【摘要】：目的:通過對(duì)2015年住院患者全腸外營養(yǎng)液(TPN)處方的全面分析,深入了解TPN的處方合理性和臨床應(yīng)用情況,為規(guī)范腸外營養(yǎng)合理使用提供可靠依據(jù)。并根據(jù)TPN處方分析中發(fā)現(xiàn)的問題開展實(shí)驗(yàn)研究,對(duì)胰島素在裝有不同營養(yǎng)液成分的PVC輸液袋中的吸附情況及典型全腸外營養(yǎng)液的穩(wěn)定性進(jìn)行考察,為TPN的安全有效應(yīng)用提供實(shí)驗(yàn)依據(jù)。方法:采用回顧性調(diào)查方法對(duì)1533份TPN處方進(jìn)行整理,記錄并分析患者基本信息(性別、年齡、體重、診斷結(jié)果、營養(yǎng)狀況等)及TPN用藥情況(藥物種類、用量及用藥天數(shù))。以糖脂比、熱氮比、液體量、營養(yǎng)組分組成、電解質(zhì)濃度及用藥天數(shù)為主要評(píng)價(jià)指標(biāo)對(duì)TPN處方進(jìn)行全面分析。模擬臨床使用狀態(tài),將胰島素與葡萄糖注射液、氯化鈉注射液及TPN溶液分別置于PVC袋中混合,采用高效液相色譜法,測定不同時(shí)間取樣時(shí)胰島素的濃度變化情況,計(jì)算PVC袋對(duì)胰島素的吸附率。選擇四組臨床常用的典型TPN處方,按標(biāo)準(zhǔn)操作規(guī)范配制腸外營養(yǎng)液,測定腸外營養(yǎng)液的滲透壓、pH值及在不同時(shí)間脂肪乳粒徑的變化情況,考察腸外營養(yǎng)液的穩(wěn)定性。結(jié)果:調(diào)查顯示1533份TPN處方的使用主要分布在普通外科、消化內(nèi)科、心胸外科和肝膽外科等科室,以老年患者為主。TPN處方構(gòu)成和臨床使用比較規(guī)范,但缺少針對(duì)具體病人情況的個(gè)體化用藥方案,糖脂比、熱氮比、液體量等指標(biāo)上仍有不合理現(xiàn)象存在。為控制血糖平穩(wěn),其中有65.6%的TPN處方加入了胰島素。研究發(fā)現(xiàn)胰島素在裝有不同液體的PVC袋中10h內(nèi)未發(fā)生明顯變化,裝有葡萄糖注射液或氯化鈉注射液的PVC袋對(duì)胰島素的吸附率低于5%,裝有全腸外營養(yǎng)液的PVC袋對(duì)胰島素吸附率低于6%,與文獻(xiàn)報(bào)道不太一致。臨床常用四組不同處方的TPN溶液pH值在5.7-5.9之間,滲透壓在900~1100mOsm/L之間,加入不同電解質(zhì)的TPN溶液中脂肪乳的粒徑隨時(shí)間延長有增大的趨勢(shì),但24h內(nèi)均小于250nm,表明營養(yǎng)液性質(zhì)穩(wěn)定,符合臨床配制及使用要求。結(jié)論:1 1533份TPN處方使用基本合理、規(guī)范,藥師應(yīng)持續(xù)加強(qiáng)糖脂比、熱氮比、液體量和用藥時(shí)間等指標(biāo)的審核,同時(shí)要結(jié)合病人的具體情況,制定個(gè)體化的方案。2本研究使用的靜脈營養(yǎng)輸液袋(PVC袋)對(duì)胰島素存在一定程度的吸附,但是吸附程度比以往報(bào)道明顯偏低,不影響胰島素的降糖作用,將胰島素加入到TPN中的給藥方式既方便快捷也安全有效。3四組臨床使用的TPN溶液的滲透壓、pH值及脂肪乳粒徑均在安全使用范圍內(nèi),穩(wěn)定性良好,臨床可安全使用。本研究為TPN的安全使用提供了實(shí)驗(yàn)依據(jù)。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R927

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 徐翠玲;賈銘婧;崔鈺琪;魏嵐;孫立新;;PVC輸液器與20種藥物的相容性[J];中國醫(yī)藥工業(yè)雜志;2015年08期

2 司延斌;趙志剛;;1038例住院患者全腸外營養(yǎng)液處方分析[J];藥物流行病學(xué)雜志;2015年01期

3 高麗麗;史英欽;吳慧珍;;癌癥晚期無法進(jìn)食患者腸外營養(yǎng)處方研究[J];臨床合理用藥雜志;2013年32期

4 張素平;賴善城;林素珍;;251張腸外營養(yǎng)處方合理性分析[J];中國保健營養(yǎng);2012年22期

5 辛鳳鮮;朱東方;馬才;王曉偉;李慧娟;李娜;;PVC靜脈營養(yǎng)袋DEHP溶出量及其風(fēng)險(xiǎn)評(píng)估[J];中國醫(yī)療器械信息;2012年09期

6 李榮輝;譚鴻毅;楊雙;劉亞利;李美玲;陽國平;;復(fù)方氨基酸(19)注射液配制的全靜脈營養(yǎng)液穩(wěn)定性研究及臨床應(yīng)用[J];中南藥學(xué);2012年03期

7 徐亞杰;劉雅靜;孫苓苓;劉彤;;藥師干預(yù)靜脈高營養(yǎng)處方分析[J];山西醫(yī)藥雜志(下半月刊);2011年10期

8 施春華;倪元紅;;聚氯乙烯輸液裝置對(duì)胰島素吸附及洗脫作用的觀察[J];交通醫(yī)學(xué);2010年04期

9 劉紹德;莫永生;潘秋榮;莫惠平;;590份全腸外營養(yǎng)液應(yīng)用分析[J];中國醫(yī)院用藥評(píng)價(jià)與分析;2009年01期

10 周欣;王秀榮;翟所迪;;“全合一”靜脈營養(yǎng)液與膠體溶液配伍的穩(wěn)定性研究[J];中南藥學(xué);2008年06期

，

本文編號(hào)：2331565