1例新型冠状病毒肺炎危重型患者的营养支持分析及药学监护

Nutritional Support and Pharmaceutical Care of a Critically Ill Patient with Coronavirus Disease 2019

目的探讨新型冠状病毒肺炎(COVID-19)危重型患者营养支持的药学监护要点,为后续治疗提供参考。方法以医院收治的1例COVID-19危重型患者为研究对象,关注其营养方案的制订和调整,监护其症状体征、相关营养和生化指标变化,分析药师的药学监护要点。结果该患者的营养治疗方案制订做到了个体化,经过肠内外营养的支持治疗,其前白蛋白(PA)、白蛋白(ALB)等营养指标恢复正常;通过鼻饲给药的药物种类较多,用药过程中避免了药物的相互作用;治疗过程中发生了轻微腹泻、腹胀、便秘不适及三酰甘油(TG)升高的情况,均经干预后改善。结论 COVID-19危重型患者治疗措施复杂,药师在进行药学监护时除了要关注患者的营养方案外,还需评估其用药依从性,做好用药及饮食教育,监测肠内外营养与其他治疗药物间的相互作用,防治胃肠道、代谢性等并发症。

Objective To investigate the key points of pharmaceutical care of nutritional support for a critically ill patient with coronavirus disease 2019( COVID-19),and to provide reference for the subsequent treatment of COVID-19. Methods A critically ill patient with COVID-19 admitted to our hospital was taken as the research object,the formulation and adjustment of nutrition plan were concerned,the changes of symptoms and signs,related nutrition and biochemical indexes were monitored,and the key points of pharmaceutical care provided by pharmacists were analyzed. Results The formulation of the nutritional treatment plan for this patient was individualized. After the enteral and parenteral nutrition support treatment,the nutritional indexes such as prealbumin( PA) and albumin( ALB) have returned to the normal range. There were many types of drugs administered through nasal feeding,and the drug interactions were avoided during medication. Slight diarrhea,abdominal distention,constipation discomfort and elevated triglycerides( TG) occurred during the process of treatment,all of them improved after the intervention. Conclusion The treatment of critically ill patients with COVID-19 is complicated. During the monitoring of these patients,pharmacists should not only pay attention to the nutritional plan,but also need to evaluate their medication compliance,do a good job in medication and diet education,monitor the interaction between enteral and parenteral nutrition and other therapeutic drugs,prevent and treat gastrointestinal,metabolic and other complications caused by enteral and parenteral nutrition.