Physical pain is a common uncomfortable symptom for pregnant women , and doing exercise for improving pain experience during pregnancy has been approved by national and international people .Exercise during pregnancy has various forms , and the exercise interventions of pain to different parts of the body have been carried out at domestic and abroad with favorable effect .Affected by the Chinese traditional recognition , the Chinese women′s acceptance of the exercise during pregnancy is low .This paper will summarize the exercise development during pregnancy of domestic and international , types of exercise for cutting pain , efficacy and safety of safeguard measures , and advocate nursing staff to carry out multi-specialty cooperation for investigation , promote the implementation and promotion of exercise during pregnancy so as to improve the service quality of pregnancy and delivery .

Objective:To explore the risk factors of subsyndromal delirium (SSD) after cardiac surgery in adults and construct a risk model.Methods:The convenience sampling method was used to select 620 adult patients undergoing cardiac surgery admitted to the Surgical Intensive Care Unit (SICU) of Zhejiang Provincial People's Hospital from January 1, 2017 to December 31, 2018 as the research object. Patients with postoperative SSD were included in the SSD group, and patients without postoperative SSD were included in the non-SSD group. The preoperative, intraoperative and postoperative clinical data and various indicators of all patients were recorded in detail. Through univariate analysis and binary Logistic regression analysis, the risk factors of SSD after cardiac surgery in adults were explored, and the risk model function was constructed.Results:A total of 569 cases were included in the study. Among them, 399 cases of postoperative subdelirium did not occur (non-SSD group) , 170 cases of postoperative subdelirium occurred (SSD group) , and the incidence of SSD was 29.9%. Univariate analysis found that the influencing factors of adult SSD after cardiac surgery were age, emergency surgery, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, aortic occlusion time, deep hypothermia circulatory arrest time, intraoperative plasma transfusion, SICU stay time and the use of dexmedetomidine, and the differences between the two groups were statistically significant ( P<0.05) . The binary Logistic regression analysis found that age>76 years [odds ratio ( OR) =4.332, 95% confidence interval ( CI) : (2.103, 8.965) , P<0.001], emergency surgery [ OR=3.453, 95%CI: (1.143, 7.534) , P<0.05], APACHEⅡ score> 15 [ OR=5.453, 95% CI: (1.453, 9.536) , P<0.001], deep hypothermia circulatory arrest time > 34.2 min [ OR=2.132, 95% CI: (1.053, 5.532) , P<0.05] and SICU stay time > 50.0 h [ OR=1.675, 95% CI: (0.832, 5.233) , P<0.05] were independent risks of SSD after cardiac surgery in adults, and the use of dexmedetomidine [ OR=1.536, 95% CI: (0.763, 4.862) , P<0.05] was a protective factor. Conclusions:Age > 76 years, emergency surgery, APACHE Ⅱ score > 15, deep hypothermia circulatory arrest time > 34.2 min, and SICU stay time >50.0 h are independent risk factors for SSD after cardiac surgery in adults, and the use of dexmedetomidine can reduce the occurrence of SSD.

Objectives:To retrieve,evaluate and summarize the contemporary evidence of strategies for weaning from extracorporeal membrane oxygenation(ECMO)of adult patients,and to provide evidence-based reference for clinical practice. Methods:The Web of Science,Embase,Cochrane Library,PubMed,Wanfang Database,CNKI,VIP website,SinoMed,BMJ Best Practice,National Institute for Health and Care Excellence,Joanna Briggs Institute Library,UpToDate and the website of Agency for Healthcare Research and Quality,Society of Critical Care Medicine,American Association of Critical-Care Nurses,European Society of Intensive Care Medicine and Extracorporeal Life Support Organization were researched to collect the literature related to randomized controlled trials,systematic reviews,guidelines,evidence summaries,expert consensuses and clinical decisions in this field.The time limit for the retrieval is from the inception of databases until July 2023. Results:A total of 13 related literature were retrieved,including 4 guidelines,4 expert consensuses,3 clinical decisions and 2 system reviews.Totally 42 evidences were formulated based on retrieved literature,including adequately accessing the ability of gas exchange before weaning from veno-venous ECMO(V-V ECMO)and withdrawing from veno-arterial ECMO(V-A ECMO)as soon as possible when patients's heart function has recovered,involving six aspects such as team composition,anticoagulation measures,assessment before weaning,weaning implementation,cannula and wound management and quality measures. Conclusions:It is suggested to build a professional ECMO team based on the actual hospital situation,to follow the contemporary evidence to standardize the weaning process of patients from ECMO to ensure the patients'safety and improve the outcomes.