ABSTRACT
Objective To compare the difference between crystalloids and colloids under goal-directed fluid therapy (GDFT) in elective hepatectomy.Methods Seventy patients undergoing hepatectomy, 42 males and 28 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ, were included and randomly divided into three groups base on fluid treatment: conventional fluid therapy (group C, n=24), goal-directed fluid therapy filled with colloids (group G1, n=23) and goal-directed fluid therapy filled with crystalloids (group G2, n=23).Group C received conventional fluid therapy mainly based on MAP while group G1 and group G2 received goal-directed fluid therapy based on MAP, stroke volume variation (SVV) and cardiac index (CI), and the Flotrac/Vigileo system was used to obtain SVV and CI in group G1 and group G2.250 ml colloids were administered if SVV>13% in group G1 while 250 ml crystalloids were administered in group G2.If CI<2.5 L·min-1·m-2, dobutamine 2.0-10.0 μg·kg-1·min-1 was given until CI≥2.5 L·min-1·m-2.The ScvO2, Lac and Glu were tested at 5 min before anesthesia induction (T1), 5 min before hepatectomy (T2), 5 min after hepatectomy (T3) and the end of operation (T4).The duration of operation, fluid requirement, urinary output, bleeding volume, and the use of vasoactive agent were recorded.The exhaust time, ambulation time and postoperative hospital stay were recorded.Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up.Results Compared with group C, the total volume was lower, flatus time, ambulation time and postoperative hospital stay were shorter, ScvO2 at T3 and T4 were higher, Lac at T2-T4 were lower, Glu at T3 and T4 were lower, ALT and AST on the third day and the fifth day after surgery were lower in group G1 (P<0.05).Compared with group G1, the amount of crystalloids was increased, the incidences of postoperative nausea and vomiting were significantly higher in group G2 (P<0.05).There was no significant difference in flatus time, ambulation time and postoperative hospital stay between group G1 and group G2.Conclusion GDFT in hepatectomy propably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay.GDFT using colloids bolus contribute to a much lower incidence of postoperative nausea and vomiting.There is no significant difference in tissue perfusion and postoperative recovery between colloids and crystalloids.
ABSTRACT
This study is to investigate the apoptotic induction effect of the combination of diosgenin and TNF-related apoptosis-inducing ligand (TRAIL) on non-small-cell lung cancer cell line A549 by using the Chou-Talalay method, and observe the mechanism of the combination. The apoptotic effect of diosgenin or TRAIL alone and their combination on A549 and normal cell line 293T proliferation was measured by MTT assay. Chou-Talalay method was used to evaluate the combination effect. Apoptosis was examined by Hoechst 33342 staining and flow cytometry assay. Western blotting detects the expression of apoptosis-associated proteins. Diosgenin or TRAIL alone can inhibit proliferation ofA549 in a concentration-dependent manner. According to the Chou-Talalay method, when f(a) = 0.1, CI > 1, when f(a) > 0.1, CI < 1. Combined with TRAIL, the IC50 of diosgenin decreases from 21.864 to 14.810 micromol x L(-1) (P < 0.05) on A549 cells. But for 293T cells, IC50 of diosgenin does not change significantly. As with Hoechst 33342 staining and flow cytometry assay, the apoptosis ratios also increased in the combination group. At protein expression level, combination-treated group displays increased Caspase-8, Caspase-9, Bid, Caspase-3 activation and PARP cleavage, significantly decreased Bcl-2 and increased Bax expression, and MAPK pathways were activated. The combination of diosgenin and TRAIL has synergistic effect on A549 cells.