全靜脈營養代謝性異常及併發症

Metabolic Abnormalities and Complications in Total Parenteral Nutrition

全靜脈營養（Total Parenteral Nutrition簡稱TPN）導致的中心靜脈導管敗血症和代謝性異常之發生率，國內外均有許多文獻探討。但探討具症狀的代謝性併發症發生率的文章則不多，國內亦無相關文獻發表。本研究分析2001年一年期間226個使用TPN的成年患者，代謝性異常之發生率，發現35.4%的病患，在接受TPN治療期間，發生至少一項代謝性異常。其中高血糖（＞300mg/dL）佔20.8%，低血糖（＜65mg/dL）佔0.9%，高血鈉（＞150mEq/L）佔3.1%，低血鈉（＜125mEq/L）佔3.1%，高血鉀（＞5.5mEq/L）佔2.2%，低血鉀（＜3mEq/L）佔11.9%，高血磷（＞5.5mg/dL）佔2.2%，低血磷（＜2mg/dL）佔10.2%，而低血鎂（＜1.5mg/dL）佔0.45%。但沒有觀察到具症狀的代謝性併發症。本研究發現使用TPN引起的代謝性異常發生率不低，但適當的監測，可以預防具症狀的代謝性併發症的發生。

The incidence of catheter-related sepsis and metabolic derangements induced by total parenteral nutrition had been studied extensively. However, the incidence of symptomatic metabolic complications was seldom discussed in Taiwan. Two hundred and twenty six adult patients received TPN were recruited during 1-year period. The incidence of metabolic abnormalities were identified and recorded. At least one metabolic abnormality was found in 35.4% of the patients. The data were hyperglycemia(>300mg/dL), 20.8%; hypoglycemia(< 65mg/dL), 0.9%; hypernatremia (>150mEq/L), 3.1%; hyponatremia(<125mEq/L), 3.1%; hyperkalemia(> 5.5mEq/L), 2.2%; hypokalemia(< 3mEq/L), 11.9%; hyperphosphatemia(> 5.5mg/dL), 2.2%; hypophosphatemia(< 2mg/dL), 10.2% and hypomagnesemia(< 1.5mg/dL), 0.45%. No metabolic abnormalities associated clinical event were detected. Our data indicate that the incidence of metabolic abnormalities induced by TPN are high. However, symptomatic metabolic complications can be prevented by appropriate monitoring system.