572张肿瘤患者肠外营养处方用药分析

Analysis of Drug Use of 572 Parenteral Nutrition Prescriptions for Cancer Patients

目的:了解肿瘤患者肠外营养(parenteral nutrition,PN)制剂使用情况,为临床合理用药提供参考。方法:调取2016—2018年某三级甲等医院静脉用药调配中心的肿瘤患者PN处方572张,对患者的一般情况、PN制剂的种类和PN处方涉及的热氮比、糖脂比、总热量及总液体量等指标进行统计分析。结果:572张处方涉及17种药品制剂,均使用了葡萄糖、脂肪乳和氨基酸等3大基础营养素,此外,丙氨酰谷氨酰胺的使用也较为频繁(53张,占9.3%);热氮比为(100～200)∶1的处方有497张(占86.9%);糖脂比为(1～2.3)∶1的处方有453张(占79.2%);存在一定的不合理用药现象,包括热氮比、糖脂比不在肠外肠内营养指南规定的范围内,提供的总热量不足或超量及液体量不在规定范围内。结论:PN制剂的合理、规范应用需引起临床医师的重视,有必要成立营养支持小组对PN的合理应用进行干预及指导。

OBJECTIVE: To investigate the application of parenteral nutrition(PN) in patients with tumor, so as to provide reference for the rational drug application in clinic. METHODS: From 2016 to 2018, 572 PN prescriptions of tumor patients were obtained from PIVAS of a grade Ⅲ level A hospital. General information of the patients, types of PN preparations, and indicators such as hot-nitrogen ratio, sugar-fat ratio, total heat and total liquid volume involved in PN prescriptions were statistically analyzed. RESULTS: The 572 prescriptions involved in 17 pharmaceutical preparations, all of which used three basic nutrients, including glucose, fatty milk and amino acid. In addition, alanyl glutamine was also frequently used(53 prescriptions, 9.3%). There were 497 prescriptions(86.9%) with a heat-to-nitrogen ratio of(100-200)∶ 1 and 453 prescriptions(79.2%) with a ratio of glycol to lipid(1-2.3)∶ 1. There were still some irrational medication phenomenon, namely, the ratio of hot nitrogen and sugar to fat was not within the range of the guidelines for parenteral and enteral nutrition, and the total quantity of heat provided was insufficient or excessive, and the amount of liquid was not within the range of the guidelines. CONCLUSIONS: The rational and standardized application of PN preparations needs to be paid attention to by clinicians. It is necessary to establish a nutrition support group to intervene and guide the rational application of PN.