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PHỤ LỤC 1 BỆNH ÁN NGHIÊN CỨU
HÀNH CHÍNH
Họ và tên (viết tắt tên)..................................................................................
Số hồ sơ:
Số nhập viện:
Địa chỉ (tỉnh, thành phố) ..............................................................................
Ngày tháng năm sinh: Giới: Nam Nữ Ngày nhập viện:
TRƯỚC PHẪU THUẬT
Cân nặng ………………kg Diện tích cơ thể………. m2
Tiền căn: ......................................................................................................
Stent PDA Stent RVOT
BT shunt
Bất thường di truyền(Down, Di Georgre...) Cơn tím:
SpO2:
Hct ………….% Hb.................
Siêu âm tim:
Thông liên thất: số lượng...........phần màng phần phễu
Đường kính …………….mm ĐMC cưỡi ngựa……………%
Vòng van ĐMP………….mm, Z score vòng van ĐMP......
Thân ĐMP ………. Z score............ĐMP P ………. ĐMP T ………… Vị trí hẹp: dưới van tại van trên van ĐMP nhánh..................... Van ĐMP: số mảnh....hình dạng các lá van