经皮胃镜下胃造瘘术在颅脑损伤后昏迷伴吞咽困难患者中的早期应用研究  

Study of Early Application of Percutaneous Endoscopic Gastrostomy for Patients with Coma and Dysphagia after Acute Craniocerebral Injury

作　　者：桑林[1] 郑重[1] 周峰[1] 解飞[1] 葛留锁 马延山[1] 

机构地区：[1]北京市丰台区医院神经外科,100071

出　　处：《中国全科医学》2012年第21期2473-2475,共3页Chinese General Practice

基　　金：北京市丰台区科技基金资助项目

摘　　要：目的探讨经皮胃镜下胃造瘘术(PEG)与经鼻胃管(NGT)肠内喂养在颅脑损伤后昏迷伴吞咽困难患者中的临床应用。方法选取2008年10月—2011年11月我院收治的重型颅脑损伤后昏迷伴吞咽困难患者60例,分别采取PEG与NGT肠内喂养各30例,比较分析治疗前1 d、治疗后2周、治疗后4周两组患者的非瘫痪侧肱三头肌皮褶厚度、肱三头肌肌围、血红蛋白、血清清蛋白4项营养指标,同时比较两组治疗前后消化道出血、肺部感染、反流性食管炎、低蛋白血症并发症的发生情况。结果两组患者营养指标比较,差异均有统计学意义(P<0.01),不同时间间比较,差异亦有统计学意义(P<0.01)。治疗4周后,PEG组患者消化道出血、肺部感染、反流性食管炎的发生率与NGT组比较,差异均有统计学意义(P<0.01)。结论 PEG肠内喂养在改善颅脑损伤后昏迷伴吞咽困难患者的营养状况及降低并发症发生等方面安全、有效。Objective To evaluate the efficacy and safety of percutaneous endoscopic gastrostomy（PEG） and nasogastric tube（NGT） for patients with coma and dysphagia after acute craniocerebral injury.Methods 60 patients with coma and dysphagia after acute craniocerebral injury admitted to our hospital from October 2008 to November 2011 were selected.The patients were divided into PEG group and NGT group,with each group 30 cases.Upper arm skin-fold thickness and mid-arm circumference of triceps,concentrations of haemoglobin and serum albumin were compared and analyzed one day before treatment,at the second week of the treatment and the at the fourth week of the treatment.Meanwhile,alimentary tract hemorrhage,pulmonary infection,reflux esophagitis and hypoproteinemia were also compared between the two groups before and after treatment.Results The nutritive indexes of the two groups showed statistically significant differences（P〈0.01）.The nutritive indexes of the two groups at different times also showed statistically significant differences（P〈0.01）.After four weeks treatment,the incidence of alimentary tract hemorrhage,pulmonary infection and reflux esophagitis of PEG group showed statistically significant differences compared with those of the NGT group（P〈0.01）.Conclusion PEG tube feeding is safe and effective in improving nutritive indexes and reducing the incidence of complications in patients with coma and dysphagia after acute craniocerebral injury.

关 键 词：颅脑损伤 吞咽障碍 经皮胃镜下胃造瘘术 鼻胃管 

分 类 号：R651.15[医药卫生—外科学]