Australasian society for parenteral and enteral nutrition (AuSPEN) adult vitamin guidelines for parenteral nutrition

澳大利亚肠外与肠内营养学会（AuSPEN）肠外营养成人维生素指南

Emma J Osland ； Azmat Ali ； Truc Nguyen ； Melvyn Davis ； Lyn Gillanders

《Asia Pacific Journal of Clinical Nutrition》 25卷3期 (2016/09) Pp. 636-650

https://doi.org/10.6133/apjcn.022016.05

摘要

背景与目的：该项工作是对AuSPEN 1999年指南针对接受肠外营养（PN）的成人患者补充微量元素进行逐步审查的第二部分。方法与研究设计：进行系统文献综述，基于现有证据，同时考虑澳大利亚和新西兰（NZ）实践环境的特殊因素提出了推荐。对每一项证据支撑的推荐的强度进行了评估。一个多学科指导委员会和外部评审员对指南提供了反馈意见。结果：通过现有文献综述，发现在澳大利亚和新西兰，现有的肠外复合维生素制剂，对常规接受PN且复合维生素作为PN处方一部分的成年人，足以避免不足，且不会造成毒性。维生素D是澳大利亚和新西兰人群最容易缺乏的维生素。结论：维生素是肠外营养的重要组成部分，应为所有接受PN的患者提供维生素。除了推荐的每年监测维生素D外，常规监测维生素含量，对接受常规复合维生素制剂的患者未必是必须的。当评估、开处方以及监测接受PN的患者时，临床评估是个重要的因素。有待进一步研究的领域也已经确定。

關鍵字

维生素 ； 指南 ； 肠外营养 ； 维生素D ； 复合维生素

並列摘要

7Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Background and Objectives: This work represents the second part of a progressive review of AuSPEN's 1999 Guidelines for Provision of Micronutrient Supplementation in adult patients receiving parenteral nutrition. Methods and Study Design: A systematic literature review was undertaken and recommendations made based on the available evidence and with consideration to specific elements of the Australian and New Zealand (NZ) practice environment. The strength of evidence underpinning each recommendation was assessed. A multidisciplinary steering committee and external reviewers provided feedback on the guidelines. Results: On review of the available literature it appears that the parenteral multivitamin preparations presently available in Australia and NZ are to sufficient avoid deficiency without causing toxicity in most clinical situations for adults receiving PN when provided regularly as part of the PN prescription. Vitamin D is the most vulnerable vitamin for the Australian and NZ PN population. Conclusions: Vitamins are an essential component of PN and should be provided from commencement for all patients receiving PN. With the exception of vitamin D, which is recommended to be monitored annually, routine monitoring of vitamin levels is unlikely to be necessary in patients receiving regular parenteral multivitamin preparations. Clinical judgement is an important element when assessing, prescribing and monitoring patients receiving PN. Areas requiring further research have been identified.

並列關鍵字

vitamins ； guidelines ； parenteral nutrition ； vitamin D ； micronutrients