促肾上腺皮质激素兴奋试验用于醛固酮增多症患者分型诊断中的护理

Safety of ACTH stimulation test in subtyping of primary aldosteronism patient and its nursing strategy

目的探讨促肾上腺皮质激素兴奋试验用于醛固酮增多症分型诊断的安全性及护理对策。方法对我院施行生理盐水试验的43例原发性醛固酮增多症患者,进一步行促肾上腺皮质激素兴奋试验。患者于试验前日20:00禁食,22:00禁水,0:00服用地塞米松1 mg,试验日8:00静脉推注促肾上腺皮质激素50 U。推药前0 min及推药后5 min、15 min、30 min、60 min、90 min、120 min测量血压及心率,同时观察患者的不良反应。结果全部患者用药后收缩压、舒张压出现升高后逐步下降,同时心率出现减慢后逐步恢复。11例患者主诉头晕、6例患者胸闷及25例患者主诉消化道灼烧感等不适,其中需要服用降压药患者1例,需要服用降压药及静脉推注奥克患者1例。结论促肾上腺皮质激素兴奋试验中的血压升高及心率减慢多发生于推注促肾上腺皮质激素后90 min内,经对症处理后缓解。试验过程中严密监测血压、心率,重视患者不适主诉,可确保试验安全。

Objective To explore the safety of ACTH stimulation test with 1 mg dexamethasone suppression test(DST)in subtyping of primary aldosteronism(PA)patient and its nursing strategy.Methods Forty-three patients with PA confirmed by saline infusion test underwent ACTH stimulation tests with 1 mg dexamethasone suppression test(DST).The patients fasted at 20:00 before the trial,were deprived of fluids at 22:00,took dexamethasone at 0:00 for 1 mg,and were injected 50 U of corticotropin intravenously at 8:00 on the day of the trial.Blood pressure and heart rate were measured at 0 min before injection and 5 min,15 min,30 min,60 min,90 min,120 min after injection,and the adverse reactions were observed.Results During the test,forty-three patients had varying degree of change in blood pressure,heart rate,complexion,and discomfort complains such as dizziness,tightness chest,gastrointestinal discomfort etc.All of them completed the trial safely with immediate nursing care.Conclusion There is potential risk in ACTH stimulation test.Close observation with blood pressure,heart rate and discomfort complains of the patient are pivotal to maintaining the safety of the test as well as improving nursing quality.