临床药师干预对肠外营养合理性的影响
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摘要
目的:临床药师通过儿童营养风险筛查工具STRONGkids(screening tool risk on nutritional status and growth)评分观察不同营养风险等级的肠套叠患儿使用肠外营养支持对营养指标、术后恢复情况等是否有影响,根据结果对医生进行宣教并干预,推动肠外营养的使用更加合理,减少住院费用和不良反应的发生。方法:采用STRONGkids评分对肠套叠患儿进行营养风险筛查,根据STRONGkids评分的不同分值将患儿分组,各组按仅使用肠外营养、未使用任何营养支持再分为A、B组,分别统计2组的比例,以及术后第7天患儿营养指标、术后恢复情况和住院费用,观察不同分值组肠外营养使用率以及使用肠外营养是否有必要。临床药师根据研究结果与医生沟通并干预,1年后比较干预前后肠外营养使用率、不良反应发生率及住院费用等。结果:1～2分的患儿中A组与B组在营养指标、术后住院时间上没有显著差异,但A组住院费用显著高于B组;3分的患儿中B组较A组患儿的体质量、前白蛋白、视黄醇结合蛋白显著降低,住院天数A组显著短于B组;总体使用肠外营养的患儿不良反应发生率更高。临床药师根据上述结果指导医生根据相关指南对肠外营养适应证进行探讨和改进。干预1年后再次统计,STRONGkids评分1分组肠外营养使用率由77.78%下降至7.50%,2分组由85.42%下降至17.65%;总体不良反应发生率由18.80%下降至7.27%,住院费用由16 599.50±1 952.22元下降至14 647.09±2 300.16元,差异均有显著性。结论:通过临床药师干预,低营养风险患者肠外营养使用率降低,合理性增加,患者住院期间不良反应发生率及住院费用降低。临床药师在推动肠外营养合理使用中发挥了重要作用。
OBJECTIVE Clinical pharmacists used children's nutritional risk screening tool STRONGkids to observe the influences on nutritional indexes and postoperative recovery of different nutrition risk levels of children with intussusception in the use of parenteral nutrition support, and intervention was carriedout in doctors to promote the rationaluse of parenteral nutrition and reducehospitalization costs and incidence of adverse reactions. METHODS Children with intussusceptions were grouped by different scores of STRONGkids, and each group was divided into group A and B according to parenteral nutrition alone or no use of any nutritional support. The proportion of the two groups, as well as the nutritional indicators, postoperative recovery and hospitalization costs of the children 7 days after operation, were analyzed to observe the use rate of parenteral nutrition and the necessity of using parenteral nutrition in different score groups. The clinical pharmacist communicated with the doctors and intervention wasimplemented according to the research results. 1 year later, the parenteral nutrition use rate, hospitalization costs and incidence of adverse reactions of before and after the intervention of different score groups were compared. RESULTS There was no significant difference in nutritional indicators and postoperative hospital stay between group A and group B in children with score 1-2, but the hospitalization cost in group A was significantly higher than that in group B; the body weight, prealbumin and retinol-binding protein in group B were significantly lower than those in group A in children with score 3, and the hospital stay in group A was significantly shorter than that in group B; the overall incidence of adverse reactions was higher in children using parenteral nutrition. According to above results, the clinical pharmacistsguide the physicians to discuss and improve the parenteral nutrition indications according to the relevant guidelines.1 year later, the use rate of parenteral nutrition dropped from 77.8% to 22.5% in 1-score group, and dropped from 85.4% to 60.8% in 2-score group. The incidence of adverse reactions dropped from 18.80% to 7.27%, the cost of hospitalization dropped from $16 599.50±1 952.22 to $14 647.09±2 300.16, and the differences were significant. CONCLUSION Through the intervention of clinical pharmacists, the use rate of parenteral nutrition in patients with low nutritional risk decreasedwhile the rational use of parenteral nutritionincreased.The incidence of adverse reactions and hospitalization costs were reduced during hospitalization. Clinical pharmacists have played an important role in promoting the rational use of parenteral nutrition.
OBJECTIVE Clinical pharmacists used children's nutritional risk screening tool STRONGkids to observe the influences on nutritional indexes and postoperative recovery of different nutrition risk levels of children with intussusception in the use of parenteral nutrition support, and intervention was carriedout in doctors to promote the rationaluse of parenteral nutrition and reducehospitalization costs and incidence of adverse reactions. METHODS Children with intussusceptions were grouped by different scores of STRONGkids, and each group was divided into group A and B according to parenteral nutrition alone or no use of any nutritional support. The proportion of the two groups, as well as the nutritional indicators, postoperative recovery and hospitalization costs of the children 7 days after operation, were analyzed to observe the use rate of parenteral nutrition and the necessity of using parenteral nutrition in different score groups. The clinical pharmacist communicated with the doctors and intervention wasimplemented according to the research results. 1 year later, the parenteral nutrition use rate, hospitalization costs and incidence of adverse reactions of before and after the intervention of different score groups were compared. RESULTS There was no significant difference in nutritional indicators and postoperative hospital stay between group A and group B in children with score 1-2, but the hospitalization cost in group A was significantly higher than that in group B; the body weight, prealbumin and retinol-binding protein in group B were significantly lower than those in group A in children with score 3, and the hospital stay in group A was significantly shorter than that in group B; the overall incidence of adverse reactions was higher in children using parenteral nutrition. According to above results, the clinical pharmacistsguide the physicians to discuss and improve the parenteral nutrition indications according to the relevant guidelines.1 year later, the use rate of parenteral nutrition dropped from 77.8% to 22.5% in 1-score group, and dropped from 85.4% to 60.8% in 2-score group. The incidence of adverse reactions dropped from 18.80% to 7.27%, the cost of hospitalization dropped from $16 599.50±1 952.22 to $14 647.09±2 300.16, and the differences were significant. CONCLUSION Through the intervention of clinical pharmacists, the use rate of parenteral nutrition in patients with low nutritional risk decreasedwhile the rational use of parenteral nutritionincreased.The incidence of adverse reactions and hospitalization costs were reduced during hospitalization. Clinical pharmacists have played an important role in promoting the rational use of parenteral nutrition.
引文
[1] Li XX, Liu F, Zhai SD. The present situation and controversial issues of nutrition support in clinic[J]. Chin J Drug Appl Monit(中国药物应用与监测), 2015, 12(2): 116-119.
[2] Yang Y,Peng NH, Zhu WM. Application of NRS2002 in preoperative nutritional risk screening for Crohn's disease patients[J].Parenter Enteral Nutri(肠外与肠内营养),2013,20(3):188-189.
[3] Van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP,et al.Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting [J].Clin Nutr, 2014, 33(1):39-58.
[4] Yang Y. Nutritional risk assessment and early nutritional support in children with surgical malignancies using STRONGkids [J]. Acta Universitatis Medicinalis Nangjing(Natural Science)(南京医科大学学报(自然科学版)),2015, 35(12):1779-1781.
[5] Teixeira AF, Viana KD.Nutritional screening in hospitalized pediatric patients: a systematic review[J].J Pediatr (Rio J), 2016, 92(4):343-352
[6] Chourdakis M, Hecht C, Gerasimidis K, et al. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population[J].Am J Clin Nutr, 2016 ,103(5):1301-1310
[7] White M, Lawson K, Ramsey R,et al.Simple nutrition screening tool for pediatric inpatients[J]. J Parenter Enteral Nutr, 2016,40(3):392-398.
[8] Li T, Bai YH, Zhang YS,et al. Application value of albumin, retinol binding protein, pre-albumin in nutrition therapy of critically ICU patients[J]. Labeled Immunoassays Clin Med(标记免疫分析与临床), 2016,23(01):54-56.
[9] Huang CX, Huang LH, Xing MY. Effects of oral nutritional supplement on malnutrition status in patients with haemodialysis:a metaanalysis of randomized controlled trials[J].Chin J Nurs(中华护理杂志),2015, 50(12):1425-1431.
[10] Peng LT, Li R, Zhao WH, et al. Nutritional risk screening and its clinical significance in 706 children hospitalized in the surgical department [J]. Chin J Contemp Pediatr(中国当代儿科杂志), 2013, 15(10):880-885.
[11] Forga L, Bolado F, Goňi MJ,et al. Low serum levels of prealbumin, retinol binding protein, and retinol are frequent in adult type 1 diabetic patients [J].J Diabetes Res, 2016,2016:2532108. doi: 10.1155/2016/2532108.
[12] Qiao YL, Yang CX, Shen X,et al. Correlation between prealbumin,retinol binding protein levels and nutritional status of preschool children [J]. Labeled Immunoassays Clin Med(标记免疫分析与临床),2017, 24(8):888-891.
[13] Chen HW, Zhen ZJ, Pan WS. Significance of prealbumin and retinol binding protein in assessment of parenteral nutrition [J]. Parenter Enteral Nutr(肠外与肠内营养),2001,03:149-150.
[14] Pediatric Collaborative Group, Society of Parenteral and Enteral Nutrition. Guidelines for pediatric clinical application of enteral and parenteral nutritional support in China[J]. Chin J Pediatr(中华儿科杂志), 2010, 48(6):436-441.
[15] Abunnaja S, Cuviello A, Sanchez JA.Enteralandparenteral nutritionin the perioperative period: state of the art[J].Nutrients, 2013, 5(2):608-623.
[16] Yi F, Ge L, Zhao J,et al. Meta-analysis:total parenteral nutritionversustotalenteral nutritionin predicted severe acute pancreatitis[J].Intern Med, 2012, 51(6):523-530.
[17] Nguyen DL.Guidance for supplemental enteral nutrition across patient populations[J].Am J Manag Care, 2017,23(12 Suppl):S210-S219.
[18] Bai YN,Zhao CY,Jiang MY.Analysis of the rationality of perioperative 427 parenteral nutritional prescriptions and the effect of clinical pharmacist intervention [J].Chin Hosp Pharm J (中国医院药学杂志),2017,(3):286-290.
[19] Xie XS,Pan XL,He XM, et al.Continuous quality improvement method in reduction of irrational medical orders of total nutrient adminxture (TNA) [J].Chin Hosp Pharm J (中国医院药学杂志), 2018,(10):1114-1118.
[20] Wang MH, Ren J, Chen YB, et al. The impact of prescription audit of parenteral nutrition on the normalization and cost of parenteral nutrition support medical orders [J].Chin Hosp Pharm J (中国医院药学杂志),2014,(2):136-139.
[2] Yang Y,Peng NH, Zhu WM. Application of NRS2002 in preoperative nutritional risk screening for Crohn's disease patients[J].Parenter Enteral Nutri(肠外与肠内营养),2013,20(3):188-189.
[3] Van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP,et al.Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting [J].Clin Nutr, 2014, 33(1):39-58.
[4] Yang Y. Nutritional risk assessment and early nutritional support in children with surgical malignancies using STRONGkids [J]. Acta Universitatis Medicinalis Nangjing(Natural Science)(南京医科大学学报(自然科学版)),2015, 35(12):1779-1781.
[5] Teixeira AF, Viana KD.Nutritional screening in hospitalized pediatric patients: a systematic review[J].J Pediatr (Rio J), 2016, 92(4):343-352
[6] Chourdakis M, Hecht C, Gerasimidis K, et al. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population[J].Am J Clin Nutr, 2016 ,103(5):1301-1310
[7] White M, Lawson K, Ramsey R,et al.Simple nutrition screening tool for pediatric inpatients[J]. J Parenter Enteral Nutr, 2016,40(3):392-398.
[8] Li T, Bai YH, Zhang YS,et al. Application value of albumin, retinol binding protein, pre-albumin in nutrition therapy of critically ICU patients[J]. Labeled Immunoassays Clin Med(标记免疫分析与临床), 2016,23(01):54-56.
[9] Huang CX, Huang LH, Xing MY. Effects of oral nutritional supplement on malnutrition status in patients with haemodialysis:a metaanalysis of randomized controlled trials[J].Chin J Nurs(中华护理杂志),2015, 50(12):1425-1431.
[10] Peng LT, Li R, Zhao WH, et al. Nutritional risk screening and its clinical significance in 706 children hospitalized in the surgical department [J]. Chin J Contemp Pediatr(中国当代儿科杂志), 2013, 15(10):880-885.
[11] Forga L, Bolado F, Goňi MJ,et al. Low serum levels of prealbumin, retinol binding protein, and retinol are frequent in adult type 1 diabetic patients [J].J Diabetes Res, 2016,2016:2532108. doi: 10.1155/2016/2532108.
[12] Qiao YL, Yang CX, Shen X,et al. Correlation between prealbumin,retinol binding protein levels and nutritional status of preschool children [J]. Labeled Immunoassays Clin Med(标记免疫分析与临床),2017, 24(8):888-891.
[13] Chen HW, Zhen ZJ, Pan WS. Significance of prealbumin and retinol binding protein in assessment of parenteral nutrition [J]. Parenter Enteral Nutr(肠外与肠内营养),2001,03:149-150.
[14] Pediatric Collaborative Group, Society of Parenteral and Enteral Nutrition. Guidelines for pediatric clinical application of enteral and parenteral nutritional support in China[J]. Chin J Pediatr(中华儿科杂志), 2010, 48(6):436-441.
[15] Abunnaja S, Cuviello A, Sanchez JA.Enteralandparenteral nutritionin the perioperative period: state of the art[J].Nutrients, 2013, 5(2):608-623.
[16] Yi F, Ge L, Zhao J,et al. Meta-analysis:total parenteral nutritionversustotalenteral nutritionin predicted severe acute pancreatitis[J].Intern Med, 2012, 51(6):523-530.
[17] Nguyen DL.Guidance for supplemental enteral nutrition across patient populations[J].Am J Manag Care, 2017,23(12 Suppl):S210-S219.
[18] Bai YN,Zhao CY,Jiang MY.Analysis of the rationality of perioperative 427 parenteral nutritional prescriptions and the effect of clinical pharmacist intervention [J].Chin Hosp Pharm J (中国医院药学杂志),2017,(3):286-290.
[19] Xie XS,Pan XL,He XM, et al.Continuous quality improvement method in reduction of irrational medical orders of total nutrient adminxture (TNA) [J].Chin Hosp Pharm J (中国医院药学杂志), 2018,(10):1114-1118.
[20] Wang MH, Ren J, Chen YB, et al. The impact of prescription audit of parenteral nutrition on the normalization and cost of parenteral nutrition support medical orders [J].Chin Hosp Pharm J (中国医院药学杂志),2014,(2):136-139.