地高辛中毒-潜在的杀手.ppt

Materials and Methods: 70 patients (30 men; age 74 ±12 years) were enrolled in this retrospective study. Patients were divided into two groups: group 1 with TCP and group 2 without TCP. A digoxin overdose was defined as a serum digoxin level higher than 2.0 ng/ml combined with the presence of digoxin-related symptoms. Results: Group 1 included 24 patients The rhythms prior to pacemaker insertion in group 1 included sinus arrest with junctional bradyarrhythmias (n = 9), atrial fibrillation with a slow ventricular rate (n = 11), and high-degree atrioventricular block (n = 4). The mean duration of pacemaker implantation was 5.8 ± 2.9 days (2–12 days). There was no major arrhythmic event or mortality after TCP in group 1. Two patients in group 2 (4%) died of ventricular tachyarrhythmias. Group 1 had a higher level of blood urea nitrogen (45.1 ± 26.0 vs. 33.4 ± 19.3 mg/dl),of left ventricular ejection fraction (68 vs. 56%), and of digoxin (4.4 ± 2.1 vs. 3.4 ± 1.3 ng/ml) but a lower serum calcium level (8.7 B 0.6 vs. 9.1 B 0.8 mg/dl). 正确使用洋地黄，防止地高辛中毒 熟悉洋地黄中毒的临床表现 高钾与预后 缓慢性心律失常：阿托品、临时起搏 室性心律失常：利多卡因或苯妥英钠 慎重电复律 血液净化研究不充分 血液透析 期待地高辛抗体 Among the 1485 patients in the digoxin group, the mean steadystate serum digoxin level was 0.86 ng/ml at the 1-month visit and 0.80 ng/ml at the 12-month visit At the one-month visit, 88.3 % of the patients in the digoxin group had serum digoxin levels within the therapeutic range of 0.5 to 2.0ng /ml. the mean serum digoxin levels 0.76 ng /ml , 0.125 mg/d 0.89 ng /ml , 0.250 mg /d 0.88 ng /ml, 0.375 mg /d 0.88 ng/ml , 0.500 mg /d 男患，76岁，因一次性口服地高辛90片约45 min急诊人院 既往有高血压病20余年，高心病合并心衰约10年。因长期生病失去生活的信心而自杀 PE：T：36.5 ℃，P：62次／min，R：21次/min，BP：130／60 mmHg神清，口唇无紫绀，瞳孔直径约3.0 mm，对光反射灵敏。双肺未闻及啰音，心浊音界左下扩大，HR：68bpm，律不齐，A2P2。腹平软，肝脾肋下未及。双下肢轻度凹陷性浮肿，NS（－） 洗胃、导泻 血K+ 6.47 、Na+ 136.4 、CI- 98.4、Ca2+ 2.28 、C02－CP 21.3 、BUN 18.44 、Cr 331.8 ?mol／L，心肌酶谱正常 心电图：房颤，约60bpm。立即转ICU 入院后6 h