NEJM:阑尾炎选择手术治疗还是抗生素治疗?

2020-10-11 liangying MedSci原创

抗生素治疗已被提议作为手术治疗阑尾炎的替代。

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长期以来,阑尾切除术一直是阑尾炎的标准治疗方法,尽管在60多年前就有报道称成功地使用抗生素作为替代疗法。早在2014年,超过95%的美国阑尾炎患者接受了阑尾切除术。然而,随着2019年冠状病毒病大流行(Covid-19),卫生系统和美国外科学会(American College of surgeons)等专业团体建议重新考虑医疗服务的许多方面,包括抗生素在阑尾炎治疗中的作用。

NEJM近期发表的研究进行了抗生素治疗和阑尾切除术(CODA)的结果的比较。研究者在美国25个中心进行了一项实用、非盲、非劣效、随机试验,比较抗生素治疗(10天疗程)和阑尾切除术对阑尾炎患者的治疗效果。主要结果是30天的健康状况,用欧洲生活质量5维度(EQ-5D)问卷进行评估(得分范围从0到1,得分越高表示健康状况越好;非劣效性边际为0.05分)。次要结果包括抗生素组的阑尾切除术和90天内的并发症;根据阑尾的存在与否对亚组进行预先指定的分析。

从2016年5月3日至2020年2月5日,共有8168名患者接受筛查,其中1589名(19%)因临床或阑尾炎相关原因不符合入组条件。总计1552名成人(414名有阑尾)接受了随机分组;776人接受抗生素治疗(47%的患者没有住院接受指数治疗),776人接受阑尾切除术(96%的患者接受腹腔镜手术)。

基线时患者的社会人口学和临床特征。

根据30天的EQ-5D评分,在抗生素组中,29%的患者在90天内接受了阑尾切除术,包括41%的阑尾结石患者和25%的无阑尾结石患者。并发症在抗生素组比阑尾切除术组更常见(8.1比3.5 / 100参与者;率比,2.28;95% CI, 1.30至3.98);抗生素组的严重不良事件发生率为4.0 / 100,阑尾切除术组为3.0 / 100(比率比为1.29;95% CI为0.67至2.50)。

在这个针对阑尾炎抗生素的大型随机试验中,根据对30天内健康状况的常用测量结果,抗生素并不比阑尾切除术差。NSQIP(美国外科医师协会(ACS)国家手术质量改善项目)定义的并发症在抗生素组比阑尾切除组更常见,与没有阑尾的参与者相比,后者出现严重不良事件的风险更高。到1周时,两组患者阑尾炎症状的缓解情况相似。被分配接受抗生素治疗的参与者中有近一半没有住院进行指数治疗。抗生素组的参与者比阑尾切除术组缺席工作时间更少,但指数治疗后急诊和住院更为常见。

许多次要结果,包括手术(如果参与者最初接受抗生素治疗),并发症,在医疗机构花费的时间,以及工作失误,也被认为是重要的决策考虑因素。另一个相关的结果是未接受阑尾切除术的患者可能会出现肿瘤漏诊。虽然几乎所有的参与者都接受了CT检查,并且结果暗示肿块的可能性被排除,但在阑尾切除标本中依然发现了9个肿瘤。而在使用抗生素组的参与者中发现的肿瘤较少,目前尚不清楚早期肿瘤发现是否影响患者的预后。

该报告有以下局限性。它只包括90天的随访数据,因此低估了复发和长期并发症。尽管几乎所有的阑尾炎患者都参与了试验,但只有大约30%的符合条件的患者同意接受随机分组,且该百分比在不同的位点存在差异,而这一因素可能引入了选择偏倚;一项包括约500名选择治疗的患者的平行观察队列研究目前正在进行中。因为这是一个实用的试验,该方案并没有明确要求住院治疗或给定的抗生素方案。该试验不是盲目的,这个因素可能影响多种结果,包括主要结果。此外,阑尾切除术组的部分患者拒绝手术,抗生素组的部分患者在不符合手术规范的情况下接受了阑尾切除术。

抗生素组阑尾切除术的累积发生率

总之,这项疗效比较试验表明,至少在短期内,就一般健康状况的标准衡量结果来看,抗生素治疗阑尾炎并不逊色于阑尾切除术。在抗生素组,近3 / 10的参与者在90天内接受了阑尾切除术。与没有阑尾结石的参与者相比,有阑尾结石的参与者进行阑尾切除术和并发症的风险更高。

 

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    2020-10-19 白日尽落

    阑尾炎复发问题也没法忽视

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=917771, encodeId=aa8091e7717a, content=<a href='/topic/show?id=dc7b9e339ea' target=_blank style='color:#2F92EE;'>#阑尾炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97339, encryptionId=dc7b9e339ea, topicName=阑尾炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Mon Jan 18 16:52:30 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893004, encodeId=45d2893004cf, content=阑尾炎复发问题也没法忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/MXdM8fMhceEguIwthekTuiadyb5sK4Eegc8fO0jGc0JpF0ULYsDTTHHbVd2V2xVK3HoZ9wic5vdJbahuHaMyiaU3g/132, createdBy=49301957295, createdName=白日尽落, createdTime=Mon Oct 19 11:08:38 CST 2020, time=2020-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290760, encodeId=49901290e6066, content=<a href='/topic/show?id=e86454454ea' target=_blank style='color:#2F92EE;'>#手术治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54454, encryptionId=e86454454ea, topicName=手术治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1345255, encodeId=8199134525557, content=<a href='/topic/show?id=cd305543152' target=_blank style='color:#2F92EE;'>#抗生素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55431, encryptionId=cd305543152, topicName=抗生素治疗)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891506, encodeId=52a589150645, content=多一个选择总是好的!特别对于那些不能进行手术治疗的人来说。, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Mon Oct 12 18:15:24 CST 2020, time=2020-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891325, encodeId=d549891325e3, content=路过, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4dc5420229, createdName=ms9000000341386020, createdTime=Sun Oct 11 21:37:31 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035451, encodeId=86ec1035451fb, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sun Oct 11 18:27:51 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891285, encodeId=2f5989128529, content=这个研究的意义在于大流行期间或可选择抗生素方案应急。但是长久来看未必可取。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210315/480e12f811f44bc39b347d2521d56e86/67d0e6d503124ea685205b567af3dffd.jpg, createdBy=f9435296193, createdName=Baodongxu, createdTime=Sun Oct 11 16:47:14 CST 2020, time=2020-10-11, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=917771, encodeId=aa8091e7717a, content=<a href='/topic/show?id=dc7b9e339ea' target=_blank style='color:#2F92EE;'>#阑尾炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97339, encryptionId=dc7b9e339ea, topicName=阑尾炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Mon Jan 18 16:52:30 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893004, encodeId=45d2893004cf, content=阑尾炎复发问题也没法忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/MXdM8fMhceEguIwthekTuiadyb5sK4Eegc8fO0jGc0JpF0ULYsDTTHHbVd2V2xVK3HoZ9wic5vdJbahuHaMyiaU3g/132, createdBy=49301957295, createdName=白日尽落, createdTime=Mon Oct 19 11:08:38 CST 2020, time=2020-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290760, encodeId=49901290e6066, content=<a href='/topic/show?id=e86454454ea' target=_blank style='color:#2F92EE;'>#手术治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54454, encryptionId=e86454454ea, topicName=手术治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1345255, encodeId=8199134525557, content=<a href='/topic/show?id=cd305543152' target=_blank style='color:#2F92EE;'>#抗生素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55431, encryptionId=cd305543152, topicName=抗生素治疗)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891506, encodeId=52a589150645, content=多一个选择总是好的!特别对于那些不能进行手术治疗的人来说。, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Mon Oct 12 18:15:24 CST 2020, time=2020-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891325, encodeId=d549891325e3, content=路过, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4dc5420229, createdName=ms9000000341386020, createdTime=Sun Oct 11 21:37:31 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035451, encodeId=86ec1035451fb, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sun Oct 11 18:27:51 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891285, encodeId=2f5989128529, content=这个研究的意义在于大流行期间或可选择抗生素方案应急。但是长久来看未必可取。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210315/480e12f811f44bc39b347d2521d56e86/67d0e6d503124ea685205b567af3dffd.jpg, createdBy=f9435296193, createdName=Baodongxu, createdTime=Sun Oct 11 16:47:14 CST 2020, time=2020-10-11, status=1, ipAttribution=)]
    2020-10-12 Jessica

    多一个选择总是好的!特别对于那些不能进行手术治疗的人来说。

    0

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    2020-10-11 ms9000000341386020

    路过

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=917771, encodeId=aa8091e7717a, content=<a href='/topic/show?id=dc7b9e339ea' target=_blank style='color:#2F92EE;'>#阑尾炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97339, encryptionId=dc7b9e339ea, topicName=阑尾炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Mon Jan 18 16:52:30 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893004, encodeId=45d2893004cf, content=阑尾炎复发问题也没法忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/MXdM8fMhceEguIwthekTuiadyb5sK4Eegc8fO0jGc0JpF0ULYsDTTHHbVd2V2xVK3HoZ9wic5vdJbahuHaMyiaU3g/132, createdBy=49301957295, createdName=白日尽落, createdTime=Mon Oct 19 11:08:38 CST 2020, time=2020-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290760, encodeId=49901290e6066, content=<a href='/topic/show?id=e86454454ea' target=_blank style='color:#2F92EE;'>#手术治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54454, encryptionId=e86454454ea, topicName=手术治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1345255, encodeId=8199134525557, content=<a href='/topic/show?id=cd305543152' target=_blank style='color:#2F92EE;'>#抗生素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55431, encryptionId=cd305543152, topicName=抗生素治疗)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891506, encodeId=52a589150645, content=多一个选择总是好的!特别对于那些不能进行手术治疗的人来说。, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Mon Oct 12 18:15:24 CST 2020, time=2020-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891325, encodeId=d549891325e3, content=路过, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4dc5420229, createdName=ms9000000341386020, createdTime=Sun Oct 11 21:37:31 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035451, encodeId=86ec1035451fb, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sun Oct 11 18:27:51 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891285, encodeId=2f5989128529, content=这个研究的意义在于大流行期间或可选择抗生素方案应急。但是长久来看未必可取。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210315/480e12f811f44bc39b347d2521d56e86/67d0e6d503124ea685205b567af3dffd.jpg, createdBy=f9435296193, createdName=Baodongxu, createdTime=Sun Oct 11 16:47:14 CST 2020, time=2020-10-11, status=1, ipAttribution=)]
    2020-10-11 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=917771, encodeId=aa8091e7717a, content=<a href='/topic/show?id=dc7b9e339ea' target=_blank style='color:#2F92EE;'>#阑尾炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97339, encryptionId=dc7b9e339ea, topicName=阑尾炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Mon Jan 18 16:52:30 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893004, encodeId=45d2893004cf, content=阑尾炎复发问题也没法忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/MXdM8fMhceEguIwthekTuiadyb5sK4Eegc8fO0jGc0JpF0ULYsDTTHHbVd2V2xVK3HoZ9wic5vdJbahuHaMyiaU3g/132, createdBy=49301957295, createdName=白日尽落, createdTime=Mon Oct 19 11:08:38 CST 2020, time=2020-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290760, encodeId=49901290e6066, content=<a href='/topic/show?id=e86454454ea' target=_blank style='color:#2F92EE;'>#手术治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54454, encryptionId=e86454454ea, topicName=手术治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1345255, encodeId=8199134525557, content=<a href='/topic/show?id=cd305543152' target=_blank style='color:#2F92EE;'>#抗生素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55431, encryptionId=cd305543152, topicName=抗生素治疗)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Tue Oct 13 06:27:51 CST 2020, time=2020-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891506, encodeId=52a589150645, content=多一个选择总是好的!特别对于那些不能进行手术治疗的人来说。, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Mon Oct 12 18:15:24 CST 2020, time=2020-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891325, encodeId=d549891325e3, content=路过, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4dc5420229, createdName=ms9000000341386020, createdTime=Sun Oct 11 21:37:31 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035451, encodeId=86ec1035451fb, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sun Oct 11 18:27:51 CST 2020, time=2020-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=891285, encodeId=2f5989128529, content=这个研究的意义在于大流行期间或可选择抗生素方案应急。但是长久来看未必可取。, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210315/480e12f811f44bc39b347d2521d56e86/67d0e6d503124ea685205b567af3dffd.jpg, createdBy=f9435296193, createdName=Baodongxu, createdTime=Sun Oct 11 16:47:14 CST 2020, time=2020-10-11, status=1, ipAttribution=)]
    2020-10-11 Baodongxu

    这个研究的意义在于大流行期间或可选择抗生素方案应急。但是长久来看未必可取。

    1

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