186例胃癌患者术后全胃肠外营养处方用药合理性分析

Rationality Analysis of Total Parenteral Nutrition Prescriptions in 183 Patients with Gastric Cancer After Operation

目的:探讨胃癌患者术后全胃肠外营养(total parenteral nutrition,TPN)处方的合理性。方法:通过电脑随机抽取2018年1月至2019年5月哈尔滨医科大学附属第一医院(以下简称“我院”)肿瘤科收治的186例术后接受TPN治疗的胃癌患者,回顾性分析患者的病历资料,对TPN处方用药合理性进行评价与分析,并分析配药室及病房对TPN液的配置情况与输注情况。结果:186例术后接受TPN治疗的胃癌患者中,TPN使用时间<5d者共28例(占15.05%),5~7d者共99例(占53.23%),>7~14d者共54例(占29.03%),>14d者共5例(占2.69%);TPN液体量<1.0L者共31例(占16.67%),1.0~1.5L者共54例(占29.03%),>1.5L者共101例(占54.30%);TPN处方用药不合理包括电解质使用过量(11例,占5.91%)、胰岛素用量不当(8例,占4.30%)、配伍不当(22例,占11.83%)和氨基酸补充量不足(10例,占5.38%)。接受TPN治疗后,180例患者治愈,治愈率为96.77%;6例患者出现并发症状,其中3例出现导管堵塞(发生率为1.61%),1例出现高血糖表现(发生率0.54%),2例出现低血糖并发症(发生率为1.08%)。结论:临床为胃癌患者术后提供TPN的治疗过程中,营养液处方的设定需多学科合作,根据患者实际营养状态进行分析,优化完善营养液配方,不断提高TPN治疗的安全性。

OBJECTIVE:To probe into the application rationality of total parenteral nutrition (TPN) prescriptions in patients with gastric cancer after operation.METHODS:Totally 186 patients with gastric cancer after operation undergoing TPN from oncology department in the First Affiliated Hospital of Harbin Medical University (hereinafter referred to as “our hospital”) from Jan.2018 to May 2019 were randomly extracted.The medical orders were retrospectively analyzed to evaluate the rationality of TPN prescription,and the configuration and infusion of TPN solution in dispensing room and ward were analyzed.RESULTS:Of the 186 patients,there were 28 cases (15.05%) with TPN duration <5 d,99 cases (53.23%) with 5-7 d,54 cases (29.03%) with >7-14 d,and 5 cases (2.69%) with >14 d.There were 31 cases (16.67%) of TPN liquid volume <1.0 L,54 cases (29.03%) of 1.0-1.5 L,and 101 cases (54.30%) of >1.5 L.Irrational prescription of TPN included excessive use of electrolytes (11 cases,5.91%),improper use of insulin (8 cases,4.30%),compatibility (22 cases,11.83%) and insufficient amino acid supplements (10 cases,5.38%).After receiving TPN treatment,180 cases were cured,the cure rate was 96.77%;6 cases had complications,and 3 cases (1.61%) of them had catheter occlusion,1 case (0.54%) had hyperglycemia,2 cases (1.08%) had complications of hypoglycemia.CONCLUSIONS:During the clinical treatment of postoperative TPN for gastric cancer patients,the formulation of nutrient solution should be set up in a multidisciplinary manner,and the formulation of nutrient solution should be optimized and improved according to the actual nutritional status of the patients,so as to continuously improve the safety of TPN treatment.