临床药师应在肠外肠内营养治疗中发挥作用

肠外肠内营养在临床的应用越来越普遍,但临床应用过程中存在许多问题,临床药师可以利用自己的优势开展肠外肠内营养工作。本文主要从合理用药的几个方面分别阐述临床药师可以发挥的作用,以及对工作中存在的问题进行探讨。     

全胃切除术后早期肠内外营养的临床研究

目的探讨全胃切除术后早期肠外营养(TPN)与肠内营养(EN)的疗效。方法将因胃癌行全胃切除术的48例随机分为TPN组与EN组,每组24例。观察两组患者术后临床症状、并发症、平均住院时间、手术前后各组血清蛋白的变化及免疫功能状况指标。结果 EN组与TPN组比较术后肛门排气时间早、并发症低、住院时间短,两组比较差异有统计学意义(P<0.05);术后第3天及术后第14天,EN组的总蛋白、白蛋白、转铁蛋白水平明显高于TPN组(P<0.05);术后第7天两组CD4+T细胞、NK细胞、IgM、IgG均明显升高,两组比较差异有统计学意义(P<0.05)。结论全胃切除术后早期EN是安全、有效的营养支持途径,可迅速恢复患者的免疫状态,缩短肠道功能恢复时间和住院时间。     

胃癌全切术后早期肠内外混合营养与单纯肠外营养支持的疗效观察

目的探讨胃癌患者全胃切除术后早期肠内外混合营养和单纯肠外营养支持的临床疗效差异。方法回顾性分析我院2006年1月～2009年10月收治的144例老年胃癌手术患者,随机分为肠内外混合营养组(82例)和肠外营养组(62例)。比较观察两组患者不良反应及血清白蛋白(ALB)、转铁蛋白(TF)和前白蛋白(PA)、淋巴细胞总数(TLC)等临床指标的变化。结果混合营养组肺部感染和咽部不适发生率低于肠外营养组(P<0.05);而在切口感染、排气时间及住院时间的比较上,两组数据没有显著性差别(P>0.05)。混合营养组的TLC、TF、PA等临床指标改善明显,与肠外营养组比较均有显著性意义(P<0.05)。结论胃癌患者术后应用肠内外混合营养支持具有改善营养状态提高机体免疫水平,有利于减少术后肺部感染及咽部不适等并发症,对胃癌患者全胃切除术后恢复有重要意义。     

肠内营养与肠外营养支持治疗重症急性胰腺炎的临床疗效对比观察

目的观察比较肠内营养(EN)与肠外营养(PN)分别用于重症急性胰腺炎(SAP)的临床疗效。方法将31例SAP患者随机分为试验组16例和对照组15例。试验组采用EN方式,对照组给予PN方式。观察2组在血清学指标、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分多层螺旋CT(Balthazar CT)评分及并发症发生情况。结果试验组血淀粉酶、血常规及C-反应蛋白(CRP)恢复时间均短于对照组,APACHEⅡ评分和Balthazar CT评分均低于对照组,并发症发生率均低于对照组,差异均有统计学意义(P<0.05)。结论 SAP患者早期进行EN较PN更可靠、有效,可作为SAP营养支持治疗的首选。     

早产儿肠外营养和肠内营养的疗效研究

目的：对比研究肠内营养和肠外营养治疗早产低出生体重儿的疗效。方法：将72例早产低体重儿随机分为两组,每组36例,在积极治疗原发病的基础上,观察组治予胃肠外营养（parenteral nutrition,PN）,对照组用胃肠内营养支持治疗,观察两组患儿的平均每日体重增加量、住院时间以及治愈率等指标。结果：观察组平均每日体重增加量为（15.48±5.29）g,显著高于对照组的（11.31±4.90）g（P〈0.05）;住院时间观察组为（18.58±7.26）d明显短于对照组的（24.38±6.75）d（P〈0.05）;治愈率观察组（93.33%）高于对照组（73.33%）（P〈0.05）,两组患儿均无明显不良反应出现。结论：PN可明显改善早产低体重儿营养状况,缩短住院时间,提高治愈率,且无明显不良反应,安全有效。     

药物经济学在肠内肠外营养制剂中的应用

目的：利用药物经济学对某三甲医院住院患者肠外营养制剂的临床应用进行评价,分析经济成本效果,进而促进优选方案的形成,提高医药资源使用的总体效率。方法：提取该院2017年期间使用肠外营养药物的患者的病案号,并从中随机抽取200例进行回顾性分析,再从中抽取符合入选标准的病历63例,并运用经济学评价方法进行分析,为规范临床安全、有效、经济地应用肠外营养制剂提供参考。结果：在63例中,有63.5%只接受肠外营养（PN）,有36.5%接受肠外和肠内联合营养（PN+EN）;接受PN的人均营养费用为2 375.92元,接受PN+EN的人均营养费用为2 067.90元;PN的成本效果比为2 500.9,PN+EN的成本效果比为2 160.8,PN+EN的成本效果比较低,敏感度分析结果与成本效果分析结果一致。结论：PN与PN+EN均有较好的疗效,但PN+EN是比较经济有效的营养支持方式,适合在临床上推广。     

Comparison the inflammatory effects of early supplemental parenteral nutrition plus enteral nutrition versus enteral nutrition alone in critically ill patients

BACKGROUND AND THE PURPOSE OF THE STUDY: It is believed that enteral nutrition (EN) support is the preferred route as compared to parenteral nutrition (PN). Critically ill patients on EN receive less than 60% of their metabolic requirements. To meet patients' calorie goal addition of PN to EN was proposed. This study was conducted to determine whether supplemental PN have any difference with EN alone in regard to inflammatory indices. METHODS: Twenty patients were randomized to either receive EN alone or EN+PN for 7 days. Pre albumin and inflammatory indices including interleukin IL-1, IL-6 and tumor necrosis factor-α (TNF-α) were measured on days of 0, 3,7. Also Sequential Organ Failure Assessment (SOFA) score and Therapeutic Intervention Scoring System-28 (TISS-28) score were calculated on days of 0, 3 and 7. RESULTS AND MAJOR CONCLUSION: IL-1, IL-6 and TNF-α did not show significant difference between two interventions. Pre-albumin was increased from baseline by 9% and 81% in EN and EN+PN groups respectively but it did not reach to statistical significance. SOFA score did not show significant difference. TISS score was higher in EN+PN group on days of 3 and 7. No difference was found between EN and EN+PN regimens in regard to inflammation, while severity of illness may not change with these regimens, nursing workload increases with implementation of supplemental PN.     

Pharmacy-based distribution system for enteral nutrition products

A hospital pharmacy department's implementation of enteral nutrition product distribution and its proposal for an enteral nutrition product admixture service are described. Responsibility for the distribution of enteral nutrition formulations was transferred from the central distribution department to the pharmacy after problems with inventory control, billing procedures, and inappropriate administration of enteral nutrition products were recognized by personnel from the central-distribution area and nutrition services. After additional problems were identified using a multi-disciplinary approach, the pharmacy department implemented an enteral nutrition product distribution system and developed an enteral nutrition product formulary. A proposal was developed for a pharmacy-based enteral nutrition admixture service, but implementation of this service was deferred because data from a cost-effectiveness evaluation and random bacteriologic monitoring did not justify adding the service. Pharmacy-based distribution and formulary control of enteral nutrition products alleviated problems with inaccurate patient charges and accumulation of stock on the nursing units. Pharmacists at this hospital hope to develop an enteral nutrition product admixture program that will result in cost savings for the institution.     

Interpretation of data in patients with enteral and parenteral nutrition

Multivariate statistical analysis is performed using clinical data characterizing the state of patients subject to early enteral (EEN) and pareneteral (PN) nutrition after major gastrointestinal surgery. Several patterns of linkage, between the clinical parameters for both groups of observed patients (with mixed (EEN+PN) and with parenteral nutrition only (TPN)), were found and interpreted. Discriminating indices for the internal grouping of patients were found related to the type of nutrition and the clinical status of the patients. It was found that the mixed (enteral and parenteral) nutrition offers better options for the overcoming of the metabolic stress after the surgery.     

肠外肠内高营养治疗溃疡性结肠炎89例临床分析

目的:探讨肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)支持治疗溃疡性结肠炎(ulcerative colitis,UC)的临床疗效.方法:回顾分析89例活动期溃疡性结肠炎患者资料,其中,45例给予EN/PN支持治疗4周.结果:EN/PN支持治疗后临床痊愈15例(33.3％),好转23例(51.1％),无效7例(15.3％),总有效率84.4％.EN/PN支持治疗后血清总蛋白、白蛋白浓度较治疗前明显增高(P＜0.05).结论:EN及PN作为一类安全有效的营养支持疗法,可显著改善溃疡性结肠炎患者的临床病情.     

Enteral and parenteral nutrition therapy for Crohn's disease

Even with the development of new therapeutic agents, such as infliximab, enteral nutrition (EN) and parenteral nutrition (PN) therapies remain important for the treatment of Crohn's disease because Crohn's patients often require nutritional support. Furthermore, nutritional therapies can be used in the control of disease activity. Elemental diets, which are mainly used in EN therapy, consist of a refined amino acid mixture, glucose or maltodextrins and minimal essential fatty acids. EN therapy can reduce mucosal inflammation by the elimination of dietary antigens, which induce inflammation, and by reductions in fat, which activates inflammation. EN is applied not only as induction therapy, but also as maintenance therapy after remission (home EN). However, the unpalatability of elemental diets, difficulties related to self-intubation and the high cost of EN have limited its application as a primary therapy in western countries. PN is utilized as complete bowel rest supporting nutrition. However, since the therapeutic efficacies of EN and PN are similar, the indications for PN are limited and PN is mainly utilized in patients with bowel obstructions or severe fistulas. PN is also used as home therapy in the treatment of Crohn's patients with short bowel syndrome. However, long-term PN sometimes causes life-threatening complications including catheter-induced sepsis, liver failure and lethal mineral deficiencies. We suggest that gastroenterologists should recognize the advantages and limitations of all therapies and choose carefully or combine various therapies in order to maintain the quality of life in individual patients even if in cases where remission can not be achieved.     

胃肿瘤术后早期肠内营养与肠外营养支持的疗效比较

目的比较胃肿瘤患者术后早期肠内营养与肠外营养支持的疗效。方法146例胃肿瘤术后患者,按照随机数字表法分为肠内营养组（EN组）72例,肠外营养组（PN组）74例,比较两组治疗前、后血清白蛋白（ALB）、前白蛋白（PA）、血红蛋白（HB）、转铁蛋白（TF）和淋巴细胞总数（TLC）、免疫球蛋白IgA、IgG、IgM。比较治疗后24h尿素（Urea）和肌酐排泄量（Cr）、肛门排气时间、排便时间、住院时间。结果两组治疗后与同组治疗前比较,PA、HB、TF和TLC、IgA、IgG、IgM水平差异均有统计学意义（t=1．263、2．143、2．204、2．195、2．263、2．187、2．248、2．177、0．752、2．011、2．137、2．141、2．136、2．077、2．056、2．033,均P〈0．05）,治疗后两组PA、HB、TF和IgA、IgG、IgM水平差异均有统计学意义（t：2．013、2．148、2．177、2．185、2．063、2．107,均P〈0．05）。EN组与PN组比较,Urea、Cr、排便时间、住院时间等差异均有统计学意义（t=2．109、2．231、2．357、2．211、2．173,均P〈0．05）。结论胃肿瘤患者术后早期肠内营养,有助于胃肿瘤患者早期的营养状态的改善,提高机体免疫力及减少并发症的发生。     

胃癌根治术后肠内营养与全肠外营养应用疗效的对比研究

目的探讨胃癌根治术后肠内营养(enteral nutrition,EN)与肠外营养(totalparenteral nutrition,TPN)对患者术后恢复的影响比较。方法回顾性分析2004年5月至2011年5月行胃癌根治术后患者75例,并将其分为肠内营养组和全肠外营养组,分别于术前第1天及术后第1天、7d对血清白蛋白(g/L)、血总淋巴细胞计数(109/L)及肛门排气时间、术后并发症发生率及住院费用等进行比较。结果肠内营养组与全肠外营养组患者的术后营养状况及术后并发症的发生率无明显差异(P>0.05),无统计学意义,但前者肠功能恢复较后者快、住院费用较后者低(P<0.05),具有统计学意义。结论肠内营养对胃癌根治术后患者营养支持同肠外营养一样安全有效,但能促进肠功能恢复、降低住院费用。     

危重病患者肠内肠外营养联合使用的研究进展

<正>危重病患者代谢及病理生理改变极其复杂,早期营养及代谢支持治疗日益得到重视。营养支持治疗的关键是保护和改善各器官的氧输送并使之与氧消耗相适应,以维持并改善     

肠内外营养对肝硬化患者的治疗价值

目的：探讨肠内外营养治疗对肝硬化患者的临床价值。方法肝硬化患者77例,随机分为两组,实验组给予肠内外营养治疗,对照组给予营养膳食指导,对比两组患者治疗后营养指标及肝功能的变化情况。结果治疗结束后,实验组谷草转氨酶、谷丙转氨酶和血浆前白蛋白等肝功能指标得到明显改善,与对照组比较差异具有统计学意义（P〈0.05）。结论对肝硬化患者实施肠内外营养支持,有助于缓解患者的临床症状,提高治疗效果,具有十分积极的临床意义。     

Quality of life of patients receiving home parenteral or enteral nutrition support

Limited data are available on the impact of enterally or parenterally supplied home nutritional support on quality of life. Data from national registries have been useful in identifying the outcome of different patient groups in terms of their functional capacity and rehabilitation status. Results in patients with inflammatory bowel disease are used as the 'gold standard' for this type of therapy. The annual cost of home parenteral nutrition can range from $US100 000 to $US150 000 per patient, depending on the frequency of feeding. Only one cost-utility analysis has been reported in the literature, based on a Canadian home parenteral nutrition programme which suggested that the estimated quality-adjusted survival of patients receiving this treatment is 4 times greater than if they had not been treated. There are many controversial areas associated with the use of home parenteral and enteral nutrition, including the treatment of patients with terminal malignant disease or severe dementia, and those infected with human immunodeficiency virus. To date, the clinical benefit of providing this type of nutritional support for these patient groups has not been clearly demonstrated. Prospective randomised controlled trials are necessary to evaluate the costs and benefits of this expensive high technology treatment.