急性肺栓塞结局与国际指南依从性的关联：新冠疫情期间医院压力下的墨西哥三级中心经验
该研究在墨西哥三级中心回顾性纳入2019至2022年每年50例急性肺栓塞患者，评估新冠疫情期间及前后指南依从性与临床结局的关联。结果显示总体不依从率为45.4%，不依从与复合结局独立相关（OR=2.36，95%CI 1.23-4.54）。
要点
- 总体指南不依从率为45.4%，主要风险因素包括非低危肺栓塞和PESI非I级。
- 不依从管理与复合结局独立相关，OR=2.36（95%CI 1.23-4.54）。
- 需优先配置人力和物力资源以确保肺栓塞患者遵循标准诊疗。
核心结论
- 急性肺栓塞患者中指南不依从率为45.4%，不依从管理与院内不良复合结局独立相关。
研究设计与样本
- 采用多变量和逻辑回归模型分析指南依从性与临床结局的关联。
主要发现
- 总体不依从率为45.4%。
- 不依从的主要风险因素为任何高于低危的死亡风险分类（OR=3.47，95%CI 2.07-5.82）和PESI非I级（OR=1.57，95%CI 1.04-2.37）。
- 在新冠季和非新冠季，不依从管理与复合结局相关（OR=2.36，95%CI 1.23-4.54）。
- 不依从组复合结局发生率为47.7/1000人日（95%CI 33.39-67.50），依从组为21.08/1000人日（95%CI 10.97-40.51）。
- 归因风险为1.09%（95%CI -8.47%-10.64%）。
临床怎么用
- 对急性肺栓塞患者应优先保障人力和物力资源以确保遵循国际指南标准诊疗。
- 对非低危肺栓塞及PESI非I级患者应重点关注指南依从性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
PLoS One. 2026 Apr 29;21(4):e0347761. doi: 10.1371/journal.pone.0347761. eCollection 2026. ABSTRACT BACKGROUND: Lack of adherence to international recommendations leads to worse outcomes. During the COVID-19 pandemic, the total number and proportion of hospitalized patients increased, consequently straining hospital care and hindering adherence. AIMS: To evaluate adherence to clinical guidelines at our center, before, during, and shortly after the COVID-19 pandemic-induced hospital strain, and its association with clinical outcomes, using a random, balanced retrospective cohort. DESIGN: A balanced and randomized sample of 50 patients per year between 2019 and 2022 was drawn from electronic medical records and analyzed with multivariable and logistic regression models. The primary outcome was a composite of in-hospital death, hemodynamic decompensation within the first 7 days, and in-hospital bleeding. RESULTS: The global non-adherence in our study was 45.4%. The main risk factors for non-adherence were any mortality risk classification above low-risk PE and a PESI class different from class I, with ORs of 3.47 (95% CI 2.07-5.82) and 1.57 (95% CI 1.04-2.37), respectively. In both periods (COVID-19 season and non-COVID-19 season), non-adherent management strongly correlated with the composite outcome, OR = 2.36 (95% CI, 1.23-4.54). Non-adherence was also associated with worse in-hospital outcomes, with an incidence rate of the composite outcome of 21.08 per 1000 days/person (95% CI 10.97-40.51) and 47.7 per 1000 days/person (95% CI 33.39-67.50), and an attributable risk of 1.09% (95% CI -8.47%-10.64%). CONCLUSIONS: Overall, our findings highlight the need to prioritize human and material resources to ensure adherence to the standards of care for PE patients. PMID: 42054381 | PMC: PMC13127952 | DOI: 10.1371/journal.pone.0347761
引用
- 指南共识 · 肺栓塞：Outcomes in acute pulmonary embolism and their association with adherence to international recommendations around COVID-19 pandemic-induced hospital-strain: The experience in a Mexican tertiary care center
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。