摘要
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�
Objective To discuss the necessity on serum concentration monitoring of herat failure patients treated by digoxin.Methods Three hundred cases of heart failure received in our hospital from March 2010 to March 2013 were selected.All patients were treated with digoxin oral and the maintenance dose was 0.125-0.250 mg/d,and all patients were taking more than 5 times the half-life.All patients were divided into group A （0.125 mg/d digoxin,193 cases） and group B （0.250 mg/d digoxin,107 cases） according to digoxin dosage.Fluorescence polarization immunoassay method were used for monitoring the digoxin serum concentrations in patients with heart failure,the relationship of serum concentrations monitoring results with different doses of digoxin,the relationship of different oral doses of digoxin with the clinical efficacy,and the relationship of different digoxin plasma concentrations with the clinical efficacy were analyzed and compared.Results The proportion of patients of digoxin plasma concentration 〈 0.8 μg/L and 0.8-1.4 μg/L in group A were significantly more than the dose of group B [13.0% （25 cases）vs 1.9% （2 cases）,24.4% （47 cases） vs 7.5% （8 cases）],the differences were statistically significant （Х^2 =10.33,13.09,P 〈 0.05） ; The proportion of patients of digoxin serum concentrations 〉 2.0 μg/L in digoxin dose of group A was significantly less than the dose of group B [4.1% （8 cases） vs 37.4% （40 cases）],the difference was statistically significant （Х^2 =45.74,P 〈 0.05） ; The effective rate in digoxin dose of group A was 80.3%,which was significantly higher than the dose of group B （65.4%）,the difference was statistically significant （Х^2 =8.14,P 〈 0.05） ; The poisoning rate in digoxin dose of group A was 7.8%,which was significantly lower than that dose of group B （16.8%）,the difference was statistically significant （Х^2 =5.76,P 〈 0.05）.When plasma digoxin concentrations were below 0.8 μg/L,the patients＇ invalid rate was significantly
出处
《中国医药》
2014年第4期454-458,共5页
China Medicine
关键词
心力衰竭
地高辛
血药浓度
Heart failure
Digoxin
Plasma concentration
