消化道瘘病人的再喂养综合征

Refeeding syndrome in patients with digestive fistula

目的 通过了解再喂养综合征在消化道瘘病人中的发病率 ,评价再喂养方案的安全性和有效性。方法 回顾性分析 2 0 0 0年 11月至 2 0 0 2年 11月收治的消化道瘘病人中发生再喂养综合征的 15例病人再喂养过程中血清磷、镁、钙、钾的变化及所出现的症状和体征。结果 所有病人均成功地恢复了全量营养支持。在再喂养过程中 ,病人分别出现肌无力、肢体麻痹、轻度呼吸困难、感觉异常、心动过速和腹泻 ,血清磷质量浓度在 2 4h内即有下降 ,在 (3 3± 1 5)d达到最低点 ,经过 (6 1± 2 1)d的补充恢复正常。 3例经过生长激素治疗的病人出现了比其他病人更严重的低磷血症 (<0 2 0mmol/L)。血清镁、钾、钙在再喂养过程中没有明显变化并保持在正常水平。结论 磷酸盐代谢的改变是再喂养综合征的中心环节。电解质和维生素的补充是再喂养综合征治疗的重点。生长激素的治疗可能会加重再喂养综合征的程度。

Objective To estimate the morbidity of refeeding syndrome in patie nts with digestive fistula, and assess the safety and efficacy of refeeding regime. MethodsFifteen patients who suffer ed from g astrointestinal fistula with refeeding syndrome between Nov, 2000 and Nov, 200 2 were reviewed. The reviewed contents included the changes of their serum levels o f phosphorus, magnesium, calcium and potassium as well as symptoms and signs th e y presented.ResultsAll patients recovered by fu ll nutrition supp ort. During the refeeding procedure, patients presented weakness, paral ysis of limbs, slight dyspnea, paresthesia, tachycardia , edema and diarrhea. Th e serum phosphorus concentration decreased in all patients within 24 hours of re feeding. It reached the lowest level after (3 3±1 5) days, taking (6 1±2 1 ) days to return to normal concentration. Three patients who were treated with growth horm one presented more severe hypophosphatemia (less than 0 20mmol/L) than the othe r s. The serum calcium, potassium and magnesium levels did not change significantl y and stayed within the normal range during renourishment. Conclusion Alteration s in phosphate metabolism are central to the refeeding syndrome. The supplement of the electrolure and vitamin is the key to treatment of this synd rome. Growth hormone treatment may aggravate this syndrome. Monitoring of the electrolure and electrocardiogram is necessary to the high- risk population.