个体化与预混肠外营养配方对胃肠肿瘤围手术期营养支持成本-效果分析  

Cost-effectiveness analysis on nutrition therapy of perioperative patients with gastrointestinal tumors receiving parenteral nutrition:compounded parenteral vs pre-mixed multi-chamber bag

作　　者：谢莉娜 于玲[1] 王冬雪[1] 张新茹[1] XIE Li-na;YU Ling;WANG Dong-xue;ZHANG Xin-ru(Department of Pharmacy,Second Hospital of J ilin University,Changchun 130041,P.R.China)

机构地区：[1]吉林大学第二医院药学部,吉林长春130041

出　　处：《中华肿瘤防治杂志》2018年第24期1729-1732,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的胃肠肿瘤患者常伴有营养不良,围手术期营养支持是保障手术安全有效的基本措施。本研究分析胃肠肿瘤围手术期患者肠外营养配方应用情况,评价个体化与预混式肠外营养配方对于胃肠肿瘤患者围手术期营养支持的成本-效果影响。方法回顾性分析2014-01-01-2016-12-31吉林大学第二医院334例接受胃肠肿瘤手术患者的临床资料,按照营养支持方案分为个体化配制的"全合一"营养液(compounded parenteral,COM)组(127例)和商业预混多腔袋(multi-chamber bag,MCB)组(122例)。COM组患者营养液配方能量由葡萄糖和中、长链脂肪乳提供,氮源为复方氨基酸,均常规加入水溶性维生素、脂溶性维生素、矿物质等;MCB组营养液配方为使用商业预混营养液脂肪乳氨基酸(17%)葡萄糖(11%)注射液(卡文)。评价两组临床结局指标,计算各种费用,并进行"成本-效果比"评价。结果总住院时间COM组(18.5±6.1)d,MCB组(17.6±9.1)d,P=0.408;术后住院时间COM组(12.7±4.9)d,MCB组(11.1±6.5)d,P=0.331;再次手术率COM组2.3%,MCB组1.6%,P=0.454;两组比较差异无统计学意义,P>0.05。MCB组营养支持的时间(4.9±2.6),费用(1.7±0.9)千元;COM组营养支持的时间(8.0±3.5)d,费用(6.3±3.5)千元;MCB组明显少于COM组,P<0.05。MCB组总住院费用(63.3±28.4)千元,药费(21.3±11.6)千元;COM组总住院费用(75.0±28.8)千元,药费(30.0±13.7)千元;MCB组明显低于COM组,P<0.05。术后感染率COM组26.0%明显高于MCB组10.6%,P<0.05。MCB组未发生感染成本-效果比(645)元,未再次手术成本-效果比(586)元;COM组发生感染成本-效果比(1 047)元,未再次手术成本-效果比(793)元;MCB组低于COM组,P<0.05。结论胃肠肿瘤围手术期患者的营养支持MCB配方较COM配方具有良好的成本-效果比和药物经济学价值。OBJECTIVE Patients with gastrointestinal tumors are often accompanied by malnutrion.Perioperative nutritional support is the basic measure to ensure the safety and effectiveness of surgery.The purpose of this study was to analyze the application of parenteral nutrition formula in gastrointestinal cancer patients during perioperative period and investigate the cost-effectiveness of perioperative patients diagnosed with gastrointestinal tumors taking compounded (COM)PN or pre-mixed multi-chamber bag(MCB)PN based on the underlying infection risk.METHODS A retrospective study was conducted in perioperative 334 patients with gastrointestinal tumors receiving parenteral nutrition in the Second Hospital of Jilin University from January 2014 to December 2016.Totally 122 patients were found to receive parenteral nutrition by pre-mixed multi-chamber bag.Totally 127 patients were receiving parenteral nutrition by compounded parenteral.The clinical outcomes and costs were measured and cost-effectiveness analysis was conducted.RESULTS No significant difference was found in the length of total hospital stay,postoperative hospital stay and reoperation rate between the MCB group[(17.6±9.1)d,(11.1±6.5)d,1.6%)]and COM group [(18.5±6.1)d,(12.7±4.9)d, 2.3%)],P>0.05.However,postoperative infection rate and the overall costs in the MCB group[(10.6%,(63.3±28.4)×10^3 RMB)]was significantly decreased compared to COM group[(26.0%,(75.0±28.8)×10^3 RMB)],P<0.05.Moreover,the cost effectiveness ratio of non-infection rate and non-reoperation rate in MCB group were 645 RMB and 586 RMB respectively,which were lower than those in COM group(1 047 RM13,793 RMt3),P(0.05.CONCLUSIONS The standardized pre-mix formulations for perioperative patients with gastrointestinal tumors shows acceptable cost-effectiveness ratio and pharmacoeconomic value than compounded parenteral fromulations.

关 键 词：个体化配方 预混配方 成本-效果 营养支持 胃肠肿瘤 围手术期 

分 类 号：R735[医药卫生—肿瘤]