1533份全肠外营养处方分析及营养液稳定性考察

发布时间：2018-11-14 15:28

【摘要】：目的:通过对2015年住院患者全肠外营养液(TPN)处方的全面分析,深入了解TPN的处方合理性和临床应用情况,为规范肠外营养合理使用提供可靠依据。并根据TPN处方分析中发现的问题开展实验研究,对胰岛素在装有不同营养液成分的PVC输液袋中的吸附情况及典型全肠外营养液的稳定性进行考察,为TPN的安全有效应用提供实验依据。方法:采用回顾性调查方法对1533份TPN处方进行整理,记录并分析患者基本信息(性别、年龄、体重、诊断结果、营养状况等)及TPN用药情况(药物种类、用量及用药天数)。以糖脂比、热氮比、液体量、营养组分组成、电解质浓度及用药天数为主要评价指标对TPN处方进行全面分析。模拟临床使用状态,将胰岛素与葡萄糖注射液、氯化钠注射液及TPN溶液分别置于PVC袋中混合,采用高效液相色谱法,测定不同时间取样时胰岛素的浓度变化情况,计算PVC袋对胰岛素的吸附率。选择四组临床常用的典型TPN处方,按标准操作规范配制肠外营养液,测定肠外营养液的渗透压、pH值及在不同时间脂肪乳粒径的变化情况,考察肠外营养液的稳定性。结果:调查显示1533份TPN处方的使用主要分布在普通外科、消化内科、心胸外科和肝胆外科等科室,以老年患者为主。TPN处方构成和临床使用比较规范,但缺少针对具体病人情况的个体化用药方案,糖脂比、热氮比、液体量等指标上仍有不合理现象存在。为控制血糖平稳,其中有65.6%的TPN处方加入了胰岛素。研究发现胰岛素在装有不同液体的PVC袋中10h内未发生明显变化,装有葡萄糖注射液或氯化钠注射液的PVC袋对胰岛素的吸附率低于5%,装有全肠外营养液的PVC袋对胰岛素吸附率低于6%,与文献报道不太一致。临床常用四组不同处方的TPN溶液pH值在5.7-5.9之间,渗透压在900~1100mOsm/L之间,加入不同电解质的TPN溶液中脂肪乳的粒径随时间延长有增大的趋势,但24h内均小于250nm,表明营养液性质稳定,符合临床配制及使用要求。结论:1 1533份TPN处方使用基本合理、规范,药师应持续加强糖脂比、热氮比、液体量和用药时间等指标的审核,同时要结合病人的具体情况,制定个体化的方案。2本研究使用的静脉营养输液袋(PVC袋)对胰岛素存在一定程度的吸附,但是吸附程度比以往报道明显偏低,不影响胰岛素的降糖作用,将胰岛素加入到TPN中的给药方式既方便快捷也安全有效。3四组临床使用的TPN溶液的渗透压、pH值及脂肪乳粒径均在安全使用范围内,稳定性良好,临床可安全使用。本研究为TPN的安全使用提供了实验依据。
[Abstract]:Objective: to investigate the rationality and clinical application of total parenteral nutrition solution (TPN) for inpatients in 2015, and to provide a reliable basis for regulating the rational use of parenteral nutrition. According to the problems found in TPN prescription analysis, the adsorption of insulin in PVC infusion bag with different nutrient components and the stability of typical total parenteral nutrient solution were investigated. To provide experimental basis for the safe and effective application of TPN. Methods: 1533 prescriptions of TPN were collected by retrospective investigation, and the basic information (sex, age, weight, diagnosis, nutritional status, etc.) and the use of TPN (kinds of drugs, dosage and days of medication) were recorded and analyzed. The prescription of TPN was analyzed with the main evaluation indexes of the ratio of sugar to fat, the ratio of heat to nitrogen, the liquid volume, the composition of nutrient components, the concentration of electrolyte and the days of drug use. The insulin was mixed with glucose injection, sodium chloride injection and TPN solution in PVC bag. The concentration of insulin was determined by HPLC. The adsorption rate of PVC bag on insulin was calculated. Four groups of typical TPN prescriptions were selected to prepare the parenteral nutrition solution according to the standard operation standard. The osmotic pressure, pH value and the diameter of fat milk at different time were measured, and the stability of the parenteral nutrition solution was investigated. Results: 1533 TPN prescriptions were mainly used in the departments of general surgery, digestive department, cardiothoracic surgery and hepatobiliary surgery. However, there are still some unreasonable phenomena in the indexes of sugars / lipids ratio, hot nitrogen ratio, liquid volume and so on. Insulin was added to 65.6% of the TPN prescriptions to keep blood sugar stable. It was found that there was no significant change in insulin in PVC bags containing different liquids within 10 hours. The adsorption rate of insulin in PVC bags containing glucose injection or sodium chloride injection was less than 5%. The adsorption rate of insulin in PVC bag containing total parenteral nutrient solution was less than 6%, which was not consistent with the literature. The pH value of TPN solution with different prescriptions was 5.7-5.9, the osmotic pressure was between 900~1100mOsm/L and the diameter of fat emulsion in TPN solution with different electrolytes increased with time, but within 24 hours, the size of fat emulsion was less than 250nm. The results show that the nutrient solution is stable and meets the requirement of clinical preparation and application. Conclusion: the use of 1 1533 TPN prescriptions is basically reasonable and standardized. Pharmacists should continuously strengthen the examination of the indexes such as the ratio of sugar to lipid, the ratio of heat to nitrogen, the volume of liquid and the time of medication, and at the same time, combine with the specific conditions of the patients. 2 the intravenous nutrition infusion bag (PVC bag) used in this study had a certain degree of adsorption on insulin, but the degree of adsorption was obviously lower than that of previous reports, which did not affect the hypoglycemic effect of insulin. The administration of insulin into TPN was convenient, quick and safe. 3 the osmotic pressure, pH value and fat emulsion size of TPN solution in the four groups were within the safe range of use, the stability was good, and the clinical use was safe. This study provides experimental evidence for the safe use of TPN.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R927

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