Objective To investigate the feasibility of Narcotrend-guided application of small dose of dexmedetomidine ( DEX) for sedation during combined spinal-epidural anesthesia for elderly patients. Methods Fifty cases of ASA II or Ⅲelderly patients were randomly divided into treatment group and control group (25 patients of each group). After combined spinal-epidural anesthesia, both groups received continuous intravenous infusion of DEX, at 0. 4 μg·kg-1 in 10 min, and then the rate was lowered to 0. 4 μg·kg-1 per hour. For the treatment group, infusion rate was adjusted to reach a Narcotrend Index (NTI) of 75-85, and for the control group, infusion rate was adjusted to reach an OAA/S score of level 3-4. MAP, HR, RR, SpO2 , NTI and OAA/S score were recorded at the beginning of DEX treatment ( t0 ) , 10 min ( t1 ) , 20 min ( t2 ) , 30 min ( t3 ) , and 60 min ( t4 ) after the beginning of DEX treatment, and at the end of surgery ( t5 ) . The incidence rates of adverse events including bradycardia, hypotension, low oxygenation, and respiratory depression were also recorded. The patients were followed up until 24 h after surgery to record loss of memory about the surgical events. Results In comparison with t0 , NTI and MAP of both groups significantly decreased at t1-t5(P<0. 01). Comparison between the two groups showed no difference in MAP at each time point, and NTI of treatment group was higher than that of control group at t2-t5(P<0. 05). In comparison with t0, OAA/S of both groups significantly decreased at t1-t5(for t1, P<0. 05;for t2-t5, P<0. 01). Comparison between the two groups showed no difference in OAA/S at each time point (P>0. 05). Follow-up at 24 h after surgery observed total amnesia in 72. 0% of DEX group patients and in 76. 0% of the control group, without significant difference (P>0. 05). Conclusion Sedating elderly patients undergoing spinal-epidural anesthesia with DEX under the guidance of Narcotrend is safe and feasible, and the patients can be sedated properly.

Objective To investigate the risk of postpartum haemorrhage in HBV-infected pregnant women. Methods Cohort or case-control studies that discussed the relationship between hepatitis b virus infection and pregnancy outcome were searched in PubMed , EMBASE , Wiley Online Library , Cochrane Library , Google Scholar, CBM, WanFang database and CNKI etc. (till August 2015). The quality of included Cohort or case-control studies was evaluated , and Meta-analysis was performed with Rev Man5.2 software. Results Four observational case-control studies and 17 cohort studies , involving 19 549 women in observation , were identifled. Meta-Analysis results displayed that the incidence of postpartum haemorrhage in HBV-infected women was 9.3%, while 2.8% in women without HBV [RR = 2.97, 95% CI (2.25 ~ 3.92),P < 0.01]. Compared with normal-risk women , the incidence of postpartum haemorrhage of HBV-infected women with normal hepatic function was also higher [RR = 2.56, 95% CI (2.01 ~ 3.25),P < 0.01]. HBV-infected women with hepatic dysfunction had higher incidence of postpartum haemorrhage than those with normal hepatic function [RR = 2.67, 95% CI (2.17~ 3.28),P < 0.01]. Conclusions HBV-infected women are at higher risk of postpartum haemorrhage than normal pregnancy women and further hepatic dysfunction would lead to a continuing increase of the risk.

Objective:To explore the effect of narrative nursing on the psychological resilience, self-esteem, and medication compliance of adolescent depression patients.Methods:This study is a quasi-experimental study. From August 2021 to January 2022, 86 adolescent depression patients admitted to the Department of Mental Health at the First Hospital of Shanxi Medical University were selected as the subject by convenience sampling. According to the order of admission time, the patients were divided into a control group and an intervention group, with 43 patients in each group. The control group received routine nursing, while the intervention group received narrative nursing on the basis of routine nursing. We compared the scores of the Self-Rating Depression Scale (SDS), Hamilton Depression Scale (HAMD), Self-Esteem Scale (SES), Connor-Davidson Resilience Scale (CD-RISC), and Morisky Medication Adherence Scale (MMAS-8) before and after intervention between two groups of patients.Results:Before intervention, there was no statistically significant difference in SDS, HAMD, SES, CD-RISC, and MMAS-8 scores between the two groups ( P>0.05). After intervention, the total scores of SDS and HAMD in the intervention group were lower than those before intervention and in the control group, and the toughness, optimism, self-improvement scores and the CD-RISC total score, SES scores and MMAS-8 scores were higher than those before intervention and in the control group, with statistically significant differences ( P<0.05) . Conclusions:Narrative nursing can improve the depressive mood of adolescent depression patients, enhance their psychological resilience, self-esteem, and medication compliance, and can be promoted and applied in clinical practice.