再喂养综合征在危重疾病中的研究进展

Research progress of refeeding syndrome in critical illnesses

再喂养综合征(RFS)是一种潜在的、危及生命的疾病,由于机体长时间饥饿后重新进食引起,囊括了一系列标志性实验室指标异常(如低磷血症、低钾血症、低镁血症和硫胺素缺乏)和/或临床症状。本病涉及错综复杂的代谢和营养转变,在危重疾病中非常常见。近年来,RFS在神经性厌食症(AN)、脓毒症和恶性肿瘤等危重疾病中已取得了一定的研究进展。为防治RFS,应尽早筛查长期饥饿、营养不良和低体重指数等相关高危因素,对于AN高危患者推荐初始高热量[30~40 kcal/(kg·d)]的再喂养方案,对于其他危重的高危患者推荐初始低热量[10~20 kcal/(kg·d)]的再喂养方案。本文主要聚焦于危重疾病中RFS的高危因素及RFS在常见危重疾病中的研究进展,以提高临床医师的重视度。

Refeeding syndrome(RFS)is a potentially life-threatening condition caused by the body’s return to eating after prolonged starvation that encompasses a range of signature laboratory abnormalities(e.g.,hypophosphatemia,hypokalemia,hypomagnesemia,and Thiamine deficiency)and/or clinical symptoms.It involves intricate metabolic and nutritional transformations and is common in critical illnesses.In recent years,RFS has made some progress in critical diseases such as anorexia nervosa(AN),sepsis,and malignant tumor.To prevent and treat RFS,long-term hunger,malnutrition,low body mass index,and other related risk factors should be screened as early as possible.An initial high-calorie(30-40 kcal/[kg·d])refeeding regimen is recommended for high-risk patients with AN,and an initial low-calorie(10-20 kcal/[kg·d])refeeding regimen is recommended for other critically high-risk patients.This paper mainly focuses on the risk factors of RFS in critical diseases and the research progress of RFS in common critical diseases,so as to improve the attention of clinicians.