某院全肠外营养液住院医嘱分析

Analysis of Inpatient Medical Orders of Total Parenteral Nutrition in a Hospital

目的为住院患者全肠外营养液(TPN)中氨基酸、维生素等营养素的合理应用提供参考。方法参照专家共识、相关指南及药品说明书制订TPN用药合理性评价标准,选取南京医科大学附属淮安第一医院2019年至2021年的246例住院患者的267份TPN用药医嘱,对其氨基酸、维生素、葡萄糖、脂肪乳等营养素的应用进行合理性评价。结果246例TPN患者中,≥60岁152例(61.79%);肝胆胰外科收治145例(58.94%);平均疗程(7.19±5.18)d,疗程5~10 d 119例(48.37%)。267份TPN医嘱中,肝功能正常使用复方氨基酸(20AA)107份(40.07%),肝功能异常使用复方氨基酸(18AA-Ⅱ)及复方氨基酸(18AA-Ⅱ-SF)11份(4.12%);使用维生素合理22份(8.24%),使用脂溶性维生素未使用水溶性维生素233份(87.27%);使用甘油磷酸钠21份(7.87%)。结论TPN中各种复方氨基酸注射液和维生素的应用存在较多问题,较突出的是磷制剂和药理营养素应用比例较低。临床药师应加强TPN医嘱前置审核,促进TPN中各种复方氨基酸注射液和维生素制剂的合理、规范使用。

Objective To provide a reference for the rational application of various nutrients such as amino acids and vitamins in total parenteral nutrition(TPN)for inpatients.Methods According to the expert consensus,relevant guidelines and package inserts of drugs,the evaluation criteria for the rationality of TPN use were formulated.A total of 267 medical orders from 246 inpatients in the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from 2019 to 2021 were selected,and the rationality of the application of amino acids,vitamins,glucose,fat emulsion and other nutrients was evaluated.Results Among the 246 patients,152 patients(61.79%)were aged more than or equal to 60 years old,and 145 patients(58.94%)admitted to the Department of Hepatobiliary and Pancreatic Surgery.The average course of treatment was(7.19±5.18)d,and 119 patients(48.37%)underwent 5-10 d of treatment.Among the 267 TPN medical orders,107 medical orders(40.07%)used compound amino acid(20AA)for patients with normal liver function,and 11 medical orders(4.12%)used compound amino acid(18AA-Ⅱ)and compound amino acid(18AA-Ⅱ-SF)for patients with abnormal liver function;22 medical orders(8.24%)used vitamins reasonably,while 233 medical orders(87.27%)only used fat-soluble vitamins without water-soluble vitamins;21 medical orders(7.87%)used sodium glycerophosphate.Conclusion There are many problems in the application of various compound amino acid injections and vitamins in TPN,among which the prominent one is the low proportion of phosphorus preparations and pharmacological nutrients.Clinical pharmacists should strengthen the pre-review of TPN medical orders and promote the rational and standardized use of various compound amino acid injections and vitamin preparations in TPN.