早產兒靜脈營養醫療

Parenteral Nutrition Support for Preterm Infants

本研究的目的是要評估早產兒營養醫療時所用全靜脈營養（TPN）配方的合理性，供作日常作業加強例行監測的指引，以提昇早產兒靜脈營養醫療之品質。自91年11月21日至92年2月20日共3個月，由閱讀本院加護病房使用靜脈營養的早產兒之紙本病歷與院內網路搜尋其電子病歷（檢醫部報告、病摘、累積報告、手術報告、診斷等）及TPN處方組成，填表、輸入Excel檔，整理後逐項營養評估與檢討。收案之早產兒23名（男12、女11）。極低出生體重者及非常低出生體重者各佔34.8%，低出生體重者佔21.7%，正常出生體重者僅佔8.7%。使用TPN期間4-64日，>60日者佔8.7%，31-60日者佔26%，11-30日者佔47.8%，<10日者佔17.3%。由TPN提供早產兒的營養素中，熱量符合文獻建議劑量範圍（RDA）者佔69.6%，< RDA者佔30.4%。葡萄糖量符合RDA者佔91.3%，< RDA者佔8.7%。蛋白質量符合RDA者佔95.7%，< RDA者佔4.3%。脂肪量符合RDA者佔78.3%，< RDA者佔21.7%。非蛋白質熱量對氮素比值符合RDA者34.8%，< RDA者佔47.8%，> RDA者佔17.4%。血清檢驗值方面；鉀在正常值（normal level; NL）者佔78.3%，< NL者佔8.7%，> NL者佔13%。血清鈉在NL者佔56.5%，< NL者佔43.5%。血清氯在NL者佔52.2%，< NL者佔17.4%，> NL者佔30.4%。血清鈣在NL者佔87%，< NL者佔13%。血清磷在NL者佔60.9%，< NL者佔30.4%，> NL者佔4.3%。個案中併發不良反應者佔30.4%（7人），血清電解質不平衡者眾，藥師應加強監測並適時建議醫師調整PN輸液之電解質含量，對於需較長期使用靜脈營養的早產兒，醫療團隊也應加強日常監測血糖、SGOT、SGPT、ALP、T-Bil和D-Bil與病患的臨床表徵，以提昇早產兒靜脈營養醫療之品質和增進病患安全。

The objective of this study was to monitor and evaluate the rationall of total parenteral nutrition support for hospitalized preterm infants in order to set up the monitoring guidelines to improve the nutrition support care (NSC) in the future routines. Firstly, we monitored and documented 23 preterm infants (12M, 11F) in the NICU (Neonatal Intensive Care Unit) who were supported with parenteral nutrition solutions (TPNs) during the period of Nov. 21, 2002 to Feb. 20, 2003 (3 months). Then, retrieved the relevant data from the charts and electronic medical records via the e-Hospital website of NTUH. We also examined the laboratory data, progress note, keyed in an Excel sheet and discussed with the on-duty nurses and residents to clarify the NSC outcome for the specific patient. Furthermore, we evaluated TPNs against the corresponding patients' complications and underlying disorders. Among these 23 cases collected, 91.3% were born with low to extremely low birth weight and administered TPNs for 4-64 days and fed well till discharge. The percentage of cases who used TPNs to provide nutrients that respectively met the recommended daily allowance and requirements (RDA) were 69.6% for individual total calories, 91.3% (for dextrose), 95.7% (for amino acids), 78.3%(for lipids). During NSC, 30.4% and 43.5% of the cases decreased serum phosphate and serum sodium respectively to abnormal level. Also, 30.4% of these cases increased their serum chloride to higher than 108 mmol/L. The incidence of complications increased 21.7%, 12.7%, 21.7% and 21.7% respectively for elevation of SGOT, SGPT, T-Bil, and D-Bil. Thus, it is necessary to closely monitor, evaluate and modulate the TPNs formula for the preterm newborns during TPN support to prevent complications and to further improve the patient safety and quality of care as well.