洋地黄在急性心肌梗死中：有益还是有害？

Digitalis in acute myocardial infarction: help or hazard?

作者信息

Rahimtoola S H, Gunnar R M

出版信息

Ann Intern Med. 1975 Feb;82(2):234-40. doi: 10.7326/0003-4819-82-2-234.

Abstract

The use of digitalis in acute myocardial infarction remains controversial because of disagreement regarding the electrophysiologic, hemodynamic, and metabolic risks and benefits. However, there is no convincing evidence of an increased incidence of arrhythmias following digitalis therapy. Direct measurement of left ventricle function shows improvement of impaired left ventricular performance. The increased metabolic cost of enhanced inotropy following digitalis is countered by reductions in left ventricular end-diastolic pressure and volume, especially when left ventricular failure is present. Extension of infarct size shown in the dog after administration of digitalis may occur only in that experimental model or only if cardiac failure is absent. We conclude that digitalis may be recommended following acute myocardial infarction if the usual indications, supraventricular tachyarrhythmias or cardiac failure, are present.

摘要

由于在电生理、血流动力学及代谢方面的风险和益处存在争议，洋地黄在急性心肌梗死中的应用仍存在争议。然而，没有令人信服的证据表明洋地黄治疗后心律失常的发生率会增加。左心室功能的直接测量显示，受损的左心室功能得到改善。洋地黄增强心肌收缩力后增加的代谢成本被左心室舒张末期压力和容积的降低所抵消，尤其是在存在左心室衰竭的情况下。洋地黄给药后犬类出现梗死面积扩大的情况可能仅发生在该实验模型中，或者仅在不存在心力衰竭的情况下发生。我们得出结论，如果存在常见适应症，即室上性快速心律失常或心力衰竭，那么急性心肌梗死后可以推荐使用洋地黄。