内镜下经皮胃造瘘术在悉尼西南区脑卒中吞咽功能障碍患者中的应用对策分析  

Strategy of percutaneous endoscopic gastrostomy in stoke patients with dysphagia in Sydney South West Area Australia

作　　者：姜跃龙[1] XinshengLiu DanielKYChan 

机构地区：[1]卫生部北京医院消化内科,100730 [2]澳大利亚新南威尔士州悉尼市Bankstown-Lidcombe医院老年科

出　　处：《中华老年医学杂志》2012年第12期1073-1075,共3页Chinese Journal of Geriatrics

摘　　要：目的比较吸人性肺炎、上消化道出血患者在经皮胃造瘘术前、术后临床资料，并通过各项重要参数评分、综合评估指导治疗决策的制定。方法人组患者52例，统计6个月内的生存情况，通过设定各重要参数临界点综合评分后，比较生存组与死亡组评分分值差异。结果52例患者中，经皮胃造瘘管置放前后，吸人性肺炎[50．0Yoo（26／52）比34．6％（18／52），x2=2．52，P=0．164]与上消化道出血[5．8％（3／52）比7．7％（4／52），x2=0．15，P=1．0003的发生率比较，差异均无统计学意义。死亡组综合评分（10．9±0．3）分，生存组（9．4±0．2）分，两组比较差异有统计学意义（t=3．81，P=0．001）。结论经皮胃造瘘并不能降低卒中患者的吸人性肺炎及上消化道出血的发生率，通过设定重要参数评分的方法可以预测是否需要选择经皮胃造瘘治疗。Objective To compare the results of aspiration pneumonia and upper digestive tract bleeding before and after percutaneous endoscopic gastrostomy（PEG）, and to evaluate and predicate risk of death that can help to decide PEG by means of critical parameter score system. Methods A total of 52 patients undergoing PEG feeding due to persistent deglutition disorders during the period o% 6 months were retrospectively consecutive studied. Parameter means as critical points were created as scoring system, and the scores were calculated to analyse the difference between survival group and death group. Results No statistic difference was found in rates of aspiration pneumonia[50.0% （26/52） vs. 34.6 % （ 18/52）, X2 = 2.52, P = 0. 1641 and upper gastrointestinal hemorrhage（5.8 % （3/ 52）vs. 7.70/oo （4/52） ,X2 =0. 15,P=1. 000] between before PEG and after PEG. There was significant difference in total scores between the death group （16 cases） and survival group （36 cases） （10.9± 0. 3 vs. 9.4±0.2, t= 3.81, P= 0. 001） . Conclusions PEG can＇t reduce morbidities of aspiration pneumonia and upper gastrointestinal hemorrhage. Scoring system may guide clinicians for selecting patients for PEG.

关 键 词：吞咽障碍 卒中 胃造口术 

分 类 号：R473.74[医药卫生—护理学]