Objective: To investigate the effect of postoperative restrictive fluid management by ensuring adequate tissue perfusion on the recovery of gastrointestinal function after elective colonic resection.
Methods: Thirty patients suffered with elective colonic resection, after 6 hours of anesthesia recovery, were randomly divided into restrictive fluid management group (restrictive group, n=15) and traditional fluid management group (control group, n=15). From the surgery day to the 4th postoperative day, patients in restrictive group and control group received the total fluids of 25-35 ml×kg(-1)×d(-1) or 40-50 ml×kg(-1)×d(-1) respectively. Fluid balance, tissue perfusion, gastrointestinal function recovery time and the imbalance of fluid and electrolyte were recorded.
Results: The total fluid input and net fluid balance in restrictive group were significantly fewer than those in control group (total fluid input: 1782.56±258.38 ml/d vs. 2707.50±294.64 ml/d, net fluid balance: 316.67±202.86 ml/d vs. 623.33±244.38 ml/d, both P<0.05), and central venous pressure (CVP) was significantly lower than that in control group (4.03±1.81 mm Hg vs. 6.47±3.09 mm Hg, P<0.05). There were no differences in heart rate (HR) and mean arterial pressure (MAP) between two groups (HR: 85.03±13.49 bpm vs. 81.44±12.49 bpm, MAP: 80.65±11.39 mm Hg vs. 82.38±8.28 mm Hg, both P>0.05). The lactate clearance rate of the first postoperative 24 hours in restrictive group was higher than that in control group [35 (17, 53)% vs. 17 (-6, 33)%, P<0.05]. The times of bowel sounds recovery, the first flatus and stool passed in restrictive group were shorter than those in control group (bowel sounds: 37.43±24.97 hours vs. 46.36±19.34 hours, flatus: 53.63±12.78 hours vs. 75.43±20.07 hours, stool: 78.73±46.48 hours vs. 93.40±41.08 hours, all P<0.05). Vomiting was reduced in the restrictive group compared with control group (2 vs. 7, P<0.05). There were no differences in the occurrences of electrolyte imbalance (5 vs. 3), fluid insufficient (2 vs. 0) and fluid overload (0 vs. 1) between the two groups.
Conclusion: The postoperative restrictive fluid management by ensuring tissue perfusion can shorten the gastrointestinal function recovery time after elective colonic resection, and may not increase the incidence of water and electrolyte disorders.
Objective: To observe the effects of rosiglitazone (RSG) and ceftazidime (CAZ) on peroxisome proliferator activated receptor γ (PPARγ) activity in nucleated cells and interleukin (IL-4, IL-6) levels in plasma in septic rats.
Methods: According to randomized digital table, 180 male Sprague-Dawley (SD) rats were assigned to control group, sham operation group, sepsis group, CAZ group, RSG group and combined CAZ and RSG group. Sepsis model was established by cecal ligation and puncture (CLP). Drugs were administered by intraperitoneal injection at 3-hour post-operation, once every 12-hour. The PPARγ activity in nucleated cells and IL-4, IL-6 levels in plasma were detected by enzyme linked immunosorbent assay (ELISA) at 12, 24 and 48 hours post-operation.
Results: There was no difference in PPARγ activity and levels of IL-4 and IL-6 at each time point post-operation between control group and sham operation group. Compared with control group and sham operation group, PPARγ activity [absorbance (A) value] in nucleated cells in sepsis group, where downward trend was seen as time went on, significantly reduced (0.263±0.017 vs. 0.292±0.005, 0.294±0.007, both P<0.05). PPARγ activity was significantly higher in CAZ group, RSG group and CAZ + RSG group than in sepsis group (0.282±0.008, 0.336±0.020, 0.347±0.007 vs. 0.263±0.017, all P<0.05), CAZ + RSG group>RSG group >CAZ group (both P<0.05). Plasma IL-6 and IL-4 levels were higher in sepsis group than in control group and sham operation group (IL-6: 436.77±62.28 ng/L vs. 45.11±10.42 ng/L, 42.28±7.54 ng/L; IL-4: 89.24±25.06 ng/L vs. 41.34±7.08 ng/L, 41.49±7.27 ng/L, all P<0.05) and reached peak at 24 hours and 48 hours post-operation, respectively. Compared with sepsis group, IL-6 and IL-4 levels in CAZ group, RSG group and CAZ + RSG group were significantly decreased (IL-6: 273.48±12.13 ng/L, 317.64±14.10 ng/L, 253.94±13.57 ng/L vs. 436.77±62.28 ng/L; IL-4: 59.12±7.03 ng/L, 68.37±8.28 ng/L, 53.81±8.34 ng/L vs. 89.24±25.06 ng/L, all P<0.05), CAZ + RSG group < CAZ group < RSG group (all P<0.05).
Conclusion: In septic rats, PPARγ activity in nucleated cells was decreased. On the basis of effective antibiotic treatment, RSG might play a role in improving PPARγ activity in nucleated cells and reducing the levels of inflammation mediators and anti-inflammatory in plasma.
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