Surgical Metabolism and Nutrition Laboratory, Department of Surgery, University Hospital, Upstate Medical University, State University of New York, Syracuse, NY 13210, USA.
Nutrition. 2010 Feb;26(2):156-67. doi: 10.1016/j.nut.2009.11.017.
Refeeding syndrome (RFS) represents a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support. Cardiac arrhythmias, multisystem organ dysfunction, and death are the most severe symptoms observed. As the cachectic body attempts to reverse its adaptation to the starved state in response to the nutritional load, symptoms result from fluid and electrolyte imbalances, with hypophosphatemia playing a central role. Because guidelines for feeding the malnourished patient at risk for refeeding syndrome is scarce, we have provided management recommendations based on the knowledge derived from a collection of reported English literature cases of the RFS. A MEDLINE search using keywords including "refeeding syndrome," "RFS," and "refeeding hypophosphatemia" was performed. References from initial cases were utilized for more literature on the subject. We have emphasized the continued importance of managing patients at risk for RFS, compared how management of the severely malnourished patients have evolved over time, and provided comprehensive clinical guidelines based on the sum of experience documented in the case reports for the purpose of supplementing the guidelines available. Based on our review, the most effective means of preventing or treating RFS were the following: recognizing the patients at risk; providing adequate electrolyte, vitamin, and micronutrient supplementation; careful fluid resuscitation; cautious and gradual energy restoration; and monitoring of critical laboratory indices.
再喂养综合征（RFS）代表了一组在接受营养支持的严重营养不良个体中出现的临床发现。心律失常、多系统器官功能障碍和死亡是观察到的最严重症状。由于消瘦的身体试图在营养负荷下逆转对饥饿状态的适应，因此会出现液体和电解质失衡的症状，其中低磷血症起着核心作用。由于缺乏针对有再喂养综合征风险的营养不良患者的喂养指南，我们根据从一系列报告的 RFS 英文文献病例中获得的知识提供了管理建议。使用包括“再喂养综合征”、“RFS”和“再喂养低磷血症”等关键词进行了 MEDLINE 搜索。从初始病例中引用的参考文献用于更广泛地了解该主题的文献。我们强调了继续管理有再喂养综合征风险的患者的重要性，比较了随着时间的推移严重营养不良患者的管理如何演变，并根据病例报告中记录的经验提供了全面的临床指南，旨在补充现有的指南。基于我们的审查，预防或治疗 RFS 最有效的方法是：识别有风险的患者；提供充足的电解质、维生素和微量营养素补充；仔细进行液体复苏；谨慎和逐步恢复能量；以及监测关键实验室指标。
