目的 通过对胃癌术后并发乳糜性腹水患者营养支持方案的优化干预和药学监护,探讨临床药师在合理用药中的作用。方法 临床药师对乳糜性腹水的高龄患者术前术后的营养支持方案进行全程药学监护。临床药师对术前营养支持方案、术后早期营养支持方式以及出现并发症(乳糜腹水)时营养支持方案的调整进行干预。结果 具有营养风险的高龄患者术前可在饮食基础上口服标准整蛋白型制剂,术后出现乳糜性腹水时采用无脂饮食可使腹水消退。结论 临床药师参与营养支持治疗,可协助医师制定更加安全、有效的个体化营养支持方案,减轻术后并发症,缩短住院时间。

OBJECTIVE To explore the role of clinical pharmacists in the rational use of drugs by optimizing the interventions and conducting pharmaceutical care for nutritional support treatment of one elderly patient complicated with chylous ascites after gastric cancer operation. METHODS Clinical pharmacist provided preoperative and postoperative pharmaceutical care for nutritional support treatment of one elderly patient with chylous ascites,including adjustment of preoperative nutritional support regimens,early postoperative nutritional support METHODS and nutritional support regimens when chylous ascites occurred. RESULTS Elderly patients who have high nutritional risks can take standard enteral nutrition as oral nutrition supplement besides oral diet. The use of fat-free diet is an effective treatment means of chylous ascites. CONCLUSION Involvement of clinical pharmacists in nutritional support treatment can help physicians develop safer and more effective individualized nutrition support regimens,reduce postoperative complications,and shorten hospital stay.