Pažintinių funkcijų sutrikimai ir delyras po širdies operacijų dirbtinės kraujo apytakos sąlygomis: rizikos veiksniai ir prevencija
Apžvalga / Review
Pažintinių funkcijų sutrikimai ir pooperacinis delyras po širdies operacijos yra neretai pasitaikanti perioperacinė komplikacija. Delyro išsivystymas pooperaciniu laikotarpiu didina pacientų perioperacinio sergamumo ir mirtingumo riziką. Atviros širdies operacijos dažnai atliekamos naudojant dirbtinę kraujo apytaką, o tai yra viena iš pagrindinių priežasčių, lemiančių pooperacinių kognityvinių komplikacijų pasireiškimą. Siekiant išvengti šių komplikacijų, reikia tinkamai atpažinti ir valdyti rizikos veiksnius bei taikyti prevencijos priemones, kurios apima medikamentinį ir nemedikamentinį būdus.
Cognitive decline and postoperative delirium after cardiac surgery are widely recognized occurrences. The development of delirium increases the risk of mortality in patients. Intraoperative cardiopulmonary bypass is often performed during heart surgery, further increasing the risk of cognitive impairment and postoperative delirium. To avoid this complication, it is necessary to properly identify and manage the risk factors. Additionally, preventive measures, including medicinal and non-medicinal methods, should be applied to patients. Aim: to review the risk factors and prevention for cognitive decline and delirium after cardiac surgery under cardiopulmonary bypass. Methods and materials: the literature search was performed in the computerized bibliographic databases of PubMed and ScienceDirect. Keywords and their combinations were used: cognitive decline after cardiac surgery, delirium after cardiac surgery, risk factors for cognitive decline and cardiac surgery, cognitive decline prevention and cardiac surgery, cardiopulmonary bypass. Conclusion. 1. The main risk factors for cognitive decline and delirium after cardiac surgery under cardiopulmonary bypass are old age, carotid stenosis, diabetes and depression. Old age are non – modifiable risk factor, but other risk factors should be optimally controlled. 2. Dexmedetomidine and melatonin can be an effective medication to prevent postoperative cognitive decline and delirium, but more studies should be provided. Physiotherapy and cognitive training are effective non-medicated prevention of cognitive decline and delirium after cardiac surgery.