地高辛血药浓度监测及分析

目的分析地高辛血药浓度监测结果,为临床合理用药提供参考依据。方法采用荧光免疫偏振法监测使用地高辛的72例患者血药浓度,对监测结果进行比较分析。结果 0.5-2.0μg/L为地高辛安全有效血药浓度,共监测72例,其中在有效血药浓度范围内共50例（占69.44%）,低于治疗浓度下限的共9例（占12.50%）,高于治疗浓度上限的共13例（占18.06%）。结论由于地高辛安全范围窄,个体差异大,故应对使用地高辛的患者进行血药浓度监测,并制订个体化给药方案,为临床安全、有效、合理地使用地高辛提供依据。     

补肺养心安神汤对慢性肺源性心脏病患者血液流变学的影响

目的:观察补肺养心安神汤治疗慢性肺源性心脏病的疗效及对其血液流变学的影响。方法:130例患者按照随机数字表顺序分为对照组和治疗组,每组65例,对照组在基础治疗的同时,予地高辛片0.25 mg口服,每日1次;治疗组在对照组基础上加用中药补肺养心安神汤治疗,两组均以15 d为1个疗程,1个疗程后比较两组疗效及血液流变学变化。结果:两组临床疗效比较,对照组有效率为80.00%,治疗组有效率为90.77%,差异有统计学意义(P0.05)。两组心电图疗效比较,对照组有效率为84.62%,治疗组有效率为92.31%,差异有统计学意义(P0.05)。治疗组全血黏度高切、全血中切、全血低切、血浆黏度、全血还原黏度与对照组比较,差异有统计学意义(P0.05)。结论:补肺养心安神汤治疗慢性肺源性心脏病疗效显著,且能改善患者全血黏度高切、全血中切、全血低切、血浆黏度、全血还原黏度。     

地高辛联合美托洛尔治疗老年顽固性房颤的临床效果观察

目的：探讨地高辛与美托洛尔联合应用控制老年顽固性房颤患者转复心室率并长期维持的临床疗效观察。方法选取老年顽固性房颤患者经治疗后的临床效果进行分析,将78例符合入组条件的持续性房颤患者,随机分为2组,对照组39例,维持单一地高辛治疗;试验组39例,使用地高辛联合美托洛尔治疗,观察2组治疗前后静息心室率、活动后的最高心率、最低心率及不良反应的发生情况。结果试验组组患者房颤伴快速心室率病情治疗效果为89.7%,显著优于对照组的治疗效果72.0%（P＜0.05）;2组患者均未出现严重的药物不良反应;试验组治疗后3个月随访的最高心率(115.0±13.9)次/分,低于对照组,差异有统计学意义（P<0.05）。最低心率(90.0±18.1)次/min及静息心率（97.0±9.6）次/min与对照组相比,差异无统计学意义。结论地高辛与美托洛尔联合应用可作为控制持续性房颤并心室率的首选药物之一,对老年患者效果较好,值得在临床推广使用,但应注意谨慎用药,密切观察病情,以防并发症的发生。     

地尔硫卓联合地高辛治疗心力衰竭并慢性快速房颤分析

目的观察地尔硫卓联合小剂量地高辛对心力衰竭并慢性快速房颤患者血压、心室率和心功能的影响。方法 :心功能Ⅱ～Ⅲ级慢性房颤患者 10 6例 ,随机分为二组 ,对照组 5 0例 ,单用地高辛 ,治疗组 5 6例 ,地尔硫卓与地高辛联用 ,其余治疗二组相同 ,7～ 10d为一疗程 ,观察治疗前后血压、心率、左室射血分数 (LVEF)、心输出量 (CO)。结果 :治疗组较对照组心室率明显下降 ,控制满意 ,血压、LVEF及CO变化二组相似。结论 :地尔硫卓联合小剂量地高辛治疗心衰并慢性快速房颤患者心室率较单用地高辛效果更好 ,且较为安全。     

Differential effect of potassium on the action of digoxin and digoxigenin in guinea-pig heart.

The effect of potassium on the binding of digoxin or digoxigenin to isolated Na+, K+-ATPase was compared with that of potassium on the positive inotropic action of the agents in guinea-pig hearts. The binding of digoxigenin to the enzyme in vitro was reduced to a greater extent by potassium than was the binding of digotoxin. The digoxigenin-induced increase in the force of contraction of left atrial preparations estimated at steady state was reduced at higher potassium concentrations. Potassium had a lesser effect when digoxin was used as the inotropic agent. In contrast, potassium concentrations. Potassium had a lesser effect when digoxin was used as the ininotropic agent. In contrast, potassium reduced the rate of development and also the rate of loss of the positive inotropic action of digoxin observed with left atrial and Langendorff preparations, respectively, to a greater extent than those of digoxigenin. The loss of the positive inotropic effect was more rapid with digoxigenin than with digoxin at each KCl concentration. These data support the contention that the extent of the interaction of digitalis with Na+,K+-ATPase determines the degree of the positive inotropic effect.     

Digoxin intoxication: An old enemy in modern era

Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. Conclusion This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.     

Digitalis intoxication and treatment with digoxin antibody fragments in renal failure

Summary Severe digitalis intoxication today is preferentially treated by intravenous infusion of Fab fragments of digoxin antibodies (Digitalis Antidot BM). The kinetics of Fab fragments in the circulation are well known when kidney function is normal or slightly impaired. There are no data available, however, in complete renal failure. We observed a patient with life-threatening digitalis intoxication (serum digoxin, 3.7 ng/ml) and anuria, who was treated successfully by 160 mg Fab fragments i.v. Serum digoxin and Fab fragment concentrations could be followed for 229 h. The extrarenal clearance of Fab fragments was lower (5.6 ml/min) than in patients with normal kidney function (10.9 ml/min). This finding suggests that lower doses than usual might be sufficient for treating patients with severe digitalis intoxication and renal failure.Abbreviations AUC area under the curve - FAB fragments digoxin antibody fragments - h hour     

Inhibition by basic drugs of digoxin secretion into human bile

Summary Bile samples from previous interaction studies in man were re-analysed by a combined HPLC/radioimmunoassay method. Quinidine, quinine and verapamil but not probenecid or spironolactone were found to inhibit the biliary secretion of unchanged digoxin.     

Compliance with medication in the helsinki heart study

Summary Compliance with medication has a decisive influence on the findings in clinical intervention studies, so the reliable estimation of compliance is vital to the success of such research. This report describes the main findings about compliance in the Helsinki Heart Study, a five-year, double-blind, primary prevention trial of gemfibrozil as a lipid-lowering agent compared with placebo, in 4,081 dyslipidaemic middle-aged men. Three estimation methods were employed: capsule counting at every three-month follow-up visit, urine gemfibrozil analysis at six-month intervals, and, a novel technique, a digoxin marker added to both gemfibrozil and placebo capsules at the end of the third and fifth study years. The estimates of compliance for the study population as a whole generated by these three methods are discussed here.The mean daily capsule count showed that 36% of patients on gemfibrozil men and 39% of those on placebo took more than 90% of their capsules, while only 5% of both groups consumed half or less of the prescribed treatment. According to urinary gemfibrozil analysis, 30% of gemfibrozil subjects had more than 90% positive results and 28% had half or fewer positive. Among study completers, there were 42% gemfibrozil subjects and 50% placebo subjects who on both occasions had the good result in the digoxin marker analysis, while 14% of the gemfibrozil men and 12% of the placebo men scored poor in both marker analyses. Capsule counting revealed a slight deterioration in compliance over the trial period, which was confirmed by the other two methods; for example, the proportion of positive results in the semiannual urine gemfibrozil analyses decreased from 76% to 65%. Medication compliance was slightly better in the placebo group according to capsule counting and digoxin marker methods.In the Helsinki Heart Study there were 34% fewer cardiac end points among participants in the gemfibrozil group compared to placebo. The reduction occurred in a study group with 30% drop outs and with about 20% of study completers having poor medication compliance, according to all three methods.