心血管介入術(shù)后不良事件監(jiān)控系統(tǒng)的研發(fā)及應(yīng)用
[Abstract]:Objective: to construct an adverse event monitoring system for cardiovascular intervention after (percutaneous coronary intervention, PCI), evaluate the effectiveness of the monitoring system, and use it to extract clinical data. The risk factors of contrast-agent nephropathy (contrast-induced nephropathy, CIN) after PCI in patients with early stenting thrombotic (early stent thrombosis, EST) after PCI and (acute coronary syndrome, ACS) with acute coronary syndrome were analyzed respectively. Methods: (1) the monitoring system was compared with the hospital. Information system (Hospital Information System, HIS) system real-time docking, The clinical data of all surgical patients were integrated into the system, and the medical information database of the patients after PCI was constructed. (2) 2041 patients who were admitted to the Department of Cardiovascular Medicine of the General Hospital of the Chinese people's Liberation Army from May 2015 to August 2015 were enrolled in PCI operation. By manually verifying the adverse events one by one and comparing the results of the adverse events monitored by the monitoring system, To calculate the authenticity and reliability of the monitoring system for the identification of adverse events. (3) to extract the clinical data of patients after PCI operation in the General Hospital of the Chinese people's Liberation Army from January 1, 2010 to December 31, 2015 through the adverse event monitoring system. The patients with postoperative EST were compared with those who did not have EST in the same period of PCI, and the clinical data were analyzed by statistical method. The risk factors of EST after PCI were found. (4) ACS patients with CIN after PCI operation in PLA General Hospital from January 2014 to January 2015 were extracted as case group by monitoring system. The clinical data of ACS patients without CIN after PCI were analyzed, and the risk factors of CIN after PCI were found. The results showed that: (1) the monitoring system could monitor the adverse events of PCI in real time. Statistical analysis, composition analysis, ranking analysis, traceability analysis, data extraction and other functions to realize the data of adverse events after PCI, information management. (2) in the selected patients, The sensitivity, specificity, accuracy and accuracy of the monitoring system for the identification of adverse events after PCI were 94.5, 98.6 and 98.2, respectively. (3) the total length of emergency PCI, stent implantation was too long. Low left ventricular ejection fraction (left ventricular ejection fraction, LVEF) and sleep apnea (obstructive sleep apnea, OSA) were independent risk factors for EST after PCI. (4) the age of 70 years and the history of chronic renal insufficiency (chronic renal insufficiency, CRI). The dosage of intraoperative contrast agent (contrastmedium,CM) was 200ml, systolic blood pressure (systolic blood pressure,SBP) was 100mmhgg / L, leukocyte (white blood cell,WBC count was 10 脳 1012mmol / L, and cardiac troponin T (TroponinT, TNT) 0.5ng / ml BNP (brain-type natriuretic peptide,BNP 300ng/ml) was the independent risk factor of CIN after PCI in ACS patients. Conclusion: (1) the sensitivity of adverse event monitoring system for the identification of complications after PCI. Specificity, high accuracy, reliable data, labor-saving, real-time feedback, worthy of clinical promotion. (2) this study found that the total length of the emergency PCI, stent is too long and the total length of the stent is low. OSA was the independent risk factor of EST after PCI. (3) the age of 70 years old, the dosage of CM during operation was 200ml, SBP 100mm / g / L / L TNT 0.5ng / ml / ml was the independent risk factor of CIN after PCI, and SBP 100mm / g / L / L TNT 0.5ng / ml / L was the independent risk factor of CIN after PCI.
【學(xué)位授予單位】:中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2017
【分類號(hào)】:TP277;R54
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