BRAIN BLOOD AND COGNITIVE DISORDERS
WITH HEART OPERATIONS
I.A. Chigareva, J.N.Olimov
*Chigareva I.A.
postgraduate of State-financed Institution of Moscow city
"Scientific Research Institute of Healthcare Organization and Medical Management
of Moscow Department of Healthcare
**Olimov J.N. assistant department of neurology by Bukhara Medical Institute
named after Ibn Sina
Summary: The article analyzes the current understanding of the causes of
the development of brain dysfunction during cardiac surgery performed in
cardiopulmonary bypass. Considered therapeutic measures that contribute
to the prevention of brain damage, ways to create new cerebroprotective
strategies.
Key words: neuropsychiatric complications, extracorporeal circulation.
Introduction: During the last decade, mental disorders in cardiac surgery
acquire the status of one of the factors that are of paramount importance
for the quality of postoperative clinical and social rehabilitation of patients
and prediction of survival. Since the 90s of the last century, mental
disorders (along with cardiological and other somatic indicators) are
considered as an obligate component of clinical and statistical models of
outcomes of cardiac surgical interventions [5; 6; 7; 8]. The frequency of
mental disorders in the preoperative period of CABG, according to various
authors, is 40-60% [9; ten;]. According to data for 2000, about 3000 heart
operations are performed annually in Russia [5].
Objective: To reduce the incidence of postoperative cognitive dysfunction
in patients with stenosing atherosclerosis of the coronary arteries, operated
on in conditions of artificial blood circulation, through the use of combined
high-chest epidural anesthesia
Objectives of the study:
1. To study the cerebral arterial blood flow and the reactivity of cerebral
vessels in IHD patients over 60 years old.
2. To study the dynamics of cerebral blood flow during surgery with
artificial blood circulation under conditions of total intravenous and
combined epidural anesthesia.
3. To determine the frequency of cognitive impairment in patients with
coronary artery disease over 60 years of age with direct myocardial
revascularization.
4. To determine the risk group for the development of postoperative
cognitive dysfunction among IHD patients over 60 years old.
Material and methods: Surveyed 112 patients (men) with coronary heart
disease who were undergoing surgical treatment, operated from July 2019
to December 2020. The average age of patients was 61.6 ± 0.4 years. All
patients underwent coronary artery bypass surgery. To study the initial
state of cerebral blood flow depending on age, the patients were divided
into two groups. The main group consisted of elderly patients 61–71 years
old (n = 90). In the comparison group - patients 49-59 years old (n = 22).
The groups were comparable in severity of the underlying disease. To
accomplish the main goal of the study, patients over 60 years old were
divided, depending on the method of surgical myocardial revascularization,
into two groups. The first group consisted of 70 men who were operated on
in the IC condition; the second group included 20 patients operated on a
working heart. In subgroup 1a, 50 men were included who were operated
on under multi-component anesthesia in combination with a high thoracic
epidural blockade (VGEB). Epidural catheterization was performed 3 hours
before the operation at the level of Th3-Th5. Epidural blockade was
provided by the introduction of a 0.5% solution of 15-20 ml of bupivacaine
and 2-3 mg of morphine. Subgroup 1b consisted of 20 patients who
underwent 7. In the group operated on the working heart, multicomponent
anesthesia was performed in combination with a high thoracic epidural
blockade. Transcranial dopplerography was performed on a Pioneer TC8080
Companion III ultrasound machine, manufactured by Nicolet Vascular,
(USA), with Nic Vue software version 2.5.1. The M2 segment of the middle
cerebral artery was located using a 2 MHz transducer in the pulsating (PW)
mode. In the group operated on the working heart, multicomponent
anesthesia was performed in combination with a high thoracic epidural
blockade. Transcranial dopplerography was performed on a Pioneer TC8080
Companion III ultrasound machine, manufactured by Nicolet Vascular,
(USA), with Nic Vue software version 2.5.1. The M2 segment of the middle
cerebral artery was located using a 2 MHz transducer in the pulsating (PW)
mode. To assess the embolic intraoperative load, monitoring was performed
with
the automatic
microembolic
signal counter
(MES) turned
on.
Cerebrovascular reactivity, which characterizes the mechanisms of cerebral
autoregulation, was studied twice: on the eve of the operation and after
tracheal intubation, at the stage of anesthesia maintenance, in the
preperfusion period. The content of CO2 in exhaled air was controlled using
an Engstrem-Elisa capnograph. The study of higher nervous activity (GNI)
in patients with IHD over 60 years old was conducted using standard,
widely used techniques described in the works of A.R. Luria, A.A.
Skoromets, N.A. Schneider The results of medical and psychological testing
were compared twice. 2-3 days before surgery and 7 days after surgery.
Medico-psychological testing was performed in the office of the functional
diagnostics department. The study of higher nervous activity (GNI) in
patients with IHD over 60 years old was conducted using standard, widely
used techniques described in the works of A.R. Luria, A.A. Skoromets, N.A.
Schneider The results of medical and psychological testing were compared
twice. 2-3 days before surgery and 7 days after surgery. Medicopsychological testing was performed in the office of the functional
diagnostics department.
Conclusions: Clinical assessment of cerebral blood flow in IHD patients
depending on age showed that the linear cerebral blood flow rate in
patients over 60 years old was 19.4% (p <0.05) lower than in the group of
patients 49-59 years old. At the same time, according to Echo KG, the left
ventricular ejection fraction in both groups did not have a statistically
significant difference, which indicates 9 that the atherosclerosis of the
changed vascular wall influences the FSC in the elderly. Clinical assessment
of cerebral blood flow in IHD patients depending on age showed that the
linear cerebral blood flow rate in patients over 60 years old was 19.4% (p
<0.05) lower than in the group of patients 49-59 years old. At the same
time, according to Echo KG, the left ventricular ejection fraction in both
groups did not have a statistically significant difference, which indicates 9
that the atherosclerosis of the changed vascular wall influences the FSC in
the elderly. In order to prevent the effect of memorizing tests, we used
various variants of their execution. The decrease in the test score by 10% or
more was regarded as a manifestation of cognitive dysfunction. The groups
analyzed the initial state of cerebral blood flow, the dynamics of indicators
during surgery and in the early postoperative period; doses of drugs for
anesthesia, time of treatment in the intensive care unit, the degree of
cognitive impairment according to test data. Archiving and statistical
processing of data was carried out on a PC using the program "STATISTICA
6.0".
References:
1.Kazakova I. G. Contractile function of the left ventricle, functional status
and survival of patients with coronary artery disease in the long-term period
after coronary artery bypass surgery (a prospective ten-year observation).
Author. dis. Cand. honey. sciences. M., 2002.
2)CABRI
Trial
Participants.
Angioplasty versus
First-year
results
of
CABRI
(Coronary
Bypass Revascularisation Investigation). Lancet 1995;
346: 1179-84.
3) Mueller RL, Rosengart TK, Isom OW. The history of surgery for ischemic
heart disease. Ann Thorac Surg 1997; 63: 869-78.
4) Аlonso JJ. Seeking normalcy: the experience of coronary artery bypass
surgery. Res Ners Health 2000; 14 (3): 173-8.
5) Zamotaev Yu.N. Clinical and psychodynamic aspects of rehabilitation of
patients after AKSH. Author. dis. ... Dr. med sciences. M., 2000.
6) Sologub K.N. Peculiarities of psychological status and its correction in
patients with post-infarction LV remodeling. Author. dis. ... Cand. honey.
Sciences, 2001.
5) Zamotaev Yu.N. Clinical and psychodynamic aspects of rehabilitation of
patients after AKSH. Author. dis. ... Dr. med sciences. M., 2000.
6) Sologub K.N. Peculiarities of psychological status and its correction in
patients with post-infarction LV remodeling. Author. dis. ... Cand. honey.
Sciences,2001
Отзывы:
Авторизуйтесь, чтобы оставить отзыв