CAJ | 학술논문

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.
목적관찰 ICU 환자장내、장외영양치료시재위양종합정(RFS)적발생솔,탐토 RFS 적방치책략.방법선택 ICU수치적60례환자,안조입원순서분위장외영양(TPN)조、장내영양(EN)조,매조30례.전해질소량결핍급여비사,엄중결핍이정맥보충위주,매일감측생화지표1~5차,근거검측결과조정린、미、갑、납공급량,보충도정상범위.분별우영양치료전급치료제1、3、7、14천검측혈장백단백(ALB)、전백단백(PA)、갑、납、린、미、개등수평.관찰량조환자상관병발증적발생솔.결과량조환자치료전ALB、PA 저우정상치,치료제14천 ALB、PA 명현승고,여치료전적차이유통계학의의(P<0.05).TPN 조치료제3、7천혈청중린수평여치료전적차이유통계학의의(P<0.05);EN 조치료제1、3천적린수평여치료전적차이유통계학의의(P<0.05).여 TPN 조비교,EN조치료제1천시갑수평교고,차이유통계학의의(P<0.05).량조환자치료전후납、개、미수평적차이균무통계학의의(균 P >0.05).저린혈증 TPN 조27례,기중경도19례、중도5례、중도3례,EN 조12례균위경도.저미혈증 TPN 조경중도19례,중도2례,EN 조경중도3례.저갑혈증 TPN 조24례,EN 조10례.TPN 조쾌속심률실상8례,급성좌심쇠갈3례,기력하강5례,성시2례,창해3례, RFS 21례;EN 조쾌속심률실상6례,기력하강2례,창해2례,RFS10례.여 EN 조비교,TPN 조급성좌심쇠갈、기력하강、RFS 적발생솔교고,차이유통계학의의(P<0.05).결론장내、외영양균가도치 RFS 적발생,예방시관건.
@@@@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.