经中线导管进行全肠外营养支持的处方分析

Prescription Analysis of Patients with Total Parenteral Nutrition Support via Midline Catheter

目的:研究经中线导管进行全肠外营养支持(TPN)的安全性及处方分析。方法:对某医院消化内科2017年1月~2018年12月进行TPN治疗的41例患者进行回顾性分析,统计分析TPN输注途径、使用天数、并发症发生率、TPN处方等临床资料。结果:41例患者使用TPN,其中31例(75.6%)经中心静脉进行TPN,并发症发生率为22.6%,平均治疗天数(10.5±7.7)d;10例(24.4%)患者经中线导管进行TPN,平均治疗天数(4.1±2.0)d,并发症发生率为50.0%。经中线导管进行TPN治疗患者处方中葡萄糖终浓度8.8%~13.2%,氨基酸终浓度2.5%~4.2%,全营养混合液(TNA)渗透浓度923~1363 mOsm·L-1,均高于指南推荐的安全范围。结论:短期内经中线导管进行TPN是可行的,但应降低能量和氮量,TNA的渗透浓度应低于900 mOsm·L-1。渗透浓度过高易出现静脉炎和形成静脉血栓。

Objective:To study the safety and prescription characteristics of patients with total parenteral nutrition support(TPN)via midline catheter.Methods:A retrospective analysis was performed on 41 patients undergoing TPN treatment from January 2017 to December 2018 in a department of gastroenterology in a hospital,and statistical analysis of clinical data such as TPN infusion route,number of days used,incidence of complications,and TPN prescription.Results:41 cases used TPN,31 cases(75.6%)received TPN via central venous catheter,and the complication rate was 22.6%.The average number of days of treatment was(10.5±7.7)d,10 cases(24.4%)received TPN via a midline catheter.The average number of days of treatment was(4.1±2.0)d,the complication rate was 50%;the final glucose concentration in the prescription of patients treated with TPN via a midline catheter was 8.8%to 13.2%,the final amino acid concentration was 2.5%to 4.2%,and the total nutrient mixture(TNA)Osmotic concentration was 923 to 1363 mOsm·L-1,which were all higher than the safe range recommended by the guidelines.Conclusion:Short-term TPN via a midline catheter is feasible,but energy and nitrogen should be reduced,and the osmotic concentration of TNA should be less than 900 mOsm·L-1.Excessive osmotic concentration is prone to phlebitis and venous thrombosis.