安徽地区多中心住院病人肠外营养使用状况横断面调查研究

目的:借鉴"营养日"调查问卷模式,评估住院病人营养状况。重点探讨其肠外营养使用现状。方法:采用横断面调查研究的方法,根据欧洲通用的"营养日"调查问卷内容,收集2017年5月5日当天,安徽地区10家综合医院所有输注PN的成年住院病人(≥18岁)的基本信息、营养状况及PN使用情况等相关信息。结果:调查共收集问卷287份,其中63.1%(181/287)存在营养风险。PN的输注形式上"多瓶串输"者46.0%(132/287)和"全合一"者54.0%(155/287)的比例基本相当。PN输注途径主要为外周静脉69.0%(198/287),中心静脉占31.0%(89/287)。营养液平均输注时间为(10.3±4.4)h。PN配方的糖脂比中位数和上、下四分位间距为0.6(0.2,0.7),热氮比中位数和上、下四分位间距为163.4(115.3,244.1)。结论:住院病人营养风险的发生率较高。肠外营养支持治疗过程中尚存在诸多不合理现象,需通过提高PN处方水平以规范PN支持治疗合理有序的开展。     

住院患者肠外营养支持的适应证(草案)

临床营养支持（clinical nutrition support）一般认为是经口、肠道或肠外途径为患者提供比较全面的营养素，目前临床上包括肠内营养（entemal nutrition，EN）和肠外营养（parenteral nutrition，PN）。EN是指经消化道管饲较全面的营养素。PN即经静脉输注氨基酸、脂肪和糖等3大类营养素及维生素和矿物质．又称全肠外营养（total parenteral nutrition，TPN）。     

高位肠外瘘患者个体化营养支持疗法分析

肠瘘是腹部外科中常见的严重疾病，肠瘘发生后将对机体全身状况产生重大影响，产生一系列的病理生理改变及各种并发症，这些并发症会加重机体损害，导致病情更为复杂，治疗更为困难［1］。在肠外营养未广泛开展的时候，肠外瘘死亡率高达50％～60％，高流量瘘死亡率接近100％［2］。     

高位肠外瘘患者个体化营养支持疗法分析

肠瘘是腹部外科中常见的严重疾病,肠瘘发生后将对机体全身状况产生重大影响,产生一系列的病理生理改变及各种并发症,这些并发症会加重机体损害,导致病情更为复杂,治疗更为困难[1].     

全肠外营养支持并发症2例报告

肠外营养支持在外科疾病的治疗中发挥着重要作用 ,但使用不当亦可致多种并发症 ,现就我们遇到的 2例报告如下。1　临床资料　例 1　男性 ,73岁 ,因粘连性肠梗阻给予肠外营养支持 ,经右锁骨下静脉置管给予全营养混合液(ＴＮＡ)。既往无糖尿病和应用外源性胰岛素史。肠外营养支持前检查血糖正常。ＴＮＡ中葡萄糖2 5 0 ｇ/ｄ ,加入胰岛素 5 0Ｕ/ｄ ,持续法输注 ,应用至第 4天病人出现全身湿冷、乱语、神志不清 ,继而昏睡。查血糖 1.18ｍｍｏｌ/Ｌ ,诊断为低血糖昏迷 ,停用ＴＮＡ ,给予 5 0 %葡萄糖静注后病人立即清醒 ,能正确回答问题 ,复查血…     

肠外营养支持在骨髓移植中的应用

６例白血病、１例恶性淋巴瘤病人，在进行自体（异体）骨髓移植过程中，出现严重的口腔溃疡、恶心、呕吐，导致食欲下降，进食困难，营养状况恶化。通过静脉输注１０％脂肪乳剂、安达美、水乐维他、１７种氨基酸及葡萄糖等肠外营养支持，有效地改善了骨髓移植病人的营养状况，顺利地渡过了骨髓空虚期，促进了骨髓移植的成功。     

应用肠外营养支持治疗短肠综合征2例

0 引言 短肠综合征(SBS)的治疗包括营养支持、短肠康复治疗以及手术治疗.我们近期诊治2例病人,其中1例为全小肠切除.肠外营养(PN)、谷氨酰胺(Gln)和生长激素(GH)在这2例短肠综合征病人治疗中发挥了重要的作用,现报道如下.     

营养风险筛查与肠外营养支持的合理应用

20世纪30年代以来，外科患者围手术期的液体治疗是综合治疗计划中不可或缺的部分，其目的在于维持水电解质平衡，为机体提供稳定的内环境。最近的调查结果表明，外科手术后和非手术住院患者中接受电解质和葡萄糖输液的比例分别达到63。7％和75．5％。     

肠外营养输液途径合理性和适应证分析--3979例患者回顾性调查

目的 探讨肠外营养（PN）输液途径的合理性及适应证。方法 回顾性分析3979例患者的营养状况、科室分布、PN使用时间、输液途径等，对其输液途径合理性、适应证等进行分析。结果 使用PN患者主要为普通外科、胸心外科等13个科室，外科系统占93．2％，内科系统占6．8％，其中胃肠外科接受PN治疗的患者营养不良发生率为14．7％。PN治疗时间大多数≤7天，没有严格的掌握适应证。中心静脉插管占89％，外周静脉插管占11％。在中心静脉置管方式上以锁骨下静脉为主。结论 多数应用中心静脉营养没有严格掌握适应证，营养处方没考虑到患者个体差异，中心静脉插管以锁骨下静脉为主。应加强全面临床营养知识培训，推广简单的营养不良及营养不良风险的评估方法，提高对PN治疗的适应证认识，采用推荐的经周围静脉中心静脉插管途径。     

完全肠外营养支持的应用及护理

0 引言 本组301例病人采取全胃肠外营养支持,除12例恶性肿瘤病人因多器官功能障碍死亡外,其余均治愈出院,现报道如下.     

某三级甲等医院院肿瘤患者肠外营养处方使用情况的横断面调查

目的　通过对肠外营养处方的综合分析,了解其使用情况和处方存在的问题,为规范肠外营养的临床应用提供实践指导。方法　对某三级甲等医院住院部肿瘤患者的肠外营养处方进行为期1个月的横断面调查,对使用肠外营养患者的一般情况、肠外营养制剂的种类和肠外营养处方涉及的热氮比、糖脂比、非氮热量、液体量等指标进行分析和评价。结果　共收集肠外营养处方528份,肠外营养使用存在不合理现象,处方中三大营养素不全处方308份,占比高达58.3%,热氮比（100～200）:1处方170份,占32.2%,糖脂比（1～2）:1处方109份,占20.6%,多数未在规定范围之内。结论　肠外营养的合理规范应用亟需引起临床医师的重视,有必要成立临床营养支持小组对肠外营养的正确使用进行相应的干预和指导。     

Quality control of parenteral nutrition in hospitalized patients

ObjectiveFor hospitalized patients requiring parenteral nutrition (PN), adequate nutritional support has a profound effect on hospital length of stay, morbidity, mortality, and complication rates. Inappropriate or inadequate nutritional therapy may worsen clinical outcome. The aim of this study was to investigate the compliance with nutritional guidelines for PN in a university hospital setting.MethodsOver a 6-mo period, this monocentric study prospectively recruited 107 (41 women, 66 men) hospitalized medical and surgical patients requiring PN. Data on nutritional support were collected before nutritional counseling. Nutritional requirements were estimated on the basis of the European Society for Clinical Nutrition and Metabolism (ESPEN) Guidelines for Adult Parenteral Nutrition (2009).ResultsThe mean patient age was 65 ± 1.4 y and the mean body mass index was 23.2 ± 0.5 kg/m². Only 75% of the caloric requirement was met. Multivitamin supplementation was adequate in only 37%, and for vitamin K in only 6% of cases. Trace element supplementation was adequate in only 35%. PN in complete agreement with the ESPEN guidelines was achieved in none of the patients.ConclusionsIn routine hospital practice, PN is generally not provided in compliance with established guidelines. To improve the quality of nutritional therapy, a nutritional support team should be established. Furthermore, there should be periodical training sessions in nutrition for medical and nursing staff, as well as in standard operating procedures.     

The prevalence of coagulation abnormalities in hospitalized patients receiving lipid-based parenteral nutrition

BACKGROUND: Vitamin K is not a component of the multivitamin preparation added to parenteral nutrition (PN) solutions, and hospitalized patients receiving parenteral nutrition support are at risk of developing vitamin K deficiency. METHODS: In this study, 84 consecutive patients receiving PN were followed up prospectively to determine the incidence of a raised international normalized ratio (INR). All patients received lipid in their PN, which contains approximately 30 microg of vitamin K/100 mL. RESULTS: Patients were followed up for the course of PN or up to 4 weeks if they needed longer total parenteral nutrition. A raised INR compared with baseline developed in 3.6% of patients. All elevations were mild, and no patients developed clinical bleeding. CONCLUSIONS: It may be unnecessary to routinely supplement patients with vitamin K if they are receiving a lipid emulsion containing significant amounts of vitamin K. For patients receiving warfarin therapy, it will be important for nutrition support services to be aware of the vitamin K content of the lipid emulsion they are using as patients receiving a multivitamin preparation containing vitamin K and lipid emulsion may receive increased amounts of vitamin K, which could lead to warfarin resistance.     

Cyclic parenteral nutrition in hospitalized adult patients: a 9-year experience

We are reporting our 9-year experience of cyclic parenteral nutrition with 200 in-patients (mean age 52 years) treated 64 +/- (SEM)3 days (range: 15-230) for Gl diseases. During the first period (A, n = 38), all-in-one nutritive bags with intralipid 10% were used; in a second period (B, n = 135), intralipid 10% was infused separately over the first 6 h of nutrition; in the final period (C, n = 27), Intralipid 20% was used in all-in-one nutritive bags. Indications for parenteral nutrition were non-malignant digestive diseases in 89.5% of the cases. The frequency of complications appearing during cyclic parenteral nutrition was the following: catheter-related sepsis 8%, catheter obstruction 8%, hypertriglyceridemia 33%, hypercholesterolemia 14.7%, liver function test abnormalities 28% and biliary sludge and/or lithiasis 31.6%. 5 patients, with chronic obstructive small bowel disease, developed jaundice with no identifiable cause other than parenteral nutrition. The prevalence of catheter obstruction significantly decreased (P < 0.01) during period B, as compared with periods A and C. The prevalence of liver function test abnormalities decreased significantly (P < 0.01) during periods B and C, as compared with period A. Mortality rate related to cyclic parenteral nutrition was 3%. These results suggest that a) the separate infusion of lipid emulsion reduces the prevalence of catheter obstruction; b) as compared with 10% intralipid in all-in-one nutritive bags, the separate infusion of 10% Intralipid or the 20% Intralipid given in all-in-one nutritive bags is associated with a decreased prevalence of liver function test abnormalities; c) chronic small intestine obstruction seems to play a key role in parenteral-associated jaundice.     

Catheter-related infection in patients on home parenteral nutrition: results of a prospective survey

BACKGROUND & AIMS: Central venous catheter (CVC) infection is the most frequent complication during home parenteral nutrition (HPN). We prospectively assessed incidence and catheter-related sepsis (CRS)-associated factors in the 42 adult patients enrolled in our HPN centre since its opening. METHODS: Age, frequency of infusions, CVC type, autonomy or nurse/family aid, underlying disease, involved infectious organism(s), hospital stay, efficacy of antibiotic-lock and other infectious complications, were studied. RESULTS: CRS occurred 39 times (3/1000 days of HPN). In 37/39 cases, it was proven by both peripheral and central blood cultures. In 56% of patients, clinical signs were discrete, delaying diagnosis. Individual factors like learning potency, underlying disease (especially chronic intestinal obstruction with bacterial overgrowth), and length of remaining colon and small intestine, were slightly associated with higher CRS incidence. Usually, one organism (S. epidermidis; 51%) was detected. A total of 14 CVC were immediately removed. In the others, antibiotic-lock was more effective in patients having tunnelled catheters (TC, 50%) than implanted devices (25%; P<0.05). Mean hospital stay was 22+/-15 days, which was influenced by 3 patients presenting associated osteomyelitis. CONCLUSIONS: CRS incidence was 3/1000 days of HPN. Clinical symptoms were often discrete, suggesting importance of rigorous survey. Individual apprenticeship and risk for higher bacterial translocation seem associated to higher CRS incidence. CVC sterilization was more frequent in patients with TC.     

Mortality in patients on home parenteral nutrition

Fifty out of 228 patients recorded on the U.K. Home Parenteral Nutrition Register have died. The earliest to die was at 10 days following the commencement of home parenteral nutrition (HPN), and the longest to die was after 5 1/2 years. Half of the patients who died, did so within 6 months of commencing HPN. Sixty % died of their underlying disease. Most patients with scleroderma or an underlying malignancy are dead within a year of commencing HPN. In contrast, patients with Crohn's disease or the short bowel syndrome due to volvulus do well. In only 14 patients was death attributable to the administration of HPN. In this group the main causes were septicemia, SVC thrombosis, and hepatic failure. Our study suggests that HPN should be used in patients with malignancy and scleroderma only in exceptional circumstances and that further work is necessary for the prevention of SVC thrombosis.