地高辛血清浓度临床相关因素研究

Study on Clinical Influencing Factors of Serum Concentration of Digoxin

目的:通过对地高辛血清浓度(SDC)监测结果及临床相关因素进行分析,为临床医师合理用药提供参考。方法:收集137例患者的病案资料数据,采用统计学方法进行相关分析及多元回归分析,研究各影响因素与SDC之间的关系。结果:剂量、身高、体质量、去脂体质量、体表面积、肌酐清除率、血清肌酐与SDC显著相关(P<0.05)。门诊慢性心力衰竭患者地高辛日剂量宜≤0.125mg,SDC最好控制在0.5～0.9ng.mL-1之内;当肾小球滤过率(GFR)<50mL.min-1.1.73m-2时,病死率随着GFR的升高显著增加。结论:地高辛剂量、体表面积、血清肌酐、肌酐清除率能显著影响SDC。临床医师应结合SDC监测结果,用低剂量达到有效低浓度,能显著降低心力衰竭患者的病死率、再住院率和中毒发生率。

OBJECTIVE：To analyze clinical influencing factors and monitoring results of serum concentration of digoxin （SDC） to provide reference for rational use of drug. METHODS： 137 medical records were collected and analyzed statistically with multiple regression analysis in order to study the relationship of SDC with influencing factors. RESULTS： SDC was significantly affected by dosage, height, body weight, free fat body weight, body surface area, creatinining clearance rate, serum creatinine （P0.05）. The daily dose of digoxin in outpatients with chronic heart failure should be below 0.125 mg and SDC should be kept within 0.5～0.9 ng·mL-1. When glomerular filtration rate （GFR） was below 50 mL·min-1·1.73 m-2, mortality increased sharply along with increase of GFR. CONCLUSION： Effect of digoxin on SDC represents as following respects, such as dose, body surface area, creatinine clearance rate and serum creatinine. Clinicians should achieved effective low serum concentration with low dose of digoxin combining with SDC monitoring results to reduce mortality, re-hospitalization rate and poisoning incidence in patients with heart failure.