中国临床药学杂志

目的 探究药师参与的营养支持多学科诊疗（MDT）模式对肿瘤患者营养支持治疗质量的提升效果。方法 收集我院2021至2023年收治的住院病例68 112例，其中2021年23 281例，2022年19 530例，2023年25 301例。2023年全院收治肿瘤（有肿瘤诊断）病例3 204例，其中主要肿瘤科室[肿瘤内科、普外二科（肿瘤外科）和放疗科]的病例有2 141例。分析药师参与的营养支持MDT模式实施后全院及主要肿瘤科室的营养风险筛查、肠内营养（EN）/肠外营养（PN）的使用、药学监护与医嘱点评等情况。结果 全院和主要肿瘤科室采用营养风险筛查（NRS-2002）量表进行营养评估的病例占比从2021年的26.92%和26.70%增加至2023年的63.57%和94.39%，采用主观整体营养状况评估工具（PG-SGA）进行营养评估的病例占比从2021年的0.53%和4.45%增加至2023年的3.31%和32.93%。全院EN/PN治疗率从2021年的14.06%和0.97%降低至2023年的12.38%和0.83%,NRS-2002量表评分≥3且进行EN/PN治疗的病例占比从2021年的1.60%增加至2023年的4.95%；主要肿瘤科室EN/PN治疗率从2021年的17.19%和3.46%增加至2023年的24.66%和4.58%,NRS-2002量表评分≥3且进行EN/PN治疗的病例占比从2021年的4.91%增加至2023年的26.53%。2023年放疗科EN/PN治疗率最高（45.31%），普外二科使用的全营养混合液（TNA）均经静脉用药调配中心（PIVAS）调配，占比（100.00%）最高。结论 药师参与的营养支持MDT模式能够提升营养风险筛查覆盖率及营养支持治疗的效率和合理性，专科临床药师的高度参与保障了肿瘤患者的营养支持治疗的疗效。

AIM To explore the effectiveness of the pharmacist-involved multidisciplinary team(MDT) modelin improving the quality of nutrition support therapy for cancer patients. METHODS A total of 68 112 hospitalized caseswere collected at our institution from 2021 to 2023, comprising 23 281 cases in 2021, 19 530 in 2022, and 25 301 in 2023. In2023, 3 204 cancer-diagnosed cases were documented hospital-wide, of which 2 141 cases were managed by core oncologydepartments: Medical Oncology, General Surgery Ward II(Oncology Surgery Department), and Radiotherapy Department.The study evaluated the implementation of the pharmacist-integrated MDT model for nutritional support by analyzing thefollowing parameters across the entire hospital and major oncology departments: nutritional risk screening compliance,utilization patterns of enteral nutrition(EN) and parenteral nutrition(PN), pharmaceutical care interventions and prescriptionreview outcomes. RESULTS From 2021 to 2023, significant improvements were observed in nutritional assessment andintervention practices. The utilization rate of the nutritional risk screening 2002(NRS-2002) scale increased from 26.92%to 63.57% hospital-wide and from 26.70% to 94.39% in major oncology departments. Concurrently, the adoption proportionof the patients using patient-generated subjective global assessment(PG-SGA) tool rose from 0.53% to 3.31% hospital-wideand from 4.45% to 32.93% in oncology departments. While the overall EN/PN treatment rate decreased hospital-wide(EN:from 14.06% to 12.38%; PN: from 0.97% to 0.83%), the proportion of high-risk patients(NRS-2002 score ≥ 3) receivingEN/PN interventions increased from 1.60% to 4.95%. In contrast, the overall EN/PN treatment rate in the main oncologydepartment increased(EN: from 17.19% to 24.66%; PN: from 3.46% to 4.58%), the proportion of high-risk patients(NRS-2002 score ≥ 3) receiving EN/PN interventions also increased from 4.91% in 2021 to 26.53% in 2023. Notably, in 2023, theRadiotherapy Department achieved the highest EN/PN treatment rate(45.31%), while General Surgery Ward II attained fullcompliance(100.00%) with pharmacy intravenous admixture services(PIVAS)-prepared total nutrient admixtures(TNA).CONCLUSION The MDT model for nutritional support with pharmacists' participation could increase the coverage rate ofnutritional risk screening and improve the efficiency and rationality of nutritional support therapy. The high-level involvementof specialized clinical pharmacists could ensure the efficacy of nutritional support therapy for cancer patients.