再喂养综合征。
Refeeding Syndrome.
机构信息
Institut für Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of LeipzigMedical Center, Leipzig, GermanyInstitute for Human Genetics, University of Leipzig Medical Center, Leipzig, GermanyDepartment of Endocrinology, Nephrology, Rheumatology, Division of Endocrinology, University ofLeipzig Medical Center, Leipzig, GermanyDepartment of Endocrinology, Nephrology, Rheumatology, Special Division of Endocrinology,University of Leipzig Medical Center, Leipzig, Germany Klinik und Poliklinik für Endokrinologie,Nephrologie, Rheumatologie, Spezialbereich Ernährungs medizin, Universitätsklinikum LeipzigHelmholtz Institute for Metabolic, Obesity, and Vascular Research (HI-MAG), Helmholtz ZentrumMünchen, University of Leipzig, and the University Hospital Leipzig, Leipzig, GermanyInstitute for Laboratory Medicine, Microbiology, Clinical Pathology, and Pathobiochemistry, UniversityHospital Lippe, Detmold, Germany.
出版信息
Dtsch Arztebl Int. 2023 Feb 17;120(7):107-114. doi: 10.3238/arztebl.m2022.0381.
BACKGROUND
Refeeding syndrome (RFS) can occur in malnourished patients when normal, enteral, or parenteral feeding is resumed. The syndrome often goes unrecognized and may, in the most severe cases, result in death. The diagnosis of RFS can be crucially facilitated by the use of clinical decision support systems (CDSS).
METHODS
The literature in PubMed was searched for current treatment recommendations, randomized intervention studies, and publications on RFS and CDSS. We also took account of insights gained from the development and implementation of our own CDSS for the diagnosis of RFS.
RESULTS
The identification of high-risk patients and the recognition of manifest RFS is clinically challenging due to the syndrome's unspecific symptoms and physicians' lack of awareness of the risk of this condition. The literature shows that compared to patients without RFS, malnourished patients with RFS have significantly greater 6-month mortality (odds ratio 1.54, 95% confidence interval: [1.04; 2.28]) and an elevated risk of admission to intensive care (odds ratio 2.71 [1.01; 7.27]). In a prospective testing program, use of our own CDSS led to correct diagnosis in two thirds of cases.
CONCLUSION
RFS is difficult to detect and represents a high risk to the patients affected. Appropriate CDSS can identify such patients and ensure proper professional care.
背景
重新喂养综合征（RFS）可发生于营养不良的患者在开始正常、肠内或肠外喂养时。该综合征常常未被识别，在最严重的情况下，可能导致死亡。临床决策支持系统（CDSS）的使用可以极大地促进 RFS 的诊断。
方法
在 PubMed 中搜索了关于当前治疗建议、随机干预研究以及关于 RFS 和 CDSS 的出版物。我们还考虑了从开发和实施我们自己的 RFS 诊断 CDSS 中获得的见解。
结果
由于该综合征的非特异性症状和医生对这种情况的风险缺乏认识，识别高危患者和明确的 RFS 具有临床挑战性。文献表明，与没有 RFS 的患者相比，患有 RFS 的营养不良患者 6 个月死亡率显著更高（比值比 1.54，95%置信区间：[1.04; 2.28]），并且入住重症监护病房的风险增加（比值比 2.71 [1.01; 7.27]）。在一项前瞻性测试计划中，使用我们自己的 CDSS 可使三分之二的病例得到正确诊断。
结论
RFS 难以发现，对受影响的患者构成高风险。适当的 CDSS 可以识别此类患者并确保提供适当的专业护理。
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