地高辛对合并心房颤动心力衰竭患者的影响。
Digoxin Impact on Heart Failure Patients with Atrial Fibrillation.
机构信息
Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
Department of Surgery, University Hospital of Patras, Patras, Greece.
出版信息
Med Arch. 2022 Feb;76(1):23-28. doi: 10.5455/medarh.2022.76.23-28.
BACKGROUND
Digoxin is a cardiac glycoside, derived from the plant Digitalis purpurea. For many years digitalis has been widely used in the treatment of heart failure (HF), owing to its cardiotonic and neurohormonal effects and atrial fibrillation (AF), due to its parasympathomimetic effect on the AV node.
OBJECTIVE
The aim of this paper is to evaluate the available evidence on the safety and efficacy of digoxin in patients with HF and AF, by reviewing the pertinent literature.
METHODS
We conducted a PubMed/MEDLINE and SCOPUS search to evaluate the currently available evidence on the administration of digoxin and its association with all-cause mortality risk in patients with AF and HF.
RESULTS
Several observational analyses of clinical trials and meta-analyses have shown conflicting results on the safety and efficacy of digoxin administration in patients with AF and HF. According to these results, digoxin should be avoided in patients without HF, as it is associated with worse outcomes. On the other hand, in patients with AF and HF digoxin should be used with caution.
CONCLUSION
The impact of digoxin on all-cause mortality and adverse effects in these patients remains unclear based on the current evidence. More trials at low risk of bias evaluating the effects of digoxin are needed.
背景
地高辛是一种从毛地黄属植物中提取的强心苷。多年来，地高辛因其正性肌力作用和神经激素效应而被广泛用于心力衰竭（HF）的治疗，同时因其对房室结的拟副交感作用而被用于心房颤动（AF）的治疗。
目的
本文旨在通过回顾相关文献，评估地高辛在 HF 和 AF 患者中的安全性和疗效的现有证据。
方法
我们进行了 PubMed/MEDLINE 和 SCOPUS 检索，以评估目前关于地高辛给药及其与 AF 和 HF 患者全因死亡率风险的相关性的现有证据。
结果
几项关于临床试验的观察性分析和荟萃分析对 AF 和 HF 患者中地高辛给药的安全性和疗效得出了相互矛盾的结果。根据这些结果，地高辛不应在无 HF 的患者中使用，因为它与更差的结局相关。另一方面，在 AF 和 HF 的患者中应谨慎使用地高辛。
结论
根据现有证据，地高辛对这些患者的全因死亡率和不良影响的影响仍不清楚。需要更多低偏倚风险的试验来评估地高辛的效果。
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