Mundi Manpreet S, Nystrom Erin M, Hurley Daniel L, McMahon M Molly
1 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
2 Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.
JPEN J Parenter Enteral Nutr. 2017 May;41(4):535-549. doi: 10.1177/0148607116667060. Epub 2016 Sep 1.
Despite the high prevalence of malnutrition in adult hospitalized patients, surveys continue to report that many clinicians are undertrained in clinical nutrition, making targeted nutrition education for clinicians essential for best patient care. Clinical practice models also continue to evolve, with more disciplines prescribing parenteral nutrition (PN) or managing the cases of patients who are receiving it, further adding to the need for proficiency in general PN skills. This tutorial focuses on the daily management of adult hospitalized patients already receiving PN and reviews the following topics: (1) PN basics, including the determination of energy and volume requirements; (2) PN macronutrient content (protein, dextrose, and intravenous fat emulsion); (3) PN micronutrient content (electrolytes, minerals, vitamins, and trace elements); (4) alteration of PN for special situations, such as obesity, hyperglycemia, hypertriglyceridemia, refeeding, and hepatic/renal disease; (5) daily monitoring and adjustment of PN formula; and (6) PN-related complications (PN-associated liver disease and catheter-related complications).
尽管成年住院患者中营养不良的发生率很高,但调查仍不断报告称,许多临床医生在临床营养方面的培训不足,因此对临床医生进行有针对性的营养教育对于实现最佳患者护理至关重要。临床实践模式也在不断演变,更多学科开始开具肠外营养(PN)处方或管理接受肠外营养患者的病例,这进一步增加了掌握一般PN技能的必要性。本教程重点关注已接受PN的成年住院患者的日常管理,并回顾以下主题:(1)PN基础知识,包括能量和容量需求的确定;(2)PN的宏量营养素含量(蛋白质、葡萄糖和静脉脂肪乳剂);(3)PN的微量营养素含量(电解质、矿物质、维生素和微量元素);(4)特殊情况下PN的调整,如肥胖、高血糖、高甘油三酯血症、再喂养以及肝脏/肾脏疾病;(5)PN配方的每日监测和调整;以及(6)PN相关并发症(PN相关肝病和导管相关并发症)。