肠外营养输液途径合理性和适应证分析——3979例患者回顾性调查

Indications of Parenteral Nutrition and Rationality of Its Infusion Routes: a Retrospective Survey on 3 979 Cases

目的探讨肠外营养(PN)输液途径的合理性及适应证。方法回顾性分析3979例患者的营养状况、科室分布、PN使用时间、输液途径等,对其输液途径合理性、适应证等进行分析。结果使用PN患者主要为普通外科、胸心外科等13个科室,外科系统占93.2％,内科系统占6.8％,其中胃肠外科接受PN治疗的患者营养不良发生率为14.7％。PN治疗时间大多数≤7天,没有严格的掌握适应证。中心静脉插管占89％,外周静脉插管占11％。在中心静脉置管方式上以锁骨下静脉为主。结论多数应用中心静脉营养没有严格掌握适应证,营养处方没考虑到患者个体差异,中心静脉插管以锁骨下静脉为主。应加强全面临床营养知识培训,推广简单的营养不良及营养不良风险的评估方法,提高对PN治疗的适应证认识,采用推荐的经周围静脉中心静脉插管途径。

Objective To explore the rationality and indications of parenteral nutrition（PN） and its infusion routes. Methods The nutritional status, distribution in different departments, time of therapy and infusion route of 3 979 patients from March, 2000 to December, 2004 were retrospective by analyzed. Results The patients receiving PN were mainly distributed in 13 departments, including the department of general surgery and the department of cardiothoracic surgery. Among them 93.2% were in surgery departments and only 6.8% in internal medicine departments. Specifically, the malnutrition rate among the patients receiving PN was 14.7%. Most of the PN supports were taken less than 7 days. Centeral parenteral nutrition （CPN） and periperal parenteral nutritim accounted for 89% and 11% respectively. Conclusions The indications of CPN were not strictly obeyed in most cases and the nutrition prescriptions were not tailored. Central venous catheters via subelavian vein was the main infusion route of CPN. It is important to strengthen clinical nutrition training, promote the use of simpler assessment methodologies of malnutrition and its risks, increase the awareness of the indications of PN therapy, and apply the recommended peripherally inserted central venous catheter route.