ABSTRACT
Objective@#To investigate the effect of intraoperative routine fluid therapy and goal-directed fluid therapy(GDFT) by FloTrac/Vigileo monitoring system on the recovery of intestinal function in aged patients with rectal cancer.@*Methods@#Sixty ASAⅠ~Ⅲ patients undergoing laparoscopic anterior resection of rectal cancer(Dixon operation), who were treated in the Third People's Hospital of Datong from August 2018 to May 2019 were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.Group C received routine intraoperative fluid administration, and the total rate of fluid=deficit+ maintenance administration+ loss+ third space losses.Group G fluid therapy goal: cardiac index (CI) 2.5~4.0 L·min-1·(m2)-1, stroke volume variability (SVV)<13%, mean arterial pressure (MAP) 65~110 mmHg; if CI<2.5 L·min-1·(m2)-1, SVV>13%, rapidly infused sodium lactate Ringer's injection 3 mL/kg(within 10 min via an infusion pump); if CI<2.5 L·min-1·(m2)-1, SVV<13%, infused dobutamine; if MAP<65 mmHg, CI≥2.5 L·min-1·(m2)-1, infused norepinephrine.Two groups were continously infused sodium lactate Ringer's injection 3 mL·kg-1·h-1.Equivalent volume 6% hetastarch was infused to supplement the blood loss.During the operation, Hb<80 g/L and red blood cells were transfused when bleeding continued.The total fluid intake, bleeding volume, urine volume, postoperative hospital stay days, postoperative intestinal function recovery(postoperative flatus time and eating time), the incidence of postoperative intestinal complications(postoperative inflammatory bowel obstruction, anastomotic leakage and anastomotic bleeding) were recorded.Intestinal fatty aid binding protein (iFABP) was measured at T0(before the induction), T1(at the end of surgery), T2(2 h after surgery), T3(24 h after surgery) by using ELISA kits.@*Results@#The intraoperative fluid intake was (2 051±466)mL in group C, and (1 811±413)mL in group G, there was statistically significant difference between the two groups(t=2.111, P=0.039). The postoperative exhaust time and hospitalization days in group G were 28.6(23.3, 32.1)h and 10.2(9.9, 12.1)d, respecticely, which were shorter than those in group C [32.6(27.1, 40.9)h and 11.6(10.7, 12.2)d] (Z=2.321, P=0.020, Z=2.435, P=0.015). The incidence of postoperative complications was 13%(4/30) in group C, and 10%(3/30) in group G, there was no statistically significant difference(P>0.05). The iFABP of group C at T1 and T2 after operation was significantly higher than those of group G(t=2.445, 3.098, P=0.018, 0.003).@*Conclusion@#GDFT can reduce intraoperative crystalloid infusion, promote early intestinal function recovery in elderly patients with rectal cancer, and reduce perioperative intestinal mucosal ischemic injury.
ABSTRACT
Los parásitos helmintos producen y secretan una gran variedad de proteínas que unen lípidos (LBPs, del inglés lipid binding proteins) que podrían participar en la obtención de nutrientes tales como ácidos grasos y colesterol desde el hospedador. Asimismo, se postula que las LBPs podrían intervenir en la regulación de la respuesta inmune del hospedador. Conocer más acerca de las estructuras de estas proteínas, así como de sus interacciones con ligandos y membranas, es claramente pertinente para comprender las interacciones parásito-hospedador que ellas pudieran mediar. Por otra parte, dichos estudios permitirán profundizar en el conocimiento de los mecanismos de infección helmíntica y en el papel que estas proteínas juegan en la biología de los helmintos en general. Asimismo, esta información podría contribuir al establecimiento de medidas terapéuticas y de prevención de las enfermedades causadas por estos parásitos.
Helminth parasites produce and secrete a great variety of lipid binding proteins (LBPs) that may participate in the acquisition of nutrients such as fatty acids and cholesterol from their host. It is also postulated that LBPs might interfere in the regulation of the host's immune response. Knowing more about the structure of these proteins as well as their interactions with ligands and membranes is important in order to understand the host-parasite interaction that they could mediate. On the other hand, these studies will contribute to obtain further knowledge about the mechanisms of helminth infection and the role that these proteins play in helminth biology. Moreover, this information would be useful to set new therapeutic and prevention measures for the diseases caused by these parasites.
Os parasitas helmintos produzem e secretam uma grande variedade de proteínas que ligam lipídios, LBPs (Lipid Binding Proteins, por sua sigla em inglês), que poderiam estar envolvidas na obtenção de nutrientes tais como ácidos graxos e colesterol a partir do hospedeiro. Do mesmo modo, é postulado que as LBPs poderiam intervir na regulação da resposta imune do hospedeiro. Saber mais sobre as estruturas dessas proteínas, bem como sobre as suas interações com ligantes e membranas é claramente pertinente para compreender as interações parasita-hospedeiro que elas pudessem mediar. Além disso, estes estudos irão permitir um melhor entendimento dos mecanismos de infecção helmíntica e o papel que estas proteínas desempenham na biologia de helmintos em geral. Também, essa informação poderia ajudar a estabelecer medidas terapêuticas e de prevenção das doenças provocadas por esses parasitas.