全靜脈營養對於腸道營養不能或不足的病患有助於病情改善，然而過度的給予反而會引起更多的併發症。因此定期檢討全靜脈營養給予的適當性是必要的。本研究目的為評估本院全靜脈營養三大熱量的給予與美國靜脈暨腸道營養 醫學會(ASPEN)的符合度，並監測台灣 靜脈暨腸道營養醫學會(TSPEN)相關品 質指標，以期能建立「營養醫療品質之 監測」。

由本院資訊室提供自2004年1月至2006 年 12 月，共三年成人住院病患全 靜脈營養使用基本資料，回溯性分析三大熱量（含葡萄糖輸注速率、蛋白質、 脂肪）、NPC：N、碳水化合物與脂肪比 例及非蛋白質熱量。並探討品質監測指 標（含計算葡萄糖輸注速率、葡萄糖輸 注速率大於 5 mg/kg/min、給予脂肪前是 否監測三酸甘油酯、全靜脈營養處方評 估次數、使用全靜脈營養的天數）及停 止使用全靜脈營養原因。本院三年期間使用全靜脈營養的人數共1198人。平均年齡 63.6 ± 18.7 歲。女性與男性比例 1：2。平均體重 56.7  ±  13.3 公斤，約 10% 病患理想體重百分比大於130%，此族群的熱量以調整體重計算。本院使用全 靜脈營養的病患每位皆有計算葡萄糖輸 注 速 率 ， 葡 萄 糖 輸 注 速 率 小 於   5 mg/kg/min 佔 95%，大於 5 mg/kg/min 由2004年6.5%、2005年 4.2%降至2006年 1.3% 。 94% 病 患 蛋 白 質 給 予   0.8-2 g/kg/day 、 99.6% 病 患 脂 肪 給 予 小 於2g/kg/day。80%病患碳水化合物與脂肪比例為 70：30 及  60：40。70%病患非蛋白質熱量（ NPC ）為20-30 kcal/kg/day。NPC：N有90% 病患在100-199。平均使用全靜脈營養的天數為14天，而同一配方使用的平均天數為6天，每位病患平均調整2次處方。有65%病患恢復腸道營養而停止使用全靜脈營 養，另外有30%病患死亡。有15%病患未監測三酸甘油酯即給脂肪製劑。 

依據ASPEN之建議，葡萄糖輸注速率與脂肪給予分別應小於5 mg/kg/min及2.5g/kg/day，而蛋白質則 為 0.8-2  g/kg/d。本院三大熱量的給予九成符合ASPEN的建議。而葡萄糖輸注速率大於 5 mg/kg/min 情形則逐年下降。

本院每週依據檢驗數據及臨床訪視結果調整病患營養配方。雖然本院大部分的 熱量給予及品質監測指標皆符合建議， 本院仍將積極探討約一成異常情況以期提高營養醫療品質。 

Total Parenteral Nutrition (TPN) has a beneficial effect on malnourished patient.However overfeeding or underfeeding may have opposed effect that bring harm to patient. It is necessary to evaluate TPN used in hospital periodically.

To compared the agreement of macronutrient supplied in our hospital with ASPEN (American Society for Parenteral and Enteral Nutrition) guideline  and  to  execute  TSPEN  (  Taiwan Society  for  Parenteral and  Enteral  Nutrition ) guideline  of  qualified  NST  (Nutrition Support Team) to monitor our quality of practice.

A retrospective review of patient using TPN between 2004 and  2006. The medical records will identify using our hospital data base. Data were extracted on patient demographics, macronutrient supplement (including glucose infusion rate/GIR, protein, fat ), the ratio of carbohydrate and fat, and non protein calorie (NPC). We also figures the indicators which pronounced in TSPEN guideline ( including GIR level, frequency of PN order being evaluated by NST, mean days of TPN use, GIR > 5mg/kg/min and TG data before fat emulsion given ).

There were 1198 patients using TPN within 3 years of study period. The mean age of patients was 63.6 ± 18.7 years. The mean body weight was   56.7±13.3   kg,   about   10%   of   study populations were obese, defined as body weight > 130% of the ideal. Most of the patients (95%) having GIR < 5 mg/kg/min. GIR > 5 mg/kg/min was decreased from 2004 to 2006, as 6.5%, 4.2% and 1.3% each year, 94% protein provision was 0.8-2  g/kg/day,99.6%  fat provision  was  < 2g/kg/day, 80% of the ratio of carbohydrate and fat was 70:30 and 60:40, 70% NPC provision was 20-30 kcal/kg/day. The average of TPN use was 14 days (1-120 days). TPN order being evaluated  by  NST  weekly.  65%  of  patients restore enteral feeding and 30% was death. 15% of patients don’t have TG data before fat emulsion given.

TPN practice in our hospital is 94% in line with current guideline. Lack of clinical outcome is  our  study limitation. Based on the  ASPEN suggestion, GIR  should  be  <  5  mg/kg/min to reduce the incidence of hyperglycemia. However, to  date,  there  is  no  study  to  evaluate  the frequency of hyperglycemia in patients receiving GIR below 5  mg/kg/min, and  the  risk factors influence the blood glucose in Taiwanese patients. In future study, we may further find out the rational range of GIR in Taiwanese patients.TPN team comprising of a physician, nurse, dietitian and pharmacist. In addition to compounding, pharmacist should be responsible for TPN practice quality monitoring.