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血液灌流治疗实验性慢性洋地黄中毒(作者译)

[Treatment of the experimental chronic digitalisintoxication by hemoperfusion (author's transl)].

作者信息

Bischoff K O, Flohr E, Graben N, Hager W, Merguet P

出版信息

Z Kardiol. 1977 Nov;66(11):656-62.

PMID:595775
Abstract

In 5 adult dogs experimental chronic digitalis intoxication was produced by oral administration of different digitalis-types (digoxin, beta-methyl-, beta-acetyl-digoxin, digitoxin). 18 to 24 hours after the last application of digitalis, charcoal hemoperfusion was performed in Dipidolor-N2O-anesthesia and serum digitalis-concentrations in the arterial and venous lines of the hemoperfusion system were determined by RIA J125. The Ecg was registered continuously as a simple clinical parameter of cardiac digitalis intoxication. Initial multiple cardiac arrhythmias (AVII degree, SAII degree, tachycardia of the atrium) subsided in the dogs with digoxin, beta-methyl- and beta-acetyl-digoxin during hemocolperfusion within 130 to 160 min. The disturbances of rhythm persisted up to 200 min after onset of hemoperfusion in the dog intoxicated by digitoxin. The clearances of digoxin and derivatives (35.8--43.1 ml/min) are higher than the digitoxin clearance (17--23.2 ml/min) which is supposed to be the reason for cardiac detoxication in the digoxin-intoxicated dogs. Hemoperfusion using polymer coated charcoal appears to be effective for the elimination of digoxin leading to a marked improvement of cardiac arrhythmias. By contrast digitoxin induced cardiac arrhythmias are not influenced during hemoperfusion.

摘要

在5只成年犬中,通过口服不同类型的洋地黄制剂(地高辛、β-甲基地高辛、β-乙酰地高辛、洋地黄毒苷)诱发实验性慢性洋地黄中毒。在最后一次给予洋地黄制剂18至24小时后,在双氯芬酸 - N₂O麻醉下进行血液灌流,并用¹²⁵I放射免疫分析法测定血液灌流系统动脉和静脉管路中的血清洋地黄浓度。连续记录心电图作为心脏洋地黄中毒的一个简单临床参数。在血液灌流过程中,使用地高辛、β-甲基地高辛和β-乙酰地高辛的犬,最初的多种心律失常(房室传导阻滞Ⅱ度、窦房传导阻滞Ⅱ度、心房过速)在130至160分钟内消失。而在洋地黄毒苷中毒的犬中,心律失常在血液灌流开始后持续长达200分钟。地高辛及其衍生物的清除率(35.8 - 43.1毫升/分钟)高于洋地黄毒苷的清除率(17 - 23.2毫升/分钟),这被认为是地高辛中毒犬心脏解毒的原因。使用聚合物包裹活性炭进行血液灌流似乎对消除地高辛有效,可显著改善心律失常。相比之下,血液灌流过程中洋地黄毒苷诱发的心律失常不受影响。

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