低出生体重儿应用标准化肠外营养处方及配置流程优化研究

Research on the standardization of parenteral nutrition prescriptions and optimization of preparation processes for infants with low birth weight

摘要

目的 旨在研究低出生体重儿使用标准化肠外营养与个体化肠外营养配置流程的时间效率和对体重增长的影响。方法 选取2015年下半年至2020上半年在我院新生儿科住院的162名低出生体重儿为研究对象,其中标准化组82例,对照组80例.前者采用标准化肠外营养配方,后者采用个体化肠外营养配方,比较两组配方的从开写医嘱到确认医嘱的时间、配置完成时间及对患儿体重增长的影响。结果 标准化组共应用1553次,对照组共应用1427次;标准化组从医师开处方到护士确认医嘱时间每人每次所需时间平均为(3.82±1.65)min,对照组为(6.20±2.23)min(t=7.735,P<0.001);标准化组护士摆药到配制完成每人每次所需时间平均为(30.30±13.70)min;对照组为(46.50±16.30)min(t=6.854,P<0.001).标准化肠外营养组从医生开处方到护士确认医嘱时间减少38.39%,从护士摆药到配置完成所需要的时间平均减少34.84%.标准化组体重增长大于对照组(t=22.530,P<0.001),并发症发生率小于对照组(χ²=4.691,P=0.030)。结论 本研究表明,标准化肠外营养配方在配置流程方面表现更精简,时间效率更佳,更好地增加低出生体重儿的体重.

Abstract

Objective This study aimed at studying the time efficiency of standardized parenteral nutrition versus individualized parenteral nutrition formulation processes in low birth weight infants and its impact on weight gain. Methods A total of 162 low birth weight infants hospitalized in the Neonatology Department of our hospital from the second half of 2015 to the first half of 2020 were selected as the study subjects. Among them, 82 cases were in the standardized group and 80 cases in the control group. The former used a standardized parenteral nutrition formula, while the latter used an individualized parenteral nutrition formula. The study compared the time taken from writing the medical order to confirming the order, the time taken to complete the preparation, and the impact on the weight gain of the infants between the two groups. Results The standardized group had a total of 1553 applications, while the control group had a total of 1427 applications; the average time required for each person in the standardized group from the physician prescribing to the nurse confirming the order was 3.82±1.65 minutes, compared to 6.20±2.23 minutes in the control group (t=7.735, P<0.001); the average time required for nurses in the standardized group to prepare medication was 30.30±13.70 minutes, while in the control group it was 46.50±16.30 minutes (t=6.854, P<0.001). The time from the doctor's prescription to the nurse confirming the medical order in the standardized parenteral nutrition group was reduced by 38.39%. The average time from the nurse dispensing medication to the completion of preparation was reduced by 34.84%. A comparison of weight gain between the two groups of children showed that the standardized group had a greater weight increase than the control group (t=22.530, P<0.001), and the incidence of complications was lower than that of the control group (χ²=4.691, P=0.030). Conclusion This study indicates that standardized parenteral nutrition formulas have a more streamlined preparation process, greater time efficiency, and better contribute to weight gain in low birth weight infants.

关键词

低出生体重儿 / 标准化肠外营养 / 配置流程 / 时间效率 / 体重增长 / 并发症

Key words

low birth weight infants / standardized parenteral nutrition / preparation process / time efficiency / weight gain / complications

参考文献

[1] 蔡威, 汤庆娅, 冯一, 等. 中国新生儿营养支持临床应用指南[J]. 中华小儿外科杂志, 2013, 34(10): 782-787.

[2] Mihatsch W, Braegger C, Bronsky J, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition[J]. Clin Nutr, 2018, 37(6 Pt B): 2303-2305.

[3] Mihatsch W, Shamir R, Goudoever J, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: guideline development process for the updated guidelines[J]. Clin Nutr, 2018, 37(6 Pt B): 2306-2308.

[4] Joosten K, Embleton N, Yan W, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: energy[J]. Clin Nutr, 2018, 37(6 Pt B): 2309-2314.

[5] Goudoever J, Carnielli V, Darmaun D, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: amino acids[J]. Clin Nutr, 2018, 37(6 Pt B): 2315-2323.

[6] Lapillonne A, Fidler M, Goulet O, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutritionl: lipids[J]. Clin Nutr, 2018, 37(6 Pt B): 2324-2336.

[7] Mesotten D, Joosten K, Kempen A, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: carbohydrates[J]. Clin Nutr, 2018, 37(6 Pt B): 2337-2343.

[8] Jochum F, Moltu S, Senterre T, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: fluid and electrolytes[J]. Clin Nutr, 2018, 37(6 Pt B): 2344-2353.

[9] Domellof M, Szitanyi P, Simchowitz V, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Iron and trace minerals[J]. Clin Nutr, 2018, 37(6 Pt B): 2354-2359.

[10] Mihatsch W, Fewtrell M, Goulet O, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Calcium, phosphorus and magnesium[J]. Clin Nutr, 2018, 37(6 Pt B): 2360-2365.

[11] Bronsky J, Campoy C, Braegger C. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Vitamins[J]. Clin Nutr, 2018, 37(6 Pt B): 2366-2378.

[12] Hill S, Ksiazyk J, Prell C, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: home parenteral nutrition[J]. Clin Nutr, 2018, 37(6 Pt B): 2401-2408.

[13] Riskin A, Picaud J, Shamir R. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: standard versus individualized parenteral nutrition[J]. Clin Nutr, 2018, 37(6 Pt B): 2409-2417.

[14] Hartman C, Shamir R, Simchowitz V, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: complications[J]. Clin Nutr, 2018, 37(6 Pt B): 2418-2429.

[15] 国家药典委员会 编. 中华人民共和国药典 2020年版二部[M]. 北京: 中国医药科技出版社, 2020: 1-1899.

[16] 黄小伟, 吴虹. 脐静脉营养联合早期肠内母乳喂养在早产低出生体重儿治疗中的应用效果[J]. 当代医药论丛, 2023, 21(16): 91-94.

[17] Ray S. NICE guideline review: neonatal parenteral nutrition (NG154)[J]. Arch Dis Child Educ Pract Ed, 2021, 106(5): 292-295.

[18] 张小雯, 刘彦彦. 系统化喂养管理结合静脉营养干预在低出生体重早产儿中的应用研究[J]. 当代护士:上旬刊, 2023, 30(8): 71-74.

[19] 吴如成, 姜海云. «医疗机构药事管理规定»解读[J]. 中国医药科学, 2011, 1(13): 150.

[20] 中华人民共和国卫生部. 静脉用药集中调配质量管理规范[M]. 人民卫生出版社, 2010: 1-30.

[21] 方宝霞, 吴松潮, 刘菁, 等. 静脉用药集中调配中心全面质量管理体系的构建与应用[J]. 中国药房, 2023, 34(15): 1798-1803.

[22] 广东省药学会. 肠外营养临床药学共识(第二版)[J]. 今日药学, 2017, 27(5): 289-303.

基金资助

北京市科技计划课题(Z201100005420032)