Objective:To discuss the quantitative evaluation of the consciousness state in patients with primary brainstem stroke（PBS）and the correlation between the hyperbaric oxygen（HBO）therapy and the outcomes of PBS patients.Methods:A total of 54 PBS patients admitted to Nanjing Zijin Hospital for comprehensive HBO treatment from January 2020 to June 2021 were selected，according to the exclusion criteria that the patient should not have central nerve injuries outside the brainstem，metabolism disorders，or on medication that may affect their consciousness states. According to stroke volume，the 54 subjects were divided into three groups：<6 ml，6-10 ml，and >10 ml. According to stroke location，they were divided into four groups：midbrain，pons，midbrain-to-pons，and medulla oblongata. The Chinese Nanjing Persistent Vegetative State Scale（CNPVSS）score of each patient was measured. The consciousness states of the patients before discharge and at admission were compared between groups of different stroke volumes and stroke locations，and the influencing factors of outcome and their correlations with outcomes were explored.Results:The CNPVSS scores of all patients was 7（1，17）at admission and 13（3，19）before discharge，and the difference was statistically significant（ P<0.01）. Consciousness states differed significantly among groups with different brainstem stroke volumes，both at admission and before discharge（ P<0.01），but there was no significant difference in consciousness states among groups with different stroke locations（ P>0.05）. The CNPVSS score was positively correlated with the times of HBO therapy（ P=0.040），and negatively correlated with the stroke volume（ P<0.05）. Conclusion:The CNPVSS can be used to quantitatively evaluate the consciousness state of the patients with brainstem stroke. The effect of brainstem stroke volume on the consciousness states was greater than that of stroke location. HBO therapy may be a positive factor in improving the consciousness states in patients with brainstem stroke.

我国老一辈脑复苏领域专家编制的中国南京持续性植物状态量表（CNPVSS）在临床应用已有20余年。20多年来随着人们对意识障碍的深入研究，其概念也在不断发生变化，对该量表的解读也在临床研究中不断完善。同时工作中也存在着初学者不能正确理解和运用量表，量表的命名和某些子项目的描述需进一步修订等问题。笔者根据多年来大量意识障碍患者临床病例的量表应用经验，结合国内外有关意识障碍的研究成果，提出了量表的操作方法和结果解读方案，也提出了修订建议，供同行及相关专家评议。

Objective:To explore the therapeutic outcome of consciousness disorders induced by different brain injury mechanisms.Methods:A total of 130 patients with impaired consciousness after brain injuries treated in Nanjing Zijin Hospital from January 2016 to May 2021 were taken as research subjects. According to the causes of injury，they were divided into cerebrovascular accident group（ n = 37），brain trauma group（ n=68），hypoxic-ischemic encephalopathy group（ n = 7），and cerebral aneurysm group（ n = 18）. The patients in the four groups were all given comprehensive treatment，including hyperbaric oxygen（HBO）therapy，electrical stimulation，acupuncture，passive training，and drug therapy. The Glasgow Coma Scale（GCS）scores and China Nanjing persistent vegetative state scale（CNPVSS）scores of the four groups before treatment and after three months of comprehensive treatment combined with HBO were compared，and the consciousness recovery rate and the overall curative effect of the four groups were also compared. Results:After three months of comprehensive treatment combined with HBO，the GCS scores and CNPVSS scores of the four groups were improved compared with those before treatment（all P < 0.05）；the most significant increase of GCS scores and CNPVSS scores was in the cerebral aneurysm group. The highest consciousness recovery rate was in the cerebrovascular accident group（64.86%，24/37），followed by cerebral aneurysm group（55.56%，10/18），and there were statistically significant differences in the consciousness recovery rate among the four groups（ P < 0.01）. The overall effective rate was in the descending order of cerebrovascular accident group［86.49%（32/37）］，cerebral aneurysm group［83.33%（15/18）］，brain trauma group［69.12%（47/68）］，and hypoxic-ischemic encephalopathy group［42.86%（3/7）］，with statistically significant differences（ P < 0.05）. The cerebrovascular accident group and the cerebral aneurysm group achieve higher consciousness recovery rates and greater improvement in consciousness disturbance compared with the other two groups after three months of comprehensive treatment combined with HBO. Conclusion:Different injury mechanisms affect the therapeutic outcomes of consciousness disorders induced by brain injuries.

Objective:To study the reliability and validity of the Chinese Nanjing persistent vegetative state scale（CNPVSS）in assessing the state of consciousness of brain-damaged patients in different gender and age subgroups，so as to provide a point of scientific reference for the clinical application of the scale.Methods:The reliability of the CNPVSS was calculated by statistically analyzing the CNPVSS scores of 1 100 patients in different states of consciousness after brain injury. The validity of the scale was analyzed by applying it to four states of consciousness：coma，vegetative state / unresponsive awakening syndrome（VS/UWS），minimally conscious state（MCS），and conscious wakefulness. The male and female patients were further divided into four age subgroups，respectively：1–20 years old，21–40 years old，41–60 years old，and 61–80 years old. The reliability and validity of CNPVSS scale in the eight groups were then evaluated.Results:The reliability of CNPVSS was good，and the Cronbach’s alpha coefficient was 0.969；the internal consistency was good（ P<0.001），and the correlation between the score of each item and the total score was statistically significant（ P<0.001）；the total scores of different states of consciousness：coma［1（1，2）］，VS / UWS［2（2，3）］，MCS［7（6，9）］，and conscious wakefulness［19（16，20）］，with statistically significant difference（ P<0.001）. The reliability and validity of the scale in different gender and age subgroups come out well，and the results were basically consistent with the overall analysis. Conclusion:CNPVSS is a good instrument for assessing the state of consciousness，which can be used for quantitative analysis of consciousness states of brain-damaged patients under 80 of different gender.

Objective:To investigate hospital acquired infection (HAI) in hospitalized patients who were mainly treated with hyperbaric oxygen (HBO) during the period when the whole society and the hospital were in level one public health emergency response to COVID-19.Methods:The HAI incidence and infectious pathogen test results of 138 patients (the observation group) who were given HBO therapy in Nanjing Zijin Hospital in February 2020, the period of level one public health emergency response to COVID-19, were collected, and they were analyzed in year-on-year comparison with the corresponding data of the 133 patients (the control group I) admitted to the hospital in February 2019, and in month-on-month comparison with the corresponding data of the 213 patients (the control group II) admitted to the hospital in December 2019.Results:The HAI incidence of the observation group (10.87%) was about 5% lower than that (15.04%) in the control group I and that (15.02%) in the control group II, but there was no statistical difference ( χ2=1.43, P=0.49). The pathogens detected in the observation group were pseudomonas aeruginosa, acinetobacter baumannii, and serratia marcescens, which were less than those detected in the control group II. Conclusion:Strict social isolation and ward infection control measures can effectively reduce HAI incidence in patients given HBO therapy, but the reliability of such measures needs further demonstration by multi-center and large-sample data.

Objective:To explore the predictive value of China Nanjing persistent vegetative state scale (CNPVSS) on the curative effect of the patients with chronic disorder of consciousness, by analyzing the curative effect of the rehabilitation treatment combined with hyperbaric oxygen (HBO) for patients with chronic disorder of consciousness.Methods:A total of 48 patients with chronic disorder of consciousness admitted to Nanjing Zijin Hospital to receive rehabilitation treatment combined with HBO from the September of 2016 to the May of 2019 were selected according with the analytical criteria. Before the treatment, the patients were evaluated by CNPVSS and received electroencephalogram (EEG) and evoked potentials (EPs) examinations. The patients′ consciousness was evaluated again before discharge, the results of CNPVSS and electrophysiological examinations were recorded, and the correlation between the results and the changes of the consciousness was analyzed statistically.Results:The results of CNPVSS was positive correlated with near-term curative effect ( r=0.401, P=0.005); the rate of awakening after treatment was 46.2% among those who were scored as minimally conscious state (MCS) by CNPVSS; the rate of awakening after treatment was 17.1% among those who were at vegetative state (VS) or in a coma; the rate of awakening after treatment of the MCS patients was higher than those of the patients at VS or in a coma ( χ2=4.255, P=0.039). The recordings of right somatosensory evoked potentials (SSEPs) N20 was positive correlated with curative effect ( r=0.312, P=0.031); and the left visual evoked potentials (VEPs) V100 was positive correlated with curative effect ( r=0.285, P=0.049). There were no statistical significance found between other electrophysiological recordings with curative effect. Conclusion:CNPVSS can be an important tool to predict the outcome of the rehabilitation treatment combined with HBO for the patients with chronic disorder of consciousness, and the recordings of SSEPs and VEPs also are of a certain reference value in predicting the prognosis.

目的:探讨脑损伤后意识障碍高压氧介入时机.方法:随机选取我院收治的脑损伤后意识障碍患者178例,患者入院后排除高压氧禁忌症后尽早行高压氧舱治疗,辅以我院常规促醒治疗,分别统计患者自脑损伤后一月内、两月内、三月内、三月后行高压氧舱治疗,统计患者意识状态及CNPVSS评分的变化.结果:针对入组178例患者,其中患者意识转清及CNPVSS评分提升,治疗率达90.45%,一月内、两月内、三月内、三月后高压氧治疗患者意识转清及CNPVSS评分提升,分别达78.9%、49.7%、36.4%、50%.结论:脑损伤后意识障碍患者宜尽早行高压氧治疗,有效提升意识状态及肢体功能恢复,大大缩短住院周期及治疗经费.

Objective: To investigate significance of the spiral nasointestinal tube nutrition therapy in severe encephalopathy patients combined with aspiration pneumonia. Methods: The clinical data of 40 patients undergoing severe encephalopathy with aspiration pneumonia were retrospectively analyzed.20 cases treated with spiral nasal bowel tube enteral nutrition were as the experimental group and 20 patients in control group were treated with stomach tube enteral nutrition. Results: After the use of enteral nutrition,the nutrition index gradually returned to normal. Of the two groups,vomiting,abdominal distention,diarrhea and gastric retention complications were not significantly different. The time of antibiotic use in experimental group was obviously less than control group and the difference was statistically significant. Conclusion: The enteral nutrition therapy can effectively improve the nutritional status of patients. For patients suffering severe encephalopathy combined with aspiration pneumonia,the spiral nasointestinal tube nutrition therapy is better.