Moreno Villares J M, Fernández-Shaw Toda C, Muñoz García M J, Gomis Muñoz P
Servicio de Farmacia, Hospital 12 de Octubre, Carretera de Andalucía, km. 5,400, 28041 Madrid.
Nutr Hosp. 2002 Sep-Oct;17(5):251-5.
The prescription and preparation of paediatric parenteral nutrition in Spain are subject to great variability.
To identify how paediatric parenteral nutrition is prescribed and prepared in Spain.
During the first quarter of 2001, a telephone survey was carried out among most of the hospitals in which parenteral nutrition is habitually prepared. The survey included questions on who was in charge of the prescription, the use of different solutions, addition of supplements (carnitine, heparin and glutamine), as well as information on the shelf-life of the mixtures. Subsequently, the results of the survey were compared with the following guidance documents: "Enteral and parenteral nutrition in paediatrics", drafted under the auspices of the Spanish Association for Paediatric Gastroenterology, Hepatology and Nutrition (2000) and the "Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients"/"Nutrition support practice manual" from the American Society for Parenteral and Enteral Nutrition (1998).
Of the 48 hospitals surveyed, paediatric parenteral nutrition was not prepared in 12 of them. the number of food bags prepared daily correlated directly with the size of the hospital. In all cases, the paediatricians were responsible for prescription. In 87% of the centres, this prescription was customized (i.e. solutions adapted to each individual patient). All of the hospitals used dextrose as the source of carbohydrates and specific amino acid solutions for paediatric medicine. Basically, lipid emulsions with long chain triglycerides were used in 65% of cases and another 19% used physical mixtures of MCT and LCT. Only half of the hospitals routinely used all-in-one mixtures. Inorganic phosphate continued to be used in most cases (78%) versus sodium glycerol phosphate. Vitamins and trace elements were added daily in 65% of the hospitals, with alternate administration in the remainder. In half of the centres, heparin was added to the mixture and carnitine in 27%. For 40% of the centres responding to the survey, the solution had to be used within 24 hours of its preparation; 11% did not indicate the shelf-life.
Although parenteral nutrition is prescribed by the paediatricians on all occasions, the preparation protocols differ significantly between hospitals. Standardization is exceptional. It is noteworthy that all-in-one mixtures are only used in half of the hospitals surveyed. We suggest the creation of a multidisciplinary working party (pharmacists, paediatricians, neonatologists) in order to draw up protocols for the preparation of paediatric parenteral nutrition.
西班牙儿科肠外营养的处方和配制存在很大差异。
确定西班牙儿科肠外营养的处方和配制方式。
在2001年第一季度，对大多数惯常配制肠外营养的医院进行了电话调查。调查问题包括谁负责处方、不同溶液的使用、补充剂（肉碱、肝素和谷氨酰胺）的添加，以及混合液的保质期信息。随后，将调查结果与以下指导文件进行比较：由西班牙儿科胃肠病学、肝病学和营养学会主持起草的《儿科肠内和肠外营养》（2000年）以及美国肠外和肠内营养学会的《成人和儿科患者肠外和肠内营养使用指南》/《营养支持实践手册》（1998年）。
在接受调查的48家医院中，有12家未配制儿科肠外营养。每日配制的营养液袋数量与医院规模直接相关。在所有情况下，儿科医生负责处方。在87%的中心，这种处方是定制的（即根据每个患者的情况调整溶液）。所有医院都使用葡萄糖作为碳水化合物来源，并使用儿科专用氨基酸溶液。基本上，65%的病例使用长链甘油三酯脂肪乳剂，另有19%使用中链甘油三酯和长链甘油三酯的物理混合物。只有一半的医院常规使用全合一混合液。在大多数情况下（78%）继续使用无机磷酸盐而非甘油磷酸钠。65%的医院每日添加维生素和微量元素，其余医院交替添加。在一半的中心，混合液中添加了肝素，27%添加了肉碱。对于40%回复调查的中心，溶液必须在配制后24小时内使用；11%未标明保质期。
尽管儿科医生在所有情况下都负责肠外营养的处方，但各医院的配制方案差异显著。标准化情况罕见。值得注意的是，在接受调查的医院中只有一半使用全合一混合液。我们建议成立一个多学科工作小组（药剂师、儿科医生、新生儿科医生），以制定儿科肠外营养的配制方案。
