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

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