Mølstad P
Feiring Clinic, Feiring, Norway.
Herz. 1993 Apr;18(2):118-23.
For more than two centuries digitalis has been used in the treatment of cardiac disease. Despite this long clinical experience with the drug, controversy still exists as to its clinical effect and impact on survival, especially in patients after myocardial infarction. In the last decade a number of studies have addressed the problem of assessing the clinical effect of digitalis in patients with sinus rhythm and left ventricular dysfunction. An overall conclusion from these studies seems to indicate that a modest clinical beneficial effect can be expected from the drug. Regarding the effect of digitalis on the mortality in patients after a myocardial infarction controversy still prevails. All studies show an increased mortality in patients using digitalis, but opinions differ as to whether this is due solely to baseline imbalances between the populations or that a harmful effect of digitalis itself exists as well. This question cannot be answered with certainty until the results from a large, randomized study are available. In the meantime digitalis can probably be used as a first line therapy in patients with atrial fibrillation and left ventricular dysfunction. In patients with sinus rhythm and heart failure, however, it is probably wise to reserve digitalis to those that are still symptomatic after diuretics, nitrates and ACE inhibitors have been tried.
两个多世纪以来，洋地黄一直用于治疗心脏病。尽管对该药物有如此长期的临床经验，但关于其临床效果以及对生存率的影响仍存在争议，尤其是在心肌梗死后的患者中。在过去十年中，一些研究探讨了评估洋地黄对窦性心律和左心室功能不全患者临床效果的问题。这些研究的总体结论似乎表明，该药物有望产生一定程度的临床有益效果。关于洋地黄对心肌梗死后患者死亡率的影响，争议仍然存在。所有研究都表明使用洋地黄的患者死亡率增加，但对于这仅仅是由于不同人群之间的基线不平衡，还是洋地黄本身也存在有害作用，各方观点不一。在获得大型随机研究的结果之前，这个问题无法得到确切答案。与此同时，洋地黄可能可用于心房颤动和左心室功能不全的患者作为一线治疗。然而，对于窦性心律和心力衰竭的患者，在尝试使用利尿剂、硝酸盐和血管紧张素转换酶抑制剂后仍有症状的患者中使用洋地黄可能是明智的。
