r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2022-27-2-76-84r-n-j-300Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSВосстановление когнитивных функций и самообслуживания у пациентов, оперированных в остром периоде субарахноидального кровоизлияния вследствие разрыва церебральных аневризмRecovery of cognitive functions and self-service in patients with rupture of cerebral aneurysmshttps://orcid.org/0000-0001-8975-7875ШетоваИ. М.ShetovaI. M.

Москва

Moscow

shetova@gmail.comhttps://orcid.org/0000-0002-7584-3083ШтадлерВ. Д.ShtadlerV. D.

Москва; Пермь

Moscow; Perm

vladislav.shtadler@gmail.comhttps://orcid.org/0000-0002-1473-9901ГригорьевскийЕ. Д.Grigor’evskijE. D.

Москва

Moscow

Grigorevskiyed@gmail.comhttps://orcid.org/0000-0002-2864-9675ШатохинТ. А.ShatochinT. A.

Москва

Moscow

xshatokhinx@mail.ruhttps://orcid.org/0000-0003-4518-9874ЛукьянчиковВ. А.LukyanchikovV. A.

Москва

Moscow

vik-luk@yandex.ruhttps://orcid.org/0000-0003-1216-4566АроновМ. С.AronovM. S.

Москва

Moscow

mosesmoscow@yandex.ruhttps://orcid.org/0000-0001-5256-0905КрыловВ. В.KrylovV. V.

Москва

Moscow

manuscript@inbox.ruФГБОУ ВО «Московский государственный медицинский университет им. А.И. Евдокимова» МЗ РФРоссияA.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationФГБОУ ВО «Московский государственный медицинский университет им. А.И. Евдокимова» МЗ РФ; ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; ГАУЗ ПК «Городская клиническая больница №4»РоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry; N.V. Sklifosovsky Research Institute for Emergency Medicine; City Clinical Hospital №4Russian FederationФГБОУ ВО «Московский государственный медицинский университет им. А.И. Евдокимова» МЗ РФ,РоссияA.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationФГБОУ ВО «Московский государственный медицинский университет им. А.И. Евдокимова» МЗ РФ; ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry; N.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationФГБУ «ГЦН РФ Федеральный медицинский биофизический центр им. А.И. Бурназяна» ФМБА России; ФГБОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» МЗ РФРоссияA.I. Burnazyan Federal Medical Biophysical Center; I.M. Sechenov UniversityRussian Federation1ФГБОУ ВО «Московский государственный медицинский университет им. А.И. Евдокимова» МЗ РФ, Москва, Россия 2ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry; N.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation2022140520222727684Copyright © Шетова И.М., Штадлер В.Д., Григорьевский Е.Д., Шатохин Т.А., Лукьянчиков В.А., Аронов М.С., Крылов В.В., 20222022Шетова И.М., Штадлер В.Д., Григорьевский Е.Д., Шатохин Т.А., Лукьянчиков В.А., Аронов М.С., Крылов В.В.Shetova I.M., Shtadler V.D., Grigor’evskij E.D., Shatochin T.A., Lukyanchikov V.A., Aronov M.S., Krylov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/300

До настоящего времени отсутствует единый алгоритм ведения пациентов с последствиями субарахноидального кровоизлияния (САК) в отдаленном периоде.

Цель исследования

Цель исследования. Изучение влияния характера и тяжести САК, особенностей клинического проявления кровоизлияния, выбора методики вмешательства в остром периоде заболевания на отдаленные результаты лечения аневризм.

Материал и методы

Материал и методы. В отдаленном периоде, в средние сроки 3,5 года после аневризматического САК, обследованы 100 пациентов, которым выполнялось микрохирургическое вмешательство (n = 48), эндоваскулярное выключение аневризмы из кровотока (n = 14), симультанное вмешательство, включающее микрохирургическое вмешательство и наложение экстра-интракраниального сосудистого шунта (n = 23), а также микрохирургическое вмешательство с последующим введением фибринолитика в субарахноидальное пространство (n = 15).

Результаты

Результаты. Факторами риска неблагоприятного клинического восстановления пациентов, а также развития когнитивных и психических нарушений стали внутримозговая гематома, дислокационный синдром, длительность временного клипирования более 7 мин, объем интраоперационной кровопотери более 300 мл. Лучшее функциональное восстановление в отдаленном периоде было отмечено у пациентов, которым выполнили микрохирургическое клипирование аневризмы, дополненное выполнением хирургической реваскуляризации (р = 0,003).

Заключение

Заключение. Сохранение в течение длительного времени последствий хирургического вмешательства по поводу разрыва церебральных аневризм обусловливает необходимость длительного наблюдения пациентов, разработку индивидуальных программ физической и психологической реабилитации.

There is no unified management of patients with the consequences of subarachnoid hemorrhage in the long term.

Purpose of the study

Purpose of the study. To study the nature and severity of SAH, the clinical manifestation of hemorrhage, the choice of the intervention technique in the acute period of the disease for the long-term results of the treatment of aneurysms.

Materials and methods

Materials and methods. In the long-term period, at an average time of 3.5 years after aneurysmal subarachnoid hemorrhage, 100 patients were examined who underwent microsurgical intervention (n = 48), endovascular exclusion of the aneurysm from the bloodstream (n = 14), simultaneous intervention, including microsurgical intervention and extra-intracranial vascular bypass (n = 23), as well as microsurgical intervention followed by the introduction of a fibrinolytic agent into the subarachnoid space (n = 15).

Results

Results. Risk factors for unfavorable clinical recovery of patients, as well as the development of cognitive and mental disorders, were: intracerebral hematoma, dislocation syndrome, duration of temporary clipping more than 7 minutes, the volume of intraoperative blood loss of more than 300 ml. The best functional recovery in the long-term period was noted in patients who underwent microsurgical clipping of the aneurysm, supplemented by surgical revascularization (p = 0.003).

Conclusion

Conclusion. The results of our study demonstrated the persistence of the consequences of surgical intervention for the rupture of cerebral aneurysms for a long time, which necessitates long-term observation of patients, the development of individual programs of physical and psychological rehabilitation, and clinical examination of persons at high risk.

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