地高辛治疗老年人心血管相关疾病的临床研究

Elderly cardiovascular related disease clinical study of digoxin treatment

目的研究影响血清地高辛浓度关键因素,为老年人患者提供更安全、个性化治疗方案。方法收集2013年12月到2015年4月495例老年患者的血清地高辛浓度数据,通过统计分析,研究地高辛血药浓度与患者性别、年龄及服用剂量等因素之间关系。结果在495例老年患者中,地高辛血药浓度在有效浓度范围0.5-2.0 mg/ml之间,占68.69%,出现中毒症状仅7例;地高辛血药浓度〉2.0 ng/ml时,占20.80%,出现中毒症状46例。地高辛血药浓度越高,中毒比率也明显升高。随着患者年龄增高,地高辛血药浓度也逐渐增高。高地高辛药物浓度在〈0.5 ng/ml和〉2.0 ng/ml的年龄分布上差异具有显著性（P〈0.05）。女性比男性地高辛血药浓度要高（1.32±0.56 mg/ml比1.21±0.97 mg/ml）,但不同性别地高辛血药浓度分布差异无显著性（P〉0.05）。从剂量方面临床研究发现,高、中、低剂量组地高辛平均血药浓度分别为2.43±1.12 mg/ml、1.54±0.75 mg/ml和0.86±0.43 mg/ml。血药浓度是随着服用的药物剂量而增加的。结论地高辛血药浓度在不同个体之间存在明显差异,因此需要考虑多种影响因素。对于大多数患者,地高辛药物服用剂量应不大于0.15 mg/d,而女性地高辛服药量应该适当减少。对地高辛血药浓度进行监测,有助于更深入理解影响地高辛血药浓度关键因素,为老年人患者提供更合理治疗方案。

Objective To investigate the influence of the digoxin serum concentrations,and provide safer,individualized treatment programs in the elderly patients. Methods The data of 495 serum digoxin concentration were collected,and to understand the relationship between digoxin serum concentration of sex,age,dose and other factors through statistical analysis in December 2013 to April 2015. Results 495 cases in the serum concentration of 0. 5 - 2. 0 mg / ml effective range,accounting for 68. 69%,symptom of poisoning happened in seven cases. As age increases,the digoxin serum concentration gradually increased,the average serum digoxin concentration of those over 80 was 1. 68 ± 1. 01 mg / ml.Gender had more significant influence in women than men. The digoxin plasma concentration is higher in women than men（ 1. 32 ± 0. 56 mg / ml vs. 1. 21 ± 0. 97 mg / ml）. In the aspect of dosage,digoxin plasma concentration had more influence in the sequence of high- dose group middle dose group small dose,dose- compliance. Conclusion Digoxin serum concentration differences between the individual obviously need to consider a variety of factors. Most patients taking the drug digoxin dose is not more than 0. 15 mg / d. Digoxin in female patient should be appropriate to reduce the amount of medication,and therefore clinical digoxin serum concentration monitoring for the elderly can provide more appropriate treatment plan.