Hypoxic-ischemic brain injuries in cardiosurgical patients
(rationale of causal connections)
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2022.1.12972Keywords:
hypoxic-ischemic lesions, embolism, hypoperfusion, systemic inflammatory response, anesthesiaAbstract
Summary. The presented article substantiates the materials on causation in the most common variants of hypoxic-ischemic brain lesions in cardiac surgery patients. The study showed that the functional changes assumed by the patient's brain (under the conditions of heart surgery using the resources of artificial circulation), reflects the state of the structural patterns of the whole organism.
The aim of the study – to analyze the clinical and anamnestic materials on pathogenetic prototypes of hypoxic-ischemic lesions that occur in patients as a result of cardiac surgery.
Materials and Methods. The materials were the results of anamnestic profile clinical examinations and observations of patients (n = 118) who were on routine hospitalization in the profile department of the State Institution "Heart Institute of the Ministry of Health of Ukraine" in Kyiv. The study used a thematic map of the patient, developed and processed by the author. Its content was related to clinical prototypes associated with the leading symptoms of the disease and contributed to the understanding of the pathogenetic mechanisms of the latter.
Results. The complex research, scientific-theoretical, methodological, and patent-licensing information on the specialty has shown that embolism is considered to be a priority mechanism for the development of hypoxic-ischemic lesions. Another important factor in the pathogenesis of hypoxic-ischemic disorders is hypoperfusion. One of the reasons for the development of stroke during cardiac surgery, especially in the surgical treatment of aortic pathology, is hypoperfusion due to instability of central hemodynamics. The next level of influence on systemic processes of development of hypoxic-ischemic defeats of the brain of cardiac surgery patients is the systemic inflammatory response. According to some researchers, CNS damage after cardiac surgery is largely due to side effects associated with the use of artificial circulation. An important point associated with the occurrence of hypoxic-ischemic changes in the brain is called general anesthesia. The technique of total intravenous and/or inhalation anesthesia does not provide adequate protection of CNS structures from intraoperative pain.
Conclusions. Analysis of clinical and anamnestic materials on pathogenetic prototypes of hypoxic-ischemic lesions that occur in patients as a result of cardiac surgery, shows the presence of a complex of pathogenetic components, among which the leading role is played by: embolism; hypoperfusion; systemic inflammatory response with changes in hemostasis and the use of an arsenal of general anesthesia.
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