- 期刊
成人全靜脈營養標準配方組成差異對營養支持療效及併發症之影響
Effect of Different Components of the Total Parenteral Nutrition on Clinical Efficacy and Complications
摘要
目的：比較某區域醫院不同成人全靜脈營養（TPN）配方差異對營養支持治療效果及高血糖、膽汁鬱積等併發症影響。方法：以2016年使用舊TPN標準配方病人為對照組，2017年則為實驗組。觀察兩組血清白蛋白、血糖、血清全膽紅素在每週平均濃度差異及每週發生高血糖症及高血清總膽紅素血症人數比例，檢視對療效及併發症影響。結果：對照組及實驗組各32及33人，由TPN攝取營養組成有顯著差異為葡萄糖（3.03±0.35vs. 2.31±0.50 g/kg/day, p ＜0.001）及熱量（28.2±3.4vs. vs. 25.2±4.4 kcal/kg/day, p ＜0.001）。療效由血清白蛋白濃度每週比較無顯著差異。平均血糖每週在兩組無顯著差異；高血糖人數比例在第三週對照組高於實驗組（54.5%vs. 6.3%, p =0.005）。膽汁鬱積以血清總膽紅素來監測，第三週對照組顯著高於實驗組（4.23±5.91 vs.0.85±1.39mg/dL, p =0.037）；比較每週出現高血清總膽紅素血症人數比例，第三週對照組顯著高於實驗組（54.5%vs.6.3% p =0.005）。結論：新標準配方在調整醣類與胺基酸比例後，在血糖及血清總膽紅素濃度似乎有較穩定趨勢，可見標準配方調整後，對於避免TPN治療期間病人出現併發症具正面效益，但是否對營養支持有同樣效益尚待進一步研究證實。
並列摘要
Objective: To examine the influences of difference in total parenteral nutrition (TPN) standard formulations on the treatment effects of nutrition support and complications (e.g., hyperglycemia and cholestasis) in adult patients of a regional hospital. Methods: Patients treated with conventional TPN standard formula in 2016 were allocated to the control group, while those treated with newly-designed standard formula in 2017 were allocated to the experimental group. We investigated the average weekly concentration of serum albumin, blood glucose, and total serum bilirubin, as well as the proportion of the patients with hyperglycemia and hyper-total-bilirubinemia between the two groups. Results: A total of 32 patients were allocated to the control group, and 33 patients were allocated to the experimental group. Significant differences were found in glucose levels (3.03±0.35vs. 2.31±0.5g/kg/ day, p＜0.001) and calories (28.2±3.4 vs. 25.2±4.4 kcal/kg/day, p＜0.001). The weekly serum albumin concentration and the average blood glucose showed no significant difference between the two groups. On the other hand, the proportion of hyperglycemia in the control group was higher than in the experimental group in the third week (54.5% vs. 6.3%, p=0.005). The total serum bilirubin in the control group was significantly higher than the experimental group (4.23±5.91 vs. 0.85±1.39mg/dL, p=0.037), and the proportion of hyper-total bilirubinemia in the control group was significantly higher than the experimental group in the third week (54.5% vs. 6.3% p=0.005). Conclusion: Through the adjustment of amino acids and glucose ratio of the standard formula, blood glucose and bilirubin tended to be more stabilized, suggesting that the adjustment has positive effects in avoiding complications during TPN treatment. Whether the change contributes to nutrition support of similar effects is still to be examined and confirmed.