| OBJECTIVE:Clinical pharmacists are involved in the design of individualised total nutrition mix formulations for patients with gastrointestinal tumours and provide information on the impact of different dosing regimens on patients,evaluating their clinical efficacy and pharmacoeconomic indicators;as well as analysing the variability of total nutrition mix formulations between different disease types.METHODS:Clinical data were collected from patients with gastrointestinal tract tumours treated with parenteral nutrition support in a tertiary care hospital from 2019-2022.The patients were divided into individualized total nutrition mixture(TNA)infusion group(individualized group),commercialized multi-lumen bag infusion group(commercialized group)and single bottle infusion group of nutritional agents(single bottle group)according to the drug administration method.The individualised and commercialised groups had a clinical pharmacist involved in the documentation of the nutritional support treatment,while the single bottle group was administered nutritional therapy under the orders of the treating physician.Nutritional parameters(albumin ALB,prealbumin PA,total protein TP,retinol binding protein RBP,C-reactive protein CRP),liver and kidney parameters(alanine aminotransferase ALT,glutamic aminotransferase AST,total bilirubin TBi L,direct bilirubin DBi L,urea nitrogen BUN),associated costs and complications were compared between the three groups before and after treatment.In addition,three years of prescription lists for the allocation of total nutrition mixes were collected to compare the variability of grouping between conditions such as intestinal obstruction,pneumonia,renal disease,gastrointestinal bleeding and oncology,as well as the variability of grouping between different cancers.RESULTS:1.A total of 53 cases in the single bottle group,42 cases in the commercialized group and 48 cases in the individualized group of patients with gastrointestinal tract tumors were collected;a total of 292 total mixed nutrient formulas,including 27 for intestinal obstruction,30 for pneumonia,53 for renal disease,13 for gastrointestinal bleeding,14 for pancreatitis and 155 for tumors;including 50 for intestinal cancer,17 for esophageal cancer,35 for gastric cancer,23 for pancreatic cancer and 30 for other cancers.2.The differences in the indices and general demographic data of the patients in the three groups before treatment were not statistically significant P > 0.05),and the differences in RBP,TP,ALB,DBIL,and BUN in the three groups after treatment were statistically significant(P < 0.05).All five indexes in the individualized group were significantly higher than those in the single bottle group,and DBIL in the commercialized group was higher than that in the single bottle group.The differences of indexes before and after treatment in the three groups were statistically significant(P < 0.05)when comparing CRP,RBP,PA,ALB,and AST.The magnitude of changes in CRP,RBP,PA,and ALB in the individualized was significantly better than that in the single bottle group,and the AST in the commercialized group was significantly higher than that in the single bottle group.No statistically significant differences in other indicators.3.Among the three groups of patients,9 cases(17%)in the single bottle group had nutrition support-related complications;10 cases(23.8%)in the commercialized group;and 2 cases(4.2%)in the individualized group.The differences were statistically significant when comparing the patients with complications in the three groups by chi-square test,and the incidence of infection complications in the individualized group was 4.2% significantly lower than that in the other two groups(P < 0.05);no adverse reactions occurred in all three groups.4.There were significant differences in the number of days of nutritional support and cost of nutritional support between the two groups(p<0.05).2004.7)and individualized group(2133.1±1461.3).There was no difference in the number of hospital days,total cost and total drug cost;the cost-effectiveness ratio was RMB67559.0,77341.8 and 60855.6 in the individualized,commercialized and single vial groups respectively.5.The individualised total nutrition mix cohort for the different diseases had the lowest BMI and days on medication and the highest NRS2002 score and days in hospital for pneumonia.There were significant differences between the four diseases in the comparison of glucose energy,amino acid energy,glycolipid ratio,total fluid volume and monovalent cation concentration.All five indicators were lower in the nephropathy group than in the other diseases,with significant differences mainly with the intestinal obstruction and tumour groups;total fluid volume was significantly higher in intestinal obstruction and tumour than in pneumonia and nephropathy.The addition of alanyl glutamine to the formula was significantly higher in intestinal obstruction and neoplasm than in pneumonia and nephropathy,and the addition of insulin was significantly higher in nephropathy than in neoplasm.6.Among the contents of the total nutrition mix grouping for different cancers,oesophageal cancer had the longest hospitalization days,and the weight of patients with intestinal cancer was significantly higher than that of oesophageal and gastric cancers.The four cancers differed in terms of glucose energy,amino acid energy,fatty milk energy,total energy,glucose-to-pancreas ratio,total fluid volume and osmolality,with oesophageal cancer being significantly lower than intestinal cancer in all seven indicators;gastric cancer was significantly lower than intestinal cancer in four areas: amino acid energy,total energy,glucose-to-pancreas ratio and osmolality;pancreatic cancer was significantly lower than gastric cancer in terms of glucose-to-pancreas ratio and total fluid volume,and osmolality was significantly lower than intestinal cancer.CONCLUSION:The individualised group has a good efficacy and cost effectiveness ratio compared to the other two groups.Different diseases have different characteristics,and pharmacists and treating physicians should combine the relevant characteristics to reasonably design the contents and ratios of parenteral nutrition formulas.The participation of clinical pharmacists in parenteral nutrition support and the provision of pharmacy services is more suitable for the diversity of clinical patients’ disease states,and parenteral nutrition support treatment should take into account clinical efficacy,pharmacoeconomics and other factors,and strive to achieve individualisation. |
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