Impairment of higher mental functions can complicate the course of the postoperative period even after short and minimally invasive, including laparoscopic, surgical procedures. Postoperative cognitive dysfunction significantly challenges patients’ quality of life, negating real success of surgical intervention and anesthetic support. In some cases, early postoperative cognitive dysfunction may be one of the main predictors of persistent cognitive impairment.The purpose of the review. To contemplate etiology, pathogenesis and the current perspective of postoperative cognitive dysfunction.We analyzed 96 publications in various databases (PubMed, Medline, RSCI and others), including 67 papers published over the past 5 years.The review provides an overview of current definitions and classification of postoperative cognitive dysfunction, data on the prevalence, polyethyology and risk factors, potential impact of the type of anesthesia and surgical intervention on the development of postoperative cognitive dysfunction. Various pathogenetic mechanisms of higher mental functions impairment alongside with available effective pharmacotherapies to correct them were considered.Conclusion. Numerous adverse factors of the perioperative period, such as neurotoxic effects of general anesthetics, neuroinflammation in response to operational stress and surgical trauma, impaired autoregulation of the cerebral blood flow, imperfect oxygen homeostasis, interactions of neurotransmitter, etc., can potentially cause postoperative cognitive dysfunction. Further deeper insights into etiology and pathogenesis of early postoperative cognitive dysfunction are relevant and necessary to improve prevention strategies and identify most effective pharmacotherapies to correct such disorders.
The objective: To conduct a comparative assessment of efficacy of Cytoflavin and Cellex for management of cognitive disorders after videolaparoscopic cholecystectomy performed under general inhalation anesthesia with sevoflurane.Results. In three representative groups (n = 30) of patients, markers of inflammation (CRP and IL-6), levels of brain-specific proteins (S-100 and NSE) were studied. Neuropsychological testing were performed by using the MoCA test, frontal dysfunction test battery (FAB) by two stages (stage I ‒ on the eve of the operation, stage II ‒ on the 7th day of the postoperative period). In patients of Group I (n = 30), disorders of higher mental functions of the early postoperative period persisted, which served as the basis for finding ways to eliminate and manage the identified disorders. For this purpose, Cytoflavin was used in Group II (n = 30), and Cellex was used in Group III (n = 30).Comparative characteristics of the level of brain-specific proteins revealed a statistically significant decrease at stage I in Groups II and III versus Group I. The lowest level of both NSE (by 1.45 μg/l, p = 0.041) and S-100 (by 10.1 ng/l, p = 0.044) was observed in Group III versus Group II. In addition, at the second stage of the study, the greatest severity of the inflammatory response was noted in Groups II and III of patients compared to Group I and this degree of severity could be potentiated by the ongoing drug therapy. If in Group I, disorders of higher mental functions persisted on the 7th day of the postoperative period, then as a result of the ongoing drug therapy in Groups II and III, it was possible to achieve significantly better results of neuropsychological testing.Conclusion. Administration of drug therapy contributed to the improvement of higher mental function eliminating cognitive deficit in the early postoperative period.
Учредитель и издатель Федеральное государственное бюджетное образовательное учреждение высшего образования «Алтайский государственный медицинский университет» Министерства здравоохранения Российской Федерации (ФГБОУ ВО АГМУ Минздрава России) 656038, РФ, Алтайский край, Барнаул, проспект Ленина, 40 www.asmu.ru РЕДАКЦИЯ Главный редактор Салдан Игорь Петрович доктор медицинских наук, профессор Заместитель главного редактора Жариков Александр Юрьевич доктор биологических наук, доцент Редактор-организатор Киселев Валерий Иванович член-корреспондент РАН, доктор медицинских наук, профессор Выпускающий редактор Широкоступ Сергей Васильевич кандидат медицинских наук, доцент Научные редакторы Брюханов Валерий Михайлович доктор медицинских наук, профессор Колядо Владимир Борисович доктор медицинских наук, профессор Лукьяненко Наталья Валентиновна доктор медицинских наук, профессор Шойхет Яков Нахманович член-корреспондент РАН, доктор медицинских наук, профессор Редакционная коллегия Брико Николай Иванович академик РАН, доктор медицинских наук, профессор Воевода Михаил Иванович академик РАН, доктор медицинских наук, профессор Дыгай Александр Михайлович академик РАН, доктор медицинских наук, профессор Злобин Владимир Игоревич академик РАН, доктор медицинских наук, профессор Лобзин Юрий Владимирович академик РАН, доктор медицинских наук, профессор Мадонов Павел Геннадьевич доктор медицинских наук, профессор Онищенко Геннадий Григорьевич академик РАН, доктор медицинских наук, профессор Павлова Наталья Григорьевна доктор медицинских наук, профессор Полушин Юрий Сергеевич академик РАН, доктор медицинских наук, профессор Рахманин Юрий Анатольевич академик РАН, доктор медицинских наук, профессор Ответственный за перевод Широкова Валерия Олеговна БЮЛЛЕТЕНЬ МЕДИЦИНСКОЙ НАУКИ №3 (11) 2018 2 СОДЕРЖАНИЕ Науки о здоровье Влияние минеральной воды на течение экспериментальной гастропатии Онищенко Г.Г.
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