不同时期经皮内镜胃造瘘术在神经外科长期昏迷患者中的应用  

Percutaneous endoscopic gastrostomy in long-term coma patients at different phases： a report from neurosurgical department

作　　者：徐海松[1] 姜启周[1] 王卫民[1] 肖国民[1] 程军[1] 吴建跃[1] 

机构地区：[1]杭州师范大学附属医院神经外科,310015

出　　处：《中华消化内镜杂志》2010年第5期248-251,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的 探讨不同时期经皮内镜胃造瘘术（PEG）在神经外科长期昏迷鼻饲患者中的应用价值.方法 将51例长期昏迷鼻饲患者随机分为25～39 d造瘘组和40～60 d造瘘组,在相应时间内行PEG术.对两组患者造瘘前后的上消化道出血率、出血患者的平均出血次数及平均止血时间、误吸率和吸入性肺炎发生率进行分析比较.结果 造瘘后上消化道出血率、误吸率和吸人性肺炎发生率均明显低于造瘘前（P〈0.05）.25～39 d造瘘组造瘘前上消化道出血率、出血患者平均出血次数、误吸率及吸入性肺炎发生率均明显低于40～60 d造瘘组（P〈0.05）,两组出血患者平均止血时间的差异无统计学意义（P〉0.05）.造瘘后两组患者的上消化道出血率、误吸率及吸入性肺炎发生率的差异无统计学意义（P〉0.05）.结论 在神经外科长期昏迷患者中,PEG能减少因长期置鼻胃管所致的上消化道出血、误吸和吸人性肺炎的发生,发病后25～39 d行PEG比发病≥40 d行PEG对患者更有利.如无PEG禁忌证,发病后25～39 d可能是行PEG的合适时机.Objective To evaluate percutaneous endoscopic gastrostomy （PEC） in long-term coma patients at different phases who received trans-nasal feeding in Department of Neurosurgery. Methods A total of 51 patients who received trans-nasal feeding because of long-term coma were randomly divided into 2 groups to undergo PEG at 25-39 days after coma （n =24） or at 40-60 days （n = 27） , respectively. The rates of upper gastrointestinal bleeding, average episodes of bleeding, average hemostatic time, the rates of aspiration and aspiration pneumonia were compared between the 2 groups. Results The rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in post-PEG patients were significantly lower than those in pre-PEG patients （P 〈 0.05）. Before the procedure of PEG, the rates of upper gastrointestinal hemorrhage,average episodes of bleeding, rates of aspiration and aspiration pneumonia in 25-39-day group were significantly lower than those in 40-60-day group （P 〈 0.05）. There was no significant difference between 2 groups, in regarding of either hemostatic time, or rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia after PEG （P 〉 0. 05）. Conclusion PEG may decrease the rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in neurosurgical patients receiving trans-nasal feeding because of long-term coma. PEG is preferably performed on 25-39 days of onset to 40-60 days. If there is no contraindication, 25-39 days after coma is likely to be the optimal time for PEG.

关 键 词：时间因素 内窥镜 插管术 鼻饲 昏迷 

分 类 号：R459.3[医药卫生—治疗学]