目前接受腸道營養治療之灌食病患並未有其專用之內服液劑藥物劑型，而大 都是將一般口服固體劑型藥物改變後直 接經由餵食管灌食投予，但此可能潛藏著各種不同程度的用藥安全性風險問題；且 若將藥物與管灌營養品混合灌食時，亦可能產生不易預測之效果與配伍禁忌。使用不適當的管灌方法經由餵食管投予藥物 將可能導致餵食管阻塞、毒性增加或療效 降低，進而增加醫院之醫療成本。
本研究於某一區域教學醫院中，選 取 2004 年 1 月至 12月之間接受腸道營養治療並經由鼻胃管灌食期間之住院病患，合計 875 人次之所有口服劑型電子 藥歷檔資料，共 11,542 筆藥物。針對接 受腸道營養並經由鼻胃管投予口服藥物 時、所可能產生之潛在不適當用藥性問 題實施一病歷回顧性評估研究。納入評估之不適當問題類別共有六項：一、具藥劑學性配伍禁忌。二、應以特殊之管灌方法投藥。三、具阻塞鼻胃管之風險，四、具與含聚氯乙烯之鼻胃管壁材質產 生吸附作用之風險。五、具藥物與營養 液產生交互作用之風險。六、具危害醫護人員或照護者之風險。研究結果發現具潛在用藥不適當問題的件數為1,871件，整體平均盛行率為 16.2%。其中依不適當問題類別項目、科別、疾病主診斷別、藥理作用類別之各項統計分析結果，分別佔居最高盛行率者為：藥劑學性配伍禁忌之盛行率為 10.3%，瀉劑及緩瀉劑類之盛行率為 3.6%，胸腔內科之盛行率為 5.4%，主診斷為急性呼吸衰竭 之盛行率為 6.7 %。
經由鼻胃管接受腸道營養之灌食病 人，大都屬病情危急且用藥複雜性高，這群病人之用藥安全迫切需要相關醫療人員與有關單位之重視。
Currently there is no commercially available oral form of liquid dosage, specifically for tube feeding patients.It has the potential to cause various levels of risks of medication safety when oral form of solid dosage is crushed and administered via a feeding tube. Unpredictable side effects and incompatibilities might be caused if drug are administered with tube-feeding nutrition; however, tube obstruction, increased toxicity, or reduced efficacy may occur as well if an improper administration method is used. Then, it may increase medical costs of hospital.
The purpose of this study was to survey the prevalence of medical safety risks for inpatients that received enteral nutrition with medication via nasogastric tube feeding. To collect all drug profiles for all inpatients that have received enteral nutritions with medications via nasogastric tube feeding in a regional teaching hospital between Jan. to Dec. in 2004.It included 875 patients with 11,542 medication contents for evaluation, and makes a review of assessment of prescriptions.The categories of evaluation were: (1) pharmaceutical incompatibilities, (2) special medication via feeding tube, (3) clogged feeding tube, (4) PVC adsorption with medication, (5) drug- nutrient interactions, and (6) the risks of dangers to medical personnel or caretakers.This study discovered that total amount of potential medication safety risks was 1,871 and the overall prevalence was 16.2%.
The highest prevalences of items of results depending on categorizes of evaluation, medical specialty, diagnosis and pharmacology were as follows: pharmaceutical incompatibilities; 10.3%, pulmonary disease;5.4%, acute respiratory failure; 6.6%, cathartics and laxatives; 3.6%.
Most inpatients using enteral tube feeding are critical and have medication complexities. The medication safety for those patients is urgent and needs to be emphasized.
