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.

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.

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。

可穿戴设备在热射病中的应用进展

随着全球气候变化和户外活动的增加,热射病的发生率呈上升趋势。传统的热射病防控措施往往依赖于环境监测和个人经验,缺乏个体化的预防策略。近年来,可穿戴技术的发展为热射病的预防和评估提供了新的可能性。本文旨在综述可穿戴设备在监测体温、生理参数、环境因素以及提供预警信息方面的研究进展,并探讨其在预防和评估热射病中的应用前景,为热射病的进一步的研究和临床实践提供参考。

醒脑静注射液治疗急性脑梗死伴意识障碍的疗效观察

目的观察醒脑静注射液对急性脑梗死合并意识障碍患者的临床疗效。方法将136例急性脑梗死伴有意识障碍患者随机分为治疗组(醒脑静注射液组)和对照组(复方丹参注射液组)各68例,在治疗前后对患者分别用Glasgow昏迷评定量表(GCS)和脑卒中患者临床神经功能缺损程度评分与临床疗效评定标准进行判定。结果两组GCS评分在治疗前差异无统计学意义(P>0.05);治疗组在治疗后24 h GCS评分即有所提高,但差异无统计学意义(P>0.05);治疗组在治疗后7 d和14 d GCS评分均较治疗前明显提高(P<0.05),且治疗14 d后治疗组GCS评分高于对照组,差异有统计学意义(P<0.05);同时,治疗14 d后,治疗组基本痊愈率、显著进步率及总有效率均明显优于对照组,恶化及死亡率低于对照组,两组间比较,差异均有统计学意义(P<0.05)。结论醒脑静注射液治疗急性脑梗死合并意识障碍疗效确切,安全可靠。

脑状态指数在脑外伤患者意识监测中的应用研究

目的分析脑状态指数(CSI)在脑外伤患者意识监测中的应用价值,总结护理体会。方法筛选2012年1月～2013年3月我院收治的200例脑外伤患者为研究对象,入ICU 6h内监测CSI,根据CSI指数水平分为4组:CSI 70～80组、CSI 60～70组、CSI 40～60组、CSI 20～40组,每组50例。比较一般情况、手术率、遵医嘱运动百分率、并发症情况,并给予相应护理。结果随着CSI递减,组间手术率依次增加,遵医嘱运动百分率依次降低(P<0.05);皮肤及呼吸、消化、心血管系统并发症发生率也依次升高(P<0.05)。结论CSI可以作为脑外伤患者意识障碍的监测指标,对制定护理措施具有积极的指导作用。

NICU伴意识障碍脑卒中患者肠内营养支持的探讨

目的探讨3种不同肠内营养支持对重症伴意识障碍脑卒中患者的营养状态和临床疗效的影响。方法将46例入住NICU的急性脑卒中患者随机分为EN(肠内高营养)组(14例)、EN(肠内高营养)+PN(肠外营养)组(16例)和普通膳食对照组(16例)给予营养支持。入院第1、14、21天分别检测患者营养指标的变化;治疗前和治疗后21 d检测患者T细胞亚群的变化;住院第1天、21天统计GCS评分、APACHEⅡ评分、NIHSS评分;统计患者住院期间并发症及21天病死率。结果各组在入院第14天、21天较第1天均出现TP、ALB、Hb的下降,普通膳食组下降更明显(P<0.05)。入院第21天EN组、EN+PN组TP、ALB、Hb指标优于普通膳食组,EN+PN组ALB、Hb指标优于EN组(P<0.05)。治疗后EN组、EN+PN组CD3+、CD4+、CD4+/CD8+淋巴细胞增殖较普食组高,EN+PN组CD3+水平高于EN组(P<0.05)。各组21 d GCS、APACHEⅡ、NIHSS评分较第1天明显改善,EN+PN组较普通膳食组NIHSS评分改善更为明显(P<0.05)。EN组、EN+PN组吸入性肺炎发生率较普通组明显减少,但EN组高血糖发生率增加,腹泻人数较多,而普通膳食组呕吐发生率较高(P<0.05)。3组相比病死率无明显差异(P>0.05)。结论重症脑卒中患者随病程延长,营养状况呈恶化趋势。肠内高营养可改善患者营养状况及预后,其中肠内+肠外营养联合疗法较单纯肠内高营养疗效更佳。

体感诱发电位和脑干听觉诱发电位预测恢复期严重意识障碍患儿意识恢复的价值

目的探讨恢复期严重意识障碍患儿体感诱发电位(SEP)、脑干听觉诱发电位(BAEP)动态变化特点,及其对患儿意识恢复的预测价值。方法 2013年7月-2014年6月住院治疗的脑损伤恢复期严重意识障碍患儿52例,入住康复科48h内完成临床评估和SEP、BAEP评估,病程满12个月、脱离最低意识状态、死亡为评估止点。结果 52例患儿在病程1年内有27例恢复意识,意识恢复率为51.2%,各种病因所致的严重意识障碍患儿的意识恢复率差异无统计学意义(P>0.05)。首次SEP检查分级越高,意识恢复率越低(P<0.001);首次SEP检查分级为Ⅰ级的患儿24例,其中20例意识恢复,有4例(3例多次复查SEP均为1级,1例转为3级)在病程1年时其意识仍未恢复。首次SEP检查为Ⅱ级或Ⅲ级的患儿28例,有3例患儿由Ⅱ级转为Ⅰ级,其中2例意识完全恢复,有2例患儿由Ⅲ级转为Ⅰ级,其中有1例意识完全恢复。其余23例持续为Ⅱ级或Ⅲ级,在病程1年时最终只有3例意识完全恢复。52例患儿中有50例BAEP检查正常,Ⅱ级、Ⅲ级各1例。结论 SEP可以作为恢复期严重意识障碍患儿意识是否恢复的有效预测指标。BAEP对于处于恢复期的严重意识障碍患儿的意识是否恢复缺乏预测性。

音乐疗法对ICU颅脑损伤意识障碍（Doc）患者意识的影响

目的探讨音乐疗法对ICU颅脑损伤意识障碍(Doc)患者意识的影响。方法选择2018年1~12月在我院ICU治疗的颅脑损伤意识障碍患者60例为研究对象,随机分为观察组与对照组各30例。对照组实施常规治疗,观察组在此基础上加用音乐疗法。比较两组治疗前后GCS、CRS-R评分以及苏醒率、平均苏醒时间。结果(1)随着治疗时间的延长,两组患者GCS评分均呈上升趋势,治疗2周、3周及4周,观察组GCS评分显著高于对照组,差异有统计学意义(P<0.05)。(2)随着治疗时间的延长,两组患者CRS-R评分均呈上升趋势,治疗2周、3周及4周,观察组CRS-R评分显著高于对照组,差异有统计学意义(P<0.05)。(3)治疗4周后,观察组意识清醒率显著高于对照组,差异有统计学意义(P<0.05);观察组清醒患者平均清醒时间显著短于对照组,差异有统计学意义(P<0.05)。结论音乐疗法对颅脑损伤意识障碍患者的意识有一定的唤醒作用,临床上可根据情况推广应用。

脑弥漫性轴索损伤的治疗效果分析

目的探讨脑弥漫性轴索损伤(DAI)的发病机制、临床特点、诊断、有效治疗措施和预后,提高临床治疗成功率及临床生存质量。方法回顾性分析35例DAI患者的受伤方式、格拉斯哥昏迷(glasgow come scale,GCS)评分、影像学特征、并发症及治疗方法和预后。结果伤后6个月根据格拉斯哥结局量表(glasgow outcomescale,GOS)进行预后评分:死亡7例,植物生存5例,重残8例,中残5例,轻残4例,良好6例。结论入院时GCS评分越低,患者昏迷持续时间越长,预后越差,病死率、致残率和植物生存率越高;早期综合治疗结合高压氧及尽早康复功能介入等可改善预后。

精神症状突出、重要实验室检查阴性的不典型病毒性脑炎15例报道

目的总结15例精神症状突出、临床症状符合病毒性脑炎（viralencephalitis，VE），各项实验室检查结果均为阴性，按VE治疗获临床痊愈患者的临床特点与治疗经验，为今后临床处理类似情况积累经验。方法分析15例精神症状突出、临床症状符合VE，各项实验室检查结果均为阴性，且按VE治疗获临床痊愈患者临床表现、血清及脑脊液、头颅影像学、脑电图等实验室检查特点、治疗及转归。结果15例（男12例、女3例）患者发病年龄14-45（平均25．5）岁，多以精神症状起病（10例），15例均出现意识障碍，均有不同程度的意识清晰度水平下降，6例出现谵妄。15例均行头颅影像及脑电图检查均未见异常，脑脊液病毒学及其他病原体检测未见异常。曾诊为精神分裂症（8例）及抑郁症（2例）。经过抗病毒治疗15例均获得了近期及远期的临床痊愈（最短3周，最长达14周）。结论对于精神症状突出、临床症状符合VE，而重要实验室检查无特异性表现，特别是未找到任何病原学依据的患者，不应完全排除VE的可能，应请精神科会诊，结合精神科、神经科病史及查体情况进行临床诊断。在拟诊为VE后有必要积极给予抗病毒治疗辅助临床诊断并观察疗效。