| Summary: | 碩士 === 高雄醫學大學 === 藥學研究所 === 88 === Background Total prenteral nutrition (TPN) had been applied for several years in patients with diseases which make enteral nutrition unsuitable. There was little assessment at the influence of TPN on patients in the past. This study is designed to clarify the advantage and disadvantage of TPN.
Conventional two-combined formulae (two in one) of parenteral nutrition contain glucose and amino acids. For fat supply, additional entrance must be established. If acceptable, total nutritional admixture (three in one) consisting of those three components simultaneously seems to have the advantages of less use of IV sets, probability of infections, nursing load, and expenditure as well as more tolerance of patients to fat emulsions. This study was designed to evaluate the stability of various three-combined admixtures.
Methods From April 1999 to May 2000, we screened consecutive patients who require TPN for at least 10 days. Criteria for exclusion were a diagnosis of sepsis, receipt of albumin or blood component therapy. 25 men and eight women 53.216.6 years of age were enrolled in this study. Mean duration of administration of TPN was 20 10 days. Blood samples were obtained before and after application of TPN for measurement of changes in biochemistry and hematology.
Admixtures with various concentration were made. In addition to observation of changes in appearance, the pH values were measured. By Coulter counter, the distribution of particular sizes and the means of their diameters were got. The influence of temperature, various kinds of amino acids, and duration of storage on the particular sizes was assessed, too.
Results Significant results which have P < 0.05 by t-test consist of both negative and positive effects. Negative effects were noted on levels of hemoglobin and hematocrit. Positive effects were noted on levels of platelet count, albumin, pre-albumin, alkaline phosphatase, phosphate, and blood urea nitrogen.
Paired t-test showed no significant difference in comparison with two-combined admixtures and three-combined ones about distribution of various particles and their diameters. ANOVA disclosed no effect of cold temperature and duration for storage on particular distribution and sizes of three—combined preparations. However, different amino acid has impact on distribution of small particles except their size is more than 10um.
Conclusions In addition to improvement in some components in both biochemistry and hematology, disadvantage such as elevation of levels of alkaline phosphatase which is an indicator of cholestasis exists for those receiving TPN. It is still controversial about if the complication is exclusively attributed to TPN. Nevertheless, encouragement to switch TPN to enteral nutrition as soon as possible is still considered to be mandatory for decreasing the possible adverse reactions.
According to the reliable stability, it seems practicable to mix present standard formulae of parenteral nutrition in KMUH with fat emulsion. Even so, if another changes in regimens will be tried, it is necessary to reevaluate the stability of new ones.
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