Журнал Современные проблемы науки и образования

2070-7428

Общество с ограниченной ответственностью "Издательский Дом "Академия Естествознания"

10.17513/spno.34686

ART-34686

КОМПЛЕКСНАЯ СТРАТЕГИЯ ПРОФИЛАКТИКИ ПОСЛЕОПЕРАЦИОННЫХ НЕЙРОКОГНИТИВНЫХ РАССТРОЙСТВ У ПОЖИЛЫХ ПАЦИЕНТОВ: НАРРАТИВНЫЙ ОБЗОР ЛИТЕРАТУРЫ

Романов

А.В.

Romanov

A.V.

Saha_ro@mail.ru

Трембач

Н.В.

Trembach

N.V.

trembachnv@mail.ru

Краснодарский филиал ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России S Fyodorov Eye Microsurgery State Institution, Krasnodar, Russia ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России Kuban State Medical University, Krasnodar, Russia ГБУЗ «Краевая клиническая больница № 2» Минздрава Краснодарского края Krasnodar Regional Clinical Hospital No 2

10 07 2026

7 12 12

This is an open-access article distributed under the terms of the CC BY 4.0 license.

https://science-education.ru/ru/article/view?id=34686

Ограниченный спектр терапевтических методов лечения послеоперационных нейрокогнитивных расстройств, а также экономические последствия, связанные с увеличением продолжительности пребывания пациентов в стационаре, снижением качества их жизни и повышением уровня смертности, указывают на то, что профилактика развития этих осложнений является более предпочтительным подходом по сравнению с лечением уже возникших осложнений. Цель исследования: провести анализ данных современной научной литературы по методам профилактики периоперационных нейрокогнитивных расстройств у пациентов пожилого возраста. Для изучения современной научной базы проводился поиск публикаций в базах данных PubMed, Google Scholar и российской научной электронной библиотеке eLIBRARY.RU за период с января 2020 года по апрель 2026 года включительно; последняя дата поиска - 1 мая 2026 года. Дополнительно были включены отдельные ключевые публикации 1999–2019 годов, имеющие фундаментальное значение для рассматриваемой проблемы. Профилактика периоперационных нейрокогнитивных расстройств у пожилых пациентов и пациентов высокого риска должна включать своевременную диагностику, стратификацию риска и коррекцию модифицируемых факторов в периоперационном периоде. Основу профилактики составляют многокомпонентные нефармакологические вмешательства; фармакологические подходы следует рассматривать селективно, с учетом профиля безопасности, риска брадикардии/гипотензии и неоднородности доказательной базы. Комплекс мероприятий необходимо адаптировать к индивидуальным характеристикам пациента.

The limited range of therapeutic options for postoperative neurocognitive disorders, together with the economic burden associated with prolonged hospital stay, reduced quality of life, and increased mortality, indicates that prevention is a more effective strategy than the treatment of established complications. The aim of this study was to analyze current scientific evidence on strategies for the prevention of perioperative neurocognitive disorders in older patients. A literature search was conducted in PubMed, Google Scholar, and the Russian Science Citation Index (eLIBRARY.RU) for publications issued from January 2020 through April 2026, with the final search performed on May 1, 2026. In addition, selected key publications published between 1999 and 2019 that were considered fundamental to the topic were included. Prevention of perioperative neurocognitive disorders in older and high-risk patients should include timely diagnosis, risk stratification, and correction of modifiable perioperative risk factors. Multicomponent non-pharmacological interventions should constitute the cornerstone of preventive strategies, whereas pharmacological approaches should be considered selectively, taking into account their safety profile, the risk of bradycardia and hypotension, and the heterogeneity of the available evidence. Preventive measures should be individualized according to each patient’s clinical characteristics.

нейрокогнитивные расстройства периоперационный период нейропсихологические тесты хрупкость пожилой делирий профилактические программы в области здравоохранения дексмедетомидин

neurocognitive disorders perioperative period neuropsychological tests frailty aged delirium preventive health program dexmedetomidine

1. Ren X, Huiqiao L, Wu Y, Zhang T, Chen P, Li L, Zhao G, Wang F. Perioperative neurocognitive disorders: a comprehensive review of terminology, clinical implications, and future research directions. Front Neurol. 2025 Aug 26;16:1526021. DOI: 10.3389/fneur.2025.1526021.

2. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, Oh ES, Crosby G, Berger M, Eckenhoff RG. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology. 2018;129(5):872-879. DOI: 10.1097/ALN.0000000000002334.

3. Dilmen OK, Meco BC, Evered LA, Radtke FM. Postoperative neurocognitive disorders: A clinical guide. J Clin Anesth. 2024 Feb;92:111320. DOI: 10.1016/j.jclinane.2023.111320.

4. Ma L, Jasem HJ, Gu WJ, Zeng Q, Wang X, Liu XD. Postoperative neurocognitive disorders in the elderly: how can we stop the harm? A literature review. Front Med (Lausanne). 2025 Mar 6;12:1525639. DOI: 10.3389/fmed.2025.1525639.

5. Abess AT, Deiner SG, Briggs A, Whitlock EL, Charette KE, Chow VW, Shaefi S, Martinez-Camblor P, O'Malley AJ, Boone MD. Association of neurocognitive disorders with morbidity and mortality in older adults undergoing major surgery in the USA: a retrospective, population-based, cohort study. Lancet Healthy Longev. 2023 Nov;4(11):e608-e617. DOI: 10.1016/S2666-7568(23)00194-0.

6. Freud T, Vostrikov A, Dwolatzky T, Punchik B, Press Y. Validation of the Russian Version of the MoCA Test as a Cognitive Screening Instrument in Cognitively Asymptomatic Older Individuals and Those With Mild Cognitive Impairment. Front Med (Lausanne). 2020 Aug 13;7:447. DOI: 10.3389/fmed.2020.00447.

7. Huang J, Zheng H, Zhu X, Zhang K, Ping X. The efficacy and safety of haloperidol for the treatment of delirium in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2023 Jul 27;10:1200314. DOI: 10.3389/fmed.2023.1200314.

8. Page VJ, Ely EW, Gates S, Zhao XB, Alce T, Shintani A, Jackson J, Perkins GD, McAuley DF. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2013 Sep;1(7):515-523. DOI: 10.1016/S2213-2600(13)70166-8.

9. Pennings CH, Van Boxtel M, De Korte-De Boer D, Buhre W, Vossen CJ. Anaesthesia as a risk factor for long-term cognitive decline: Results of the prospective MAAS cohort study. Eur J Anaesthesiol. 2025 May 1;42(5):468-477. DOI: 10.1097/EJA.0000000000002133.

10. Liu H, Chen J, Ling J, Wu Y, Yang P, Liu X, Liu J, Zhang D, Yin X, Yu P, Zhang J. The association between diabetes mellitus and postoperative cognitive dysfunction: a systematic review and meta-analysis. Int J Surg. 2025 Mar 1;111(3):2633-2650. DOI: 10.1097/JS9.0000000000002156.

11. Densky J, Eskander A, Kang SY, Chan J, Tweel B, Sitapara J, Ozer E, Agrawal A, Carrau R, Rocco JW, Teknos TN, Old M. Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction. JAMA Otolaryngol Head Neck Surg. 2019;145(3):216–221. DOI: 10.1001/jamaoto.2018.3820.

12. Wu H, Yan S, Cao H, Feng C, Zhang H. Unraveling the impact of frailty on postoperative delirium in elderly surgical patients: a systematic review and meta-analysis. BMC Anesthesiol. 2025 Mar 6;25(1):114. DOI: 10.1186/s12871-025-02994-3.

13. Khaled M, Sabac D, Fuda M, Koubaesh C, Gallab J, Qu M, Lo Bianco G, Shanthanna H, Paul J, Thabane L, Marcucci M. Postoperative pain and neurocognitive outcomes after noncardiac surgery: a systematic review and dose-response meta-analysis. Br J Anaesth. 2025 Jan;134(1):89-101. DOI: 10.1016/j.bja.2024.08.032.

14. Travica N, Lotfaliany M, Marriott A, Safavynia SA, Lane MM, Gray L, Veronese N, Berk M, Skvarc D, Aslam H, Gamage E, Formica M, Bishop K, Marx W. Peri-Operative Risk Factors Associated with Post-Operative Cognitive Dysfunction (POCD): An Umbrella Review of Meta-Analyses of Observational Studies. J Clin Med. 2023 Feb 17;12(4):1610. DOI: 10.3390/jcm12041610.

15. Yang Y, Zhao X, Gao L, Wang Y, Wang J. Incidence and associated factors of delirium after orthopedic surgery in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. 2021; 33(6): 1493-1506.DOI: 10.1007/s40520-020-01674-1.

16. Ros-Nebot B, Rodiera-Olivé J, Verdera-Roig M, Tril-Queralt C, Pradas-Abadía A, Julián-González S, Falcó-Pegueroles A. Cognitive Training to Reduce Memory Disturbance Associated With Postoperative Cognitive Impairment After Elective Noncardiac Surgery: An Experimental Study. J Perianesth Nurs. 2024 Aug;39(4):558-566. DOI: 10.1016/j.jopan.2023.10.016.

17. Gao Y, Liu L, Zhao B, Wang Y, Yu S, Wang H. Effect of General and Non-general Anesthesia on Postoperative Cognitive Dysfunction. J Coll Physicians Surg Pak. 2020 Apr;30(4):407-411. DOI: 10.29271/jcpsp.2020.04.407.

18. Aldecoa C., Bettelli G., Bilotta F., Sanders R.D., Aceto P., Audisio R., Cherubini A., Cunningham C., Dabrowski W., Forookhi A., et al. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur. J. Anaesthesiol. 2024;41:81–108. DOI: 10.1097/EJA.0000000000001876.

19. Humeidan ML, Reyes JC, Mavarez-Martinez A, Roeth C, Nguyen CM, Sheridan E, Zuleta-Alarcon A, Otey A, Abdel-Rasoul M, Bergese SD. Effect of Cognitive Prehabilitation on the Incidence of Postoperative Delirium Among Older Adults Undergoing Major Noncardiac Surgery: The Neurobics Randomized Clinical Trial. JAMA Surg. 2021 Feb 1;156(2):148-156. DOI: 10.1001/jamasurg.2020.4371.

20. Ekici HS, Collins J, Kafadar AH, Yildirim MC, Phillips BE, Gordon AL. The effect of pre-operative exercise training on post-operative cognitive function: a systematic review. Eur Geriatr Med. 2024 Oct;15(5):1259-1266. DOI: 10.1007/s41999-024-01028-4.

21. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999 Mar 4;340(9):669-676. DOI: 10.1056/NEJM199903043400901.

22. Kojaie-Bidgoli A, Sharifi F, Maghsoud F, Alizadeh-Khoei M, Jafari F, Sadeghi F. The Modified Hospital Elder Life Program (HELP) in geriatric hospitalized patients in internal wards: A double-blind randomized control trial. BMC Geriatr. 2021 Oct 26;21(1):599. DOI: 10.1186/s12877-021-02520-3.

23. Chen B, Wang M, He Q, Wang Y, Lai X, Chen H, Li M. Impact of frailty, mild cognitive impairment and cognitive frailty on adverse health outcomes among community-dwelling older adults: A systematic review and meta-analysis. Front Med (Lausanne). 2022 Oct 31;9:1009794. DOI: 10.3389/fmed.2022.1009794.

24. Susano MJ, Grasfield RH, Friese M, Rosner B, Crosby G, Bader AM, Kang JD, Smith TR, Lu Y, Groff MW, Chi JH, Grodstein F, Culley DJ. Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery. Anesthesiology. 2020 Dec 1;133(6):1184-1191. DOI: 10.1097/ALN.0000000000003523.

25. Chan JY, Singh BSS, Nachiappan R, Mohd Faizal NFJ, Song ZX, Mohd FH, Abdullah FH, Izaham A. Effect of Reversal Agents on Postoperative Cognitive Disorders Following General Anesthesia in the Elderly Population: A Systematic Review and Meta-Analysis. Diagnostics (Basel). 2026 Feb 11;16(4):535. DOI: 10.3390/diagnostics16040535.

26. Luo X, Li D. Effects of epidural block anesthesia combined with general anesthesia on inflammatory factors, cognitive function and postoperative pain in patients with lung cancer after thoracoscopic surgery. Am J Transl Res. 2021 Nov 15;13(11):13024-13033. PMID: 34956520;

27. Bhushan S, Huang X, Duan Y, Xiao Z. The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis. Int J Surg. 2022 Sep;105:106854. DOI: 10.1016/j.ijsu.2022.106854.

28. Alhamdah Y, Li WY, Nagappa M, Yan E, He D, Sarieplla A, Englesakis M, Elias Z, Chan MTV, Wang DX, Chung F. Perioperative approaches to prevent delayed neurocognitive recovery and postoperative neurocognitive disorder in older surgical patients: A systematic review and meta-analysis of randomized controlled trials. J Anaesthesiol Clin Pharmacol. 2025 Jan-Mar;41(1):3-14. DOI: 10.4103/joacp.joacp_396_23.

29. Ding Y, Yu J, Cui F, Li J. Comparison of Intravenous and Inhalational Anesthetic on Postoperative Cognitive Outcomes in Elderly Patients Undergoing Cancer Surgery: Systematic Review and Meta-analysis. J Perianesth Nurs. 2022 Oct;37(5):683-690. DOI: 10.1016/j.jopan.2021.11.017.

30. Pang QY, Duan LP, Jiang Y, Liu HL. Effects of inhalation and propofol anaesthesia on postoperative cognitive dysfunction in elderly noncardiac surgical patients: A systematic review and meta-analysis. Medicine (Baltimore). 2021 Oct 29;100(43):e27668. DOI: 10.1097/MD.0000000000027668.

31. Chen X, Li L, Yang L, Li A, Wu M, Yu D. A randomized trial: bispectral-guided anesthesia decreases incidence of delayed neurocognitive recovery and postoperative neurocognitive disorder but not postoperative delirium. Am J Transl Res. 2022 Mar 15;14(3):2081-2091. PMID: 35422948;

32. Yin Q, Chen D, Gu C. Effect of intraoperative Electroencephalogram-guided anesthesia on postoperative cognitive function in elderly patients: a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. BMC Anesthesiol. 2025 Aug 26;25(1):423. DOI: 10.1186/s12871-025-03297-3.

33. van Zuylen ML, Gribnau A, Admiraal M, Ten Hoope W, Veelo DP, Hollmann MW, Preckel B, Hermanides J. The role of intraoperative hypotension on the development of postoperative cognitive dysfunction: a systematic review. J Clin Anesth. 2021 Sep;72:110310. DOI: 10.1016/j.jclinane.2021.110310.

34. Заболотских И.Б., Горобец Е.С., Григорьев Е.В., Котовская Ю.В., Лебединский К.М., Мусаева Т.С., Мхитарян Э.А., Овечкин А.М., Остапенко В.С., Розанов А.В., Рунихина Н.К., Ткачева О.Н., Трембач Н.В., Хороненко В.Э., Чердак М.А. Периоперационное ведение пациентов пожилого и старческого возраста. Методические рекомендации. Вестник интенсивной терапии им. А.И. Салтанова. 2022;3:7–26. DOI: 10.21320/1818-474X-2022-3-7-26

35. Hu AM, Qiu Y, Zhang P, Zhao R, Li ST, Zhang YX, Zheng ZH, Hu BL, Yang YL, Zhang ZJ. Higher versus lower mean arterial pressure target management in older patients having non-cardiothoracic surgery: A prospective randomized controlled trial. J Clin Anesth. 2021 May;69:110150. DOI: 10.1016/j.jclinane.2020.110150.

36. Krzych ŁJ, Pluta MP, Putowski Z, Czok M. Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review. J Clin Med. 2020 Sep 30;9(10):3183. DOI: 10.3390/jcm9103183.

37. Marcucci M, Chan MTV, Painter TW, Efremov S, Aguado HJ, et al. Effects of a Hypotension-Avoidance Versus a Hypertension-Avoidance Strategy on Neurocognitive Outcomes After Noncardiac Surgery. Ann Intern Med. 2025 Jul;178(7):909-920. DOI: 10.7326/ANNALS-24-02841.

38. Wang J, Zhu L, Li C, Lin Y, Wang B, Lin X, Bi Y. The relationship between intraoperative hypothermia and postoperative delirium: The PNDRFAP study. Brain Behav. 2024 May;14(5):e3512. DOI: 10.1002/brb3.3512.

39. Ju JW, Nam K, Sohn JY, Joo S, Lee J, Lee S, Cho YJ, Jeon Y. Association between intraoperative body temperature and postoperative delirium: A retrospective observational study. J Clin Anesth. 2023 Aug;87:111107. DOI: 10.1016/j.jclinane.2023.111107.

40. Mossie A, Regasa T, Neme D, Awoke Z, Zemedkun A, Hailu S. Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting: Systematic Review Article. International Journal of General Medicine. 2022;15:4053–4065. DOI: 10.2147/IJGM.S349232.

41. Ghosh D, Kumar M, Kumar M, et al. The Effect of Two Different Intraoperative Doses of Dexmedetomidine on Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Major Abdominal Surgery Under General Anesthesia: A Randomized Controlled Study. Cureus 18(3): e104579. (March 02, 2026) DOI: 10.7759/cureus.104579.

42. Tabari M, Moradi A, Rezaieh GA, Aghasizadeh M. Effects of Midazolam and Dexmedetomidine on Cognitive Dysfunction Following Open-Heart Surgery: A Comprehensive Review. Brain Behav. 2025 Apr;15(4):e70421. DOI: 10.1002/brb3.70421.

43. Wang D, He X, Li Z, Tao H, Bi C. The role of dexmedetomidine administered via intravenous infusion as adjunctive therapy to mitigate postoperative delirium and postoperative cognitive dysfunction in elderly patients undergoing regional anesthesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2024 Feb 23;24(1):73. DOI: 10.1186/s12871-024-02453-5.

44. Zhang X, Leng Y, Yuan X, Yang Y, Zhou C, Liu H. Efficacy of perioperative dexmedetomidine in postoperative pain and neurocognitive functions in orthopedic surgery: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials. Int J Surg. 2025 May 1;111(5):3525-3542. DOI: 10.1097/JS9.0000000000002315.

45. Bi X, Wei J, Zhang X. Effects of dexmedetomidine on neurocognitive disturbance after elective non-cardiac surgery in senile patients: a systematic review and meta-analysis. J Int Med Res. 2021 May;49(5):3000605211014294. DOI: 10.1177/03000605211014294.

46. Zang H. Effects of Different Doses of Dexmedetomidine on Perioperative Stress Response and Postoperative Recovery in Elderly Patients. J Perianesth Nurs. 2026 Apr;41(2):273-279. DOI: 10.1016/j.jopan.2025.05.014.

47. Shin HW, Kwak JS, Choi YJ, et al. Efficacy and safety of perioperative melatonin for postoperative delirium in patients undergoing surgery: a systematic review and meta-analysis. Journal of International Medical Research. 2024;52(5). DOI:10.1177/03000605241239854.

48. Tsukinaga A, Mihara T, Takeshima T. et al. Effects of melatonin on postoperative sleep quality: a systematic review, meta-analysis, and trial sequential analysis. Can J Anesth/J Can Anesth 70. 2023;901–914. DOI: 10.1007/s12630-023-02442-1.

49. Коваленко А.Л., Нагибович О.А., Вишневский А.Ю.. Белехов Г.А., Губайдуллин Р. Р., Попов Д.В., Агафьина А.С. Применение препарата, влияющего на нейрометаболизм, для профилактики послеоперационных когнитивных расстройств. Общая реаниматология. 2022;18(2):12–21. DOI: 10.15360/1813-9779-2022-2-12-21.

50. Лестева Н.А., Дрягина Н.В., Домнина Н.С., Никифорова А.А., Киселева Л.С., Кондратьев А.Н. Применение нейрометаболического препарата для профилактики послеоперационной когнитивной дисфункции у пациентов пожилого возраста, оперированных на пояснично-крестцовом отделе позвоночника // Вестник анестезиологии и реаниматологии. 2025. Т. 22. № 5. С. 50–59. DOI: 10.24884/2078-5658-2025-22-5-50-59.

51. Агеенко А.М., Никифоров Д.С., Никифорова Т.А. Влияние использования цитофлавина на частоту развития послеоперационного делирия при эндопротезировании крупных суставов у пациентов старших возрастных групп. Наука молодых (Eruditio Juvenium). 2020. Т. 8. № 3. С. 370-377. DOI: 10.23888/HMJ202083370-377.

52. Danquah MO, Yan E, Lee JW, et al. The utility of the Montreal cognitive assessment (MoCA) in detecting cognitive impairment in surgical populations - A systematic review and meta-analysis. J Clin Anesth. 2024;97:111551. DOI: 10.1016/j.jclinane.2024.111551.