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The main clinical research advances of critical care in 2023 includes: new trials of Chinese herbal medicine, hydroxocobalamin (vitamin B12), methylene blue as well glucocorticoids have shown the potential to improve outcomes of patients with sepsis and septic shock; international committees launched new global definition and managing recommendations for acute respiratory distress syndrome (ARDS). Besides, a cluster of new evidences has emerged in many aspects as following: fluid control strategy in sepsis (restrictive/liberative), antibiotic infusion strategy (continuous/intermittent), oxygen-saturation targets for mechanical ventilation (conservative/liberative), blood pressure targets after resuscitation from out-of-hospital cardiac arrest (hypotension/hypertension), blood pressure targets after successful stroke thrombectomy (intensive/conventional), and nutritional support strategies (low protein-calories/conventional protein-calories, fasting/persistent feeding before extubation). Thus, given above progress, carrying out high -quality domestic multi-center clinical registration researches, constructing shareable standardized databases, as well raising public awareness of sepsis, should be the essential steps to improve our level of intensive care medicine.
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Objective:To explore the effects of multi-disciplinary nutrition support team on nutritional status and quality of life in lung cancer patients undergoing chemotherapy, so as to provide reference for the formulation of nutritional intervention plans for lung cancer patients undergoing chemotherapy.Methods:This was a quasi experimental study. A total of 74 patients with lung cancer undergoing chemotherapy in Jinshan Hospital of Fudan University from February 2021 to July 2022 were selected as the research object by convenient sampling method. They were divided into two groups according to their admission time, 37 cases of patients from February to August 2021 for the control group, using conventional nursing interventions, 37 cases of patients from September 2021 to July 2022 for the observation group, with multi-disciplinary nutrition support team. A follow-up was conducted for three chemotherapy cycles, serum nutrition indicators and quality of life were compared between the two groups.Results:There were 27 males and 10 females in the control group, aged (68.14 ± 6.82) years old. There were 30 males and 7 females in the observation group, aged (65.92 ± 9.17) years old. There was no significant difference in the serum nutrition indicators and quality of life before intervention between the two groups (all P>0.05). The serum total protein, albumin and prealbumin levels in the observation group were (69.41 ± 5.87), (38.11 ± 4.04) g/L, and (243.57 ± 67.58) mg/L, which were higher than those in the control group (65.54 ± 8.33), (35.78 ± 5.39) g/L, and (200.84 ± 60.84) mg/L, the differences were statistically significant ( t=-2.31, -2.10, -2.86, all P<0.05). After intervention, the observation group showed higher scores for emotional function and overall health/life quality, with (88.29 ± 16.72), (60.36 ± 13.24) points, compared to the control group with (76.80 ± 17.58), (46.40 ± 16.38) points. The scores for fatigue, nausea/vomiting, insomnia, and loss of appetite were (34.53 ± 22.19), (11.26 ± 8.83), (20.72 ± 16.39), (24.32 ± 18.67) points in the observation group, which were lower than the scores in the control group (45.65 ± 22.95), (25.68 ± 18.67), (36.94 ± 23.29), (40.54 ± 22.41) points, all the differences were statistically significant ( t values were -4.03-4.24, all P<0.05). Conclusions:During chemotherapy in lung cancer patients, the multidisciplinary nutrition support team has been shown to significantly improve the patients′ nutritional status and enhance their quality of life.
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Resumen El soporte nutricional (SN) en pacientes adultos que reciben terapia de oxigenación por membrana extracorpórea (ECMO, extracorporeal membrane oxygenation) es controvertido. Si bien existen guías para el SN en pacientes pediátricos con ECMO, en adultos no se cuenta con estos lineamientos para el uso, tipo, ruta y momento de la terapia nutricional. En pacientes críticamente enfermos es bien sabido que la nutrición enteral (NE) temprana es beneficiosa, no obstante existe la posibilidad de que en pacientes con ECMO la NE temprana condicione complicaciones gastrointestinales. Asimismo, no se han establecido metas calóricas, proteicas y dosis o tipos de micronutrimentos que usar para esta población en específico, siendo un reto para el clínico encargado de brindar el SN. Aunado a esto los pacientes con ECMO son algunos de los más gravemente enfermos en las unidades de cuidados intensivos, donde la desnutrición se asocia con una mayor morbilidad y mortalidad. En cuanto al uso de nutrición parenteral (NP), no se tiene descrito si implica riesgo de falla en el circuito al momento de introducir lípidos al oxigenador. Por lo anterior es imperativa una correcta evaluación e intervención nutricional específica, realizada por expertos en el tema para mejorar el pronóstico y la calidad de vida en esta población, siendo un objetivo primordial en los cuidados de los pacientes adultos que reciben terapia de ECMO.
Abstract Nutritional support in adult patients receiving extracorporeal membrane oxygenation (ECMO) therapy is controversial. Although there are guidelines for the NS (Nutritional support) in pediatric patients with ECMO, in adults these guidelines are not available for the use, type, route and timing of nutritional therapy. In critically ill patients it is well known that early enteral nutrition is beneficial, however there is the possibility that in patients with ECMO early enteral nutrition leads to gastrointestinal complications. Likewise, there have not been established caloric targets, proteins and doses or types of micronutrients to use for this specific population being a challenge for the clinician. In addition, patients with ECMO are some of the most seriously ill in intensive care units, where malnutrition is associated with increased morbidity and mortality. Regarding the use of parenteral nutrition (NP) it has not been described if it implies a risk of circuit failure at the time of introducing lipids to the oxygenator. Therefore, a correct evaluation and specific nutritional intervention by experts in the field is imperative to improve the prognosis and quality of life in this population, which is a primary goal in the care of adult patients receiving extracorporeal membrane oxygen.
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Lysinuric protein intolerance (LPI) is an autosomal recessive disorder caused by defective plasma membrane transport of cationic amino acids (lysine, arginine, and ornithine). LPI is characterized by recurrent vomiting and diarrhea, coma following intake of protein-rich foods, and aversion to high-protein foods, further leading to malnutrition and even death. Some children with LPI also develop alveolar proteinosis. Nutrition support is an important part of treatment. Here we report a case of a 4-year-old girl with LPI, alveolar proteinosis, systemic lupus erythematosus, and cellular immune dysfunction, where nutrition support successfully improved her nutritional status. The relevant literatures are reviewed to provide guidance on the nutritional diagnosis and treatment of LPI.
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Objective:To analyze the paradigm and changes of enteral nutrition support for hospitalized children in Shanghai Children's Medical Center affiliated to School of Medicine of Shanghai, Jiao Tong University in last ten years, so as to provide guidance for nutritionists and dietitians on the application and management of enteral nutrition.Method:Relevant data were collected and analyzed from 2011 to 2020 in the Clinical Nutrition Department of Shanghai Children's Medical Center, including the implementation status of parenteral and enteral nutrition as well as the types and distribution of different enteral nutrition formulas and diet.Results:The Clinical Nutrition Department of our hospital provided seventy-five types of diet for hospitalized children. The utilization of ordinary diets and specialized diets has been stable at about 76,000 cases per year. In the past decade, twenty-one ordinary formulas and special formulas were provided every year by the Clinical Nutrition Department in our hospital and the utilization has been stable at 46,000 cases per year. The total consumption of ordinary formulas and the proportion of ordinary formulas users showed a descending trend. The proportion of specialized formulas users among discharged patients remained at 10%, with an upward trend in the proportion of high-calorie formulas and extensively-hydrolyzed formulas.Conclusions:The enteral nutrition formulas and inpatient diets are important components of nutritional treatment. The evolution of its clinical application to some extent reflects the changes of disease spectrum and the development of clinical disciplines. In short, the dietitians play a significant role in the nutrition support team.
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In the context of shortage of donor livers, split liver transplantation has achieved the goal of "one donor liver for two recipients", which effectively alleviates the shortage of donor livers and has promising development prospect. With the advancement of liver transplant techniques, split liver transplantation may yield clinical prognosis equivalent to total liver transplantation. However, perioperative management of split liver transplantation still encounters multiple challenges, with demanding techniques requirement and high-risk postoperative complications. Besides, there is a possibility of dividing one high-quality donor liver into two marginal donor livers, which will affect the development of liver transplantation. In this article, perioperative management of split liver transplantation was discussed from the perspectives of preoperative evaluation, recipient management and postoperative complication management, aiming to provide reference for promoting the development of split liver transplantation and enhancing clinical prognosis of recipients after split liver transplantation.
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@#According to ESPEN, surgical and cancer patients with high risk of malnutrition need to receive additional nutrition during the perioperative period. Most of the hospitals in Indonesia provide that through enteral food that is made of real food (homemade/non-industrial) for surgical patients. But this kind of enteral nutrition has several weaknesses. The development of enteral food has been done using local food that has complete nutrients and it can be given to surgical patients. This research aims to provide nutritional foods with high protein and antioxidants for malnourished recti cancer patients undergoing surgery. This product was made from local Indonesian food ingredients that is safe to consume and widely accepted by patients. The result showed that the effect of additional nutritional support through the formulated enteral food showed changes in the patient’s nutritional status during the perioperative period. Also, the absence of postoperative complications indicates that this nutritional support is effective for surgical patients during the preoperative period.
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The number of children receiving prolonged mechanical ventilation has increased significantly in recent years.Nutritional support is very important to improve the prognosis of children on prolonged mechanical ventilation.But there is a lack of research, expert consensus or guidelines on nutritional support for children on prolonged mechanical ventilation now.This review summarized the process and strategy of nutrition support for children with prolonged mechanical ventilation based on the current research results.Multidisciplinary collaboration helps improve nutritional support outcomes.A large number of high-quality studies are needed to provide evidences to develop more rational and standardized nutritional support strategies.
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Chronic intestinal failure represents a long-lasting condition of intestinal dysfunction that contributes to inadequate absorption of macronutrients and/or water and electrolytes. It is heterogeneous in clinical manifestation, intervention and prognosis, and usually requires multi-disciplinary management. This review elucidates the state-of-the-art consensus on diagnosis and definition in chronic intestinal failure and exemplifies relevant nutritional management principles with interventions in short bowel syndrome, in hopes of improving the identification and management of chronic intestinal failure in domestic practice.
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Clinical data, nutrition support and 6-year follow-up results of a patient with Tricho-hepato-enteric syndrome (THES) diagnosed in the Children′s Hospital of Nanjing Medical University in December 2013 were analyzed.The patient suffered severe malnutrition, growth retardation, hypophosphatemia, hypoglobulinemia, high nutritional risk status and significant intestinal dysfunction.The genetic testing revealed SKIV2 L gene variation in this case of THES.During the acute exacerbation of diarrhea, enteral nutrition and periodical short-term parenteral nutrition were given as nutrition support.Deep-hydrolyzed formula by oral and low-fat, low-residue, high-quality-protein diet was given during the remission phase.At last, the diarrhea and nutritional status of the patient improved gradually.The growth and development, including neuromotor development of the case also caught up to children with the same age, and he was capable of schooling.It is suggested that rational individualized nutrition support can significantly improve intestinal function and nutritional status of children with THES, which overcome the dangerous period, improve the quality of life and prolong the survival time.
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Objective:To discuss the onset and development pattern and characteristics of refeeding syndrome (RFS) induced by nutrition support and to provide reference for rational drug use in parenteral nutrition management.Methods:Case reports of RFS from CNKI, Wanfang, VIP database and Pubmed from 2000 to 2020 were retrieved. The clinical data were collected and statistically analyzed.Results:A total of 17 reports, including 17 cases, were included in the analysis. Patients were 6 males(35.29%) and 11 females (64.71%). The distribution of age was from 29 weeks in a premature neonate to 87 years old. 12 cases (70.59%) of RFS occurred within 3 days after starting the nutrition support. The most common clinical manifestation were cardiovascular system symptoms (88.23%), with dyspnea as the most reported symptom (41.17%). 15 patients (88.23%) recovered after appropriate intervention and 2 patients died(11.76%).Conclusions:Refeeding syndrome is a potentially fatal condition. The risk of RFS should be assessed before initiating nutrition support. Patients at risk of RFS must be monitored closely at the early stage of nutritional support.
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Objective:To explore the application of home nutrition support in children with intestinal failure.Methods:Children with intestinal failure admitted to Division of Pediatric Gastroenterology and Nutrition and Department of Pediatric Surgery in Xinhua Hospital were retrospectively enrolled since January 2009. The details of home nutrition support, nutritional status and home parenteral nutrition (HPN) associated complications were collected.Results:A total of 10 children received HPN support, 7 of whom were with short bowel syndrome (SBS) and the other 3 with pediatric intestinal pseudo-obstruction. The average length of remnant small bowel in 7 SBS children was (36.7±32.4) cm. The average age at HPN onset was (5.4±4.7) years. The average duration of follow-up was (3.1±2.1) years. The average duration of HPN was (619.5±669.1) days after (391.8±340.1) days of parenteral nutrition support in our hospital. All 10 cases started home enteral nutrition (HEN) with tube feeding (3 cases transited to oral feeding during treatment). The average duration of HEN was (536.1±429.6) days. Daily calorie intake was 104.0%±39.0% of the recommended intake according to the guideline, with 46.5%±21.3% via HPN and 57.5%±29.2% via HEN. During follow-up, 3 cases were found with severe malnutrition, 5 with moderate malnutrition and 2 with mild malnutrition. Four children suffered from catheter-related thrombosis and five children were identified with catheter-related blood stream infection. No intestinal failure associated liver disease was observed.Conclusions:HPN is feasible but needs the support of national medical insurance policy. At present, there are still frequent nutritional deficiencies and complications in HPN. Nutrition support team (NST) should provide guidance for more scientific nutrition screening and nutrition management.
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Objective:To investigate the dynamic change of nutritional risk in hepatological surgical patients during hospitalization.Methods:Anthropometric measurement and laboratory examination were conducted within 24 hours both after admission and before discharge. NRS 2002 was used to assess patients' nutritional status. The correlation between nutritional status and clinical outcomes was also analyzed.Results:A total of 600 patients were included in the study, among whom 401 were with benign diseases and 199 with malignant tumors. Compared with those values at admission, patients' weight, BMI, grip strength, calf circumference and main serum protein indicators decreased significantly at discharge ( P<0.05). The incidence of nutritional risk at discharge was 57.3%, higher than that at admission ( χ 2=6.512, P=0.011). The incidence of nutritional risk showed a significant increase during hospitalization in hepatological surgery patients ( P<0.05). Conclusions:Hepatological surgery patients were at high nutritional risk, which increased during hospitalization. The whole-course nutrition management of surgical patients should be given more attention.
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Resumen El día 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaró la enfermedad causada por el virus SARS-Cov2, COVID-19, como pandemia. La misma tiene distintas formas de presentación desde ser asintomática a formas leves atendidas en domicilio o internación para confinamiento, hasta formas complicadas en salas de clínica o requiriendo cuidados intensivos. La obesidad (especialmente, IMC>40 kg/m2) toma relevancia en esta enfermedad siendo un predictor independiente fuerte de hospitalización y agravamiento, después de la edad. Otras comorbilidades como la hipertensión arterial, diabetes y otras enfermedades cardiovasculares son también importantes en este contexto. El siguiente artículo de revisión intenta evaluar y resumir las distintas recomendaciones de atención nutricional publicadas, tanto por sociedades científicas como equipos de profesionales de instituciones sanitarias de diferentes países de la región y el mundo, así como dentro de nuestro país. El proceso de implementación del plan nutricional debe abarcar no sólo a aquellas personas hospitalizadas sino también a aquellos sujetos infectados con formas leves. El plan de atención nutricional debe estar integrado por cuatro etapas: evaluación del estado nutricional, diagnóstico nutricional, intervención y monitoreo/evaluación de los resultados, con especial atención en el cuidado del paciente en sala de cuidados intensivos. No habiendo recomendaciones espe- cíficas hasta la fecha, se sugiere adecuar las recomendaciones actuales para atención de adultos mayores, pacientes polimórbidos internados y pacientes críticos. La atención de estos grupos por profesionales de la nutrición se hace imperante para adecuar la alimentación a la sintomatología y estado de cada paciente en particular. Además, es fundamente el monitoreo al alta, dando puntual seguimiento a la recuperación y rehabilitación del estado nutricional, especialmente de la masa muscular que pudo haberse deteriorado durante la internación.
Abstract On March 11th, 2020, the World Health Organization (WHO) declared the disease caused by the SARS- Cov2 virus, COVID-19, as a pandemic. The presentation can range from being asymptomatic or mild home care stages or isolation, to complicated forms in clinic rooms or requiring intensive care units. Obesity (especially, BMI >40 kg / m2) is relevant in this disease, being a strong independent predictor of hospitalization and aggravation, following age. Other comorbidities such as high blood pressure, diabetes and other cardiovascular diseases are also important in this context. The following article aims at evaluating and summarizing the different nutritional care recommendations published both by scientific societies and professionals from health institutions in different countries of the region and the world, as well as within our country. The implementation process of the nutritional plan must include not only those hospitalized, but also the people infected with mild forms. The nutritional care process must include four stages: nutritional status assessment, nutritional diagnosis, intervention and monitoring / evaluation of the results, with special attention to patients in the intensive care units. As there are no specific recommendations to date, it is suggested to adapt the current recommendations for the care of the elderly, hospitalized polymorbid patients and critically ill patients. The attention of these groups by nutrition professionals is imperative to adapt the diet to the symptoms and condition of each individual patient. In addition, discharge monitoring is essential, giving timely follow-up to recovery and rehabilitation of the nutritional status, especially of the muscle mass that may have deteriorated during hospitalization.
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État nutritionnel , COVID-19 , Pandémies , Alimentation et nutrition , ObésitéRÉSUMÉ
OBJECTIVE: To systematically review the related guidelines of nutrition support therapy (hereinafter referred to as nutrition support) in acute respiratory disease, and to provide evidence-based evidences for clinical nutrition in coronavirus disease 2019 (COVID-19). METHODS: Retrieved from PubMed, EMBase, CNKI, etc., websites of association in nutrition and global guideline databases. The guidelines in nutrition support for related diseases were collected. Recommendations were summarized after data extraction and quality evaluation. RESULTS: A total of 10 guidelines were enrolled, with development time ranging from 2006 to 2019. There were 6 guidelines with quality of level A, 3 with level B, and 1 with level C. “scope and purpose”, “clarity” and “independence” showed the higher scores in AGREE Ⅱ, and “applicability” showed generally low scores. There were differences among emphases of guidelines, however, supplements for each other, and the recommendations for the same questions showed substantial agreement. CONCLUSION: The recommendations, in high quality guidelines of critical illness, acute respiratory distress syndrome, pneumonia, etc., could be applied to nutrition support in COVID-19.
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Chronic intestinal pseudo-obstruction (CIPO) is a rare and serious motility disorder in gastrointestinal tract, which mimics mechanical intestinal obstruction clinically. It may be primary (idiopathic CIPO) or secondary to a organic, systemic or metabolic disorder. The etiology and mechanism of idiopathic CIPO are not yet clear. It might be linked to neuromuscular disorders of the digestive tract. Although there are a variety of diagnostic approaches, no standard diagnostic criterion has been achieved. Improper and delayed treatment may cause the increase in mortality. In this review article, the current status in management of idiopathic CIPO was summarized.
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OBJECTIVE: To investigate the role of nutrition support pharmacists(NSP) in the clinical nutrition support. METHODS: By intervening the nutrition support schemes on a case of Wernicke encephalopathy occurred in the process of parenteral nutrition support, the role of NSP in the clinical nutrition support were investigated. RESULTS: NSP have proficient skill in nutrition risk screening and assessment, and may paticipate the whole process of evaluation to ascertain the patients' nutritionalstatus and whether the nutrition supports were needed. NSP were familiar with the complications of nutrition support therapy, and may alleviate the harmful impact to the patients or reduce the complications by the relevance evaluation and determination,and thus providing the solutions. NSP may educe their specialty and develop individualized nutrition support plan. CONCLUSION: The safety and effectiveness of clinical nutrition support can be improved by the participation of NSP.
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The criteria for malnutrition assessment (diagnosis) have been developed for years.Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition was issued in September 2018,which aims to build a global consensus around core diagnostic criteria for adult malnutrition in clinical settings.In this article,GLIM malnutrition assessment (diagnosis) consensus was reviewed and analyzed.
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Objective To investigate the value of resting energy expenditure (REE) monitoring in nutritional support therapy of critical patients on mechanical ventilation.Methods A prospective randomized controlled trial was conducted.Sixty critical patients [acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ) ＞ 15] on ventilation admitted to intensive care unit (ICU) of Dalian Friendship Hospital from September 2016 to October 2018 were enrolled.The enrolled patients were randomly divided into Harris-Benedict formula (HB formula) group and indirect energy measurement (metabolic vehicle) group with 30 patients in each group.The HB formula group was used traditional HB formula to determine the energy supply and ratio of nutritional support therapy,and the metabolic vehicle group was regularly measured the energy supply and proportion of nutritional support therapy.Serum albumin (ALB),total protein (TP),lymphocyte ratio,blood glucose,blood gas analysis parameters and REE value were determined at 3,5,7,9,and 11 days of nutritional support therapy.Results The value of REE at 3 days of nutritional support therapy in metabolic vehicle group was significantly higher than that in HB formula group (kJ/d:7 850.4±947.3 vs.6 915.3±875.7,P ＜ 0.05).With the time of nutritional support treatment prolonged,the REE value of metabolic vehicle group was decreased gradually,and after 7 days,the patient's condition was stable and improved,and the REE value tended to be stable gradually,it was significantly lower than that of HB formula group at 11 days (kJ/d:5 046.3 ± 493.3 vs.6 915.3 ± 875.7,P ＜ 0.05).There was no significant difference in blood gas analysis or plasma protein before nutritional support therapy between the two groups.After 5 days of nutritional support therapy,the respiratory function of critical patients in both groups was improved,and the lymphocyte ratio and plasma protein parameters were alleviated.After 11 days of nutrition support therapy,the respiratory function of critical patients in both groups was further improved,the ventilator model was adjusted to continuous positive airway pressure (CPAP) mode,the lymphocyte ratio and plasma protein parameters were improved,and the skin color and elasticity were improved,the granulation of the wound was fresh and healed well,and the plasma protein level was increased obviously,ALB level in metabolic vehicle group was significantly higher than that in HB formula group (g/L:31.8 ± 2.5 vs.26.7 ± 2.3,P ＜ 0.05).In the metabolic vehicle group,REE value was decreased from the maximum level on the 3rd day (k J/d:7 850.4 ± 947.3) to a stable level after 11 days (k J/d:5 046.3 ± 493.3),and its energy ratio changed significantly,from carbohydrate:fat of 77％ ∶ 21％ with protein consumption gradually transition in the early (3 days) to carbohydrates:fat of 56％ ∶ 44％ without protein consumption in the later stage (11 days),which showed the tendency of energy consumption was reasonable.Conclusion The energy metabolism rule of critical patients on ventilation could be determined by using the accurate metabolic vehicle and dynamic monitoring of REE value,which could be used for the implementation of nutritional support therapy.
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Objective To investigate the use of parenteral nutrition preparations in Jiangsu Province,and to provide reference for the standardized management of parenteral nutrition preparations.Methods 720 cases using parenteral nutrition preparations from January 2017 to June 2017 in the department of general surgery of 12 hospitals in Jiangsu province were selected.The rate of nutritional risk screening,the indications of parenteral nutrition,the way of infusion,the rationality and economy of the prescriptions were retrospectively evaluated.The calorie,amino acid content,non-protein calorie/nitrogen ratio,glycolipid ratio and cation concentration of the patients received total parenteral nutrition were calculated.Results The total costs of parenteral nutrition preparations of 720 cases were 1.614 1 millions,and 346 cases did not have the indications for parenteral nutrition.The results of prescription comment showed that only 16 patients were screened for nutritional risk by Nutritional Risk Screening 2002 tool at admission.544 cases were intravenous dripped with amino acid and fat emulsion from peripheral vein.In the 176 total parenteral nutrition prescriptions,there were 39 non-protein calorie/nitrogen ratio cases,15 glycolipid ratio cases,69 cation concentration cases,61 calorie cases and 32 amino acid content cases failing to comply with the recommendation of the guidelines.Only 31 total parenteral nutrition prescriptions were completely reasonable.Conclusion The costs of parenteral nutrition preparations used in hospitals of Jiangsu are high but the rate of rationality is low.Nutrition support team should be established to regulate the use of parenteral nutrition preparations and save medical resources.