居家靜脈營養服務：二十年回顧

Home Parenteral Nutrition Services: 20 Years' Experience in a Medical Center

林麗真(Lie-Jane Lin) ； 謝德瀅(Der-Yirng Hsieh) ； 林明燦(Ming-Tsan Lin) ； 賴鴻緒(Hong-Shiee Lai) ； 倪衍玄(Yen-Hsuan Ni) ； 陳燕惠(Yen-Hui Chen)

《台灣醫學》 11卷2期 (2007/03) Pp. 119-129

https://doi.org/10.6320/FJM.2007.11(2).01

摘要

1986年2月起本院提供無菌調配居家靜脈營養服務(HPN)，希望20年來累積123名個案（成人69名、小兒54名）的資料與經驗和大家分享，以提昇醫療品質、增進病友安全與療效。營養醫療小組(NST)做回溯性的病歷回顧，並與國外文獻對照比較與探討。初期（1986-1990年）提供HPN服務8名個案（成人3名、小兒5名），用HPN的主要適應症除1名小兒為腹膜腔後腫瘤之外，其餘均為腸胃疾病。成人都因高齡與原疾病而死亡。小兒年齡小，除1個案經長期用HPN改善後自然攝食外，其餘3名個案失聯。中期（1991-1997年）有成人5名、小兒18名，近期（1998-2006年2月）有成人61名、小兒31名。迄今持續用HPN的有12名（成人4名、小兒8名）、改用腸道營養（含經口攝食）的有45名（成人18名、小兒27名）、有63名（成人47名、小兒16名）不幸死亡（佔51.2%）。追蹤、評估近期使用居家靜脈營養個案的結果，無可避免地，長期使用HPN有相當比率的病友SGOT升高（佔67%）、ALP升高（佔40%）、SGPT升高（佔87%）。發生併發症比率高（導管感染率佔40%、膽汁鬱積佔20%），但在NST團隊照護下，所給HPN的各營養素符合每日需要量，維持大部分個案之血糖、血清尿素氮、血清鈉、鉀、鈣離子都維持正常範圍，87%個案的血清氯、磷酸根、鎂離子維持正常，73%個案的血清白蛋白及三甘油酯值正常，相較於國外的HPN服務狀況，本院在併發症的發生比率仍偏高，是可以再改善處。本院提供HPN服務20年，於不同時間點取樣所得評估結果殊異，但推行經驗值得國內推行HPN服務之參考。研究中最大的困難是早期個案因資料不全、不活動病歷或縮影而有限制。未來建議以程式自動化登錄取代人工，並及時分析資料，使研究、應用上更有效率。

關鍵字

居家靜脈營養 ； 營養醫療小組 ； 營養評估 ； 靜脈營養配方 ； 醫療品質與成效 ； 病友安全

並列摘要

Since Feb. 1986 we have provided Home Parenteral Nutrition (HPN) for 123 cases. We would like to share our experiences to promote healthcare quality and patient safety. Our NST (Nutrition Support Team) reviewed patients’ medical records retrospectively and compared our results with those published in the literature. During the first period (1986-1990) we provided HPN service to eight patients (three adults, five children). The indication of HPN was for GI disease except one girl suffering from retroperitonealtumor. Among our five pediatric patients, only one girl received long term HPN and advanced to take food orally, one girl expired and the others lacked follow-up. Those adult patients expired due to old age and the underlying diseases. There were five adults and 18 children in the second period (1991-1997) and 61 adults and 31 children in the third period (1998-2006). Forty-five patients (18 adults, 27 children) progressed to enteral feeding and unfortunately 63 patients (47 adults, 16 children) expired. We have reviewed and evaluated these HPN cases to detect elevated SGOT (67%), SGPT (87%), and ALP (40%) after long-term HPN. The nosocomial catheter infection rate was 40%, and the incidence of cholestasis was 20%. However, most cases received appropriate HPN formulae to maintain normal serum level of sugar, BUN, sodium, potassium, and calcium. Eighty seven percent maintained normal serum hloride, phosphorus, and magnesium while 73% maintained normal serum ABL and TG. In comparison with results published by foreign HPN services, our incidence of complication was relatively higher. Our hospital has provided HPN services for more than 20 years. The limitation of our study was incomplete data tracking. Our next step will be to interface our HPN database with a hospital computer system. Results will be downloaded automatically via HIS (Health Information System of our hospital). As a result we can collect perspective data and eliminate redundancy of manual transcription.

並列關鍵字

home parenteral nutrition HPN ； enteral nutrition ； nutrition support team NST ； catheter infection rate ； HPN quality