再喂养综合征与急诊重症患者细胞免疫功能以及院内死亡的关系分析

Relationship of refeeding syndrome with cellular immune function and nosocomial death in severe emergency patients

目的探讨再喂养综合征(RFS)与急诊重症患者细胞免疫功能以及院内死亡的关系。方法回顾2020年1月至2022年1月西安交通大学第二附属医院收治的因营养不良接受营养支持治疗后出现RFS患者122例(RFS组),另选择接受营养支持治疗后未出现RFS患者131例作为对照组。检测所有患者入院时(基线)和营养支持第3天电解质、白蛋白水平和细胞免疫功能,收集临床资料以及院内结局。采用Kaplan-Meier曲线分析不同分组患者院内生存差异,Cox风险比例回归模型分析造成急诊重症患者院内死亡的危险因素。结果RFS组基线和营养支持第3天BMI、磷酸盐(PO_(4)^(3-))、镁离子(Mg^(2+))、钾离子(K^(+))、白蛋白水平,CD3^(+)T细胞、CD4^(+)T细胞、CD4^(+)/CD8^(+)、CD3^(-)CD56^(+)NK细胞、CD56brightNK细胞、CD56dimNK细胞占比均低于对照组(均P<0.05)。RFS组院内存活率低于对照组(50.00%比85.50%,P<0.01)。死亡组基线PO_(4)^(3-)水平,营养支持第3天PO_(4)^(3-)、Mg^(2+)、K^(+)水平,CD4^(+)T细胞、CD4^(+)/CD8^(+)、CD3^(-)CD56^(+)NK细胞占比,补磷、补维生素B1占比均低于存活组(均P<0.05),RFS、RFS重度占比,急性生理学及慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA),并发急性肾损伤、心力衰竭发生率均高于存活组(均P<0.01)。RFS、并发心力衰竭是造成急诊重症患者院内死亡的危险因素(均P<0.01),营养支持后第3天血PO_(4)^(3-)水平、补磷是保护因素(均P<0.01)。结论发生RFS的患者基线营养状态较差,细胞免疫功能降低,RFS是急诊重症患者院内死亡的危险因素,积极纠正电解质失衡对改善急诊重症患者临床结局可能有重要意义。

Objective To investigate the relationship of refeeding syndrome(RFS)with cellular immune function and nosocomial death in severe emergency patients.Methods One hundred and twenty two patients who developed RFS after receiving nutritional support therapy in Emergency ICU of the Second Affiliated Hospital of Xi'an Jiaotong University from January 2020 to January 2022(RFS group)and 131 patients without RFS after receiving nutritional support therapy(control group)were enrolled in the study.Electrolytes and albumin levels and cellular immune function of all subjects were determined,and clinical data and hospital outcomes were documented.Kaplan-Meier curve was used to analyze the survival during hospitalization,and Cox proportional regression model was used to analyze the factors influencing nosocomial death in acute and severe patients.Results The levels of body mass index(BMI),PO_(4)^(3-),Mg^(2+),K^(+)and albumin,the proportion of CD3^(+)T cells,CD4^(+)T cells,CD4^(+)/CD8^(+),CD3^(-)CD56^(+)NK cells,CD56brightNK cells and CD56dimNK cells at baseline and the third day after nutritional support in RFS group were lower than those in control group(all P<0.05).The nosocomial survival rate of RFS group was lower than that of control group(50.00%vs.85.50%,P<0.01).The baseline PO43-level,the levels of PO_(4)^(3-),Mg^(2+)and K^(+),the proportion of CD4^(+)T cells,CD4^(+)/CD8^(+)and CD3^(-)CD56^(+)NK cells,the proportion of phosphorus supplement and vitamin B1 supplement,the proportion of RFS and severe RFS at the third day after nutritional support in the death group were lower than those in the survival group(P<0.05).APACHEⅡ score and SOFA score,the incidence of acute kidney injury and heart failure in death group were higher than those of survival group(P<0.01).Cox regression model showed that RFS and heart failure were the risk factors for nosocomial death in emergency patients(P<0.01),and PO43-level and phosphorus supplementation at the third day after nutritional support were the protective factors(P<0.01).Conclusion Emergency severe patients with RFS have poor baseline nutritional status and reduced cellular immune function.RFS is a risk factor for nosocomial death in acute and severe patients.Active correction of electrolyte imbalance may be effective to improve the clinical outcome of emergency severe patients.