肠外营养个体化给药实践评价

doi:10.19803/j.1672-8629.20230036

摘要/Abstract

摘要： 目的评价临床药师参与全营养混合液(TNA)组方设计,为患者提供个体化给药方案的临床疗效。方法研究2020年1月1日至2021年12月15日在某院进行肠外营养支持治疗的消化类疾病患者,分成临床药师参与设计的个体化全营养混合液输注组49例（个体化组）和营养药剂单瓶输注组56例（单瓶组）。记录2组患者治疗前后营养、肝肾功能等生化指标以及并发症、不良反应、住院天数等。结果个体化组治疗前后前白蛋白、肌酐、视黄醇结合蛋白和C反应蛋白组内比较有差异,单瓶组前白蛋白和肌酐组内比较有差异（P<0.05）。2组治疗后尿素和前白蛋白有显著差异;单瓶组的前白蛋白和视黄醇结合蛋白相较治疗前下降,个体化组出现上升趋势,2组C反应蛋白均较治疗前下降,但是个体化组下降幅度显著大于单瓶组（P<0.05）,其他指标无统计学差异;并发症发生率个体化组19.6%显著低于单瓶组6.12%（P<0.05）;2组在营养支持天数[（14.66±7.15）d vs（10.41±8.22）d]差异有统计学意义（P<0.05）,2组均无相关的不良反应报告。结论个体化组相较于单瓶组具有良好的疗效,帮助临床了解药师参与肠外营养治疗给药方案给患者带来的获益,个体化肠外营养支持治疗有助于提高临床疗效。

关键词: 临床药师, 肠外营养, 个体化组方, 疗效评价

Abstract: Objective To evaluate the clinical efficacy of clinical pharmacists’ involvement in the design of a total nutrition admixture (TNA) formulary to provide individualized dosing regimens for patients. Methods The clinical data of patients with digestive disorders treated with parenteral nutrition support between January 1, 2020 and December 15, 2021 was retrospectively studied. There were 49 cases in the individualized total nutrition admixture infusion group (individualized group) in which clinical pharmacists participated and another 56 cases in the single bottle infusion of nutritional drugs group (single bottle group). Such data as the nutritional indexes, liver and kidney function indicators, complications, adverse reactions, and hospital stay were collected. Results The levels of prealbumin, retinol-binding protein. C-reactive protein and creatinine in the individualized group changed significantly after treatment, so were the levels of prealbumin and creatinine in the single bottle group (P<0.05). Levels of urea and pre-albumin were significantly different in the two groups after treatment. Prealbumin and retinol binding protein decreased in the single bottle group after treatment, but increased in the individualized group. C-reactive protein decreased in both groups after treatment, especially in the individualized group (P<0.05), but there was no statistically significant difference in other indexes. The rate of complications was 6.12% in the individualized group, significantly lower than 19.6% in the single bottle group (P<0.05). There was significant difference between the two groups in the duration of parenteral nutrition support [(14.66±7.15) d vs (10.41±8.22)d] (P<0.05), but not in the length of hospital stay. No related adverse reactions were reported in either group. Conclusion The individualized group has better efficacy than in the single bottle group, which can help clinicians better understand the benefits pharmacists’ involvement in parenteral nutrition therapy. The individualized parenteral nutrition support therapy helps improve clinical outcomes.

Key words: clinical pharmacist, parenteral nutrition, individualized formulary, efficacy evaluation

中图分类号:

R994.11

陈婕, 秦侃. 肠外营养个体化给药实践评价[J]. 中国药物警戒, 2023, 20(7): 812-816.

CHEN Jie, QIN Kan. Evaluation of individualized parenteral nutrition delivery[J]. Chinese Journal of Pharmacovigilance, 2023, 20(7): 812-816.

参考文献

[1] TOBERT CM, HAMILTON-REEVES JM, NORIAN LA, et al.Emerging impact of malnutrition on surgical patients: literature review and potential implications for cystectomy in bladder cancer[J]. The Journal of Urology, 2017, 198(3): 511-519.
[2] SKEIE E, SYGNESTVEIT K, NILSEN RM, et al.Prevalence of patients “at risk of malnutrition” and nutritional routines among surgical and non-surgical patients at a large university hospital during the years 2008-2018[J]. Clinical Nutrition, 2021, 40(7): 4738-4744.
[3] JIANG ZM, CHEN W, ZHU SN, et al.A survey on the prevalence of malnutrition (deficiency), nutritional risk, and use of nutritional support at tertiary hospitals of major cities in east, middle, and west China was conducted[J]. Chinese Journal of Clinical Nutrition(中国临床营养杂志), 2008, 16(6): 335-337.
[4] ZHANG L, WANG X, HUANG Y, et al.NutritionDay 2010 audit in Jinling hospital of China[J]. Asia Pacific Journal of Clinical Nutrition, 2013, 22(2): 206-213.
[5] SUN H, ZHANG L, ZHANG P, et al.A comprehensive nutritional survey of hospitalized patients: results from nutrition Day 2016 in China[J]. PLOS ONE, 2018, 13(3): e0194312.
[6] ZHANG YP, ZHANG L, HUANG YC, et al.Analysis of risk factors for malnutrition and length of stay in Chinese hospitalized patients[J]. Parenteral & Enteral Nutrition(肠外与肠内营养), 2020, 27(3): 136-142.
[7] TUCKER A, YBARRA J, BINGHAM A, et al.American society for parenteral and enteral nutrition (A.S.P.E.N.) standards of practice for nutrition support pharmacists[J]. Nutrition in Clinical Practice, 2015, 30(1): 139-146.
[8] SHEN J, QIN K.A multicenter cross-sectional survey on parenteral nutritional status of hospitalized patients in Anhui area[J]. Parenteral & Enteral Nutrition(肠外与肠内营养), 2018, 25(4): 213-217.
[9] LIU H, HUANG ZG, WANG XH, et al.A multicenter cross-sectional survey on nutritional status andusing nutritional drugs for hospitalized patients with malignant digestive system tumors in Anhui area. Chinses Journal of Hospital Pharmacy(中国医院药学杂志), 2021, 41(10): 1044-1048.
[10] WU GH, TAN SJ.Chinese expert consensus on home parenteral nutrition for adults[J]. Chinese Journal of Practical Surgery(中国实用外科杂志), 2017, 37(4): 406-411.
[11] ZHAO B, LAO DH, SHANG YG, et al.Consensus for parenteral nutrition solutions compounding[J]. Chinese Journal of Clinical Nutrition(中华临床营养杂志), 2018, 26(3): 136-148.
[12] KONDRUP J.Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials[J]. Clinical Nutrition, 2003, 22(3): 321-336.
[13] CORISH CA, BARDON LA.Malnutrition in older adults: screening and determinants[J]. Proceedings of the Nutrition Society, 2019, 78(3): 372-379.
[14] Geriatric Nutrition Support Group, Society of Parenteral and Enteral Nutrition, Chinese Medical Association. Guidelines for the application of parenteral and enteral nutrition in elderly Chinese patients[J]. Chinese Journal of Geriatrics(中华老年医学杂志), 2020, 39(2): 119-132.
[15] HERSBERGER L, BARGETZI L, BARGETZI A, et al.Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial[J]. Clinical Nutrition, 2020, 39(9): 2720-2729.
[16] KROC Ł, FIFE E, PIECHOCKA-WOCHNIAK E, et al.Comparison of nutrition risk screening 2002 and subjective global assessment form as short nutrition assessment tools in older hospitalized adults[J]. Nutrients, 2021, 13(1): 225.
[17] ADIAMAH A, SKOŘEPA P, WEIMANN A, et al. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis[J]. Annals of Surgery, 2019, 270(2): 247-256.
[18] CHEN HY, LI LL, QIU HY, et al.474 cases of adverse reactions caused by intravenous infusion of MCT/LCT lipid emulsion and nursing countermeasures[J]. Modern Diagnosis and Treatment(现代诊断与治疗), 2022, 33(13): 2048-2051.
[19] BOHL DD, SHEN MR, HANNON CP, et al.Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture[J]. Journal of Bone and Joint Surgery, 2017, 99(24): 2110-2118.
[20] INGENBLEEK Y.Plasma Transthyretin as a biomarker of sarcopenia in elderly subjects[J]. Nutrients, 2019, 11(4): 895.
[21] JONES BG, OSHANSKY CM, BAJRACHARYA R, et al.Retinol binding protein and vitamin D associations with serum antibody isotypes, serum influenza virus-specific neutralizing activities and airway cytokine profiles[J]. Clinical and Experimental Immunology, 2016, 183(2): 239-247.
[22] WANG Y, LI LY, WANG J.Pharmacy interventions in the nutritional support treatment of critically ill patients and their impact on rational drug use[J]. Journal of Clinical Rational Drug Use(临床合理用药杂志), 2022, 15(3): 174-176.
[23] ZHOU X, QIU F, WAN D, et al.Nutrition support for critically ill patients in China: role of the pharmacist[J]. Asia Pacific Journal of Clinical Nutrition, 2019, 28(2): 246-251.
[24] CHEN M, QIN K, SHEN J, et al.Application of the Delphi method in developing the index system of nutritional support pharmaceutical care[J]. Chinses Journal of Hospital Pharmacy(中国医院药学杂志), 2020, 40(22): 2366-2371.