我院肠外营养处方用药合理性与经济性分析

Analysis of rationality and economy of parenteral nutrition prescription in our hospital

目的探讨我院肠外营养处方用药的合理性和经济性。方法选取我院2018年3月至2019年3月的2 000例住院患者的2 000份肠外营养处方进行统计分析。分析肠外营养处方中各营养物质占比、肠外营养处方用药不合理情况,并对肠外营养处方的日平均费用进行分类统计。结果围术期患者肠外营养处方各营养素合理范围占比分别为氨基酸73.90%、葡萄糖97.70%、热氮比79.35%、糖脂比81.75%、一价阳离子84.75%、二价阳离子92.90%。2 000份肠外营养处方中,不合理处方487张。其中未添加维生素、微量元素占比最高,为47.43%,其次磷盐选择不合理、胰岛素应用不适宜分别为25.67%、20.94%,复方氨基酸与丙氨酰谷氨酰胺注射液配比不当占比最低,为2.05%。患者的平均日费用600~899元的肠外营养处方占比最高,为34.55%;其次300~599、<300元占比分别为23.85%、20.60%;而平均日费用>1 200元占比最低,为3.40%。结论我院住院患者肠外营养处方用药存在不合理之处,因而临床中应加强对肠外营养处方的规范使用,以确保用药处方的合理性,并实现肠外营养处方的经济性最优化。

Objective To explore the rationality and economy of parenteral nutrition prescription in our hospital.Methods A total of 2 000 parenteral nutrition prescriptions of 2 000 inpatients from March 2018 to March 2019 were selected for statistical analysis. The proportion of various nutrients in parenteral nutrition prescription, the unreasonable use of parenteral nutrition prescription were analyzed, and the daily average cost of parenteral nutrition prescription were classified and counted. Results The proportion of nutrients in reasonable range in parenteral nutrition prescriptions of perioperative patients was 73.90% in amino acid, 97.70% in glucose, 79.35% in heat-nitrogen ratio, 81.75% in sugar-lipid ratio, 84.75% in monovalent cation and 92.90% in bivalent cation, respectively. There were 487 unreasonable prescriptions in the 2 000 parenteral nutrition prescriptions. Among them, the proportion of non added vitamins and microelements was the highest, which was 47.43%, followed by unreasonable selection of phosphorus salt and inappropriate application of insulin, which were 25.67% and 20.94%, respectively, and the proportion of compound amino acid and alanyl glutamine injection improper proportioning was the lowest, which was 2.05%. The proportion of parenteral nutrition prescriptions with the daily average cost of 600-899 yuan was highest, which was 34.55%, followed by 300-599 yuan and <300 yuan, which was 23.85% and 20.60% respectively, while the lowest proportion of prescriptions with the daily average cost more than 1200 yuan was highest, which was 3.40%. Conclusion There are some irrationalities in the use of parenteral nutrition prescription for inpatients in our hospital, so it should strengthen the standardized use of parenteral nutrition prescription in clinical practice, so as to ensure the rationality of the prescription and realize the economic optimization of parenteral nutrition prescription.