临床药师参与1例肠外营养相关性肝损伤治疗的药学监护

doi:10.19803/j.1672-8629.2022.07.20

摘要/Abstract

摘要： 目的探讨临床药师在1例肠外营养（PN）相关性肝损伤患者治疗中的作用,为临床营养药物的合理应用提供借鉴。方法临床药师参与1例PN相关性肝损伤患者的PN治疗过程,一方面确定导致肝损伤的原因,另一方面建议将PN配方调整为50%葡萄糖注射液500 mL,8.5%复方氨基酸注射液（18AA-V）1 500 mL,20%中/长链脂肪乳注射液250 mL,其余配方不变。并在患者原发病情控制后,逐渐减少PN的量,过渡到肠内营养（EN）。结果医师采纳临床药师的调整建议,该患者的丙氨酸氨基转移酶和碱性磷酸酶等肝功能指标基本恢复正常。结论 PN使用时间,PN中脂质种类等都可能进一步加重肝损伤。临床药师在临床营养治疗中开展药学监护可确保营养药物安全、有效地利用,减少并发症及药品不良反应的发生。

关键词: 肠外营养不足, 肝损伤, 临床营养, 药学监护, 临床药师

Abstract: Objective To explore the role of a clinical pharmacist in the treatment of a patient with parenteral nutrition related hepatic damage so as to provide reference for rational use of nutritional drugs. Methods One clinical pharmacist participated in the treatment of a patient with hepatic insufficiency, who not only identified the cause of hepatic injury, but also suggested that the parenteral nutrition formula be adjusted to 500 mL of 50% glucose injection, 1 500 mL of 8.5% compound amino acid injection (18AA-V), and 250 mL of 20% medium / long chain fat emulsion injection. The rest of the recipes remained unchanged. The amount of PN was decreased gradually and replaced by enteral nutrition (EN). Results Physicians adopted the suggestions of clinical pharmacist so that such liver function indexes as alanine aminotransferase and alkaline phosphatase returned to normal. Conclusion The duration of PN use and the types of lipids in PN may further aggravate liver injury. The participation of a clinical pharmacist in pharmaceutical care for patients can assure effective and safe use of nutritional drugs, and minimize complications and adverse drug reactions.

Key words: insufficient parenteral nutrition, liver injury, clinical nutrition, pharmaceutical care, clinical pharmacist

中图分类号:

R977.4

唐静雅. 临床药师参与1例肠外营养相关性肝损伤治疗的药学监护[J]. 中国药物警戒, 2022, 19(7): 786-788.

TANG Jingya. Pharmaceutical care by a clinical pharmacists in the treatment of parenteral nutrition related hepatic damage: a case report[J]. Chinese Journal of Pharmacovigilance, 2022, 19(7): 786-788.

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