胃肠外科PN和EN药学监护的实践探讨

发布时间：2018-03-09 23:16

本文选题：临床营养支持　切入点：肠内营养　出处：《延边大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的胃肠外科是较容易发生营养风险的科室,可能与胃肠外科较多的胃肠肿瘤的患者且需要手术治疗有关,对于有影响风险的患者进行营养支持可以改善其临床结局,但不适当的营养支持却会导致患者并发症的增多、医疗费用增加,延缓住院天数等一系列负面临床结局。笔者通过对胃肠营养及疝外科有营养风险指症并进行营养支持(nutrition support,NS)的患者进行个体化药学监护,在PN和EN支持过程中,对药学监护的实践要点进行探讨。方法选取某三甲医院胃肠外科163例营养评分≥3分,年龄在18～90岁,住院1天以上且接受营养支持治疗的患者进行药学监护,对营养评分暂3分的成年患者每周进行重新营养筛查,若评分≥3分且进行营养支持的患者则重新进入监护管理。药学监护方法:(1)每日交接班、医学查房、药学查房记录患者的饮食、营养状况和用药史,跟患者家属沟通营养支持的重要性,以及营养支持期间的注意事项,书写用药教育方便患者家属更好的护理进行营养支持的患者,提高患者的依从性;(2)对医结合患者的病例和现状,分析患者的生化指标,结合医师的治疗原则和治疗需求,计算营养需求量和合理的糖脂比、热氮比;(3)在护士配液前审核当天的肠外肠内营养处方,告知配液时的注意事项和流程;(4)节假日期间的病例通过医院信息管理系统(Hospital Information System,HIS)进行信息采集,记录的内容包括患者基本信息、入院诊断、营养支持的方案、营养支持的种类及用法用量、是否发生药物并发症及不良反应、各项生化指标情况等。结果监护期间发现不合理处方29次,干预成功次数为27次,成功率93.1%,其余2次根据患者不同指症,与医师进行协商后进行修改;发现肠外肠内营养并发症的患者26次,占总患者的15.9%,与往年相比,合理的药学监护可以缩短患者住院天数、减少患者的住院费用、且可以预防大部分营养支持带来的一系列并发症的发生。医师对能量计算、三大营养物质供能比例,离子含量计算、维生素的生物效能以及护师对配液的注意事项和配伍禁忌等仍需要临床药师以专业知识来参与,且使用营养支持时并发症时常会出现,为保证患者用药的安全、有效、经济性,需要临床药师进行个体化的监护。结论临床营养支持由于应用复杂、药学相关专业性强、且患者使用时并发症发生率较高,需要进行个体化药学监护和用药教育。合理化的药学监护可以缩短患者住院天数、减少患者住院费用以及并发症等,既往对肠外肠内营养的研究都与营养支持的方式对临床结局影响的研究,未有对PN和EN监护路径方法的系统研究,所以本论文在营养支持的监护上有一定的创新性,本研究在临床工作中可以起到建议性的作用,为医师和护师都提供相关的参考,为患者接受更好的治疗提供保障。
[Abstract]:Gastrointestinal surgery purpose is more prone to nutritional risk department, may be related to gastrointestinal surgery more gastrointestinal tumors and patients need surgical treatment, the effect of patients at risk for nutritional support can improve the clinical outcome, but inappropriate nutritional support will increase to guide patients with complications, increase in medical expenses, hospitalization delay the number of days in a series of adverse clinical outcomes. The nutritional risk indication and nutritional support for gastrointestinal nutrition and hernia surgery (nutrition support, NS) were treated with individualized pharmaceutical care in the PN and EN support process, discusses the practice points of pharmaceutical care. Methods of gastrointestinal surgery in a hospital in 163 patients with nutritional score more than 3 cent, at the age of 18~90, more than 1 days of hospitalization and treatment of patients receiving nutritional support on nutritional pharmaceutical care, 3 adult patients with temporary score Re nutrition screening every week, if the score more than 3 cent and nutritional support of patients re entering the care management of pharmaceutical care. Methods: (1) the daily shift, medical rounds, pharmacy rounds record the patient's diet, nutritional status and medication history, the importance of communication with the families of patients nutrition support, attention and nutrition support during the writing of nursing education of medication convenience better for families of patients with nutritional support of patients, improve patient compliance; (2) combined with the status quo of medical cases and patients, analysis of biochemical indicators of patients, treatment principle and treatment needs and combined with the physician, calculating the nutritional demand and reasonable lipid ratio, heat N ratio; (3) review the parenteral and enteral nutrition prescription in nurses with liquid before the liquid, inform the matters needing attention and process; (4) during the holidays the case through the hospital information management system (Hospital Information System, HIS) for information collection, which include basic information, admission diagnosis, nutritional support, content types and usages of nutritional support, whether the occurrence of complications and drug adverse reactions, biochemical indexes etc. results during the monitoring found unreasonable prescription 29 times, successful intervention was 27 times of success the rate of 93.1%, the remaining 2 patients according to different indications, in consultation with the physician after modification; complications of parenteral and enteral nutrition in patients with 26 patients, accounted for 15.9%, compared with previous years, reasonable pharmaceutical supervision can shorten the hospitalization days of patients, reduce the hospitalization expenses of patients, and can prevent most of the nutrients to support a series of complications caused by occurrence. The physician of the energy calculation, the three major nutrients supply proportion, ion content, vitamin and biological effects of the compounding nurse notices and coordination Five taboos still need clinical pharmacists to participate in professional knowledge, and the use of nutritional support complications often appear, in order to ensure the safety of patients with medication, effective, economical, care needs of individual clinical pharmacists. Conclusion the clinical nutritional support due to the application of complex and related professional, and the use of patients with complications the rate is higher, need individualized pharmaceutical care and health education. The rationalization of pharmaceutical care can shorten the hospitalization days, reduce hospitalization expenses and complications, previous studies on parenteral and enteral nutrition research and nutrition support on clinical outcome, a systematic study on the PN and EN path monitoring method no, so this paper has certain innovation in the care of nutritional support, this study can play a constructive role in the clinical work, for doctors and nurses are provided Relevant references are provided for patients to receive better treatment.

【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R95

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