Cognitive functions in the acute period of polytrauma and correction of their disorders with thiocetam.
DOI:
https://doi.org/10.26641/2307-0404.2017.3.111927Ключові слова:
cognitive disorders, polytrauma, posttraumatic stress disorder, thiocetamАнотація
Aim of the work – to evaluate the effectiveness of thiocetam as a medicine that prevents cognitive impairments in patients with polytrauma, as well as to compare the scales of cognitive function assessment - MoCA and MMSE. We examined 50 victims with polytrauma without severe intracranial lesions, randomly divided into a control group (26 patients) and a main (24 patients) group. Patients of the control group received conventional intensive therapy for traumatic illness, patients of the main group in addition to this therapy received thiocetam. The somatic status was assessed according to the generally accepted clinical and laboratory indicators. The level of cognitive functions before the injury was assessed by the CFQ questionnaire for 2-3 days after the injury; The MoCA and MMSE scales were used on the 2nd day, when patients weretransferred from the intensive care unit and before the discharge. The severity of injury was assessed by the ISS scale. The severity of the response to traumatic stress was assessed by the IES-R scale. In both groups, the baseline level of cognitive function was within the age range. On the second day after the trauma, significant inhibition of cognitive functions in both groups was noted, but in the maingroup this decrease was unreliably less. At subsequent stages a gradual increase in both groups was noted, however, in the main group recovery of cognitive functions occurred more rapidly. After 3 months, decrease in cognitive functions preserved at a level when patients were discharged from the hospital. In the maingroup there were significantly fewer patients whose posttraumatic stress after 3 months increased from minimal to low. When using the MoCA scale, there was a more pronounced decrease in cognitive functions than with the MMSE scale, but it in the less degree consider peculiarities of thinking. Thiocetam prevents the decrease of cognitive functions in patients with polytrauma and, due to that, also reduces the severity of posttraumatic stress reaction. For practical using in intensive care units it is preferable to use the MMSE scale.
Посилання
Volkov AO, Kligunenko EN,VetoshkaIA[How to assess cognitive function before caesarean section?]. Sovremennyje problemy nauki i obrazovanija. 2014;3. Available from: https://science-education.ru/ru/article/view?id=13474. Russian.
Kozlovskjy VI, Konevalova NYu, Kozlovskaja SP. [The new cytoprotector tiotriazolin]. Vestnik farmacii. 2007;4(38);55-59. Available from: http://elib.vsmu.by/bitstream/123/7101/1/vf_2007_4_55-59.pdf. Russian.
Krishtafor AA. [Cognitive impairment due to critical conditions, as a manifestation of cerebral insufficiency]. Medycina nevidkladnyh staniv. 2015;2(65). Available from: http://cyberleninka.ru/article/n/kognitivnye-narusheniya-obuslovlennye-kriticheskimi-sostoyaniyami-kak-proyavlenie-tserebralnoy-nedostatochnosti. Russian.
Melnickaja TB, Havylo AV, Belyh TV. [Scale of the impact of the traumatic event (IES-R) as applied to the radiation factor]. Psihologicheskie issledovanija: elektronnyj nauchnyj zhurnal. 2011;5(19). Available from: http://psystudy.ru/index.php/num/2011n5-19/546-melnitskaya-et-al-19.html. Russian.
UsenkoLV, Krishtafor AA, Polinchuk IS, Tuytuynnik AG, UsenkoAA, Petrashenok EV. [Postoperative cognitive disorders as a complication of general anesthesia. The importance of early pharmacological neuroprotection]. Medycina nevidkladnyh staniv. 2015;2(65). Available from: http://cyberleninka.ru/article/n/posleoperatsionnye-kognitivnye-rasstroystva-kak-oslozhnenie-obschey-anestezii-znachenie-ranney-farmakologicheskoy-neyroprotektsii. Russian.
UsenkoLV, Rizk ShE, Krishtafor AA, Kanjuka GS, Kushh IP. [Prophylaxis and correction of postoperative cognitive dysfunctions in elderly patients (methodical recommendations)]. Mezhdunarodnyj nevrologicheskij zhurnal. 2008;3(19):99-110. Russian.
Rumjanceva SA. [Neurological disorders in multiorgan insufficiency syndrome]. Nervnye bolezni. 2003:2. Available from: http://cyberleninka.ru/article/n/nevrologicheskie-rasstroystva-pri-sindrome-poliorgannoy-nedostatochnosti. Russian.
TarabrinaNV. [Workshop on the psychology of post-traumatic stress]. SPb:Piter. 2001;272. Russian.
UsenkoLV, Rizk ShE, Krishtafor AA. [Postoperative cognitive dysfunction as an anesthetic problem and ways to solve it]. Bil’, zneboluvannja i intensyvna terapia. 2008;4:14-20. Russian.
Farshatov RS, Kil’debekova RN. [Quality of life intensive care patients as one of the most important indicators of the effectiveness of intensive therapy]. Journal Medicina. 2016;2:23-31. Russian.
Dunajev VV, Gubskjy YuI, Belenichev IF, et al. [Cerebroprotective effects of antioxidants in neurodegenerative disorders due to toxic effects of oxygen radicals]. Sovremennyje problemy toksikologii. 2004;1:7-14. Russian.
Beth Skwarecki. Delirium in ICU Patients Linked to Mortality, Longer Stays Medscape; 2015. Available from: http://www.medscape.com/viewarticle/845901.
Holsinger T, Deveau J, Boustani M, Williams JW. Does This Patient Have Dementia? JAMA. 2007;297(21):2391-404. doi: 10.1001/jama.297.21.2391.
Salluh JIF, Wang H, Schneider EB, Nagaraia N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015;350. doi: https://doi.org/10.1136/bmj.h2538 (Published 03 June 2015).
Baker S, O’Niell B, Haddon W, Long W. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187-96.
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. TheMontrealCognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. Journal of the American Geriatrics Society. 2005;53(4):695-99. doi: 10.1111/j.1532-5415.2005.53221.
##submission.downloads##
Як цитувати
Номер
Розділ
Ліцензія
Авторське право (c) 2017 Медичні перспективи
Ця робота ліцензується відповідно до Creative Commons Attribution 4.0 International License.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.