ICU 患者营养支持治疗时再喂养综合征的发生及防治

摘要

Objective To estimate the incidence of refeeding syndrome (RFS) in ICU patients with enteral nutrition (EN) and total parenteral nutrition (TPN). Methods Sixty ICU patients were randomized into total parenteral nutrition group and enteral nutrition group with 30 in each. The serum levels of ALB, PA, K, Na, P, Mg and Ca were measured before and d1, 3, 7, 14th after treatment. Electrolytes were supplied according to daily requirement at baseline and the results of blood biochemical monitoring. The incidence rate of acute left heart failure, arrhythmia, cardiac arrest, hoarseness, cough, muscle strength decline were ob-served. Results The serum levels of P, Mg, K decreased and the incidence of RFS rates were higher in TPN than that in EN group (P<0.05). There were no significantly differences in levels of serum Na and Ca before and after treatment in two groups(P>0.05). There were 27 cases of hypophosphatemia, including 5 mild, 19 moderate and 3 severe cases in group TPN, while in group EN there only 12 mild hypophosphatemia cases. There were 19 cases of mild to moderate hypomagnesesmia and 2 severe cases in group TPN, while there were only 3 mild to moderate cases in group EN. There were 8 cases of arrhythmia, 3 cases of a-cute left heart failure, 5 cases of muscle weakness, 2 cases of hoaresness and 3 cases of cough in EN group; while in group TPN there were 6 cases of arrhymia, 2 cases of muscle weakness, 2 cases of cough. Conclusion Both TPN and EN can lead to the occurrence of refeeding syndrome, mainly presenting the reduced blood phosphorus, magnesium and potassium levels. Patients with TPN have a higher incidence rate of RFS than those with EN group in ICU.%　　目的观察 ICU 患者肠内、肠外营养治疗时再喂养综合征（RFS）的发生率，探讨 RFS 的防治策略。方法选择 ICU收治的60例患者，按照入院顺序分为肠外营养（TPN）组、肠内营养（EN）组，每组30例。电解质少量缺乏给予鼻饲，严重缺乏以静脉补充为主，每日监测生化指标1～5次，根据检测结果调整磷、镁、钾、钠供给量，补充到正常范围。分别于营养治疗前及治疗第1、3、7、14天检测血浆白蛋白（ALB）、前白蛋白（PA）、钾、钠、磷、镁、钙等水平。观察两组患者相关并发症的发生率。结果两组患者治疗前ALB、PA 低于正常值，治疗第14天 ALB、PA 明显升高，与治疗前的差异有统计学意义（P＜0.05）。TPN 组治疗第3、7天血清中磷水平与治疗前的差异有统计学意义（P＜0.05）；EN 组治疗第1、3天的磷水平与治疗前的差异有统计学意义（P＜0.05）。与 TPN 组比较，EN组治疗第1天时钾水平较高，差异有统计学意义（P＜0.05）。两组患者治疗前后钠、钙、镁水平的差异均无统计学意义（均 P ＞0.05）。低磷血症 TPN 组27例，其中轻度19例、中度5例、重度3例，EN 组12例均为轻度。低镁血症 TPN 组轻中度19例，重度2例，EN 组轻中度3例。低钾血症 TPN 组24例，EN 组10例。TPN 组快速心律失常8例，急性左心衰竭3例，肌力下降5例，声嘶2例，呛咳3例， RFS 21例；EN 组快速心律失常6例，肌力下降2例，呛咳2例，RFS10例。与 EN 组比较，TPN 组急性左心衰竭、肌力下降、RFS 的发生率较高，差异有统计学意义（P＜0.05）。结论肠内、外营养均可导致 RFS 的发生，预防是关键。