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Clinical Characteristics and Analysis of Factors Associated with Severe COVID-19 Patients in Liaoning, China: A Multicenter Retrospective Study 中国辽宁省重症COVID-19患者临床特征及相关因素分析:一项多中心回顾性研究
Pub Date : 2020-10-01 DOI: 10.4103/jtccm.jtccm_7_21
Xin Li, Lu Li, Xiaotong Li, Zhidan zhang, Xiaochun Ma
Background: The prevalence of clinical manifestations in severe patients with COVID-19 was highly variable across region, populations, and assessment methods. We investigated the characteristics in patients with COVID-19 and the risk factors associated with severe cases and progression to severe patients during hospitalization. Methods: In this retrospective, multicenter observational study, we collected the clinical manifestations and laboratory regarding from 125 patients with laboratory-confirmed COVID-19 in Liaoning province, China. The collected COVID-19 patients were divided into two groups, including nonsevere group and severe group which were according to the Chinese national guideline for COVID-19 diagnosis and treatment. Results: One hundred and twenty-five laboratory-confirmed COVID-19 patients from three centralized diagnosis and treatment centers were enrolled. The median age was 44 years old, 68 (54.4%) were male. One hundred and twelve (81.6%) patients were in nonsevere group and 23 (18.4%) were in severe group. The overall hospital mortality is 1.6%. About 34% patients had been to Wuhan, 35.2%patients had contact with confirmed COVID-19 patient in Wuhan. Thirty-five (28%) patients were local and 11 (8.8%) patients had a history of direct contact with wildlife. About 20.8% of the patients had comorbidity, hypertension was the most common comorbidity (14.4%). Four patients changed from nonsevere to severe during hospitalization. Most patients were admitted in January and February (98.4%). The median hospital stay was 16 days (interquartile range [IQR]: 12–21). On admission, fever was the most common symptom (60.8%). Duration from onset symptom to hospitalization was 5 days (IQR, 2–8). Compared with nonsevere group, severe cases were associated with significant increased NE (74.19 ± 13.87 vs. 62.32 ± 12.80, P = 0.001), C-reactive protein (CRP) (33.27 ± 38.60 vs. 15.53 ± 29.35, P = 0.003), D2 (1.52 ± 2.83 vs. 0.44 ± 0.93, P = 0.021), lower lymphocyte count (0.81 ± 0.41 vs. 2.32 ± 6.63, P = 0.042), and lymphocyte percentage (LY%) (15.94 ± 10.47 vs. 28.83 ± 11.66, P < 0.001). Kaletra and Chinese medicine were most widely used, the proportion was 61.6% and 66.4%, respectively. Age (odds ratio [OR] = 1.030, 95% confidence interval [CI], 0.99–1.09; P = 0.042), fever on admission (OR = 5.23, 95% CI, 1.32–20.79; P = 0.019), increased NE (OR = 10.53, 95% CI, 3.55–31.25; P = 0.000), and decreased LY% (OR = 7.72, 95% CI, 2.61–22.83; P = 0.000) were independently associated with the severe COVID-19. Age (OR, 1.12; 95% CI, 1.01–1.23; P = 0.025), myalgia (OR, 30.82; 95% CI, 1.58–600.16; P = 0.024), and CRP (OR = 1.04, 95% CI, 1.004–1.073; P = 0.030) were associated with higher risk of development to severe COVID-19 cases. Conclusions: 1. Identification of individuals at risk for severe COVID-19 after severe acute respiratory syndrome coronavirus 2 infection is important 2. The effects of conventional methods on predicting those patients who will g
背景:COVID-19重症患者临床表现的患病率在地区、人群和评估方法之间存在很大差异。我们调查了COVID-19患者的特征以及住院期间重症病例和进展为重症患者的相关危险因素。方法:采用回顾性、多中心观察性研究方法,收集中国辽宁省125例实验室确诊的COVID-19患者的临床表现和实验室资料。将收集到的新冠肺炎患者按照中国国家新冠肺炎诊疗指南分为非重症组和重症组。结果:共纳入3个集中诊疗中心实验室确诊病例125例。中位年龄44岁,男性68例(54.4%)。非重症组112例(81.6%),重症组23例(18.4%)。医院总死亡率为1.6%。约34%的患者曾到过武汉,35.2%的患者曾在武汉接触过新冠肺炎确诊患者。当地35例(28%),有野生动物直接接触史11例(8.8%)。约20.8%的患者有合并症,高血压是最常见的合并症(14.4%)。4例患者在住院期间由非重症变为重症。1月和2月住院患者最多(98.4%)。中位住院时间为16天(四分位数间距[IQR]: 12-21)。入院时,发热是最常见的症状(60.8%)。从出现症状到住院时间为5天(IQR, 2-8)。与非重症组相比,重症组NE(74.19±13.87比62.32±12.80,P = 0.001)、c反应蛋白(CRP)(33.27±38.60比15.53±29.35,P = 0.003)、D2(1.52±2.83比0.44±0.93,P = 0.021)、淋巴细胞计数(0.81±0.41比2.32±6.63,P = 0.042)、淋巴细胞百分比(LY%)(15.94±10.47比28.83±11.66,P < 0.001)显著升高。使用最多的是中药,分别占61.6%和66.4%。年龄(优势比[OR] = 1.030, 95%可信区间[CI], 0.99-1.09;P = 0.042),入院时发热(OR = 5.23, 95% CI, 1.32-20.79;P = 0.019), NE升高(OR = 10.53, 95% CI, 3.55 ~ 31.25;P = 0.000), LY%下降(OR = 7.72, 95% CI, 2.61 ~ 22.83;P = 0.000)与重症COVID-19独立相关。年龄(OR, 1.12;95% ci, 1.01-1.23;P = 0.025),肌痛(OR, 30.82;95% ci, 1.58-600.16;P = 0.024), CRP (OR = 1.04, 95% CI, 1.004-1.073;P = 0.030)与发展为严重COVID-19病例的高风险相关。结论:1。在感染严重急性呼吸综合征冠状病毒2后,识别有感染严重COVID-19风险的个体非常重要。传统方法在预测那些将继续发展为严重COVID-19的患者方面的效果有限。年龄、入院时发热、NE升高和LY%降低与重症COVID-19独立相关4。年龄、肌痛和CRP是与严重COVID-19发展相关的独立危险因素。
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引用次数: 0
The Relationship Between Perioperative Regional Cerebral Oxygen Saturation and Postoperative Cognitive Dysfunction: A Systematic Review and Meta-Analysis 围手术期局部脑氧饱和度与术后认知功能障碍的关系:系统回顾和荟萃分析
Pub Date : 2020-10-01 DOI: 10.4103/jtccm.jtccm_2_21
Q. Feng, Songmei Jiang, S. Deng, Y. Ai, Q. Peng, Yunan Mo, Lina Zhang
Objective: Postoperative cognitive dysfunction (POCD) and neurologic deficit continues to be an important neuropsychological adverse affecting patients' outcome. We conducted this systematic review to investigate the relationship between regional cerebral oxygen saturation (rSO2) and early POCD in postoperative patients. Materials and Methods: Our search included MEDLINE (PubMed) and Cochrane library, from inception to October 31, 2018. We included studies reporting values of rSO2 at the beginning of and/or during surgery, and the primary outcome was POCD, and excluded articles who do not put postoperative cognitive function as the main observation. Two reviewers assessed the quality of the included articles using the Newcastle-Ottawa Scale and extracted the data. Results: Seven prospective cohort studies that included 532 patients incorporate into this systematic review. About 37.78% (201/532) patients achieved POCD. POCD was associated with significantly lower overall values of rSO2 during surgery compared to the population that did not achieve POCD (mean difference [MD] −1.98; 95% confidence interval [CI] −3.30 to −0.66; P = 0.003). In the subgroup, the lowest rSO2 values intraoperative period were a better predictor of POCD (MD −2.91; 95% CI −4.37 to − 1.46; P < 0.0001) than the mean rSO2 values (MD − 2.94; 95% CI −5.71 to − 0.17; P = 0.04). However, all of two were proved superior to baseline rSO2 values (MD −0.13; 95% CI -1.33 to 1.07; P = 0.83); patients with intraoperative cerebral oxygen <50% are nearly four times more likely to have early POCD (odds ratio = 3.65; 95% CI 1.62–8.23, P = 0.002). Conclusions: Patients with POCD have significantly lower cerebral oxygenation during operation than their counterparts. The lowest rSO2 values intraoperative period and patients with intraoperative cerebral oxygen <50% were a better predictor of POCD.
目的:术后认知功能障碍(POCD)和神经功能缺损仍然是影响患者预后的重要神经心理不良因素。我们进行了这项系统综述,探讨术后患者局部脑氧饱和度(rSO2)与早期POCD的关系。材料和方法:我们的检索包括MEDLINE (PubMed)和Cochrane图书馆,从成立到2018年10月31日。我们纳入了报道手术开始和/或手术期间rSO2值的研究,主要结局为POCD,并排除了未将术后认知功能作为主要观察的文章。两位审稿人使用纽卡斯尔-渥太华量表评估纳入文章的质量并提取数据。结果:7项前瞻性队列研究包括532例患者纳入本系统评价。约37.78%(201/532)患者达到POCD。与未实现POCD的人群相比,POCD与手术期间rSO2的总体值显著降低相关(平均差[MD] - 1.98;95%置信区间[CI]−3.30 ~−0.66;P = 0.003)。在亚组中,术中最低rSO2值是POCD的较好预测指标(MD为- 2.91;95% CI为−4.37 ~−1.46;P < 0.0001)高于rSO2平均值(MD−2.94;95% CI为−5.71 ~−0.17;P = 0.04)。然而,这两种方法均优于基线rSO2值(MD - 0.13;95% CI -1.33 ~ 1.07;P = 0.83);术中脑氧<50%的患者发生早期POCD的可能性高出近4倍(优势比= 3.65;95% ci 1.62-8.23, p = 0.002)。结论:POCD患者术中脑氧合明显低于其他患者。术中最低rSO2值和患者术中脑氧<50%是POCD的较好预测指标。
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引用次数: 0
Heart Rate Variability: A Potential Noninvasive Biomarker in Viral Sepsis by COVID19 Infection 心率变异性:covid - 19感染的病毒性败血症的潜在无创生物标志物
Pub Date : 2020-10-01 DOI: 10.4103/jtccm.jtccm_3_20
L. Moscote-Salazar, Tariq Janjua, W. Florez-Perdomo, E. García-Ballestas, A. Amit
Luis Rafael Moscote‐Salazar1,2, Tariq Janjua3, William A. Florez‐Perdomo2,4, Ezequiel Garcia‐Ballestas1,2, Agrawal Amit5 1Center of Biomedical Research, Faculty of Medicine, University of Cartagena, 2Department of Neurocritical Care, Latinamerican Council of Neurocritical Care, Cartagena, 4Department of Medicine, Soutcolombian University, Neiva, Colombia; 3Neurocritical Care, Critical Care Unit, Regions Hospitals, Saint Paul, Minnesota, USA; 5Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
Luis Rafael Moscote‐salazar1,2, Tariq janju3, William A. Florez‐Perdomo2,4, Ezequiel Garcia‐ballestas1,2, Agrawal Amit5 1卡塔赫纳大学医学院生物医学研究中心,2卡塔赫纳拉丁美洲神经危重症护理委员会神经危重症护理部,4南哥伦比亚大学医学部,内瓦,哥伦比亚;3美国明尼苏达州圣保罗地区医院重症监护病房神经危重症护理;5印度中央邦博帕尔全印度医学科学研究所神经外科
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引用次数: 0
Endoplasmic Reticulum Stress and Critical Care Medicine 内质网应激与危重症医学
Pub Date : 2020-07-01 DOI: 10.4103/jtccm.jtccm_16_20
Ying Shi, Tingting Wang, X. Zuo
Many patients suffer from multiple organ dysfunction syndrome (MODS), which represents a dominant cause of death in the intensive care unit. Current theories about the mechanisms of MODS include inflammation, dysregulated immune response, reduced cellular oxygen utilization, cytopathic hypoxia, and apoptosis. Moreover, an increasing number of studies have shown that endoplasmic reticulum stress (ERS) is related to organ dysfunction. The endoplasmic reticulum is an organelle that is responsible for secretion and membrane protein synthesis and assembly as well as some other physiological activities. Under certain conditions, the homeostasis of ER can be lost, causing the accumulation of unfolded or misfolded protein, which is termed as ERS. During ERS, unfolded protein response (UPR) is activated. Once UPR fails to rebuilt cellular homeostasis, cell function will be impaired and apoptosis will be induced. To better understand the relationship between ERS and severe diseases, we summarize the current research in the context of ERS and UPR signaling associated with various organ dysfunction and severe diseases, including acute lung injury, hepatic injury, heart failure, hemorrhagic shock with multiple organ dysfunction, sepsis, and some other diseases. We also discuss ERS or UPR as a novel therapeutic target and their future directions.
许多患者患有多器官功能障碍综合征(MODS),这是重症监护病房死亡的主要原因。目前关于MODS机制的理论包括炎症、免疫反应失调、细胞氧利用率降低、细胞病变性缺氧和细胞凋亡。此外,越来越多的研究表明内质网应激(ERS)与器官功能障碍有关。内质网是一种细胞器,负责分泌和膜蛋白的合成和组装以及其他一些生理活动。在一定条件下,内质网的稳态可能会失去,导致未折叠或错误折叠的蛋白质积累,这被称为内质网。在ERS过程中,未折叠蛋白反应(UPR)被激活。一旦UPR不能重建细胞内稳态,细胞功能就会受损,进而诱导细胞凋亡。为了更好地了解ERS与重症之间的关系,我们对ERS和UPR信号与各种脏器功能障碍和重症相关的研究现状进行了总结,包括急性肺损伤、肝损伤、心力衰竭、多脏器功能障碍的失血性休克、败血症等疾病。我们还讨论了ERS或UPR作为新的治疗靶点及其未来的发展方向。
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引用次数: 0
D Vitamin, Coronavirus, and Neurological Injuries D维生素、冠状病毒和神经损伤
Pub Date : 2020-07-01 DOI: 10.4103/jtccm.jtccm_5_20
Willie Perdomo, H. Ucrós, L. Moscote-Salazar
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引用次数: 1
Patients Admitted to the Intensive Care Unit Should Receive Central Venous Pressure Monitoring: We Should Personalize Our Approach 入住重症监护室的患者应该接受中心静脉压监测:我们应该个性化我们的方法
Pub Date : 2020-07-01 DOI: 10.4103/jtccm.jtccm_10_20
P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels
{"title":"Patients Admitted to the Intensive Care Unit Should Receive Central Venous Pressure Monitoring: We Should Personalize Our Approach","authors":"P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels","doi":"10.4103/jtccm.jtccm_10_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_10_20","url":null,"abstract":"","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"4 1","pages":"66 - 66"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88221501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Cerebral Venous Thrombosis in Air Travelers during COVID-19 Times: Is the Risk Higher? 2019冠状病毒病期间航空旅客发生脑静脉血栓的风险是否更高?
Pub Date : 2020-07-01 DOI: 10.4103/jtccm.jtccm_18_20
L. Moscote-Salazar, Tariq Janjua, Pilar Bosque-Varela, A. Agrawal
Luis Rafael Moscote‐Salazar1,2, Tariq Janjua3, Pilar Bosque‐Varela1, Amit Agrawal4 1Neurology, Paracelsus Medical University, Salzburg, Austria; 2Department of Neurosurgery, Center of Biomedical Research (CIB), University of Cartagena, Cartagena de Indias, Colombia; 3Neurology, Regions Hospital, Saint Paul, MN, USA; 4Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
Luis Rafael Moscote‐salazar1,2, Tariq Janjua3, Pilar Bosque‐Varela1, Amit agrawal11神经病学,奥地利萨尔茨堡Paracelsus医科大学;2卡塔赫纳大学生物医学研究中心神经外科,哥伦比亚卡塔赫纳;3美国明尼苏达州圣保罗地区医院神经内科;4印度中央邦博帕尔全印度医学科学研究所神经病学
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引用次数: 0
Research Progress on Sepsis-Related Liver Injury 脓毒症相关性肝损伤的研究进展
Pub Date : 2020-07-01 DOI: 10.4103/jtccm.jtccm_27_20
K. Kang, Nagel' Li, Yang Gao, Xue Du, Xinyu Zhang, Mingsheng Zhao, Kaijiang Yu
Liver injury is one of the most common critical clinical illnesses and is one of the manifestations of multiple organ dysfunction induced by sepsis. The liver plays a central role in the development of sepsis. The role of the liver in removing bacteria and regulating immune inflammation is crucial, and the liver is the target of sepsis-related injuries. However, the mechanism of liver injury in sepsis is still not clear. This review discusses the pathophysiology, clinical manifestations, and treatment of sepsis-related liver injury. Liver injury, pathophysiological mechanism, sepsis, sepsis-related liver injury
肝损伤是临床最常见的危重疾病之一,是脓毒症引起多脏器功能障碍的表现之一。肝脏在脓毒症的发展中起着核心作用。肝脏在清除细菌和调节免疫炎症中的作用至关重要,肝脏是败血症相关损伤的目标。然而,脓毒症中肝损伤的机制尚不清楚。本文就脓毒症相关肝损伤的病理生理、临床表现及治疗进行综述。肝损伤,病理生理机制,败血症,败血症相关肝损伤
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引用次数: 0
Differential Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on COVID-19 血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对COVID-19的差异作用
Pub Date : 2020-05-11 DOI: 10.4103/2665-9190.329042
L. Su, Jiahao Zhang, Nanhui Jiang, Jie Yang, Li He, Qin-jing Xie, Rong Huang, Fang Liu, Ying Feng, K. Kashani, Q. Lu, Zhongyi Sun, Z. Peng
ABSTRACT Background: The effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) on the coronavirus disease 2019 (COVID-19) remains controversial from clinic evidence. Objectives: The objectives of this study were to report the major characteristics and clinical outcomes of COVID-19 patients treated with ACEIs and ARBs and compare the different effects of the two drugs for outcomes of COVID-19 patients. Methods: This is a retrospective, two-center case series of 198 consecutive COVID-19 patients with a history of hypertension. Results: Among 198 patients, 58 (29.3%) and 16 (8.1%) were on ARB and ACEI, respectively. Patients who were on ARB or ACEI/ARB had a significantly lower rate of severe illness and acute respiratory distress syndrome (ARDS) when compared with patients treated with ACEI alone or not receiving RAAS blocker (P < 0.05). The Kaplan–Meier survival curve showed that patients with ARB in their antihypertensive regimen had a trend toward a higher survival rate when compared with individuals without ARB (adjusted hazard ratio, 0.27; 95% confidence interval [CI], 0.07–1.02; P = 0.054). The occurrence rates of severe illness, ARDS, and death were similar in the two groups regardless of receiving ACEI. The Cox regression analyses showed a better survival in the ARB group than the ACEI group (adjusted hazard ratio, 0.03; 95% CI, 0.00–0.58; P = 0.02). Conclusions: Our data may provide that some evidence of using ARB, but not ACEI, was associated with a reduced rate of severe illness and ARDS, indicating their potential protective impact in COVID-19. Further large sample sizes and multiethnic populations are warranted to confirm our findings.
背景:血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEIs/ARBs)治疗2019冠状病毒病(COVID-19)的临床疗效仍存在争议。目的:本研究的目的是报告ACEIs和ARBs治疗COVID-19患者的主要特征和临床结局,并比较两种药物对COVID-19患者结局的不同影响。方法:对198例连续有高血压病史的COVID-19患者进行回顾性、双中心病例分析。结果:198例患者中,ARB和ACEI分别为58例(29.3%)和16例(8.1%)。与单独使用ACEI或未使用RAAS阻滞剂的患者相比,ARB或ACEI/ARB组患者严重疾病和急性呼吸窘迫综合征(ARDS)发生率显著降低(P < 0.05)。Kaplan-Meier生存曲线显示,在降压方案中合并ARB的患者与未合并ARB的患者相比,生存率有更高的趋势(校正风险比,0.27;95%置信区间[CI], 0.07-1.02;P = 0.054)。无论是否接受ACEI治疗,两组的严重疾病发生率、ARDS发生率和死亡率相似。Cox回归分析显示,ARB组的生存率高于ACEI组(校正风险比,0.03;95% ci, 0.00-0.58;P = 0.02)。结论:我们的数据可能提供了一些使用ARB(而不是ACEI)与严重疾病和ARDS发生率降低相关的证据,表明它们在COVID-19中具有潜在的保护作用。进一步的大样本量和多民族人群验证了我们的发现。
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引用次数: 1
A Cross-Sectional Survey on Nonhepatic Hyperglycemia in Intensive Care Unit, Heilongjiang Province, China 中国黑龙江省重症监护病房非肝性高血糖横断面调查
Pub Date : 2020-04-01 DOI: 10.4103/jtccm.jtccm_29_20
Yue Li, Zhipeng Yao, Tong Li, Hongliang Wang
Introduction: The importance of blood ammonia detection and nonhepatic hyperammonemia (NHH) in the treatment and prognosis of patients has been neglected clinically. The purpose of this study was to evaluate the etiology, diagnosis, treatment, and prognosis of NHH in intensive care unit adults in Heilongjiang province, China. To solve this problem, we designed a provincial-level survey of severe adult NHH, including its etiology, risk factors, incidence, prognosis, and treatment strategies. Methods: The present study refers to a cross-sectional survey of the whole province, involving five cities in Heilongjiang province. All patients who met the inclusion criteria were eligible to apply to participate in the study, which included baseline demographics, clinical presentation, and follow-up related to diagnosis and treatment. Results: The total number of patients to be recruited in this study was estimated to reach 759. All patients who met the inclusion criteria were eligible to apply to participate in the study, which included baseline demographics, clinical presentation, and follow-up related to diagnosis and treatment. Conclusion: This study is expected to provide a theoretical basis for the development of more scientific and standardized NHH diagnosis and treatment methods. Ethics and Dissemination: Ethical approval was obtained from the ethics committee of The Second Affiliated Hospital of Harbin Medical University (registration number KY2019-184). The findings of this review will be communicated through peer-reviewed publications and scientific presentations. Trial Registration Number: ChiCTR1900026632.
简介:血氨检测和非肝性高氨血症(NHH)在患者治疗和预后中的重要性在临床上一直被忽视。本研究的目的是评估中国黑龙江省重症监护病房成人NHH的病因、诊断、治疗和预后。为了解决这一问题,我们设计了一项省级严重成人NHH调查,包括其病因、危险因素、发病率、预后和治疗策略。方法:采用全省横断面调查的方法,涉及黑龙江省5个城市。所有符合纳入标准的患者均有资格申请参加研究,包括基线人口统计学,临床表现以及与诊断和治疗相关的随访。结果:本研究招募的患者总数估计达到759例。所有符合纳入标准的患者均有资格申请参加研究,包括基线人口统计学,临床表现以及与诊断和治疗相关的随访。结论:本研究有望为制定更加科学、规范的NHH诊疗方法提供理论依据。伦理与传播:获得哈尔滨医科大学第二附属医院伦理委员会伦理批准(注册号KY2019-184)。本次审查的结果将通过同行评议的出版物和科学报告进行交流。试验注册号:ChiCTR1900026632。
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引用次数: 0
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Journal of Translational Critical Care Medicine
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