Диссертация (1139975), страница 20
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– 2013. – Vol.344. – P. 665-672.136Приложение А.(справочное)Карта участника исследования №__________I)Демографическая часть:1.2.3.4.5.II)ФИО: _________________________________________________________________Возраст:Пол: м / жРост:Вес:ИМТ:Расовая принадлежность: ________________________Клиническая часть:Объективно:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ФАКТОРЫ РИСКА, АССОЦИИРОВАННЫЕ С РАЗВИТИЕМ РЕЗИСТЕНТНОСТИ ККЛОПИДОГРЕЛУ:1.
Активное курениеСопутствующая патология:1. Гиперлипидемия:____________________________________________________________________________________________________________________________________________2. Сахарныйдиабет:__________________________________________________________________________________________________________________________________________________________3.
Артериальная гипертония:_____________________________________________________________________________137___________________________________________________________________________________4. Ишемический инсульт: ________________________________________________________________________________________________________________5. Почечная недостаточность:___________________________________________________________________________________________________________________________________________6. Анемия:_________________________________________________________________________________________________________________________________________________________7. Другое:________________________________________________________________________________________________________________________________________________________________Заболевания сердечно-сосудистой системы в анамнезе:1.
ИБС. Q-образующий ИМ __________/ _____________________________________________________________________________________________________________________________________________________________________________________2. ИБС. Не-Q-образующий ИМ __________/ _____________________________________________________________________________________________________________________________________________________________________________________3. ИБС. ИМ неуточненный __________/ ____________________________________________________________________________________________________________________________________________________________________________________4. Тромбоз стента в анамнезе: _____________/_________________________________________________________________________________________________________________________________________________________________________________5.
Хроническая сердечная недостаточность: _________/_____________________________________________________________________________________________________________________________________________________________________________________6. Другое : _________/___________________________________________________________________________________________________________________Оперативные вмешательства на сосудах и сердце:1. Предшествующие ЧКВ: __________/ ____________________________________________________________________________________________________________________2. Предшествующее коронарное шунтирование: __________/ ____________________________________________________________________________________________________________________Предшествующее эндоваскулярное вмешательство на периферическихартериях:138__________/____________________________________________________________________________________________________________________Другие заболевания иоперации:________________________________________________________________________________________________________________________________________________________________Таблица А 1.
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