medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-19-49-56medsovet-6531Research ArticleКОГНИТИВНЫЕ РАССТРОЙСТВАCOGNITIVE DISRODERSПослеоперационные когнитивные нарушения: этиология, клинические проявления, подходы к диагностикеPostoperative cognitive dysfunction: etiology, clinical features, diagnosishttps://orcid.org/0000-0002-6928-2355БордовскийС. П.BordovskyS. P.

Бордовский Сергей Петрович, аспирант кафедры нервных болезней и нейрохирургии

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Sergey P. Bordovsky, Postgraduate Student of the Department of Neurology and Neurosurgery

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russiа

sbordoche@gmail.comhttps://orcid.org/0000-0001-5203-4497КрупенинП. М.KrupeninP. M.

Крупенин Павел Михайлович, аспирант кафедры нервных болезней и нейрохирургии

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Pavel M. Krupenin, Postgraduate Student of the Department of Neurology and Neurosurgery

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russiа

krupeninpavel@gmail.comРозенА. И.RozenA. I.

Розен Андрей Игоревич, врач-нейрохирург отделения нейрохирургии, Клиника нервных болезней имени А.Я. Кожевникова

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Andrey I. Rozen, Neurosurgeon of the Department of Neurosurgery, Clinic of Nervous Diseases

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russiа

rozen_a_i@staff.sechenov.ruhttps://orcid.org/0000-0002-6715-6021ЕвзиковГ. Ю.EvzikovG. Yu.

Евзиков Григорий Юльевич, д.м.н., профессор кафедры нервных болезней и нейрохирургии

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Grigoriy Yu. Evzikov, Dr. Sci. (Med.), Professor

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russiа

evzikov_g_yu@staff.sechenov.ruhttps://orcid.org/0000-0001-7891-7263КиричукЯ. В.KirichukY. V.

Киричук Яна Владиславовна, врач-психиатр

143965, Россия, Реутов, Юбилейный пр., д. 8

Yana V. Kirichuk, Psychiatrist

8, Yubileiny Ave, Reutov, 143965, Russia

yanakirichuk@yandex.ruhttps://orcid.org/0000-0002-9193-1219ФанталисД.FantalisD.

Фанталис Давид, аспирант кафедры нервных болезней и нейрохирургии

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

David Fantalis, Postgraduate Student of the Department of Neurology and Neurosurgery

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russiа

doctor.fant@gmail.comhttps://orcid.org/0000-0002-9097-898XПреображенскаяИ. С.PreobrazhenskayaI. S.

Преображенская Ирина Сергеевна, д.м.н., профессор кафедры нервных болезней и нейрохирургии

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Irina S. Preobrazhenskaya, Dr. Sci. (Med.), Professor, Department of Neurology and Neurosurgery

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russiа

irinasp2@yandex.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationЦентр ментального здоровья «Эмпатия»РоссияMental Health Center “Empathy”Russian Federation2021301120210194956Copyright © Бордовский С.П., Крупенин П.М., Розен А.И., Евзиков Г.Ю., Киричук Я.В., Фанталис Д., Преображенская И.С., 20212021Бордовский С.П., Крупенин П.М., Розен А.И., Евзиков Г.Ю., Киричук Я.В., Фанталис Д., Преображенская И.С.Bordovsky S.P., Krupenin P.M., Rozen A.I., Evzikov G.Y., Kirichuk Y.V., Fantalis D., Preobrazhenskaya I.S.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-sovet.pro/jour/article/view/6531Введение

Введение. В настоящем исследовании был проведен анализ возможности использования нейропсихологических тестов для оценки послеоперационной когнитивной дисфункции (ПОКД). Были получены новые данные: в послеоперационном периоде у пациентов преобладают гиппокампальные нарушения памяти, что делает целесообразным использование методов диагностики первичных модально-неспецифических мнестических расстройств у пациентов, которым предстоит нейрохирургическое вмешательство на спинном мозге.

Цель исследования – оценить влияние операции, проведенной под наркозом, на состояние когнитивных функций.

Материалы и методы

Материалы и методы. Всего в исследование включено 20 пациентов среднего возраста. Все пациенты были прооперированы спинально. Тотальная внутривенная анестезия была на основе пропофола (4–12 мг/кг/ч). Исследование когнитивных функций до оперативного вмешательства (день 1-й) и на следующий день после (день 2-й) проводилось с использованием: МоСА, TMT A и B, FCSRT, тест Спилбергера на личностную (ЛТ) и ситуативную тревожность (СТ).

Результаты

Результаты. Развитие ПОКД отмечено в 15% случаев. У пациентов выявлено снижение индекса подсказок FCSRT (1-й день = 87 ± 9,0; 2-й день = 83 ± 15; p = 0,0005), при этом общая выраженность когнитивных нарушений (общий балл МоСА) достоверно не изменялась (среднеквадратичное отклонение по МоСА: 24,25 ± 2,86 в 1-й день и 24 ± 3,24 во 2-й день, р = 0,61). Уровень ЛТ снизился на 2-й день: 44,65 ± 7,4 против 41,1 ± 8,2 (р = 0,001). Проведенный корреляционный анализ не показал взаимосвязи возраста пациентов, уровня образования, сопутствующей патологии и развития ПОКД, однако длительность анестезии была взаимосвязана со снижением баллов МоСА (коэффициент корреляции Пирсона r = –0,44; р = 0,050).

Выводы

Выводы. Проведенное нами исследование показывает, что исследование гиппокампальных нарушений памяти важно у пациентов с ПОКД. Эти данные отличаются от данных исследователей, представленных ранее, где наиболее важными клиническими проявлениями ПОКД считают снижение внимания и скорости психических процессов. Безусловно, малый объем выборки диктует необходимость проведения дополнительных исследований.

Introduction

Introduction. The present study analyzed the possibility of using neuropsychological tests to assess postoperative cognitive dysfunction. New data were obtained: in the postoperative period, hippocampal memory impairments predominate in patients, which makes it expedient to use methods for diagnosing primary modal-nonspecific memory disorders in patients who are to undergo neurosurgical intervention on the spinal cord.

The aim of the study to evaluate the influence of surgery with anesthesia on the cognitive functions of middle-age patients.

Materials and methods

Materials and methods. The study included 20 middle-aged patients. All patients had to undergo spinal surgery. Patients received total intravenous anesthesia with propofol induction (4–12 mg/kg/hr). Cognitive functions before and after the operation were made with the use of the MoCA, TMT A and B, FCSRT, state-trait anxiety inventory test (STAI).

Results

Results. The development of POCD was noted in 15% of cases. The patients showed a decrease in the FCSRT prompt index (1st day = 87 ± 9.0; 2nd day = 83 ± 15; p = 0,0005), while the overall severity of cognitive impairments (total score of MoCA) did not change significantly (standard deviation according to MoCA: 24.25 ± 2.86 on day 1 and 24 ± 3.24 on the second day, p = 0.61). The RT level decreased by day 2: 44.65 ± 7.4 versus 41.1 ± 8.2 (p = 0.001). Correlation analysis did not show the relationship between the age of patients, education level, comorbidity and development of POCD; however, the duration of anesthesia was associated with a decrease in MoCA scores (Pearson’s correlation coefficient r = –0.44; p = 0.050).

Conclusion

Conclusion. Thus, our study shows that the study of hippocampal memory impairments is important in patients with POCD. These data differ from the data of researchers presented earlier, where the most important clinical manifestations of POCD are considered to be a decrease in attention and speed of mental processes. Of course, the small sample size dictates the need for additional research.

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