危重患者营养支持治疗中药学监护模式的探索与实践

Exploration and Practice of Pharmaceutical Care Model for Nutrition Support Therapy in Critically Ill Patients

目的:探讨营养支持药师参与危重患者综合营养治疗管理的药学监护模式和要点,促进其在临床合理用药中发挥积极作用。方法:通过营养支持药师全程参与107例高风险危重患者的营养治疗管理及案例分析,阐述了营养药学监护"全合一"模式的构建流程和实施要点。结果:营养药学监护"全合一"模式的构建流程包括筛选患者、建立营养治疗档案、制订和实施"全合一"药学监护计划、优化和调整营养治疗方案、记录营养治疗相关资料与归档,实施要点包括规范化与个体化、整体化与精细化、安全性与有效性、专科化与团队化的统一。在典型案例中,药师通过调整患者营养药物治疗方案,发挥了自身的专业特长,能够有效发现、预防和解决危重患者营养治疗中所存在的问题;在107例实践中,41例患者由肠外营养顺利过渡到肠内营养,11例患者的营养药品治疗费用降低,多例患者血糖异常、血脂异常以及肝功能损伤等并发症得到有效控制或避免。结论:作为多学科治疗团队中的成员,营养支持药师提供全程监护,能够提高危重患者营养支持治疗的安全性、有效性和经济性,体现临床药学的核心价值和作用。

OBJECTIVE:To explore the model and key points of pharmaceutical care provided by nutrition support pharmacists in comprehensive management of nutrition support therapy for critically ill patients,and promote their positive role in clinical rational drug use.METHODS:Through nutrition support pharmacists participated in nutrition treatment management and case analysis of 107 high risk critically ill patients,construction process and implementation points of the“all-in-one”mode of nutrition pharmaceutical care were expounded.RESULTS:The construct procedure of“all-in-one”mode of nutrition pharmaceutical care included that patient selection,establishment of nutrition treatment files,formulation and implementation of“all-in-one”pharmaceutical care plan,nutrition treatment plan optimization and adjustment,records of nutrition treatment related data and file.The key points of mode implementation included standardization and individuation,integration and refinement,safety and effectiveness,specialization and teamwork.In typical cases,pharmacists adjusted the nutrition treatment plan,played their professional expertise,found,prevented and solved the problems of nutrition treatment for critically ill patients effectively.In 107 practice cases,41 patients transferred to enteral nutrition from parenteral nutrition;11 patients had cost reduction of nutritional medications;common complications in several patients such as abnormal blood glucose,abnormal blood lipid and liver function injury had been prevented and controlled.CONCLUSIONS:The nutrition support pharmacists,as the member of the multidisciplinary medical team,provide over-all pharmaceutical care,which improves the safety,effectiveness and economy of nutrition support therapy in critically ill patients and proves the core value and function of clinical pharmacy.