作者：刘东升1，刘娜1，李国林2，王艳琳1

单位：

1.061001河北省沧州市人民医院心内科 　2.061001河北省沧州市人民医院介入血管外科

Units：

1.Department of Cardiology, Cangzhou People's Hospital, Cangzhou 061001, China2.Department of Interventional Vascular Surgery, Cangzhou People's Hospital, Cangzhou 061001, China

关键词：

De Winter综合征；心肌梗死；心电图

Keywords：

De Winter syndrome; Myocardial infarction; Electrocardiogram

CLC：

R 542.22

DOI：

10.12114/j.issn.1008-5971.2022.00.252

Funds：

河北省医学科学研究课题计划（20220312）

摘要：

目的　分析De Winter综合征患者心电图形态多样性。方法　选择2018-01-16至2022-01-29在沧州市人民医院就诊的以前降支或对角支为罪犯血管的急性心肌梗死患者2 396例，其中De Winter综合征75例（占3.13%）。主要分析De Winter综合征患者的心电图检查结果，包括是否有动态演变、胸前导联ST段压低形态、胸前导联J点压低最深及T波振幅最高的导联、胸前导联QRS波群形态及演变特点、aVR及下壁导联特点。结果　75例De Winter综合征患者中，有心电图动态演变50例（66.7%），无心电图动态演变25例（33.3%）；胸前导联ST段压低呈经典上斜形41例（54.7%），平缓上斜形10例（13.3%），几乎水平形7例（9.3%），类似鱼钩形17例（22.7%）；胸前导联J点压低最深位于V2导联4例（5.3%），位于V3导联22例（29.3%），位于V4导联27例（36.0%），位于V5导联20例（26.7%），位于V6导联2例（2.7%）；胸前导联T波振幅最高位于V2导联28例（37.3%），位于V3导联42例（56.0%），位于V4导联5例（6.7%），位于V5或V6导联者0例。QRS波群宽度正常69例（92.0%），增宽6例（8.0%）；胸前导联R波递增正常62例（82.7%），递增不良11例（14.7%），递增过快1例（1.3%），胸前导联移行区提前1例（占1.3%）。aVR导联抬高60例（80.0%），正常15例（20.0%），压低0例；Ⅱ导联压低55例（73.3%），正常20例（26.7%），抬高0例；Ⅲ导联压低43例（57.3%），正常29例（38.7%），抬高3例（4.0%）；aVF导联压低50例（66.7%），正常25例（33.3%），抬高0例。结论　De Winter综合征患者心电图形态多样，主要表现为胸前导联ST段压低呈经典上斜形、aVR导联抬高及Ⅱ、Ⅲ、aVF导联压低，胸前导联J点压低最深主要位于V3~V5导联，胸前导联T波振幅最高主要位于V3导联。

Abstract：

Objective　To analyze the morphological diversity of ECG in patients with De Winter syndrome.Methods　A total of 2 396 patients with acute myocardial infarction whose criminal vessels were left anterior descendingor diagonal branches admitted to Cangzhou People's Hospital from January 16th, 2018 to January 29th, 2022 were selected,among them, 75 cases (3.13%) were De Winter syndrome. The results of ECG were analyzed in patients with De Wintersyndrome, including whether there was dynamic evolution, ST-segment depression morphology of chest lead, the lead withthe deepest J-point depression and the highest T-wave amplitude, QRS complex morphology and evolution characteristicsof chest lead, characteristics of aVR and inferiors lead. Results　Among the 75 patients with De Winter syndrome, 50 cases(66.7%) had dynamic evolution in ECG and 25 cases (33.3%) had no dynamic evolution in ECG; the ST-segment depression ofthe chest lead was classical upsloping shape in 41 cases (54.7%) , gentle upsloping shape in 10 cases (13.3%) , almost horizontalshape in 7 cases (9.3%) , and similar fish hook shape in 17 case (22.7%) ; the deepest depression of J-point of chest lead waslocated in V2 lead in 4 cases (5.3%) , V3 lead in 22 cases (29.3%) , V4 lead in 27 cases (36.0%) , V5 lead in 20 cases (26.7%) andV6 lead in 2 cases (2.7%) ; the highest amplitude of T-wave of chest lead was located in V2 lead in 28 cases (37.3%) , V3 leadin 42 cases (56.0%) , V4 lead in 5 cases (6.7%) , and V5 or V6 lead in 0 case. The QRS complex width was normal in 69 cases(92.0%) and widened in 6 cases (8.0%) ; 62 cases (82.7%) had normal increment of R-wave in chest lead, 11 cases (14.7%) hadpoor increment, 1 case (1.3%) had rapid increment, and 1 case (1.3%) had advanced transition zone; .aVR lead elevated was in60 cases (80.0%) , normal in 15 cases (20.0%) , and depressed in 0 case; Ⅱ lead was depressed in 55 cases (73.3%) , normal in20 cases (26.7%) and elevated in 0 case; Ⅲ lead was depressed in 43 cases (57.3%) , normal in 29 cases (38.7%) and elevated in 3cases (4.0%) ; aVF lead was depressed in 50 cases (66.7%) , normal in 25 cases (33.3%) , and elevated in 0 case. Conclusion　TheECG of patients with De Winter syndrome have morphological diversity, it mainly shows that ST-segment depression in the chest leadpresents classical upsloping shape, aVR lead elevates and Ⅱ , Ⅲ and aVF lead depresses, the deepest depression of J-point in chestlead is mainly located in V3-V5 leads, and the highest T-wave amplitude in chest lead is mainly located in V3 lead.

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