Objective To investigate the effect of flurbiprofen 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 Ⅰor 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 one-lung 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. Key words: Cyclooxygenase inhibitors; Respiration, artificial; Immunity, cellular; Thoracoscopy
Read full abstract