AIM OF RESEARCH: To estimate the cognitive status dynamics ofpatients during the early postoperative period after cardiac interventions and to reveal predictors of cognitive functions deterioration at this category of patients.
Materials and methods: 118 cardiac patients were tested of neurocognitive functions one days before operation, and then for the 2-3rd days after operation by means of the MMSE test, the FAB test, Shulte's test, a questionnaire of a depression of CES-D, the BATTERY OF FRONTAL DYSFUNCTION TEST. Data of the perioperation's period was analyzed.
Results: Deterioration of results in the 2nd and more tests were registered at 61% of patients. The main distinctions between patients with postoperative deterioration of testing results and without it were: parameters of mehanical ventilation (tidal volume/ideal body weight, airways pressure), initial condition and existence of signs of initial deficit of blood circulation (decrease in the cardiac index and O2 delivery, increase of level of a lactate), decrease in cerebral oksimetry, existence of respiratory alkalosis dekompensation during CPB. Administration of the Dopamine before CPB and use of Desfluran demonstrated the positive influence to the cognitive status.
Conclusions: 1) Neurocognitive dysfunction during the early postoperative period after cardiac surgery is tipical for 30-70% of patients. 2) The most significant predictors of deterioration of neurocognitive function in the postoperative period are the excessive depth of anesthesia and significant intraoperative decrease in the cerebral oxygenation. 3) Influence of the mehanical ventilation parameters on postoperative neurocognitive function is revealed, use of the large tidal volumes is especially negative. 4) Existence of the blood circulation deficit and decrease in oxygen delivery without timely intraoperative correction, and also an intraoperative hyperglycemia worsen a neurocognitive function in the postoperative period. 5) Desfluran administration has positive impact on the neurocognitive function.