De Winter心电图改变对急性前壁心肌梗死患者病情进展的影响  

Influence of de Winter changes on electrocardiogram on progression of acute anterior myocardial infarction

作　　者：时长琴 龚艳艳[1] 潘令新[1] Shi Changqing;Gong Yanyan;Pan Lingxin(Electrocardiogram Room,People's Hospital of Tongling City,Tongling 244002,China;不详)

机构地区：[1]铜陵市人民医院心电图室,铜陵244002

出　　处：《中国循证心血管医学杂志》2021年第6期738-741,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的分析de Winter心电图改变对急性前壁心肌梗死患者病情进展的影响。方法选择2017年3月至2020年3月于铜陵市人民医院心内科收治的316例急性前壁心肌梗死患者,按照患者是否存在de Winter心电图改变将其分为研究组(n=13)与对照组(n=303)。比较两组患者一般资料、分析研究组心电图特征及心电图与病情进展的关系。结果研究组患者年龄、左心室射血指数低于对照组,冠状动脉粥样硬化性心脏病(冠心病)家族史、三酰甘油、血清氯水平高于对照组(P<0.05)。研究组所有患者为窦性心律,QRS波时限、PR间期、QTc间期、心率正常,症状发生后首次出现de Winter心电图平均时间为107 min。De Winter心电图改变发展为STEMI心电图占69.23%,de Winter心电图改变发展为STEMI心电图的平均时间113 min。13例de Winter心电图改变患者V_(1)导联正常,而V_(2)~V_(6)导联出现J点后ST段压低,伴正向高大对称的T波改变;V_(3)~V_(5)导联均存在ST压低,最压低为V_(3)导联;V_(2)~V_(6)导联均存在高大直立T波,V_(3)导联T波最高;还发现当患者出现de Winter心电图改变时,后壁、右室导联ST段、T波正常或ST段、T波轻度压低,倒置,且行治疗后ST段均回至基线;随病情发展,9例患者胸前导联可在短时间内由de Winter心电图改变发展为ST段抬高或病理性Q波、R波递增不良、T波倒置形成的急性前壁STEMI心电图,以V_(1)~V_(4)导联主表现;4例患者胸前导联de Winter心电图改变发展为R波递增不良。结论De Winter心电图改变可发展为ST段抬高、形成病理Q波、R波不良递增,是出现早期急性STEMI的心肌缺血的表现。Objective To analyze the influence of de Winter changes on electrocardiogram(ECG)on disease progression in patients with acute anterior myocardial infarction.Methods The patients(n=316)were chosen from Department of Cardiology in People’s Hospital of Tongling City from Mar.2017 to Mar.2020.All patients were divided,according to de Winter changes on ECG,into study group(n=13)and control group(n=303).The general materials were compared between 2 groups,and ECG features and relationship between ECG and disease progression were analyzed in study group.Results The age and left atrial ejection index were lower,and family history of coronary heart disease(CHD)and levels of triglycerides,and serum chloride were higher in study group than those in control group(P<0.05).In study group,all patients had sinus rhythm,and their QRS duration,PR interval,QTc interval and heart rate were normal.The average time of the first occurrence of de Winter changes after symptom onset was 107 min.The proportion of de Winter changes developing into STEMI changes was 69.23%,and average time was 113 min.The patients(n=13)with de Winter changes had normal lead V_(1),and depressed ST-segment after point J in leads V_(2)~V_(6) accompanied by forward high-symmetric T wave.Leads V_(3)~V_(5) had ST depression and the lowest depression was lead V_(3).There was tall and upright T wave in leads V_(2)~V_(6),and lead V_(3) had the highest T wave.When de Winter changes were observed,ST-segment and T wave of posterior wall and right ventricular lead were normal,or ST-segment and T wave were slightly depressed and inverted,and ST-segment returned to baseline after treatment in all patients.With disease development,the chest lead developed from de Winter changes acute anterior STEMI changes with ST-segment elevation or pathological Q wave,poor R wave increase and T wave inversion in a short time,and main manifestation was presented on leads V_(1)~V_(4) in 9 patients.De Winter changes in precordial leads developed into poor R wave increase in 4 patients.Co

关 键 词：de Winter心电图改变 急性前壁心肌梗死 病情进展 

分 类 号：R542.22[医药卫生—心血管疾病]