Perioperative Use Of Lung Protection Ventilation Strategy Combined With Flurbiprofen Axetil On Immune Function In The Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

Objective The purpose of our study is to evaluate the lung protection ventilation strategy combined with flurbiprofen axetil on immune function in the patients undergoing thoracoscopic radical resection of lung cancer.Methods We received 80 patients with lung cancer who underwent thoracoscopic radical resection of lung cancer under general anesthesia between December 2016 and December 2017.The preoperative pulmonary function tests showed no abnormalities.The American Association of Anesthesiologists（ASA）Grade I or II,age 35 to 64 years old,gender is not limited,BMI 18²8Kg/m².Patients were randomly divided into four groups:protective mechanical ventilation group（group P,n=20）;conventional mechanical ventilation（group C,n=20）;protective mechanical ventilation combined with flurbiprofen axetil group（group P+F,n=20）;conventional mechanical ventilation combined with flurbiprofen axetil（group C+F,n=20）.Volume-controlled ventilation was performed in the four groups.Protective mechanical ventilation mode was setted as follows:tidal volume（V_T）8ml/kg and respiratory rate（RR）12-14 breaths/min during two-lung ventilation（TLV）;V_T 6 ml/kg,PEEP 5 cmH₂0 and RR 14-16 breaths/min during one-lung ventilation（OLV）.Conventional mechanical ventilation mode was setted as follows:tidal volume（V_T）10ml/kg and respiratory rate（RR）10-12breaths/min during two-lung ventilation（TLV）;V_T 8 ml/kg and RR 13-16 breaths/min during one-lung ventilation（OLV）.Flurbiprofen axetil 2mg/Kg was administrated by peripheral vein at 5 mins before the induction of anaesthesia.All patients received patient-controlled intravenous analgesia（PCIA）after surgery.PCIA solution contained sufentanil 100 ug and ondansetron 16 mg in 100 ml of normal saline in the group P and group C.PCIA solution contained sufentanil 100ug,ondansetron 16mg and flurbiprofen axetil 2 mg/kg in 100 ml of normal saline in the group P+F and group C+F.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.Before induction of anesthesia（T₀）,at the end of surgery（T₁）,at 24 h after surgery（T₂）,at 72h after surgery（T₃）and at 1 week after surgery（T₄）,blood samples were taken from the central venous for measure of peripheral T lymphocyte subsets CD3⁺,CD4⁺,CD8⁺and NK cell.The CD4⁺/CD8⁺ratio and the incidence of abnormal pulmonary function and adverse effects were also recorded after surgery.Results Compared with T₀,the percentage of CD3⁺,CD4⁺,NK cell and the CD4⁺/CD8⁺ratio was significantly decreased at T_1-3-3 in all groups（P<0.05）.Compared with group C,the degree of the decrease with respect of the percentage of CD3⁺,CD4⁺,NK cell and the CD4⁺/CD8⁺ratio in the group C+F and P at T_1-3-3 was significantly smaller（P<0.05）.Compared with group P,the degree of the decrease regarding the percentage of CD3⁺,CD4⁺,NK cell and the CD4⁺/CD8⁺ratio in the group P+F at T_1-3-3 was significantly lower（P<0.05）.Compared with T₀,the level of CD3⁺,CD4⁺,NK cell and the CD4⁺/CD8⁺ratio in four groups increased in varying degrees,and there was no significant difference at T₃ with respect of the percentage of CD3⁺,CD4⁺,NK cell and the CD4⁺/CD8⁺ratio in the group P+F（P>0.05）,while those parameters still lower at T₃ in other three groups（P<0.05）.The level of CD3⁺,CD4⁺,NK cell and the CD4⁺/CD8⁺ratio recovered to preoperative levels at T₄,and the difference between groups was not statistically significant（P>0.05）.There were no significant differences in CD8⁺T cells between the four groups at each time（P>0.05）.There was no significant difference in the incidence of pulmonary dysfunction and other adverse reactions among the four groups（P>0.05）.Conclusion Perioperative use of lung protective ventilation strategy combined with flurbiprofen axetil could not only alleviate the short-term immune suppression but also make the immune function recover faster in patients undergoing thoracoscopic elective radical resection of lung cancer.