儿童个体化全肠外营养液应用分析
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摘要
目的:分析个体化设计的儿童全肠外营养(TPN)液使用情况,促进TPN支持药物的合理应用。方法:收集苏州大学附属儿童医院2017年209例住院患儿个体化设计TPN液处方3 060张,并查阅我院电子病历系统,结合临床诊断和住院天数等信息,对TPN液应用的适应证、使用疗程、营养素种类、各营养组分配比和用药合理性等进行统计分析。结果:儿童使用TPN液适应证用药189例(91. 40%),使用疗程<4 d 60例(28. 71%),应用强化营养素谷氨酰胺(1～2 d)和ω-3鱼油脂肪乳(<10 d)的使用疗程过短;糖脂比合格率88. 30%,热氮比合格率82. 51%,非蛋白热量、液体量和糖胰比合理。结论:我院儿童使用个体化TPN液存在不合理的情况,仍有待进一步改进。
Objective: To analyze the individualized application of the total parenteral nutrition( TPN) fluid in children,and promote the rational application of TPN support drugs.Methods: A total of 3,060 prescriptions for the TPN of 209 hospitalized children in the Children's Hospital of Soochow University from Jan.to Dec.2017 were collected,and the electronic medical record system of our hospital was retrieved.Combined with information such as clinical diagnosis and length of stay,the indications for the application of TPN solution,the course of treatment,the categories of nutrients,the distribution ratio of each nutrition group and the rationality of medication were statistically analyzed.Results: Totally 189 cases( 91. 40%) were treated with TPN solution,60 cases( 28. 71%) with the course of treatment <4 d,and the course of treatment of intensive nutrient glutamine( 1 ～ 2 d) and ω-3 fish oil fat emulsion( < 10 d) was too short.The ratio of glycolipid to fat was 88. 30%,the rate of heat and nitrogen was 82. 51%,and the non-protein calories,liquid amount and sugar pancreas were rational. Conclusion: The individualized application of TPN in children is irrational and needs further improvement.
Objective: To analyze the individualized application of the total parenteral nutrition( TPN) fluid in children,and promote the rational application of TPN support drugs.Methods: A total of 3,060 prescriptions for the TPN of 209 hospitalized children in the Children's Hospital of Soochow University from Jan.to Dec.2017 were collected,and the electronic medical record system of our hospital was retrieved.Combined with information such as clinical diagnosis and length of stay,the indications for the application of TPN solution,the course of treatment,the categories of nutrients,the distribution ratio of each nutrition group and the rationality of medication were statistically analyzed.Results: Totally 189 cases( 91. 40%) were treated with TPN solution,60 cases( 28. 71%) with the course of treatment <4 d,and the course of treatment of intensive nutrient glutamine( 1 ～ 2 d) and ω-3 fish oil fat emulsion( < 10 d) was too short.The ratio of glycolipid to fat was 88. 30%,the rate of heat and nitrogen was 82. 51%,and the non-protein calories,liquid amount and sugar pancreas were rational. Conclusion: The individualized application of TPN in children is irrational and needs further improvement.
引文
[1]王静敏,刘秀平,张怡.儿童营养与保健[M].第四军医大学出版社,2012:3-5.
[2]马天龙.SMOF新型脂肪乳肠外营养对腹部术后患者影响的Meta分析[D].兰州大学,2017.
[3]林君容,李娜,于西全.2014-2016年南京军区福州总医院肠内外营养药物的使用情况分析[J].现代药物与临床,2017,32(6):1141-1145.
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[5]周丽花,郑飞跃.全肠外营养液处方536例合理性评价[J].药品评价,2013(14):34-36.
[6]雷婷,杨琍琦,汪泳,等.98例早产低出生体质量儿肠内肠外营养支持回顾性研析[J].药学与临床研究,2017,25(6):540-542.
[7]张良聚,曹宪福.完全胃肠外营养在普外临床中的应用[J].中国医药指南,2013,11(29):65-66.
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[12]徐文芳,贾萍,王华飞,等.我院新生儿肠外营养处方合理性分析[J].儿科药学杂志,2016,22(9):40-42.
[13]袁少筠,胡伟杰,黄彬娜.880份住院患者使用全肠外营养液的调查与分析[J].中国现代药物应用,2014(22):211-213.
[14]司延斌,赵志刚.1 038例住院患者全肠外营养液处方分析[J].药物流行病学杂志,2015(1):48-50.
[15]吴永佩,焦雅辉,颜青,等.临床静脉用药调配与使用指南[J].北京:人民卫生出版社,2010-250.
[16]赵彬,老东辉,商永光.规范肠外营养液配制[J].协和医学杂志,2018,9(4):320-331.
[17]龚露,胡兰.谷氨酰胺强化的营养支持治疗在危重患儿中的研究进展[J].中华急诊医学杂志,2016,25(5):690-694.
[18]肖吉群,蔡苗.丙氨酰谷氨酰胺在机械通气极低出生体质量儿肠外营养中的作用[J].儿科药学杂志,2015,21(5):16-18.
[19]王健,程芳,赵然,等.406例全肠外营养处方分析[J].药品评价,2017,14(4):34-38.
[2]马天龙.SMOF新型脂肪乳肠外营养对腹部术后患者影响的Meta分析[D].兰州大学,2017.
[3]林君容,李娜,于西全.2014-2016年南京军区福州总医院肠内外营养药物的使用情况分析[J].现代药物与临床,2017,32(6):1141-1145.
[4]姚颖.临床营养指南[M].北京:科学出版社,2013:6-35.
[5]周丽花,郑飞跃.全肠外营养液处方536例合理性评价[J].药品评价,2013(14):34-36.
[6]雷婷,杨琍琦,汪泳,等.98例早产低出生体质量儿肠内肠外营养支持回顾性研析[J].药学与临床研究,2017,25(6):540-542.
[7]张良聚,曹宪福.完全胃肠外营养在普外临床中的应用[J].中国医药指南,2013,11(29):65-66.
[8]中华医学会肠外肠内营养学分会儿科协作组.中国儿科肠内肠外营养支持临床应用指南[J].中华儿科杂志,2010,48(6):436-441.
[9]肠外营养临床药学共识(第二版)[J].今日药学,2017,27(5):289-303.
[10]中华医学会肠外肠内营养学分会儿科学组,蔡威,汤庆娅,等.中国新生儿营养支持临床应用指南[J]中华小儿外科杂志,2013,2(10):282-291.
[11]中华医学会.临床诊疗指南·肠外肠内营养学分册[M].2008版.北京:人民卫生出版社,2009:46.
[12]徐文芳,贾萍,王华飞,等.我院新生儿肠外营养处方合理性分析[J].儿科药学杂志,2016,22(9):40-42.
[13]袁少筠,胡伟杰,黄彬娜.880份住院患者使用全肠外营养液的调查与分析[J].中国现代药物应用,2014(22):211-213.
[14]司延斌,赵志刚.1 038例住院患者全肠外营养液处方分析[J].药物流行病学杂志,2015(1):48-50.
[15]吴永佩,焦雅辉,颜青,等.临床静脉用药调配与使用指南[J].北京:人民卫生出版社,2010-250.
[16]赵彬,老东辉,商永光.规范肠外营养液配制[J].协和医学杂志,2018,9(4):320-331.
[17]龚露,胡兰.谷氨酰胺强化的营养支持治疗在危重患儿中的研究进展[J].中华急诊医学杂志,2016,25(5):690-694.
[18]肖吉群,蔡苗.丙氨酰谷氨酰胺在机械通气极低出生体质量儿肠外营养中的作用[J].儿科药学杂志,2015,21(5):16-18.
[19]王健,程芳,赵然,等.406例全肠外营养处方分析[J].药品评价,2017,14(4):34-38.