psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2025-23-1-28-38psychiatry-1313Research ArticleПСИХОПАТОЛОГИЯ, КЛИНИЧЕСКАЯ И БИОЛОГИЧЕСКАЯ ПСИХИАТРИЯPSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRYКлинические типы послеоперационного делирия у лиц, перенесших кардиохирургическую операциюClinical Features of Postoperative Delirium in Patients Who Underwent Cardiac Surgeryhttps://orcid.org/0000-0003-3081-338XДикК. П.DikK. P.

Карина Павловна Дик, ассистент, кафедра психиатрии, психотерапии и наркологии

Екатеринбург

Karina P. Dik, Assistant professor, Department of Psychiatry, Psychotherapy and Narcology

Ekaterinburg

psychkpd@gmail.comhttps://orcid.org/0000-0002-4218-6603МельникА. А.MelnikA. A.

Алена Александровна Мельник, врач-психиатр; ассистент, кафедра психиатрии, психотерапии и наркологии

Екатеринбург

Alyona A. Melnik, Psychiatrist, Sverdlovsk Regional Clinical Psychiatric Hospital; Assistant professor, Department of Psychiatry, Psychotherapy and Narcology

Ekaterinburg

alena.melnik.94@inbox.ruhttps://orcid.org/0000-0002-1806-7321ПономаревИ. А.PonomarevI. A.

Илья Александрович Пономарев, ординатор, кафедра психиатрии, психотерапии и наркологии

Екатеринбург

Ilya A. Ponomarev, Resident, Department of Psychiatry, Psychotherapy and Narcology

Ekaterinburg

ponomarev.i.25@icloud.comhttps://orcid.org/0009-0001-6419-7047ДовлатоваА. Т.DovlatovaA. T.

Анаис Тариковна Довлатова, ординатор, кафедра психиатрии, психотерапии и наркологии

Екатеринбург

Anais T. Dovlatova, Resident, Department of Psychiatry, Psychotherapy and Narcology

Ekaterinburg

anais94@mail.ruhttps://orcid.org/0000-0003-1210-8193БусыгинИ. Д.BusyginI. D.

Иван Дмитриевич Бусыгин, студент

Екатеринбург

Ivan D. Busygin, Student, Ural State Medical University

Ekaterinburg

busygin.ivan001@gmail.comhttps://orcid.org/0009-0005-1458-7521МамоноваА. Д.MamonovaA. D.

Алена Дмитриевна Мамонова, врач анестезиолог-реаниматолог

Екатеринбург

Alyona D. Mamonova, Anesthesiologist-intensive care physician

Ekaterinburg

alena_mamonoWa@mail.ruhttps://orcid.org/0000-0002-9112-1259ЛевитА. Л.LevitA. L.

Александр Львович Левит, доктор медицинских наук, профессор, кафедра анестезиологии и реаниматологии; главный анестезиолог-реаниматолог Министерства здравоохранения Свердловской области; заведующий отделением кардиореанимации

Екатеринбург

Alexander L. Levit, Dr Sci (Med), Professor, Department of Anesthesiology and Reanimatology; chief anesthesiologist-resuscitator of the Ministry of Health of the Sverdlovsk region; Head of the Department of Cardiac Intensive Care

Ekaterinburg

al_levit@mail.ruhttps://orcid.org/0000-0001-5142-3992СиденковаА. П.SidenkovaA. P.

Алена Петровна Сиденкова, доктор медицинских наук, заведующая кафедрой, кафедра психиатрии, психотерапии и наркологии

ResearcherID: AAH-7439-2020 SCOPUSAUHTORID: 6468015100

Екатеринбург

Alena P. Sidenkova, Dr Sci (Med), Head of the Department, Department of Psychiatry, Psychotherapy and Narcology

ResearcherID: AAH-7439-2020 SCOPUSAUHTORID: 6468015100

Ekaterinburg

sidenkovs@mail.ruУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationСвердловская областная клиническая психиатрическая больница; Уральский государственный медицинский университетРоссияUral State Medical University ; Sverdlovsk Regional Clinical Psychiatric HospitalRussian FederationСвердловская областная клиническая больница № 1РоссияSverdlovsk Regional Clinical Hospital No.1Russian FederationУральский государственный медицинский университет ; Свердловская областная клиническая больница № 1РоссияUral State Medical University ; Sverdlovsk Regional Clinical Hospital No.1Russian Federation2025080520252312838Copyright © Дик К.П., Мельник А.А., Пономарев И.А., Довлатова А.Т., Бусыгин И.Д., Мамонова А.Д., Левит А.Л., Сиденкова А.П., 20252025Дик К.П., Мельник А.А., Пономарев И.А., Довлатова А.Т., Бусыгин И.Д., Мамонова А.Д., Левит А.Л., Сиденкова А.П.Dik K.P., Melnik A.A., Ponomarev I.A., Dovlatova A.T., Busygin I.D., Mamonova A.D., Levit A.L., Sidenkova A.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/1313

Обоснование: возрастающее число кардиохирургических операций, в том числе у пациентов старшего возраста с серьезными сердечно-сосудистыми заболеваниями, частое развитие послеоперационного делирия (ПОД), его неблагоприятный прогноз, гиподиагностика отдельных клинических типов делирия обусловили актуальность настоящего исследования. Цель исследования — изучить клинические типы послеоперационного делирия у лиц, перенесших кардиохирургическую операцию. Пациенты и методы: в проспективном наблюдательном исследовании клинических типов послеоперационного делирия у пациентов кардиохирургического профиля, выполненном на базе кардиохирургического и кардио-реанимационного отделений «Областной клинической больницы № 1» г. Екатеринбурга, участвовало 157 пациентов. Применены клинико-психопатологический, психометрический, статистический методы исследования. Результаты: за период наблюдения в раннем послеоперационном периоде выявлен 31 (19,7% от общего числа оперированных больных, принявших участие в настоящем исследовании) пациент с делирием. На основании психометрической (суммарные баллы шкал Confusion Assessment Method-Intensive Care Unit и Richmond Agitation-Sedation Scale) и клинико-психопатологической оценки состояния пациентов показана клиническая гетерогенность послеоперационного делирия. В 87,1% случаев диагностировали гипоактивный делирий, в 9,7% — смешанный, в 3,2% — гиперактивный тип. Синдромальная структура гиперактивного и гипоактивного послеоперационного делирия различна. Обсуждение: различная синдромальная структура гиперактивного и гипоактивного типов делирия позволяет предположить отличия в патогенезе разных моторных типов делирия, что может отчасти объяснить недостаточность чувствительности применяемых диагностических инструментов. Заключение: совершенствование типологии делирия у кардиохирургических пациентов необходимо для прогноза развития послеоперационного делирия и разработки методик его предотвращения.

Background: the increasing number of cardiac surgeries in older patients with serious cardiovascular diseases, the frequent development of postoperative delirium, its unfavorable prognosis, and underdiagnosis of certain types of delirium determined the relevance of this study. The aim was to identify clinical types of postoperative delirium in patients who underwent cardiac surgery. Patients and Methods: a total of 157 patients participated in prospective observational study of clinical types of postoperative delirium in patients undergoing cardiac surgery. The study was conducted at the cardiac surgery and cardiology intensive care departments of the Sverdlovsk Regional Clinical Hospital No.1. Clinical, psychopathological, psychometric, and statistical methods were used. Results: 31 patients (19.7% of the total number of operated patients who participated in this study) with delirium were identified in the early postoperative period. Based on the psychometric (total scores of the Confusion Assessment Method Intensive Care Unit and Richmond Agitation-Sedation Scale) and clinical and psychopathological assessment of the patients’ condition, clinical heterogeneity of postoperative delirium was revealed. Different types of delirium were determined including hypoactive type in 87.1% f, mixed in 9.7% and hyperactive delirium in 3.2% of cases. The syndromic structure of hyperactive and hypoactive postoperative delirium is different. Discussion: different syndromic structure of hyperactive and hypoactive types of delirium allow us to assume the different pathogenetic mechanisms. This may partially explain the insufficient sensitivity of the diagnostic tools used. Conclusion: improvement of the typology of delirium in cardiac surgery patients is necessary to predict the development of postoperative delirium and develop methods for its prevention.

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