论文部分内容阅读
历史背景二百年前 Withering 报告“当给予大剂量洋地黄时会发生恶心、呕吐、腹泻、眩晕、视觉紊乱、视物呈绿或黄色;尿量增加、频繁,有时失禁;脉搏缓慢,甚至慢达35次/分,冷汗、抽搐、昏厥、死亡”。Rothberger 和 Winterberg在1910年首先发表了在狗身上用洋地黄造成心律失常后的系统性心电图研究。本文将讨论人类洋地黄中毒的心电图表现,侧重于对洋地黄中毒有高度特异性的心律失常,以及曾经一度较为常见而目前由于洋地黄中毒发生率明显下降已不常发生的心脏中毒电生理学表现。另外,那些与洋地黄中毒时所见到的相同的心律失常也可能是心肌本身病变或是各种心外因素或两者兼有的一种表现。有时心脏洋地黄中毒可能无临床证据而处于“隐性”或被“掩盖”的状态,直到主要心律减慢,以致出现加速的辅助起搏点。这种被掩盖的中毒造成洋地黄中毒诊断的复杂化。
Historical Background Two hundred years ago Withering reported “nausea, vomiting, diarrhea, dizziness, visual disturbances, and visual acuity of green or yellow when given to large doses of digitalis; increased urine output, frequent and sometimes incontinence; slow or even slow pulse Up to 35 beats / min, cold sweat, convulsions, fainting, death. ” Rothberger and Winterberg first published systematic electrocardiographic studies in 1910 following the arrhythmia of digitalis in dogs. This article discusses the electrocardiographic manifestations of digitalilla poisoning in humans, focusing on arrhythmias that are highly specific for digitalis poisoning, as well as electrophysiological evidence of cardiotoxicity, which was once more common and has been infrequent for the time being due to a marked decline in the incidence of digitalis intoxication . In addition, those same arrhythmias seen with digitalis poisoning may also be a manifestation of the myocardium itself or a variety of extracardiac factors or both. Sometimes digitalis intoxication may be “hidden” or “masked” without clinical evidence until the main rhythm slows, resulting in an accelerated secondary pacemaker. This concealed poisoning causes the diagnosis of digitalis poisoning complicated.