本文選題：臨床營(yíng)養(yǎng)支持　切入點(diǎn)：腸內(nèi)營(yíng)養(yǎng)　出處：《延邊大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的胃腸外科是較容易發(fā)生營(yíng)養(yǎng)風(fēng)險(xiǎn)的科室,可能與胃腸外科較多的胃腸腫瘤的患者且需要手術(shù)治療有關(guān),對(duì)于有影響風(fēng)險(xiǎn)的患者進(jìn)行營(yíng)養(yǎng)支持可以改善其臨床結(jié)局,但不適當(dāng)?shù)臓I(yíng)養(yǎng)支持卻會(huì)導(dǎo)致患者并發(fā)癥的增多、醫(yī)療費(fèi)用增加,延緩住院天數(shù)等一系列負(fù)面臨床結(jié)局。筆者通過對(duì)胃腸營(yíng)養(yǎng)及疝外科有營(yíng)養(yǎng)風(fēng)險(xiǎn)指癥并進(jìn)行營(yíng)養(yǎng)支持(nutrition support,NS)的患者進(jìn)行個(gè)體化藥學(xué)監(jiān)護(hù),在PN和EN支持過程中,對(duì)藥學(xué)監(jiān)護(hù)的實(shí)踐要點(diǎn)進(jìn)行探討。方法選取某三甲醫(yī)院胃腸外科163例營(yíng)養(yǎng)評(píng)分≥3分,年齡在18～90歲,住院1天以上且接受營(yíng)養(yǎng)支持治療的患者進(jìn)行藥學(xué)監(jiān)護(hù),對(duì)營(yíng)養(yǎng)評(píng)分暫3分的成年患者每周進(jìn)行重新營(yíng)養(yǎng)篩查,若評(píng)分≥3分且進(jìn)行營(yíng)養(yǎng)支持的患者則重新進(jìn)入監(jiān)護(hù)管理。藥學(xué)監(jiān)護(hù)方法:(1)每日交接班、醫(yī)學(xué)查房、藥學(xué)查房記錄患者的飲食、營(yíng)養(yǎng)狀況和用藥史,跟患者家屬溝通營(yíng)養(yǎng)支持的重要性,以及營(yíng)養(yǎng)支持期間的注意事項(xiàng),書寫用藥教育方便患者家屬更好的護(hù)理進(jìn)行營(yíng)養(yǎng)支持的患者,提高患者的依從性;(2)對(duì)醫(yī)結(jié)合患者的病例和現(xiàn)狀,分析患者的生化指標(biāo),結(jié)合醫(yī)師的治療原則和治療需求,計(jì)算營(yíng)養(yǎng)需求量和合理的糖脂比、熱氮比;(3)在護(hù)士配液前審核當(dāng)天的腸外腸內(nèi)營(yíng)養(yǎng)處方,告知配液時(shí)的注意事項(xiàng)和流程;(4)節(jié)假日期間的病例通過醫(yī)院信息管理系統(tǒng)(Hospital Information System,HIS)進(jìn)行信息采集,記錄的內(nèi)容包括患者基本信息、入院診斷、營(yíng)養(yǎng)支持的方案、營(yíng)養(yǎng)支持的種類及用法用量、是否發(fā)生藥物并發(fā)癥及不良反應(yīng)、各項(xiàng)生化指標(biāo)情況等。結(jié)果監(jiān)護(hù)期間發(fā)現(xiàn)不合理處方29次,干預(yù)成功次數(shù)為27次,成功率93.1%,其余2次根據(jù)患者不同指癥,與醫(yī)師進(jìn)行協(xié)商后進(jìn)行修改;發(fā)現(xiàn)腸外腸內(nèi)營(yíng)養(yǎng)并發(fā)癥的患者26次,占總患者的15.9%,與往年相比,合理的藥學(xué)監(jiān)護(hù)可以縮短患者住院天數(shù)、減少患者的住院費(fèi)用、且可以預(yù)防大部分營(yíng)養(yǎng)支持帶來的一系列并發(fā)癥的發(fā)生。醫(yī)師對(duì)能量計(jì)算、三大營(yíng)養(yǎng)物質(zhì)供能比例,離子含量計(jì)算、維生素的生物效能以及護(hù)師對(duì)配液的注意事項(xiàng)和配伍禁忌等仍需要臨床藥師以專業(yè)知識(shí)來參與,且使用營(yíng)養(yǎng)支持時(shí)并發(fā)癥時(shí)常會(huì)出現(xiàn),為保證患者用藥的安全、有效、經(jīng)濟(jì)性,需要臨床藥師進(jìn)行個(gè)體化的監(jiān)護(hù)。結(jié)論臨床營(yíng)養(yǎng)支持由于應(yīng)用復(fù)雜、藥學(xué)相關(guān)專業(yè)性強(qiáng)、且患者使用時(shí)并發(fā)癥發(fā)生率較高,需要進(jìn)行個(gè)體化藥學(xué)監(jiān)護(hù)和用藥教育。合理化的藥學(xué)監(jiān)護(hù)可以縮短患者住院天數(shù)、減少患者住院費(fèi)用以及并發(fā)癥等,既往對(duì)腸外腸內(nèi)營(yíng)養(yǎng)的研究都與營(yíng)養(yǎng)支持的方式對(duì)臨床結(jié)局影響的研究,未有對(duì)PN和EN監(jiān)護(hù)路徑方法的系統(tǒng)研究,所以本論文在營(yíng)養(yǎng)支持的監(jiān)護(hù)上有一定的創(chuàng)新性,本研究在臨床工作中可以起到建議性的作用,為醫(yī)師和護(hù)師都提供相關(guān)的參考,為患者接受更好的治療提供保障。
[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.

【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R95

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本文編號(hào)：1590715