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Objective:To quantitatively evaluate the guidelines for hypertensive disorders of pregnancy (HDP) at home and abroad, and to provide a reference for the development of related guidelines in the future.Methods:Guidelines related to HDP published at home and abroad from 1 January 2018 to 31 December 2022 were retrieved from several databases, including CNKI, Wanfang Database, Yiigle, VIP Database, PubMed, Embase, and Web of Science with the terms of "hypertension in pregnancy", "hypertensive disorders of pregnancy", "pre-eclampsia", "eclampsia", and "guidelines". The retrieved guidelines were evaluated with the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) and Scientific, Transparent and Applicable Rankings (STAR) tool. According to the manual of AGREE Ⅱ two researchers graded the retrieved guidelines from six domains: scope and purpose, participants, rigor, clarity, applicability, and independence. Mean standardized score of each domain and the overall score were obtained. STAR tool was used to grade the guidelines by two researchers and one methodologist from 11 domains: registration, protocol, funding, working groups, conflicts of interest, clinical issues, evidence, consensus methods, recommendations, accessibility, and others.Results:A total of 19 related guidelines were included, covering six countries on three continents. The mean standardized scores of the 19 guidelines in the six domains of scope and purpose, participants, rigor, clarity, applicability, and independence using the AGREE II instrument were 73.98%, 63.16%, 59.98%, 66.37%, 56.36%, and 71.93%, respectively. Scores in the 11 domains of registration, protocol, funding, working groups, conflicts of interest, clinical issues, evidence, consensus methods, recommendations, accessibility, and others using the STAR tool were 0.00%, 0.00%, 76.15%, 39.87%, 58.92%, 65.19%, 60.80%, 49.78%, 78.95%, 30.89%, and 42.11%, respectively. According to the overall evaluation results, 12 guidelines were recommended and seven needed further modifications. It was found that most guidelines were unanimous in their recommendations on the prevention of preeclampsia with aspirin, medications for patients with severe hypertension, and the timing of pregnancy termination in preeclampsia patients, with the consensus rates of 10/13, 9/13, and 9/13, respectively. Besides, these recommendations were supported by substantial evidence.Conclusions:The overall quality of guidelines related to HDP at home and abroad is high, but there is still room for improvement. When developing relevant guidelines in the future, statisticians and methodologists should be included in the working groups to improve the evidence-based quality, and much attention should be paid to the disclosure of conflicts of interest guidelines. Registration and protocol are needed before publishing a guideline. The development of multiple versions for different users will conduce to improving the management of HDP.
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Objective To investigate the characteristics of pathogenic bacteria/the drug resistance/the correlated risk fators/the prophylaxis control strategy of the severe craniocerebral injury patients combined with intracranial infection .Methods The clinical data of 35 craniocerebral injury patients with intracranial infection were retrospectively analyzed .Results 35 patients′cerebrospinal fluid were separated and 54 pathogenic bacterium had been cultured ,including G+ bacterium(61 .11% ) ,the G - bacteria(33 .33% ) , fungi(5 .56% ) .The pathogenic bacteria showed a higher resistance .The single factor analysis found that the wound itself exists in-fection factors ,the postoperative drainage of incision ,liquorrhoea ,with other basic diseases ,surgery lasted for a long time (>4 h) reoperative ,surgery is placed foreign body is severe craniocerebral trauma combined with intracranial infection were the main rele-vant factors .The total effective rate was 62 .86% ,and the mortality was 11 .43% by the positive therapy .Conclusion G+ bacteria were the main pathogenic bacterium in the severe craniocerebral injury patients combined with intracranial infection .The iatrogenic factors leaded to the increase of the proportion of intracranial infection and the resistance increased year after year .The clinical in-travenous antibiotics combined intrathecal injections were beneficial to control intracranial infection ,shorten the course of treatment and enhance the curative effect .