To achieve this goal, the generally accepted methods of clinical and laboratory examination, score scales, statistical methods are used.
The prospective cohort study sequentially included, in three stages, 135 elderly patients who underwent surgery on the abdominal organs. In the first stage, the study included 30 patients who underwent routine surgery (comparison group), in the second stage - 45 patients who underwent emergency surgery (control group) and the third stage included 60 urgent patients with a high risk of delirium (research group). Patients in the study group underwent non - drug prevention of delirium and perioperatively used one of the techniques of regional analgesia, namely blockade of the anterior abdominal wall (subgroup RA, n = 20), epidural analgesia (subgroup EA, n = 20) and one of the types of regional combined block intravenous infusion of dexmedetomidine (subgroup RA + D, n = 20). Dexmedetomedin was administered as a continuous infusion on the first day after surgery at a rate of 0,1 mkg / kg / h. Target level of sedation 0, -1 point on the RASS scale.
All patients in the preoperative period were determined the level of wear, the risk of POD, cognitive impairment, the level of sedation and agitation, performed screening for delirium. After surgery, cognitive status was assessed daily in the morning, delirium was screened twice daily, and pain was assessed every 4 hours.
For the first time in Ukraine, preoperative screening among elderly patients in abdominal surgery has been scientifically substantiated and developed, which includes a combination of indicators, namely: level of cognitive impairment (Mini-Cog), wear (Frailty) and risk of POD (Delphi) to identify patients high risk of postoperative delirium and choice of management tactics.
For the first time in Ukraine, it has been scientifically substantiated and proven that the use of regional methods of postoperative analgesia optimizes the recovery of patients after abdominal surgery, primarily reducing the incidence of delirium, cognitive impairment and providing early mobilization.
Extended scientific data on the use of dexmedetomidine in elderly patients after surgery on the abdominal cavity to prevent postoperative delirium.
Updated scientific data on risk factors and their thresholds for initiating postoperative delirium in patients after surgery on the abdominal cavity for among: age over 78 years, baseline cognitive deficits with a score of Mini-Cog ≤ 3 points, wear (Frailty ≥ 3 points), inflammatory reaction of the body (leukocyte level 13,4 × 109 units / l) and postoperative analgesia with narcotic analgesics (OR 6,6 95 %, CI 1,62 – 27,5).
A routine preoperative risk assessment of postoperative delirium has been introduced to identify high-risk patients.
