普外科手术患者肠外营养液处方分析与营养液的稳定性研究

Analysis of total parenteral nutrition prescription and study on stability of nutrition solution in patients undergoing general surgery

目的通过分析普外科手术患者肠外营养液(TPN)处方,对其稳定性进行了解,制定出完善处方的具体对策。方法323张6种不同种类的处方,分别为处方1、处方2、处方3、处方4、处方5、处方6。由专业人士配制TPN,在TPN配制完成后,分别在0、1、4、8、24 h进行取样,分析本院常用的6种TPN处方的成分及外观、观察TPN的pH值测定结果以及不溶性微粒检查结果。结果通过对配制完成后的TPN外观进行检查,发现并未出现较为明显的变化,并且处方2、4为透明液体,无色,在24 h内未产生沉淀,处方1、3、5和6为不透明液体,颜色呈现乳白色,在24 h内没有出现沉淀或者分层的情况。6种处方配制完成时以及配制24 h内,发现TPN的p H值并未出现明显的变化。通过对不溶性微粒实施检查:以葡萄糖或者葡萄糖氯化钠为基础的TPN,其中包含的不溶性微粒数量满足药典相关要求,加入了维生素C的处方2的不溶性微粒数量大于同期处方1,但是依然符合相关的要求和标准。加入了水溶性维生素和维生素C后,处方4中微粒的数量大于同期处方3。处方3和处方4两种处方在分别放置了4、8 h后,颗粒的数量均符合相关要求。含有中/长链脂肪乳、不含脂溶性维生素或者水溶性维生素的处方5,TPN中粒径≥10μm的大粒径微粒数量比较少,但不符合要求,但是粒径≥25μm的微粒含量符合要求。TPN中含有水溶性维生素、脂溶性维生素、多种微量元素注射液的处方6配置完成时,不溶性微粒增加速度快,配制8 h后,不溶性微粒的数量虽然逐渐减少,但依然超过标准范围。结论针对TPN的稳定性来说,其会受到多种物质的影响,造成不溶性颗粒的数量增加,还需要不断的对处方进行完善,保证TPN的整体稳定性和用药安全性。

Objective To analyze the total parenteral nutrition prescription and understand its stability,so as to formulate specific countermeasures to improve the prescription.Methods 323 prescriptions of six different types,namely prescription 1,prescription 2,prescription 3,prescription 4,prescription 5,and prescription 6,were prepared by professionals,and samples were taken at 0,1,4,8,and 24 h after the preparation of TPN,and the six TPN prescriptions commonly used in our hospital were analyzed for composition and appearance,and the results of pH measurement of TPN and insoluble particulate examination were observed.Results By examining the appearance of the TPN after preparation,there were no more obvious changes,and prescriptions 2 and 4 were clear liquids,colorless and did not produce precipitation within 24 h;prescriptions 1,3,5 and 6 were opaque liquids,cream in color,and did not show precipitation or stratification within 24 h.No significant changes in the pH of the TPNs were observed at the completion of the six prescriptions and within 24 h of dispensing.The insoluble particles were examined:the TPN based on glucose or sodium chloride glucose contained a number of insoluble particles that met the pharmacopoeial requirements,while prescription 2 with vitamin C had a larger number of insoluble particles than prescription 1 for the same period.However,the relevant requirements and standards were still met.With the addition of water-soluble vitamins and vitamin C,the number of particles in prescription 4 was greater than that in prescription 3 for the same period.Both prescriptions 3 and 4 met the relevant requirements for the number of particles after being left for 4 and 8 h,respectively.Prescription 5,which contained medium/long chain fat milk and no fat-soluble vitamins or water-soluble vitamins,had fewer large-size particles with particle size≥10μm in TPN but did not meet the requirements,but the content of particles with particle size≥25μm met the requirements.Prescription 6,in which TPN contained water-soluble vitamins,fat-soluble vitamins,a variety of trace elements injection,the number of insoluble particles increased rapidly when the preparation was completed,and after 8 h of preparation,the number of insoluble particles gradually reduced,but still exceeded the standard range.Conclusion The stability of TPN can be affected by a variety of substances,causing an increase in the number of insoluble particles,and constant refinement of the prescription is needed to ensure the overall stability and safety of TPN administration.