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 1. 2. B12 50 B12 100 2 3. 4. 5. 98 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar. 31 2012
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% 4. 5. TPN (1) (cholecystokinin; CCK) 28 1 Mar. 31 2012 藥 學 雜 誌 第 110 冊 99
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 34 2 19 119 87/35 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 3 10 190 mg/dl Venolipid 3 15 3 18 TPN ( ) 表 一 住 院 期 間 血 液 生 化 值 2 19 2 21 2 23 2 26 2 28 3 2 3 8 3 10 3 12 3 14 Ht (%) 36-46 29.1 26.8 31.6 31.1 32 33.7 35.3 Hb (g/dl) 12-16 9.7 15.4 14.6 12.1 10.9 10.4 11.1 WBC (10 3 /ul ) 5-10 10.3 17.2 15.9 19.3 15.4 14.1 13.5 12.9 12. Plt (10 3 /ul) 150-400 101 116 364 427 201 324 SGOT (U/L) 10-30 17 21 32 41 63 69 SGPT (U/L) 2-32 22 27 31 45 58 72 BUN (mg/dl) 5-25 6 9 18 23 25 Cr (mg/dl) 0.5-1.4 0.9 0.9 0.8 0.7 0.9 Glucose (mg/dl) 75-110 187 197 220 279 Na (meq/l) 137-145 152.1 149.8 143.5 139.3 140.7 138.2 K (meq/l) 3.1-5.3 2.8 3.3 3.9 4.2 3.9 3 Ca (mg/dl) 8.4-10.2 7.1 7.9 7.8 7.9 8.8 9.2 9.1 TG (mg/dl) 21-177 405 299 190 179 Albumin (g/dl) 3.1-4.8 2.3 3.1 Bilirubin (mg/dl) 0.2-1.4 16.9 11.2 7.8 5.9 3.1 100 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar. 31 2012
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 1 3 10 11 4 1 3 10 11 ( ) 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) 5 28 1 Mar. 31 2012 藥 學 雜 誌 第 110 冊 101
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) 1222 1217 1217 917 (kcal) 807 1027 842 900 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: 402-413. 2. Jackson CS, Buchman AL: The nutritional management of short bowel syndrome. Nutr Clin Care 2004; 7: 114-121. 3. Jeejeebhoy KN: Short bowel syndrome: a nutritional and medical approach. CMAJ 2002; 166: 1297-1302. 4. Angelico M,Guardia PD: Hepatobiliary complications associated with total parenteral nutrition. Aliment Pharmacol Ther 2000; 14: 54-57. 5. Kowdley KV: Ursodeoxycholic acid therapy in hepatobiliary disease. Am J Med 2000; 108: 481-486. 6. Liu LL, Gropper MA : Postoperative analgesia and sedation in the adult ICU. Drugs 2003; 63: 755-767. 102 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar. 31 2012
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. 28 1 Mar. 31 2012 藥 學 雜 誌 第 110 冊 103