垂体瘤患者术后生长激素激发试验安全性观察与护理

摘要

目的 探讨垂体瘤患者术后生长激素激发试验用于诊断成人生长激素缺乏症的安全性与临床护理要点.方法 采用胰岛素耐量试验(insulin telerance test,ITT)作为探测垂体生长激素储备功能的药物激发试验.选择15例垂体瘤术后(无功能性腺瘤和催乳素大腺瘤)患者术后进行ITT试验,行ITT前禁食10 h,静脉注射短效人胰岛素 0.1～0.15 U/kg,于静注短效人胰岛素前30 min、推注前即刻,推注后第30、第45、第60、第90、第120分钟各采血3.5 mL做生长激素及静脉血糖测定,同时监测上述时间点心率及出现低血糖的频率与严重性.结果 血糖低谷主要发生在注射胰岛素后的30～45 min,试验中所有受试者均诱导出生化低血糖,30 min发生低血糖12例,45 min发生低血糖3例,其中需要静脉注射质量浓度50 g/L葡萄糖缓解症状者仅2例.结论 ITT用于诊断生长激素缺乏症过程中低血糖多发生于推注胰岛素后30～45 min,经对症处理后低血糖症状多迅速缓解.试验过程中严密监测血糖可保证试验的安全性.%Objective To explore the safety and clinical nursing of growth hormone (CH) stimulation test in the diagnosis of adult growth hormone deficiency. Methods 15 patients (including nonfunctioning pituitary adenomas and macro-prolactinomas) who had received the pituitary tumor surgery, received insulin tolerance test (ITT), which was applied as a stimulation test of growth hormone to evaluate the function of pituitary in secreting growth hormone. After fasting for 10 hours, regular insulin (0.1～ 0.15U/kg) were injected intravenously. At 30 min before the insulin injection, 0 min instantly before injecting, and 30 min, 45 min, 60 min, 90 min, 120 min after the injection, the monitoring of heart rate and the measuring of blood glucose and GH were necessary. At the same time, the frequency and severity of hypoglycemia were observed. Results Hypoglycemia occurred in all patients and mainly happened 30～45min after the injection. Among them. 12 cases occurred 30 min after the insulin injection and 3 cases happened 45 min after the injection. Only 2 patients needed 50 g/L glucose to be injected intravenously in order to relieve symptoms. Conclusion Hypoglycemia occurs mainly 30～45 min after the insulin injection during ITT. Most of the hypoglycemia cases can be relieved by symptomatic treatment. Close monitoring of blood glucose, heart rate and blood pressure can guarantee the security of the test.