Storstein O, Hansteen V, Hatle L, Hillestad L, Storstein L
Am Heart J. 1977 Apr;93(4):434-43. doi: 10.1016/s0002-8703(77)80405-5.
In a prospective study of digitalis intoxication in 649 patients on maintenance treatment with digitoxin a low incidence of digitalis toxicity was found, namely, 5.8 per cent. This is mainly due to a more careful use to digitalis glycosides. It is especially important to reduce the dose of digitoxin in the liver and partly excreted metabolized in the liver and partly excreted through the kidneys as metabolities. Serum half-time of digitoxin is shortened in patients with impaired renal function. Patients with reduced renal function may be treated with digitoxin in the same doses as individuals with normal renal function. This is in contrast to patients treated with digoxin. Digitoxin should therefore be the cardiac glycoside of choice in treatment of patients with renal failure. Digitoxin is further rapidly eliminated in patients with reduced liver function in spite of its extensive hepatic metabolism. In this study extracardia symptoms were found equally often as cardiac signs of toxicity. Patients intoxicated usually had several symptoms and signs of toxicity at the same time. The specificity of commonly used symptoms and signs a digitalis intoxication is very low. In this study atrial tachycardia with block, which has been considered to be an important cardiotoxic arrhythmia, very seldom was found in digitalis intoxication. There is an overlap in digitalis serum concentration between toxic and nontoxic patients. The diagnosis of toxicity was made on clinical grounds. Most of the intoxicated patients had high serum concentrations, but some had concentrations in the normal or low range. Apart from being a guide to the diagnosis of digitalis intoxication, serum digitalis levels may further be a guide to underdigitalization of cardiac patients, especially patients in sinus rhythm.
在一项对649例接受洋地黄毒苷维持治疗患者的洋地黄中毒前瞻性研究中，发现洋地黄毒性发生率较低，即5.8%。这主要归因于对洋地黄糖苷的使用更加谨慎。尤其重要的是，由于洋地黄毒苷部分在肝脏代谢并部分以代谢产物形式经肾脏排泄，所以要降低其剂量。肾功能受损患者洋地黄毒苷的血清半衰期缩短。肾功能减退患者可以与肾功能正常者使用相同剂量的洋地黄毒苷进行治疗。这与地高辛治疗的患者形成对比。因此，洋地黄毒苷应是治疗肾衰竭患者的首选强心苷。尽管洋地黄毒苷有广泛的肝脏代谢，但在肝功能减退患者中它仍可被快速清除。在本研究中，心外症状与心脏毒性体征出现的频率相同。中毒患者通常同时有几种毒性症状和体征。常用的洋地黄中毒症状和体征的特异性很低。在本研究中，曾被认为是重要心脏毒性心律失常的伴有传导阻滞的房性心动过速，在洋地黄中毒时很少发现。中毒和未中毒患者的洋地黄血清浓度有重叠。毒性诊断基于临床依据。大多数中毒患者血清浓度较高，但有些患者的浓度处于正常或低范围。血清洋地黄水平除了可作为洋地黄中毒诊断的指导外，还可进一步作为心脏病患者，尤其是窦性心律患者洋地黄用量不足的指导。
