The research is devoted to the study of the features of the disorders of cognitive functions after operations under general anesthesia in elderly and senile patients with acute surgical pathology of the abdominal cavity organs and the development of methods for their improvement. At the present time, when there is a clear tendency towards the post of the population, the problems of provision of effective medical care to the elderly are progressively becoming urgent. The aim of the study was to evaluate the state of cognitive functions and to develop a method for their correction in gerontological patients with acute surgical pathology by improving the methods of intensive care. The study included 96 patients of the elderly with acute surgical abdominal pathology, which was operated under general anesthesia. Three groups of research were formed depending on application of methods of restoration of cognitive functions after surgery. The group of patients in groups was randomized. The unevenness in the number of patients in the groups is due to the exclusion of a fraction of them from the study. The first group included 26 patients aged (74.4 ± 8.1) years. Among them are 9 men and 17 women. After surgery, patients did not receive any therapy, which would be specifically aimed at improving cognitive function. The second group included 34 patients at the age (74.0 ± 7.6) years. Among them are 14 men and 20 women. After surgery to restore cognitive function, patients received a nootropic drug with antioxidant properties of tiocetam. Morpholinium-methyl-thiazolyl-thioacetate and 2-OXO- 1-pyrrolidinecetamide was intended for this scheme. The saturation dose immediately after receiving the patients from the operating room to the intensive care unit was 25 ml. A maintenance dose of 25 ml per day was infused over a period of 7 days. Then the patients took the preparation for 2 tablets a day until the end of the month after the operation. The third group included 36 patients at the age (72.0 ± 7.4) years. Among them are 13 men and 23 women. After surgery to restore cognitive function, patients received a vitamin-antioxidant complex (VAC) containing amber acid, inosine, niacinamide and riboflavin. VAC after surgery was prescribed 10 ml twice daily infusion in 5% dextrose solution for 7 days. Then the patients took the preparation for 2 tablets a day until the end of the month after the operation. Neuropsychological tests were performed prior to surgery, and then on the first, second, fifth, twelfth and thirtieth day after it. Neuropsychological tests included: Mini-Mental State Examination (MMSE), battery of test for frontal dysfunction (BTFD), 5-word Test, Clock Test, and Schulte Test. Patients performed hemodynamic monitoring with the definition of indicators of central hemodynamics using integral tetrapolar rheography, respiration monitoring and pulse oxymetry, thermometry, blood glucose concentration, creatinine, urea, total bilirubin and its fractions, aminotransferase activity. Uniform methods of laboratory research were applied. The results of the study were processed using multiple scoring criteria and the Pearson linear correlation coefficient. As a result of the research, it was determined: In gerontological patients with acute surgical abdominal pathology in the preoperative period there is a decrease in the level of cognitive functions, which is expressed in the deterioration of the quality of performance of neuropsychological tests: the result of testing on the scale MMSE is (25,4 ± 1,5) points, for BTFD - (14, 8 ± 1,5) points, according to the clock drawing test - (9,1 ± 0,8) points, according to the test of 5 words - (9,2 ± 0,7) points, the execution time of the Schulte test - 46,1 ± 7 , 2 sec. The total cognitive deficit, calculated on the basis of our proposed method, was 0.67 ± 0.28 (norm - from 0 to 0.25). After the urgent operations on the abdominal cavity performed under general anesthesia with VIB on the basis of thiopental-sodium in gerontological patients develop a marked postoperative cognitive dysfunction, reaching the maximum on the first day after the operation, when the total cognitive deficiency increases to the level of severe 1.54 ± 0.35 Restoration of the preoperative level of cognitive function occurs only on the 30th day after surgery. The main factor determining cognitive deficiency in the preoperative period is the age of the patients. Pearson correlation coefficient between age and total cognitive deficits is 0.89 ± 0.02. In the postoperative period, the leading factor that causes post-operative cognitive dysfunction is the duration of the operation. Its influence is maximal on the first day (r = 0.91 ± 0.03) and is maintained, gradually weakening, to 30 days postoperative period (on the 2nd day r = 0.90 ± 0.04, on the 5th day r = 0.77 ± 0.038, on the 12th day r = 0.63 ± 0.12, on the 30th day r = 0.46 ± 0.15). The second most significant factor affecting the severity of cognitive dysfunction is the intensity of stress responses, which is evaluated by the level of glycemia. The maximum relationship between glycemia and total cognitive deficiency reaches the 2nd day (r = 0.65 ± 0.11), it becomes weak at day 5 (r = 0.34 ± 0.17) and then disappears. Dependence on age in the postoperative period becomes weak and reversible in relation to the preoperative period, that is, in older patients, the increase in cognitive deficit is less pronounced than in younger gerontological patients (the correlation coefficient between age and the total cognitive deficiency in the 1 st day is 0.25 ± 0, 18, in the 2nd day - 0.31 ± 0.18, then it loses significance). This indicates a greater vulnerability of cognitive functions of younger patients and their lower plasticity in the elderly. Morpholinium-methyl-thiazolyl-thioacetate and 2-OXO-1-pyrrolidinecetamide, a combination of a nootropic antioxidant, and a VAC as a combination of metabolites with coenzymes, greatly accelerate the restoration of cognitive functions and improve their condition compared with the original in gerontological patients with acute surgical abdominal pathology. Restoration of the initial level of cognitive functions in the application of these drugs is already on the 5th day after the operation, and up to 30 days this level significantly exceeds the original, and the VAS provides a significantly lower cognitive deficiency. When using tiocetam, the total cognitive deficit to 30 days is 0.40 ± 0.20, while in the appointment of VAC 0.31 ± 0.11 (p <0.05). This occurs primarily due to the reduction of the duration of the operation on the level of cognitive functions, and when injected thiocetam this effect disappears on the 12th day, and when the introduction of VAC - already on the 2nd day. The results obtained suggest that Morpholinium-methyl-thiazolyl-thioacetate and 2-OXO-1-pyrrolidinecetamide and VAC effectively regulate postoperative cognitive dysfunction, with VAC superior to tiocetam in this respect. In addition, the VAC is devoid of the inherent tiocetam negative effects, which is the ability to cause, in some cases, the excitation of the central nervous system. All this makes it possible to recommend VAC for the correction of postoperative cognitive dysfunction in gerontological patients with acute surgical abdominal pathology.
