Analysis of the ameliorative effect of Flurbiprofen Axetil combined with AOI on non-ventilated lung injury and alveolar macrophage transformation in patients with one-lung ventilation

DUAN Xiaowen; DANG Jingjing; WEI Jianan; YUE Han; YANG Xi

doi:10.3969/j.issn.1002-3429.2025.24.008

Abstract：Objective To investigate the ameliorative effect of Flurbiprofen Axetil combined with apneic oxygenation insufflation(AOI)on non-ventilated lung injury and alveolar macrophage(AM)transformation in patients with one-lung ventilation(OLV).Methods A total of 120 patients with lung cancer who underwent thoracoscopic lobectomy from October 2020 to October 2024 were selected and divided into three groups according to the random number table method,with 40 patients in each group.The control group was given OLV under general anesthesia,the AOI group was given 3 L/min AOI on the non-ventilated lung at the initiation of OLV,while the combination group was given 3 L/min AOI on the non-ventilated lung at the initiation of OLV,and Flurbiprofen Axetil 1.0 mg/kg was intravenously injected at 15 min before anesthesia induction.The clinical indicators,as well as arterial blood gas parameters[partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2)],oxygenation index(OI),pulmonary shunt fraction(Qs/Qt),lung injury score,AM survival rate,AM apoptosis rate,AM transformation markers[interleukin-6(IL-6),inducible nitric oxide synthase(iNOS),tumor necrosis factor-α(TNF-α),arginase-1(Arg-1),IL-10]before operation(T0),at the time of anesthesia induction(T1),and at 30 min(T2),60 min(T3),120 min(T4)after OLV initiation as well as incidence of lung injury were compared among the three groups.Results No significant differences were observed among the three groups in terms of duration of operation,anesthesia time,blood loss,fluid infusion volume,and duration of OLV(P＞0.05).PaO2 at T2-T4 in the combination group was higher than that in the AOI group and the control group,which was higher in the AOI group than in the control group(P＜0.05),while PaCO2 at T2-T4 in the combination group was lower than that in the AOI group and the control group,which was lower in the AOI group than in the control group(P＜0.05).The OI at T2-T4 in the combination group was higher than that in the AOI group and the control group,which was higher in the AOI group than in the control group(P＜0.05),while the Qs/Qt at T2-T4 in the combination group was lower than that in the AOI group and the control group,which was lower in the AOI group than in the control group(P＜0.05).The lung injury score and AM apoptosis rate of the combination group were lower than those of the AOI group and the control group,which were lower in the AOI group than in the control group(P＜0.05),while the survival rate of AM in the combination group was higher than that of the AOI group and the control group,which was higher in the AOI group than in the control group(P＜0.05).The levels of iNOS,IL-6 and TNF-α in the combination group were lower than those in the AOI group and the control group,which was lower in the AOI group than in the control group(P＜0.05),while the Arg-1 and IL-10 in the combination group were higher than those in the AOI group and the control group,which were higher in the AOI group than in the control group(P＜0.05).The incidence of lung injury in the combination group[0(0/40)]was lower than that in the AOI group[15.00％(6/40)]and the control group[40.00％(16/40)],which was lower in the AOI group than in the control group(P＜0.05).Conclusion Flurbiprofen Axetil combined with AOI has a significant ameliorative effect on non-ventilated lung injury in patients during OLV,which can improve oxygenation,promote the transformation of alveolar AM from Ml type to M2 type,and reduce the body's inflammatory response.