基于中国生物医学文献数据库的VAP研究现状的可视化分析

Visualization studies on research status of the ventilator-associated pneumonia based on SinoMed database

目的分析呼吸机相关性肺炎(VAP)相关文献的分布特点和研究热点。方法以中国生物医学文献数据库为数据源,对建库至2017年12月发布的VAP相关文献进行检索、统计和分析。采用书目信息共现挖掘系统分析软件(BICOMS软件)对作者信息及其所在区域和机构信息进行提取、整理并生成共现矩阵;用Gcluto软件对主题词进行聚类分析,生成主题词可视化曲面图和可视化矩阵,分析当前研究热点;用Ucinet 6.0软件中的NetDraw按照中心度排列各主题词之间的关系,并绘制作者、作者所在区域和机构的社会网络图,分析VAP研究合作现状。结果初步检索VAP相关文献4851篇,排除会议摘要、新闻报道、资讯和信息缺失文献43篇,最终共4808篇纳入可视化分析。2001至2004年,VAP相关文献每年发文量<10篇;从2009年开始,发文量稳步增长;2010至2017年达到高峰,占总发文量的91.7%(4411/4808)。发文量分析显示,在我国发表VAP相关文献的34个省级行政区域中排前3位的依次为广东省(628篇)、江苏省(478篇)和浙江省(404篇);医院发文量以重庆医科大学附属第一医院最多(20篇);载文量>100篇的期刊只有1本,而载文量仅为1篇的期刊多达154本,占期刊总数的34.8%。参加VAP相关文献撰写的作者共9921人,但高产作者数量并不多,且所在机构无法形成有效的社会关系网络,提示医院院内、院外应加强沟通合作。主题词社会网络分析结果显示:VAP研究主要围绕“机械通气”“重症加强治疗病房(ICU)”“危险因素分析”“护理”“病因分析”“预防措施”和“病原菌”等核心展开,而目前的研究热点是处于网络图边缘的“药敏分析”“鲍曼不动杆菌”“支气管肺泡灌洗(BAL)”“慢性阻塞性肺疾病急性加重(AECOPD)”等。通过对80个高频主题词进行聚类分析显示,目前VAP研究热点主要集中在5个主题,即阻塞性肺疾病,特别是急性加重时,易发生VAP;关注新生儿、儿童VAP;ICU中VAP病原菌的种类、耐药性及抗菌药物的选择;通过预防措施、肺部支持治疗及综合护理干预,VAP的临床疗效和预后;机械通气时的口腔护理与气道管理也是治疗VAP的关键环节。结论近年来我国学者重视VAP的相关研究,发文量达到历史高峰,研究方向纷呈,但需加强各机构间合作,做好各地流行病学资料收集、统计,提高和扩大临床诊疗、护理、预防、病原菌分布及耐药性分析的研究质量和规模。

Objective To survey the distribution pattern and subject domain knowledge of the literatures about ventilator-associated pneumonia (VAP).Methods Literatures about VAP published until December 2017 were identified in SinoMed database for statistics and analysis.The information of author,organization and province was extracted by BICOMS software for generating co-occurrence matrix,at the same time,the topic words were cluster analyzed by Gcluto software to generate topical visual surface maps and visualization matrices,and the current research hotspots were analyzed.NetDraw from Ucinet 6.0 software was used to arrange the relationship among topic words according to the centrality,and the social network diagrams of authors,authors'provinces and institutions were draw to analyze the current status of VAP research cooperation.Results 4851 VAP-related literatures were retrieved preliminarily,and 43 were excluded from abstracts,news reports,information and missing literatures.Finally,a total of 4808 articles were enrolled in the visual analysis.From 2001 to 2004,the number of VAP-related literatures published was less than 10.Since 2009,the number of VAP documents had increased steadily,from 2010 to 2017,the peak period of publications reached 91.7%(4411/4808).According to the analysis of the amount of publications,the top three of 34 provincial administrative regions that published VAP-related literature in China were Guangdong Province (n =628),Jiangsu Province (n =478) and Zhejiang Province (n =404),the number of hospitals issued by the First Affiliated Hospital of Chongqing Medical University was the largest (n =20);there was only one journal with more than 100 articles,and there were 154 journals with only one article,accounting for 34.8% of the total number of journals.A total of 9921 authors participated in the VAP-related literature writing,the number of high-yielding authors was not large,and the institution could not establish an effective social network diagram,suggesting that communication and cooperation should be strengthened in hospitals and outside hospitals.The results of the topic words social network analysis showed that the VAP research field was centered around the core of "mechanical ventilation","intensive care unit (ICU)","risk factor analysis","nursing","etiological analysis","preventive measures"and "pathogens".The current research hotspots were at the edge of the network map, such as "drug sensitivity analysis","Acinetobacter baumannii","bronohoalveolar lavage (BAL)"and "acute exacerbation of chronic obstructive pulmonary disease (AECOPD)".By clustering 80 high-frequency topic words,at present,VAP research hotspots were mainly focus on five topics:obstructive pulmonary disease,especially in acute exacerbation,was prone to VAP;concerned about newborns and children's VAP;types,drug resistance and selection of antimicrobial agents for VAP pathogens in ICU;clinical efficacy and prognosis of VAP through preventive measures,pulmonary supportive care and comprehensive care interventions;oral care and airway management during mechanical ventilation was also the key aspect of the treatment of VAP.Conclusions In recent years,the academics had attached great importance to the study of VAP,the number of publications had reached a historical peak,and the research direction was diverse.However,it was necessary to strengthen cooperation among research institutes,collect and count epidemiological data,improve and expand the research quality and scale of clinical diagnosis,nurse,prevention,pathogen distribution and drug resistance analysis.