早期康复锻炼对ICU患者获得性衰弱影响的Meta分析

目的:系统评价早期康复锻炼对ICU患者获得性衰弱(ICU-AW)的影响。方法: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及Cochrane Library数据库从建库至2019年4月关于早期康复锻炼对ICU患者获得性衰弱影响的随机对照试验。由2名研究者独立筛选文献、提取资料、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11个随机对照试验,共1 078例患者。Meta分析结果显示,试验组ICU-AW发生率[OR=0.27,95%CI(0.15,0.49),P <0.000 1]、MRC-score(肌力)[MD=7.57,95%CI (5.57,9.57),P<0.000 01]、独立生活能力(BI评分)[MD=12.29,95%CI(5.38,19.20),P=0.000 5]及独立行走能力(6分钟步行试验)[MD=30.06,95%CI(22.00,38.12),P<0.000 01]均优于对照组,机械通气时间[MD=-1.90,95%CI(-2.50,-1.31),P<0.000 01]和总住院时间[MD=-3.33,95%CI(-5.13,-1.52),P=0.000 3]均短于照组。结论:早期康复锻炼可有效降低ICU-AW发生率,促进肌力恢复,提高患者独立功能状态,缩短机械通气时间及总住院时间,值得临床推广应用。

Enhance Interaction Between Taxpayers and Tax Administrations to Serve Modern Tax Governance

The State Taxation Administration of China(STA)has strengthened interaction between taxpayers and tax administrations by collecting and classifying taxpayers’needs,responding to common and individual demands in all aspects,as well as evaluating and improving the effectiveness of interaction.This article briefly introduces the initiatives,achievements and related experience of the Chinese tax authorities in strengthening interaction between taxpayers and tax administrations in recent years.