肠外营养制剂配置实践指南和专家共识的系统评价  

Systematic review of clinical practice guidelines and expert consensuses for parenteral nutrition practice procedures

作　　者：赵捷宇[1,2] 门鹏 李潇潇[1] 赵荣生[1] ZHAO Jie-yu;MEN Peng;LI Xiao-xiao;ZHAO Rong-sheng(Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Department of Pharmacy Administration and Clinical Pharmacy,School of Pharmaceutical Sciences,Peking University,Beijing 100191,China)

机构地区：[1]北京大学第三医院药剂科,北京100191 [2]北京大学药学院药事管理与临床药学系,北京100191

出　　处：《临床药物治疗杂志》2018年第12期20-25,共6页Clinical Medication Journal

基　　金：国家卫生健康委医疗管理服务指导中心课题:静脉用药集中调配管理

摘　　要：目的:对肠外营养(parenteral nutrition, PN)制剂配置流程相关的指南和专家共识进行系统评价,为PN制剂配置的临床实践提供指导和帮助。方法:系统检索国内外医学数据库及PN相关权威学术组织网站。分别使用AGREEⅡ和CASP量表对临床指南和管理指南(或专家共识)的质量进行评价。同时,围绕国内PN配置流程所包含的项目对纳入文献进行健全度分析,以评价其全面性和精确性。结果:最终共纳入1篇临床指南和4篇管理指南(或专家共识,其中1篇为国内共识)。其中,美国肠内肠外营养学会2014年的临床指南质量评价结果为A级;4篇管理指南(或专家共识)中,德国医学营养学会2009年肠外营养指南第10章全静脉营养配置的质量评价结果最佳。另外,健全度分析结果显示美国肠内肠外营养学会的肠外营养安全共识涉及的内容最为全面,且内容叙述最为详尽。5篇文献都对PN医嘱的开具、PN制剂的配制和临床使用等3个方面内容给出了相关推荐,主要涉及PN医嘱的适应证要求、PN制剂混合配置的安全操作以及PN制剂在临床使用的稳定性和安全性。结论:国外的相关指南的质量略有不同,各具特点,推荐意见的描述也较为详尽。国内尚无相关指南,应根据我国肠外营养制剂配置的临床实际情况制定相关的指南指导配置实践。Objective This study systematically evaluated existing guidelines and expert consensuses for PN practice procedures,which could guide and assist the clinical practice of PN.Methods We searched Pubmed,Embase,CNKI,Wanfang,Sinomed,and international academic databases on PN,performed a content analysis of retrieved guidelines and consensuses,and evaluated their quality.AGREE Ⅱ was used for quality evaluation of clinical guidelines,and the CASP checklist was used for evaluation of expert consensuses.At the same time,a comprehensive content analysis of the guidelines was performed for the comprehensiveness and accuracy of the guidelines and expert consensuses.Results A total of five guidelines and expert consensuses were finally included.American Society for Parenteral and Enteral Nutrition (ASPEN) guideline was graded A level by AGREE Ⅱ evaluation.According to CASP evaluation,the expert consensus of the German Society for Nutritional Medicine was of the highest quality among the four consensuses.In the comprehensive content analysis,expert consensus of ASPEN was determined to be comprehensive and detailed.The five guidelines and expert consensuses mentioned three aspects of producing PN formulations processes,including indications of PN,safety of compounding PN preparations and clinical practices.Conclusion The quality of relevant foreign guidelines and expert consensuses is slightly different,each has its own characteristics,and the description of the recommended opinions is also more detailed.There are no relevant guidelines in China currently,and relevant guidelines should be developed according to the clinical conditions of the preparation of PN preparations in China.

关 键 词：肠外营养 指南 系统评价 

分 类 号：R977[医药卫生—药品] R95[医药卫生—药学]