A case study of nutritional support for a patient with malignant obstructive jaundice during the perioperative period
-
摘要: 目的 探讨临床药师在恶性梗阻性黄疸患者围术期营养支持中发挥的作用,为营养支持在围术期患者中的临床应用提供参考。 方法 临床药师应用营养风险筛查工具对1例恶性梗阻性黄疸患者进行术前营养风险筛查,并制订营养支持计划。根据病情变化,对围术期营养支持方案进行调整,将30%长链脂肪乳剂250 ml调整为20%中/长链脂肪乳剂250 ml,同时加用经口肠内营养补充剂,并对患者实施药学监护。 结果 患者于围术期内由肠外营养支持过渡至肠内营养支持,手术创伤恢复较好,无并发症发生,黄疸情况较前改善。 结论 临床药师应协助医师制订和调整营养支持方案,加强药学监护,改善患者营养状态。Abstract: Objective To demonstrate the role of clinical pharmacists in nutritional support for a patient with malignant obstructive jaundice and to provide a reference for the clinical application of nutritional supplements in patients during the perioperative period. Methods Clinical pharmacists evaluated the nutritional status of an obstructive jaundice patient with nutrition risk screening tool and developed nutrition support programs perioperatively. The daily dose of 30% long-chain fat emulsion 250 ml was replaced with 20% medium/long-chain fat emulsions 250 ml. Oral nutrition support was added. Pharmaceutical care was implemented for the patient during the perioperative period. Results During the perioperative period, parenteral nutrition support was changed to enteral nutritional support. The patient's nutritional status and jaundice were improved. The patient recovered well from surgery with no complication. Conclusion Clinical pharmacists work closely with physicians in developing and adjusting nutritional support program to improve the nutritional status and pharmaceutical care for patients.
-
Key words:
- nutritional support /
- perioperative period /
- jaundice /
- pharmaceutical care
-
[1] 李强,于世平,苏秀琴,等. 支架置入治疗不同梗阻部位恶性梗阻性黄疸的疗效评价[J]. 中国医学创新,2015,12(18):130-132. [2] 阿如汉. 梗阻性胆汁淤积的诊断与治疗[J]. 现代消化及介入诊疗,2015,20(5):553-557. [3] 中华医学会. 成人围术期营养支持指南[J]. 中华外科杂志,2016,54(9):641-657. [4] 刘利东. 含脂肪乳全成分胃肠外营养在肝功能不全中应用进展[J]. 实用医学杂志,2004,24(1):72-73. [5] 陈洁.脂肪乳的特点及临床应用[J]. 中国医学创新,2012,9(4):158-161. [6] Piper SN, Röhm KD, Boldt J,et al.Hepatocellular integrity in patients requiring parenteral nutrition:comparison of structured MCT/LCT vs. a standard MCT/LCT emulsion and a LCT emulsion[J]. Eur J Anaesthesiol,2008,25(7):557-565. [7] 中华医学会肠外肠内营养学分会. 临床诊疗指南2008版:肠外肠内营养学分册[M]. 北京:人民卫生出版社,2009:91-96. [8] 吴国豪. 实用临床营养学[M]. 上海:复旦大学出版社,2006:277-287. [9] Alwayn IP, Gura K, Nosé V,et al. Omega-3 fatty acid supplementation prevents hepatic steatosis in a murine model of nonalcoholic fatty liver disease[J]. Pediatr Res, 2005,57(3):445. [10] Palova S,Charvat J,Kvapil M. Comparison of soybean oil-and olive oil-based lipid emulsions on hepatobiliary function and serum triacylglycerols level during realimentation[J]. J Int Med Res, 2008,36(3):587-593.
计量
- 文章访问数: 2994
- HTML全文浏览量: 507
- PDF下载量: 419
- 被引次数: 0