慢重症患者再灌食综合征的防治

Prevention and management of refeeding syndrome in patients with chronic critical illness

由于慢重症患者广泛存在类似于恶性营养不良的状态，故营养支持治疗是其渡过慢重症进入康复期的一种重要手段．但在营养支持治疗过程中往往容易出现再灌食综合征。再灌食综合征主要表现为严重的电解质紊乱，其中低磷血症最为常见，是营养支持治疗过程中威胁生命的严重并发症。再灌食综合征经常被医生忽视，但是其在临床上却有较高的发病率，需要我们在临床工作中高度重视，积极进行防治。本文主要基于英国NICE临床营养支持治疗指南．对慢重症患者再灌食综合征的危险因素、治疗方法及预防措施进行探讨。我们认为，对于再灌食综合征的高危患者，营养支持治疗时应从低热卡缓慢增加到完全需要量，恢复循环容量并严密监测液体平衡情况，同时注意维生素、微量元素、血浆离子的补充。当出现再灌食综合征的症状后，应减少甚至停止热卡的摄入，积极治疗电解质紊乱，补充维生素B，维护各个器官的功能。

Nutritional support is an important means to treat the patients with chronic critical illness for commonly associated malnutrition. Refeeding syndrome is a serious complication during the process, mainly manifested as severe electrolyte with hypophosphataemia being the most common.Refeeding syndrome is not uncommon but it is often ignored. In our future clinical work, we need to recognize this chinical situation and use preventative and treatment measures. According to NICE clinical nutrition guideline, we discussed the risk factors, treatment methods and preventive measures of refeeding syndrome in patients with chronic critical illness. We argued that for patients with high risk refeeding syndrome, nutritional support treatment should be initially low calorie and slowly increased to complete requirement. Circulation capacity should be recovered, fluid balance must be closely monitored and supplement of vitamins, microelement, electrolytes should be noted. After the emergence of refeeding syndrome, we should reduce or even stop the calorie intake, give an active treatment for electrolyte disorder, provide vitamin B, and maintain the functions of multiple organs.