Objective To explore the fatigue development trajectory and influencing factors of postoperative patients with acute myocardial infarction（AMI）. Methods From December 2019 to January 2021,206 patients with first AMI in the cardiology department of a tertiary hospital in Huzhou were selected by convenience sampling method. The multidimensional fatigue scale-20 was used to investigate the patient’s fatigue level on the second day after admission and 1,2,4 months after discharge,and the latent class growth model and single factor analysis were used for data processing. Results It is recognized that the fatigue trajectory of AMI patients is divided into 3 potential categories,namely,the obvious improvement group（15.2%）,the slow remission group（62.8%）,and the continuous fatigue group（22.0%）;single factor analysis shows that the 3 trajectory categories are different with statistical significance in gender （χ²=29.384,P<0.001）,marital status （χ²=6.774,P=0.034）,number of comorbidi-ties（χ²=27.131,P<0.001） and cardiac function classification（χ²=20.416,P<0.001）. Conclusion The fatigue of most patients with AMI can be improved within 4 months from acute admission to discharge. There is group heterogeneity in fatigue trajectory. Medical staff should formulate staged and specific full-course nursing interventions according to different trajectory categories.

Objective To investigate the influencing factors of filter rupture in membrane-based therapeutic plasma exchange（mTPE） for neurological diseases. Methods A retrospective study was conducted to collect the clinical data of 196 cases of mTPE in 42 patients admitted to the department of Neurology in a tertiary hospital from January 2018 to May 2020. Univariate and multivariate Logistic regression analysis was conducted to analyze the risk factors for membrane rupture of the filter. Transmembrane pressure was used as a predictive indicator,and data of 35 plasma exchanges from June 2020 to October 2020 was collected for clinical verification and the best cut-off of transmembrane pressure was analyzed. Results Filter rupture occurred in 19（9.69%） cases of the 196 cases of mTPE. Logistic regression analysis showed that transmembrane pressure（OR=1.192） was an independent risk factor for filter rupture in（mTPE）（P<0.05）.The area under ROC curve（AUC） was 0.977 and 95%CI were 0.952~1.000（P<0.01）. According to the maximum Youden index value of 0.839,the optimal cut-off value of transmembrane pressure was 50 mmHg;the sensitivity was 89.5%;the specificity was 94.4%. With 50 mmHg as the cut-off value,the verification results showed that the sensitivity was 100%;the specificity was 91.42%;the accuracy was 91.42%. Conclusion The transmembrane pressure has a good predictive effect on filter rupture in mTPE. The clinical transmembrane pressure is maintained below 50 mmHg to prevent the filter rupture.