内科理论与实践

内科理论与实践 ›› 2025, Vol. 20 ›› Issue (02): 157-161.doi: 10.16138/j.1673-6087.2025.02.10

• 论著 • 上一篇    下一篇

优化胰岛素用量在垂体功能减退患者生长激素刺激试验中的应用效果研究

江淳弘, 史佳()   

  1. 上海交通大学医学院附属瑞金医院内分泌与代谢病科，上海 200025
  • 收稿日期:2024-09-02 出版日期:2025-04-28 发布日期:2025-07-08
  • 通讯作者: 史佳 E-mail:sj21698@rjh.com.cn

Effect of optimizing insulin dosage in insulin-induced hypoglycemia-growth hormone stimulation test in patients with hypopituitarism

JIANG Chunhong, SHI Jia()   

  1. Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2024-09-02 Online:2025-04-28 Published:2025-07-08
  • Contact: SHI Jia E-mail:sj21698@rjh.com.cn

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摘要：

目的：探讨优化胰岛素耐量试验（insulin tolerance test, ITT）中胰岛素用量计算方法在垂体功能减退患者中的应用效果。方法：收集2021年2月—2023年3月收治的106例垂体功能减退患者进行ITT，其中男性79例，女性27例，年龄14~61岁。试验中使用胰岛素优化公式得出胰岛素剂量，即体重×{-0.034+0.000 176×[0.5×(空腹胰岛素＋180 min胰岛素)+60 min胰岛素+120 min胰岛素]＋0.009 846×体质量指数（body mass index，BMI）}，分别监测试验前30 min、静脉推注即刻及推注后30、45、60、90、120 min患者血糖变化并记录主诉。结果：106例患者均完成试验，无1例出现低血糖昏迷、垂体危象等严重临床反应。其中76例（71.70%）在试验开始后30 min即发生低血糖，22例（20.75%）在试验开始后45 min发生低血糖，其余8例（7.55%）试验未激发成功。比较106例患者血糖曲线下面积（area under the curve of glucose, AUCGlu），发现伴有2种激素（生长激素和皮质醇）同时缺乏者较单一激素（生长激素）缺乏者整体血糖水平更低。所有患者试验结束时血糖均恢复正常。结论：在临床中使用优化的ITT胰岛素用量计算方法，计算得出的试验用胰岛素注射剂量会使患者低血糖发生时间前移，提示护士在试验前应做好充分评估，试验过程中应密切关注患者主诉及血糖变化，做好相应的试验护理。

关键词: 胰岛素耐量试验, 生长激素刺激试验, 垂体功能减退, 低血糖, 护理

Abstract:

Objective To investigate the effect of optimizing calculation method of insulin dosage in hypoglycemia growth hormone stimulation test [insulin tolerance test (ITT)] in patients with hypopituitarism.Methods Totally 106 patients with hypopituitarism admitted from February 2021 to March 2023 were selected for ITT, including 79 males and 27 females aged 14 to 61 years. Insulin dosage obtained by insulin optimization formula was used in the test, which is, insulin dosage (U) = body weight ×{-0.034+0.000 176×[0.5×(fasting insulin +180 min insulin)+60 min insulin +120 min insulin]+0.009 846×body mass index (BMI)}. The blood glucose changes of patients were monitored 30 min before the test, immediately after intravenous infusion and 30, 45, 60, 90 and 120 min after intravenous infusion, respectively, and the main complaints of patients were recorded.Results All 106 patients completed the test without any severe clinical reactions such as hypoglycemic coma or pituitary crisis. Among them, 76 patients (71.70%) experienced hypoglycemia within 30 min after the start of the test, 22 patients (20.75%) experienced hypoglycemia at 45 min, and the remaining 8 patients (7.55%) did not achieve a successful stimulation response. Comparison of the area under the glucose curve (AUCGlu) among the 106 patients revealed that patients with simultaneous deficiencies in two hormones (growth hormone and cortisol) had lower overall blood glucose levels than those with a single hormone (growth hormone) deficiency. All patients’ blood glucose levels returned to normal by the end of the test.Conclusions The use of an optimized insulin dosage calculation method in ITT results in an earlier onset of hypoglycemia. This underscores the importance of thorough pre-test assessment by nurses, close monitoring of patients’ subjective complaints and blood glucose levels during the test, and proper nursing care to ensure the safety and success of the procedure.

Key words: Insulin tolerance test, Growth hormone stimulation test, Hypopituitarism, Hypoglycemia, Nursing

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