Hack Jason B, Wingate Sue, Zolty Ron, Rich Michael W, Hauptman Paul J
Brody School of Medicine, East Carolina University, Greenville, Nc.
Gaithersburg, Md.
Am J Med. 2025 Jan;138(1):25-33.e14. doi: 10.1016/j.amjmed.2024.08.018. Epub 2024 Sep 11.
While there has been a decline in the use of digoxin in patients with heart failure and atrial fibrillation, acute and chronic digoxin toxicity remains a significant clinical problem. Digoxin's narrow therapeutic window and nonspecific signs and symptoms of toxicity create clinical challenges and uncertainty around the diagnostic criteria of toxicity and responsive treatment choices for the bedside clinician. A systematic review of published literature on digoxin toxicity (34,587 publications over 6 decades, with 114 meeting inclusion criteria) was performed to develop 33 consensus statements on diagnostic and therapeutic approaches which were then evaluated through a modified Delphi process involving a panel of experts in cardiology, nursing, emergency medicine, and medical toxicology. The results demonstrate agreement about the need to consider time of ingestion and nature of the exposure (ie, acute, acute-on-chronic, chronic) and the use of digoxin immune Fab for life-threatening exposure to decrease risk of death. While several areas of continued uncertainty were identified, this work offers formalized guidance that may help providers better manage this persistent clinical challenge.
虽然心力衰竭和心房颤动患者使用地高辛的情况有所减少，但急性和慢性地高辛中毒仍然是一个重大的临床问题。地高辛狭窄的治疗窗以及中毒的非特异性体征和症状给临床医生带来了临床挑战，也使得中毒的诊断标准和合适的治疗选择存在不确定性。我们对已发表的关于地高辛中毒的文献进行了系统综述（60年间有34587篇出版物，其中114篇符合纳入标准），以制定33条关于诊断和治疗方法的共识声明，然后通过一个经过改进的德尔菲法进行评估，该方法涉及心脏病学、护理、急诊医学和医学毒理学领域的专家小组。结果表明，大家一致认为需要考虑摄入时间和暴露性质（即急性、慢性基础上的急性、慢性），以及对于危及生命的暴露使用地高辛免疫Fab来降低死亡风险。虽然确定了几个仍存在不确定性的领域，但这项工作提供了正式的指导，可能有助于医疗人员更好地应对这一持续存在的临床挑战。
