临床药师参与营养评估和干预在肝胆胰恶性肿瘤患者治疗中的效果分析  

Participation of clinical pharmacists in nutritional assessments and interventions for patients with hepatobiliary and pancreatic malignancies

作　　者：刘红[1] 汪燕燕[1] 钱叶本[2] 葛朝亮[1] LIU Hong;WANG Yanyan;QIAN Yeben;GE Chaoliang(Department of Pharmacy,First Affiliated Hospital,Anhui Medical University,GradeⅢPharmaceutical Chemical Laboratory of State Administration of Traditional Chinese Medicine,Anhui Hefei 230022,China;Department of Hepatopancreatobiliary Surgery,First Affiliated Hospital,Anhui Medical University,Anhui Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院药剂科,国家中医药管理局中药化学三级实验室,安徽合肥230022 [2]安徽医科大学第一附属医院肝胆胰外科,安徽合肥230022

出　　处：《中国医院药学杂志》2024年第17期2038-2043,共6页Chinese Journal of Hospital Pharmacy

基　　金：安徽省十三五临床重点专科建设项目(临床药学)基金项目(编号:卫科教秘〔2017〕529号)。

摘　　要：目的:分析营养风险筛查2002(NRS 2002)和患者主观整体评估(PG-SGA)在肝胆胰恶性肿瘤患者营养风险筛查与评估中的临床应用,探讨临床药师参与的营养治疗对方案合理性、有效性、患者住院时间及住院费用的影响。方法:根据临床药师是否参与营养治疗方案的制定,将患者分为干预组和对照组。临床药师对干预组患者进行营养评估和营养治疗方案的个体化干预,分析营养风险、营养不良与患者年龄及肿瘤部位的相关性和筛查评估工具的一致性,对比干预组和对照组患者营养治疗方案的合理性、有效性、住院时间与住院费用等。结果:干预组和对照组患者营养风险发生率为分别为55.4%和49.5%;干预组营养不良发生率为81.1%,不同年龄和部位的恶性肿瘤患者,营养风险发生率和PG-SGA分级组间差异存在统计学意义(P<0.05)。干预组和对照组患者在营养方案的能量供给、糖脂比、蛋白质供给和肠外营养输注方式等方面合理率差别有统计学意义(P<0.05);药师参与干预组营养治疗后,患者白蛋白和前白蛋白明显高于对照组,且住院费用明显降低,差异有统计学意义(P<0.05)。完全采纳建议组患者,治疗前后白蛋白和前白蛋白下降幅度明显小于部分采纳和未采纳组,组间差异存在统计学意义(P<0.05)。结论:70岁以上肝胆胰恶性肿瘤患者中重度营养不良(PG-SGA C~D级)发生率高。临床药师参与的营养治疗可提高治疗方案的合理性和有效性,降低患者住院费用,有利于提高营养治疗水平,促进患者转归。OBJECTIVE To explore the clinical applications of Nutritional Risk Screening 2002(NRS2002)and Patient-Generated Subjective Global Assessment(PG-SGA)in the screening and assessment of nutritional risk in patients with hepatobiliary and pancreatic malignancies and explore the effects of nutritional therapy involving clinical pharmacists on rationality,effectiveness,length of stay and hospitalization expense.METHODS A total of 167 patients were divided into two groups of intervention(n=74)and control(n=93)according to whether or not clinical pharmacists participated in the formulation of nutritional treatment.Clinical pharmacists conducted nutritional assessments and individualized interventions of nutritional treatment for intervention group.The correlations were examined between nutritional risk,malnutrition,patient age,tumor site and consistency of screening evaluation tools.And two groups were compared in terms of rationality and effectiveness of treatment protocols,hospitalization stay and hospitalization expense.RESULTS The incidence of nutritional risk in intervention and control groups was 55.4%and 49.5%respectively.And the incidence of malnutrition group was 81.1%in intervention.Statistical differences existed in the incidence of nutritional risk and PG-SGA classification among different ages and sites(P<0.05).Statistically significant inter-group differences existed in energy supply,carbohydrate-lipid ratio,protein supply and parenteral nutrition infusion modes(P<0.05).After pharmacists participated in nutritional treatment,albumin and prealbumin were significantly higher in intervention group than those in control group.And hospitalization expense was significantly lower in intervention group than that in control group(P<0.05).The declining magnitudes of albumin and prealbumin were significantly lower in intervention group than those in control group(P<0.05).CONCLUSION The incidence of moderate/severe malnutrition(PG-SGA grade C/D)is high in patients with hepatobiliary and pancreatic malignancies aged ove

关 键 词：营养风险筛查2002 患者主观整体评估 营养治疗 临床药师 药学干预 

分 类 号：R969.3[医药卫生—药理学]