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目的 调查某院神经外科重症患者肠内营养（EN）制剂的应用情况，制定EN制剂应用的合理性评价标准，为药学干预方案的制订提供依据。方法 收集2022年1至12月使用EN制剂的神经外科重症病例136例，并记录营养支持治疗的相关信息，对EN制剂应用的合理性与安全性进行分析。结果 纳入的136例病例均符合EN适应证；16例病例（占11.76%）EN启动时机不适宜；19例病例（占13.97%）遴选药品不适宜；13例病例（占9.56%）存在药物相互作用问题；100例病例（占73.53%）给药剂量不适宜。在安全性方面，40例病例（占29.41%）发生了EN相关性腹泻，无营养管堵塞事件发生。结论 我院神经外科重症患者EN制剂的应用存在EN启动时机不适宜、遴选药品不适宜、给药剂量不适宜及药物相互作用等问题。针对发现的问题，后续将进行药学干预，以提高用药合理性。
Abstract：AIM To investigate the use of enteral nutrition(EN) formulations in patients admitted to a hospital'sneurosurgical intensive care unit(ICU), establish evaluation criteria for the rational use of EN formulations, and provide abasis for developing pharmacological intervention protocols. METHODS A total of 136 severe neurosurgical cases usingEN preparations were collected from January 2022 to December 2022. The relevant information on nutritional supporttreatment within 7 days of the cases' admission to the intensive care unit was gathered, and the rationality and safety of ENpreparations were analyzed. RESULTS A total of 136 patients included had indications for EN. However, 16 cases(11.76%)had inappropriate timing for EN initiation, 19 cases(13.97%) had inappropriate drug selection, 13 cases(9.56%) had druginteraction issues, and 100 cases(73.53%) had inappropriate dosing. Regarding safety, 40 cases(29.41%) experienceddiarrhea associated with EN, and no feeding tube blockage events occurred. CONCLUSION The key issues identifiedin the application of EN formulations for critically ill neurosurgical patients include inappropriate timing of EN initiation,suboptimal formula selection, inadequate dosing regimens, and insufficient consideration of drug-nutrient interactions.These findings provide an evidence base for implementing pharmacy interventions to enhance rational drug use.
[1]广东省药学会.肠内营养临床药学共识(第二版)[J].今日药学,2017, 27(6):361.
[2] KUTSOGIANNIS J, ALBERDA C, GRAMLICH L, et al. Early use of supplemental parenteral nutrition in critically ill patients:results of an international multicenter observational study[J]. Crit Care Med, 2011, 39(12):2691.
[3]黎介寿.首选肠内营养的合理性[J].肠外与肠内营养, 2013,20(6):321.
[4]祁献芳,王志,何丹丹,等.郑州某三甲医院成人住院患者肠外营养治疗的现状调查:一项回顾性横断面研究[J].中国医院药学杂志, 2023, 43(12):1402.
[5]中华医学会神经外科分会,中国神经外科重症管理协作组.中国神经外科重症患者营养治疗专家共识(2022版)[J].中华医学杂志, 2022, 102(29):2236.
[6]李红玲,谭娜,庄红玲,等.中国医院药物警戒系统对某院药品不良反应上报的影响[J].医药导报, 2020, 39(2):265.
[7]侯永芳,宋海波,刘红亮,等.基于中国医院药物警戒系统开展主动监测的实践与探讨[J].中国药物警戒, 2019, 16(4):212.
[8]中华医学会肠外肠内营养学分会.中国成人患者肠外肠内营养临床应用指南(2023版)[J].中华医学杂志, 2023, 103(13):946.
[9] COMPHER C, BINGHAM A L, MCCALL M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient:The American Society for Parenteral and Enteral Nutrition[J]. JPEN J Parenter Enteral Nutr, 2022, 46(1):12.
[10] SINGER P, BLASER A R, BERGER M M, et al. ESPEN practical and partially revised guideline:Clinical nutrition in the intensive care unit[J]. Clin Nutr, 2023, 42(9):1671.
[11]中华医学会肠外肠内营养学分会神经疾病营养支持学组,中华医学会神经病学分会神经重症协作组,中国医师协会神经内科医师分会神经重症专业委员会,等.神经系统疾病肠内营养支持中国专家共识(第二版)[J].中华临床营养杂志, 2019, 27(4):193.
[12]米元元,黄海燕,尚游,等.中国危重症患者肠内营养治疗常见并发症预防管理专家共识(2021版)[J].中华危重病急救医学,2021, 33(8):903.
[13]中华护理学会重症护理专业委员会,北京医学会肠外肠内营养学分会护理学组.神经重症患者肠内喂养护理专家共识[J].中华护理杂志, 2022, 57(3):261.
[14]国家药典委员会.临床用药须知[J].北京:中国医药科技出版社,2020:1088.
[15]李德品,苏佳沌,曹科,等.重症患者营养支持现状对临床结局的影响[J].中南药学, 2024, 22(3):567.
[16]左俊焘,李嘉琪,徐瑶,等.重症病人肠内营养中断现状及其对热卡达标的影响研究[J].肠外与肠内营养, 2023, 30(3):166.
[17] SHAO Y, HENG W W, LI S S, et al. Tube feeding with a diabetesspecific enteral formula improves glycemic control in severe acute ischemic stroke patients[J]. JPEN J Parenter Enteral Nutr, 2018,42(5):926.
[18] MESEJO A, VAQUERIZO ALONSO C, ACOSTA ESCRIBANO J,et al. Guidelines for specialized nutritional and metabolic support in the critically-ill patient:update. Consensus SEMICYUCSENPE:introduction and methodology[J]. Nutr Hosp, 2011,26(Suppl 2):1.
[19]边萌,张杰,陈淑敏,等.我国六城市重症医学科患者肠内营养药物应用现状[J].临床药物治疗杂志, 2023, 21(7):23.
[20] CHURCH A, ZOELLER S. Enteral nutrition product formulations:a review of available products and indications for use[J]. Nutr Clin Pract, 2023, 38(2):277.
[21] MCCLAVE S A, DIBAISE J K, MULLIN G E, et al. ACG clinical guideline:nutrition therapy in the adult hospitalized patient[J].Am J Gastroenterol, 2016, 111(3):315.
[22] VAN ZANTEN A R H, PETIT L, DE WAELE J, et al. Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients:a double-blind randomized trial[J]. Crit Care,2018, 22(1):156.
[23] VAN ZANTEN A R H, DE WAELE E, WISCHMEYER P E.Nutrition therapy and critical illness:practical guidance for the ICU, post-ICU, and long-term convalescence phases[J]. Crit Care, 2019, 23(1):368.
[24]李红炎,金静芬,姚梅琪,等.神经重症肠内营养患者腹泻的发生现状及影响因素研究[J].护理与康复, 2022, 21(12):21..
[25]陈琳,谌艳芳,余爱华,等.神经内科危重症病人肠内营养喂养不耐受现状及其影响因素[J].护理研究, 2021, 35(7):1285.
[26] SHIMONI Z, AVERBUCH Y, SHIR E, et al. The addition of fiber and the use of continuous infusion decrease the incidence of diarrhea in elderly tube-fed patients in medical wards of a general regional hospital:a controlled clinical trial[J]. J Clin Gastroenterol, 2007, 41(10):901.
[27] WESSELINK E, KOEKKOEK K W A C, LOOIJEN M, et al.Associations of hyperosmolar medications administered via nasogastric or nasoduodenal tubes and feeding adequacy, food intolerance and gastrointestinal complications amongst critically ill patients:a retrospective study[J]. Clin Nutr ESPEN, 2018,25:78.
[28] PITTA M R, CAMPOS F M, MONTEIRO A G, et al. Tutorial on diarrhea and enteral nutrition:a comprehensive step-by-step approach[J]. JPEN J Parenter Enteral Nutr, 2019, 43(8):1008.
[29]中华医学会创伤学分会神经创伤专业学组.颅脑创伤患者肠内营养管理流程中国专家共识(2019)[J].中华创伤杂志, 2019,35(3):193.
基本信息:
DOI：10.19577/j.1007-4406.2025.03.004
中图分类号:R459.3;R651
引用信息:
[1]黄燕勤,余靓平,刘忠等.神经外科重症患者肠内营养制剂临床应用情况[J].中国临床药学杂志,2025,34(03):180-186.DOI:10.19577/j.1007-4406.2025.03.004.
基金信息: