ИЗМЕНЕНИЯ ЦЕРЕБРО-КАРДИАЛЬНЫХ ВЗАИМОДЕЙСТВИЙ ПРИ ВЕГЕТАТИВНОМ СОСТОЯНИИ В ОТВЕТ НА НЕЙРОТРОПНУЮ ТЕРАПИЮ

The purpose of our study was to find out the characteristics of cerebro-cardiac interactions in patients with acute cerebral insufficiency of different genesis with the outcome in the vegetative state, the study of the effectiveness of alpha glycerol phosphoryl choline in this category of patients. Materials and methods. The article uses the data of the open prospective case-control study in 2011-2018 on the basis of Donetsk clinical territorial medical association. The study group consisted of 11 patients with acute cerebral insufficiency as a result of severe craniocerebral trauma (5 patients), cerebral stroke (3 patients), after «post-systolic syndrome» (3 patients). The diagnosis of vegetative state in patients with GI was made on the basis of accepted international criteria (Vegetative State and Minimal Conscious State, 2010). We analyzed the level of consciousness by the scales of Glasgow coma, Glasgow-Pittsburgh coma scale, Scandinavian stroke scale and Glasgow outcomes, quantitative EEG (Nihon Kohden Corporation EEG-1200K), heart rate variability (Yutas YUM 200). Cerebro-cardiac interactions were investigated on the background of pharmacological tests with alpha glycerol phosphoryl choline. The duration of observation of patients from 2 to 8 months. Statistical data processing included the study of correlation density (MedStat program). Results and discussions. The transformation of the vegetative state into a «state of small consciousness» as a result of the treatment was recorded in 5 patients. The condition is unchanged in 3 patients. Three patients had died.In response to the administration of alpha glycerol phosphoryl choline, statistically significant (p≤0.05) increases in the parameter of relative spectral power in the EEG-range of beta1, beta2-rhythm (maximum in the right hemisphere), in the range of alpha activity (maximum in the region of Central and occipital leads bilaterally), in the «narrow» ranges of 14-16 Hz and 11-12 Hz were revealed, which reflected the significant activation of GABA – ergic and dopaminergic neurotransmitter systems CNS. There were no statistically significant changes (p>0.05) in the relative spectral power in the EEG range of Theta rhythm, in the range of 6-7.5 Hz, associated with the activation of cholinergic neurotransmitter structures. In response to the introduction of alpha glycerol phosphoryl choline, there was a significant increase in density with a change in the nature of the correlation between the parameters of heart rate variability and quantitative EEG. Conclusions. Features of cerebro-cardiac interactions in patients whose coma was transformed into a vegetative state, testified to the formation of several pathological systems in the central nervous system, due to interhemispheric dissociation and the lack of interactions between the reticular formation of the superior and diencephalic level. The study of cerebro-cardiac interactions reveals neurotransmitter (choline, GABA, dopamine and serotoninergic) predictors in the formation of vegetative state. The use of the Central cholinomimetics of alpha glycerol phosphoryl choline at the first stage of the study allowed to identify unusual changes in the so-called «cholinergic» neurotransmitter structures associated with the formation of pathological systems.