The study of the clinical and phenomenological features of neurological complications of CSI, their comprehensive analysis and characterization, as well as the development of modern approaches to early diagnosis and prognosis of neurological pathology based on the data of these studies is an effective way to solve the problem of neurological complications of CSI, and has valid medical and social significance.
The aim of the work was to increase the effectiveness of prevention of neurological disorders in cardiosurgical interventions based on preoperative risk prediction and personalization of correction of neurological disorders, assessment of the severity of oxidative homeostasis disorders, taking into account the psychoneurological status of patients with the development of the structure and tools of perioperative neurological monitoring.
The study was conducted in three stages: in the first stage, 700 people were selected, they were treated at the State Institution "Heart Institute of the Ministry of Health of Ukraine" in connection with surgical pathology of the aorta, and those who underwent heart surgery with using artificial blood circulation; in the second stage, a clinical-neurological and psychometric examination of patients, instrumental and biochemical research and analysis of the results of these studies were carried out; in the third stage, prognostic models were developed and their verification was carried out based on the relevant arrays of patients, conclusions and practical recommendations for application were formulated in health care practice. Clinical and anamnestic, clinical-neurological, socio-demographic, instrumental (electroencephalography, magnetic resonance tomography and magnetic resonance spectroscopy, X-ray computed tomography, ultrasound duplex scanning of extra- and intracranial arteries); biochemical methods (research of gas and alkaline-acid homeostasis of blood and redox metabolism); psychometric (depression and anxiety scales by M. Hamilton; A. Beck depression questionnaire; Bass-Durkey aggressiveness questionnaire; symbol connection test; verbal speed test; Stroop test; Luria test for remembering ten unrelated words and method of assessing the quality of life of I. Mezzich et al., adapted by N. O. Maruta), catamnetic, statistical methods.
It was found out that the most common postoperative complication is postoperative cognitive dysfunction (72.0% of patients), postoperative encephalopathy (31.0%) is less common, and cerebral infarction is the least common (12.2%).
A criterion algorithm for preoperative risk assessment (prediction) of neurological disorders was substantiated and developed. It depends on significant clinical and anamnestic, as well as operative and technological factors, their prognostic potential and diagnostic value were determined, their ranking was performed, and the threatometric approach to certain forms of hypoxic-ischemic complications to ensure neurological accompanying cardiosurgical patients was substantiated. An algorithm and a visual-analogue scale for assessing the personalized risk of hypoxic-ischemic complications in general, as well as their individual nosological forms were developed. The reference values of the indicators for each of the scales have been determined. Based on the results of the study, we proposed a mathematical model for predicting the development of psychosocial maladjustment in patients who have undergone CSI in the conditions of the AV. It is based on a comprehensive assessment of three key vectors that can have a mutually potentiating pathogenetically related effect on the course of the postoperative period and the formation of PDA: surgical, neurological and psychopathological. The reference values of PDA indicators when applying the specified model were determined. A complex of diagnostic, corrective and preventive measures for each of the risk groups has been developed. Verification of the proposed model on a representative sample of patients confirmed its high predictive ability and reliability in use.
