Цель исследования -изучение когнитивных функций и уровня белков острого повреждения мозга в группе пациентов, получавших препарат «Церебролизин», и в группе сравнения в до-и послеоперационном периодах операции коронарного шунтирования (КШ).Материалы и методы. В открытое рандоминизированное сравнительное контролируемое параллельное исследование были включены 60 мужчин, возраст в группе пациентов, получавших терапию препаратом «Церебролизин», -61,5 (57÷66) лет, в группе сравнения -61 (56÷65) лет (р > 0,05).Результаты. Группы статистически значимо отличались по фракции выброса левого желудочка: 56 (48÷64) -в группе сравнения, 61 (59÷65) -в группе пациентов, получавших терапию препаратом «Церебролизин» (p < 0,05). В группе пациентов, получавших препарат «Церебролизин», выявлено увеличение баллов по MMSE (р < 0,01): с 25 (24÷27) до 26,2 (24÷28), в группе без использования нейропротекции головного мозга в предоперационном периоде уменьшение баллов по краткой шкале оценки психического статуса -с 25,5 (25÷27) до 25 (23÷27) (р < 0,01). Клиническое значение уровня белка S100ß как биологического показателя когнитивной дисфункции после операции на сердце требует дополнительных исследований.

Objective. To study the structural and functional retinal changes developed in cardiac surgery patients as a consequence of cardiopulmonary bypass and to identify the factors aff ecting the nature and extent of changes observed.Material and Methods. Ten patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) were studied. The ophthalmologic examination was performed before cardiac surgery and 10–14 days after the surgery.Results. On days 10 to 14, after cardiac surgery, visual acuity was restored to the maximum; the perimetry indicators, the level of intraocular pressure, and the structures of the anterior segment of the eyeballs did not change signifi cantly. The ophthalmoscopy revealed the foci of ischemic edema in the fundus along with the fi rst- and second-order arteries in 30% of cases. The thickness of ganglionic and nerve fi ber layers decreased in one patient (10%), which may be associated with the intraoperative ischemia of orbital artery branches feeding the optic nerve. These changes had direct relationships with the level of maximum mean blood pressure (MBP) during CPB and the fl uctuation of absolute MBP values during CPB: MBP ≥ 90 mmHg during CPB was associated with the occurrence of ischemic foci in the retina in 100% of cases. If the diff erence between the maximum and minimum MBP levels during CPB exceeded 20 mmHg, the changes in the retina occurred more frequently (p = 0.0350) than in the cases where MBP fl uctuations during CPB were less than 20 mmHg.Conclusions. The most signifi cant changes in the vision organs of patients undergoing cardiac surgery under CPB occur in the retina. Factors associated with the occurrence of pathological ischemic changes in the retina were fl uctuations in MBP during CPB (≥20 mmHg) and the absolute value of maximum MBP during CPB (>90 mmHg). 

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Introduction. Cardiac surgeries using cardiopylmonary bypass (CB) have been successfully performed for more than 60 years, but at present it is necessary to further study the changes in tissue hemodynamics during interventions to minimize possible iatrogenic complications. One of these tissues available for direct observation of the vessels of the microvasculature is the retina. Aim – to study the structural and functional state of the retina in patients who underwent cardiac surgery with the use of CB, and to identify potential factors that negatively affect the retinal blood flow. Materials and methods. The clinical study involved 10 patients (20 eyes). All patients before cardiac surgery using CB and 10–14 days after it underwent visometry, perimetry, non-contact tonometry, biomicroscopy, reverse binocular ophthalmoscopy, fundus photography, optical coherence tomography of the retina of the macular region and optic nerve head with determination of the thickness of the layer of ganglion cell and the layer of nerve fibers. To carry out CB, pharmaco-cold cardioplegia was performed with the Custodiol solution using unified surgical and anesthetic tactics. CB was performed on a device with disposable membrane oxygenators (Strockert, Germany) under normothermic conditions, blood circulation was provided with non-pulsating blood flow with a volumetric flow rate of 2.4–2.8 L/min/m2 at an initial dose of heparin of 300 U/kg. Results. The studies revealed a correlation between changes in the histoarchitectonics of the retina and the level of mean arterial pressure (MAP). So, in 30 % of patients, the appearance of ischemic foci along the vascular arcades was found. In 10 % of patients, a decrease in the thickness of the ganglion layer and the layer of retinal nerve fibers was reported as a result of impaired blood circulation in the vessels supplying the optic nerve. Conclusion. Increase in MAP up to 90 mm Hg and above and fluctuations in its level of more than 20 mm Hg (p<0.05) during cardiac surgery under cardiopulmonary bypass in 67 % of cases is accompanied by transient disturbance of regional blood circulation at the level of vessels of the microvasculature of the retina with the appearance of ischemic foci in the retinal tissue. In this regard, it is necessary to carefully monitor the MAP parameters during the cardiopulmonary bypass to prevent circulatory disorders in various organs and tissues of the body.