重症患者再喂养综合征发生率及影响因素的Meta分析

doi:10.3761/j.issn.0254-1769.2024.21.012

摘要/Abstract

摘要：

目的系统评价重症患者再喂养综合征（refeeding syndrome，RFS）的发生率及影响因素，为护理人员早期识别RFS、制订预防措施提供参考。方法系统检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science、CINAHL和Cochrane Library中关于重症患者RFS发生率及影响因素的文献，检索时限为建库至2024年5月29日，采用Stata 16.0软件进行分析。结果纳入29篇文献，总样本量为5 720例。Meta分析结果显示，重症患者RFS发生率为33.68%。亚组分析结果显示，在调查时间为2020年及以后（38.22%）、调查地区为美洲地区（36.39%）、仅使用电解质水平变化情况作为诊断依据（37.51%）的研究中，重症患者RFS的发生率更高。重症患者RFS的危险因素包括急性生理与慢性健康状况Ⅱ评分较高（OR=1.41）、序贯器官衰竭评分较高（OR=1.29）、入住ICU后48 h内开始喂养（OR=3.36）、年龄≥60岁（OR=2.82）、合并糖尿病（OR=3.53）、前白蛋白浓度<150 g/L（OR=5.53）、白蛋白浓度<30 g/L（OR=3.26）、热量摄入量>25%标准热量（OR=2.86）、肠内营养液温度为36~38 ℃（OR=2.32）、喂养速度>50 ml/h（OR=3.76）、喂养前禁食时间≥2 d（OR=2.46）、有酗酒史（OR=2.64）。结论重症患者RFS发生率较高，影响因素较多。护理人员应提高对RFS的认识水平和重视程度，准确识别高危人群及危险因素，并通过多学科协作，制订全程、精细和个性化的干预措施，以预防RFS。

关键词: 再喂养综合征, 发生率, 影响因素, Meta分析, 危重病护理

Abstract:

Objective To systematically review the incidence and influencing factors of refeeding syndrome （RFS） in critically ill patients，and provide references for early identification of RFS and formulation of preventive measures. Methods Computerized searches were conducted for studies on RFS in critically ill patients in the databases of China National Knowledge Infrastructure（CNKI），Wanfang，VIP，CBM，PubMed，Embase，Web of Science，CINAHL，Cochrane Library from inception to May 29th，2024. Data analysis was performed using Stata 16.0 software. Results A total of 29 articles with 5 720 participants were included. The Meta-analysis showed that the incidence of RFS in critically ill patients was 33.68%. The subgroup analysis showed that the incidence of RFS in critically ill patients was higher in studies conducted in 2020 or later（38.22%），in the Americas（36.39%），and with only electrolyte changes as the diagnostic basis（37.51%）.Risk factors for RFS in critically ill patients included higher acute physiological and chronic health evaluation Ⅱ scores（OR=1.41），higher sequential organ failure assessment scores（OR=1.29），initiation of feeding within 48 h of ICU admission（OR=3.36），age≥60 years（OR=2.82），diabetes mellitus（OR=3.53），pre-albumin concentration<150 g/L（OR=5.53），albumin concentration<30 g/L （OR=3.26），caloric intake>25% standard calories（OR=2.86），enteral solution temperature of 36~38 ℃（OR=2.32），feeding rate>50 ml/h（OR=3.76），fasting time≥2 d before feeding（OR=2.46），history of alcoholism（OR=2.64）. Conclusion The incidence of RFS in critically ill patients is high and there are many influencing factors. Nurses should improve their awareness and attention to RFS，accurately identify high-risk groups and risk factors，and adopt a multidisciplinary collaborative model to develop whole-course，detailed and personalized intervention measures to prevent RFS.

Key words: Refeeding Syndrome, Incidence, Influencing Factor, Meta-Analysis, Critical Care Nursing

邹小翠, 毛孝容, 王利学, 杨小娟, 文青. 重症患者再喂养综合征发生率及影响因素的Meta分析[J]. 中华护理杂志, 2024, 59(21): 2640-2648.

ZOU Xiaocui, MAO Xiaorong, WANG Lixue, YANG Xiaojuan, WEN Qing. Incidence and influencing factors of refeeding syndrome in critically ill patients：a Meta-analysis[J]. Chinese Journal of Nursing, 2024, 59(21): 2640-2648.

图/表 6

图1 PubMed检索策略

Figure 1 Search strategies of PubMed databases

图2 文献筛选流程

Figure 2 Flow chart of literature screening

表1 纳入文献的基本特征及质量评价结果（n=29）

Table 1 The basic characteristics and quality evaluation results of the included literature（n=29）

表2 重症患者再喂养综合征发生率的亚组分析结果

Table 2 Subgroup analysis results of the incidence of RFS in critically ill patients

表3 自变量赋值方式

Table 3 Assignment method of independent variables

表4 重症患者再喂养综合征影响因素的Meta分析结果

Table 4 Meta analysis results of influencing factors of RFS in critically ill patients

参考文献 45

[1]	Heuft L, Voigt J, Selig L, et al. Refeeding syndrome[J]. Dtsch Arztebl Int, 2023, 120(7):107-114.
[2]	王润秋, 李秀川. 重症病人再喂养综合征研究的范围综述[J]. 循证护理, 2023, 9(23):4242-4248.
	Wang RQ, Li XC. Research on refeeding syndrome in severe patients:a scope review[J]. Chin Evid Based Nurs, 2023, 9(23):4242-4248.
[3]	马慧颖, 绳宇, 朱信雨, 等. 重症病人再喂养综合征与预后关系的Meta分析[J]. 护理研究, 2022, 36(17):3023-3031.
	Ma HY, Sheng Y, Zhu XY, et al. Relationship between refeed-ing syndrome and prognosis in severe patients:a meta-analysis[J]. Chin Nurs Res, 2022, 36(17):3023-3031.
[4]	McKnight CL, Newberry C, Sarav M, et al. Refeeding syndrome in the critically ill:a literature review and clinician’s guide[J]. Curr Gastroenterol Rep, 2019, 21(11):58. DOI PMID
[5]	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. DOI PMID
[6]	Colmenero M, Morón R, de Dios-Chacón I, et al. Incidence of hypophosphataemia after ICU admission in mechanically ventilated patients and its relationship with risk factors for refeeding syndrome[J]. Med Intensiva, 2024, 48(6):317-325. DOI PMID
[7]	苏燕, 徐九云, 雷海露, 等. 老年危重症患者发生再喂养综合征的危险因素回归方程的构建及干预措施分析[J]. 实用临床医药杂志, 2024, 28(1):123-128.
	Su Y, Xu JY, Lei HL, et al. Establishment of a regression equation for risk factors of refeeding syndrome in critically ill elderly patients and analysis of intervention measures[J]. J Clin Med Pract, 2024, 28(1):123-128.
[8]	张静, 李丹, 林朝霞, 等. 危重症肠内营养患者再喂养综合征现状及影响因素分析[J]. 中外医学研究, 2024, 22(8):147-151.
	Zhang J, Li D, Lin CX, et al. Current status and influencing factors of refeeding syndrome among critically ill patients with enteral nutrition[J]. Chin Foreign Med Res, 2024, 22(8):147-151. DOI
[9]	崔建伟, 赵炳朕, 苏海英. 重症监护病房重症肠内营养支持患者并发再喂养综合征的相关危险因素分析[J]. 基层医学论坛, 2024, 28(5):48-51.
	Cui JW, Zhao BZ, Su HY. Analysis of related risk factors of severe enteral nutrition support patients complicated with refeeding syndrome in intensive care unit[J]. Med Forum, 2024, 28(5):48-51.
[10]	杨帅. ICU患者再喂养综合征风险预测模型的构建与验证[D]. 广州: 广州医科大学, 2023.
	Yang S. Construction and verification of risk prediction model of refeeding syndrome in ICU patients[D]. Guangzhou: Guang-zhou Medical University, 2023.
[11]	陈梦琳, 陈云霞, 孟晓冰. ICU肠内营养患者再喂养综合征危险因素分析及列线图预测模型构建[J]. 齐鲁护理杂志, 2023, 29(19):85-88.
	Chen ML, Chen YX, Meng XB. Analysis of risk factors of re-feeding syndrome in ICU patients with enteral nutrition and construction of nomogram prediction model[J]. J Qilu Nurs, 2023, 29(19):85-88.
[12]	周文杰, 冯笑, 张中伟, 等. 危重症患者再喂养综合征现况调查及其影响因素分析[J]. 中华保健医学杂志, 2023, 25(5):599-601.
	Zhou WJ, Feng X, Zhang ZW, et al. Investigation on feeding syndrome in critically ill patients and analysis of its influencing factors[J]. Chin J Health Care Med, 2023, 25(5):599-601.
[13]	Zhang W, Zhang SX, Chen SF, et al. Development and valida-tion of risk prediction model for refeeding syndrome in neurocritical patients[J]. Front Nutr, 2023, 10:1083483.
[14]	张婧, 何芸, 朱梦莉, 等. 重症急性胰腺炎患者再喂养综合征的危险因素及预后[J]. 临床与病理杂志, 2023, 43(9):1664-1669.
	Zhang J, He Y, Zhu ML, et al. Risk factors and prognosis of refeeding syndrome in patients with severe acute pancreatitis[J]. J Clin Pathol Res, 2023, 43(9):1664-1669.
[15]	徐阳, 吴淑璐, 张杰, 等. ICU再喂养综合征早期危险因素的探查及模型预测[J]. 临床急诊杂志, 2023, 24(1):35-40.
	Xu Y, Wu SL, Zhang J, et al. Investigation and model predic-tion of early risk factors for ICU refeeding syndrome[J]. J Clin Emerg, 2023, 24(1):35-40.
[16]	李芳芳, 卜晶, 高菲, 等. 危重症肠内营养支持患者再喂养综合征风险预测模型的构建与应用检验[J]. 护理实践与研究, 2023, 20(20):3071-3077.
	Li FF, Bu J, Gao F, et al. Construction and application testing of a risk prediction model for refeeding syndrome in critically ill patients receiving enteral nutrition support[J]. Nurs Pract Res, 2023, 20(20):3071-3077.
[17]	仲伟莹, 潘习, 徐岚, 等. 重症卒中患者再喂养综合征的发生率和危险因素[J]. 国际脑血管病杂志, 2023, 31(7):506-511.
	Zhong WY, Pan X, Xu L, et al. Incidence and risk factors of refeeding syndrome in patients with severe stroke[J]. Int J Cere-brovasc Dis, 2023, 31(7):506-511.
[18]	崔亚茹. ICU肠内营养患者再喂养综合征发生现况及危险因素研究[D]. 苏州: 苏州大学, 2022.
	Cui YR. Study on the current situation and risk factors of re-feeding syndrome in ICU patients with enteral nutrition[D]. Suzhou: Soochow University, 2022.
[19]	王虹, 杨德兴, 王强, 等. ICU脓毒症患者发生再喂养综合征的危险因素分析及预测模型建立[J]. 昆明医科大学学报, 2022, 43(11):44-51.
	Wang H, Yang DX, Wang Q, et al. Risk factors analysis and prediction model establishment of refeeding syndrome in ICU patients with sepsis[J]. J Kunming Med Univ, 2022, 43(11):44-51.
[20]	邬媛, 刘仲, 张茹, 等. 再喂养综合征与急诊重症患者细胞免疫功能以及院内死亡的关系分析[J]. 浙江医学, 2022, 44(22):2394-2399,2423.
	Wu Y, Liu Z, Zhang R, et al. Relationship of refeeding syn-drome with cellular immune function and nosocomial death in severe emergency patients[J]. Zhejiang Med J, 2022, 44(22):2394-2399,2423.
[21]	陈曦, 张新超. 老年急危重症患者再喂养综合征对近期预后的影响及风险因素[J]. 中国急救医学, 2021, 41(4):296-301.
	Chen X, Zhang XC. The influence of refeeding syndrome on the short-term prognosis and the risk factors of refeeding syndrome in the elderly patients[J]. Chin J Crit Care Med, 2021, 41(4):296-301.
[22]	龙兴霞, 姚梅琪, 姚金兰, 等. ICU肠内营养患者再喂养综合征发生现状及影响因素研究[J]. 中华护理杂志, 2021, 56(6):818-823. DOI
	Long XX, Yao MQ, Yao JL, et al. Investigation and analysis of factors related to refeeding syndrome in ICU patients under-going enteral nutrition[J]. Chin J Nurs, 2021, 56(6):818-823.
[23]	冯谢宇. ICU住院患者再喂养综合征相关影响因素分析[J]. 首都食品与医药, 2020, 27(23):13-14.
	Feng XY. Analysis of related factors of refeeding syndrome in ICU inpatients[J]. J Pharm Res, 2020, 27(23):13-14.
[24]	Olthof LE, Koekkoek WACK, van Setten C, et al. Impact of caloric intake in critically ill patients with,and without,refeeding syndrome:a retrospective study[J]. Clin Nutr, 2018, 37(5):1609-1617. DOI PMID
[25]	倪军喜, 周树生, 刘宝. 重症监护室患者再喂养综合征风险评估和预后的关系[J]. 中国老年学杂志, 2017, 37(20):5109-5111.
	Ni JX, Zhou SS, Liu B. Relationship between risk assessment and prognosis of refeeding syndrome in ICU patients[J]. Chin J Gerontol, 2017, 37(20):5109-5111.
[26]	Fuentes E, Yeh DD, Quraishi SA, et al. Hypophosphatemia in enterally fed patients in the surgical intensive care unit:common but unrelated to timing of initiation or aggressi-veness of nutrition delivery[J]. Nutr Clin Pract, 2017, 32(2):252-257. DOI PMID
[27]	Brown CA, Sabel AL, Gaudiani JL, et al. Predictors of hypo-phosphatemia during refeeding of patients with severe anorexia nervosa[J]. Int J Eat Disord, 2015, 48(7):898-904.
[28]	Coşkun R, Gündoğan K, Baldane S, et al. Refeeding hypophos-phatemia:a potentially fatal danger in the intensive care unit[J]. Turk J Med Sci, 2014, 44(3):369-374.
[29]	Vignaud M, Constantin JM, Ruivard M, et al. Refeeding syndr-ome influences outcome of anorexia nervosa patients in intensive care unit:an observational study[J]. Crit Care, 2010, 14(5):R172.
[30]	Ferlicolak L, Altintas ND. Refeeding hypophosphatemia in oldest old critically ill patients[J]. Ir J Med Sci, 2024, 193(2):1085-1089.
[31]	Vahdat Shariatpanahi Z, Vahdat Shariatpanahi M,Shahbazi E, et al. Refeeding syndrome and its related factors in critically ill coronavirus disease 2019 patients:a prospective cohort study[J]. Front Nutr, 2022, 9:830457.
[32]	Xiong RQ, Huang H, Wu YM, et al. Incidence and outcome of refeeding syndrome in neurocritically ill patients[J]. Clin Nutr, 2021, 40(3):1071-1076. DOI PMID
[33]	Ralib AM, Mat Nor MB. Refeeding hypophosphataemia after enteral nutrition in a Malaysian intensive care unit:risk factors and outcome[J]. Asia Pac J Clin Nutr, 2018, 27(2):329-335.
[34]	Marik PE, Bedigian MK. Refeeding hypophosphatemia in criti-cally ill patients in an intensive care unit. A prospective study[J]. Arch Surg, 1996, 131(10):1043-1047.
[35]	da Silva JSV, Seres DS, Sabino K, et al. ASPEN consensus re-commendations for refeeding syndrome[J]. Nutr Clin Pract, 2020, 35(2):178-195.
[36]	Friedli N, Stanga Z, Culkin A, et al. Management and preven-tion of refeeding syndrome in medical inpatients:an eviden-ce-based and consensus-supported algorithm[J]. Nutrition, 2018, 47:13-20.
[37]	Doig GS, Simpson F, Heighes PT, et al. Restricted versus con-tinued standard caloric intake during the management of refeeding syndrome in critically ill adults:a randomised,parallel-group,multicentre,single-blind controlled trial[J]. Lan-cet Respir Med, 2015, 3(12):943-952.
[38]	National Institute for Health and Clinical Excellence. Nutri-tion support in adults:oral nutrition support,enteral tube feeding and parenteral nutrition[M]. London: National Institu-te for Health and Clinical Excellence(NICE), 2006.
[39]	崔钰, 盖恬恬, 何月, 等. 危重症患者再喂养综合征识别及预防的研究进展[J]. 中华护理杂志, 2019, 54(9):1419-1422. DOI
	Cui Y, Gai TT, He Y, et al. Research progress on identifi-cation and prevention of refeeding syndrome in critically ill patients[J]. Chin J Nurs, 2019, 54(9):1419-1422.
[40]	Naik NM, Li JH, Seres D, et al. Assessment of refeeding syn-drome definitions and 30-day mortality in critically ill adults:a comparison study[J]. JPEN J Parenter Enteral Nutr, 2023, 47(8):993-1002.
[41]	Schneeweiss-Gleixner M, Haselwanter P, Schneeweiss B, et al. Hypophosphatemia after start of medical nutrition therapy indicates early refeeding syndrome and increased electrolyte requirements in critically ill patients but has no impact on short-term survival[J]. Nutrients, 2024, 16(7):922.
[42]	Dieraert S, Merckx-Fraty M, Piguel X, et al. Refeeding syndro-me and insulin therapy in the discovery of type 2 diabetes:impact on electrolytes:a pilot study[J]. Clin Nutr ESPEN, 2023, 58:515.
[43]	张珊, 庞旭峰, 万香玉, 等. ICU肠内营养患者高血糖发生现况及影响因素分析[J]. 中华护理杂志, 2019, 54(9):1349-1353. DOI
	Zhang S, Pang XF, Wan XY, et al. Investigation and analysis of factors related to hyperglycemia in ICU patients under-going enteral nutrition[J]. Chin J Nurs, 2019, 54(9):1349-1353.
[44]	Butts M, Sundaram VL, Murughiyan U, et al. The influence of alcohol consumption on intestinal nutrient absorption:a com-prehensive review[J]. Nutrients, 2023, 15(7):1571.
[45]	Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline:clinical nutrition in the intensive care unit[J]. Clin Nutr, 2023, 42(9):1671-1689.