Table_1_Opioid-induced short-term consciousness improvement in patients with disorders of consciousness.docx

IntroductionEffective treatment to facilitate recovery from prolonged disorders of consciousness is a complex topic for the medical community. In clinical practice, we have found that a subset of patients has a short-term improvement of consciousness after general anesthesia.
MethodsTo determine the clinical factors responsible for the consciousness improvement, we enrolled 50 patients with disorders of consciousness who underwent surgery from October 2021 to June 2022. Their states of consciousness were evaluated before surgery, within 48 h after surgery, and 3 months after surgery. Clinical-related factors and intraoperative anesthetic drug doses were collected and compared between patients with and without consciousness improvement. Independent associations between selected factors and postoperative improvement were assessed using multivariate logistical regression analyses.
ResultsPostoperative short-term consciousness improvement was found in 44% (22/50) of patients, with significantly increased scores of auditory and visual subscales. Patients with traumatic etiology, a preoperative diagnosis of minimally conscious state, and higher scores in the auditory, visual, and motor subscales were more likely to have postoperative improvement. This short-term increase in consciousness after surgery correlated with patients’ abilities to communicate in the long term. Furthermore, the amount of opioid analgesic used was significantly different between the improved and non-improved groups. Finally, analgesic dose, etiology, and preoperative diagnosis were independently associated with postoperative consciousness improvement.
DiscussionIn conclusion, postoperative consciousness improvement is related to the residual consciousness of the patient and can be used to evaluate prognosis. Administration of opioids may be responsible for this short-term improvement in consciousness, providing a potential therapeutic approach for disorders of consciousness.

【引言】促进长期意识障碍（prolonged disorders of consciousness）患者康复的有效治疗方案，是医学界面临的复杂课题。在临床实践中，我们观察到部分患者在接受全身麻醉（general anesthesia）手术后，意识状态会出现短期改善。
【研究方法】为明确意识改善相关的临床影响因素，本研究纳入2021年10月至2022年6月期间接受手术治疗的50例意识障碍患者。分别于术前、术后48小时内及术后3个月对患者的意识状态进行评估；收集并对比意识改善组与未改善组的临床相关因素及术中麻醉药物使用剂量；采用多因素logistic回归分析，评估筛选出的因素与术后意识改善之间的独立相关性。
【研究结果】本研究中44%（22/50）的患者出现术后短期意识改善，其听觉子量表与视觉子量表评分均显著升高。存在创伤性病因、术前诊断为微意识状态（minimally conscious state），且听觉、视觉及运动子量表评分较高的患者，术后意识改善的概率更高。术后短期意识改善与患者的长期沟通能力存在相关性。此外，改善组与未改善组的阿片类镇痛药（opioid analgesic）使用剂量存在显著差异。最终分析显示，镇痛药物剂量、病因及术前诊断均与术后意识改善存在独立相关性。
【讨论】综上，术后意识改善与患者残留意识功能相关，可用于评估意识障碍患者的预后。阿片类药物的使用或为该短期意识改善的潜在机制，可为意识障碍的治疗提供新的潜在思路。