营养不良患者再喂养综合征的临床实践体会

Practical experience of refeeding syndrome in malnourished patients

目的调查营养不良患者再喂养综合征(RFS)的临床特征。方法回顾性分析67例营养不良住院患者的临床资料,其中RFS患者24例(RFS组),非RFS患者43例(RFS组),病例选择的主要标准为营养风险筛查总分(NRS 2002)≥3分,入院后接受肠内或肠外营养超过3天及入院前没有接受肠内营养。RFS的诊断标准参阅文献报告。结果两组患者的平均年龄均接近70岁。在疾病构成方面,约1/3(非RFS组32.6%和RFS组33.3%)为癌症放化疗相关的营养不良及体重降低,约1/4患者(非RFS组23.3%和RFS组25.0%)为感染性疾病,两组间疾病构成的差异没有统计学意义(P>0.05)。两组的营养支持方式相似,约50%患者采用正常进食+口服营养剂,约40%肠外营养+口服营养剂。RFS组患者的磷酸盐水平、血清镁、血K^(+)、白蛋白显著低于非RFS组患者(P<0.05)。此外,RFS组患者伴发外周水肿例数明显高于非RFS组患者(P<0.05);患者发生心动过速、呼吸急促例数的差别没有统计学意义(P>0.05)。在治疗过程中,RFS组患者总Na补充的量明显高于非RFS组患者(P<0.05),但补充磷酸盐、镁及钙的量,两组间差异没有统计学意义(P>0.05)。随访1月,RFS组没有死亡病例,非RFS组有1例因晚期肺癌死亡;RFS组平均住院时间明显长于非RFS组(P<0.05);RFS组有4例再入院,非RFS组有1例再入院,两组间差异没有统计学意义(P>0.05)。结论本组病例中,RFS患者多表现为电解质平衡紊乱,更低的血清蛋白水平及外周组织水肿,RFS患者会延长住院时间。

Objective To investigate the clinical features of refeeding syndrome(RFS)in malnourished patients.Methods The data of 67 hospitalized patients with malnutrition were retrospectively analyzed.Among them,24 were RFS patients(RFS group)and 43 were non-RFS patients(RFS group).The main criterion for case selection was the Nutritional Risk Screening total score(NRS 2002)≥3 points,received enteral or parenteral nutrition for more than 3 days after admission and did not receive enteral nutrition before admission.The diagnostic criteria of RFS was referred to the published literature.Results The average age of patients in both groups was close to 70 years old.In terms of disease composition,about 1/3(32.6% of the non-RFS group and 33.3%of the RFS group)were malnutrition and weight loss associated with cancer radiotherapy and chemotherapy,and about 1/4 of the patients(23.3%of the non-RFS group and 25.0%of the RFS group)were infectious disease,and the difference in disease composition between the two groups was not statistically significant(P>0.05).The nutritional support of the two groups were similar.About 50%of the patients used normal eating+oral nutrition,and about 40%parenteral nutrition+oral nutrition.The phosphate level,serum magnesium,blood K^(+),and albumin of patients in the RFS group were significantly lower than those in the non-RFS group(P<0.05).In addition,patients in the RFS group with peripheral edema were significantly higher than those in the non-RFS group(P<0.05);there was no statistically significant difference in the number of patients with tachycardia and shortness of breath(P>0.05).During the treatment,the total amount of Na supplementation in the RFS group was significantly higher than that in the non-RFS group(P<0.05),but there was no significant difference in the amount of phosphate,magnesium and calcium supplementation between the two groups(P>0.05).The patients were followed up for 1 month,there were no deaths in the RFS group,and one in the nonRFS group died of advanced lung cancer;the average hospital stay in the RFS group was significantly longer than that in the non-RFS group(P<0.05);four patients in the RFS group were re-admitted to the hospital,and one in the non-RFS group Patients were re-admitted to the hospital,and the difference between the two groups was not statistically significant(P>0.05).Conclusion In these cases,patients with RFS mostly showed electrolyte balance disorders,lower serum protein levels and peripheral tissue edema,and RFS patients prolonged the hospital stay.