A dissertation is devoted to the research of the problem of cognitive disorders caused by surgical intervention and critical conditions, substantiating and introducing into clinical practice prevention methods of these disorders and cognitive functions restoration.
The aim of the work is to improve the quality of life of patients who underwent surgery or experienced critical condition caused by major trauma, by preventing persistent cognitive dysfunction in the distant period, based on determining the impact of post-operative surgery or critical condition and associated stress on cognitive functions and developing pharmacological methods of prevention and treatment of cognitive disorders in complex of intensive care.
The study presents the results of the examination and treatment of 1090 patients, of whom 785 were examined retrospectively and 305 - prospectively. Retrospective data provided insight into the contemporary nature and severity of civilian trauma at tertiary care centers and allowed the selection criteria to be developed for the prospective part of the study. Prospective patients with the operative, civilian, and combat injuries were randomized to control groups and groups using cerebroprotective medications - reamberin, thiocetam, and gliatilin.
Study results allow us to consider ataralgesia an effective method of analgesia in elderly patients. However, its negative impact on cognitive functions with the development of persistent POCD was revealed. Civil and combat injuries adversely affect the victim’s condition due to hyperdynamic circulation, toxic effects of muscle destruction products and psycho-emotional stress response, which causes cognitive disorders in the early post-critical period and persistent cognitive dysfunction. Chronic stress, which precedes combat trauma and exacerbates it in the long term, has a more pronounced effect on cognitive functions than acute stress in civilian trauma, resulting in combat trauma more often causing persistent and more severe cognitive dysfunction. The investigated cerebroprotective medications prevented cognitive dysfunction development. Reamberin had a rapid but short-term clinical effect, whereas thioacetam and gliatilin effect began more slowly but lasted in the long term. It was determined that civilian and combat trauma victims had more pronounced cognitive impairment than patients with surgical trauma and general anesthesia. The acute stress that accompanies civilian trauma has a negative effect on average cognitive function (rs = -0.4844; p = 0.00238). At the same time, chronic stress, which is the background when receiving trauma in combat, has a greater impact on cognitive functions (rs = -0.6110; p = 0.00250). The use of cerebroprotective medications in the injured partially reduced the dependence of cognitive functions on the duration and severity of psycho-emotional stress response, although this correlation was still significant. Surgery in the elderly and critical conditions associated with civilian or combat trauma causes a decline in both physical and mental components of the quality of life. The impact of these conditions on the physical component of health mostly regarded independence from pain at home and in professional activity. The use of investigational medications improved the quality of life of patients in the long term.
Keywords: cognitive dysfunction, critical condition, operative trauma, civilian trauma, combat trauma, thiocetam, reamberin, gliatilin.
