北京多中心住院患者肠外营养支持应用现状调查

A multicenter cross-sectional survey on the use of parenteral nutrition in hospitalized patients in Beijing

目的借鉴欧洲“营养日”（NutritionDay）调查模式，对住院患者进行肠外营养（PN）使用现况调查，评估医院PN使用情况，并初步探讨PN输液并发症的主要影响因素。方法北京6家医院设定一天（2013年11月25日），采用欧洲通用调查问卷，调查全院所有输注PN的314例成年（≥18岁）住院患者疾病状况、营养风险及营养支持中PN使用及输液相关并发症。结果314例患者中311例完成全部调查资料，PN应用“全合一”者76．2％（237／311），多瓶串输者23．8％（74／311）；经中心静脉输注者56．8％（171／301），经外周静脉者43．2％（130／301）；输注时间平均（12．5±5．1）h。PN配方的糖脂比、热氮比平均分别为0．84和531．1，总能量低于推荐摄入量。认为输注PN会影响活动和睡眠的患者分别占38．6％（120／311）和33．4％（104／311）。引起输液相关疼痛占19．9％（62／311），多因素分析发现输液疼痛最主要的影响因素是输液途径（x^2=25．911，P=0．000）和静脉总入量（r=6．053，P=0．014）。结论PN支持患者能量供给普遍不足，建立适宜的输液途径是降低输液相关疼痛、提高PN耐受性的关键。

Objective To investigate the use of parenteral nutrition in hospitalized patients and to exam- ine the process of care ＇of patients receiving parenteral nutrition （PN） in hospital, in light of European ＂Nutrition Day＂ study, and to preliminarily explore the possible main risk factors for complications. Methods We recrui- ted 314 adult hospitalized patients （ ≥ 18 years） requiring PN on a predetermined day （November 25, 2013 ） in 6 hospitals in Beijing and investigated their disease status, nutrition risk, the use of PN and venous infusion relat- ed complications using the European Nutrition Day survey questionnaire. Results Of the 314 patients, 311 com- pleted the survey. In the 311 patients, the proportion of patients who received PN of ＂all-in-one＂ mixed prepara- tion was 76. 2% （237/311 ）, the proportion of patients receiving multibottle system was 23.8% （74/311 ） ; PN was administered via central vein in 56. 8% （ 171/301 ） of the patients and via peripheral veins in 43.2% （ 130/ 301 ） of the patients. The mean duration of infusion was （ 12. 5 ± 5.1 ） hours. The ratio of glucose to fat was 0. 84 and the ratio of non-protein to calories 531.1. The total energy provision was less than the recommended intake. 38.6% （ 120/311 ） of the patients reported that PN infusion would affect activity, and 33.4% （ 104/311 ） thought PN affected their sleep, and the incidence of infusion-related pain was 19. 9% （62/311）. Multivariate analysis result showed that the most important factors of infusion-related pain were intravenous route of PN （x^2 = 25.911,P = 0. 000） and total venous infusion volume （x^2 = 6. 053, P = 0. 014）. Conclusions The total energy provi- sion of PN is generally inadequate in hospitalized patients in Beijing. The key factor for reducing transfusion-re- lated pain and enhancing PN tolerance is to establish appropriate infusion route.