FEATURES OF THE POSTOPERATIVE COURSE IN PATIENTS WITH DIABETIC FOOT SYNDROME AND SYSTOLIC MYOCARDIAL DYSFUNCTION AFTER LOWER LIMB AMPUTATION.

Abstract

Background: Diabetic foot syndrome is a serious complication of diabetes mellitus, often requiring amputations and associated with high mortality. In patients with diabetic foot syndrome and systolic myocardial dysfunction on the background of obesity, surgical treatment is complicated by systemic inflammation, circulatory disorders and tissue perfusion.

Objective: To evaluate the effect of optimizing systolic cardiac function on the postoperative period in patients with diabetic foot syndrome and systolic left ventricular dysfunction in lower limb amputations above and below the knee.

Materials and methods: The study included 38 patients with type 2 diabetes mellitus, obesity (BMI >30 kg/m2) and systolic myocardial dysfunction (EF <50%). All patients underwent lower limb amputation (25 at the hip level, 13 at below the knee level). Patients were divided into 2 groups: control (n=20), which received standard therapy, and main (n=18), where hyperosmolar solutions and inotropic therapy were additionally used.

Results: 72 hours after surgery, patients in the main group showed a significant improvement in hemodynamic and metabolic parameters. The mean blood pressure in the main group was 75±12 mm Hg vs. 62±7.1 mm Hg in the control group. The number of patients who required vasopressor infusion after 72 hours was lower in the main group (11% vs. 40% of patients). The dynamics of blood lactate levels ranged from 3.7±0.4 to 2.9±0.5 mmol/l in patients in the control group and from 3.5±0.08 mmol/l to 1.5±0.2 mmol/l in the main group. Acute kidney injury and wound complications in patients of the main group were observed three times less often (22% vs. 60% and 22% vs. 65%, respectively) (p<0.05).

Conclusions: Optimization of myocardial systolic function through the use of hyperosmolar solutions and inotropic therapy effectively reduces the risk of complications and mortality in patients with diabetic foot ulcers and systolic myocardial dysfunction.