某院老年患者全胃肠外营养药物使用合理性分析  

Rationality of the Application of Total Parenteral Nutrition Drugs in Elderly Patients in a Hospital

作　　者：徐芹 周璐 谢继青[1] 董玉波 马晓雯 陈瑞霞[1] XU Qin;ZHOU Lu;XIE Jiqing;DONG Yubo;MA Xiaowen;CHEN Ruixia(No.960 Hospital of the PLA,Jinan,Shandong,China 250000)

机构地区：[1]中国人民解放军第九六〇医院,山东济南250000

出　　处：《中国药业》2025年第5期18-22,共5页China Pharmaceuticals

基　　金：山东省自然科学基金项目(第一批)[ZR2020QH349]。

摘　　要：目的 促进医院静脉用药调配中心(PIVAS)老年住院患者全胃肠外营养(TPN)支持方案的合理应用。方法 收集医院PIVAS2020年1月至2022年12月审核的老年患者TPN医嘱13 132条,总结药物使用情况,结合相关指南和专家共识判断TPN医嘱的合理性,采用帕累托图法分析不合理用药的主要因素和次要因素,以及不合理医嘱涉及的TPN制剂。结果 共拦截不合理医嘱3 903条,用药不合理率为29.72%。TPN医嘱不合理因素中,液体量不足(20.96%)、能量不足(17.96%)、糖脂比不合格(15.99%)、热氮比不合格(13.89%)为主要因素,电解质用量超量(12.30%)、营养素缺失(8.51%)为次要因素。不合理TPN医嘱共涉及16个品种的制剂,主要为10%氯化钾注射液(17.32%)、胰岛素注射液(13.07%)、注射用脂溶性维生素(Ⅱ)(成都)(12.25%)等。结论 药师应加强老年患者的TPN用药监测,并针对性地进行干预,以促进TPN制剂的合理应用。Objective To promote the rational application of total parenteral nutrition(TPN)support plan for elderly inpatients in the pharmacy intravenous admixture service(PIVAS)in the hospital.Methods A total of 13132 TPN medical orders for elderly patients reviewed by the PIVAS in the hospital from January 2020 to December 2022 were collected.The drug use was summarized,and the rationality of TPN medical orders was judged based on relevant guidelines and expert consensus.The Pareto chart was used to analyze the main and secondary factors of irrational drug use,as well as the TPN preparations involved in irrational medical orders.Results A total of 3903 irrational medical orders were intercepted,with an irrational drug use rate of 29.72%.Among the reasons for irrational use of TPN mediccal orders,insufficient liquid volume(20.96%),insufficient energy(17.96%),unqualified sugar-lipid ratio(15.99%),and unqualified thermal-nitrogen ratio(13.89%)were the main factors,and the excessive electrolyte usage(12.30%)and missing nutrients(8.51%)were the secondary factors.Irrational TPN medical orders involved 16 types of preparations,mainly including 10%Potassium Chloride Injection(17.32%),Insulin Injection(13.07%),and Fat-Soluble Vitamin(Ⅱ)(Chengdu)(12.25%).Conclusion Pharmacists should strengthen the monitoring of TPN medication in elderly patients,and provide targeted interventions to promote the rational use of TPN preparations.

关 键 词：静脉用药调配中心 全胃肠外营养 帕累托图 不合理用药 老年患者 

分 类 号：R95[医药卫生—药学]