Michael E. DeBakey Medical Center, Houston, Texas, USA.
Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA.
JPEN J Parenter Enteral Nutr. 2018 Feb;42(2):387-392. doi: 10.1177/0148607116673186. Epub 2017 Dec 12.
Studied since the 1940s, refeeding syndrome still has no universal definition, thus making comparison of studies difficult. Negative outcomes (eg, metabolic abnormalities) may occur with the use of specialized nutrition, such as parenteral nutrition (PN). Less than half of medical institutions have a nutrition support team (NST) managing PN. Interdisciplinary team management of PN may reduce negative outcomes of PN. The objective of this study was to show the value of the NST by measuring differences in PN variables, especially electrolyte abnormalities (EAs), before and after NST initiation at a large medical center and to identify factors associated with EAs among adult subjects receiving PN.
During this retrospective study, computerized medical charts (N = 735) from 2007-2010 were reviewed for electrolyte changes (particularly potassium, magnesium, and phosphorus) the first 3 days following PN initiation in hospitalized adults. Changes in EAs with other variables were compared before and after NST implementation. Equivalent samples sizes were collected to better evaluate the impact of the team.
Following the implementation of the NST, fewer EAs were seen in PN patients (53%; χ = 10.906, P = .004); significantly less potassium, phosphorus, and magnesium intravenous piggyback supplementation (88.8% vs 94%; χ = 5.05, P = .026) was used; and mortality within 30 days of PN cessation was significantly less (12.7% vs 10.6%, P = .012).
Our study complements existing research, finding that an NST was associated with a decreased occurrence of EAs and mortality in the hospitalized adult receiving PN.
自 20 世纪 40 年代以来，再喂养综合征一直没有通用的定义，因此难以对研究进行比较。使用特殊营养，如肠外营养（PN），可能会出现不良后果（例如代谢异常）。不到一半的医疗机构有营养支持小组（NST）管理 PN。PN 的跨学科团队管理可能会降低 PN 的不良后果。本研究的目的是通过测量大型医疗中心 NST 启动前后 PN 变量（特别是电解质异常[EAs]）的差异，并确定接受 PN 的成年患者发生 EAs 的相关因素，来展示 NST 的价值。
在这项回顾性研究中，对 2007 年至 2010 年住院成人 PN 启动后前 3 天的电解质变化（特别是钾、镁和磷）的计算机化病历（N=735）进行了回顾。比较了 NST 实施前后 EAs 与其他变量的变化。收集了等效的样本量，以更好地评估团队的影响。
实施 NST 后，PN 患者的 EAs 减少（53%；χ²=10.906，P=0.004）；静脉推注钾、磷、镁补充量明显减少（88.8%比 94%；χ²=5.05，P=0.026）；PN 停止后 30 天内的死亡率显著降低（12.7%比 10.6%，P=0.012）。
我们的研究补充了现有研究，发现 NST 与接受 PN 的住院成年患者 EAs 发生率和死亡率降低有关。
