澳大利亚肠外肠内营养学会肠外营养成人维生素指南
2016年7月，亚太临床营养学会、澳大利亚临床营养学会、国际营养科学联盟官方期刊《亚太临床营养杂志》第25卷第3期正式发表澳大利亚皇家布里斯班女子医院、昆士兰大学、亚历山德拉公主医院、悉尼迈尔·戴维斯咨询顾问、新西兰米德尔莫尔医院、奥克兰市医院、奥克兰大学起草的《澳大利亚肠外肠内营养学会肠外营养成人维生素指南》。
该指南是对澳大利亚肠外肠内营养学会1999年指南针对接受肠外营养的成人患者补充微量元素进行逐步审查的第二部分。
该指南通过系统文献回顾，基于现有证据，同时考虑澳大利亚和新西兰实践环境的特殊因素提出推荐，对每项证据支持的推荐强度进行评估。多学科指导委员会和外部评审者对指南提供了反馈意见。
该指南通过文献回顾发现，维生素D是澳大利亚和新西兰人群最容易缺乏的维生素。澳大利亚和新西兰现有的肠外复合维生素制剂，对于常规接受肠外营养，且将复合维生素作为肠外营养处方一部分的成年人，足以避免不足，且不会造成毒性。
因此，该指南认为：维生素是肠外营养的重要组成部分，应为所有接受肠外营养的患者提供维生素；除了推荐的每年监测维生素D外，常规监测维生素含量对接受常规复合维生素制剂的患者未必是必须的；当评估、处方以及监测接受肠外营养的患者时，临床评估是重要的因素。该指南还确定了有待进一步研究的领域。
Asia Pac J Clin Nutr. 2016;25(3):636-50.
Australasian society for parenteral and enteral nutrition (AuSPEN) adult vitamin guidelines for parenteral nutrition.
Osland EJ, Ali A, Nguyen T, Davis M, Gillanders L.
Royal Brisbane and Women's Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia; Middlemore Hospital, Auckland, New Zealand; Mel Davis and Associates, Sydney, Australia; Auckland City Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand.
BACKGROUND AND OBJECTIVES: This work represents the second part of a progressive review of AuSPEN's 1999 Guidelines for Provision of Micronutrient Supplementation in adult patients receiving parenteral nutrition.
METHODS AND STUDY DESIGN: A systematic literature review was undertaken and recommendations made based on the available evidence and with consideration to specific elements of the Australian and New Zealand (NZ) practice environment. The strength of evidence underpinning each recommendation was assessed. A multidisciplinary steering committee and external reviewers provided feedback on the guidelines.
RESULTS: On review of the available literature it appears that the parenteral multivitamin preparations presently available in Australia and NZ are to sufficient avoid deficiency without causing toxicity in most clinical situations for adults receiving PN when provided regularly as part of the PN prescription. Vitamin D is the most vulnerable vitamin for the Australian and NZ PN population.
CONCLUSIONS: Vitamins are an essential component of PN and should be provided from commencement for all patients receiving PN. With the exception of vitamin D, which is recommended to be monitored annually, routine monitoring of vitamin levels is unlikely to be necessary in patients receiving regular parenteral multivitamin preparations. Clinical judgement is an important element when assessing, prescribing and monitoring patients receiving PN. Areas requiring further research have been identified.
PMID: 27440700
DOI: 10.6133/apjcn.022016.05
