1例重症溃疡性结肠炎患者的营养支持方案分析

Analysis of nutrition support for a severe case of ulcerative colitis

1例30岁男性患者,因"腹泻半月、解黏液脓血便一周"入院,诊断为溃疡性结肠炎(急性,初发型,重度,全结肠,活动期)。入院第7天患者解鲜血便5次,量约800 m L,伴有乏力、心慌、冷汗,BP 86/50 mm Hg,P 100次·min-1,予禁食、暂停肠内营养及对症处理。临床药师协助医生拟定肠外营养支持方案,患者使用肠外营养第2天、颈内静脉置管术后3 h输注其他静脉液体后突发剧烈右侧胸痛,不能排除导管栓塞或疾病本身导致的肺栓塞、心肌梗死,立即对肠外营养做出调整:暂停使用脂肪乳。经过13 d的肠外营养支持,患者病情明显好转并恢复经口摄入。

A 30-year-old male patient was admitted to the hospital with the pathogeny of two weeks＆#39; diarrhea and one week＇s purulent blood and mucoid stool, and diagnosed with ulcerative colitis （acute, early onset, severe, colon activity）. The 7th day after hospitalization, the patient excreted blood stool for 5 times with a total volumn of 800 mL, accompanied with fatigue, palpitation, cold sweat, blood pressure 86/50 mm Hg, a pulse of 100 beats per minute. The patient was treated with the therapy of fasting and suspended enteral nutrition （EN）. Clinical pharmacists assisted with physicians to make the scheme of parenteral nutrition （PN） support. Two days after the sustained usage of PN, and 3 hours after jugular vein catheterization, the patient developed a sudden severe pain of right chest when he received the infusion of venous fluids. We could not exclude the possibility of transcatheter embolization, pulmonary embolism associated with the disease or myocardial infarction, so clinical pharmacists suspended the usage of fat emulsion. After 13 days of PN support, condition of the patient signiifcantly improved, then the patient was transferred to oral intake.