地高辛酏剂的正确服用方法

地高辛为一种治疗指数低、毒性反应强、最低有效浓度与中毒浓度十分接近、容易发生中毒的药物.其毒性反应症状与疾病的症状往往难以区别.在儿科临床治疗中常采用地高辛酏剂(50μg/mL)以毫升数或滴数确定使用剂量.     

儿童地高辛急性过量中毒两例报告

我院儿科最近收治了两例误服大量地高辛（digoxin, DGX）引起急性中毒的儿童,服药后23h的血清地高辛浓度分别高达9.24μg·L-1与6.31μg·L-1,并出现了严重的胃肠道、神经系统、心脏、血钾浓度等方面的毒性反应。我们连续监测了两患儿的血清地高辛浓度、血钾浓度,并观察了相应的心电图和临床表现,现一并报道如下。     

长期大量服用地高辛引起中毒1例护理

地高辛是常用的强心药物，它的有效治疗量是0．5mg～1．5mg，维持量0．125mg～0．5mg，因存在个体差异，用药量没有一个绝对准确的指标地高辛耐受量与机体状态有很大关系，所以非住院患者口服地高辛时要让病人掌握用量及中毒反应的症状及体征，现将一例每日口服1．Omg他高辛，近1年致中毒同时心衰Ⅲ度的患者护理如下．##D患者男，57岁，1997年2月27日以风心病，心衰Ⅲ度、祥地黄中毒入院治疗、抬入病房，患者诊断风心病Ic余年，近两年有房颤，在中医院治疗，口服地高辛控制心律、改善心功能从0．25mg每日一次，逐渐加至10mg维持量口服约一…     

1例服用地高辛致中毒的案例分析

1 病例资料 患者,男,78岁,诊断为心律失常房颤,心功能Ⅲ级,高血压3级(极高危). 6年前诊断为心律失常,心房颤动,高血压,1个月前诊断为心力衰竭,院外服用地高辛片、螺内酯片. 无药物食物过敏史. 查BP130/84mmHg(1mmHg=0.133kPa). 心电图显示房颤,HR112次·min-1.双下肢浮肿.     

血清地高辛浓度与地高辛中毒关系的探讨

目的：探讨血清地高辛浓度与地高辛临床中毒症状的关系。方法：分析４４１例患者的临床资料。结果：６６例患者（大于２．５ｎｇ．ｍｌ＾－１所５８例,小于２．５ｎｇ．ｍｌ＾－１的８例）有地高辛中毒的临床表现,占１５％。分析与地高辛中毒的有关因素结果提示,血肌酐值高的患者出现临床中毒症状的发生率高于正常者;血钾异常及合用乙胺碘呋酮、奎尼丁等药亦易发生临床中毒症状。结论：监测血清地高辛演讲结合临床对判断地高辛中     

地高辛中毒32例分析

地高辛中毒３２例分析解放军第二六六医院（０６７０００）翟建国地高辛是治疗心功能不全、心房颤动和扑动的有效药物。临床常用维持量法，但由于多种原因地高辛中毒反应时有发生。我院自１９９１年开始对临床应用地高辛的患者进行地高辛血药浓度测定。现将地高辛血药浓度...     

地高辛中毒原因分析

地高辛 (ｄｉｇｏｘｉｎ,ＤＧ)是临床上治疗心力衰竭的有效药物 ,因其治疗指数低、安全范围窄、个体差异大、治疗量与中毒量在一定程度上相互重叠 ,其血药浓度又易受多种因素影响 ,长期使用易发生蓄积中毒[1,2 ] 。ＤＧ中毒原因很多 ,现将主要原因分析如下。1　年龄和体重1 .1　年龄老年人的肝血流和肝药酶活性降低 ,肾血流减少 ,肾小球滤过和肾小管功能亦减弱[3 ] ,这些因素均可导致ＤＧ清除率减少 ,从而可能致使ＤＧ蓄积中毒。ＤＧ在体内的半衰期随着年龄增大而延长 ,消除速率随着年龄增大而减少 ,这也是老年人易发生ＤＧ中毒的主要因素[4…     

肾功能不全病人服用地高辛中毒致死1例

病例报告：王某，女性60岁，因关节肿痛40年。心悸气短10年，浮肿、尿少、恶心、呕吐半年，连续服用地高辛0.25mg/d15天后面入院。查体：颤面、双下肢浮肿，回唇紫绀。心界向左下扩大，心律不齐，强弱不等，心率57/min，心尖区可闻及收缩期及舒张期杂音，腹水征（ ），肝肋下2.0cm。实验室检查：尿常规蛋白（ ），     

维持量地高辛治疗慢性充血性心力衰竭的疗效评价

目的：评价维持量地高辛治疗慢性充血性心力衰竭的临床疗效。方法：160例慢性充血性心力衰竭的病人,符合收缩功能不全的诊断标准,其中合并房颤62例;随机分为二组,观察组给维持量地高辛一天一次口服,对照组不给地高辛,如一周未见疗效,加用维持量地高辛。结果：观察组显效60例,占75％,有效18例,占22．5％,无效2例,占2．5％。对照组显效36例,占45％,有效28例,占35％,无效16例,占20％。加用地高辛后显效58例,占72．7％,有效21例,占26．2％,无效1例,占1．2％。结论：维持量地高辛安全,疗效确切,对是否合并房颤的慢性充血性心力衰竭均有效。     

心力衰竭患者地高辛血药浓度监测及分析

目的 探讨对应用地高辛的心力衰竭患者进行血药浓度监测的必要性.方法 选择2010年3月至2013年3月于解放军第一一三医院收治的300例心力衰竭患者,均给予地高辛进行治疗,服药时间均超过5个半衰期.将所有患者根据地高辛剂量分为A组（0.125 mg/d地高辛,193例）和B组（0.250 mg/d地高辛,107例）.采用荧光偏振免疫法对患者的地高辛血药浓度进行测定,对地高辛不同给药剂量的血药浓度监测结果、不同地高辛口服剂量与临床疗效的关系、不同地高辛血药浓度与临床疗效的关系进行分析和比较.结果 A组血药浓度＜ 0.8 μg/L和0.8～1.4 μg/L的患者比例均明显多于B组[13.0％ 25例）比1.9％（2例）,24.4％（47例）比7.5％（8例）],差异均有统计学意义（Х^2=10.33、13.09,P＜0.05）;而A组血药浓度＞ 2.0μg/L的患者比例明显少于B组[4.1％（8例）比37.4％（40例）],差异有统计学意义（Х^2=45.74,P＜0.05）.A组有效率为80.3％（155/193）,明显高于B组（65.4％,70/107）,差异有统计学意义（Х^2=8.14,P＜0.05）;A组中毒发生率为7.8％（15/193）,明显低于B组（16.8％,18/107）,差异有统计学意义（Х^2 =5.76,P＜0.05）.地高辛血药浓度＜0.8 μg/L组患者的无效率明显高于地高辛血药浓度0.8 ～1.4、1.5 ～2.0、＞2.0 μg/L组[81.5％（22/27）比36.4％（20/27）、0、0],差异有统计学意义（Х^2=42.03、137.60、137.60,P＜0.05）;地高辛血药浓度1.5 ～2.0 μg/L组有效率明显高于地高辛血药浓度＜0.8、0.8～1.4、＞2.0μg/L组[94.1％（160/170）比18.5％（5/27）、63.6％（35/55）、52.1％（25/48）],差异有统计学意义（Х^2=116.20、27.89、44.85,P＜0.05）;地高辛浓度＞2.0μg/L组的中毒发生率明显高于地高辛血药浓度＜0.8、0.8 ～1.4、1.5～2.0μg/L组[47.9％ （23/48）比0、0、5.9％ （10/170）],差异有统计学意义（Х^2=62.98、62.98、44.85,P＜0.05）.结论 对心力衰竭患者使用地高辛进行治疗时,对患者的血药浓度进行监测是非常必要的,根据监测结果实时调节给药剂量,以保证患者的治疗效果,同时预防药物过量导致中毒.     

Lack of effect on brain stem and cerebral cortex Na+, K+-ATPase during heart block produced by chronic digoxin treatment.

The autonomic nervous system has been shown to play an important role in digitalis toxicity. In order to determine whether the central nervous system could be digitalis' site of action, the effect of chronic treatment with toxic doses of digitalis on brain Na+,K+-ATPase was studied in the dog. After four weeks of digoxin treatment, Na+,K+-ATPase activity of the brainstem or cerebral cortex was unaffected at the time when digitalis toxicity (heart block) was apparent. ATP-dependent (3H)-ouabain binding to these tissues was also unaffected indicating that a significant occupancy of brain Na+,K+-ATPase by digoxin did not occur during chronic drug treatment. In contrast, cardiac Na+,K+-ATPase was markedly inhibited with the concomitant binding of digoxin to the enzyme. Since Na+,K+-ATPase is the most digitalis sensitive system identified to date, it appears that digoxin does not affect neuronal function directly.     

188例地高辛中毒血药浓度临床相关因素分析

目的研究地高辛血药浓度(CDGx)＞2.4 ng·ml-1在中毒诊断中的作用及影响因素.方法对118例CDGX＞2.4ng·ml-1住院病例进行分析.结果80.5%CDGX＞2.4ng·ml-1患者的BUN＞7.2mmol·L-1,合并使用使CDGX升高药物的占总例数的55.7%,ECG检查示房室传导阻滞的占29.7%,室性早搏占27.1%.结论CDGX＞2.4ng·ml-1是多种因素共同影响的结果,包括合并用药、肾功能损害等因素,对地高辛中毒的诊断应将血药浓度监测结果与临床症状相结合.     

The pharmacokinetics of beta-methyl digoxin compared with digoxin tablets and capsules

Summary The intestinal absorption and urinary elimination rate of total cardioactive material was compared following digoxin and beta-methyldigoxin (BMD) administration to twelve healthy volunteers. Significantly more injected digoxin was recovered in urine. Urinary clearance was more rapid for digoxin, mean half-lives of elimination being 35 hours for digoxin and 40 hours for BMD. Calculated percentage intestinal absorption was lowest for digoxin tablets with a dissolution rate of 77% in one hour, intermediate for BMD tablets, and maximal for an experimental soft gelatin formulation of digoxin in solution. Respective mean values were 75%, 87% and 97%. Similar steady state plasma concentrations followed twice daily ingestion of the 0.25 mg digoxin tablets and 0.20 mg BMD tablets. Mean peak plasma concentration and percentage urinary recovery of ingested dose were higher during continued BMD administration. Between-subject variation in absorption was higher for the digoxin tablets. The comparative intestinal absorption of BMD and digoxin depends upon the formulation. Digoxin is virtually completely absorbed from a solution encapsulated in soft gelatin. Relatively more BMD is eliminated by nonrenal routes.     

Protein binding of digoxin in human serum

Summary The protein binding of digoxin in human serum was investigated using equilibrium dialysis and tritium-labelled digoxin. A constant protein bound fraction of about 30% was found over a wide range of concentrations of digoxin including therapeutic levels. Interpretation of the findings according to the law of mass-action showed an association constantK = 0.68·10^–5l/mol; and, the number of binding sites,n , indicating an almost infinite apparent maximum binding capacity and a very small affinity of human serum proteins for digoxin.Supported by the Schweizer Nationalfond zur Förderung der wissenschaftlichen Forschung.     

口服地高辛的药代动力学影响因素的研究进展

地高辛是临床上治疗充血性心力衰竭(congestive heart failure,CHF)的主要药物。由于其安全范围窄,个体差异大,用药干扰因素影响较大,目前在临床应用过程中常对其血清浓度进行检测。患者性别、年龄、特殊病/生理状态以及合用药物等是影响血清地高辛浓度的主要因素。在诸多因素中,合并用药所带来的问题最多。临床应用地高辛时,应关注可影响其血药浓度的各种因素,做到安全合理用药。     

地高辛血药浓度监测在临床中的应用

目的：探讨地高辛血药浓度监测的临床意义,为临床合理用药提供参考。方法：采用EMIT法测定地高辛血药浓度,对50例患者的79例次m药浓度监测结果进行回顾性分析。结果：79例次地高辛血药浓度测定值在治疗浓度0．8～2．2ng·ml^-1内的共40例次,占50．63％;低于治疗浓度范围下限（〈0．8ng·ml^-1）的18例次,占22．79％;高于治疗浓度上限（〉2．2ng·ml^-1的21例次,占26．58％。性别对地高辛血药浓度兀显著影响。随年龄增大,地高辛血药浓度呈增高的趋势。结论：通过监测地高辛血药浓度说明本院应用地高辛基本合理。对高龄患者应适当减少地高辛剂量。     

Spontaneous activity of autonomie functions in coma due to drug overdose

Spontaneous heart rate, respiration rate and electrodermal activity were studied in 32 patients with different grades of severe poisoning by ingestion of various drugs. The degree of their behavioural impairment was determined with the Munich Coma Scale (MCS) which measures stimulus evoked somatomotor responses. There was a significant reduction of spontaneous variations of heart rate and respiration rate with increasing severety of coma. Spontaneous electrodermal fluctuations were present only at the least severe grades of impairment. Thus, cardiorespiratory and electrodermal activity can provide significant information on the level of behavioural impairment in severe poisoning.