ObjectiveTo evaluate the efficacy of modified ultrafiltration (MUF) combined with conventional ultrafiltration (CUF) for cardiac valve replacement in patients with severe valve disease.MethodsOne hundred and eight NYHA Ⅲ or Ⅳ patients with severe valve disease,aged≥ 18 yr,weighing 50-80 kg,scheduled for elective cardiac valve replacement under cardiopulmonary bypass (CPB) were randomized into CUF group ( n =56) and CUF combined with MUF group (CMUF group,n =52).MUF was performed at the end of CPB,and the flow and time was 400 ml/min and 15-20 min respectively.Arterial blood samples were taken for blood gas analysis and for measurement of the plasma IL-6 and IL-8 concentrations after induction of anesthesia (T1),at the beginning of CUF (T2),at the end of GUF (T3),at the beginning of MUF (T4),at the end of MUF (T5),and at 2,8 and 24 h after the termination of CPB (T5-8).The oxygenation index was calculated and the airway pressure was recorded at T5 8.The amount of urine output during operation,the amount of urine output and volume of chest tube drainage within 24 h after operation,extubation time,packed red blood cell (PRBC) transfusion and duration of stay in ICU were recorded.ResultsCompared with CUF group,the hematocrit at T5,6 and oxygenation index at T7,8 were significantly increased,extuhation time was significantly shortened,and the amount of urine output and volume of chest tube drainage within 24 h after operation and PRBC transfusion were significantly reduced ( P ＜0.05),and no significant change was found in the plasma IL-6 and IL-8 concentrations,airway pressurc,amount of urine output during operation,and the duration of stay in ICU in group CMUF ( P ＞ 0.05).ConclusionCombination of MUF and CUF during CPB can be used for cardiac valve replacement in patients with severe valve disease,improve the function of organs after operation and reduce homologous blood transfusion.

Objective To investigate the effect of dexmedetomidine combined with fentanil on postoperative sleep quality and cognitive function in elderly patients with patient-controlled intravenous analgesia (PCIA). Methods Forty elderly patients underwent thoracic surgery were randomly divided into control group (fentanil group, n = 20) and experimental group C (fentanil plus dexmedetomidine group, n = 20), The control group was mixed 15 μg/kg fentanil and 5 mg tropisetron into100 mL of normal saline in patient-controlled intravenous analgesia pump, and experimental group contained 15 μg/kg fentanil, 1. 0 μg/kg dexmedetomidine and 5 mg tropisetron in 100 mL of normal saline. The pump was withdrawn after 48 h. The total steep time, sleep quality were recorded at 1 d before surgery and on the day of surgery, and at 3 d after surgery. The Mini-Mental Status Examination (MMSE) were recorded at 1 d before surgery and 1, 3, 7 d after surgery, and the incidence of postoperative cognitive dysfunction was observed. Results Compared with control group, the sleep time of experimental group on the surgery day and at 2 d after surgery was longer (P ＜ 0. 05); the sleep quality were significantly higher (P ＜ 0. 05); the MMSE scores of experimental group on the first and third postoperative day were higher (P ＜ 0. 05), and the incidence of POPD was lower than that in the control group (P ＜ 0. 05). Conclusion Dexmedetomidine combined with fentanil administered for postoperative analgesia in elderly patients shows better efficacy in improvement of sleep status, and improve the postoperative cognitive function.

Objective To investigate the effect of dexmedetomidine combined with fentanil on postoperative sleep quality and cognitive function in elderly patients with patient-controlled intravenous analgesia (PCIA). Methods Forty elderly patients underwent thoracic surgery were randomly divided into control group (fentanil group, n = 20) and experimental group C (fentanil plus dexmedetomidine group, n = 20), The control group was mixed 15 μg/kg fentanil and 5 mg tropisetron into100 mL of normal saline in patient-controlled intravenous analgesia pump, and experimental group contained 15 μg/kg fentanil, 1. 0 μg/kg dexmedetomidine and 5 mg tropisetron in 100 mL of normal saline. The pump was withdrawn after 48 h. The total steep time, sleep quality were recorded at 1 d before surgery and on the day of surgery, and at 3 d after surgery. The Mini-Mental Status Examination (MMSE) were recorded at 1 d before surgery and 1, 3, 7 d after surgery, and the incidence of postoperative cognitive dysfunction was observed. Results Compared with control group, the sleep time of experimental group on the surgery day and at 2 d after surgery was longer (P ＜ 0. 05); the sleep quality were significantly higher (P ＜ 0. 05); the MMSE scores of experimental group on the first and third postoperative day were higher (P ＜ 0. 05), and the incidence of POPD was lower than that in the control group (P ＜ 0. 05). Conclusion Dexmedetomidine combined with fentanil administered for postoperative analgesia in elderly patients shows better efficacy in improvement of sleep status, and improve the postoperative cognitive function.