| الوصف: |
Uvod: Sindrom ponovnega hranjenja predstavlja hude elektrolitske in presnovne motnje pri podhranjenih bolnikih v začetku ponovnega hranjenja po obdobju stradanja. Pogosto ostane nediagnosticiran, kar je nevarno, saj je sindrom ponovnega hranjenja lahko življenjsko ogrožajoče stanje. Namen: Namen diplomskega dela je predstaviti najnovejše smernice za ocenjevanje, zdravljenje in preprečevanje sindroma ponovnega hranjenja. Metode dela: Uporabljena je bila deskriptivna metoda dela s pregledom literature. Iskanje literature je potekalo preko spletnega portala Digitalne knjižnice Univerze v Ljubljani v mednarodnih spletnih bazah Medline/PubMed, Cinahl, Cochrane Library ter s pomočjo kataloške baze podatkov COBIS.SI. V končno analizo je bilo vključenih pet člankov. Rezultati: Prikazani rezultati petih člankov visoke kakovosti po hierarhiji dokazov se osredotočajo predvsem na bolnike z motnjami hranjenja ter odrasle starejše, zaradi kroničnih stanj v bolnišničnem okolju. Dva članka se navezujeta na ocenjevanje sindroma ponovnega hranjenja s pomočjo označevalca – inzulinu podobnega rastnega faktorja in računalniškega strojnega modela za napovedovanje hipofosfatemije. Ugotovili so, da sta oba načina učinkovita za napovedovanje tveganja pred začetkom ponovnega parenteralnega hranjenja bolnika. Trije članki pa opisujejo načine ustrezne prehranske terapije podhranjenih bolnikov pri ponovnem peroralnem in enteralnem hranjenju. Visok energijski vnos hrane ne poveča pojavnosti sindroma ponovnega hranjenja ali umrljivosti pri teh bolnikih. Na incidenco sindroma ponovnega hranjenja in pojav hipofosfatemije ne vpliva visok ali nizek kalorični vnos hrane. Ugotovili so, da je lahko visok kalorični vnos hrane varen z dodajanjem tiamina, spremljanjem potreb bolnika po kaliju, fosfatu in tekočini v serumu. Parenteralen vnos hrane je potrebno izračunati glede na bolnikove potrebe in priporočene dnevne energijske vnose. Razprava in zaključek: Presejalni testi za prepoznavanje znakov in simptomov sindroma ponovnega hranjenja so nenatančni, zato je diagnosticiranje bolnikov oteženo. Za prepoznavanje ogroženih bolnikov za sindrom ponovnega hranjenja je potrebno ozaveščanje zdravstvenih delavcev o resnosti zdravstvenega problema pri bolnikih s tveganjem za sindrom ponovnega hranjenja. Protokoli namenjeni preprečevanju in učinkovitemu obvladovanju sindroma ponovnega hranjenja so še vedno velik izziv za kakovostno zdravstveno oskrbo podhranjenih bolnikov. Introduction: Refeeding syndrome represents a severe electrolyte disturbance and metabolic abnormalities in malnourished patients after the start of refeeding, after a period of starvation. It is often left undiagnosed which is dangerous, as the refeeding syndrome can be a life-threatening condition. Purpose: The purpose of this work is to present the latest guidelines for the assessment, treatment and prevention of SPH. Methods: A descriptive method of working with a review of the literature was used. The search for literature took place via the web portal of the Digital Library of the University of Ljubljana in the international online databases Medline / PubMed, Cinahl, Cochrane Library and with the help of the catalog database COBIS.SI. Five articles were included in the final analysis. Results: The presented results of five high-quality articles by hierarchy of evidence focus mainly on patients with eating disorders and older adults due to chronic medical conditions in a hospital setting. Two articles relate the assessment of refeeding syndrome using the marker insulin-like growth factor and a machine learning model for predicting hypophosphatemia. They concluded that both methods are effective for predicting risk before restarting parenteral nutrition. Three articles, however, describe the methods of adequate nutritional therapy of malnourished patients with repeated oral and enteral feeding. High energy food intake does not increase the incidence of refeeding syndrome or mortality in these patients. The incidence of refeeding syndrome and the occurrence of hypophosphatemia are not influenced by high or low caloric food intake. They concluded that high caloric food intake can be made safe by supplementing thiamine, monitoring the patient's serum potassium, phosphate, and fluid requirements. Parenteral food intake should be calculated according to the patient's needs and recommended daily energy intake. Discussion and conclusion: Screening tests for signs and symptoms of refeeding syndrome are imprecise, making diagnosing patients difficult. In order to identify patients at risk for refeeding syndrome, it is necessary to raise awareness among healthcare professionals about the severity of the medical problem in patients at risk for refeeding syndrome. Protocols aimed at preventing and effectively managing refeeding syndrome are still a major challenge for quality medical care of malnourished patients. |
