成人住院患者营养支持药品临床使用现状与营养支持临床药学服务实践

发布时间：2017-12-31 04:10

本文关键词：成人住院患者营养支持药品临床使用现状与营养支持临床药学服务实践　出处：《北京协和医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的：调查成人住院患者营养支持药品使用现状,探索营养支持临床药师(nutritionsupportpharmacist, NSP)的药学服务模式。方法：1)采用回顾性全医嘱分析方法,研究成人住院患者肠外营养与肠内营养药品临床使用现状。2)回顾国内外营养支持临床药学实践,探讨建立适合国内情况的临床药师工作模式及培训方法。3)探讨通过肠外营养个体化处方审核及药学干预,促进患者用药安全,体现临床药师的作用。4)通过回顾性队列研究,探讨商品化和全合一肠外营养液在胃癌术后患者应用的差别结果：调取2011年～2014年国内8家三甲医院的肠外营养(PN)和肠内营养(EN)药品的医嘱信息,分析比较PN与EN用量、营养支持患者比例、PN不同使用方式构成比、PN和EN患者比例以及营养支持联合形式；制定了营养支持临床药学模式及药学信息服务流程；个体化审核2013年北京协和医院全合一肠外营养处方6454张,实施临床药学干预处方154张(干预率为2.3996),其中不合理问题160次,预防差错44次,干预接受率为98.70%。本研究共纳入胃癌术后患者148例,个体化组与商品化制剂组总胆红素Tbil和直接胆红素Dbil的变化存在显著性差异(个体化组△Tbil值：-0.77±4.77,商品化组△Tbil值：6.74±12.18,p=0.013；个体化组△Dbil值：0.41±1.93,商品化组△Dbil值：5.09±7.78,p=0.001)。结论：8家三甲医院营养支持药品临床应用日趋规范,但多腔袋的应用以及PN/EN人次比值与欧美国家相比仍有不足,还需进一步规范；建立的营养支持临床药师工作模式、培训方法适合当前的药学模式,建立药学信息服务标准流程,为药师提供用药咨询的信息支持与管理平台；临床药师个体化审核肠外营养医嘱,并对不合理处方及用药差错进行干预,可促进患者用药安全、合理、有效、经济。对于胃癌术后肠外营养支持≥5天的患者,全合一肠外营养液对患者胆红素水平的影响小于商品化多腔袋。
[Abstract]:Objective: nutritional support in patients with drug use status of adult inpatients, to explore the nutritional support of clinical pharmacists (nutritionsupportpharmacist, NSP) of the pharmacy service model. Methods: 1) all orders by retrospective analysis method, patients with parenteral nutrition and enteral nutrition drugs in clinical use of.2 Hospital of adult) reviewed the nutritional support of clinical pharmacy practice explore the establishment, suited to the domestic circumstances of clinical pharmacists work mode and training method of.3) by parenteral nutrition individualized prescription audit and pharmaceutical intervention, promote patient safety and effect of.4 is of clinical pharmacists) through retrospective cohort study, to explore the commercialization and total parenteral nutrition in postoperative patients with gastric cancer the application of different results: from 2011 to 2014 in China 8 hospitals of parenteral nutrition (PN) and enteral nutrition (EN) drugs prescribed information, compared with PN analysis The amount of EN, the proportion of patients with nutritional support, which is different than PN is used, the ratio of PN and EN patients and nutritional support combined with nutritional support form; developed a model of clinical pharmacy and pharmacy information service process; individual audit in Peking Union Medical College Hospital in 2013 of total parenteral nutrition at 6454 prescriptions, 154 prescriptions of implementation of clinical pharmacy intervention (intervention the rate is 2.3996), of which the unreasonable problem of error prevention 160 times, 44 times, the intervention acceptance rate was 98.70%. in this study included 148 patients with gastric cancer after operation, there were significant differences in individual and group commercial formulations of serum total bilirubin and direct bilirubin Tbil Dbil (individual group Delta Tbil value: -0.77. 4.77, commercial group Delta Tbil value: 6.74 + 12.18, p=0.013; individual group Dbil: 0.41 + 1.93 group, Delta Dbil value: Commodity 5.09 + 7.78, p=0.001). Conclusion: 8 hospitals drug clinical nutritional support The application has become increasingly standardized, but the application of multi cavity bag and PN/EN people ratio compared with the United States and Europe are still inadequate, but also need to further standardize the working mode of clinical pharmacists; nutritional support to establish the training method for pharmacy mode at present, the establishment of pharmaceutical information service standard procedures, information support and management platform for the clinical pharmacists medication consultation; pharmacist audit individualized parenteral nutrition advice, and intervention on the irrational prescriptions and medication errors, can promote the safety of patients, reasonable, effective and economical for gastric cancer. Postoperative parenteral nutrition support in patients with more than 5 days, the effect of parenteral nutrition on the bilirubin level of patients with less than the commercialization of multi chamber bag.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R95

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