对强心苷类临床应用相关问题的思考
Several problems of cardiac glycosides in clinical application

强心苷类药物的主要药理机制是抑制心肌细胞膜Na+- K+-ATP酶，干扰膜内外相应离子浓度，影响细胞生理功能，致Na+-Ca2+代偿性交换增多，使心肌收缩性增强并表现相应临床效应。但膜电位的减低使心肌细胞兴奋性增高及传导性下降，为心肌电紊乱提供了可能，也为其临床应用带来诸多争议。特别是当电解质紊乱和心律失常时，对该药的选择和使用存在较多疑点，而对该类药物药理机制和心肌电生理的正确认识和理解是临床安全合理用药的保证。
The main pharmacological mechanism of cardiac glycosides is to inhibit Na+-k+-ATPase, interfere the ionconcentrations inside and outside of myocardial cell membranes, affect myocardial cell function, increase compensatoryexchange of Na+-Ca2+ and boost the myocardial contractility, thus showing the corresponding clinical effect. However,it increases the excitability of myocardial cells and reduces the conductivity, which easily induces myocardial electricaldisorders and brings many problems in clinical application. There are many queries about the choice and use ofcardiac glycosides, especially in the patients with electrolyte disorder and arrhythmia. Correct understanding of thepharmacological mechanism and myocardial electrophysiology can be an insurance of rational and safe medicationclinically