2127张全肠外营养支持处方用药分析

Analysis on 2127 Total Parenteral Nutrition Prescriptions

目的:了解苏州大学附属常熟医院/常熟市第一人民医院(以下简称"我院")全肠外营养支持(total parenteral nutriention,TPN)的临床使用情况,为临床合理应用TPN提供参考依据。方法:回顾性调查2014年1月—2016年8月我院接受TPN支持治疗的418例住院患者处方2 127张,对其用药情况进行评价与分析。结果:418例患者中,男性268例(占64.11%),女性150例(占35.89%);年龄20~96岁,≥60岁者305例(占72.97%);TPN使用疗程1~217 d,平均(11.10±15.29)d,疗程5~10 d者最多(205例,占49.04%);以消化道肿瘤、消化道出血、胆结石等腹部手术围术期为主,其次为某些肺部疾病、多发伤、中重度胰腺炎等。用药不合理主要表现为疗程不合理、液体量不足、糖脂比不合理、非蛋白能量不足、热氮比值不合理等。结论:我院TPN的使用基本合理,也存在部分问题有待改进。临床医师和审方药师需加强对TPN处方的设计和审核,为患者提供安全、有效的营养支持。

OBJECTIVE： To investigate the clinical application of total parenteral nutrition（ TPN） in Changshu Hospital Affiliated to Soochow University/Changshu the First People＇s Hospital（ hereinafter referred to as ＂our hospital＂）,so as to provide reference for the rational application of TPN in clinic. METHODS： Retrospective investigation was conducted on 418 inpatients（ 2 127 prescriptions） accepting TPN treatment from Jan. 2014 to Aug.2016,drug application status was evaluated and analyzed. RESULTS： Of the 418 patients,males were 268 cases（ 64. 11%）,females were 150 cases（ 35. 89%）; patients were aged 20-96 years old,and ≥60 years were 305 cases（ 72. 97%）. The treatment course of TNP was 1-217 d,with the average of（ 11. 10 ± 15. 29） d,patients with treatment course of 5-10 d took the lead（ 205 cases,49. 04%）. Clinical symptoms were mainly performed as perioperative period of abdominal surgery in terms of gastrointestinal tumors,digestive tracthemorrhage and gallstones,followed by some pulmonary diseases,multiple injury and severe pancreatitis,etc. The irrational drug application were mainly performed as irrational treatment course,underliquid,improper ratio of glucose to lipid,insufficient protein energy and improper ratio of energy to nitrogen,etc. CONCLUSIONS： The application of TNP in our hospital was basically rational,yet there are still some irrational problems. The clinicians and prescription-checking pharmacists need to strengthen the design and review of TNP prescriptions,so as to provide safe and effective nutrition support.