Erdmann E
Klinik III für Innere Medizin, Universität zu Köln, Germany.
Eur Heart J. 1995 Jul;16 Suppl F:16-9. doi: 10.1093/eurheartj/16.suppl_f.16.
The therapeutic efficacy of cardiac glycosides is not widely appreciated either in respect of their positive inotropic value or antiarrhythmic activity. Although cardiac glycosides do not prevent an increase in ventricular rates during exercise they do slow the heart rate at rest in patients with atrial fibrillation. The clinical importance of the potentially beneficial influence of the digitalis glycosides on the negative force-frequency relationship (Bowditch effect), preload-force relationship (Frank-Starling's Law) and baroreceptor dysfunction in heart failure await clarification. In patients with heart failure, the positive inotropic effects of the digitalis glycosides are mild, but show no tolerance during prolonged administration. Digitalis glycosides are the only group of positive inotropic drugs that persistently increase the ejection fraction during long-term administration in patients with heart failure. These haemodynamic benefits are translated into decreased symptoms and increased exercise capacity in patients with congestive heart failure. Although their clinical efficacy in the different stages of heart failure remains undefined, recent evidence indicates that their therapeutic benefit is on a par with diuretics and ACE inhibitors in symptomatic heart failure. Results of studies specifically directed to determining the impact of the cardiac glycosides on prognosis are awaited.
强心苷的治疗效果在其正性肌力作用或抗心律失常活性方面并未得到广泛认可。尽管强心苷不能防止运动期间心室率增加，但它们确实能使心房颤动患者的静息心率减慢。洋地黄苷对心力衰竭中负性力-频率关系（鲍迪奇效应）、前负荷-力关系（弗兰克-斯塔林定律）和压力感受器功能障碍的潜在有益影响的临床重要性尚待阐明。在心力衰竭患者中，洋地黄苷的正性肌力作用较轻，但在长期给药期间不会产生耐受性。洋地黄苷是唯一一组在心力衰竭患者长期给药期间能持续增加射血分数的正性肌力药物。这些血流动力学益处转化为充血性心力衰竭患者症状减轻和运动能力增强。尽管它们在心力衰竭不同阶段的临床疗效尚不确定，但最近的证据表明，在有症状的心力衰竭中，它们的治疗益处与利尿剂和ACE抑制剂相当。专门针对确定强心苷对预后影响的研究结果尚待揭晓。
