The use of dexamethasone therapy in the treatment of acute ischemia of the lower limbs in elderly and senile patients

• Islam D. Magamedov
• Lyudmila P. Pivovarova
• Sergei P. Nokhrin
• Vladimir V. Soroka
• Olga B. Ariskina
• Osipova I.V.
• Alexei N. Ryazanov
• Alexander B. Kurilov
• Kolichenko L.V.
• Olga V. Goncharova

Abstract

Aim of the work: to find out the effect of dexamethasone therapy on the parameters of immune reactivity, the intensity of oxidative stress and tissue destruction in acute ischemia of the lower limbs, which poses a threat of limb loss.

Material and methods. We examined 71 patients with acute ischemia of the lower limbs and basic therapy (46 men and 25 women), aged 70 [60; 83] years, with revealed thromboembolism against the background of arterial occlusion. Patients with uncompensated ischemia underwent revascularization, patients with irreversible ischemia underwent revascularization in order to reduce the level of amputation. 49 (69%) patients were discharged, death was observed in 22 (31%) patients. The group with additional anti-inflammatory therapy with dexamethasone included 32 patients; age 78 [68; 81] years; 14 men and 18 women, 30 (94%) patients were discharged, 2 (6%) dead. Dexamethasone was injected intravenously at a dose of 8 mg/200 ml of isotonic sodium chloride solution for 4 to 6 days after surgery. The control group consisted of 15 healthy volunteers or patients with mild systemic disorders of the same age group, with an average age of 70 [55; 80] years. Upon admission to the vascular surgery department before surgery, on the 1^st, 3^rd, 5^th, 7t^h and 10^th days after the operation, the following was investigated: the oxidative activity of blood according to the level of spontaneous and induced chemiluminescence, the total antioxidant activity of plasma, the level of C-reactive protein, the level of creatine kinase, the amount of leukocytes in blood with leukogram count. Evaluation of the treatment results was carried out according to the following criteria - the outcome of the disease and the duration of treatment in bed-days.

Results and discussion. Dexamethasone therapy allows not only to improve the results of postoperative treatment of patients with acute ischemia of the lower limbs, but also to reduce mortality from 31% with conventional therapy to 6%, the frequency of complications such as gangrene from 30% with conventional therapy to 6%; such as sepsis from 10 to 6%; suppuration of wounds from 10 to 6%, respectively. Dexamethasone treatment can reduce the number of amputations from 32% in patients with basic therapy to 16%, and reduce the duration of treatment from an average of 13 to 10 bed-days.

Conclusion. Dexamethasone therapy helps to reduce the number of postoperative complications, and postoperative mortality rate, and the duration of hospitalization.

Keywords:acute ischemia of the lower limbs, dexamethasone, inflammation, oxidative stress

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