首页|胃癌根治术后吻合口狭窄伴再喂养综合征风险患者的营养支持与药学监护

胃癌根治术后吻合口狭窄伴再喂养综合征风险患者的营养支持与药学监护

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目的:探讨胃肠外科临床药师的工作模式与药学监护重点.方法:以胃癌根治术后吻合口狭窄伴再喂养综合征(RFS)风险患者的营养支持治疗为例,阐述临床药师在胃肠外科开展药学工作的切入点及药学监护的重点.结果:经营养风险筛查和评估,临床药师发现该患者重度营养不良,存在RFS风险,建议在给予营养支持前先纠正电解质紊乱,同时给予维生素B1 预防韦尼克脑病.随后遵循"先少后多、先慢后快、逐步过渡"的原则,协助医生制定个体化营养支持方案,并进行全程药学监护.经过16天的治疗,患者可部分经口进食,营养状况较前改善,予以出院,择期化疗.结论:重度营养不良患者启动营养支持时需警惕RFS的发生.个体化的营养支持方案与药学监护,能充分发挥临床药师的专业特色,有利于患者从营养支持中得到更多获益,为促进临床营养支持的合理开展发挥积极作用.
Nutritional Support and Pharmaceutical Monitoring for Patients with Anastomotic Stenosis and Risk of Refeeding Syndrome after Radical Gastrectomy
Objective:To explore the working pattern and pharmaceutical monitoring emphasis of clinical pharmacists in gastrointestinal surgery department.Methods:Taking the nutritional support treatment in patients with anastomotic stenosis and risk of refeeding syndrome(RFS)after radical gastrectomy as an example,the cut-in points and emphasis of pharmaceutical monitoring for clinical pharmacists working in the gastrointestinal surgery department were elaborated.Results:Through screening and evaluation of nutritional risks,clinical pharmacists identified that the patient was severely malnourished and had risk of RFS,and suggested to correct electrolyte disturbances,with concurrent treatment with vitamin B1 to prevent Wernicke encephalopathy,before nutritional support.Then,the pharmacists assisted physicians in formulating individualized nutritional support scheme,according to the principle of"gradual change from small amounts to large amounts and low speed to high speed",and carried out pharmaceutical monitoring throughout the process.The patient responded to the 16 days of treatment with oral intake of some food and improved nutritional status,and was discharged with elective chemotherapy.Conclusion:For patients with severe malnutrition,the nutritional support should be initiated with attention to RFS.Individualized nutritional support and pharmaceutical monitoring can give full play to the professional characteristics of clinical pharmacists,help patients get more benefits from nutritional support,and play an active role in promoting the rational development of clinical nutritional support.

gastric canceranastomotic stenosisrefeeding syndromenutritional supportpharmaceutical monitoring

石迎迎、徐玲、冀波、陈楠

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河南中医药大学第五临床医学院(郑州人民医院),郑州 450000

胃癌 吻合口狭窄 再喂养综合征 营养支持 药学监护

河南省医学科技攻关计划项目

LHGJ20200679

2024

中国合理用药探索
中国执业药师协会

中国合理用药探索

影响因子:0.62
ISSN:2096-3327
年,卷(期):2024.21(1)
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