脑卒中后持续吞咽功能障碍患者经评估后采用内镜下经皮胃造瘘术的疗效分析  

Efficiency analysis on percutaneous endoscopic gastrostomy for patients with persistent dysphagia after stroke

作　　者：姜跃龙[1] 李鹏[3] 李巍[3] 蒋云[2] 刘芳[2] 刚锐[1] 赵丽[1] 史济华[1] 张帆[1] 刘洁[2] 王佳超[2] 赵津辰 龚涛[2] 张澍田[3] 许乐[1] 

机构地区：[1]北京医院国家老年医学中心消化内科,100730 [2]北京医院国家老年医学中心神经内科,100730 [3]首都医科大学附属北京友谊医院消化内科,100050 [4]内蒙古赤峰市宁城县医院消化内科,024200

出　　处：《中华老年医学杂志》2017年第3期282-286,共5页Chinese Journal of Geriatrics

基　　金：首都临床特色应用研究专项资助课题（Z131107002213170）

摘　　要：目的通过参数评分对脑卒中后吞咽功能持续障碍患者进行评估，应用该评分系统选择性对患者实施内镜下经皮胃造瘘（PEG），观察PEG对脑卒中后长期吞咽功能障碍患者病死率和并发症的影响。方法使用前期研究所得的评分系统将患者分为低分值组（未做PEG）、高分值（未做PEG）组以及低分值PEG组，共入组75例，每组25例，随访18个月，比较组间并发症、病死率以及生存时间的差异。结果低分值组平均吸入性肺炎发生的次数为（1．36±1．44）次、高分值组为（1．96±2．28）次、低分值PEG组为（0．36±0．64）次，3组患者吸入性肺炎发生的次数比较差异有统计学意义（H=7．148，P=0．028），无论是状态较好的低分值组或者较差的高分值组，吸入性肺炎的发生次数差异均无统计学意义（P=0．189）；低分值组采用了PEG后较低分值未采用PEG组吸入性肺炎发生次数下降（P=0．030），较高分值组明显下降（P〈0．01）；低分值组平均消化道出血的发生次数为（0．48±0．77）次，高分值组为（0．64±0．91）次，低分值PEG组为（o．12±0．33）次，3组患者消化道出血发生次数比较差异无统计学意义（H=5．532，P=0．063），低分值组与高分值组比较，消化道出血发生次数差异无统计学意义（P=0．430），低分值PEG组较低分值未采用PEG组消化道出血发生次数差异无统计学意义（P=0．079），较高分值组发生次数下降（P=0．012）。到观察终点，低分值组患者生存率88．0％（22例），高分值组患者生存率52．0％（13例），低分值PEG组生存率92．0％（23例），3组生存率比较差异有统计学意义（χ^2=7．906，P=0．001）；Kaplan—Meier生存曲线结果显示，低分值组和低分值PEG组平均生存时间均比高分值组患者长（P〈0．01），但低分值组与低分值PEG组比较生存时间差异无统计学意义（P=0�Objective To observe the effects of percutaneous endoscopic mortality and complications in patients with persistent dysphagia after stroke system for selecting PEG indication. Methods A total of 75 patients were gastrostomy （PEG） on using a points scoring divided into low score group without PEG, high score group without PEG and low score group with PEG （n~ 25 each）. The follow-up period was 18 months, and the differences in complications, mortalities and survival periods among groups were compared. Results The number of times of aspiration pneumonia was （1.36±1.44） in low score group, （1.96±2.28） in high score group, （0.36±0.64） in low score group with PEG, with statistically significant differences among three groups （H= 7. 148, P = 0. 028）. No difference in the morbidity of aspiration pneumonia was found between low score group and high score group （P=0. 189）. The number of times of aspiration pneumonia was decreased in low score groups after PEG versus in low score group without PEG （P=0. 030） and in high score group （P〈0.01）. The number of times of gastrointestinal hemorrhage was （0.48±0.77）in low score group,（0.64± 0.91） in high score group, （0.12!0.33） in low score group with PEG, with statistically significant differences among three groups （ H = 5. 532, P = 0. 063）. No statistically significant difference in gastrointestinal hemorrhage was found between low score groups and low score group after PEG （P= 0. 430）, as well as between low score group and low score group with PEG （P = 0. 079）. The morbidity of gastrointestinal hemorrhage was lower in low score group than in high score group （P= 0.012）. The survival rate at the observation end was 88.0% （22/25）, 52.0% （13/25） and 92.0% （23/25） in low score group, high score group and low score group with PEG, respectively, with statistically significant difference among the three groups （χ^2 = 7. 906, P = 0. 001 ）. Kaplan-Meier survival curve showed that the survival period

关 键 词：卒中 吞咽障碍 胃造口术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]