de Winter综合征6例临床分析  

Clinical analysis of de Winter syndrome in six patients

作　　者：熊昌 魏辉[1] 杨广龙[1] 尹琼[1] 陈礼学[1] Xiong Chang;Wei Hui;Yang Guanglong;Yin Qiong;Chen Lixue(Department of Cardiovascular Medicine,The First People's Hospital of Tianmen,Tianmen 431700,Hubei Province,China)

机构地区：[1]天门市第一人民医院心血管内科,天门431700

出　　处：《中国基层医药》2023年第8期1139-1143,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的研究de Winter综合征的病变特点,探讨这类患者的治疗时机以及预后情况。方法收集2019年7月至2020年9月在天门市第一人民医院心血管内科诊断为de Winter综合征的患者6例,观察这些患者的临床危险因素、冠状动脉病变特点、心电图演变、心脏彩超、高敏肌钙蛋白、脑钠肽等指标,并随访12个月。结果6例患者中有4例行冠状动脉造影(coronary angiography,CAG)及经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)。所有手术患者CAG结果均为前降支病变,3例闭塞,1例重度狭窄,术后均恢复心肌梗死溶栓3级血流。5例心电图演变为前壁ST段抬高,1例心电图演变为前壁加下壁ST段抬高。1例拒绝CAG,予以药物保守治疗后出院。1例未能及时识别,常规流程收入院后死亡。对好转出院的5例患者随访12个月,1例因“心力衰竭”再次入院治疗,其余4例无不良事件发生。结论正确识别de Winter综合征的心电图改变,尽早行CAG及PCI,可显著降低病死率并改善远期预后。Objective To investigate the pathological characteristics,treatment timing,and prognosis of de Winter syndrome.Methods Six patients with de Winter syndrome who received treatment in the Department of Cardiovascular Medicine,The First People's Hospital of Tianmen from July 2017 to September 2020 were included in this study.The clinical risk factors,characteristics of coronary artery lesions,electrocardiogram evolution,echocardiography,high-sensitivity troponin,and brain natriuretic peptide were evaluated.All patients were followed up for 12 months after discharge.Results Among the six patients included,four patients underwent coronary angiography and percutaneous coronary intervention.Coronary angiography results showed that anterior descending artery lesions occurred in all patients,consisting of occlusion of the anterior descending artery in three patients and severe stenosis of the anterior descending artery in one patient.After surgery,TIMI3 blood flow recovered in all patients.Electrocardiogram showed anterior wall ST segment elevation in five patients,and anterior wall and inferior wall ST segment elevation in one patient.One patient refused to undergo coronary angiography and was discharged after conservative management with drugs.de Winter syndrome was not identified in time in one patient.The patient died after being admitted to the hospital through routine procedures.Five recovered patients were followed up for 12 months,consisting of one patient who was re-admitted because of heart failure,and four patients in whom no adverse events occurred.Conclusion Identification of electrocardiogram manifestations of de Winter syndrome and implementation of coronary angiography and percutaneous coronary intervention as early as possible can substantially reduce mortality rate and improve long-term prognosis.

关 键 词：急性冠状动脉综合征 心肌梗死 经皮冠状动脉介入治疗 冠状血管造影术 心力衰竭 心电描记术 

分 类 号：R541.4[医药卫生—心血管疾病]