CN112656933A - Parenteral nutrient solution suitable for pneumonia patients - Google Patents
Parenteral nutrient solution suitable for pneumonia patients Download PDFInfo
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- CN112656933A CN112656933A CN202110022135.8A CN202110022135A CN112656933A CN 112656933 A CN112656933 A CN 112656933A CN 202110022135 A CN202110022135 A CN 202110022135A CN 112656933 A CN112656933 A CN 112656933A
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Abstract
The invention discloses a parenteral nutrient solution suitable for pneumonia patients, which comprises the following components: branched chain amino acid, compound amino acid, 20% glutamine dipeptide, 20% fat emulsion, 50% glucose, 10% glucose, 5% glucose, 0.9% normal saline, 10% sodium chloride, 10% potassium chloride, 10% calcium gluconate, 25% magnesium sulfate, rifam, trace elements, water-soluble vitamins, fat-soluble vitamins and vitamin C. The invention can improve the immune function and disease resistance of pneumonia patients, improve the disease condition and prevent the disease from progressing.
Description
Technical Field
The invention relates to the field of parenteral nutrient solutions, in particular to a parenteral nutrient solution suitable for patients with pneumonia.
Background
Pneumonia is manifested clinically as fever, asthenia, and dry cough, and a few patients have symptoms such as nasal obstruction, watery nasal discharge, pharyngalgia, and diarrhea. Severe patients often develop dyspnea and/or hypoxemia after one week of onset, and severe patients rapidly progress to acute respiratory distress syndrome, septic shock, refractory metabolic acidosis, hemorrhagic coagulation dysfunction and the like. The metabolic change of the organism is in an infectious stress state and is represented by increased energy and protein consumption, anorexia, lean body and fat tissue consumption, increased C-reactive protein, decreased lymphocyte count and the like, partial patients are combined with liver function enzymology abnormality and the like, the immune function of the patients is decreased, and malnutrition occurs.
Aiming at pneumonia diseases and organism metabolism characteristics, in order to improve the immune function and disease resistance of pneumonia patients, improve disease conditions and prevent disease progression, a nutrition treatment scheme needs to be formulated. Nutritional treatment is not simply the supply of nutrients, but is a targeted treatment that regulates organism metabolism, promotes homeostasis, reduces inflammatory states, improves cellular function, and increases appetite.
Disclosure of Invention
The invention aims to solve the technical problems and provides a parenteral nutrient solution suitable for pneumonia patients.
The invention is realized according to the following technical scheme.
A parenteral nutrition solution suitable for patients with pneumonia comprises the following components: branched chain amino acid, compound amino acid, 20% glutamine dipeptide, 20% fat emulsion, 50% glucose, 10% glucose, 5% glucose, 0.9% normal saline, 10% sodium chloride, 10% potassium chloride, 10% calcium gluconate, 25% magnesium sulfate, rifam, trace elements, water-soluble vitamins, fat-soluble vitamins and vitamin C.
Further, when the energy of the parenteral nutrition solution is set to 450kal, the parenteral nutrition solution comprises the following components and contents: 250 ml of branched chain amino acid, 150/8.5 ml/%, 50ml of 20% glutamine dipeptide, 70 ml of 20% fat emulsion, 140 ml of 50% glucose, 40 ml of 10% sodium chloride, 20 ml of 10% potassium chloride, 5 ml of 10% calcium gluconate, 5 ml of 25% magnesium sulfate, 5 ml of Grifamis, 5 ml of trace elements, 0.5 branch of water-soluble vitamin, 5 ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amount and concentration of 10% glucose, 5% glucose and 0.9% physiological saline can be adjusted according to requirements.
Further, when the energy of the parenteral nutrition solution is set to 900kal, the parenteral nutrition solution comprises the following components and contents: 250 ml of branched chain amino acid, 350/8.5 ml/%, 50ml of 20% glutamine dipeptide, 125 ml of 20% fat emulsion, 250 ml of 50% glucose, 40 ml of 10% sodium chloride, 30 ml of 10% potassium chloride, 8ml of 10% calcium gluconate, 8ml of 25% magnesium sulfate, 8ml of Grifamis, 8ml of trace elements, 0.8 branch of water-soluble vitamin, 8ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amounts and concentrations of 10% glucose, 5% glucose and 0.9% physiological saline are adjusted according to requirements.
Further, when the energy of the parenteral nutrition solution is set to 1350kal, the parenteral nutrition solution comprises the following components and contents: 250 ml of branched chain amino acid, 450/11.4 ml/%, 100ml of 20% glutamine dipeptide, 190 ml of 20% fat emulsion, 380 ml of 50% glucose, 40 ml of 10% sodium chloride, 30 ml of 10% potassium chloride, 10ml of 10% calcium gluconate, 10ml of 25% magnesium sulfate, 10ml of Griffonia, 10ml of trace elements, 1 st water-soluble vitamin, 10ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amount and concentration of 10% glucose, 5% glucose and 0.9% physiological saline can be adjusted according to requirements.
Further, when the energy of the parenteral nutrition solution is set to 1800kal, the parenteral nutrition solution comprises the following components and contents: 250 ml of branched chain amino acid, 600/11.4 ml/%, 100ml of 20% glutamine dipeptide, 240 ml of 20% fat emulsion, 500 ml of 50% glucose, 40 ml of 10% sodium chloride, 30 ml of 10% potassium chloride, 10ml of 10% calcium gluconate, 10ml of 25% magnesium sulfate, 10ml of Griffonia, 10ml of trace elements, 1 st water-soluble vitamin, 10ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amount and concentration of 10% glucose, 5% glucose and 0.9% physiological saline can be adjusted according to requirements.
The invention has the following beneficial effects:
the invention provides a parenteral nutrient solution aiming at pneumonia diseases and organism metabolism characteristics. The invention can improve the immune function and disease resistance of pneumonia patients, improve the disease condition and prevent the disease from progressing. In the integral treatment of pneumonia, the nutrient solution plays an important role, initiates a domestic advanced comprehensive treatment mode of closely combining clinical nutrition diagnosis and treatment with clinical treatment, and obtains a remarkable treatment effect.
Detailed Description
In order to further explain the technical solutions of the present invention and the technical effects achieved by the technical solutions, the present invention will be further described with reference to the following embodiments.
1. Nutritional treatment formulation
(1) Basic oral nutritional supplement
Full nutritional formula (15 g/time, 3 times daily), whey protein preparation (5 g/time, 3 times daily), probiotic preparation (5 g/time, 2 times daily).
(2) Individualized oral nutritional supplement
Full nutritional formula (15-40 g/time, 3 times a day), whey protein preparation (5-10 g/time, 3 times a day), dietary fiber (5 g/time, 2 times a day), glutamine (2.5 g/time, 3 times a day), probiotic preparation (5 g/time, 2 times a day), etc. may be selected.
(3) Basic diet
(4) Weighing meals
According to the basic diseases and metabolic states of patients, the supply amount and proportion are adjusted by referring to the nutrition treatment principle, individual weighing diet is implemented, the diet is accurate to gram, and the diet is independently prepared.
(5) Enteral nutrition by tube feeding
The amount and ratio of the feed are determined according to the disease state and gastrointestinal function of the patient by referring to the principle of nutrition therapy. The stomach feeding pathway recommends intermittent bolus injection of food homogenate, and FSMP can be supplemented to the part with insufficient energy and nutrients. The enteral feeding pathway is recommended to be performed by continuous instillation of nutrient solution.
(6) 'all-in-one' parenteral nutrient solution
The selected manufacturer types of the above components are shown in the following table
2. Basis for formulating nutrition treatment scheme for pneumonia
(1) Energy and nutrient
With reference to the dietary nutrient reference intake (DRIs) of Chinese residents, the daily energy requirement of a normal person is about 2250 kcal/d. The energy supply amount of the nutritional therapy formula is determined according to daily energy consumption such as basal metabolism, food thermogenesis effect and physical activity of adults, considering that physical activity of patients is correspondingly reduced, fever, diseases and psychological stress exist, various clinical treatments are received, and the like, and is not less than 80% of daily energy demand of normal people, namely 1800 kcal/d. And provides energy and nutrients at a ratio of 15% protein, 25% fat and 60% carbohydrate. Nutritional treatment is carried out by oral nutritional supplementation, dietary nutrition, enteral nutrition, parenteral nutrition, diet/enteral/parenteral nutrition in combination with sequential therapy.
(2) Oral nutritional supplement
Considering that C reactive protein of a patient is generally increased and inflammatory stress reaction is serious, firstly, oral nutrient supplement treatment is carried out on the whole pneumonia patient, and a full-nutrient formula preparation and non-full-nutrient whey protein are provided to improve the supply of protein, energy and various nutrients, so that the metabolism of substances is adjusted, the consumption in a stress state is supplemented, the appetite of the patient is changed, and the food intake is improved. In addition, the feed of probiotics is increased, the intestinal function is maintained, and the absorption and utilization are promoted.
(3) Basic diet, weighed diet, and enteral nutrition
According to the metabolic characteristics of diseases, the supply amount and the proportion of energy, protein, fat and carbohydrate are determined so as to promote the metabolic synthesis and utilization of human substances and improve the autoimmunity of patients.
(4) Parenteral nutrition
Complete and supplementary parenteral nutrition adopts a 'full-in-one' nutrient solution infusion mode, the supply amount and proportion are determined according to the disease condition and gastrointestinal function of a patient by referring to the supply principle of energy and nutrient, and the fatty acid, amino acid (glutamine, omega-3 fatty acid and the like), glucose, energy/nitrogen ratio, liquid amount, electrolyte, trace elements, vitamins, insulin and the like are dynamically adjusted.
Second, the principle of application of nutrition treatment formula for pneumonia patients
1. General principle of application
(1) For patients who do not have the basic diseases and can take food orally, a formula of basic diet and basic oral nutrition supplement is selected. If the dietary intake of the patient is less than 75% of the basic diet, the basic diet and the individual oral nutritional supplement are selected.
(2) For patients with basic diseases such as diabetes, gout, nephropathy, hypertension and the like and capable of taking food through mouth, weighing diet and individual oral nutrition supplement are selected.
(3) For patients who cannot eat orally, "tube fed enteral nutrition" was chosen.
(4) Patients who can not reach the target amount within 3-5 days of tube-fed enteral nutrition treatment select tube-fed enteral nutrition plus supplementary parenteral nutrition.
(5) For patients with gastrointestinal failure, a 'complete parenteral nutrition' scheme is selected, and enteral nutrition treatment is started as early as possible according to disease states and gastrointestinal recovery conditions to maintain the intestinal function.
2. Application principle of oral nutritional supplement
(1) A national approved registered food formula for special medical use (FSMP) should be selected.
(2) Depending on the disease state and nutritional status of the patient, nutritional formulations are selected and the supply and dosage are adjusted.
3. Principles of dietary therapy
(1) The grain food can be selected from rice, millet, black rice, barley, corn, sweet potato, etc., and mixed with coarse and fine grains. The meat food can be chicken, duck, pork, beef, fish, etc. The vegetables and fruits can be selected from leaf vegetables, eggplant, rhizomes, etc., and fungus food, wherein half of the vegetables are dark vegetables, and spinach, rape, broccoli, water spinach, tomato, carrot, etc. can be selected. Vegetables and fruits cannot be substituted for each other. The cooking oil is vegetable oil.
(2) The type of diet, food content, and food quantity should be selected in conjunction with the degree of tolerance of the gastrointestinal tract of the patient. The food is chopped and softened during the preparation of diet for the elderly and children, and spicy and pungent food is contraindicated. Patients with poor gastrointestinal tolerance can be supplied with energy and nutrients in stages according to the proportion of 25%, 50% and 75% of the dietary formula, and the intake of the patients is gradually increased.
(3) The patient is continuously concerned with eating and the remaining amount after the patient's dietary intake is recorded daily to assess the patient's energy and nutrient intake.
4. Enteral nutrition therapy application principle
The enteral nutritional solution should be prepared in a dedicated enteral nutrition preparation room by a professional formulator according to the medical orders and operating protocols.
5. Application principle of parenteral nutrition therapy
(1) Parenteral nutrition energy and nutrients should be supplied in stages according to the metabolic characteristics and disease state of the patient, and electrolyte supply should be combined with the physical signs and test results of the patient.
(2) For patients with ventilatory dysfunction, attention should be paid to the fat supply ratio to reduce the respiratory quotient and reduce the ventilatory burden.
(3) Parenteral nutrition solutions should be prepared in a dedicated parenteral nutrition preparation room by professional formulators according to the medical advice and operating procedures and infused through central or peripheral veins.
(4) When the osmotic pressure is more than 900mosm/L, the central vein should be selected and the peripheral veins should be forbidden.
Third, the comprehensive treatment effect of nutrition for pneumonia patients
(one) overall therapeutic effect of the patient
After analyzing 130 cases of pneumonia patients receiving nutrition treatment, the study proves that the hospitalization time of the patients is obviously shortened after multidisciplinary intervention such as nutrition treatment, the minimum hospitalization days are 3 days, the maximum hospitalization days are 33 days, and the average hospitalization days are 15.4 +/-6.8 days. Patient 9 was admitted before, with an average admission of 17.1 ± 6.8 days (85); after 9, patients (45) were admitted and were hospitalized for an average of 12.2 ± 5.6 days. After the individual nutrition therapy dry prognosis, all nutritional indexes of the patient are obviously improved when the patient is discharged from hospital, wherein the total protein is improved from 65.7 +/-7.5 g/L at a low point to 68.4 +/-5.7 g/L (P = 0.000), and the albumin is improved from 36.1 +/-6.2 g/L to 37.5 +/-3.7 g/L (P = 0.004), and the gonorrhea is improvedThe Barocyte count was 1.10. + -. 0.53X 109The L is increased to 1.51 +/-0.57 multiplied by 109L (P = 0.000), lymphocyte count < 0.8 x 10 at admission9The composition can improve 38 people at hospital discharge to different degrees, the improvement rate reaches 74%, the correction rate reaches 80% at hospital discharge for hypoproteinemia, the positive effects of hypokalemia, hyponatremia and uretone are corrected, and the nutrition treatment effect is obvious. During the treatment period, the dietary intake of the patients is obviously increased, and the standard supply amount of the dietary intake can be achieved at the time of discharge. Fully shows that the supply of the nutrient medium plays an important role in recovering cells, restoring organ functions and enhancing immunity.
(II) example of individualized treatment case
Personalized treatment regimens such as:
one 91-year-old male with severe pneumonia is diagnosed, the clinical comprehensive condition is critical, the male has a history of coronary heart disease and old myocardial infarction, the patient has obvious difference in appetite after admission, the total energy intake per day is about 600kcal, the appetite of the patient is changed after nutrition therapy, the dietary intake is gradually increased to 1000kcal, the total energy intake is increased to 1500kcal when the patient is discharged, and relevant indexes are found before the nutrition therapy and when the patient is discharged: the total protein is increased from 51.8g/L to 66.5g/L, the albumin is increased from 26.8g/L to 33.3g/L, the hemoglobin is increased from 104g/L to 124g/L, and the lymphocyte is increased from 0.55X 109L is increased to 1.40X 109And the concentration of the C-reactive protein is reduced from 97.7 mu g/ml to 44.6 mu g/ml, and the patient is recovered and discharged.
In an 82-year-old male patient, gout attacks during hospitalization, red swelling and pain of the joint of the right foot and the toe occur, a dietician immediately changes his diet advice to perform low-purine diet therapy, and the symptoms of the patient disappear soon. One elderly female patient has a history of diabetes for many years, combines abnormal renal functions, and adopts wheat starch nutrition therapy while a nutrition doctor adjusts blood sugar, so that the intake of plant protein is reduced, the kidney burden of the patient is relieved, the renal function of the patient is quickly improved, and the disease is also the first wheat starch nutrition therapy case in Haihe hospital.
The applicant declares that the above description is only a specific embodiment of the present invention, but the scope of the present invention is not limited thereto, and it should be understood by those skilled in the art that any changes or substitutions that can be easily conceived by those skilled in the art within the technical scope of the present invention are within the scope and disclosure of the present invention.
Claims (5)
1. A parenteral nutrient solution suitable for pneumonia patients is characterized in that: comprises the following components: branched chain amino acid, compound amino acid, 20% glutamine dipeptide, 20% fat emulsion, 50% glucose, 10% glucose, 5% glucose, 0.9% normal saline, 10% sodium chloride, 10% potassium chloride, 10% calcium gluconate, 25% magnesium sulfate, rifam, trace elements, water-soluble vitamins, fat-soluble vitamins and vitamin C.
2. The parenteral nutrition solution for patients with pneumonia as claimed in claim 1, wherein: when the energy of the parenteral nutrient solution is set to 450kal, the parenteral nutrient solution comprises the following components and contents: 250 ml of branched chain amino acid, 150/8.5 ml/%, 50ml of 20% glutamine dipeptide, 70 ml of 20% fat emulsion, 140 ml of 50% glucose, 40 ml of 10% sodium chloride, 20 ml of 10% potassium chloride, 5 ml of 10% calcium gluconate, 5 ml of 25% magnesium sulfate, 5 ml of Grifamis, 5 ml of trace elements, 0.5 branch of water-soluble vitamin, 5 ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amount and concentration of 10% glucose, 5% glucose and 0.9% physiological saline can be adjusted according to requirements.
3. The parenteral nutrition solution for patients with pneumonia as claimed in claim 1, wherein: when the energy of the parenteral nutrient solution is set to 900kal, the parenteral nutrient solution comprises the following components and contents: 250 ml of branched chain amino acid, 350/8.5 ml/%, 50ml of 20% glutamine dipeptide, 125 ml of 20% fat emulsion, 250 ml of 50% glucose, 40 ml of 10% sodium chloride, 30 ml of 10% potassium chloride, 8ml of 10% calcium gluconate, 8ml of 25% magnesium sulfate, 8ml of Grifamis, 8ml of trace elements, 0.8 branch of water-soluble vitamin, 8ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amounts and concentrations of 10% glucose, 5% glucose and 0.9% physiological saline are adjusted according to requirements.
4. The parenteral nutrition solution for patients with pneumonia as claimed in claim 1, wherein: when the energy of the parenteral nutrient solution is set to 1350kal, the parenteral nutrient solution comprises the following components and contents: 250 ml of branched chain amino acid, 450/11.4 ml/%, 100ml of 20% glutamine dipeptide, 190 ml of 20% fat emulsion, 380 ml of 50% glucose, 40 ml of 10% sodium chloride, 30 ml of 10% potassium chloride, 10ml of 10% calcium gluconate, 10ml of 25% magnesium sulfate, 10ml of Griffonia, 10ml of trace elements, 1 st water-soluble vitamin, 10ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amount and concentration of 10% glucose, 5% glucose and 0.9% physiological saline can be adjusted according to requirements.
5. The parenteral nutrition solution for patients with pneumonia as claimed in claim 1, wherein: when the energy of the parenteral nutrient solution is set to 1800kal, the parenteral nutrient solution comprises the following components and contents: 250 ml of branched chain amino acid, 600/11.4 ml/%, 100ml of 20% glutamine dipeptide, 240 ml of 20% fat emulsion, 500 ml of 50% glucose, 40 ml of 10% sodium chloride, 30 ml of 10% potassium chloride, 10ml of 10% calcium gluconate, 10ml of 25% magnesium sulfate, 10ml of Griffonia, 10ml of trace elements, 1 st water-soluble vitamin, 10ml of fat-soluble vitamin and 500 mg of vitamin C, and the liquid amount and concentration of 10% glucose, 5% glucose and 0.9% physiological saline can be adjusted according to requirements.
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| CN109939135A (en) * | 2019-03-20 | 2019-06-28 | 重庆医科大学附属儿童医院 | A kind of raw ketone parenteral nutrient solution and preparation method thereof |
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| CN109939135A (en) * | 2019-03-20 | 2019-06-28 | 重庆医科大学附属儿童医院 | A kind of raw ketone parenteral nutrient solution and preparation method thereof |
Non-Patent Citations (2)
| Title |
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| 毕小婷等: "2例重症监护患者肠外营养用药的合理性分析", 《中国药房》 * |
| 王明辉等: "我院全胃肠外营养不合理医嘱分析", 《中国药房》 * |
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