Rossi P, Aina F, Occhetta F, Aquili C, Bagnati A
G Ital Cardiol. 1980;10(7):826-35.
Digitalis therapy in cardiac failure is used by physicians according to conventional dosages; we call this type of digitalization "empiric". With this method digitalis intoxication in hospitalized patients is likely to occur in 8 to 20% of the cases. Another method of digitalization which we call "rational" is based upon an initial dosage of 0.015 mg per Kilo of digoxin, followed by a maintenance dosage determined by the relationship between initial dosage and daily rate of elimination. The latter depends upon the individual value of endogenous creatinine clearance (determined by age, weight and sex). Blood level of digoxin during steady state was measured in 454 patients divided randomly in four groups, each of whom following a different protocol of digitalization: 31 patients were treated with the rapid "empiric" digitalization (group I), 249 patients with the slow "empiric" digitalization (group II), 81 patients with the "rational" digitalization (group III), and 93 patients after a initial "empiric" dosage were treated with a maintenance dosage calculated by the "rational" method. An excessive initial dosage (blood level of digoxin > 2 ng/ml) was observed in 47.9% of patients of group I, in 15.9% of patients in group II, in 9.8% of patients of group III and in 14.7% of patients of group IV. manifestations of digitalis intoxication occurred in 30% patients of group I, in 10% of patients of group II, in 4.9% of patients of group III, and in 2.1% of group IV. Blood value of digoxin below therapeutic levels (under 0.5 ng/ml) was observed in only 13.1% of patients of group II, in 8.6% of patients of group III, and in 8% of patients of group IV. The lower percentage of digitalis intoxication observed in patients treated with "rational" method of digitalization is highly significant if compared with that observed in patients treated with empiric digitalization. The use of the "Lanoxin-rulex" makes the rational digitalization easier to handle, and gives the physicians the habit of considering the more important determinants of digoxin blood level. Conditions more likely to determine a wrong digitalis dosage are discussed in detail.
医生在治疗心力衰竭时使用洋地黄疗法遵循传统剂量；我们将这种洋地黄化方式称为“经验性”的。采用这种方法，住院患者中洋地黄中毒的发生率可能为8%至20%。我们称之为“合理”的另一种洋地黄化方法是基于每公斤体重0.015毫克地高辛的初始剂量，随后根据初始剂量与每日消除率之间的关系确定维持剂量。后者取决于内源性肌酐清除率的个体值（由年龄、体重和性别决定）。对454例患者进行了稳态下地高辛血药浓度测定，这些患者被随机分为四组，每组采用不同的洋地黄化方案：31例患者采用快速“经验性”洋地黄化（第一组），249例患者采用缓慢“经验性”洋地黄化（第二组），81例患者采用“合理”洋地黄化（第三组），93例患者在初始“经验性”剂量后采用“合理”方法计算的维持剂量进行治疗。第一组47.9%的患者、第二组15.9%的患者、第三组9.8%的患者以及第四组14.7%的患者观察到初始剂量过大（地高辛血药浓度>2纳克/毫升）。第一组30%的患者、第二组10%的患者、第三组4.9%的患者以及第四组2.1%的患者出现洋地黄中毒表现。仅在第二组13.1%的患者、第三组8.6%的患者以及第四组8%的患者中观察到地高辛血药浓度低于治疗水平（低于0.5纳克/毫升）。与采用经验性洋地黄化治疗的患者相比，采用“合理”洋地黄化方法治疗的患者中观察到的洋地黄中毒百分比更低，差异具有高度显著性。使用“Lanoxin - rulex”使合理洋地黄化更易于操作，并使医生养成考虑地高辛血药浓度更重要决定因素的习惯。文中详细讨论了更可能导致洋地黄剂量错误的情况。
