临床药师参与肠外营养相关性肝损害患者治疗的药学监护

发布时间：2018-04-28 03:24

本文选题：临床药师 + 肠外营养相关性肝损害　；参考：《中国药房》2017年17期

【摘要】：目的:探讨临床药师在肠外营养相关性肝损害(PNALD)患者的临床营养治疗中的作用,促进临床营养药物的合理应用。方法:临床药师参与1例PNALD患者的治疗过程,建议将原有的"全合一"营养液配方中的5%葡萄糖氯化钠注射液500 m L调整为0.9%氯化钠注射液500 m L,30%长链脂肪乳剂250 m L调整为20%中/长链脂肪乳剂250 m L,8.5%复方氨基酸注射液(18AA)1 000 m L调整为8%复方氨基酸注射液(15AA)750 m L,并加用20%丙氨酰谷氨酰胺注射液100 m L和10%ω-3鱼油脂肪乳注射液100 m L,其余配方不变。另加用保肝药物还原型谷胱甘肽、S-腺苷蛋氨酸进行保肝退黄治疗,并逐渐减少肠外营养(PN)的量,过渡到肠内营养(EN)。结果:医师采纳临床药师的调整建议,该患者的肝功能逐渐恢复正常。结论:PN使用时间,PN中脂质种类、摄入量,营养物过剩等是造成PNALD的主要因素。临床药师在患者的临床营养治疗中开展药学监护可确保营养药物安全、有效地利用,减少并发症及药物不良反应的发生。
[Abstract]:Objective: to explore the role of clinical pharmacists in the treatment of patients with parenteral nutrition associated liver injury (PNALDD) and to promote the rational application of clinical nutrition drugs. Methods: a clinical pharmacist was involved in the treatment of one case of PNALD. It is suggested that the 5% glucose sodium chloride injection 500ml in the original "all-in-one" nutrient solution formula be adjusted to 0.9% sodium chloride injection 500ml / 30ml long-chain fat emulsion 250ml to 20% medium / long chain fat emulsion 250mL8.5% compound. The amino acid injection was adjusted to 8% compound amino acid injection 1 000 mL and 20% alanyl glutamine injection 100 mL and 10% 蠅 -3 fish oil fat emulsion injection 100 mL. The other formulations did not change with the addition of 20% alanyl glutamine injection 100 mL and 10% 蠅 -3 fish oil fat emulsion injection 100 mL. In addition, glutathione S-adenosylmethionine was used to protect liver and reduce the amount of parenteral nutrition (PNN), and to make the transition to enteral nutrition. Results: the doctor accepted the clinical pharmacist's suggestion that the liver function of the patient gradually returned to normal. Conclusion the main factors of PNALD are lipid type, intake and nutrient excess. Pharmacists in the clinical nutritional care of patients can ensure the safety of nutritional drugs, effective use, reduce complications and adverse drug reactions.
【作者单位】：重庆医科大学附属第二医院药学部;
【分类号】：R575

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