重症监护病房口服药物与肠内营养剂相互作用调查分析

Investigation and Analysis of Interaction of Oral Drugs with Enteral Nutrition in ICU

目的:探讨重症监护病房口服药物与肠内营养(EN)间相互作用的发生情况及影响因素,以促进合理用药。方法:采用回顾性病例分析的方法,收集某院2012年重症监护病房收治患者中同时经鼻饲管应用口服药物与EN的患者的用药资料,并对可能发生的药物相互作用进行分析。结果:EN与口服药物在药剂学、药动学和药理学方面可发生多种相互作用,导致鼻饲管堵塞、血药浓度过高或降低;鼻饲管的位置影响抗酸剂和地高辛等药物的药效;苯妥英钠、茶碱、地高辛、伏立康唑与EN同时使用时,应进行血药浓度监测;华法林则需监测国际化标准比值(INR)。结论:临床药师运用相关的药学知识,制订安全合理的给药方案,可避免相互作用的发生,促进临床合理用药。

OBJECTIVE： To investigate the occurrence and influential factors of the interaction of oral drugs with enteral nutri- tion （EN） in ICU, and to promote rational drug use. METHODS： By retrospective analysis, the patients were collected from ICU of a hospital in 2012. The medication and drug interaction in patients who were given oral drugs and EN via nasogastric feeding tube were all analyzed. RESULTS： EN interacted with oral drugs in terms of pharmacy, pharmacokinetics and pharmacology to in- duce nasogastric feeding tube occlusion, high blood concentration or decrease of it. The location of nasogastric feeding tube influ- enced the effects of antacid and digoxin. Blood concentration should be monitored when diphenylhydantoin sodium, theophyllinum, digoxin, voriconazole and EN were used simultaneously. 1NR of warfarin should be monitored. CONCLUSIONS： Clinical pharma- cists apply pharmaceutical knowledge and formulate safe and reasonable medication scheme to avoid the occurrence of drug interac- tion and promote rational drug use in the clinic.