静脈経由の電解質補給が,親腸経由の栄養を開始した患者の再栄養症候群に与える影響
Makayla F Hoke1, Katelyn A Butler1, Marcos J Ortiz-Uriarte1,2
1North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
まとめ
腸内栄養前の静脈内電解質補給は,再給餌症候群の発生を有意に変化させなかった. しかし,それはより軽度の症例,より小さなの減少,および病院での死亡率の減少と関連していました.
科学分野:
- 臨床栄養について
- 内科 医学
- クリティカル ケア 医療
背景:
- リフィーディング症候群 (RS) は,電解質のシフトによって特徴づけられる栄養補助の危険な合併症です.
- カロリー摂取量が不十分で 腸内栄養 (PN) を受けている患者には頻繁に発生する.
- これらの患者では,電解質の不均衡をモニタリングし,予防することが重要です.
研究 の 目的:
- 静脈内 (IV) のエレクトロライト補給が再給餌症候群に与える影響を評価する.
- IVエレクトロライトを投与された患者と投与されなかった患者のRSの発生率と重症度を比較する.
- 死亡率を含む患者のアウトカムに対するIV電解質の影響を評価する.
主な方法:
- PNを10年以上に渡って受けた124人の成人患者を分析した.
- 患者は2つのグループに分けられ,PNの前にIV電解質補給を受けた患者と,その補給を受けなかった患者でした.
- 主なアウトカムは,PNの発症から5日以内に血清のリン,カリウムまたはマグネシウムの≥10%の減少として定義されたRSの発生でした.
主要な成果:
- RSの全症例発生率は,グループごとに似ていた (83. 9%対77. 4%,P=0. 4).
- 静脈電解質群では,より軽度のRS症例 (OR=2. 48,P=0. 02) と,血清リン酸値のより低い中位値減少 (MD=6. 0,P=0. 03) が報告されました.
- 病院での死亡率は,IV用電解質群で有意に低かった (OR=0. 25,P=0. 008).
結論:
- PN前IV電解質補給は,再給餌症候群の全体的な発生率を有意に変化させなかった.
- 発見は,低リン酸血症の重度の低下と病院での死亡率の低下を含む潜在的な利益を示唆しています.
- 重度のRSの予防におけるIV電解質補給の役割を確認するために,さらなる前向きな研究が必要である.
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