目的:分析近10年国内外多重耐药菌的研究现状、热点及变化趋势.方法:基于CiteSpace 5.8.R3软件分析中国知网(CNKI)和Web of Science数据库发表的近10年关于多重耐药菌文献,对发文量、文献作者、国家/地区、研究机构、关键词、文献共被引等特征进行可视化分析.结果:共纳入文献6065篇,中文文献3972篇,英文文献2093篇.国内外总体发文量呈上升趋势;主要以美国、印度、中国最为活跃;国内外发文最多的机构分别是四川大学华西医院与Univ Dschang.两大数据库分别形成七大聚类标签,国内高频关键词主要有多重耐药、医院感染、危险因素、耐药性,国外高频关键词为抗生素耐药性、细菌、感染等.结论:对多重耐药菌研究国外主要研究热点以抗生素抗性基因、抗生素耐药机制、治疗策略等方面为主,国内研究热点以多重耐药菌院内感染、危险因素探索及多重耐药菌感染预防与管理为主;国内外研究前沿分别为护理管理与毒力因子.

[目的]系统评估早期康复对重症病人生活质量的影响.[方法]通过计算机检索中国知网、万方数据库、维普中文科技期刊全文数据库、PubMed、the Cochrane Library,研究类型关于重症病人早期康复干预的随机对照试验或队列研究.检索时间为建库至2019年6月.由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.[结果]纳入16篇随机对照研究,共1433例病人.Meta分析结果显示:与对照组相比,试验组早期康复干预可改善重症病人肌力(MRC-score)情况[MD=7.02,95％CI(5.96,8.09),P<0.00001]、提升重症病人日常生活能力[SMD=1.24,95％CI(0.85,1.63),P<0.00001]、减少ICU-AW发生率[OR=0.38,95％CI(0.16,0.89),P=0.03]、缩短机械通气时间[SMD=-1.78,95％CI(-2.49,-1.07),P<0.00001]和ICU住院时间[SMD=-1.23,95％CI(-1.73,-0.74),P<0.00001].[结论]现有证据表明,早期康复干预可改善重症病人肌力(MRC-score),提升重症病人日常生活能力,减少ICU-AW发生率,缩短机械通气时间和ICU住院时间.但受纳入研究质量和数量的限制,上述结论有待更大样本量、多中心、高质量的研究验证.

BACKGROUND:The recent outbreak of coronavirus disease 2019 (COVID-19) has spread worldwide, with especially severe epidemics occurring in cities across China.OBJECTIVES:To report the epidemiological and clinical futures of the 200 patients infected with COVID-19 in Yichang, Hubei Province, China.STUDY DESIGN:200 patients confirmed with COVID-19 in a designated hospital in Yichang from Jan 30 to Feb 8, 2020 were investigated retrospectively. The epidemiological data and clinical characteristics were collected. The data between the ICU patients and non-ICU patients were compared. The patients were followed up till Feb 26, 2020.RESULTS:Of the 200 hospitalized patients with COVID-19, 98 (49.0 %) were male, and the mean age was 55 years. Eighty-seven (43.5 %) had no linkage to Wuhan or contact history. Familial clustering was found in 34 patients. Sixtyfive (32.5 %) suffered from chronic diseases. The common symptoms included fever (171[85.5 %]), cough (116[58.0 %]), and fatigue (64[32 %]). Most patients had lymphopenia. One hundred and seventy-two (86 %) patients showed typical imaging findings of viral pneumonia. Most patients received antiviral, antibiotic, and corticosteroid treatment. Compared with the non-ICU patients, 29 (14.5 %) patients in the ICU were older and more likely to show dyspnea and complications including ARDS. As of Feb 26, 15 (51.7 %) patients in the ICU had died.CONCLUSIONS:The COVID-19 infection was of clustering onset and can cause severe respiratory disease and even death. The mortality of ICU patients with COVID-19 was considerably high.

目的:系统评价ABCDE(F)集束化干预对ICU患者谵妄发生的影响.方法:计算机检索中国知网、万方数据库、维普中文科技期刊全文数据库、PubMed和Cochrane Library,关于集束化干预对ICU患者谵妄影响的随机对照试验(RCTs)或队列研究.结果:共纳入8个RCTs和10个队列研究,包括3000例患者.Meta分析结果显示,ABCDE(F)集束化干预能减少谵妄发生率[OR=0.38,95％CI(0.31,0.46),P<0.00001]、谵妄持续时间[SMD=-1.07,95％CI(-1.40,-0.74),P<0.00001]、机械通气时间[SMD=-1.02,95％CI(-1.60,-0.44),P=0.0005]及ICU住院时间[SMD=-0.85,95％CI(-1.25,-0.45),P<0.0001],可提高28天生存率[OR=3.00,95％CI(1.18,7.65),P=0.02]和改善患者满意度[RD=0.22,95％CI(0.01,0.42),P=0.04].结论:ABCDE(F)集束化干预能够减少谵妄发生率、谵妄持续时间、机械通气时间及ICU住院时间,提高患者28天生存率和患者满意度.但受纳入研究数量和质量的限制,有关ABCDE(F)集束化干预在ICU谵妄患者中的应用效果仍需高质量、大样本研究予以验证.

目的:比较中药熏洗与高锰酸钾熏洗对痔疮术后患者的治疗效果.方法:检索Pubmed、Embase、Cochrane Library、Medline、UpToDate、中国知网、万方及维普数据库,关于中药熏洗与高锰酸钾熏洗对痔疮术后患者治疗的临床随机对照试验(RCTs).检索时间为建库至2019年4月.由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件、Stata 12.0软件及TSA 0.9软件进行Meta分析.结果:共纳入22个RCTs,包括2298例患者.Meta分析结果显示,痔疮术后中药熏洗的有效率高于高锰酸钾熏洗,差异有统计学意义[OR=4.95,95％CI(3.65,6.73),P<0.00001];与高锰酸钾熏洗相比,中药熏洗明显减少疼痛评分[SMD=-1.91,95％CI(-2.77,-1.05),P<0.0001]和缩短伤口愈合时长[MD=-5.77,95％CI(-8.51,-3.03),P<0.0001].结论:中药熏洗在提高治疗有效率、缩短伤口愈合时间和减少疼痛方面优于高锰酸钾熏洗.

目的:评价系统性健康教育对预防外周静脉留置针并发症和提高留置时间的临床效果.方法:在中国知网、万方数据库、中国生物医学文献数据库、Pubmed、Medline、Cochrane library和Embase上检索相关文献,提取有效数据采用RevMan 5.3进行Meta分析.结果:Meta分析结果显示,与常规护理相比,系统性健康教育的外周静脉留置针留置时间(MD=30.35,95％ CI:21.38～39.32,P＜0.00001)更长,静脉炎发生率(OR=0.24,95％CI:0.16～0.37,P＜0.00001)、渗液发生率(OR=0.22,95％CI:0.10～0.47,P＜0.000 1)、血肿发生率(OR=0.37,95％CI:0.20～0.69,P=0.001)、堵管发生率(OR=0.20,95％CI:0.13～0.33,P＜0.000 01)和皮肤炎症发生率(OR=0.22,95％CI:0.11～0.44,P＜0.000 1)更低,患者满意度(MD=6.86,95％CI:3.06～10.66,P=0.0004)更高.结论:系统性健康教育可以提高静脉留置针的留置时间,降低并发症发生率,有效提高患者的满意度.