文章摘要
张晓钰,刘冬,刘子昀,张晋.某院消化道恶性肿瘤围手术期肠外营养临床应用分析[J].中国医药导刊,2019,21(6):325-330.
某院消化道恶性肿瘤围手术期肠外营养临床应用分析
Analysis of Parenteral Nutrition Prescription in Perioperative Period of Patient with Digestive Malignant Tumor in a Hospital
投稿时间:2019-04-08  修订日期:2019-04-27
DOI:
中文关键词: 消化道恶性肿瘤  围手术期  全肠外营养  应用分析
英文关键词: Digestive malignant tumor  Perioperative period  Total parenteral nutrition  Use analysis
基金项目:
作者单位E-mail
张晓钰 宝鸡市中心医院 zhangsmallyu@163.com 
刘冬 宝鸡市中心医院  
刘子昀 宝鸡市中心医院  
张晋 宝鸡市中心医院  
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中文摘要:
      目的:调查某院消化道恶性肿瘤患者围手术期全肠外营养(TPN)的临床应用情况,为临床合理用药提供参考。方法:采用回顾性调查的方法,对2018年1月至2018年7月某院收治的96例消化道恶性肿瘤患者围手术期TPN处方情况进行统计与适宜性分析。结果: 96例消化道恶性肿瘤患者以老年人为主,胃癌占57.3%;围手术期共接受TPN治疗918例次,以术后营养支持为主,平均疗程(9.6±4.2)d。TPN处方平均热量供给为(21.1±4.4)kcal·kg-1·d-1,39.5%的处方热量低于20 kcal·kg-1·d-1;糖脂供能比为1±0.4,41.6%的处方糖脂比小于1;氨基酸平均用量为(1.3±0.4)g·kg-1·d-1,84.4%的处方热氮比为80~150∶1;丙氨酰谷氨酰胺的使用率为81.3%,有41.7%的处方使用比例超过20%。肠外营养液的渗透压、氨基酸浓度、葡萄糖浓度及一价和二价阳离子达标率分别为95.8%、92.7%、96.8%及94.8%和95.9%。结论:该院消化道恶性肿瘤围手术期营养支持以术后为主,缺乏术前个体化营养风险评估和营养支持;围手术期TPN处方基本合理,部分处方存在热量/蛋白供给不足、脂肪乳供能占比较高、热氮比不适宜、电解质与药物浓度超标的现象。临床营养支持是一项多学科参与的工作,临床药师应积极协助医师,制定个体化的营养支持方案,提升临床营养治疗的安全性和有效性。
英文摘要:
      Objective: To investigate the application of total parenteral nutrition(TPN) in perioperative period of patient with digestive malignant tumor in a hospital, providing reference for the rational drug use. Methods: Retrospectively, the application of TPN in 96 malignant tumor surgery inpatients during January 2018 to July 2018 in a hospital were analyzed statistically.Results: The 96 malignant tumor surgical inpatients were mainly the elderly, proportion of gastric cancer reached 57.3%. Patients totally received TPN 918 times, and the average use period was (9.6±4.2)d. The average energy of TPN prescriptions was (21.1±4.4)kcal·kg-1·d-1, and the energy of 39.5% prescriptions were less than 20 kcal·kg-1·d-1. The average glycolipids energy supply ratio was 1±0.4, and the proportion of prescriptions with glycolipids energy supply ratio below 1 was 41.6%.The average amino acids of TPN prescriptions was (1.3±0.4)g·kg-1·d-1, and the proportion of prescriptions with hot nitrogen ratio of 80-150:1 was 84.4%. There were 81.3% prescriptions used alany glutamine, and the alanyl glutamine accounted for more than 20% of the amino acid in the 41.7% prescriptions. The osmotic pressure, amino acid concentration, glucose concentration, and monovalent and bivalent cations qualified rates of parenteral nutrition were 95.8%, 92.7%, 96.8%, 94.8% and 95.9% respectively. Conclusion: The nutritional support in the perioperative period of malignant tumor surgery in the hospital is mainly after operation, lack of preoperative individualized nutritional risk assessment and nutritional support. The perioperative TPN prescription is basically reasonable, however, some prescriptions are deficient in heat/protein supply, excessive in fat emulsion supply, unsuitable in heat and nitrogen ratio and exceeded the standard in electrolyte and drug concentration. Clinical nutrition support is a multidisciplinary work. Clinical pharmacists should actively assist physicians and develop individualized nutritional support programs to improve the safety and effectiveness of clinical nutrition treatment.
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