1例恶性梗阻性黄疸患者围术期营养支持的案例分析

目的 探讨临床药师在恶性梗阻性黄疸患者围术期营养支持中发挥的作用，为营养支持在围术期患者中的临床应用提供参考。方法 临床药师应用营养风险筛查工具对1例恶性梗阻性黄疸患者进行术前营养风险筛查，并制订营养支持计划。根据病情变化，对围术期营养支持方案进行调整，将30%长链脂肪乳剂250 ml调整为20%中/长链脂肪乳剂250 ml，同时加用经口肠内营养补充剂，并对患者实施药学监护。结果 患者于围术期内由肠外营养支持过渡至肠内营养支持，手术创伤恢复较好，无并发症发生，黄疸情况较前改善。结论 临床药师应协助医师制订和调整营养支持方案，加强药学监护，改善患者营养状态。

A case study of nutritional support for a patient with malignant obstructive jaundice during the perioperative period

Objective To demonstrate the role of clinical pharmacists in nutritional support for a patient with malignant obstructive jaundice and to provide a reference for the clinical application of nutritional supplements in patients during the perioperative period. Methods Clinical pharmacists evaluated the nutritional status of an obstructive jaundice patient with nutrition risk screening tool and developed nutrition support programs perioperatively. The daily dose of 30% long-chain fat emulsion 250 ml was replaced with 20% medium/long-chain fat emulsions 250 ml. Oral nutrition support was added. Pharmaceutical care was implemented for the patient during the perioperative period. Results During the perioperative period, parenteral nutrition support was changed to enteral nutritional support. The patient''s nutritional status and jaundice were improved. The patient recovered well from surgery with no complication. Conclusion Clinical pharmacists work closely with physicians in developing and adjusting nutritional support program to improve the nutritional status and pharmaceutical care for patients.