thinking Disposition Scale created by Hirayama were used for measuring intrinsic intuition ability and critical thinking disposition. Results: There were no significant differences between observation time of novices (5.0 ± 2.01 minutes) and experts (5.4 ± 1.78 minutes), nor between their total gaze time and total count. The proportion of gazing at the monitor by novice nurses and gazing at the face and bed fences by expert nurses tended to be high. The KIIS general education score influenced the gaze time and gaze count during simulated patient observation. The KIIS logical thinking score affected the gaze count to the simulated patient’s face. Conclusion: There was no significant difference between the total gaze time and the total count of novices and experts. The KIIS score affected the gaze during observation of the simulated patient.

A Nursing Case Report: The Laryngectomy Patient Secondary to <i>Pseudomonas aeruginosa</i>Pneumonia with Conscious Disturbance

The paper presents a description of the experience of the nursing for the Pseudomonas aeruginosa pneumonia patient with partial laryngectomy. The nursing of Pseudomonas aeruginosa pneumonia, conscious disturbance, electrolyte disorder, affection supports and mental nursing was provided in the process of the postoperative treatment. Our experience may provide useful insight for the nursing of laryngectomy patients secondary to pneumonia with conscious disturbance. A deeper knowledge about improving the quality of clinic special nursing for the partial or total laryngectomy patient is necessary, with the development of modern medical technologies and medicine.

Sitting position improves consciousness level in patients with cerebral disorders

Cerebral disorders are often associated with disturbance of consciousness. Since the latter could alter the prognosis of physical function, early improvement of consciousness level is important. The present study tested the hypothesis that sitting position improves disturbances of consciousness in patients with cerebral disorders. The subjects were 17 patients with cerebral disorders and disturbances of consciousness. The consciousness level was evaluated in supine position and following a change to sitting position. The consciousness level was evaluated by the Glasgow Coma Scale (GCS). The total, eye opening, and motor GCS scores were significantly higher in the sitting position compared with the supine position. In conclusions, changing from supine to sitting position improves consciousness level in patients with cerebral disorders.

脑卒中相关性肺炎患者肺部多药耐药菌感染的影响因素

目的:分析脑卒中相关性肺炎患者肺部多药耐药菌感染的影响因素。方法:采用便利抽样的方法,回顾性分析2017年1月—2022年12月潍坊市人民医院接受治疗的168例脑卒中相关性肺炎患者的临床资料,包括性别、年龄、脑卒中类型、意识障碍情况、吞咽功能情况、合并糖尿病、合并高血压、肺部感染分型、预防性使用抗生素情况、胃管留置情况等,分析脑卒中相关性肺炎患者肺部多药耐药菌感染的独立影响因素。结果:168例脑卒中相关性肺炎患者中,有113例(67.26%)为脑卒中后肺部多药耐药菌感染。单因素分析结果显示,多药耐药菌感染组意识障碍、晚发型肺炎、预防性使用抗生素占比高于非多药耐药菌感染组,差异有统计学意义(P<0.001)。Logistic多因素分析结果显示,意识障碍、晚发型肺炎、预防性使用抗生素是脑卒中后肺部多药耐药菌感染的独立影响因素(P<0.05)。结论:意识障碍、晚发型肺炎、预防性使用抗生素是脑卒中后肺部多药耐药菌感染的独立影响因素。

新型冠状病毒感染相关急性坏死性脑病1例

报告1例成人新型冠状病毒感染相关的急性坏死性脑病(COVID-19-associated acute necrotizing encephalopathy,ANEC)病例。患者在新型冠状病毒感染后12 d出现意识障碍、癫痫发作,脑MRI上显示双侧丘脑、脑干、小脑半球为主的信号改变,与急性坏死性脑病(acute necrotizing encephalitis,ANE)特征性影像表现一致。早期给予甲泼尼龙冲击联合大剂量人免疫球蛋白治疗,但患者一直处于持续昏迷状态并最终死亡。ANEC往往起病急,进展快,以意识障碍、癫痫等为主要表现,影像学丘脑及幕下对称性、多灶性病灶对诊断具有特异性,但治疗及预后仍面临挑战,需要深入研究。

金刚烷胺中毒致意识障碍1例报告

金刚烷胺中毒后可有精神异常表现,严重时可出现意识障碍,多见于老年人及肾功能异常者。本文介绍滨州市人民医院收治的1例金刚烷胺中毒致意识障碍患者的诊治过程,给予患者补液促进毒物排泄、纠正电解质紊乱、保护脏器功能等对症支持治疗后,其意识逐渐恢复。

基于神经电刺激手段对慢性意识障碍患者的治疗进展

慢性意识障碍患者康复是近年来康复医学领域关注的重中之重。我们期望通过加速康复进程、恢复患者功能,进一步降低致残率和死亡率。目前由于缺乏有效的措施,因此促醒方案的研究与开发至关重要。在电刺激疗法领域,本文对6种电刺激疗法进行总结与介绍,其中包括电刺激的作用方法和作用机理,同时提出对该领域的总结与展望,以方便相关方向研究的读者进行查阅。

肾上腺皮质功能不全合并COVID-19患者的临床转归及影响因素

目的总结肾上腺皮质功能不全(AI)合并新型冠状病毒感染(COVID-19)患者的临床特征及转归情况,分析影响转归的危险因素。方法回顾性分析2022年12月北京协和医院收治的发生COVID-19的AI患者的临床特征,并对其进行随访以收集其疾病转归情况。结果共纳入28例AI合并COVID-19患者,20例(71.4%)接受糖皮质激素基础替代。18例院外发生COVID-19患者中,11例(61.1%)居家主动加量糖皮质激素。感染后最常见症状为发热(96.4%)、消化道症状(82.1%)、意识障碍(78.6%)。出现重度意识障碍与年龄大、糖皮质激素基础替代剂量低相关(P<0.05)。20例(71.4%)患者发生肾上腺危象(AC),与糖皮质激素基础替代剂量低、低氯血症、嗜酸性粒细胞低、血小板低、活化部分凝血活酶时间(APTT)长相关(P<0.05)。2例患者死亡。26例存活患者中,意识恢复时间大于48小时者占26.3%(5/19),意识延迟恢复与入院收缩压低、血肌酐高、纤维蛋白原高相关(P<0.05)。48.0%(12/25)患者出现疲乏、纳差等长新冠症状。糖皮质激素加量的患者中,50.0%(12/24)于3周内恢复至基线激素剂量。结论AI合并COVID-19患者出现意识障碍及AC的风险较高。AI患者在感染应激期间主动加量糖皮质激素的意识不足,临床应加强对AI患者的“病期规则”教育。

基于关联规则的缺血性脑卒中患者脱水发生特征分析

目的了解缺血性脑卒中患者脱水发生特征,探索各特征之间的关联性,为制定脱水预防措施提供参考。方法基于数据挖掘的原理和方法,采集神经重症监护病房351例缺血性脑卒中并发脱水患者的11559项数据,采用Apriori算法对脱水发生特征进行关联规则分析。结果共得到279条强关联规则,结合专业知识分析,获取具有临床实际意义的强关联规则9条,脑卒中脱水患者具有自理能力重度依赖、留置胃管、意识障碍的特征表现,关联因素包括美国国立卫生研究院卒中量表分级为重度、年龄≥65岁、有糖尿病及高血压史、发热、使用呼吸机、利尿剂等。结论缺血性脑卒中患者脱水的发生有一定的特征表现,护理人员可根据强关联规则早期识别易导致脱水的高危人群及因素,及时采取防范措施。

醒脑开窍针刺法结合高压氧治疗颅脑损伤意识障碍患者的临床观察

目的观察醒脑开窍针刺法结合高压氧治疗对颅脑损伤意识障碍患者的促醒作用。方法选取颅脑损伤意识障碍患者120例,按照随机数字表法将患者分为对照组、针刺组、高压氧组及观察组各30例。对照组给予常规治疗及常规护理,针刺组在对照组的基础上给予醒脑开窍针刺,高压氧组在对照组的基础上给予高压氧治疗,观察组在对照组的基础上给予醒脑开窍针刺联合高压氧治疗。10 d为1个疗程。观察各组患者治疗前及治疗1、2、3个疗程后格拉斯哥昏迷量表(GCS)评分及疗效情况。结果治疗3个疗程后,各组患者的GCS评分均较治疗前提高(P<0.05),且观察组的改善程度最优(P<0.05);观察组总有效率高于对照组、针刺组及高压氧组(P<0.05)。结论醒脑开窍针刺法及高压氧联合运用可有效改善颅脑损伤意识障碍患者的临床症状,促进患者意识复苏,改善预后,且优于单纯采用一种治疗方法。

神经外科行PICC置管患者发生导管异位的影响因素分析

目的探讨神经外科行中心静脉导管(PICC)置管患者发生导管异位的影响因素,并讨论相关干预措施。方法选择2020年1月—2022年1月在医院神经外科收治的PICC置管患者186例患者为调查对象,收集患者的临床资料,在单因素分析的基础上,采用Logistic回归模型进行多因素分析,筛选外科行PICC置管患者发生导管异位的影响因素。结果神经外科行PICC置管患者导管异位发生率为9.68%(18/186)。经单因素筛选,将有统计学意义的因素进行多因素Logistic回归分析,结果显示:年龄≥60岁、深静脉置管史、焦虑情绪、穿刺血管类型肘正中静脉和头静脉、气管切开、机械通气、送管次数>3次、意识障碍是神经外科行PICC置管患者发生导管异位的高危因素(P<0.05)。结论神经外科行PICC置管患者发生导管异位与年龄、深静脉置管史、焦虑情绪、穿刺血管类型、气管切开、机械通气、送管次数、意识障碍有关。

醒脑静联合纳洛酮治疗急性脑出血伴意识障碍患者的效果

目的探讨醒脑静联合纳洛酮治疗急性脑出血(ACH)伴意识障碍患者的效果。方法选择2020年2月至2022年2月鄂州市鄂钢医院收治的94例ACH伴意识障碍患者作为研究对象,根据随机数字表法分为两组,每组各47例。两组患者入院后均予以常规措施治疗,对照组在此基础上予以盐酸纳洛酮溶液治疗,观察组在对照组基础上加用醒脑静注射液治疗,两组治疗时间均为10 d。比较两组治疗总有效率,采用美国国立卫生研究院卒中量表(NIHSS)评估两组患者治疗前后神经功能缺损程度,采用格拉斯哥昏迷评分(GCS)评估两组患者治疗前后昏迷程度,检测两组患者治疗前后血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及丙二醛(MDA)、超氧歧化酶(SOD)表达水平。结果观察组患者治疗总有效率高于对照组,差异有统计学意义(P<0.05);治疗前,两组患者的NIHSS、GCS指标比较,差异无统计学意义(P>0.05);治疗后,两组患者的GCS指标高于治疗前,NIHSS指标低于治疗前,且观察组的GCS指标高于对照组,NIHSS指标低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的hs-CRP、TNF-α、IL-6、MDA、SOD指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者的SOD指标高于治疗前,hs-CRP、TNF-α、IL-6、MDA指标低于治疗前,且观察组患者的SOD指标高于对照组,hs-CRP、TNF-α、IL-6、MDA指标低于对照组,差异有统计学意义(P<0.05)。结论醒脑静联合纳洛酮可明显改善ACH伴意识障碍患者神经功能,减轻炎症及氧化应激反应。

颅内静脉窦血栓形成伴脑出血及阵发性睡眠性血红蛋白尿1例

目的 分析颅内静脉窦血栓形成(CVST)伴脑出血、阵发性睡眠性血红蛋白尿(PNH)患者的临床特点、影像学表现及治疗手段。方法 总结1例CVST伴脑出血、PNH患者的临床资料,分析发病诱因、临床表现、影像学特点和治疗方法。结果 CVST的病因包括口服避孕药、妊娠、激素替代治疗、肿瘤、感染和系统性红斑狼疮等疾病。CVST临床表现包括头痛、局灶性神经症状、癫痫以及昏迷等,诊断主要依据影像学检查,抗凝是CVST治疗的主要方式,危重患者多联合局部溶栓、机械取栓、机械碎栓和抗凝治疗多种治疗方案。结论 CVST伴脑出血、PNH是一种罕见的脑血管疾病。对于长期口服雄激素和糖皮质激素的患者,当出现意识障碍、头痛和癫痫表现时,用常规的脑血管病不能解释,要考虑CVST的可能,及时给予磁共振静脉造影(MRV)等检查,对明确诊断的CVST患者根据病情给予抗凝或机械取栓等治疗。

Braden评分下的针对性护理对重症脑出血术后意识障碍患者压力性损伤风险的影响

目的 探讨Braden评分下的针对性护理对重症脑出血术后意识障碍患者压力性损伤风险的影响,以期为临床治疗提供参考。方法 选取三六三医院2019年4月—2021年4月收治的88例重症脑出血术后意识障碍患者为研究对象。采用随机数字表法将患者分为对照组与观察组,每组44例。对照组患者进行常规护理干预,观察组患者在常规护理基础上采用Braden评分下的针对性护理干预。比较2组患者压力性损伤发生情况;比较2组患者护理前后格拉斯哥昏迷量表(GCS)及美国国立卫生研究院卒中量表(NIHSS)评分;比较2组患者护理满意度。结果 观察组患者压力性损伤发生率低于对照组,差异有统计学意义(P<0.05)。护理前,2组患者NIHSS、GCS评分比较,差异无统计学意义(P>0.05)。护理后,2组患者NIHSS评分低于护理前,且观察组低于对照组,差异均有统计学意义(P<0.05)。护理后,2组患者GCS评分高于护理前,且观察组高于对照组,差异均有统计学意义(P<0.05)。观察组患者护理满意度问卷中理论技能及工作专业性、工作态度及沟通方式、环境及时间分配合理性、问题解决及宣教质量评分及总分均高于对照组,差异均有统计学意义(P<0.05)。结论 Braden评分下的针对性护理能有效减少患者压力性损伤的发生,促进患者意识、神经功能的恢复,改善患者临床症状,提高护理满意度,值得临床推广应用。

高压氧医学科亚专科分化实践与思考

国家卫健委颁布的《三级综合医院医疗服务能力指南(2022版)(征求意见稿)》中要求增设高压氧医学科,本文回顾高压氧医学历史沿革,分析高压氧医学科发展现状。高压氧医学可供治疗的病种繁多,医疗行业高压氧有着稳定、迫切的需求,同时具有可归属的若干亚专科,昏迷促醒、神经重症、高压氧治疗内外科疾病等高压氧亚专科设置也得到学界的认同,重视高压氧疾病谱对相关亚专科工作的开展至关重要。本文就高压氧亚专科的分化结合本院高压氧医学科实践模式存在问题进行梳理归纳作一述评,阐述亚专科分化的必要性,以期为今后的亚专科方向调整提供一定的启示和思路。

ICU患者镇痛镇静的研究进展

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