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Zeymer U, Arntz HR, Mark B, et al (2012), ―Efficacy and safety of a high loading dose of clopidogrel administered prehospitally to improve primary percutaneous coronary intervention in acute myocardial infarction: the randomized CIPAMI trial‖, Clinical Research in Cardiology, 101, pp. 305- 312. Phụ lục 1: PHIẾU THÔNG TIN NGHIÊN CỨU Đề tài: Nghiên cứu Lp-PLA2 và kiểu hình LDL ở bệnh nhân HCMVC 1/ Hành chánh - Họ tên bn ................................................................... Ns: .................... Nam/Nữ - Địa chỉ: ...................................................................... Nghề nghiệp: .................. - Liên lạc: ..................................................................... ....................................... - Vào viện ngày ............................................... Số NV.......................................... - Chẩn đoán(*): ............................................................ khoa: .............................. - Tiêu chuẩn chẩn đoán: ............................................... ....................................... 2/ Yếu tố nguy cơ - Chiều cao:cm; cân nặng:cm - Vòng eocm; vòng hông:.cm - huyết áp tâm thu/tâm trương:../..mmHg; điều trị: ............................... - Hút thuốc lá: có/ không ; loại :.; điếu/ngày:.. - Uống rượu: có/không ; loại ...số lượng.. - Tiểu đường có/không ; típ: từ khi nào:..điều trị gì: . .......................................... ....................................... - Bệnh lý tim mạch, đột qụy................................. ; điều trị .......................... - Cha mẹ, anh chị em ruột bị tim mạch hay đột qụy ..................................... .lúc mấy tuổi ............................................................ - Các bệnh lý hiện tại khác (chú ý viêm nhiễm): .. ....................................... 3/ Thông tin bệnh lý: - Triệu chứng ....................................................... ....................................... ............................................................................... ....................................... - K/q men tim: ..................................................... ....................................... - K/q ECG ........................................................... ....................................... - Chụp mạch vành ................................................ ....................................... - Thường quy: ...................................................... ....................................... - Các k/q lipid: ..................................................... ....................................... - Homocystein: .................................................... IL6: ................................ - CRPhs ............................................................... PLAC test:..................... - Điện di LDL: ..................................................... ....................................... 4/ Các thông tin tái khám: L1 (ngày//.) ; v/đ .................................. ....................................... L2 (ngày//.) ; v/đ .................................. ....................................... L3 (ngày//.) ; v/đ .................................. ....................................... L4 (ngày//.) ; v/đ .................................. ....................................... L5 (ngày//.) ; v/đ .................................. ....................................... L6 (ngày//.) ; v/đ .................................. ....................................... L7 (ngày//.) ; v/đ .................................. ....................................... L8 (ngày//.) ; v/đ .................................. ....................................... L9 (ngày//.) ; v/đ .................................. ....................................... L10 (ngày//.) ; v/đ ................................ ....................................... L11 (ngày//.) ; v/đ ................................ ....................................... L12 (ngày//.) ; v/đ ................................ ....................................... 5/ Các ghi chú ..................................................................................... ....................................... ..................................................................................... ....................................... ..................................................................................... ....................................... ..................................................................................... ....................................... ..................................................................................... ....................................... Ngày...//.. (*): phải ghi cụ thể đau thắt ngực không ổn định không ST chênh lên, có ST chênh lên, nhồi máu cơ tim Phụ lục 2: MẪU ĐỒNG Ý THAM GIA NGHIÊN CỨU Tôi tên:................................................................................... Sinh năm:............................................................................... Hiện là bệnh nhân (thân nhân của bệnh nhân) đang điều trị tại khoa:....................................... Sau khi được bác sĩ điều trị giải thích đầy đủ về ý nghĩa của xét nghiệm và theo dõi trong nghiên cứu. Chúng tôi đồng ý tham gia nghiên cứu, chúng tôi đồng ý các bác sĩ tiến hành thực hiện nghiên cứu trên mẫu bệnh phẩm và theo dõi bệnh của tôi trong quá trình điều trị (thời gian 2 năm). TP.Hồ Chí Minh, ngày tháng năm Người bệnh/thân nhân bệnh nhân ký tên Phụ lục 3: