处方审核和标签改进对神经重症患者肠内营养不良反应的改善作用

Effect of prescription review and label improvement on enteral nutrition adverse reactions in patients with severe neurological diseases

目的探讨营养处方审核与提示标签改进能否降低神经重症患者肠内营养(enteral nutrition,EN)不良反应,为促进EN制剂或特殊医学用途配方食品(food for special medical purpose,FSMP)的临床规范化应用提供参考。方法选取复旦大学附属华山医院神经内科和神经外科2020年6—12月收治的神经重症患者为研究对象,随机分为观察组(进行处方审核,使用常规标签并附加提示标签)和对照组(不审核处方,仅使用常规标签)。监测EN实施后不良反应的发生情况,在EN实施第1天和第7天收集白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)、总淋巴细胞计数(total lymphocyte count,TLC)和血红蛋白(hemoglobin,Hb)等营养指标,以评估处方审核与调整对营养状况的影响。结果共纳入133例患者,其中观察组68例,对照组65例。观察组不合理处方的发生率为19.1%。EN相关不良反应以腹泻、呕吐较常见。观察组总体不良反应的发生率(30.9%)显著低于对照组(52.3%,P=0.012)。两组患者在EN实施第1天和第7天的ALB、PA、TLC和Hb等营养指标差异均无统计学意义。结论营养处方审核和提示标签改进有助于降低神经重症患者EN不良反应的发生率,且不会造成营养状况恶化。

Objective To discuss whether the review of nutrition prescription and the improvement of reminder label can reduce the adverse reactions of enteral nutrition(EN)in patients with severe neurological diseases,so as to provide reference for promoting the clinical standardized application of EN preparation or food for special medical purpose(FSMP).Methods Patients with severe neurological diseases in Department of Neurology and Neurosurgery,Huashan Hospital,Fudan University from Jun to Dec 2020 were selected and randomly divided into observation group(conducting prescription review,using conventional labels and adding reminder labels)and control group(no prescription review,only conventional labels).The adverse reactions after EN implementation were monitored,and nutritional indexes such as albumin(ALB),prealbumin(PA),total lymphocyte count(TLC)and hemoglobin(Hb)were collected on the first and seventh days of the implementation of EN to assess the impact of prescription review and adjustment on nutritional status.Results A total of 133 patients were included in this study,including 68 cases in the observation group and 65 cases in the control group.The incidence of unreasonable prescriptions in the observation group was 19.1%.Diarrhea and vomiting were the most common EN related adverse reactions.The overall incidence of adverse reactions in the observation group(30.9%)was significantly lower than that in the control group(52.3%,P=0.012).There was no significant difference in ALB,PA,TLC and Hb between the two groups on the first and seventh days of the implementation of EN.Conclusion Nutrition prescription review and reminder label improvement could reduce the incidence of adverse reactions of EN in patients with severe neurological disease,and will not cause significant deterioration of nutritional status.