Lutsyk S. Intensive care of cognitive disorders in patients with acute myocardial infarction of working age

The paper presents a solution to the current clinical problem of modern anesthesiology - increasing the effectiveness of treatment of elderly patients with initial chronic heart failure by developing methods to improve perioperative analgesia and prevention of cerebral complications during anesthesia and intensive care in the perioperative period. The study included 90 elderly patients (71.2 ± 2.6 years) with surgical pathology of the abdominal cavity (bowel cancer) who underwent elective surgery - organ-sparing surgery with lymph node dissection D2-D3 - under general anesthesia with artificial lung ventilation. The selection of patients was based on the criteria of inclusion and exclusion. The diagnostic value of MPN level in the blood, the level of pain on the VAS scale, the concentration of cortisol and endothelin -1 in the blood depending on the daily need for analgesics, the frequency of their administration, the duration of effective analgesia, and studied the relationships between the indicators. The relationships of these indicators with the effect of analgesics proposed in the groups and the severity of PKD in the studied patients were studied. These changes allowed to understand the mechanism of influence of pathogenetic manifestations of pain syndrome on the background of compromised background chronic heart failure endothelium on cognitive abilities of patients, primarily integrative function of higher nervous activity, short-term memory, emotional sphere, stability of attention. Addition to the standard protocol of perioperative intensive care as analgesia nalbuphine hydrochloride and L-arginini solution in elderly patients with baseline CHF reduces the number of cardiac complications in the postoperative period in 2 times, cases of postoperative delirium more than 1.5 times, contributes to cognitive disorders