洋地黄对充血性心力衰竭左房功能的影响

目的观察地高辛对充血心力衰竭伴左房扩大的患者左房功能的影响。方法选择25例左房扩大（最大直径〉40mm）的心衰患者（NYHA分级Ⅲ～Ⅳ级）以及28例心功能正常者作为对照，口服地高辛0．25mgqd共14d，采用心脏彩超测定用药前后左房主动排空分数（AEF）、被动排空分数（PEF）、储血分数（RF），动能（KE）和平均左房周径缩短速度（Vcf）。结果心衰组的左房AEF、PEF、KE、Vcf均明显低于对照组。地高辛治疗14d后，心衰组心率下降（P〈0．001），而对照组收缩压、舒张压均升高（P〈0．001）。两组的左房AEF、PEF和KE、RF、Vcf均有增高（P〈0．001），心衰组增高更加明显（P〈0．001）。结论心衰患者的左房功能受损，左房扩张者心衰更加严重，地高辛能够改善正常和扩张的左房功能。

Effects of Digoxin on Left Atrial Function in Heart Failure

Objective To investigate the effects of digoxin on left atrial（ LA ）function in patients with congestive heart failure and dilated left atria. Methods 25 patients with enlarged left atrium（maximum LA diameter 〉 4mm） caused by heart failure（New York Heart Association functional class III or IV） were studied before and after treatment with digoxin （0.25 mg orally for 14 days）. Digoxin was also administered to 28 normal participants who served as controls. LA active（AEF） and passive emptying fractions（PEF）,reservoir fractian（RF）,kinetic energy （KE）and mean velocity of circumferential atrial fibre shortening（Vcf） were calculated from echocardiographic measurements of LA volumes and transmitral Doppler flow velocities at baseline and 14th day after digoxin administration. Results LA AEF, PEF, RF, KE, and Vcf were significantly lower in patients than in controls （P 〈 0.001 ）. LA AEF,PEF,RF,KE and Vcf increased significantly both in patients and controls after digoxin administration（P 〈 0.001 ）. This increase was greater in patients than in controls（P 〈 0.001 ）. Conclusion LA function is impaired in patients with heart failure. Dilated atrial manifest left atrial failure. Digoxin improves LA performance and LA contractility both in dilated and in normal atrial. The effects of digoxin on LA contractility are augmented in the failing atrial compared with the normal atrial.