medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2019-2-19(394)-29-33medalphabet-1261Research ArticleСтатьиПослеоперационная когнитивная дисфункция: механизмы развития и клиническая характеристикаPostoperative cognitive dysfunction: progress mechanisms and clinical characteristicsМанышеваК. Б.ManyshevaK. B.

ассистент, кафедра нервных болезней, медицинской генетики и нейрохирургии

г. Махачкала

Makhachkala

АхмедовМ. А.AkhmedovM. A.

зав. отделением анестезиологии

г. Махачкала

Makhachkala

РахмановаА. А.RakhmanovaA. A.

студентка, кафедра нервных болезней, медицинской генетики и нейрохирургии

г. Махачкала

Makhachkala

ХуталиеваС. М.KhutalievaS. M.

студентка, кафедра нервных болезней, медицинской генетики и нейрохирургии

г. Махачкала

Makhachkala

ФГБОУ ВО «Дагестанский государственный медицинский университет»; Дагестанская ассоциация (союз) неврологов, нейрохирургов и специалистов по реабилитацииРоссияDagestan State Medical University; Dagestan Association (Union) of Neurologists Neurosurgeons and Rehabilitation SpecialistsRussian FederationГБУ РД «Республиканская клиническая больница»РоссияRepublican Clinical HospitalRussian FederationФГБОУ ВО «Дагестанский государственный медицинский университет»РоссияDagestan State Medical UniversityRussian Federation201926112019219Неврология и психиатрия2933Copyright © Манышева К.Б., Ахмедов М.А., Рахманова А.А., Хуталиева С.М., 20192019Манышева К.Б., Ахмедов М.А., Рахманова А.А., Хуталиева С.М.Manysheva K.B., Akhmedov M.A., Rakhmanova A.A., Khutalieva S.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1261

Статья посвящена изучению послеоперационной когнитивной дисфункции — часто встречающегося в послеоперационном периоде синдрома, который не зависит от объема оперативного вмешательства. На основе анализа результатов современных исследований авторы приводят наиболее вероятные этиологические причины возникновения синдрома, сгруппированные в зависимости от разных категорий факторов риска. Алгоритм развития когнитивного снижения включает появление системного воспаления, повышение проницаемости гематоэнцефалического барьера на фоне эндотелиальной дисфункции, миграцию воспалительных агентов в центральную нервную систему и формирование оксидантного стресса. Клинические проявления когнитивного дефицита в исходе операций, проведенных под общей анестезией, авторы иллюстрируют собственными наблюдениями за пациентами нейрохирургического профиля со спинальной патологией, оперированными с применением пропофола, сопоставляя результаты нейропсихологического тестирования с оценкой уровня тревоги у них. В заключение авторы намечают стратегию профилактики послеоперационной когнитивной дисфункции и рекомендуют проведение нейропсихологической реабилитации как немаловажной составляющей послеоперационного восстановления всем пациентам с диагностированным когнитивным дефицитом, возникшим после хирургического вмешательства.

The article is devoted to the study of postoperative cognitive dysfunction — a syndrome that is often found in the postoperative period and does not depend on the volume of surgeon. Based on the analysis of the results of modern studies, the authors cite the most likely etiological causes of the syndrome, grouped according to different categories of risk factors. The pathogenetic algorithm for cognitive dysfunction includes the appearance of systemic inflammation, improving blood-brain barrier permeability with the endothelial dysfunction, the migration of inflammatory agents into the central nervous system, and the formation of oxidative stress. The clinical manifestations of cognitive deficit in the outcome of surgeon performed under general anesthesia, the authors illustrate with their own observations of patients with a neurosurgical profile with spinal pathology operated on with the use of propofol anesthesia, comparing the results of neuropsychological testing with an assessment of the level of anxiety. In conclusion, the authors outline a strategy for the prevention of postoperative cognitive dysfunction and recommend conducting neuropsychological rehabilitation as an important component of postoperative recovery for all patients with a diagnosed cognitive deficit that occurred after surgery.

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The authors declare that there are no conflicts of interest present.