參短腸症候群的治療一藥物治療 H2 blockers proton pump inhibitors famotidine ranitidine H2 blocker cimetidine pantoprazole omeprazole lansoprazole esomep

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1 臨床藥物治療學 Therapeutics of Clinical Drugs 短腸症候群與全靜脈營養國軍高雄總醫院藥劑科藥師侯純芳黃學揚吳乃群摘要 TPN (total parenteral nutrition; ) TPN TPN 壹前言 (short bowel syndrome; SBS) (SBS) (Crohn's disease) (radiation enteropathy) 1 貳影響短腸症候群的因素 B12 50 B THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar

2 參短腸症候群的治療一藥物治療 H2 blockers proton pump inhibitors famotidine ranitidine H2 blocker cimetidine pantoprazole omeprazole lansoprazole esomeprazole Nexium pantoprazole 8 mg/h 3 Loperamide Kaolin pectin Somatostatin cholestyramine cholestyramine metronidazole 4 二靜脈營養 TPN ( 一 ) 裝置引發的併發症 ( 二 ) 感染性的併發症 (Staphylococcus aureus) (fungus) (gram-negative bacilli) ( 三 ) 代謝性的併發症 TPN 1. B1 TPN TPN 2. TPN 400 mg/dl TPN 3. TPN TPN 10% TPN (1) (cholecystokinin; CCK) 28 1 Mar 藥學雜誌第 110 冊 99

3 臨床藥物治療學 Therapeutics of Clinical Drugs TPN 4,5 (2) chenodeoxycholic acid lithocholic acid lithocholic acid 肆病例介紹 /35 mmhg 133 / 77/54 mmhg N G t u b e ( ) c o f f e e ground ( ) omeprazole 40 mg IV q12h TPN 2 22 TPN 1 Venolipid 405 mg/dl Venolipid Propofol Midazo 2 25 TPN 3 Klebsiella pneumoniae Pisutam 3 2 Lipo 1 q12h 3 4 Bacteroides distasonis metronidazole mg/dl Venolipid TPN ( ) 表一住院期間血液生化值 Ht (%) Hb (g/dl) WBC (10 3 /ul ) Plt (10 3 /ul) SGOT (U/L) SGPT (U/L) BUN (mg/dl) Cr (mg/dl) Glucose (mg/dl) Na (meq/l) K (meq/l) Ca (mg/dl) TG (mg/dl) Albumin (g/dl) Bilirubin (mg/dl) THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar

4 表二住院期間用藥記錄 Drug 2/19 2/21 2/22 2/23 2/25 2/26 3/2 3/4 3/10 3/12 Cefazolin 1 g/vial Q8H DC Omezol 40 mg/vial Q12H QD Vit C 100 mg/2 ml Q8H Vit K 10 mg/1 ml Q8H Wincynon 50 mg/ml Q8H Propofol 1% 20 ml PRN DC KCl amp 15% 5 ml QD 5AMP DC QD 2AMP Buminate 25% 50 ml Qd DC Amoclan 1.2 g/vial Q8H DC TPN 1 ( ) QD DC Venolipid 20% 100 ml QD DC QD Bricanyl 5 mg/ml BID Bisolvon 2 mg/ml BID Midazo 15 mg/3 ml PRN TPN 3 ( ) QD Pisutam 4.5 g/vial Q8H Lipo 300 mg/cap BID Medazole 500 mg/bt Q8H 伍討論 TPN ( ) TPN- 10 (phenylalanine) (tyrosine) (Aminopoly-H 7%) TPN-11 (Amiyu7.4%) TPN 1 Venolipid propofol 3 (hypertriglyceridemia) 6 benzodiazepine Midazo 4 TPN 3 Ursodeoxycholic acid (Lipo) Mar 藥學雜誌第 110 冊 101

5 臨床藥物治療學 Therapeutics of Clinical Drugs TPN TPN Lipo 1# Bid TPN (dumping syndrome) B12 B12 陸結論表三本院 TPN 處方 TPN-1 TPN-3 TPN-10 TPN-11 TPN-1 (Standard solution) Hicalig-1 (700 ml) +Aminlo-12X(200 ml)*3+ Infuvita 5 ml*2+ Zinc Sulfate 5 ml*2 TPN-3 Hicalig-2 (700 ml) +Aminlo-12X(200 ml)*3+ Infuvita 5ml*2+ Zinc Sulfate 5 ml*1 TPN-10 (Hepatic failure) Hicalig-2 (700 ml) +Aminopoly-H(500 ml) +Infuvita 5 ml*2+ Zinc Sulfate 5 ml*1 TPN-11 (Renal failure) Hicaliq-2 (700 ml) +Amiyu(200 ml) +50%Glucose 20 ml*10 Infuvita 5 ml*2+ Zinc Sulfate 5 ml*1 (ml) (kcal) Additional orders Fat emulsion Venolipid 10% 250 ml Venolipid MCT/LCT 20% 100 ml Vitamin K 10 mg/amp (W1.4) 參考資料 : 1. Cisler JJ, Buchman AL: Intestinal adaptation in short bowel syndrome. J Invest Med 2005; 53: Jackson CS, Buchman AL: The nutritional management of short bowel syndrome. Nutr Clin Care 2004; 7: Jeejeebhoy KN: Short bowel syndrome: a nutritional and medical approach. CMAJ 2002; 166: Angelico M,Guardia PD: Hepatobiliary complications associated with total parenteral nutrition. Aliment Pharmacol Ther 2000; 14: Kowdley KV: Ursodeoxycholic acid therapy in hepatobiliary disease. Am J Med 2000; 108: Liu LL, Gropper MA : Postoperative analgesia and sedation in the adult ICU. Drugs 2003; 63: THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar

6 Short Bowel Syndrome and Total Parenteral Nutrition Chun-Fang Hou, Hsueh-Yang Huang, Nai-Chun Wu Department of Pharmacy, Kaohsiung Armed Forces General Hospital Abstract Short bowel syndrome occurs when there is insufficient lenth of the small intestine,it cannot absorb enough water vitamins and other nutrients from food. Diarrhea is the main symptom of short bowel syndrome,it can lead to dehydration malnutrition and weight loss. These problems can be severe and can cause death without proper treatment. The main treatment for short bowel syndrome is nutritional support.because nutrients cannot be absorbed in the GI tract so total parenteral nutrition (TPN) is required until bowel function returns.but there are many risks and complications associated with TPN so enteral nutrition as early as possible. Beginning enteral nutrition stimulate the remaining intestine to function better. TPN cannot be totally stopped until the patient is able to tolerate enteral feeds that can sustain all their nutritional needs Mar 藥學雜誌第 110 冊 103

臨床藥物治療學 Therapeutics of Clinical Drugs 參中醫療法綜述 1 一扶正培本法 ( ) 1 二清熱解毒法 2 三活血化瘀法 3 四軟堅散結法 4 肆癌症手術後的中醫調養一癌症術

臨床藥物治療學 Therapeutics of Clinical Drugs 參中醫療法綜述 1 一扶正培本法 ( ) 1 二清熱解毒法 2 三活血化瘀法 3 四軟堅散結法 4 肆癌症手術後的中醫調養一癌症術 Therapeutics of Clinical Drugs 臨床藥物治療學中醫藥輔助西醫癌症治療台北長庚紀念醫院中醫藥劑部藥師王麗綺張思平郭旻奇林口長庚紀念醫院中醫藥劑部藥師童承福楊榮季摘要壹前言貳中西醫對癌症的治療原則 301 藥學雜

參 短 腸 症 候 群 的 治 療 一 藥 物 治 療 H2 blockers proton pump inhibitors famotidine ranitidine H2 blocker cimetidine pantoprazole omeprazole lansoprazole esomep

參短腸症候群的治療一藥物治療 H2 blockers proton pump inhibitors famotidine ranitidine H2 blocker cimetidine pantoprazole omeprazole lansoprazole esomep