Послеоперационные нейрокогнитивные расстройства: некоторые итоги почти 400-летней истории вопроса (обзор)

История изучения послеоперационных нейрокогнитивных расстройств (ПНР) представляет собой тернистый путь длиною более 400 лет. Несмотря на накопленные данные о факторах риска и исходах, полного понимания этиологии и патогенеза данного осложнения в настоящее время не достигнуто. Более того, современная анестезиология-реаниматология по-прежнему сталкивается со сложностями и вопросами в области диагностики и классификации послеоперационных нейрокогнитивных расстройств.

Цель обзора. Рассмотреть процесс изменения представлений международного медицинского сообщества относительно структуры и методов диагностики послеоперационных нейрокогнитивных расстройств.

В обзоре отразили историю развития представлений о таких ПНР, как послеоперационный делирий, послеоперационная когнитивная дисфункция, ажитированное и делириозное пробуждение после анестезии (emergence agitation, emergence delirium). Также, в хронологическом порядке обсудили существовавшие ранее и актуальные международные классификации послеоперационных нейрокогнитивных расстройств, дополненные обсуждением их сильных и слабых сторон. В работе затронули вопрос современных представлений об этиологии ряда ПНР, а также — их связи с послеоперационными исходами.

Заключение. Современные представления о структуре и методах диагностики ПНР являются новым, но не финальным этапом работы международного медицинского сообщества. Наиболее малоизученной темой являются ранние послеоперационные нейрокогнитивные расстройства, для которых отсутствуют как утвержденные определения, так и методы диагностики. Вероятно, настало время для объединения научного медицинского сообщества для поиска ответов на актуальные нерешенные вопросы относительно послеоперационных нейрокогнитивных расстройств.

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