Abstract
Annotation. An important criterion for assessing the course of urgent surgical pathology in elderly patients is the concomitant state of sarcopenia. Decreased blood levels of cystatin C, which correlates with decreased muscle mass and strength, is an important screening criterion for perioperative intensive care therapy in these patients. The aim of the study was to increase the effectiveness of intensive care in patients with low sarcopenic index by improving the methods of influencing perioperative risk factors. We examined 90 elderly patients (73.3±7.9 years) with surgical pathology of the abdominal cavity, who underwent emergency surgery under general anesthesia based on sodium thiopental with artificial lung ventilation. Patients were divided into 3 randomized groups by age, sex, anthropometric data, volume and duration of surgery, concomitant comorbid background and perioperative intensive care: group I (n=30) – patients undergoing standard intensive perioperative therapy, group II (n=30) – standard intensive care with the addition of levocarnitine; group III (n=30) – standard intensive care with the addition of levocarnitine and a solution of D-fructose-1,6-diphosphate sodium salt hydrate. Muscle mass was determined by bioimpedancemetry on the analyzer “MEDASS” ABC-02, muscle strength was assessed by wrist dynamometry, muscle-skeletal mass index was calculated. The serum cystatin C concentration was determined by latex-enhanced immunoturbidimetry (DIALAB GmbH, Austria). The significance of the obtained data was checked using the r-Pearson correlation coefficient. It is established that additional prescription of levocarnitine and D-fructose-1,6-diphosphate sodium hydrate salt significantly reduces the number of days of treatment in the intensive care unit, improves prognosis, and promotes early activation of patients. Metabolic changes caused by a decreased sarcopenic index require further research.
Highlights
With the introduction of "sarcopenia" term in 1989 by Irwin Rosenberg (to denote a decrease in muscle mass (MM) with aging) [10] and until 2010, there were no generally accepted criteria for making this diagnosis
It was important to determine the peculiarities of metabolism and muscle condition in patients at the time of admission to the surgical hospital, comparing these parameters with the level of biochemical markers and cystatin C in the blood and the number of days in the intensive care unit depending on the intensive care algorithm (Table 1)
In patients of group I, the decrease in muscle mass, which was determined by dynamometry and was on the 1st first day of stay in the clinic 16.2±1.2 kg had a strong indirect correlation, r=-0.84, with a concentration of cystatin C in the blood, 1.46±0.22 mg/L
Summary
With the introduction of "sarcopenia" term in 1989 by Irwin Rosenberg (to denote a decrease in muscle mass (MM) with aging) [10] and until 2010, there were no generally accepted criteria for making this diagnosis. In 2010, the results of the European Consensus on sarcopenia (EWGSOP-1) were published, which presented its definitions, diagnostic criteria and classification [2]. In the practice of physicians, it is often difficult to identify the leading mechanism that led to low muscle mass in people older than 70 years, which often allows to recognize the combined etiology of sarcopenia [1, 5]. In 2018, the revised European criteria for sarcopenia (EWGSOP-2) were published, where the leading role was given to muscle strength, taking into account its greater clinical, social and prognostic significance. EW GSOP-2 does not diagnose sarcopenia with preserved strength and sarcopenic muscle mass. The aim of the study was to increase the effectiveness of intensive care in patients with low sarcopenic index by improving the methods of influencing perioperative risk factors
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