Послеоперационные психозы у пациентов с глиомами головного мозга

Обоснование:  несмотря на распространенное мнение, что психозы нередко развиваются после операции у нейрохирургических пациентов, эти расстройства до настоящего времени остаются практически не изученными. Цель:  на основании анализа научной литературы получить представление о состоянии и перспективах исследования проблемы психозов, возникающих после операций по поводу глиом головного мозга.  Материалы и методы:  работа представляет собой обзор предметного поля;  поиск публикаций по ключевым словам «послеоперационный психоз», «послеоперационный делирий», «глиомы головного мозга», «нейрохирургия», «краниотомия» проведен в базах Medline/PubMed, Scopus, Web of Science, РИНЦ и других источниках за последние 20 лет.  Заключение:  терминологические разночтения и недостатки различных видов верификации психотических расстройств препятствуют сопоставлению результатов исследования послеоперационных психозов у пациентов с глиомами головного мозга в нейрохирургии и общехирургической практике. Следствием этого становятся расхождения в результатах эпидемиологических исследований — вероятность появления послеперационного психоза у пациентов с глиомами головного мозга варьируется от 4 до 29%. Попытки определения факторов риска, необходимых и достаточных для прогноза возникновения психоза, также не приводят к информативным результатам. По данным научных публикаций, около 80 показателей претендуют на эту роль (пол, возраст, преморбидные заболевания, предоперационное психическое состояние, злокачественность опухоли, варианты нейрохирургических вмешательств и т.д.). Этот перечень не содержит концептуально важные особенности, такие как профиль индивидуальной асимметрии мозга, латерализация опухоли и др., что приводит к противоречиям в подходах к лечению и профилактике постоперационных психотических расстройств. Прежде чем оценивать эффективность основных лекарственных средств (дексмедетомидин, ГАМКергические, антипсихотические препараты и др.) и нелекарственных воздействий, необходимо ясное понимание феномена со всеми вариантами клинических проявлений заболевания и их индивидуальными особенностями.

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