中国恶性肿瘤营养治疗通路专家共识解读——经外周静脉置管部分

Interpretation of expert consensus for nutritional therapy pathway of malignant tumor in China——peripheral venous catheterization

经外周静脉肠外营养是肠外营养治疗的方式之一。经外周静脉肠外营养可用于无法行肠内营养治疗或肠内营养治疗不足患者的营养补充,也可用于无法建立中心静脉途径及短期、较低热卡、较低氮量需求的患者。经外周静脉肠外营养具有营养液通路建立快捷、简便的特点,所需医疗费用较低、并发症较少等优势。许多临床试验及研究者证实了经外周静脉肠外营养对于围术期患者是安全、有效的。渗透压较低的肠外营养制剂可安全用于经外周静脉肠外营养的观点已广为临床接受。肠外营养液中加入脂肪乳剂有助于降低氨基酸、葡萄糖及电解质产生的高渗透压,减少血栓性静脉炎的发生。同时尽量减少经外周静脉肠外营养应用时间,避免长时间应用。在经外周静脉肠外营养期间,营养支持小组应每日对穿刺、输注部位进行观察、监测,及时发现血栓性静脉炎的症状及体征并及时处理。

Peripheral parenteral nutrition(PPN)is one of the methods of parenteral nutritional support treatment.PPN can be used for nutritional supplement in patients who cannot receive enteral nutrition treatment or intake insufficient enteral nutrition treatment,as well as for patients who cannot establish central venous pathways or patients who have short term,low calorie or low nitrogen requirements.PPN has the advantages of quick and simple nutrient solution access,lower medical cost and fewer complications.Many clinical trials and researchers have confirmed that PPN is safe and effective for perioperative patients.The idea that parenteral nutrition with low osmotic pressure can be safely used for PPN has been widely accepted clinically.The addition of fat emulsions into parenteral nutrition solution can lower the high osmolarity produced by amino acids,glucose and electrolytes,and reduce the incidence of thrombophlebitis.Meanwhile,PPN application time should be shorten to avoid long-term use.During using PPN,the nutrition support group should observe and monitor the site of puncture and infusion on a daily basis,so as to timely find the symptoms and signs of thrombophlebitis and timely deal with them.