地高辛中毒患者中地高辛的不当使用。
Inappropriate use of digoxin in patients presenting with digoxin toxicity.
作者信息
Tatlisu Mustafa Adem, Ozcan Kazim Serhan, Gungor Baris, Zengin Ahmet, Karatas Mehmet Baran, Nurkalem Zekeriya
机构信息
Department of Cardiology, Sivas Numune State Hospital, Rahmi Gunay Street, Sivas 58000, Turkey.
Department of Cardiology, Kocaeli Derince Education and Research Hospital, İbni Sina Street, Kocaeli 41900, Turkey.
出版信息
J Geriatr Cardiol. 2015 Mar;12(2):143-6. doi: 10.11909/j.issn.1671-5411.2015.02.007.
BACKGROUND
Digoxin remains widely used today despite its narrow therapeutic index and toxicity. The objective of this study was to investigate the percentage of inappropriate use of digoxin and long-term outcomes of elderly patients hospitalized for digoxin toxicity.
METHODS
The study included 99 consecutive patients hospitalized for digoxin toxicity. The other study criteria for the inappropriate use of digoxin was regarded if participants having depressed left ventricular systolic function (ejection fraction < 45%) who were not on optimal medical therapy including beta-blocker and angiotensin-converting-enzyme inhibitor therapy or if participants having permanent AF who were not on optimal beta-blocker therapy.
RESULTS
Appropriate digoxin usage was confirmed in 33 of patients in spite of its narrow therapeutic index. A total of 16 of 99 patients died, with a mean follow-up time of 22.1 ± 10.3 months.
CONCLUSIONS
Contrary to popular belief, the rate of inappropriate digoxin usage remains high. On account of its narrow therapeutic index and toxicity, digoxin should be used more carefully according to the current evidence and guidelines.
背景
尽管地高辛治疗指数狭窄且具有毒性，但如今仍被广泛使用。本研究的目的是调查地高辛使用不当的比例以及因地高辛中毒住院的老年患者的长期预后。
方法
该研究纳入了99例因地高辛中毒连续住院的患者。如果参与者左心室收缩功能降低（射血分数<45%）且未接受包括β受体阻滞剂和血管紧张素转换酶抑制剂治疗在内的最佳药物治疗，或者如果参与者患有永久性房颤且未接受最佳β受体阻滞剂治疗，则认为存在地高辛使用不当的其他研究标准。
结果
尽管地高辛治疗指数狭窄，但仍有33%的患者地高辛使用得当。99例患者中共有16例死亡，平均随访时间为22.1±10.3个月。
结论
与普遍看法相反，地高辛使用不当的比例仍然很高。鉴于其治疗指数狭窄和毒性，应根据当前证据和指南更谨慎地使用地高辛。
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