Effect of flurbiprofen axetil combined with lung-protective ventilation on postoperative cellular immune function in patients undergoing thoracoscopic radical resection of lung cancer / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effect of flurbiprofcn axetil combined with lung-protective ventilation on postoperative cellular immune function in the patients undergoing thoracoscopic radical resection of lung cancer.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,with no abnormal lung function during the preoperative examination,aged 35-64 yr,with body mass index of 18-28 kg/m2,scheduled for elective thoracoscopic radical resection of lung cancer under general anesthesia,were divided into 4 groups (n =20 each) using a random number table method:conventional mechanical ventilation group (group C),flurbiprofen axetil combined with conventional mechanical ventilation group (group F+C),lung-protective ventilation group (group P) and flurbiprofen axetil combined with lung-protective ventilation group (group F+P).Flurbiprofen axetil 2 mg/kg was intravenously injected at 5 min before induction of anaesthesia in F+C and F+P groups.Patients were mechanically ventilated in volume-controlled mode in four groups.Conventional ventilator settings were adjusted with tidal volume (VT) 10 ml/kg and respiratory rate 10-20 breaths/min during two-lung ventilation and with VT 8 ml/kg and respiratory rate 13-16 breaths/min during one-lung ventilation.Lung-protective ventilator settings were adjusted with VT 8 ml/kg and respiratory rate 12-14 breaths/min during two-lung ventilation and with positive end-expiratory pressure 5 cmH2O,VT 6 ml/kg and respiratory rate 14-16 breaths/min during onelung ventilation.All patients received patient-controlled intravenous analgesia (PCIA) at the end of surgery until 24 h after surgery.PCIA solution contained sufentanil 100 μg and ondansetron 16 mg in 100 ml of normal saline in group C and group P.PCIA solution contained sufentanil 100 μg,flurbiprofen axetil 2 mg/kg and ondansetron 16 mg in 100 ml of normal saline in group F+C and group F+P.The PCIA pump was set up with a 0.5 ml bolus dose,a 15-min lockout interval and background infusion at a rate of 2 ml/h.Visual analog scale score was maintained ≤3.When visual analog scale score ＞3,tramadol 2 mg/kg was intravenously injected.Before induction of anesthesia (T0),at the end of surgery (T1),at 24 and 72 h after surgery (T2,3) and at 1 week after surgery (T4),blood samples were collected from the central vein for measurement of the levels of T lymphocyte subsets CD3+,CD4+,CD8+ and NK cells.The CD4+/CD8+ ratio was calculated.Results Compared with the baseline at T0,the levels of CD3+,CD4+ and NK cells and CD4+/CD8+ratio were significantly decreased at T1-3 in C,F+C and P groups and at T1,2 in group F+P (P＜0.05).Compared with group C,the levels of CD3+,CD4+ and NK cells and CD4+/CD8+ratio were significantly increased at T1-3 in the other three groups (P＜0.05).Compared with group F+C or group P,the levels of CD3+,CD4+ and NK cells and CD4+/CD8+ratio were significantly increased at T1-3 in group F+ P (P＜0.05).Conclusion Flurbiprofen axetil combined with lung-protective ventilation improves postoperative cellular immune function and provides better efficacy than either alone in the patients undergoing thoracoscopic radical resection of lung cancer.