慢性肾病对老年慢性心力衰竭患者地高辛治疗的影响研究

摘要

Objective To explore the influence of the chronic kidney disease ( CKD ) on elder patients with chronic heart failure ( CHF ) during the treatment with digoxin, and monitor the concentration of the serum digoxin. Methods 100 CHF patients with CKD, hospitalized in our hospital from 2007 - January to 2009 - June and treated with Digoxin were divided into 4 groups ( CKD Ⅰ ~ Ⅱ　period, Ⅲ period, Ⅳ period and V period ) according to the quality of survival guide kidney disease ( K - DOQI ) standard. Observe all the stages of CKD and Digoxin adverse reactions and the concentration of Digoxin. Results The Blood drug concentration in the four groups were different with statisticall significant ( P < 0. 05 ). In terms of the heart rate, arrhythmia, gastrointestinal reaction, central nervous system of the adverse reaction rate in the four groups, the difference was also statistically significant ( P < 0. 05 ) conclusion Evaluating kidney function was very necessary before treating CHF patients with CKD with Digoxin; Blood drug concentration must be monitored if Ⅲ and IV stage of elder CKD patients take Digoxin; And CKD stage V elderly CHF patients must be careful in taking Digoxin, because it was hard to avoid adverse reaction even if the concentration was being monitored. Doctors should carefully observe patients' clinical manifestation, and offer them individualized treatment if necessary.%目的 探讨慢性肾病(CKD)对老年慢性心力衰竭(CHF)患者地高辛治疗的影响,以及监测血清地高辛浓度的临床意义.方法 我院2007年1月-2009年6月收治的100例CHF伴CKD 应用地高辛治疗的老年患者,按肾脏病生存质量指导(K-DOQI)的标准分为4个组(CKDⅠ～Ⅱ期、Ⅲ期、Ⅳ期和Ⅴ期),观察CKD分期和地高辛不良反应与地高辛浓度间的关系.结果 4组血药浓度比较,差异有统计学意义(P＜0.05).4组心率减慢、心律失常、胃肠道反应、中枢神经系统的不良反应发生率比较,差异均有统计学意义(P＜0.05).结论 CHF伴CKD的患者应用地高辛前有必要评估肾功能;CKD Ⅲ期和Ⅳ期的老年CHF患者服用地高辛必须监测血药浓度;而CKD Ⅴ期的老年CHF患者应用地高辛治疗必须谨慎,即使监测血清地高辛浓度也难以避免不良反应,需密切观察临床表现,并进行个体化治疗.