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回顾性研究论文,常见写作问题实例解析

  • 原作者:张科宏1 文章整理:王晗玥2
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Medical Research & Publication   2023;9(3):82-83

doi: 10.14218/MRP.2023.08251

临床研究按照数据获得时间与研究设计时间的关系,可以分为前瞻性研究和回顾性研究。回顾性研究是根据某种特定的研究目的,分析以往临床工作已积累的病例资料。本文以2022年在Chinese Medical Journal上发表的一篇论文Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study为例,解析一些在回顾性研究论文写作中常见的问题。

摘要结果部分问题解析

Results: The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064–3.493, P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115–10.707, P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233–3.456, P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108–18.228, P = 0.001) in the ICU patients.

这段话中存在的问题:

1)摘要方法部分最大的问题是没有对不耐受的定义。第三句话中,不耐受有2种定义,一种是胃剩余容量大于等于200毫升和/或呕吐,另一种是大于等于500毫升和/或呕吐。那前面两句话中,描述所谓的prevalence,用的是哪一种定义?

2)比例对不上。第一句话“The prevalence of FI during the first 7 days of ICU stay was 10.95%.”说 ICU入住头7天,不耐受的比例是10.95%。但在第二句话中又说,第二天不耐受比例是15.04%,第三天是11.67%,第七天是12.03%。

按照基本的逻辑,所谓七天内不耐受的比例 the prevalence of FI during the first 7 days 应当是任何一天不耐受患者都算,所以七天内不耐受的比例 the prevalence of FI during the first 7 days 应当高于第二天、第三天和第七天的三个比例。这里不一定是作者弄错了,但至少没写明白。

3)在描述结果的FI( feeding intolerance)的比例之前,必须交代肠内营养的配方和容量,还需要交代研究对象的基本特征(年龄性别、病情严重程度等)。

论文摘要确实不需要面面俱到,也不可能交代所有的细节,但必须是对研究全貌的一个总体描绘,必须是一个大致完整的、可以解读的梗概,不可以支离破碎、盲人摸象。

论文方法部分问题解析

Methods-Participants: All the patients who initiated continuous enteral nutrition during 48h following admission via a nasogastric tube and stayed in the ICU for >2 days were enrolled.

这段话中存在的问题:

1)回顾性研究“enroll-入组”是不存在的。

2)“initiate”这个词的含义是发起、启动。肠内营养并不是病人发起的,“patients who initiated continuous enteral nutrition”这个说法是不恰当的。

3)“during 48h following admission”,改为“within the 48 hours after admission”更好。

 

Methods-Participants: Patients with orogastric tubes or nose-jejunum tubes, those who did not receive enteral nutrition during the entire stay at the ICU or the first 7 days in the ICU, those who stayed at the ICU for fewer than 2 days, and patients whose medical records contained missing data were excluded.

这段话中存在的问题:

1)“those who stayed at the ICU for fewer than 2 days”多余,上一句话载明“… and stayed in the ICU for >2 days were enrolled”,这里再说住ICU不满2天的排除,重复。

2)“those who did not receive enteral nutrition during the entire stay at the ICU or the first 7 days in the ICU”令人费解:没有在ICU全程或者没有在住ICU的前7天接受肠内营养的患者排除。按照这个说法,某病人住ICU10天,前8天接受了肠内营养,但最后两天拔除了鼻饲管,他就应当被排除。

这个研究的目的是弄清ICU患者肠内营养不耐受的比例和风险因素,像上述举例的病人,没有道理排除在分析之外。事实上,这个研究中ICU stay 的中位数是10天,则最短6天最长18天,其中有一些病人接受肠内营养但不耐受撤掉了。而这样的病人,实际上被作者纳入了分析,换句话说,这里的描述是错误的。

3)“patients whose medical records contained missing data were excluded”,表达不明确。missing data,指丢失数据。这里应当说明具体什么数据(关键的数据,没有就没法确定结局终点,比如没测胃剩余容量)丢失了才不纳入分析。

改写:

For inclusion in the final analysis, continuous enteral nutrition must be initiated within the first 48 hours after ICU admission via a nasogastric tube and had at least 1 assessment of feeding intolerance. Cases with missing key data (e.g., ???) were excluded from the analysis.

希望此次实例解析对大家论文写作有所帮助!

「白话医学研究」公众号是前哈佛大学医学院助理教授张科宏博士创办的微信公众号,累计阅读已 达 25 万余次。张科宏博士在国内外都有丰富的科研经验,于每周二在「白话医学研究」公众号发布微 视频解读论文,用论文实例从理论 - 心理 - 流程将智慧融入实战,帮助非英语母语的学者将其科研成果 展示于国内外科研平台。「白话医学研究」不仅适合入门级医学研究者关注学习,对资深医学研究者也 同样有益,对非研究型的医生提高思辨能力也有很大的帮助。

  • Medical Research & Publication
  • pISSN 2475-7500
  • eISSN 2475-7543
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回顾性研究论文,常见写作问题实例解析

原作者:张科宏<sup>1</sup> 文章整理:王晗玥<sup>2</sup>
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