1例急性肾前性肾衰竭合并尿路感染患者的营养支持治疗及思考

目的探讨营养支持药师对急性肾前性肾衰竭合并尿路感染患者营养治疗方案的制订和调整,为急性肾前性肾衰竭合并尿路感染患者的营养治疗提供参考。方法通过营养支持药师全程参与1例急性肾前性肾衰竭合并尿路感染患者的营养治疗管理及案例分析,探索该类患者的营养支持治疗方案。结果营养支持药师对急性肾前性肾衰竭患者营养状态开展全程化药学监护,随患者病情变化设计个体化小体积、低热卡、高蛋白营养支持治疗,患者血清白蛋白水平上升并维持在35 g/L,同时感染得到有效控制,肌酐值降至正常。结论小体积、低热卡、高蛋白营养支持液≤1000 ml,热卡摄入量约1000 kcal,蛋白质全程维持在1.2 g/(kg·d),对于急性肾前性肾衰竭合并尿路感染患者,可获得较好的临床结局及预后,并且能更好地维持临床可操作性,充分提高营养支持治疗的安全性、有效性和经济性。

Nutritional support therapy for patient with acute prerenal failure complicated with urinary tract infection

Objective To explore the formulation and adjustment of nutritional therapy by nutrition support pharmacists in patient with acute prerenal failure complicated with urinary tract infection,and to provide a reference for nutritional therapy in such patient.Methods With nutrition support pharmacists participated in nutrition treatment management and case analysis of a patient with acute prerenal failure complicated with urinary tract infection,we explored the nutritional support treatment plan for this type of patient.Results Nutrition support pharmacists provided pharmaceutical care throughout the course for patient with acute prerenal failure and designed an individualized low-calorie and high-protein nutritional support treatment according to the change of patient’s condition,to increase the patient’s serum albumin level and maintain at 35 g/L,at the same time the infection was effectively controlled and the creatinine value decreased to normal.Conclusion Small-volume,low-calorie,high-protein nutritional support solution≤1000 ml,calorie intake is about 1,000 kcal,and protein is maintained at 1.2 g/(kg·d)throughout the course of acute prerenal renal failure with urinary tract infected patients can obtain better clinical outcomes and prognosis,and can better maintain clinical operability,and fully improve the safety,effectiveness and economics of nutritional support treatment.