经外周静脉输注全营养混合液的安全性和适应证

研究经外周静脉输注全营养混合液安全性和适应证。随机选择 5 0例普外科大手术后病人 ,经外周静脉输注全营养混合液约 2周。结果 3例轻度静脉炎 ,更换穿刺部位后继续营养支持 ,1例严重血栓性静脉炎终止输注营养液外 ,均顺利完成营养支持治疗 ,无严重并发症。结论 :通过外周静脉输注全营养混合液进行营养支持是安全、可行的 ,适用于需短期进行营养支持的病人 ,但需防治血栓性静脉炎。经外周静脉输注全营养混合液的安全性和适应证@姜海平$暨南大学医学院第一附属医院普外科 @容松$暨南大学医学院第一附属医院普外科 @杨雪华$暨南大学医…     

全营养混合液在机械通气病人中的应用

通过营养支持、提高机械通气病人的脱机成功率。对 36例机械通气病人 ,同时采用全营养混合液支持 ,经右颈内静脉穿刺插管 2 9例 ,股静脉插管 7例 ,输注时间 5～ 6 1天 ,平均 19.2天。结果 :经合理的全营养混合液支持后 ,病人营养状况明显改善 ,增强了呼吸肌的作功能力 ,减少对呼吸机的依赖 ,提高了脱机成功率。 36例中有 31例 1次脱机成功 ,2例 2次脱机成功 ,1次脱机成功率达 86 .1% ,总脱机成功率达 91.7% ,仅 3例因 MSOF而死亡。结论 :全营养混合液输注方便、安全 ,是机械通气病人摄取全营养和能量的理想方法。全营养混合液在机械通气病…     

全营养混合液渗透浓度对周围浅静脉的影响

全营养混合液(TNA)静脉输注是临床肠功能障碍、营养不良和营养不足病人营养支持的重要方法之一。临床实践显示,反复多次周围浅静脉穿刺所造成的静脉炎有增加趋势,加之因TNA的渗透浓度变化,对外周浅静脉直接刺激,引起局部静脉化学炎性反应,发生静脉炎。这不仅给病人在原发病的     

能全力的应用与护理

目的：观察能全力的营养支持效果及其对控制腹泻和便秘的作用，介绍能全力的使用方法和护理。方法：选择了２３例病人行艰全力肠内营养支持均采用经电脑输注泵连续输注的方法给予１０００－２０００ｍｌ／ｄ，每人１４天。结果：（１）病人的营养状况明显改善，表现在体重和血清白蛋白均较营养支持前显著增加。（２）消化道反应良好，无腹泻、腹胀、便秘等发生。平均每天解糊状粪便２－３次。结论：能全力不仅能明显改善病人的营养状     

霉菌性中心静脉导管脓毒症(附12例报告)

中心静脉置管输注全营养混合液（ＴＮＡ）已广泛应用于临床。因导管引起的感染是一常见并发症，而为人们所重视。我科自１９９１年以来，对１０５４例病人进行中心静脉置管输注ＴＮＡ，有５３例发生过与导管有关的脓毒症（Ｓｅｐｓｉｓ）。其中有１２例属霉菌性感染。其流...     

肠道营养支持在胰腺疾病术后的应用

全胃肠外营养（TPN）与肠道营养（EN）的应用与发展是现代外科重危病人救治成功率得以提高的原因之一。自1992年以来，我们对19例胰腺疾病患者术后应用EN支持，效果满意。材料与方法本组19例中男8例，女11例；急性出血坏死性胰腺炎12例，胰腺损伤7例；年龄19～65岁，平均41．3岁；住院天数43～156天，平均92天；EN支持9～33天，平均19．4天。本组EN支持方法：（1）全肠道营养支持（TEN）6例，患者术后依赖EN提供营养，根据病情辅以外周静脉或直接肠内输注维持水电解质平衡。（2）TPN＋EN8例，患者因病情不允许成不能耐受肠内全量配…     

结、直肠术后早期肠内营养支持的比较研究

目的：探讨结,直肠手术后早期肠内营养的可行性,并比较肠内与肠外营养的效果。方法：３０例结,直肠术后病人随机分为早期肠内营养（ｅａｒｌｙ ｅｎｔｅｒａｌ ｎｕｔｒｉｔｉｏｎ,ＥＥＮ组）和完全胃肠外营养（ｔｏｔａｌ ｐａｒｅｎｔｅｒａｌ ｎｕｔｒｉｔｉｏｎ,ＴＰＮ组）两组,各１５例。ＥＥＮ组术后２４ｈ内经鼻肠管输注肠内营养制剂液体能全力（ｎｕｔｒｉｓｏｎ ｆｉｂｒｅ）,ＴＰＮ组经外周静脉进行,共７天。     

全胃切除术后经空肠造口行早期肠内营养的临床研究

目的：通过对全胃切除术后经空肠造口早期给予肠内营养治疗的观察，评价其疗效及可行性。方法：选择本院收治的胃癌全胃切除病人25例，随机分为两组，I组（对照组）12例，术后接受外周静脉营养；Ⅱ组（试验组）13例，术后24h开始经空肠造口行肠内营养治疗（连续7天），两组基本等热量，并对两组病人术前、术后进行营养状态评价，比较术后肠功能恢复及住院费用等。结果：试验组病人术后体重及营养状态均较对照组有明显改善，两组差异显著（P＜0．01）。而且试验组术后平均住院时间明显短于对照组（P＜0．01）。结论：全胃切除术后经空肠造口行早期肠内营养治疗，不仅安全、可靠、简便、经济，而且能有效地改善病人术后营养状况。     

全营养混合液在84例危重病人中的应用

目的 通过肠外全营养混合液（ＴＮＡ）支持，改善危重病人的全身营养状况，提高抢救的成功率。方法 对内，外科１３种疾病８４例危重病人进行肠ＴＮＡ支持，最长的为６１天，最短的为５天，平均２０．５天，结果 １３例术前严重营养不良的结肠癌病人，经营养支持后顺利地接受了手术治疗，３６例机械通气病人，３１例一次脱机成功，一次脱机成功率高达８６．１％，其余病人营养状况明显改善，结论应用肠外ＴＮＡ支持是治疗危重病人     

肠外瘘病人肠内营养支持临床应用研究

目的：观察肠内营养在肠外瘘病人应用的时机、条件、途径及肠内营养制品的选择,研究肠内营养在肠外瘘病人中的作用。方法：收集１７０例肠外瘘病人诊断、住院总天数及全肠外营养（ＴＰＮ）、全肠内营养（ＴＥＮ）、肠内＋肠外营养（ＰＮ＋ＥＮ）、经口饮食的天数,计算不同营养支持方法期间,非蛋白质热量、蛋白质的供给量和并发症的发生率。收集ＴＰＮ、ＴＥＮ支持前和支持后满１５天病人的血清白蛋白浓度。另对４０例肠外瘘病人进行为期１５天的前瞻性观察,了解肠内营养对白蛋白、前白蛋白、转铁蛋白、纤维连结蛋白、总蛋白、球蛋白和肝酶谱的影响。结果：１７０例病人的总住院天数为１３５５３天,其中１６４人曾使用ＴＰＮ６０４０天（４４．６％）;１２９人使用ＴＥＮ３６７６天（２７．１％）;８３人使用肠内＋肠外营养４８９天（３．６％）;１２８人经口饮食２３３     

全营养液对急性肝功能衰竭大鼠脂代谢的影响

目的探讨全营养液对急性肝功能衰竭大鼠脂代谢的影响。方法将56只急性肝功能衰竭模型大鼠随机分为普通饲料组、无氮饲料组、无脂肪营养液组和全营养液组。采用D-半乳糖胺诱导法复制急性肝功能衰竭大鼠模型。同时用6只健康雄性Wistar大鼠作为对照组。全营养液组大鼠每日输注的营养液提供能量221．75kJ（1kcal=4．184kJ）,氮0．365g,氮热比为1：145,氨基酸2．28g,其中支链氨基酸0．70g,葡萄糖7．85g,脂肪1．25g。颈外静脉插管穿刺手术后10天取血,监测血糖、血脂、肝肾功能。结果全营养液组的血糖水平显著高于无脂肪营养液组（P〈0．05）。4组中无脂肪营养液组的血清甘油三酯和胆固醇水平均最高,甘油三酯水平显著高于普通饲料组和无氮饲料组（P〈0．05）;全营养液组的血清甘油三酯和胆固醇水平显著高于普通饲料组（P〈0．05）。全营养液组的丙氨酰氨基转移酶、碱性磷酸酶、总胆红素、血尿素氮水平均低于无脂肪营养液组（P〈0．05）。结论本研究采用的全营养液的结构比例适合于急性肝功能衰竭大鼠的代谢需要,能促进机体的合成代谢,有利于逆转大鼠的急性肝功能衰竭。     

危机管理在新生儿静脉营养液配置中的应用

总结4年来危机管理理念在新生儿静脉营养液配置的应用体会。通过对安全配置危机因素分析,危机前的预防和准备,危机发生时的应对措施等危机管理,增强了护士危机意识与配置能力,确保患儿静脉用药安全,赢得新生儿病区的高度认可。     

新生儿静脉全营养混合液配置差错原因分析与对策

目的:探讨新生儿静脉全营养混合液(TNA)配置过程中的差错原因与对策。方法:通过回顾性分析新生儿静脉全营养混合液配置差错,采取相应的有效措施。对照组新生儿静脉全营养混合液采用传统配置方法,观察组新生儿静脉全营养混合液采用改进的配置操作流程。结果:观察组的出科差错率明显低于对照组(P0.05)。结论:优化新生儿静脉全营养混合液配置操作流程,合理调配人力资源,加强复核工作,可以提高药物配置的准确率,保障新生儿的用药安全。     

肠外营养液的配制方法

目的:探讨静脉营养液的配制方法,观察混合液中药物间的理化特性和配伍禁忌. 方法:选取2005年273例应用PN支持的病人,严格执行PN液配制的整个操作流程和规范要求,并注意药物间的相容性和稳定性,配制PN液4 200余袋. 结果:所配制的PN液在临床应用过程中,未出现因配制不当而引发输液反应及其并发症,对其中100袋PN液进行细菌学检测,均为阴性,pH检测范嗣维持在5～6之间. 结论:PN混合液中成分繁多,为了保证PN液的稳定性和药物间的相容性,配制过程中必须严格执行操作规程和混合顺序.为了保证PN液的无菌安全,操作中必须严格执行无菌操作技术和配制前后的消毒管理制度.     

儿科用静脉营养液中加入蔗糖铁对脂肪乳剂稳定性的影响

目的评估静脉营养液（TNA）中加入蔗糖铁对脂肪乳剂稳定性的影响。方法根据静脉营养配制操作规范在100mlTNA中分别加入0、0．25、0．50、0．75、1．00mg铁剂,每组各10袋。在0、24、48、72h时,采用扫描电镜观察各组脂肪颗粒直径,计算出直径〉0．5μm颗粒的百分比;并测定各组TNA的pH值及渗透浓度。结果不同时间点各组TNA的脂肪颗粒直径、直径〉0．5μm的颗粒百分比、pH值及渗透浓度差异均无统计学性意义（P均〉0．05）。在72h内,各组脂肪颗粒平均直径均〈0．5μm,各组均未见到直径〉5μm的脂肪颗粒。结论含蔗糖铁浓度0．25—1．00mg／100ml的TNA是稳定的。     

Effect of amino acid solutions on total nutrient admixture stability

The stability of total nutrient admixture (TNA) systems containing a soybean oil emulsion (Soyacal) has been reported with only one amino acid (AA) solution. This study was conducted to compare the physical stability of 10 TNA systems varied only by the AA solution used. All systems contained electrolytes, vitamins, trace elements, and heparin. The volume ratios of AA, dextrose 70% and lipid emulsion 20% were 1:1:1. Solutions were stored at 4 degrees C for 14 days and then held at ambient temperature for an additional 4 days. Each TNA was serially analyzed on days 0, 1, 3, 5, 7, 14, 15, 16, 17, and 18 for gross visual appearance, pH, osmolality, mean particle diameter, and particle size distribution. The AA solutions evaluated include: Travasol 8.5% and 10%; Aminosyn 8.5% and 10%, Aminosyn RF 5.2%; FreAmine III 8.5% and 10%; FreAmine HBC 6.9%; HepatAmine 8.0%; and NephrAmine 5.4%. The pH values of the Aminosyn solutions were lower than those of other products; however, the pH values of all TNA systems were greater than 5.7, which supported particle stability. The osmolality was not affected by the AA solutions. Based upon particle size distribution, 95% of all particles were less than 0.608 micron in diameter, with means ranging from 0.286 micron to 0.309 micron. The largest particle observed by light microscopy was 6.9 micron. These data indicate that TNA systems prepared with the 10 AA solutions and Soyacal 20% are physically stable.     

The in vivo availability of gentamicin when admixed with total nutrient solutions: a comparative study

The relative in vivo availability of gentamicin when administered by two different intravenous methods was evaluated in patients treated in a surgical intensive care unit in a randomized, prospective, crossover study. Each patient received gentamicin therapy via intravenous piggyback (IVPB) and in-line burette (ILB) methods. In the IVPB method, the drug was mixed in 5% dextrose in water (D5W) and infused intermittently. In the ILB method, the drug was mixed using the patient's total nutrient admixture (TNA) solution as the diluent in an ILB, which was inserted between the TNA bottle and its administration set and infused intermittently. A serial sampling of four sets of serum concentrations of the gentamicin was obtained. Pharmacokinetic parameters (Kel, Vd, and a maximum serum concentration) were calculated from the four sets of concentrations collected per patient. The IVPB method yielded mean values of Kel, Vd, and C1.5mg/kg of 0.13 hr-1, 0.39 liter/kg, and 5.1 micrograms/ml, respectively. The ILB method yielded mean values of Kel, Vd, and C1.5mg/kg of 0.14 hr-1, 0.34 liter/kg, and 5.6 micrograms/ml, respectively. A t-test for paired samples was applied to these mean values. Significant difference was not found (p greater than 0.05). The intermittent infusion of gentamicin, using TNA as the diluent and an ILB, produced equivalent serum concentrations when compared with D5W as the diluent.     

Catheter obstruction: analysis of filter content of total nutrient admixture

Catheter blockage in patients receiving long-term parenteral nutrition with fat-containing total nutrient admixture (TNA) is a relatively common complication. A study was carried out to characterize the material which is filtered out of the TNA and is a potential cause of catheter blockage. A total of 45 bags containing the same TNA solution were stored for 7 days at 4 degrees C. The stability of the solution in all the bags was then confirmed by light microscope and Coulter Counter, to determine the particle-size distribution, following which the solution was filtered through a 5-microns filter. Chemical analysis was then made to determine the amount of solid particles, fat and precipitates of Mg, Zn, Ca, Na, and K in the filter contents. Each bag was found to contain 7326 +/- 2681 solid particles as plasticizers and the main component of the filter contents was fat (99.4%) whereas electrolytes as precipitates constituted less than 0.5%. The amount of fat and electrolytes lost on the filter from the solution was negligible. Our analysis of the material trapped on the filter, which may block the catheter during long-term therapy, suggests the importance of filtration and of finding a means for dissolving the fat, the main component of the filter material.     

全胃肠外营养在新生儿消化道畸形中的应用

18例新生儿消化道畸形患儿经周围静脉接受TPN,常规监测血生化及肝肾功能,收集24h尿液测定氮平衡,同时测定胰岛素、肌红蛋白及CPK。结果表明,经周围静脉输注TPN安全、实用,溶液中可适当提高氨基酸浓度,以达到代谢支持的目的,系列测定CPK可作为短期TPN监测的指标。     

Hepatic Indicators of Oxidative Stress and Tissue Damage Accompanied by Systemic Inflammation in Rats Following a 24‐Hour Infusion of an Unstable Lipid Emulsion Admixture

Background: Use of lipid emulsions in parenteral nutrition therapy is an important source of daily energy in substitution of potentially harmful glucose calories when given in excess in the intensive care unit. When added to parenteral nutrition (PN) admixtures as a total nutrient admixture (TNA), the stability and safety of the emulsion may be compromised. Development of a rat model of a stable vs unstable lipid infusion would enable a study of the potential risk. Design: Prospective, randomized, controlled study. Methods: Surgical placement of a jugular venous catheter for the administration of TNAs was performed. Two groups were studied: a stable or s‐TNA (n = 16) and an unstable or u‐TNA (n = 17) as a 24‐hour continuous infusion. Stability of TNAs was determined immediately before and after infusion using a laser‐based method approved by the United States Pharmacopeia. Results: Blood levels of aspartate aminotransferase, glutathione‐S‐transferase, and C‐reactive protein were significantly elevated in u‐TNA vs s‐TNA (P < .05). Also, liver tissue concentrations of malondialdehyde were significantly higher in the u‐TNA group (P < .05), and triglyceride tissue levels were also higher in u‐TNA and approached statistical significance (P = .077). Conclusions: Unstable lipid infusions over 24 hours produce evidence of hepatic accumulation of fat associated with oxidative stress, liver injury, and a low‐level systemic inflammatory response.