我院儿外科全肠外营养医嘱合理性与不合理的原因分析

Analysis of Rationality and Irrationality of Total Parenteral Nutrition Orders in Pediatric Surgery Department of Our Hospital

目的回顾性分析我院儿外科住院患者全肠外营养(TPN)治疗医嘱,为规范TPN医嘱,保障儿外科全肠外营养液的安全有效提供参考。方法抽取我院2020年1~12月儿外科住院患儿TPN医嘱并从热氮比、糖脂比、电解质浓度、渗透压等方面进行回顾性分析。结果抽取47例患儿使用TPN适应证基本合理,存在部分不合理情况,如:热氮比和糖脂比不足或超量,氨基酸终浓度偏低等。631条医嘱中,93.51%热氮比为100:1~200:1(kcal:gN),92.70%糖脂比为1~3:1,98.10%一价阳离子<150mmol·L^(-1),100.00%二价阳离子<8mmol·L^(-1),96.19%葡萄糖终浓度在3.3%~23%;88.75%氨基酸终浓度>2.5%,95.25%糖速<1.2g/(kg·h),94.92%渗透压<900mOsm/L。结论我院儿外科TPN医嘱基本合理,但仍存在不合理的情况。临床药师需进一步加强医嘱审核以促进合理用药。

Objective To retrospectively analyze the treatment orders of Total Parenteral Nutrition(TPN)for inpatients in pediatric surgery in our hospital,so as to provide reference for standardizing TPN orders and ensuring the safety and effectiveness of total parenteral nutrition in pediatric surgery.Methods The doctor’s orders of TPN of hospitalized children in pediatric surgery in our hospital from January 2020 to December 2020 were extracted and analyzed retrospectively from the aspects of heat-nitrogen ratio,sugar-fat ratio,electrolyte concentration and osmotic pressure.Results The indications of TPN in 47 children were basically reasonable,and there were some unreasonable situations,such as insufficient or excessive ratio of heat to nitrogen and sugar to fat,low final concentration of amino acids,etc.Among the 631 medical orders,93.51%heat-nitrogen ratio is 100:1~200:1(kcal:gN),92.70%sugar-fat ratio is 1~3:1,98.10%monovalent cation is less than 150 mmol·L^(-1),and 100.00%divalent cation is less than 8 mmol·L^(-1).The final concentration of 96.19%glucose was 3.3%~23%.The final concentration of 88.75%amino acid is more than 2.5%,the sugar rate of 95.25%is less than 1.2g/(kg·h),and the osmotic pressure of 94.92%is less than 900 mOsm/L.Conclusion The doctor’s orders of TPN in pediatric surgery in our hospital are basically reasonable,but there are still unreasonable situations.Clinical pharmacists need to further strengthen the examination of doctor’s orders to promote rational drug use.