Effect of flurbiprofen axetil combined with lung-protective ventilation on postoperative cellular immune function in patients undergoing thoracoscopic radical resection of lung cancer
10.3760/cma.j.issn.0254-1416.2019.01.005
- VernacularTitle:氟比洛芬酯联合肺保护性通气对胸腔镜肺癌根治术病人术后细胞免疫功能的影响
- Author:
Jicheng HU
1
;
Xiaoqing CHAI
;
Shuhua SHU
;
Di WANG
Author Information
1. 安徽医科大学附属省立医院麻醉科
- Keywords:
Cyclooxygenase inhibitors;
Respiration,artificial;
Immunity,cellular;
Thoracoscopy
- From:
Chinese Journal of Anesthesiology
2019;39(1):18-22
- CountryChina
- Language:Chinese
-
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.
