Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Hospital Clínico de la Universidad de Chile, Santiago, Chile.
Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Nutrition. 2018 May;49:7-12. doi: 10.1016/j.nut.2017.11.023. Epub 2017 Dec 7.
Parenteral nutrition (PN) prescription can be challenging in patients with complex conditions and has potential complications.
To assess PN prescription, monitoring, and PN-related complications in a Canadian acute care setting.
This was a prospective cohort study in which patients receiving PN were assessed by an auditor for nutritional status, PN-related prescription, monitoring, and complications. In addition, length of stay and mortality were recorded.
147 patients (mean ± SD 56.1 ± 16.4 y) with complex diseases (Charlson comorbidity index, median [p25-p75] 2 [1-4]) were enrolled. Before starting PN, 18.6%, 63.9%, and 17.5% of patients were classified as subjective global assessment A, B, and C, respectively. Body mass index remained unchanged during the period on PN. On average, 89% and 73% of patients received <90% of their energy and protein requirements, respectively, but 65% received oral or enteral nutrition at some point during PN. The average daily energy provided by PN increased and stabilized on day 10, reaching 87.2 ± 20.1% of the requirements. Line sepsis (6.8% of patients) and hyperglycemia (6.9%) were the most common complications. The overall mortality was 15.6%. For those alive, length of stay was 30 (range: 4-268) d. PN was discontinued because of transitioning to an oral diet (56.6%), enteral nutrition (17.6%), home PN (14.7%), palliative care (5.1%), death (4.4%), or other (1.5%).
Most patients were malnourished at the start of PN. Energy and protein provided from PN were less than requirements, and the goals were reached with delay. Mortality was high, possibly as a result of complex diseases.
肠外营养（PN）的处方在复杂病情的患者中可能具有挑战性，并且存在潜在的并发症。
评估加拿大急性护理环境中 PN 的处方、监测和与 PN 相关的并发症。
这是一项前瞻性队列研究，其中由审核员评估接受 PN 的患者的营养状况、与 PN 相关的处方、监测和并发症。此外，还记录了住院时间和死亡率。
共纳入 147 例（平均年龄 ± 标准差 56.1 ± 16.4 岁）患有复杂疾病（Charlson 合并症指数中位数 [p25-p75] 2 [1-4]）的患者。在开始 PN 之前，分别有 18.6%、63.9%和 17.5%的患者被归类为主观整体评估 A、B 和 C。在 PN 期间，体重指数保持不变。平均而言，分别有 89%和 73%的患者接受了 <90%的能量和蛋白质需求，但有 65%的患者在接受 PN 的某个时候接受了口服或肠内营养。PN 提供的平均每日能量增加并在第 10 天稳定下来，达到需求的 87.2 ± 20.1%。最常见的并发症是导管相关血流感染（6.8%的患者）和高血糖症（6.9%）。总的死亡率为 15.6%。对于存活的患者，住院时间为 30（范围：4-268）天。PN 因转为口服饮食（56.6%）、肠内营养（17.6%）、家庭 PN（14.7%）、姑息治疗（5.1%）、死亡（4.4%）或其他原因（1.5%）而停用。
大多数患者在开始 PN 时存在营养不良。PN 提供的能量和蛋白质少于需求，且达标时间延迟。死亡率较高，可能是由于复杂的疾病。
