小儿地高辛血药浓度监测及影响因素分析

Therapeutic drug monitoring of digoxin in children and the analysis of influential factor

目的探讨地高辛血药浓度监测结果与可能影响因素,为小儿地高辛的个体化用药提供参考。方法回顾性分析2017年7月至2018年7月中国科学技术大学附属第一医院(安徽省立医院)因心脏功能异常等口服地高辛治疗的小儿病例资料56例,收集并筛选小儿个体信息、用药信息等,采用化学发光微粒子免疫分析法(CMIA)测定小儿地高辛血清浓度,通过多元线性回归方法分析影响血药浓度变化的可能因素。结果小儿使用地高辛的临床给药剂量为(9.35±4.28)μg·kg^?1·d^?1,小儿地高辛血药浓度处于有效浓度(0.5~2.0 ng/mL)为46例,占82.14%;大于2.0 ng/mL为3例,占5.36%;小于0.5 ng/mL为7例,占12.5%。地高辛的血药浓度变化与性别因素无相关性(P>0.05),与年龄和体质量因素呈负相关(r=0.182;r=0.105,P<0.01),与疾病种类、联合用药和地高辛用量呈正相关(r=0.098;r=0.243;r=0.196,P<0.01),因抽血时间基本一致,暂未纳入血药浓度影响因素分析范围。结论小儿地高辛的个体化药学指导应从小儿个体的药效学、药动学出发,结合血药浓度监测及临床观察,在注重防止地高辛中毒反应的同时,促进小儿的治疗安全、有效、合理。

Objective To analyze the blood concentration of digoxin and explore the possible influence factors,and provide impor?tant reference for the individualized and rationalized administration of digoxin in children.Methods We performed the serum blood concentration of digoxin of children in our hospital by using chemiluminescence microparticle immunoassay.The individual in?formation and combination medication information of children were collected and screened by retrospective analysis,and the possi?ble influence factors were analyzed by multivariate linear regression method.Results The dose of digoxin given to children was(9.35±4.28)μg·kg^?1·d^?1.Among 56 child patients,there were 46 cases within the effective blood concentration(0.5~2.0 ng/mL),ac?counted for 82.14%;7 cases below 0.5 ng/mL,accounted for 12.5%;and 3 cases higher than 2.0 ng/mL,accounted for 5.36%.In this study,we found that there was no correlation between blood concentration of digoxin and gender factor(P>0.05).In the meantime,the analysis showed that blood concentration of digoxin negatively correlated with age and weight factor(r=0.182;r=0.105,P<0.01),but positively correlated with the variety of disease,combination medication and dosage of digoxin(r=0.098;r=0.243;r=0.196,P<0.01).Conclusion All the children’s pharmacodynamics,pharmacokinetics,blood concentration monitoring and clinical observations should be taken into consideration to get the effective,rational and safe results and prevent the drug poisoning of digoxin.