Aubier M, Murciano D, Viirès N, Lebargy F, Curran Y, Seta J P, Pariente R
Am Rev Respir Dis. 1987 Mar;135(3):544-8. doi: 10.1164/arrd.1987.135.3.544.
We studied the effects of digoxin, a compound that has an inotropic effect on the myocardium, on diaphragmatic function in 8 patients with chronic obstructive pulmonary disease. All the patients were in acute respiratory failure and were artificially ventilated. Diaphragmatic strength was assessed by measuring the transdiaphragmatic pressure generated at functional residual capacity during bilateral supramaximal electrical stimulation of the phrenic nerves. The latter were stimulated before and at 45 and 90 min after administration of digoxin (0.02 mg/kg infused for 10 min). In all the patients, cardiac output was measured by the thermodilution technique using a Swan-Ganz catheter placed in the pulmonary artery. Arterial blood gases and pH were maintained within normal range by mechanical ventilation. In all the patients, digoxin plasma levels reached the therapeutic range (mean values, 2.82 +/- 0.17 and 2.90 +/- 0.20 nmol/L at 45 and 90 min, respectively) after digoxin administration. Diaphragmatic strength improves significantly after digoxin administration, the transdiaphragmatic pressure for an identical phrenic stimulation increasing by 19.5% (p less than 0.001) on the average. This increase was noted 45 and 90 min after digoxin administration. We conclude that digoxin has a potent effect on diaphragmatic strength generation that may be beneficial in patients with chronic obstructive pulmonary disease during acute respiratory failure. Furthermore, this inotropic positive effect of digoxin on the diaphragm, as previously observed for the myocardium, emphasizes the similarities between these 2 contractile tissues.
我们研究了地高辛（一种对心肌有正性肌力作用的化合物）对8例慢性阻塞性肺疾病患者膈肌功能的影响。所有患者均处于急性呼吸衰竭状态并接受人工通气。通过在双侧膈神经超最大电刺激时测量功能残气量下产生的跨膈压来评估膈肌力量。在给予地高辛（0.02mg/kg静脉输注10分钟）前以及给药后45分钟和90分钟刺激膈神经。所有患者均使用置于肺动脉的Swan-Ganz导管通过热稀释技术测量心输出量。通过机械通气使动脉血气和pH维持在正常范围内。所有患者在给予地高辛后血浆地高辛水平均达到治疗范围（45分钟和90分钟时的平均值分别为2.82±0.17和2.90±0.20nmol/L）。给予地高辛后膈肌力量显著改善，相同膈神经刺激下的跨膈压平均增加19.5%（p<0.001）。在给予地高辛后45分钟和90分钟时观察到这种增加。我们得出结论，地高辛对膈肌力量产生有显著作用，这可能对处于急性呼吸衰竭的慢性阻塞性肺疾病患者有益。此外，地高辛对膈肌的这种正性肌力作用，如同先前在心肌中观察到的一样，强调了这两种收缩组织之间的相似性。
