Successful management of severe hypoglycemia induced by total parenteral nutrition in patients with hepatocellular injury: Three cases reports

BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.

A study of the ameliorating effects of carnitine on hepatic steatosis induced by total parenteral nutrition in rats

AIM To investigate the effects of carnitine on ameliorating hepatic steatosis induced by total parenteral nutrition (TPN) in animal model. METHODS Eighteen normal Wistar rats and 19 cirrhotic Wistar rats induced by carbon tetrachloride were randomly divided into three groups, i.e., free access to food and drink (group A), TPN (group B) and TPN+carnitine (group C) for one week, respectively. Hepatic function, histology and its fat content were determined on the 7th day. RESULTS Hepatic triglyceride (TG) and cholesterol (CHO) contents were significantly higher in groups B and C than in group A, and significantly lower in group C than in group B in both normal and cirrhotic rats (all P <0 05). Histopathological examinations revealed that hepatic steatosis was more severe in group B than in group C in both normal and cirrhotic rats. CONCLUSION Carnitine can ameliorate hepatic steatosis associated with TPN in both non cirrhotic and cirrhotic rats.

S-adenosylmethionine in treatment of cholestasis after total parenteral nutrition: laboratory investigation and clinical application

Objective: To observe the effects of S-adenosylmethio-nine (SAMe) in the treatment of cholestasis after totalparenteral nutrition (TPN).Methods: Thirty SD rats were randomly divided intocontrol group, hypercalorie group, hypercalorie+SAMegroup, sepsis group and sepsis+SAMe group to com-pare their states of cholestasis. Sixteen patients re-ceived SAMe because of cholestasis after prolongedTPN, and the therapeutic efficacy was observed.Results: Bile flow was obviously decreased and theserum levels of total bile acid and gamma-glutamyltranspeptidase(γ-GT) were markedly increased in thehypercalorie and sepsis groups. Meanwhile, hepatocytefatty degeneration, dilatation of cholangioles, and bilesludge could be seen microscopically. SAMe adminis-tration in the hypercalorie+SAMe and sepsis+SAMegroups could increase the bile flow, decrease theserum levels of total bile acid and γ-GT, reduce thepathological damage to the liver, and clear the bilesludge in the cholangioles. Cholestasis and abnormalliver function were the main manifestations of the 16patients before SAMe administration. After SAMe treat-ment for 3 weeks, serum levels of total bilirubin, al-kaline phosphatase(AKP), γ-GT, alanine aminotrans-ferase(ALT), and aspartate aminotransferase(AST)were obviously decreased, and normalized in the 4thweek.Conclusion: SAMe could prevent and treat cholestasiswithout discontinuation of TPN.

Glutamine-supplemented total parenteral nutrition attenuates plasma interleukin-6 in surgical patients with lower disease severity

AIM： To evaluate whether the effect of Gin dipeptideenriched total parenteral nutrition （TPN） on postoperative cytokine alteration depended on the disease severity of surgical patients. METHODS： Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous （0.228 g nitrogen/kg per d） and isocaloric （30 kcal/kg per d） TPN for 6 d. Control group （Cony） using conventional TPN solution received 1.5 g amino acids/kg per day, whereas the test group received 0.972 g amino acids/kg per day and 0.417 g L-alanyI-L-glutamine （Ala-GIn）/kg per day. Blood samples were collected on d 1 and d 6 postoperatively for plasma interleukin （IL）-2, IL-6, IL-8, and interferon （IFN）-γ analysis. RESULTS： Plasma IL-2 and IFN-γ were not detectable. IL-6 concentrations were significantly lower on the 6^th postoperative day in the Ala-GIn group than those in the Cony group in patients with APACHE Ⅱ≤6, whereas no difference was noted in patients with APACHE Ⅱ〉6. There was no difference in IL-8 levels between the two groups. No difference in cumulative nitrogen balance was observed on d 2-5 after the operation between the two groups （Ala-GIn -3.2±1.6 g vs Cony -6.5±2.7 g）. A significant inverse correlation was noted between plasma IL-6 levels and cumulative nitrogen balance postoperatively in the Ala-GIn group, whereas no such correlation was observed in the Conv group. CONCLUSION： TPN supplemented with Gin dipeptide had no effect on plasma IL-8 levels after surgery. However, Gin supplementation had a beneficial effect on decreasing systemic IL-6 production after surgery in patients with low admission illness severity, and lower plasma IL-6 may improve nitrogen balance in patients with abdominal surgery when Gin was administered.

Analysis of Sodium and Potassium in Total Parenteral Nutrition Bags by ICP-MS and ICP-AES:Critical Influence of the Ingredients

The compounding of total parenteral nutrition solutions (TPN) in the hospital pharmacy is a high-risk activity for which a quality assurance programme is necessary. The complexity of parenteral nutrition solutions containing almost 50 ingredients makes it difficult to measure each of them. On the other hand, the assay of electrolytes such as sodium and potassium is accepted as a quality marker for estimating compounding errors. Thus, the aim of this study was to estimate the influence of ingredients on the accuracy of assays of electrolytes. Experiments were performed with aqueous working simulated solutions of sodium and potassium prepared by the addition of each nutrient step by step, (dextrose, amino acids, lipids, vitamins and trace elements). Sodium and potassium levels were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS) and Atomic Emission Spectroscopy (ICP-AES). The performance of these methods was compared using statistical evaluations (t-test and Mann–Whitney test).The study highlights the interference of amino acids, vitamins and trace elements when measuring sodium, but no interference was noted during the measurement of potassium. To reduce the risk and to improve the quality of compounding, we used an automated compounding device but, even in this case, the acceptance criterion for sodium and potassium determination was not <10%.

Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology

BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.

Endoscopist's approach to nutrition in the patient with pancreatitis

Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.

Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery

Background Polyunsaturated omega-3 fatty acids may beneficially influence healing processes and patient outcomes.The aim of this research was to study the clinical efficacy of fish oil enriched total parenteral nutrition in elderly patients after colorectal cancer surgery.Methods Fifty-seven elderly patients with colorectal cancer were enrolled in this prospective,randomized,double-blind,controlled clinical trial.All patients received isocaloric and isonitrogenous total parenteral nutrition by continuous infusion （20-24 hours per day） for seven days after surgery.The control group （n=28） received 1.2 g/kg soybean oil per day,whereas the treatment group （n=29） received 0.2 g/kg fish oil and 1.0 g/kg soybean oil per day.Blood samples were taken pre-operatively,and at days one and eight after the operation.The plasma levels of CD4,CD8,CD4/CD8,interleukin 6 （IL-6） and tumor necrosis factor a （TNF-a） were measured.Clinical outcomes were then analysed.Results Patient characteristics were comparable between the two groups.At day eight post-surgery,IL-6,TNF-α and CD8 titres were lower in the treatment group when compared to the control group; these results reached statistical significance.In the treatment group,there were fewer infectious complications and incidences of systemic inflammatory response syndrome （SIRS）,and shorter lengths of hospital stay were observed.The total cost of medical care was comparable for the two groups.No serious adverse events occurred in either group.Conclusions Fish oil 0.2 g/kg per day administrated to elderly patients after colorectal surgery was safe and may shorten the length of hospital stay and improve clinical outcomes.

Effects of total parenteral nutrition on drug metabolism gene expression in mice

Parenteral nutrition-associated liver disease(PNALD)is a liver dysfunction caused by various risk factors presented in patients receiving total parenteral nutrition(TPN).Omega-6 rich Intralipid?and omega-3 rich Omegaven?are two intravenous lipid emulsions used in TPN.TPN could affect the hepatic expression of genes in anti-oxidative stress,but it’s unknown whether TPN affects genes in drug metabolism.In this study,either Intralipid?-or Omegaven?-based TPN was administered to mice and the expression of a cohort of genes involved in anti-oxidative stress or drug metabolism was analyzed,glutathione(GSH)levels were measured,and protein levels for two key drug metabolism geneswere determined.Overall,the expression of most genes was downregulated by Intralipid?-based TPN(Gstpl,Gstml,3,6,Nqol,Ho-1,Mt-1,Gclc,Gclm,Cyp2d9,2f2,2b 10,and 3a11).Omegaven?showed similar results as Intralipid?except for preserving the expression of Gstml and Cyp3a11,and increasing Ho-1.Total GSH levels were decreased by Intralipid?,but increased by Omegaven?.CYP3A11 protein levels were increased by Omegaven?.In conclusion,TPN reduced the expression of many genes involved in anti-oxidative stress and drug metabolism in mice.However,Omegaven?preserved expression of Cyp3a11,suggesting another beneficial effect of Omegaven?in protecting liver functions.

Glycemic Variation in Tumor Patients with Total Parenteral Nutrition

Background：Hyperglycemia is associated with poor clinical outcomes and mortality in several patients.However,studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition （TPN） are scarce.The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients.Methods：This retrospective clinical trial selected 312 patients with various cancer types,whose unique nutrition treatment was TPN during the monitoring period.All patients had blood glucose （BG） values assessed at least six times daily during the TPN infusion.The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG.Results：The clinical trial lasted 7.5 ± 3.0 days adjusted for age,gender,family cancer history and blood types.There were six cancer types：Hepatic carcinoma （HC,21.8%）,rectal carcinoma （17.3%）,colon carcinoma （CC,14.7%）,gastric carcinoma （29.8%）,pancreatic carcinoma （11.5%）,and duodenal carcinoma （DC,4.8%）.The patients were divided into diabetes and nondiabetes groups.No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found;however,the tumor types affected by BG values were obvious.With increasing BG values,DC,HC and CC were more represented than other tumor types in this sequence in diabetic individuals,as well as in the nondiabetic group.BG was inclined to be more easily influenced in the nondiabetes group.Other factors did not impact BG values,includiug gender,body mass index,and TPN infusion duration time.Conclusions：When tumor patients are treated with TPN,BG levels should be monitored according to different types of tumors,besides differentiating diabetes or nondiabetes patients.Special BG control is needed for DC,HC and CC in both diabetic and nondiabetic patients.If BG overtly increases,positive measurements are needed to control BG values.The ClinicalTrials.gov ID is NCT02024321.

Pre-operative total parenteral nutrition improves post-operative outcomes in a subset of Crohn’s disease patients undergoing major abdominal surgery

Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adverse post-operative outcomes following gastrointestinal surgery.Data on the value of pre-operative total parenteral nutrition(TPN)in CD patients aremixed and there is a paucity of data in the biologic era.We aimed to define the role of pre-operative TPN in this population.Methods:This was a retrospective cohort study conducted at a tertiary referral center.CD patients who underwent major abdominal surgery were identified.Patients receiving pre-operative TPN were compared to controls.We compared the incidence of 30-day infectious and non-infectious post-operative complications between the two groups.Results:A total of 144 CD patients who underwent major abdominal surgery between March 2007 and March 2017 were included.Fifty-five patients who received pre-operative TPN were compared to 89 controls.Twenty-one(14.6%)patients developed infectious complications(18.2%in TPN group vs 12.3%in non-TPN group,P=0.34)and 23(15.9%)developed noninfectious complications(14.5%in TPN group vs 16.9%in non-TPN group,P=0.71).In a multivariate analysis,controlling for differences in baseline disease severity and malnutrition between groups,patients receiving pre-operative TPN for60 days had significantly lower odds of developing non-infectious complications(odds ratio 0.07,95%confidence interval:0.01–0.80,P=0.03).Weight loss of>10%in the past 6 months was a significant predictor of post-operative complications.Conclusions:In a subset of malnourished CD patients,TPN is safe and allows comparable operative outcomes to controls.Pre-operative TPN for60 days reduced post-operative non-infectious complications without associated increase in infectious complications.

Characteristics and outcomes of avoidant/restrictive food intake disorder in Japanese elementary-school students on total parenteral nutrition

The clinical outcomes of adolescents with avoidant/restrictive food intake disorder(ARFID)remain unclear.Furthermore,no report has compared the characteristics of ARFID and restricting-type anorexia nervosa(R-AN)in elementary-school students on total parenteral nutrition(TPN).This study retrospectively reviewed inpatients diagnosed with ARFID or R-AN between 2005 and 2019.Patients with ARFID(two boys and seven girls)and R-AN(13 girls)were hospitalized because of rapid physical deterioration,and nutrition therapy was continued without withdrawal.The ARFID group exhibited significantly lower body weights at admission than the R-AN group and gained an average of 6.5 kg during hospitalization;furthermore,the monthly weight gain during hospitalization was significantly higher,and no relapse was observed.Early physical improvement in ARFID resulted in good recovery.In conclusion,TPN can be easily introduced to patients with ARFID,in whom aversive eating is a concern,and is a suitable treatment for ARFID.

某院全肠外营养不合理处方的帕累托图分析

目的应用帕累托图分析年龄<60岁和年龄≥60岁的患者(老年患者)全肠外营养(total parenteral nutrition,TPN)不合理处方的情况及原因,为保障患者营养支持的安全性提供参考。方法选取福建医科大学附属泉州第一医院2023年1月至12月住院患者病历,每月随机抽取30份的TPN处方,应用帕累托图针对不合理处方的主、次要和一般因素进行分析。结果年龄<60岁的患者和老年患者TPN不合理处方类型几乎一致。但造成年龄<60岁的患者TPN不合理处方的主要因素为超适应症、热氮比不合理、糖脂比不合理,次要因素为谷氨酰胺用量不适宜;而造成老年患者TPN不合理处方的主要因素为热氮比不合理、谷氨酰胺用量不适宜、糖脂比不合理,次要因素为超适应症;一般因素均为脂溶性维生素用量不适宜和添加物不稳定。结论应用帕累托图分析年龄<60岁的患者和老年患者TPN不合理处方情况,可及时发现主次要因素,有利于临床药师针对性地进行相应的干预及营养基础知识的培训,以保障临床营养治疗的安全性和有效性。

婴儿原发性小肠淋巴管扩张症4例临床分析

目的分析婴儿原发性小肠淋巴管扩张症(PIL)的临床特征以及治疗方法,提高临床诊治水平。方法回顾性分析2012年10月至2013年12月北京世纪坛医院淋巴外科收治的4例婴儿PIL的临床表现、实验室检查、核素显像检查以及治疗方法,通过长期随访结果对婴儿期PIL诊治进行总结。结果患儿年龄4~9个月,均为女性;均以腹泻为首发症状,伴下肢对称性水肿,3例合并呼吸道感染;实验室检查血淋巴细胞绝对值、白蛋白、球蛋白降低,有轻度贫血,低钙血症、铁缺乏;放射性核素显像提示有肠道蛋白丢失。4例患儿采取保肝、补蛋白、利尿等治疗,并予以全胃肠外营养治疗3~4周,出院后个体化的中链三酰甘油(MCT)饮食治疗3~30个月。随访10年,4例患儿恢复正常饮食,复查血白蛋白正常,未再复发。结论婴儿PIL少见,临床表现以腹泻、水肿为主,常合并呼吸道感染,电解质紊乱以低钙血症、铁缺乏较为常见。对于疑诊为PIL的婴儿,放射性核素检查可作为确诊的首选方法。足疗程的全胃肠外营养治疗配合个体化的MCT饮食是婴儿PIL的有效治疗手段。

某医院肿瘤患者全肠外营养液给药方案合理性分析

目的评估某医院肿瘤患者肠外营养液给药方案的合理性,为临床合理应用肠外营养液提供依据。方法采用回顾性分析方法,对该医院2020年1月1日-2021年12月31日住院肿瘤患者的肠外营养液给药方案进行综合性评估,包括适应证、品种、能量配比、成分配比以及稳定性等。结果共收集1016份肠外营养液医嘱,给药方案设计整体合理,但仍存在热量不足或过量、热氮比和糖脂比比例不合理、电解质浓度过高、品种选择不当等问题。结论为提高全肠营养液的合理性,该院应制定个性化的营养液方案;此外,需要强化药师审核肠外营养液处方的能力,加强审方意识,促进与临床医师的紧密沟通,以提高全肠外营养液的合理应用水平。

全静脉营养支持疗法治疗早产及危重新生儿的疗效评价

目的评价全静脉营养支持疗法治疗早产及危重新生儿的疗效。方法86例早产及危重新生儿,根据不同疗法分为A组(43例)与B组(43例)。A组采用常规营养支持疗法,B组采用全静脉营养支持疗法。比较两组新生儿的临床治疗时间(营养支持时间、达全胃肠道喂养时间、恢复出生体重时间、住院时间)、营养指标(白蛋白、球蛋白、前白蛋白)、生长发育指标(体重增长、身长增长、头围增长)、不良事件发生情况(胃肠功能紊乱、高脂血症、高血糖、氮质血症)、预后情况(死亡、治愈)。结果B组营养支持时间(9.54±2.76)d、达全胃肠道喂养时间(7.04±1.45)d、恢复出生体重时间(5.52±1.03)d、住院时间(12.41±1.97)d短于A组的(12.47±3.68)、(8.68±1.93)、(7.46±1.15)、(14.72±2.14)d(P<0.05)。B组治疗后的白蛋白(38.70±3.65)g/L、球蛋白(22.18±2.73)g/L、前白蛋白(171.91±16.03)g/L高于A组的(33.36±2.79)、(18.32±2.26)、(145.25±16.82)g/L(P<0.05)。B组体重增长(0.52±0.16)kg、身长增长(1.52±0.43)cm、头围增长(1.19±0.36)cm大于A组的(0.38±0.11)kg、(1.24±0.30)cm、(1.02±0.27)cm(P<0.05)。B组的不良事件发生率4.65%低于A组的18.60%(P<0.05)。B组的治愈率93.02%高于A组的74.42%(P<0.05);两组死亡率比较无差异(P>0.05)。结论全静脉营养支持疗法治疗早产及危重新生儿的疗效较好,可缩短临床治疗时间,改善新生儿营养指标,促进其生长发育,且可降低不良事件发生率,改善新生儿预后,值得推行应用。

针对性管理在静脉配置中心全静脉营养液处方管理中的应用效果分析

目的:分析静脉配置中心的全静脉营养液处方情况,并探讨有效的管理措施,以提升全静脉营养液的使用安全性。方法:选取2019年1月—2021年12月于锦州医科大学附属医院第三医院未接受针对性管理患者55例(全静脉营养液处方550张)为对照组,选取2022年1月—2023年12月接受针对性管理患者50例(全静脉营养液处方500张)为观察组。比较两组全静脉营养液处方不合理情况。结果:观察组全静脉营养液处方总不合理应用率低于对照组,差异有统计学意义(P<0.001)。结论:医院静脉配置中心应对全静脉营养液的临床不合理用药现象进行总结,并采取针对性的预防措施,确保全静脉营养液处方安全、高效,从而保证临床治疗效果。

品管圈活动在降低静脉用药调配中心新生儿TPN混合调配误差率中的应用效果

目的探究品管圈活动(QCC)在降低静脉用药调配中心(PIVAS)新生儿全肠外营养液(TPN)混合调配误差率中的应用效果。方法运用QCC管理方法,确定以“降低新生儿TPN混合调配误差率”为活动主题,运用鱼骨图、柏拉图等方式分析导致新生儿TPN混合调配误差产生的真因,并据此制定整改措施,最终以有形成果和无形成果评价管理效果。结果改善后,新生儿TPN混合调配总误差率由5.30%下降至1.53%,其中抽吸量不准确误差率由1.97%下降至1.15%,排液量不准确误差率由1.43%下降至0.38%;目标达标率为131.82%,进步率为91.03%。圈员能力得到了显著提升。结论在PIVAS开展QCC管理能有效降低新生儿TPN混合调配误差率,提升新生儿的TPN混合调配准确性以及用药安全性。

胰岛素泵在糖尿病合并结直肠癌术后全肠外营养支持中的应用

目的:探讨胰岛素泵持续皮下胰岛素输注在糖尿病合并结直肠癌术后全肠外营养支持中的应用效果。方法:选择结直肠癌术后行全肠外营养治疗(Total parenteral nutrition,TPN)的2型糖尿病患者64例,随机分成胰岛素泵持续皮下输注人胰岛素(胰岛素泵组)和人胰岛素微量注射泵持续静脉泵入(静脉泵组)。分别监测2组患者葡萄糖目标范围内时间(Time in range,TIR)、葡萄糖高于目标范围时间(Time above range,TAR)、葡萄糖低于目标范围时间(Time below range,TBR)、平均血糖波动幅度(Mean blood glucose fluctuation amplitude,MAGE)、低血糖发生情况。结果:胰岛素泵组TIR值高于静脉泵组[(76.72±8.54)%vs(72.12±8.34)%],差异有统计学意义(P<0.05);胰岛素泵组TBR值低于静脉泵组[(13.72±5.28)%vs(16.72±5.00)%],差异有统计学意义(P<0.05);胰岛素泵组MAGE较静脉泵组血糖波动更小[(2.83±1.06)mmol·L^(-1)vs(3.39±1.06)mmol·L^(-1)],差异有统计学意义(P<0.05);2组TAR值差异无统计学意义(P>0.05);2组患者低血糖发生事件因样本量太小,无比较意义。结论:胰岛素泵用于控制糖尿病合并结直肠癌术后TPN患者血糖与静脉泵注胰岛素相比,TIR值更好,血糖更加平稳。

药师干预住院患者全肠外营养支持效果评价

目的探讨药师干预对住院患者全肠外营养(TPN)支持效果的影响。方法从医院信息系统调取2021年8月至2022年1月未经静脉用药调配中心(PIVAS)药师审核干预的全营养混合液(TNA)医嘱715份(涉及患者492例)作为对照组,以2022年2月至7月干预后的TNA医嘱882份(涉及患者608例)作为干预组。根据拟订干预标准决定药师是否参与医嘱审核干预,比较两组TNA的不规范医嘱发生率、日均费用及人均费用,并分析药师干预的理由、原则与频次。结果药师干预后,TNA不规范医嘱发生率由12.45%降至2.49%(P<0.01)。药师共协助临床调整营养支持方式21例次,包括调整为肠内营养(EN)联合肠外营养14例次,全肠内营养4例次,暂停TNA医嘱3例次。对长期(>10 d)使用TNA患者干预最多(26例次),干预原则为添加谷氨酰胺,维护肠黏膜屏障,预防肠源性感染。干预组患者日均TNA费用为(458.62±96.15)元,明显低于对照组的(572.82±84.23)元(P<0.01);干预组患者人均TNA费用为(3169.02±1908.36)元,与对照组的(3572.97±1863.15)元相当(P=0.412)。结论药师干预可促进住院患者TPN支持的规范性和合理性,保障肠外营养用药安全,减轻患者的经济负担,体现自身专业价值。