PREVENTION OF COGNITIVE DISTURBANCES IN PATIENTS OF
THE CARDIAC SURGERY PROFILE, OPERATED IN CONDITIONS OF
ARTIFICIAL CIRCULATION
I.A. Chigareva
First Moscow State Medical University by I.M. Sechenov
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 past decades, cardiac surgery and cardiac
anesthesiology have made significant progress in ensuring patient safety,
minimizing the number of complications during operations performed in IC
[1; 2]
Purpose of the study To develop measures for carrying out primary
prophylaxis in patients with neurological dysfunctions (vascular pathology
against the background of comorbidities such as myocardial infarction, TIA,
conducting secondary prophylaxis to reduce risk factors and further
treatment of postoperative complications of cardiac surgical patients.
Objective: To develop measures for carrying out primary prophylaxis in
patients with neurological dysfunctions (vascular pathology against the
background of comorbidities such as myocardial infarction, TIA, conducting
secondary prophylaxis to reduce risk factors and further treatment of
postoperative complications of cardiac surgical patients.
Material and methods: In the study, the object of the study were 1669
patients of youthful (16-21 years old) and mature (41-70 years old) age. Of
these, 497 males were examined, 1172 females, with the presence of signs
of a concomitant pathology of the heart and blood vessels operated on in IC.
During neuropsychological correction in patients, various neurological
scales were used: NIHSS stroke, MMSE mental status assessment, the
patient’s
postoperative
severity
rating
scale
—
Apache
II,
SOFA,
psychological stress level determination (Schulte tables, Luria).
Research results and their discussion: Analysis of the data on the problem
made it possible to note that cognitive dysfunctions that developed in the
early and persisting in the late postoperative period were clinically
manifested by impaired memory, concentration, and sensitivity disorders.
Patients older than 60 years were at risk, as they had on the basis of the
data obtained age-related changes in the cerebral circulation.
Research results and their discussion: Analysis of the data on the problem
made it possible to note that cognitive dysfunctions that developed in the
early and persisting in the late postoperative period were clinically
manifested by impaired memory, concentration, and sensitivity disorders.
Patients older than 60 years were at risk, as they had on the basis of the
data obtained age-related changes in the cerebral circulation.
Conclusions: Hospital mortality was not. The IR time averaged 107.0 min.
All patients underwent reconstructive surgery on heart valves. In 10% of
cases, patients without neurological deficiencies at the preoperative stage
and in the postoperative period showed transient ischemic attacks. During
examination, cognitive impairment, changes in psychomotor activity, sleep
disorders, development of personality, anxiety and affective disorders, as
well as depression were revealed in patients.
Conclusions: Hospital mortality was not. The IR time averaged 107.0 min.
All patients underwent reconstructive surgery on heart valves. In 10% of
cases, patients without neurological deficiencies at the preoperative stage
and in the postoperative period showed transient ischemic attacks. During
examination, cognitive impairment, changes in psychomotor activity, sleep
disorders, development of personality, anxiety and affective disorders, as
well as depression were revealed in patients.
Bibliography:
1. Moroz V.V. The problem of brain damage during cardiac surgery in
cardiopulmonary bypass conditions / Moroz V.V., Kornienko A.N., Mozalev
A.S., Parfenyuk A.V., Shakhmaeva S.V. // General Resuscitation. 2008. - IV. №4. - P.16-20.
2. Kozlov, I.A. Psycho-emotional state and quality of the postoperative
period at different rates of activation of cardiac surgery patients / Kozlov IA,
Khoteev A.Zh., Vitkalova TA // Thoracic and cardiovascular surgery. - 2002.
- №6 - С.22-26.
3. Levikov D.I. Biomarkers of nervous tissue damage during cardiac surgery
/ Levikov D.I. Borisov K.Yu., Schrader N.I. // Bulletin of anesthesiology and
resuscitation. 2013.- X. - №1. - pp. 38-47.
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