Hernández-Aranda J C, Gallo-Chico B, Luna-Cruz M L, Rayón-González M I, Flores-Ramírez L A, Ramos Muñoz R, Ramírez-Barba E J
Instituto Mexicano del Seguro Social, Centro Médico Nacional, León, México.
Rev Gastroenterol Mex. 1997 Oct-Dec;62(4):260-5.
The Refeeding Syndrome is conformed by a series of clinical manifestations related to electrolytic alterations associated with the restarting of the nutritive contribution both enteral and parenteral.
To detect the Refeeding Syndrome incidence in malnourished patients who required nutritional, enteral or endovenous support and its relationship with mortality.
A cohort study was performed in the service of Nutritional Support of the IMSS (Social Security Mexican Institute) Specialties Hospital CMN León, from June 1995 to May 1996. All patients with mild and severe malnutrition were included, they received endovenous or enteral nutritious support for more than 7 days, without presenting previous electrolytic unbalance. Serum potassium, phosphorous, and magnesium levels were determined before starting the nutritious support and also on the 3rd, 7th, and 10th days. Descriptive statistics, Student's t and Z test were used, with a 5% significance level.
148 patients with total nutritional support, 23 (16%) of them with restrained malnutrition and 65 (44%) with severe deficit. 54 men and 34 women with an average age of 51.6 +/- 19.4 years. Nineteen patients were eliminated due to a nutrition period of less than 7 days, and other 19 were also eliminated for presenting electrolytic alterations before the nutritive support started. An incidence of 48% of electrolytic alterations compatible with the refeeding syndrome was the result in the remaining 50 patients. The alterations were: hypomagnesemia 13/24, hypokalemia 12/24 and hypophosphatemia 4/24; in 55% of the cases the syndrome appeared at the third day of administration. Hospital sojourn of patients with the syndrome was 26.7 +/- 18 days vs 15.3 +/- 7 (p < 0.05) of those who did not present it. 15 patients died, 5 of them had electrolytic alterations before nutrition, 7 (29%) with refeeding syndrome and 3 (12%) did not presented it (p = 0.059).
Refeeding Syndrome is a frequent entity in malnourished patients submitted to enteral or parenteral nutrition; at least in this study it was of 48%; its presence was followed by a longer hospital stay and a higher mortality rate.
再喂养综合征由一系列与电解质改变相关的临床表现组成，这些电解质改变与经肠道和肠外重新开始营养供给有关。
检测需要营养支持（经肠道或静脉）的营养不良患者中再喂养综合征的发生率及其与死亡率的关系。
于1995年6月至1996年5月在墨西哥社会保障机构IMSS专科医院CMN莱昂的营养支持科进行了一项队列研究。纳入所有轻度和重度营养不良患者，他们接受了超过7天的静脉或肠道营养支持，且之前无电解质失衡情况。在开始营养支持前以及第3天、第7天和第10天测定血清钾、磷和镁水平。采用描述性统计、学生t检验和Z检验，显著性水平为5%。
148例接受全面营养支持的患者，其中23例（16%）为中度营养不良，65例（44%）为重度营养不良。54名男性和34名女性，平均年龄51.6±19.4岁。19例患者因营养支持时间不足7天被排除，另外19例因在营养支持开始前出现电解质改变也被排除。其余50例患者中，与再喂养综合征相符的电解质改变发生率为48%。改变情况为：低镁血症13/24，低钾血症12/24，低磷血症4/24；55%的病例在给药第3天出现该综合征。出现该综合征的患者住院时间为26.7±18天，未出现该综合征的患者住院时间为15.3±7天（p<0.05）。15例患者死亡，其中5例在营养支持前有电解质改变，7例（29%）有再喂养综合征，3例（12%）未出现该综合征（p=0.059）。
再喂养综合征在接受肠内或肠外营养的营养不良患者中是一种常见情况；至少在本研究中发生率为48%；其出现会导致住院时间延长和死亡率升高。
