重症卒中患者再喂养综合征的危险因素  

Risk factors for refeeding syndrome in patients with severe stroke

作　　者：熊瑞琪 黄凯滨[1] 吴永明[1] Xiong Ruiqi;Huang Kaibin;Wu Yongming(Department of Neurology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院神经内科,广州510515

出　　处：《国际脑血管病杂志》2021年第4期252-257,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的:探讨重症卒中患者发生再喂养综合征(refeeding syndrome,RFS)的危险因素。方法:回顾性纳入2013年1月至2019年7月期间入住南方医科大学南方医院神经重症监护病房且接受肠内营养支持>72 h的卒中患者。RFS定义为开始营养支持后72 h内新发的低磷血症,即血磷<0.65 mmol/L且较基线值下降>0.16 mmol/L。通过多变量logistic回归模型确定RFS的独立危险因素。结果:共纳入209例重症卒中患者,中位年龄65岁[四分位数间距(interquartile range,IQR)53~72岁],男性154例(73.7%);脑梗死136例(65.1%),脑出血73例(34.9%)。基线中位美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分15分(IQR 11~20分),中位格拉斯哥昏迷量表评分9分(IQR 6~12分),中位急性生理学与慢性健康状况评分Ⅱ评分16分(IQR 11~20分),中位重症患者营养风险(Nutrition Risk in Critically Ill,NUTRIC)评分3分(IQR 2~5分),中位序贯器官衰竭评估量表(Sequential Organ Failure Assessment,SOFA)评分4分(IQR 3~6分);基线中位血磷1.05 mmol/L(IQR 0.90~1.19 mmol/L)。共34例(16.3%)发生RFS。多变量logistic回归分析显示,男性(优势比3.565,95%置信区间1.150~11.053;P=0.028)和SOFA评分较高(优势比1.246,95%置信区间1.077~1.442;P=0.032)的患者更有可能发生RFS。结论:RFS在重症卒中患者中并不罕见,男性和病情较重的患者更易发生RFS。Objective To investigate the risk factors for refeeding syndrome(RFS)in patients with severe stroke.Methods Patients with stroke admitted to the Neuro Intensive Care Unit,Nanfang Hospital,Southern Medical University and received enteral nutrition support>72 h from January 2013 to July 2019 were enrolled retrospectively.RFS was defined as a new onset of hypophosphatemia within 72 h after the start of nutritional support,that is,blood phosphorus<0.65 mmol/L and a decrease of>0.16 mmol/L from the baseline value.The independent risk factors for RFS were identified by multivariate logistic regression model.Results A total of 209 patients with severe stroke were included,with a median age of 65 years(interquartile range[IQR]53 to 72 years),and 154 were males(73.7%);136 patients had cerebral infarction(65.1%),73 had intracerebral hemorrhage(34.9%).The baseline median National Institutes of Health Stroke Scale(NIHSS)score was 15(IQR,11-20),the median Glasgow Coma Scale score was 9(IQR,6-12),the median Acute Physiology and Chronic Health Score was 16(IQR,11-20),the median Nutrition Risk in Critically Ill(NUTRIC)score was 3(IQR 2-5),and the median Sequential Organ Failure Assessment(SOFA)score was 4(IQR,3-6);the baseline median serum phosphorus was 1.05 mmol/L(IQR,0.90-1.19 mmol/L).A total of 34 patients(16.3%)developed RFS.Multivariate logistic regression analysis showed that male(odds ratio 3.565,95%confidence interval 1.150-11.053;P=0.028)and patients with higher SOFA score(odds ratio 1.246,95%confidence interval 1.077-1.442;P=0.032)were more likely to develop RFS.Conclusions RFS is not rare in patients with severe stroke.Males and patients with severe disease are more likely to develop RFS.

关 键 词：卒中 脑梗死 脑出血 再喂养综合征 肠内营养 危重病 重症监护病房 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]