老年急危重症患者再喂养综合征对近期预后的影响及风险因素  

The influence of refeeding syndrome on the short-term prognosis and the risk factors of refeeding syndrome in the elderly patients

作　　者：陈曦[1] 张新超[1] Chen Xi;Zhang Xin-chao(Emergency Department of Beijing Hospitaly National Geriatric Center,Institute of Geriatric Mediciney Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院急诊科国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中国急救医学》2021年第4期296-301,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨老年急危重症患者重新摄入营养时并发再喂养综合征(refeeding syndrome,RFS)对近期预后的影响及风险因素。方法回顾性分析我院急诊科2019年1月1日至2020年6月30日有营养不良风险的老年急危重症患者共145例,根据RFS诊断标准,诊断RFS或亚临床RFS 65例为研究组,其余80例为对照组,对比两组患者性别、年龄、BMI指数、纳差时间、营养方式、每日摄入热卡值、糖脂供能等情况,并分析患者出现低磷血症或RFS与预后的关系。结果两组性别、BMI、纳差时间差异无统计学意义(P>0.05)。研究组患者年龄高于对照组(岁:80.91±9.46 vs. 77.57±10.07,P=0.044)。在诊治过程中出现RFS患者病死率高于未出现RFS患者(52.3%vs. 15.0%,χ^(2)=23.045,P=0.000)。ROC曲线分析发现,72 h血磷下降值曲线下面积为0.811,95%CI为(0.734,0.888)。72 h血磷下降值的约登指数最大截断值为0.395mmol/L。在营养支持治疗过程中研究组入院RFS危险因素分层、初始进行的营养类型、碳水化合物供能比例与对照组差异无统计学意义(P>0.05)。初始热卡摄入510 kcal/(kg·d)组出现RFS比例低于<5 kcal/(kg·d)组及≥10 kcal/(kg·d)组(χ^(2)=7.779,P=0.020)。结论诊治过程中出现RFS是影响老年急危重症患者近期不良预后的重要因素,有营养不良风险的老年急危重症患者中,RFS可能与初始热卡摄入情况有关。Objective To explore the impact of refeeding syndrome( RFS) on the short-term prognosis and risk factors of the elderly critically ill patients in emergency department when they re-intake nutrition. Methods To retrospectively analyze 145 elderly patients with acute and critically illness at risk of malnutrition in the emergency department of our hospital from January 1,2019 to June30,2020. According to the RFS diagnostic criteria,65 cases of RFS or subclinical RFS were included in the study group,and the remaining 80 cases were in the control group. The patients’ gender,age,BMI index,poor appetite time,nutrition mode,daily calorie intake and glycolipid energy supply were compared in two groups,and the correlation of the hypophosphatemia or RFS with the prognosis was analyzed. Results There were no significant differences in gender,BMI and poor appetite time between the study group and the control group( P >0. 05). The age of patients was significantly higher in the study group than in the control group[( 80. 91 ± 9. 46) years vs.( 77. 57 ± 10. 07) years,P = 0. 044].The mortality of patients with RFS during diagnosis and treatment was higher than that of patients without RFS,and the difference was statistically significant( 52. 3% vs. 15. 0%,χ^(2)= 23. 045,P = 0. 000).ROC curve analysis found that the area under the curve of 72-hour blood phosphorus content was0. 811,and the 95% CI was( 0. 734,0. 888). The cut-off value for the maximum Youden index of the72-hour blood phosphorus content was 0. 395 mmol/L. During the course of nutritional support treatment,the study group was not significantly different from the control group at RFS risk factors stratification when admitted to hospital,initial nutrition type,and the ratio of carbohydrate energy supply content( P >0. 05). The group with initial calorie intake 5 10 kcal/( kg·d) had lower RFS rate than <5 kcal/( kg·d) group and≥10 kcal/( kg·d) group( χ^(2)= 7. 779,P = 0. 020). Conclusions RFS occurring during hospitalization is an important factor affecting

关 键 词：再喂养综合征 低磷血症 风险因素 热卡摄入 

分 类 号：R459.7[医药卫生—急诊医学]