Page 110 - 《中国药房》2025年20期

肠外营养精细化用药规则设置及效果评价
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陈 雨 ，顾 婕，丁兰萍，马祝悦，袁红宇（南京医科大学第一附属医院药学部，南京 210029）
中图分类号 R969.3；R977.6 文献标志码 A 文章编号 1001-0408（2025）20-2588-05
DOI 10.6039/j.issn.1001-0408.2025.20.18

摘 要 目的 构建肠外营养（PN）精细化用药规则并评价其效果。方法 基于药品说明书及相关指南、专家共识，构建PN精细化
用药规则。通过合理用药监测系统（PASS）前置审核系统收集2024年1－12月（简称“干预后”）我院住院患者的PN医嘱信息，分
析干预后的医嘱审核情况；通过医嘱点评系统收集2023年1－12月和2024年1－12月我院住院患者的PN医嘱信息，评价医嘱点
评系统的PN医嘱点评合理率。结果 所建PN精细化用药规则包括系统模块规则（营养物质、药物配伍、PN浓度和渗透压）和自定
义审核规则（超适应证、药物配伍、其他用药条件）。截至2024年12月，PASS前置审核系统共建立PN系统模块规则55条、自定义
审核规则47条，共计102条。干预后，与2024年第1季度比较，第4季度的药师审核和干预的PN任务数均减少，药师干预率降低，
药师干预后医生修改率升高。PN系统模块规则下的不合理医嘱类型主要为PN浓度和渗透压不合理；自定义审核规则下的主要
不合理医嘱类型为超适应证（氨基酸适应证）和药物配伍不合理。2024年，假阳性任务数、假阳性率均呈先升高后降低的趋势，人
工点评不合理医嘱和假阴性率均呈下降趋势。2024年，经人工采用PN精细化用药规则进行PN医嘱点评后的总合理率显著高于
2023年（P＜0.01）。结论 我院成功构建了PN精细化用药规则，其能够降低PN用药风险、提高PN医嘱的合理率。
关键词 精细化用药规则；肠外营养；处方前置审核；合理用药

Fine setting and effect evaluation of parenteral nutrition refined medication rules
CHEN Yu，GU Jie，DING Lanping，MA Zhuyue，YUAN Hongyu（Dept. of Pharmacy， the First Affiliated Hospital
with Nanjing Medical University， Nanjing 210029， China）

ABSTRACT OBJECTIVE To establish refined medication rules for parenteral nutrition （PN） and evaluate its effectiveness.
METHODS Refined medication rules for PN were constructed based on drug instructions， relevant guidelines， and expert
consensus. Through the pre-approval review system of prescription automatic screening system （PASS）， PN prescription
information for inpatients from January to December 2024 （referred to as “post-intervention”） was collected to analyze the post-
intervention prescription review status. PN prescription information for inpatients at our hospital from January to December 2023
and January to December 2024 was collected through the medical order review system to evaluate the rationality rates of PN
prescriptions. RESULTS The established refined medication rules for PN included system module rules （including nutrients， drug
compatibility， PN concentration and osmotic pressure） and custom review rules （covering off-label drug use， drug compatibility，
and other drug use conditions）. As of December 2024， the PASS pre-approval review system had established a total of 102 rules，
comprising 55 system module rules and 47 custom review rules for PN. After intervention， when comparing with the first quarter of
2024， the number of PN reviewed and intervened by pharmacists decreased， the pharmacist intervention rate dropped， while the
rate of physician modifications following pharmacist intervention increased in the fourth quarter. The primary types of irrational
prescriptions identified by the system module rules were irrational PN concentration and osmotic pressure. The primary types of
irrational prescriptions identified by the custom review rules were off-label drug use （specifically indications for amino acids） and
irrational drug incompatibility. In 2024， the number of false-positive tasks and the false-positive rate initially increased and then
decreased， while both the number of irrational prescriptions identified through manual review and the false-negative rate showed a
declining trend. In 2024， the overall rationality rate after manual review PN refined medication rules for PN medical order review
system significantly increased compared to that in 2023 （P＜0.01）. CONCLUSIONS The refined medication rules for PN in our
hospital were established successfully， which can reduce the
Δ 基金项目 江苏省药学会-恒瑞医院药学基金科研项目（No.
PN-induced risks and significantly improve the rationality of
H202004）
PN prescriptions.
＊第一作者 主管药师，硕士。研究方向：临床药学。E-mail： KEYWORDS
775163531@qq.com refined medication rules； parenteral nutrition；
# 通信作者 主任中药师，副教授，硕士。研究方向：药事管理、临 prescription pre-review； rational drug use
床药学。E-mail：3066076382@qq.com

· 2588 · China Pharmacy 2025 Vol. 36 No. 20 中国药房 2025年第36卷第20期