矿难病人营养支持对预防再喂养综合征的作用
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摘要
目的:在矿难病人中采用营养支持对预防再喂养综合征发生的临床效果观察。方法:对20名矿难病人进行营养风险筛查以及再喂养综合征风险评估;采用肠外营养、肠内营养支持及膳食营养综合治疗,观察7 d。分别于治疗前、后检测病人营养和电解质水平。结果:20名病人均存在营养不良风险且伴有再喂养综合征发生风险,其中13名病人出现不同程度电解质紊乱,营养支持7 d后,不同时间相比血清电解质中钾(K)、钠(Na)、磷(P)、镁(mg)的水平差异有统计学意义且电解质水平逐渐上升。病人不同时间的总蛋白、前白蛋白、空腹血糖差异有统计学意义。结论:早期发现再喂养综合征发生风险病人并积极进行营养支持,可有效预防再喂养综合征的发生。
Objective: To explore the clinical effect of nutrition support on prevention of refeeding syndrome in patients who suffered from starvation in the mining disaster. Methods: Twenty patients who suffered from starvation in the mining disaster were screened with the nutritional risk and evaluated with the risk of refeeding syndrome. The patients were treated with parenteral and enteral nutrition as well as oral refeeding, and were prospectively followed-up for 7-days. The level of nutrition and electrolyte was observed before and after treatment. Results: All these patients were observed with the risk of malnutrition and refeeding syndrome, and 13 of the patients had different level of electrolyte disturbances. After 7-day nutrition support, there were significant improvement in the serum level of potassium(K), sodium(Na), magnesium(Mg), phosphorus(P), and there were significant differences in the levels of total protein, prealbumin and fasting glucose. Conclusion: The risk of refeeding syndrome should be realized early and successful nutritional management should be implemented, which is helpful to prevent the occurrence of refeeding syndrome.
Objective: To explore the clinical effect of nutrition support on prevention of refeeding syndrome in patients who suffered from starvation in the mining disaster. Methods: Twenty patients who suffered from starvation in the mining disaster were screened with the nutritional risk and evaluated with the risk of refeeding syndrome. The patients were treated with parenteral and enteral nutrition as well as oral refeeding, and were prospectively followed-up for 7-days. The level of nutrition and electrolyte was observed before and after treatment. Results: All these patients were observed with the risk of malnutrition and refeeding syndrome, and 13 of the patients had different level of electrolyte disturbances. After 7-day nutrition support, there were significant improvement in the serum level of potassium(K), sodium(Na), magnesium(Mg), phosphorus(P), and there were significant differences in the levels of total protein, prealbumin and fasting glucose. Conclusion: The risk of refeeding syndrome should be realized early and successful nutritional management should be implemented, which is helpful to prevent the occurrence of refeeding syndrome.
引文
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[8]范春雨,张小琼,秦钢,等.王家岭矿难生还者的生命体征及血清中的主要生化指标变化及临床意义探讨.中国急救复苏与灾害医学杂志, 2012, 7(10):897-899.
[9]史英钦,王春城,唐宇菲,等.癌症晚期病人肠外营养再喂养综合征的预防和治疗.肠胃与肠内营养, 2016, 23(4):223-225.
[10] Kaderbay A, Atallah I, Fontaine E, et al. Malnutrition and refeed‐ing syndrome prevention in head and neck cancer patients:from theory to clinical application. Eur Arch Otorhinolaryngol, 2018,275(5):1049-1058.
[2] Mehanna HM, Moledina J, Travis J. Refeeding syndrome:what it is, and how to prevent and treat it. BMJ, 2008, 336(7659):1495-1498.
[3] Crook MA. Refeeding syndrome:Problems with definition and management. Nutrition, 2014, 30(11-12):1448-1455.
[4] Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition, 2001, 17(7-8):632-637.
[5] Rio A, Whelan K, Goff L, et al. Occurrence of refeeding syndrome in adults started on artificial nutrition support:prospective cohort study. BMJ Open, 2013, 3(1). pii:e002173.
[6] Aubry E, Friedli N, Schuetz P, et al. Refeeding syndrome in the frail elderly population:prevention, diagnosis and management.Clin Exp Gastroenterol, 2018, 11:255-264.
[7] Flesher ME, Archer KA, Leslie BD,et al. Assessing the Metabolic and Clinical Consequences of Early Enteral Feeding in the Malnourished Patient. JPEN J Parenter Enteral Nutr, 2005, 29(2):108-117.
[8]范春雨,张小琼,秦钢,等.王家岭矿难生还者的生命体征及血清中的主要生化指标变化及临床意义探讨.中国急救复苏与灾害医学杂志, 2012, 7(10):897-899.
[9]史英钦,王春城,唐宇菲,等.癌症晚期病人肠外营养再喂养综合征的预防和治疗.肠胃与肠内营养, 2016, 23(4):223-225.
[10] Kaderbay A, Atallah I, Fontaine E, et al. Malnutrition and refeed‐ing syndrome prevention in head and neck cancer patients:from theory to clinical application. Eur Arch Otorhinolaryngol, 2018,275(5):1049-1058.