成人住院病人ITT试验安全风险和改进策略OA

Objective:To retrospectively analyze the data regarding the insulin tolerance test(ITT)used to stimulate growth hormone secretion in adult inpatients,identify patient safety risks associated with the procedure,and propose mitigation strategies.Methods:A retrospective analysis was conducted on the data of 43 adult inpatients who underwent the ITT trial in the Department of Endocrinology of the First Affiliated Hospital of Chongqing Medical University from January 1,2021 to December 31,2024.The contents included general information,diagnosis of major diseases upon admission,heart rate,respiratory and blood pressure before the trial and at the provocation point,blood oxygen saturation,and insulin dosage whether insulin was added and the additional dosage,the number of blood glucose monitoring,referring to the trough value of blood glucose and the trough value of intravenous blood glucose,and other data were analyzed using R software(version 4.2.2)and MSTATA software to explore the safety risks during the trial process.Results:A total of 43 patients in the ITT trial were included in the study,among whom 28 were female(65.1%)and 15 were male(34.9%).Body mass index(BMI)was significantly positively correlated with the trough value of venous blood glucose(r=0.329,P=0.031),and fasting blood glucose was significantly positively correlated with the trough value of finger blood glucose(r=0.333,P=0.036).The predictive effect of each variable in the study on trough blood glucose is very limited.When the stimulation was successful,the heart rate and respiratory rate also increased significantly(P<0.001);Among the 43 people,2 had no special symptoms during the trial process,while the symptoms of the remaining 41 people were most characterized by palpitations.Conclusion:There are safety risks in the ITT trial process,such as insufficient hypoglycemic stimulation leading to large fluctuations in blood glucose at additional doses,rapid changes in the condition of elderly and patients with multiple coexisting diseases,rapid changes in vital signs and blood glucose,inability to effectively predict blood glucose troughs,and large individual differences in symptom manifestations during the trial process.Through process refinement,dose calculation improvement,and classified treatment and other response strategies,patient safety can be further guaranteed.