clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2024-102-9-10-736-741clinmed-951Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESВлияние послеоперационной анестезии на когнитивные нарушения у пациентовThe effect of postoperative anesthesia on cognitive impairment in patientsКочубейникН. В.KochubeinikN. V.

Кочубейник Николай Владимирович — д-р мед. наук, доцент кафедры анестезиологии и реаниматологии, кафедра анестезиологии и реаниматологии

Ростов-на-Дону

Nikolay V. Kochubeinik – Doctor of Medical Sciences, Associate Professor of the Department of Anesthesiology and Resuscitation, Department of Anesthesiology and Resuscitation

Rostov-on-Don

https://orcid.org/0000-0001-9927-8798ГрошилинВ. С.GroshilinV. S.

Грошилин Виталий Сергеевич — д-р мед. наук, профессор, заведующий кафедрой хирургических болезней № 2

Ростов-на-Дону

Vitaly S. Groshilin – Doctor of Medical Sciences, Professor, Head of the Department of Surgical Diseases No. 2

Rostov-on-Don

https://orcid.org/0000-0003-1698-6479КубасовР. В.KubasovR. V.

Кубасов Роман Викторович — канд. биол. наук, доцент, доцент кафедры мобилизационной подготовки здравоохранения и медицины катастроф

Архангельск

Roman V. Kubasov – Candidate of Biology Sciences, Associate Professor, Associate Professor of the Department of Mobilization Preparation of Healthcare and Disaster Medicine

Arkhangelsk

romanas2001@mail.ruhttps://orcid.org/0000-0003-4195-273XЗакревскийЮ. Н.ZakrevskyYu. N.

Закревский Юрий Николаевич — д-р мед. наук, доцент, декан медицинского факультета

Мурманск

Yury N. Zakrevsky – Doctor of Medical Sciences, Associate Professor, Dean of the Faculty of Medicine

Murmansk

https://orcid.org/0000-0002-5833-0403ШатовД. В.ShatovD. V.

Шатов Дмитрий Викторович — канд. мед. наук, доцент, заведующий кафедрой судебной медицины

Ростов-на-Дону

Dmitriy V. Shatov –Candidate of Medical Sciences, Associate Professor, Head of the Department of Forensic Medicine

Rostov-on-Don

https://orcid.org/0000-0001-9683-7814КубасоваЕ. Д.KubasovaE. D.

Кубасова Елена Дмитриевна — канд. биол. наук, доцент, декан института фармакологии и фармации

Архангельск

Elena D. Kubasova – Candidate of Biology Sciences, Associate Professor, Dean of the Institute of Pharmacology and Pharmacy

Arkhangelsk

https://orcid.org/0000-0001-8345-0645ЛинченкоС. Н.LinchenkoS. N.

Линченко Сергей Николаевич — д-р мед. наук, профессор, заведующий кафедрой мобилизационной подготовки здравоохранения и медицины катастроф

Краснодар

Sergey N. Linchenko – Doctor of Medical Sciences, Professor, Head of the Department of Mobilization Preparation of Healthcare and Disaster Medicine

Krasnodar

https://orcid.org/0000-0003-4078-4850КоробицынА. П.KorobitsynA. P.

Коробицын Алексей Петрович — канд. мед. наук, доцент кафедры мобилизационной подготовки здравоохранения и медицины катастроф

Архангельск

Alexey P. Korobitsyn – Candidate of Medical Sciences, Associate Professor of the Department of Mobilization Preparation of Healthcare and Disaster Medicine

Arkhangelsk

ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov State Medical University of the Ministry of Health of the RussiaRussian FederationФГБОУ ВО «Северный государственный медицинский университет» Минздрава РоссииРоссияNorthern State Medical University of the Ministry of Health of the RussiaRussian FederationФГАОУ ВО «Мурманский арктический университет»РоссияMurmansk Arctic UniversityRussian FederationФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава РоссииРоссияKuban State Medical University of the Ministry of Health of the Russian FederationRussian Federation2024060220251029-10736741Copyright © Кочубейник Н.В., Грошилин В.С., Кубасов Р.В., Закревский Ю.Н., Шатов Д.В., Кубасова Е.Д., Линченко С.Н., Коробицын А.П., 20252025Кочубейник Н.В., Грошилин В.С., Кубасов Р.В., Закревский Ю.Н., Шатов Д.В., Кубасова Е.Д., Линченко С.Н., Коробицын А.П.Kochubeinik N.V., Groshilin V.S., Kubasov R.V., Zakrevsky Y.N., Shatov D.V., Kubasova E.D., Linchenko S.N., Korobitsyn A.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/951

Изучение проблемы послеоперационных когнитивных нарушений началось с первого момента применения анестезии. За многолетнюю историю наблюдений накоплено достаточно клинической информации, однако порой она противоречива и сложна для понимания. В большинстве случаев подтверждена связь между фактом хирургического вмешательства с применением наркоза и замедлением нейрокогнитивного восстановления у пациентов. До сих пор продолжается дискуссия о том, можно ли объяснить влияние анестезии на когнитивные способности самими анестетиками или же другими факторами.

Цель работы

Цель работы: с помощью нарративного обзора изучить современные представления о влиянии анестезии на возникновение когнитивных нарушений и развитие в дальнейшем когнитивных дисфункций.

Материал и методы

Материал и методы. Для анализа литературы использованы источники из международных баз данных Web of Science, Scopus, PubMed, а также отечественной библиотечной системы eLibrary.

Результаты и обсуждение

Результаты и обсуждение. Проведенный обзор позволил собрать результаты многолетних клинических наблюдений, а также экспериментальных исследований. Выдвинуто несколько гипотез о потенциальных механизмах, запускающих возникновение и развитие послеоперационных когнитивных расстройств, носящих общее название «послеоперационная когнитивная дисфункция». В частности, обращено особое внимание на изменение содержания Aβ- и Tau-белковых субстанций, повышение иммунологических маркеров воспаления, нарушение регуляции кальция, митохондриальную дисфункцию. Все эти механизмы нельзя рассматривать по отдельности. Они представляют собой комплекс взаимосвязанных, последовательных явлений. В связи с увеличением распространенности среди населения различных форм деменции существует необходимость более глубокого изучения потенциальных факторов, влияющих на послеоперационные когнитивные нарушения.

Выводы

Выводы. Перед современными исследователями стоит задача дальнейшего изучения факторов риска послеоперационных когнитивных нарушений, их систематизация, разработка и внедрение в клиническую практику. Новые подходы к анестезии при хирургических вмешательствах подразумевают модернизацию методик, снижающих потенциальный риск развития когнитивных дисфункций.

The study of the problem of postoperative cognitive impairment arose from the first moment of anesthesia usage. Over the long history of observations, enough clinical information has been accumulated, however, sometimes it is contradictory and difficult to understand. In most cases, the connection between the fact of surgical intervention with the use of anesthesia and a slowdown in neurocognitive recovery in patients has been confi rmed. There is still an ongoing debate about whether the effects on cognitive abilities can be explained either by the anesthetics themselves or by other factors.

The aim of the work is to use a narrative review to study modern ideas about the effect of anesthesia on the occurrence of cognitive impairment and the further development of cognitive dysfunctions.

Material and methods

Material and methods. To analyze the literature, sources from the international databases Web of Science, Scopus, PubMed, as well as the national library system eLibrary were used.

Results and discussion

Results and discussion. The review made it possible to collect the results of long-term clinical observations, as well as experimental studies. Several hypotheses have been put forward about the potential mechanisms triggering the occurrence and development of postoperative cognitive disorders, commonly referred to as postoperative cognitive dysfunction. In particular, special attention was paid to changes in the content of Aß- and Tau-protein substances, increased immunological markers of inflammation, impaired regulation of calcium, and mitochondrial dysfunction. All these mechanisms cannot be considered separately. It represents a complex of interrelated, consistent phenomena. Due to the increasing prevalence of various forms of dementia among the population, there is a need to solve the problem of a deeper study of potential factors affecting postoperative cognitive impairment.

Conclusions

Conclusions. Contemporary researchers are faced with the task of further studying the risk factors of postoperative cognitive impairment, their systematization, development and implementation in clinical practice. New methods of anesthesia in surgical interventions involve the modernization of techniques that reduce the potential risk of cognitive dysfunction.

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The authors declare that there are no conflicts of interest present.