我院2015-2017年儿外科围手术期营养治疗分析

Perioperative Nutritional Therapy in Pediatric Surgery from 2015 to 2017 in Our Hospital

目的:回顾性分析吉林大学第一医院儿外科住院患儿围手术期营养治疗处方,为进一步促进临床合理用药提供参考。方法:收集我院2015-2017年儿外科住院患儿围手术期全肠外营养(TPN)处方并进行回顾性分析。结果:我院儿外科围手术期TPN处方存在部分不合理情况,如热氮比和糖脂比不足和超量、糖速及糖浓度不合理等。TPN处方组成成分主要包括葡萄糖类、脂肪乳类、氨基酸类、电解质类、维生素类及微量元素类药品,其中91.05%的处方糖脂比为1∶1~2∶1,92.53%的处方热氮比为100∶1~200∶1(kcal∶gN),95.18%的处方输注糖速<1.2 g/(kg·h),各类电解质离子添加使用率在98.82%以上。结论:肠外营养液的应用应根据患儿实际病情设计给药方案。患儿在使用了不合理肠外营养处方后未出现不良反应,但营养支持并不能达到理想效果,临床药师应进一步加强审方意识,积极与临床医师沟通,规范肠外营养液的合理应用。

Objective:To retrospectively analyze the perioperative nutritional therapy prescription of hospitalized children in the pediatric surgery of the First Hospital of Jilin University,so as to provide reference for further promoting the rational drug use in clinic.Methods:Perioperative total parenteral nutrition(TPN)prescriptions of hospitalized children in the pediatric surgery of our hospital from 2015 to 2017 were collected and analyzed retrospectively.Results:There are some irrational cases of perioperative TPN prescriptions in the pediatric surgery of our hospital,such as insufficient and excessive ratio of calories and nitrogen and ratio of glucose and lipid,improper glucose rate and glucose concentration.The perioperative TPN prescriptions in pediatric surgery of our hospital was made up of glucose,lipid emulsion,amino acids,electrolytes,vitamins and multi-micronutrient drugs.Among them,91.05%of the prescriptions with ratio of glucose and lipid was from 1∶1 to 2∶1,92.53%of the prescriptions with ratio of calories and nitrogen was from 100∶1 to 200∶1(kcal∶gN),95.18%of the prescriptions with glucose rate was less than 1.2 g/(kg·h),and the utilization rate of various electrolyte ions was more than 98.82%.Conclusion:The utilization of parenteral nutrient solution should be designed according to the actual conditions of the children.There are no adverse drug reactions after the utilization of irrational parenteral nutrition prescription,yet the nutritional support couldn’t obtain the desired effects.Clinical pharmacists should further strengthen the awareness of prescription review and actively communicate with the clinicians to standardize the rational utilization of parenteral nutrition solution.