urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2023-22-5-5-13urmj-1322Research ArticleОригинальные статьи | Original articlesOriginal articlesДинамика липопероксидации и аминокислотного спектра у пациентов с делирием после интрамедуллярного остеосинтеза, перенесших эпидуральную анестезию ропивокаиномDynamics of lipoperoxidation and amino acid spectrum in patients with delirium after intramedullary osteosynthesis with ropivocaine epidural anesthesiahttps://orcid.org/0000-0002-9402-5203НедбайлоИ. Н.NedbailoI. N.

Игорь Николаевич Недбайло, заведующий отделением реанимации и интенсивной терапии, ассистент кафедры анестезиологии и реаниматологии

Челябинск

Igor N. Nedbailo, Head of the Intensive Care Unit, Assistant of the Department of Anaesthesiology and Intensive Care

Chelyabinsk

nedb-igor@yandex.ruhttps://orcid.org/0000-0002-8865-6412ШатроваЮ. М.ShatrovaJu. M.

Юлия Михайловна Шатрова, кандидат биологических наук, старший преподаватель кафедры биохимии им. Р.И. Лифшица, научный сотрудник НИИ иммунологии

Челябинск

Julia M. Shatrova, PhD (Biology), Senior Lecturer of the R.I. Lifshitz Department of Biochemistry, Researcher at the Research Institute of Immunology

Chelyabinsk

shatr20@yandex.ruhttps://orcid.org/0000-0002-6625-1457УльяновА. А.UlianovA. A.

Алексей Алексеевич Ульянов, врач анестезиолог-реаниматолог отделения реанимации и интенсивной терапии

Челябинск

Alexey A. Ulianov, Anaesthesiologist and Intensive Care Specialist in the Intensive Care Unit

Chelyabinsk

alexey.ulianov2014@yandex.ruhttps://orcid.org/0000-0001-6327-2685ШамаеваТ. Н.ShamaevaT. N.

Татьяна Николаевна Шамаева, математики, медицинской информатики, информатики и статистики, физики

Челябинск

Tat’jana N. Shamaeva, PhD (Pedagogy), Associate Professor of the Department of Mathematics, Medical Informatics, Computer Science and Statistics and Physics

Chelyabinsk

shamtan@rambler.ruЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian Federation202324102023225513Copyright © Недбайло И.Н., Шатрова Ю.М., Ульянов А.А., Шамаева Т.Н., 20232023Недбайло И.Н., Шатрова Ю.М., Ульянов А.А., Шамаева Т.Н.Nedbailo I.N., Shatrova J.M., Ulianov A.A., Shamaeva T.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1322Введение

Введение. Патогенез послеоперационного делирия, причины его возникновения, факторы, способствующие его развитию, остаются предметом дискуссий. Представляется перспективным исследование динамики липопероксидации, уровня кортизола и аминокислотного обмена у пациентов с развитием послеоперационного делирия. Подобные исследования позволят выявить диагностические и прогностические маркеры.

Цель работы – выявить различия в динамике процессов липопероксидации, аминокислотного баланса и уровня кортизола у пациентов с делирием и без делирия.

Материалы и методы

Материалы и методы. В исследование включен 41 пациент, оперированный по поводу перелома бедренной кости под эпидуральной анестезией. Всем пациентам ежедневно проводился тест Метод Оценки Спутанного Сознания. В случае его положительного результата был диагностирован делирий. Таким образом, выделены две группы: с послеоперационным делирием (n = 12) и без делирия (n = 29).

Результаты

Результаты. В группе делирия до операции выявлена относительная недостаточность уровня глюкокортикостероидов, определяемого по сниженному уровню кортизола (pU < 0,01), и угнетение процессов перекисного окисления липидов в виде снижения оснований Шиффа (pU = 0,01). Показатели аминокислотного обмена не имели значимых различий по основным пулам аминокислот. Интраоперационный период в обеих группах имел сходные характеристики, значимые отличия отсутствовали. В послеоперационном периоде угнетение липопероксидации в группе делирия менялось на большую ее активацию, которую определяли по повышенному уровню кетодиенов и сопряженных триенов в изопропанольную фазу (pU < 0,01). Также было отмечено увеличения пула ароматических (pU < 0,01) за счет увеличения содержания больших нейтральных аминокислот (фениаланина, pU = 0,0, триптофана, pU = 0,02, тирозина, pU < 0,01) и снижения пула алифатических (pU < 0,01). В группе делирия уровень кортизола оставался достоверно ниже (pU < 0,01).

Обсуждение

Обсуждение. Дооперационное снижение исследуемых показателей в группе делирия может свидетельствовать об исходном редуктивном стрессе. В послеоперационном периоде пациенты с делирием и без делирия по-разному проявляют метаболическую активность в отношении процессов липопероксидации и аминокислотного обмена, уровень кортизола остается достоверно меньше в группе делирия.

Заключение

Заключение. Развитию делирия способствуют исходный редуктивный стресс и толерантная стратегия адаптации.

Introduction The pathogenesis of postoperative delirium, its causes, and factors contributing to its development remain a subject of debate. We consider it promising to study the dynamics of lipoperoxidation, cortisol levels and amino acid metabolism in patients with postoperative delirium. Such studies will reveal diagnostic and prognostic markers.

The aim was to identify differences in the dynamics of lipoperoxidation, amino acid balance and cortisol levels in patients with and without delirium.

Materials and methods A total of 41 patients who underwent surgery for a femoral fracture under epidural anaesthesia were included in the study. All patients underwent a daily test, the Confused Consciousness Assessment Method. If it was positive, delirium was diagnosed; thus, two groups were identified: with postoperative delirium (n = 12) and without delirium (n = 29).

Results In the preoperative delirium group, there was a relative lack of glucocorticosteroids as measured by reduced cortisol levels (pU < 0.01) and inhibition of lipid peroxidation as reduced Schiff bases (pU = 0.01). There were no significant differences in amino acid metabolism of the major amino acid pools. The intraoperative period in both groups had similar characteristics and no significant differences. In the postoperative period inhibition of lipoperoxidation in the delirium group changed into its greater activation, which was revealed by increased levels of ketodienes and conjugated trienes in isopropanol phase (pU < 0.01). There was also an increase in the aromatic pool (pU < 0.01) due to an increase in large neutral amino acids (phenialanine, pU = 0.0, tryptophan, pU = 0.02, tyrosine, pU < 0.01) and a decrease in the aliphatic pool (pU < 0.01). Cortisol levels remained significantly lower in the delirium group (pU < 0.01).

Discussion The preoperative decrease in the studied indices in the delirium group may indicate initial reductive stress. In the postoperative period, patients with and without delirium differ in their metabolic activity with respect to lipoperoxidation and amino acid metabolism, and cortisol levels remain significantly lower in the delirium group.

Conclusion The development of delirium is facilitated by initial reductive stress and a tolerant adaptation strategy. 

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