Camarero E, Varea D, Fernández Alvarez J A, Lamas M J, Sanmartín P, Muñoz V
Sección de Nutrición y Dietética (Servicio de Endocrinología y Nutrición), Complejo Hospital General de Galicia/Hospital Médico-Quirúrgico de Conxo.
Nutr Hosp. 1994 Nov-Dec;9(6):394-8.
To assess the degree of compliance with standards defined for Total Parenteral Nutrition (TPN) quality control in our hospital in the two-year period 1991-1992.
All available information was assessed concerning 52 patients (32 men and 17 women) for whom a TPN course was prescribed in relation with certain pre-set indications. These patients received a total of 1140 TPN units with the TPN lasting an average of 21.9 days (range, 1-73 days). Monitoring was done by the Nutrition and Diet Section. The degree of compliance was assessed with the standards model proposed by the Providence Medical Center, Portland (USA) (PMCP) with 24 parameters (PM): indications, initiation in the first 24 hours, nutritional assessment in the first 24 hours, period of the TPN, metabolic complications (14 PM), septic complications (3 PM), nutritional consequences (2 PM) and TPN losses. All parameters were appraised and admitted, except for urea, which was corrected to standard values of our Laboratory (< 44 mg/dl), with Transferrin evaluation instead of iron binding capacity (TIBC), taking as compliance standard a figure of > 190 mg/dl. All analytical calculations were carried out in our Central Laboratory Service.
Of all the parameters, the following were discarded, not being calculated on a routine basis: total CO2, serous magnesium, urinary uric nitrogen, nitrogen balance, positive hemocultures, catheters and TPN losses. Levels of compliance varied between 31.9% and 100%, with 8 parameters within the standards (Initiation, 100%; evaluation in first 24 hours, 100%; extent, 100%; creatinine, 100%; total bilirubin, 92.2%; cholesterol, 99.5%; transferrin, 35.9%). Seven parameters fell short (Na, 88.1%; K, 92.9%; Cl, 89.3%; Urea, 54.4%; Glucose, 96.4%; P, 94.1%; Triglycerides, 71.9%).
We infer from our study that there is a need to make use of a large part of the indicators described in the literature as indicators for quality guarantee of a TPN program, and the use of new parameters must be assessed in normal monitoring.
评估我院1991 - 1992年两年期间全胃肠外营养（TPN）质量控制标准的遵守程度。
评估了52例患者（32例男性和17例女性）的所有可用信息，这些患者因某些预设适应症接受了TPN疗程。这些患者共接受了1140个TPN单位，TPN平均持续21.9天（范围1 - 73天）。由营养与饮食科进行监测。根据美国波特兰普罗维登斯医疗中心（PMCP）提出的标准模型评估遵守程度，该模型有24个参数（PM）：适应症、24小时内开始、24小时内营养评估、TPN疗程、代谢并发症（14个PM）、感染并发症（3个PM）、营养后果（2个PM）和TPN损耗。除尿素外，所有参数均进行评估并认可，尿素校正为我院实验室标准值（<44 mg/dl），用转铁蛋白评估代替铁结合能力（TIBC），以>190 mg/dl为遵守标准。所有分析计算均在我院中央实验室进行。
在所有参数中，以下参数未常规计算，被排除：总二氧化碳、血清镁、尿尿酸氮、氮平衡、血培养阳性、导管和TPN损耗。遵守水平在31.9%至100%之间变化，8个参数符合标准（开始，100%；24小时内评估，100%；范围，100%；肌酐，100%；总胆红素，92.2%；胆固醇，99.5%；转铁蛋白，35.9%）。7个参数未达标（钠，88.1%；钾，92.9%；氯，89.3%；尿素，54.4%；葡萄糖，96.4%；磷，94.1%；甘油三酯，71.9%）。
我们从研究中推断，需要采用文献中描述的大部分指标作为TPN计划质量保证的指标，并且在正常监测中必须评估新参数的使用。
