目的调查重症监护病房(intensive care unit,ICU)护士预防再喂养综合征知识、态度和行为现况,并分析其影响因素,为临床开展相关教学、培训提供依据。方法采用便利抽样法,自行编制一般资料调查表、ICU护士对预防RFS再喂养综合征(refeedin...目的调查重症监护病房(intensive care unit,ICU)护士预防再喂养综合征知识、态度和行为现况,并分析其影响因素,为临床开展相关教学、培训提供依据。方法采用便利抽样法,自行编制一般资料调查表、ICU护士对预防RFS再喂养综合征(refeeding syndrome,RFS)知识、态度和行为问卷以及护理阻碍因素及知识需求问卷,对上海市5所三级甲等综合医院和2所二级甲等综合医院的366名ICU护士进行调查,并采用多重线性回归分析RFS的知识、态度和行为的影响因素。结果366名ICU护士预防RFS知识、态度和行为问卷总分、知识维度、态度维度、主观规范、感知行为控制及行为意向维度得分分别为(133.73±20.55)分、(35.79±9.04)分、(37.44±6.20)分、(12.07±2.27)分、(17.82±4.00)分、(30.61±6.09)分,总分处于中等水平。多重线性回归分析显示,医院级别、ICU类型以及是否为营养学组成员、接受过相关培训、从学术期刊获取知识的频率是ICU护士对预防RFS知识、态度和行为的影响因素(均P<0.05),共同解释其20.90%的变异。结论从学术期刊获取知识、三级医院、综合ICU及接受过RFS相关知识培训、营养学组成员的护士有较高的预防RFS知识、态度和行为水平。护理管理者应重视ICU护士的培训,加强其对预防RFS护理的知识和行为,从而提高ICU护理管理质量。展开更多
目的:系统评价营养支持病人发生再喂养综合征风险预测模型。方法:计算机检索PubMed、EMbase、CINAHL、Web of Science、中国生物医学文献数据库、中国知网和万方数据库中有关再喂养综合征风险预测模型的研究,检索时限为建库至2023年5月1...目的:系统评价营养支持病人发生再喂养综合征风险预测模型。方法:计算机检索PubMed、EMbase、CINAHL、Web of Science、中国生物医学文献数据库、中国知网和万方数据库中有关再喂养综合征风险预测模型的研究,检索时限为建库至2023年5月11日。2名研究者独立进行文献检索、筛选与资料提取,采用诊断或预后多因素预测模型研究偏倚风险的评估工具对纳入研究进行偏倚风险和适用性评价。结果:最终纳入10篇文献,包含14个营养支持病人再喂养综合征风险预测模型,模型中已报道的受试者工作特征曲线下面积(AUC)值为0.626~0.950。纳入预测模型中常见预测因子包括年龄、SOFA评分、利尿剂的使用、基线血钾、急性生理与慢性健康状况(APACHEⅡ)评分和蛋白质摄入情况。所有研究的适用性较好,但存在一定的偏倚风险。结论:现有证据表明,目前建立的再喂养综合征预测模型主要针对重症监护室病人,对于风险因素的分析和建模还处于初级阶段。有必要明确再喂养综合征的诊断标准,开展多中心、大样本的研究,并进行内外部的验证。展开更多
目的 明确重症监护(intensive care unit, ICU)患者再喂养综合征(refeeding syndrome, RFS)发生率及危险因素,为早期识别和预防再喂养综合征提供依据。方法 计算机检索国内外数据库中与ICU患者RFS发生率及危险因素相关的文献,检索时限...目的 明确重症监护(intensive care unit, ICU)患者再喂养综合征(refeeding syndrome, RFS)发生率及危险因素,为早期识别和预防再喂养综合征提供依据。方法 计算机检索国内外数据库中与ICU患者RFS发生率及危险因素相关的文献,检索时限为建库至2023年5月31日,利用Stata 17软件进行Meta分析。结果 共纳入21篇文献,总样本量5056例,阳性病例1935例,RFS发生率37.88%[95%CI(30.33%~45.43%)]。其中,年龄(MD=3.40)、合并糖尿病(OR=2.49)、体质量指数(MD=-1.21)、急性生理与慢性健康评分(MD=2.63)、序贯器官功能衰竭评分(MD=1.87)、格拉斯哥昏迷评分(MD=-2.53)、重症营养风险评分(MD=1.00)、血清磷水平(MD=-0.45)、血清钾水平(MD=-0.38)、血清钙水平(MD=-0.19)、血清钠水平(MD=-2.96)、白蛋白水平(MD=-1.64)、前白蛋白水平(MD=-67.83)等13项为ICU患者发生RFS的危险因素(均P<0.01)。结论 护理人员可依据上述危险因素早期识别ICU患者RFS高发人群,及时采取针对性措施,从而改善患者的预后。展开更多
Early life overfeeding in the rat can be experimentally induced by reducing litter size. This investigation assessed the consequences of this manipulation on glucose metabolism in vivo and in isolated hepatocytes in 1...Early life overfeeding in the rat can be experimentally induced by reducing litter size. This investigation assessed the consequences of this manipulation on glucose metabolism in vivo and in isolated hepatocytes in 150-day old rats. Additionally, after body growth, the effects of caloric restriction and refeeding were tested. Adult rats from control （G9） and reduced litters （G3L） did not differ in body and fat weights, glucose tolerance or insulin resistance （insulin-induced hypoglycemia）, or hepatocyte glucose release under basal or gluconeogenic conditions. Caloric restriction （G3R） reduced body and fat weights, decreased glucose decay after insulin injection and decreased hepatocyte gluconeogenic glucose release. Refeeding after caloric restriction reversed these parameters to those of the freely-fed groups （G9 and G3L）. Taken together, these results suggest that the liver glucose metabolism is not programmed by lactational overfeeding, but rather is responsive to the current nutritional condition of the animal.展开更多
Objective: To explore the objective basis of the time and characterstics of refeeding of patients with acute pancreatitis (AP). Methods: AP patients were randomly divided into routine group (n=105) and special group (...Objective: To explore the objective basis of the time and characterstics of refeeding of patients with acute pancreatitis (AP). Methods: AP patients were randomly divided into routine group (n=105) and special group (n=99). The refeeding time and characteristics of the routine group were based on their levels of blood and urine amylase, function of the gastrointestinal tract, and symptoms and signs, and those of the special group on their imaging changes of ultrasonography and CT of the pancreas. Clinical data from the groups were analyzed prospectively and statistically. Results: At the beginning of refeeding, patients of the two groups showed a high recurrence rate of ab- dominal pain (routine group, 9.1%; special group, 10.5%), but no AP relapse. Three days to 2 weeks after refeeding, the patients of the routine group had a higher recurrence rate of abdominal pain (11.1%) and a relapse rate of AP (14.1%) as compared with those of the special group (P<0. 05). Two weeks later, both rates decreased apparently. However, 3 days to 4 weeks after refeeding, the patients of the special group had no recurrence of abdominal pain and relapse of AP. Imaging changes of the pancreas and peripancreatic tissue were not consistent with the symptoms and signs of AP patients. The higher the Balthazar CT grading and APACHE-Ⅱ score, the higher the recurrence rate of abdominal pain and the relapse rate of AP after refeeding (P<0. 05). Conclusions: Symptoms and signs were usually dis- cordant to the imaging changes of the pancreas in AP patients. Imaging changes of the pancreas might serve as a basis for the best occasion of refeeding light semi-fluid or light food in AP patients.展开更多
Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP)therapy,the right time and type of diet to be offered to patients recovering from an acute attack are a ...Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP)therapy,the right time and type of diet to be offered to patients recovering from an acute attack are a great challenge to clinicians who treat this condition.Fortunately,the last decade was noted for several trials looking for the best answer to the question:"when and how to start oral refeeding in AP?"It is well known that 80%of patients present with mild disease characterized by usually uncomplicated clinical course are managed with pancreatic rest through nil per oral;while the use of specific nutritional intervention is an exception.Therefore,mild AP has been the most investigated form of AP and researchers have tried different kind of meals to offer calories and reduce costs by shortening hospitalization time.Usually in mild AP,the oral refeeding is introduced between the first 3 d and 7 d after hospitalization but,the type of diet and patients’tolerance have been scrutinized in detail with mixed results.Although 20%to 25%have pain recurrence requiring nutritional support and greater time of hospitalization,most patients seem to tolerate oral refeeding well.We propose analyzing the most recent investigations of this matter and their conclusions to develop a better understanding of the management of AP.展开更多
Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities,in the absence of significant coronary artery obstruction. This syndrome usually occurs in ...Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities,in the absence of significant coronary artery obstruction. This syndrome usually occurs in women and is frequently associated with an intense emotional or physical stress. It usually involves apical segments,but in the recent years atypical forms have been described. Inverted or reverse Takotsubo is a variant in which the basal and midventricular segments are hypokinetic,sparing contractile function of the apex. In this report we describe the case of a 54-year-old woman,with chronic malnutrition,initially admitted because of hypoglycemia and severe electrolyte disturbance due to a refeeding syndrome. Within the next hours she experienced acute cardiac symptoms and developed heart failure with low cardiac output. Electrocardiogram(ECG),elevation of troponin and echocardiographic findings were consistent with inverted Takotsubo cardiomyopathy. To the best of our knowledge,this is the first incidence reported of inverted Takotsubo triggered by refeeding syndrome.展开更多
The present study investigated the effect of starvation-refeeding status on cholesterol metabolism in rats fed a high-cholesterol diet or a cholesterol-free diet. Twenty male and 20 female Donryu rats (age 5 weeks) we...The present study investigated the effect of starvation-refeeding status on cholesterol metabolism in rats fed a high-cholesterol diet or a cholesterol-free diet. Twenty male and 20 female Donryu rats (age 5 weeks) were fed a cho-lesterol-free diet for 14 days. Then the male and female rats were each divided into two groups: feeding and starva-tion-refeeding groups. The feeding groups were fed the experimental diet for 3 days, and the starvation-refeeding groups fasted for 2 days followed by 3 days of feeding. Half of each of groups was fed a cholesterol-free diet and the other half was fed a high-cholesterol diet. Starvation-refeeding significantly increased the plasma free cholesterol and HDL-cholesterol concentrations in both the high-cholesterol-diet-fed rats and the cholesterol-free-diet-fed rats. In the female rats, plasma total cholesterol and cholesteryl ester concentrations were significantly higher in the high-cholesterol groups than in the cholesterol-free groups, whereas TG concentration and total cholesterol/TG ratio were not significantly different among all of the groups. Liver total cholesterol and cholesteryl ester were significantly higher in the high-cholesterol groups than in the cholesterol-free groups in both male and female rats. These results suggest that starvation-refeeding affected cholesterol metabolism at least in part. The reactivity of the cholesterol me-tabolism may be different between male and female rats.展开更多
文摘目的调查重症监护病房(intensive care unit,ICU)护士预防再喂养综合征知识、态度和行为现况,并分析其影响因素,为临床开展相关教学、培训提供依据。方法采用便利抽样法,自行编制一般资料调查表、ICU护士对预防RFS再喂养综合征(refeeding syndrome,RFS)知识、态度和行为问卷以及护理阻碍因素及知识需求问卷,对上海市5所三级甲等综合医院和2所二级甲等综合医院的366名ICU护士进行调查,并采用多重线性回归分析RFS的知识、态度和行为的影响因素。结果366名ICU护士预防RFS知识、态度和行为问卷总分、知识维度、态度维度、主观规范、感知行为控制及行为意向维度得分分别为(133.73±20.55)分、(35.79±9.04)分、(37.44±6.20)分、(12.07±2.27)分、(17.82±4.00)分、(30.61±6.09)分,总分处于中等水平。多重线性回归分析显示,医院级别、ICU类型以及是否为营养学组成员、接受过相关培训、从学术期刊获取知识的频率是ICU护士对预防RFS知识、态度和行为的影响因素(均P<0.05),共同解释其20.90%的变异。结论从学术期刊获取知识、三级医院、综合ICU及接受过RFS相关知识培训、营养学组成员的护士有较高的预防RFS知识、态度和行为水平。护理管理者应重视ICU护士的培训,加强其对预防RFS护理的知识和行为,从而提高ICU护理管理质量。
文摘目的:系统评价营养支持病人发生再喂养综合征风险预测模型。方法:计算机检索PubMed、EMbase、CINAHL、Web of Science、中国生物医学文献数据库、中国知网和万方数据库中有关再喂养综合征风险预测模型的研究,检索时限为建库至2023年5月11日。2名研究者独立进行文献检索、筛选与资料提取,采用诊断或预后多因素预测模型研究偏倚风险的评估工具对纳入研究进行偏倚风险和适用性评价。结果:最终纳入10篇文献,包含14个营养支持病人再喂养综合征风险预测模型,模型中已报道的受试者工作特征曲线下面积(AUC)值为0.626~0.950。纳入预测模型中常见预测因子包括年龄、SOFA评分、利尿剂的使用、基线血钾、急性生理与慢性健康状况(APACHEⅡ)评分和蛋白质摄入情况。所有研究的适用性较好,但存在一定的偏倚风险。结论:现有证据表明,目前建立的再喂养综合征预测模型主要针对重症监护室病人,对于风险因素的分析和建模还处于初级阶段。有必要明确再喂养综合征的诊断标准,开展多中心、大样本的研究,并进行内外部的验证。
文摘Early life overfeeding in the rat can be experimentally induced by reducing litter size. This investigation assessed the consequences of this manipulation on glucose metabolism in vivo and in isolated hepatocytes in 150-day old rats. Additionally, after body growth, the effects of caloric restriction and refeeding were tested. Adult rats from control （G9） and reduced litters （G3L） did not differ in body and fat weights, glucose tolerance or insulin resistance （insulin-induced hypoglycemia）, or hepatocyte glucose release under basal or gluconeogenic conditions. Caloric restriction （G3R） reduced body and fat weights, decreased glucose decay after insulin injection and decreased hepatocyte gluconeogenic glucose release. Refeeding after caloric restriction reversed these parameters to those of the freely-fed groups （G9 and G3L）. Taken together, these results suggest that the liver glucose metabolism is not programmed by lactational overfeeding, but rather is responsive to the current nutritional condition of the animal.
文摘Objective: To explore the objective basis of the time and characterstics of refeeding of patients with acute pancreatitis (AP). Methods: AP patients were randomly divided into routine group (n=105) and special group (n=99). The refeeding time and characteristics of the routine group were based on their levels of blood and urine amylase, function of the gastrointestinal tract, and symptoms and signs, and those of the special group on their imaging changes of ultrasonography and CT of the pancreas. Clinical data from the groups were analyzed prospectively and statistically. Results: At the beginning of refeeding, patients of the two groups showed a high recurrence rate of ab- dominal pain (routine group, 9.1%; special group, 10.5%), but no AP relapse. Three days to 2 weeks after refeeding, the patients of the routine group had a higher recurrence rate of abdominal pain (11.1%) and a relapse rate of AP (14.1%) as compared with those of the special group (P<0. 05). Two weeks later, both rates decreased apparently. However, 3 days to 4 weeks after refeeding, the patients of the special group had no recurrence of abdominal pain and relapse of AP. Imaging changes of the pancreas and peripancreatic tissue were not consistent with the symptoms and signs of AP patients. The higher the Balthazar CT grading and APACHE-Ⅱ score, the higher the recurrence rate of abdominal pain and the relapse rate of AP after refeeding (P<0. 05). Conclusions: Symptoms and signs were usually dis- cordant to the imaging changes of the pancreas in AP patients. Imaging changes of the pancreas might serve as a basis for the best occasion of refeeding light semi-fluid or light food in AP patients.
基金Supported by A grant from CNPq,Brazil(to Julio Maria Fonseca Chebli)a clinical research fund from the CNPq and FAPE- MIG,Brazil(in part)
文摘Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP)therapy,the right time and type of diet to be offered to patients recovering from an acute attack are a great challenge to clinicians who treat this condition.Fortunately,the last decade was noted for several trials looking for the best answer to the question:"when and how to start oral refeeding in AP?"It is well known that 80%of patients present with mild disease characterized by usually uncomplicated clinical course are managed with pancreatic rest through nil per oral;while the use of specific nutritional intervention is an exception.Therefore,mild AP has been the most investigated form of AP and researchers have tried different kind of meals to offer calories and reduce costs by shortening hospitalization time.Usually in mild AP,the oral refeeding is introduced between the first 3 d and 7 d after hospitalization but,the type of diet and patients’tolerance have been scrutinized in detail with mixed results.Although 20%to 25%have pain recurrence requiring nutritional support and greater time of hospitalization,most patients seem to tolerate oral refeeding well.We propose analyzing the most recent investigations of this matter and their conclusions to develop a better understanding of the management of AP.
基金Supported by Hospital Universitario Fundación Alcorcón,Madrid(Spain)
文摘Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities,in the absence of significant coronary artery obstruction. This syndrome usually occurs in women and is frequently associated with an intense emotional or physical stress. It usually involves apical segments,but in the recent years atypical forms have been described. Inverted or reverse Takotsubo is a variant in which the basal and midventricular segments are hypokinetic,sparing contractile function of the apex. In this report we describe the case of a 54-year-old woman,with chronic malnutrition,initially admitted because of hypoglycemia and severe electrolyte disturbance due to a refeeding syndrome. Within the next hours she experienced acute cardiac symptoms and developed heart failure with low cardiac output. Electrocardiogram(ECG),elevation of troponin and echocardiographic findings were consistent with inverted Takotsubo cardiomyopathy. To the best of our knowledge,this is the first incidence reported of inverted Takotsubo triggered by refeeding syndrome.
文摘The present study investigated the effect of starvation-refeeding status on cholesterol metabolism in rats fed a high-cholesterol diet or a cholesterol-free diet. Twenty male and 20 female Donryu rats (age 5 weeks) were fed a cho-lesterol-free diet for 14 days. Then the male and female rats were each divided into two groups: feeding and starva-tion-refeeding groups. The feeding groups were fed the experimental diet for 3 days, and the starvation-refeeding groups fasted for 2 days followed by 3 days of feeding. Half of each of groups was fed a cholesterol-free diet and the other half was fed a high-cholesterol diet. Starvation-refeeding significantly increased the plasma free cholesterol and HDL-cholesterol concentrations in both the high-cholesterol-diet-fed rats and the cholesterol-free-diet-fed rats. In the female rats, plasma total cholesterol and cholesteryl ester concentrations were significantly higher in the high-cholesterol groups than in the cholesterol-free groups, whereas TG concentration and total cholesterol/TG ratio were not significantly different among all of the groups. Liver total cholesterol and cholesteryl ester were significantly higher in the high-cholesterol groups than in the cholesterol-free groups in both male and female rats. These results suggest that starvation-refeeding affected cholesterol metabolism at least in part. The reactivity of the cholesterol me-tabolism may be different between male and female rats.
