我院肠外营养临床应用评价

Application Evaluation of Clinical Parenteral Nutrition in Our Hospital

目的:尝试建立基层医院肠外营养(PN)临床合理应用评价方法。方法:收集脂肪乳氨基酸(17)葡萄糖(11%)注射液的使用病例进行调查,统计分析病例资料的完整性,评价配伍用药情况,计算基础代谢值(BMR)并作相关评估。结果:营养风险评估基本参数不全的病例占66.7%,各病例疗程差异显著但用量无差别,脂肪乳氨基酸(17)葡萄糖(11%)注射液非蛋白热卡占个体BMR比例,平均值为72.1%(S=8.9)。脂肪乳氨基酸(17)葡萄糖(11%)注射液配伍用药中加入氯化钾注射液的病例占63.0%,其中70.6%超推荐剂量;加入丙氨酰谷氨酰胺的病例为62.9%,用量全部超推荐剂量。结论:本院PN应用中营养风险评估基本缺失,合理的个体化方案制订水平与指南要求有较大差距,建议医院临床药师在PN应用方面加大相关监测评价等工作力度。

Objective：To establish the methods and standard for the evaluation of rational application of parenteral nutrition （ PN） in primary hospitals. Methods：Medical records with the use of fat emulsion, amino acids （17） and glucose （11%） injection were col-lected. The integrity of the medical records was analyzed, the compatibility of supplementary drugs was evaluated, and basal metabo-lism rate（BMR） was calculated for the relevant assessment. Results：Totally 66. 7% of the patients had incomplete basic parameters of nutritional risk assessment, the cases had different course of treatment but showed no significant difference in total usage of fat emul-sion, amino acids （17） and glucose （11%） injection,and the non-protein calories of fat emulsion, amino acids （17） and glucose （11%） injection accounted for 72. 1% of basal metabolism rate of an individual on average （S=8. 9）. Supplementary usage of KCl accounted for 63. 0% of the cases, of which 70. 6% were overdosed;62. 9% of the cases used supplementary alanyl-glutamine with overdosage. Conclusion：In the PN application in our hospital, nutritional risk assessment is basically missed, and there is a great gap between the level of developing reasonable individual program and the requirements in guidelines. Clinical pharmacists should enhance the related monitoring and evaluation in PN application.