心血管介入术后不良事件监控系统的研发及应用

发布时间：2018-09-11 10:01

【摘要】：1、目的:构建心血管介入术(percutaneous coronary intervention, PCI)后不良事件监控系统,对监控系统进行有效性评估,并运用其提取临床数据,分别对PCI术后早期支架内血栓(early stent thrombosis, EST )及急性冠状动脉综合征(acute coronary syndrome, ACS )患者PCI术后发生对比剂肾病(contrast-induced nephropathy, CIN )进行危险因素分析。2、方法:(1)监控系统通过与医院信息系统(Hospital Information System, HIS )系统实时对接,将所有手术患者临床资料纳入系统,构建PCI术后患者的医疗信息数据库。(2)入选2015年5月-2015年8月在中国人民解放军总医院心血管内科住院行PCI术的患者共2041例,通过人工逐一验证确认不良事件与监控系统监控的不良事件结果相对比,计算出监控系统对不良事件识别的真实性及可靠性指标。(3)通过不良事件监控系统提取2010年1月1日至2015年12月31日在中国人民解放军总医院PCI术后患者的临床资料,将术后发生EST的患者作为病例组,与同期住院的PCI患者中未发生EST的患者对比,用统计学方法分析临床资料,发现PCI术后发生EST的危险因素。(4)通过监控系统提取出解放军总医院2014年1月至2015年1月收治的PCI术后并发CIN的ACS患者作为病例组,并与同期住院行PCI术后不伴CIN的ACS患者作为对照组,对其临床资料进行分析,从而发现ACS患者PCI术后发生CIN的危险因素。3、结果:(1)监控系统可实现对PCI术后不良事件的实时监控,统计分析、构成分析、排行分析、溯源分析、数据提取等功能,实现对PCI术后不良事件的数据化、信息化管理。(2 )在入选的患者中,监控系统对于PCI术后不良事件识别的灵敏度高达94.5%,特异度高达98.6%,准确度高达98.2%,对于高危不良事件的识别准确度可高达100%。(3)急诊PCI,植入支架总长度过长,左室射血分数(left ventricular ejection fraction, LVEF )低,合并睡眠呼吸暂停(obstructive sleep apnea, OSA)为 PCI 术后EST的独立危险因素。(4)年龄 70岁、合并慢性肾功能不全(chronic renal insufficiency, CRI)病史,术中对比剂(contrastmedium,CM)用量200ml、入院时收缩压(systolic blood pressure,SBP ) 100mmhg、LVEF 50%、白细胞(white blood cell,WBC )计数10×1012mmol/L、肌钙蛋白 T(TroponinT, TNT) 0.5ng/ml、B 型脑利钠肽(brain-type natriuretic peptide,BNP ) 300ng/ml 是 ACS 患者 PCI 术后CIN发生的独立危险因素。4、结论:(1) PCI术后不良事件监控系统对于并发症的识别灵敏度、特异度、准确度高,数据较为真实、可靠,节省人力,实时反馈,值得临床推广。(2 )本研究发现急诊PCI,植入支架总长度过长,LVEF低,合并OSA为PCI术后EST形成的独立危险因素。(3 )年龄 70 岁、术中 CM 用量 200ml、入院时 SBP 100mmhg、LVEF 50%、WBC10×1012mmol/L、TNT0.5ng/ml、BNP300ng/ml 是 PCI 术后CIN发生的独立危险因素。
[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.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：TP277;R54

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