РОЛЬ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ В РАЗВИТИИ ПОСЛЕОПЕРАЦИОННОЙ КОГНИТИВНОЙ ДИСФУНКЦИИ
Ключевые слова:
когнитивная дисфункция, искусственное кровообращение, системный воспалительный ответ, кардиохирургияАннотация
Вопрос органопротекции всегда занимал особое положение в кардиохирургии, что связано с использованием в ней искусственного кровообращения (ИК). Являясь необходимой частью большинства операций на сердце, одновременно ИК представляет наибольшую угрозу для органов и систем пациента. Ввиду того, что головной мозг очень чувствителен к различным патологическим влияниям, нередко оперативные вмешательства в условиях ИК приводят к его повреждению и нарушению нормального функционирования на короткий или же длительный период. В данной статье описаны подобные нарушения и частота их встречаемости. Кроме того, акцентировано внимание на патофизиологических механизмах церебрального повреждения под действием ИК с акцентом на нейроваскулярную единицу головного мозга. Такими повреждающими факторами являются микроэмболия сосудов головного мозга, недостаточная церебральная оксигенация, интраоперационная трансфузия и системный воспалительный ответ как многофакторный процесс, в этиологию которого входят все вышеперечисленные факторы, а также многие другие, упомянутые в статье. Представлены современные методы контроля и профилактики таких осложнений.
Библиографические ссылки
Bakker EWM, Visser K. An in vivo comparison of bubble elimination in Quadrox and Capiox oxygenators. Evidence-Based ClinicalDecision Support at the Point of Care. 2011;1:20-27.
Bilotta F, Gelb AW, Stazi E, Titi L, Paoloni FP, Rosa G. Pharma- cological perioperative brain neuroprotection: a qualitativereview of randomized clinical trials. British Journal of anaesthesia. 2013;110:113-120.https://doi.org//10.1093/bja/aet059
Brown C, Laflam A, Max L, Lymar D, Neufeld KJ, Tian J, ShahAS, Whitman GJ, Hogue CW. The impact of delirium after cardiac surgical procedures on postoperative resource use. Annals ofThoracic Surgery. 2016;101:1663-1669.https://doi.org/10.1016/j.athoracsur.2015.12.074
Cerejeira J, Firmino H, Vaz-serra A, Mukaetova-ladinska EB. Theneuroinflammatory hypothesis of delirium. ActaNeuropathologica.2010;119:737-754.
https://doi.org/10.1007/s00401-010-0674-1
Closure. Journal of Artificial Organs. 2016;40(5):470-479.https://doi.org/10.1111/aor.12587
GholampourDehaki M, Niknam S, Azarfarin R, Bakhshandeh H, Mahdavi M. Zero-Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and Improves the Respiratory Function in Infants After Cardiopulmonary Bypass: A Randomized ControlledTrial. Journal of Artificial Organs. 2019;43(2):167-172.https://doi.org/10.1111/aor.13325
Coppola S, Caccioppola A, Chiumello D. Internal clock and thesurgical ICU patient. CurrOpinAnaesthesiol. 2020;33(2):177-84.https://doi.org/10.1097/ACO.0000000000000816.
Denes A, Vidyasagar R, Feng J, Narvainen J, McColl BW, Kauppinen RA, Allan SM J. Proliferating resident microglia after focalcerebral ischaemia in mice. Journal of Cerebral Blood Flow & Metabolism. 2007;27(12):1941-1953.
https://doi.org/10.1038/sj.jcbfm.9600495
Engelman R, Baker RA, Likosky DS, et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists,and The American Society of Extra Corporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass — Temperature Management during Cardiopulmonary Bypass. Journal of Extra Corporal Technology. 2015;47(3):145-154. PMID: 26543248.
Federico A, Tamburin S, Maier A. Multifocal cognitive dysfunctionin high-dose benzodiazepine users: a cross-sectional study. Neurology Science. 2017;38(1):137-142.https://doi.org/10.1007/s10072-016-2732-5
Fudickar A, Peters S, Stapelfeldt C, Serocki G, LeiendeckerJ, Meybohm P. Postoperative cognitive deficit after cardiopulmonary bypass with peserved cerebral oxygenation: a rospective observational pilot study. BMC Anesthesiology.2011;11:7.https://doi.org/10.1186/1471-2253-11-7
Gottesman RF, Grega MA, Bailey MM, Pham, Zeger SL,Baumgartner WA, Selnes OA, McKhann GM. Delirium after coronary artery bypass graft surgery and late mortality. Annals of Neurology. 2010;67(3):338-344.https://doi.org/10.1002/ana.21899
Grigore AM, Murray CF, Ramakrishna H, Djaiani G. A core review of temperature regimens and neuroprotection during pulmonary bypass: does rewarming rate matter? Anesthesia and analgesia. 2009;109(6):1741-1751.https://doi.org/10.1213/ANE.0b013e3181c04fea
Guenther U, Theuerkauf N, Frommann I, Brimmers K, Malik R,Stori S, Scheidemann M, Putensen C, Popp J. Predisposing and precipitating factors of delirium after cardiac surgery. A prospective observational cohort study. Annals of Surgery. 2013;257:1160-1167.
https://doi.org/10.1097/sla.0b013e318281b01c
Hirata Y. Cardiopulmonary bypass for pediatric cardiac surgery.General Thoracic and Cardiovascular Surgery. 2018;66(2):65-70.https://doi.org/10.1007/s11748-017-0870-1
Hori D, Max L, Laflam A, Brown C, Neufeld KJ, Adachi H, Sciortino C, Conte JV, Cameron DE, Hogue CW, Mandal K. Bloodpressure deviations from optimal mean arterial pressure during cardiac surgery measured with a novel monitor of cerebral blood flowand risk for perioperative delirium: a pilot study. Journal of Cardiothoracic and Vascular Anesthesia. 2016;30:606-612.https://doi.org/10.1053/j.jvca.2016.01.012
Järvelä K, Porkkala H, Karlsson S, Martikainen T, Selander T,Bendel S. Postoperative Delirium in Cardiac Surgery Patients. Jouranal Cardiothoracic Vascular Anesthesia. 2018;32(4):1597-1602.https://doi.org/10.1053/j.jvca.2017.12.030
Kaushal V, Schlichter LC. Mechanisms of microglia-mediated neurotoxicity in a new model of the stroke penumbra. Journal of Neuroscience. 2008;28(9):2221-2230.
https://doi.org/10.1523/JNEUROSCI.5643-07.2008
Kazmierski J, Kowman M, Banach M, Fendler W, Okonski P,Banys A, Jaszewski Y, Mikhailidis DP, Sobow T, Kloszewska I.Incidence and predictors of delirium after cardiac surgery: results from the IPDACS study. Journal of Psychosomatic Research.
;69(2):179-185.https://doi.org/10.1016/j.jpsychores.2010.02.009
Lang SM, Syed MA, Dziura J, Rocco E, Kirshbom P, Bhandari V,John S Giuliano Jr. The Effect of Modified Ultrafiltration on Angiopoietins in Pediatric Cardiothoracic Operations. The Annals ofThoracic Surgery. 2014;98(5):1699-1704. https://dx.doi.org/10.1016/j.athoracsur.2014.06.053
Lei L, Katznelson R, Fedorko L, Carroll J, Poonawala H, Machina M, Styra R, Rao V, Djaiani G. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial. Anaesthesia. 2017;72(12):1456-1466.https://doi.org/10.1111/anae.14056
Lin Y, Chen J, Wang Z. Meta-analysis of factors which influencedelirium following cardiac surgery. Journal of Cardiac Surgery.2012;27:481-492.
https://doi.org/10.1111/j.1540-8191.2012.01472.x
Mansur Muratovich Matlubov, Jasur Tolibovich Yusupov, & Nigina Ulugbekovna Mukhamedieva. (2020). Preoperative Preparation Of Elderly Patients With Concomitant Hypertension In The Practice Of Ophthalmic Surgery. The American Journal of Medical Sciences and Pharmaceutical Research, 2(11), 8–15. https://doi.org/10.37547/TAJMSPR/Volume02Issue11-02
Marcantonio ER, Juarez G, Goldman L, et al. The relationshipof postoperative delirium with psychoactive medications. Jama.1994;272:1518-1522.https://doi.org/10.1001/jama.1994.03520190064036
Muratovich, M. M., Abduvakil, M. A., Gafarovna, K. E., & Tolibovich, Y. J. (2021). Hemodynamic indicators in pregnant women with obesity of various degrees of expression. European Journal of Molecular & Clinical Medicine, 8(02), 2021.
Muratovich, M. M., Abduvakilovich, M. A., & Tolibovich, Y. J. (2021). Assessment of the degree of preservation of coronary reserves in pregnant women with mitral stenosis. CENTRAL ASIAN JOURNAL OF MEDICAL AND NATURAL SCIENCES, 2(1), 20-23.
Muratovich, M. M., Tolibovich, Y. J., Sadullayevich, M. S., & Hamidullayevich, K. K. (2020). Optimization of anesthesiological assistance in women with arterial hypertension in hysterectomy. Достижения науки и образования, (5 (59)), 82-86.
Pozhilenkova EA, Lopatina OL, Komleva YK, Salmin VV, Salmina AB. Blood-brain barrier-supported neurogenesis in healthy anddiseased brain. Reviews in the Neurosciences. 2017;28(4):397-415. https://doi.org/10.1515/revneuro-2016-0071
Ramlawi B, Rudolph JL, Mieno S, Khabbaz K, Sodha NR, Boodhvani M, Levkoff SE, Marcantonio ER, Sellke FW. Serologicmarkers of brain injury and cognitive function after cardiopulmonary bypass. Annals of Surgery. 2006;244(4):593-601.
https://doi.org/10.1097/01.sla.0000239087.00826.b4
Rudolph JL, Inouye SK, Jones RN, Yang FM, Fong TG, Levkoff SE,Marcantonio ER. Delirium: an independent predictor of functionaldecline after cardiac surgery. J Am Geriatr Soc. 2010;58:643-649.https://doi.org/10.1111/j.1532-5415.2010.02762.x
Russell MD, Pinkerton C, Sherman KA, Ebert TJ, Pagel PS.Predisposing and Precipitating Factors Associated With Postoperative Delirium in Patients Undergoing Cardiac Surgery at a
Veterans Affairs Medical Center: A Pilot Retrospective Analysis.Journal of Cardiothoracic and vascular anesthesia. 2020;S1053-0770(20)30120-8.
https://doi.org/10.1053/j.jvca.2020.02.004
SandrikovVA, SadovnikovVI, FedulovaSV, AlievSM. Monitoring of microembolic signals in the vessels of the brain in theearly postoperative period in cardiac patients. Ul’trazvukovayaIfunkcional’nayadiagnostika (Russian Journal of Ultrasound andfunctional diagnostics). 2010;5:54-63. (In Russ.). Reis EE, Menezes LD, Justo CCL. Gaseous microemboli in cardiac surgery with cardiopulmonary bypass: the use of veno-arterial shunts as preventive method. EvistaBrasileira de Cirurgia Cardiovascular. 2012;27(3):436-445.https://doi.org/10.5935/1678-9741.20120073
Schmitt KR, Fedarava K, Justus G, Redlin M, Böttcher W, Delmo Walter EM. Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect
Sharipov, I. L., Yusupov, J. T., & Xolbekov, B. K. (2022). PERSONALIZATION AND PREVENTATIVE PREMEDICATION: USED DRUGS VALUE AND EFFICIENCY. Web of Scientist: International Scientific Research Journal, 3(02), 740-748.
Shrader NI, Shaybakova VL, Likhvantsev VV, Levikov DI, Levin OS. Neurological complications of coronary artery bypassgrafting. Nevrologiyaipsihiatriyaim. S.S. Korsakova. 2012;3:76-81. (In Russ).https://doi.org/10.1007/s11055-013-9796-y
Sprung J, Roberts RO, Weingarten TN, Cavalcante AN, Knopman DS, Petersen RC, Hanson AC, Schroeder DR, Warner DO.Postoperative delirium in elderly patients is associated with subsequente cognitive impairment. British Journal of Anaesthesia.2017;119(2):316-323.
https://doi.org/10.1093/bja/aex130
Stehouwer MC, Boers C, Vroege R, Kelder JC, Yilmaz A, Bruins P. Clinical evaluation of the air removal characteristics of anoxygenator with integrated arterial filter in a minimized extracorporeal circuit. The International Journal of Artificial Organs.2011;34(4):374-382.
https://doi.org/10.5301/ijao.2011.7749
Stehouwer MC, de Vroege R, Bruggemans EF, Hofman FN, Molenaar MA, Oeveren W, Mol BA, Bruins P. The influence of gaseous microemboli on various biomarkers after minimized cardiopulmonary bypass. Perfusion. 2019;35(3):202-208.https://doi.org/10.1177/0267659119867572
Toomasian CJ, Aiello SR, Drumright BL, Major TC, Bartlett RH,
Toomasian JM. The effect of air exposure on leucocyte and cytokine activation in an in-vitro model of cardiotomy suction. Perfusion. 2018;33:538-545.https://doi.org/10.1177/0267659118766157
Torbett BE, Baird A, Eliceiri BP. Understanding the rules of theroad: proteomic approaches to interrogate the blood brain barrier.Frontiers in Neuroscience. 2015;4(9):70.
https://doi.org/10.3389/fnins.2015.00070
Wang Y, Lin X, Yue H, Kissoon N, Sun B. Evaluation of systemicinflammatory response syndrome-negative sepsis from a Chineseregional pediatric network. Collaborative Study Group for PediatricSepsis in Huai’an BMC Pediatr. 2019;8:19(1):11.https://doi.org/10.1186/s12887-018-1364-8.
Матлубов M., Хамдамова, Э. ., & Юсупов, Ж. (2022). ТАКТИКА ИНТЕНСИВНОЙ ТЕРАПИИ И АНЕСТЕЗИИ У БЕРЕМЕННЫХ ЖЕНЩИН И РОЖЕНИЦ ИНФИЦИРОВАННЫХ И БОЛЬНЫХ COVID-19. Журнал кардиореспираторных исследований, 1(SI-1), 66–67. https://doi.org/10.26739.2181-0974-2020-SI-1-21
Матлубов, М. М., Хамдамова, Э. Г., & Юсупов, Ж. Т. (2021). Оптимизация обезболивания у пожилых больных с сопутствующей артериальной гипертензией при холецистэктомии. Молодой ученый, (4), 116-118.
Рахимов, А., Негматджанов, Б., Юсупов, Ж., Ганиев, Ф., & Мамасолиева, Ш. (2018). Определение клинико-экономической эффективности симультанных операций у женщин. Журнал проблемы биологии и медицины, (4 (104)), 209-212.
Сандриков В.А., Садовников В.И., Федулова С.В., Алиев С.М. Мониторинг микроэмболических сигналов в сосудахголовного мозга в раннем послеоперационном периоде у кардиохирургических больных. Ультразвуковая и функциональная диагностика. 2010;5:54-63.
ШрадерН.И., ШайбаковаВ.Л., ЛихванцевВ.В., ЛевиковД.И., ЛевинО.С. Неврологические осложнения аортокоронарного шунтирования. Неврология и психиатрия им. С.С. Корсакова. 2012;3:76-81.
