重症卒中患者再喂养综合征的发生率和危险因素  

Incidence and risk factors of refeeding syndrome in patients with severe stroke

作　　者：仲伟莹 潘习 徐岚[1] 王稚[2] 姚林 李佳璇 Zhong Weiying;Pan Xi;Xu Lan;Wang Zhi;Yao Lin;Li Jiaxuan(Department of Nursing,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院护理部,苏州215006 [2]苏州大学附属第一医院神经内科,苏州215006

出　　处：《国际脑血管病杂志》2023年第7期506-511,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨重症卒中患者中再喂养综合征(refeeding syndrome,RFS)的发生率以及相关危险因素。方法回顾性纳入2017年12月至2022年10月期间苏州大学附属第一医院神经内科收治的禁食后再次接受营养治疗的重症卒中患者。总结重症卒中患者的RFS发生率,利用多变量logistic回归模型分析RFS的独立危险因素,结合限制性立方样条模型探讨相关指标与RFS的剂量-反应关系。结果共纳入188例患者,男性108例,女性80例,中位年龄72岁(四分位数间距63~77岁);缺血性卒中185例(98.4%),脑出血3例(1.6%);59例(31.4%)接受肠内营养,36例(19.1%)接受胃肠减压,30例(16.0%)接受机械通气;60例(31.9%)发生RFS。多变量logistic回归分析显示,肌酐[优势比(odds ratio,OR)1.011,95%置信区间(confidence interval,CI)1.001~1.020;P=0.025)、血清钾(OR 8.349,95%CI 3.025~23.039;P<0.001)、血清磷(OR 46.578,95%CI 6.444~336.661;P<0.001)和糖尿病(OR 2.173,95%CI 1.087~4.345;P=0.028)是发生RFS的独立危险因素。限制性立方样条模型分析显示,肌酐与RFS呈非线性关系,RFS发生风险随着肌酐的升高呈"S"型增高,当肌酐超过70.68μmoI/L时,RFS发生风险持续增高。血清磷和血清钾与RFS均不存在非线性关系。结论肌酐、血清磷、血清钾和糖尿病是重症卒中患者发生RFS的独立危险因素。应利用这些危险因素早期识别RFS高危患者,并尽早采取针对性措施。Objective To investigate the incidence and related risk factors of refeeding syndrome(RFS)in patients with severe stroke.Methods Patients with severe stroke admitted to the Department of Neurology,the First Affiliated Hospital of Soochow University underwent nutritional treatment again after fasting between December 2017 and October 2022 were included retrospectively.The incidence of RFS in patients with severe stroke was summarized.Multivariate logistic regression models were used to analyze the independent risk factors for RFS.A restricted cubic spline model was used to explore the dose-response relationship between relevant indicators and RFS.Results A total of 188 patients were included,including 108 males and 80 females,with a median age of 72 years(interquartile range,63-77 years);185 patients(98.4%)had ischemic stroke and 3(1.6%)had cerebral hemorrhage;59(31.4%)received enteral nutrition,36(19.1%)received gastrointestinal decompression,30(16.0%)received mechanical ventilation;and 60 patients(31.9%)developed RFS.Multivariate logistic regression analysis showed that serum creatinine(odds ratio[OR]1.011,95%confidence interval[CI]1.001-1.020;P=0.025),serum potassium(OR 8.349,95%CI 3.025-23.039;P<0.001),serum phosphorus(OR 46.578,95%CI 6.444-336.661;P<0.001)and diabetes(OR 2.173,95%CI 1.087-4.345;P=0.028)were the independent risk factors for the occurrence of RFS.The restricted cubic spline model analysis showed that there was a non-linear relationship between serum creatinine and RFS,and the increased risk of RFS showed an"S"shape with the increase of serum creatinine.When serum creatinine exceeded 70.68μmoI/L,the risk of RFS continued to increase.There was no non-linear relationship between serum phosphorus and serum potassium and RFS.Conclusions Serum creatinine,serum phosphorus,serum potassium and diabetes are the independent risk factors for RFS in patients with severe stroke.These risk factors should be utilized to identify the high-risk patients with RFS early and the targeted measures should be taken a

关 键 词：卒中 危重病 营养支持 再喂养综合征 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]