经皮内镜下胃造瘘术在老年肌萎缩侧索硬化症患者中应用的安全性分析  

Safety of percutaneous endoscopic gastrostomy in older patients with amyotrophic lateral sclerosis

作　　者：刘文正[1] 马玉环 闫秀娥 常虹[1] 姚炜[1] 王迎春[1] 郑炜[1] 张耀朋[1] 黄永辉 Liu Wenzheng;Ma Yuhuan;Yan Xiu'e;Chang Hong;Yao Wei;Wang Yingchun;Zheng Wei;Zhang Yaopeng;Huang Yonghui(The Gastroenterology Department,Peking University Third Hospital,Beijing 100191,China;The Gastroenterology Department,Beijing Tsinghua Changgung Hospital,Beijing 102218,China)

机构地区：[1]北京大学第三医院消化科,北京100191 [2]北京清华长庚医院消化科,北京102218

出　　处：《中华老年医学杂志》2025年第1期40-45,共6页Chinese Journal of Geriatrics

摘　　要：目的探讨经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)在老年肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)患者中应用的安全性及主要并发症的相关影响因素,为后续优化手术方式和手术时机提供更多依据。方法回顾性收集2006年1月至2024年1月于北京大学第三医院行PEG的老年ALS患者(≥60岁)的临床数据资料(包括一般情况、ALS病程进展、合并疾病、手术资料及相关并发症等),分析纳入患者术后并发症的情况,分析吸入性肺炎的危险因素。结果共纳入140例患者,平均(68.2±5.9)岁,其中男性69例(49.3%),平均(68.4±6.5)岁;女性71例(50.7%),平均(67.7±6.0)岁。139例手术成功(99.3%),1例未完成的原因为术中误吸所致呼吸骤停。术后并发症出现36例(25.7%),包括伤口感染9例(6.4%)、腹腔感染1例(0.7%)、吸入性肺炎21例(15.0%)、造瘘口局部渗漏1例(0.7%)、一过性发热2例(1.4%),住院期间死亡2例(1.4%)。单因素和多因素分析结果均显示发病时长≤1年(β=-1.219,SE=0.527,P=0.020,OR=0.295,95%CI:0.099~0.804)和半坐位(β=-1.211,SE=0.528,P=0.022,OR=0.298,95%CI:0.100~0.813)会显著影响吸入性肺炎的发生且均为保护性因素(β<0,OR<1)。结论对于老年ALS患者而言,PEG是一种安全的肠内营养方法。吸入性肺炎是常见且严重的并发症,早期手术和采用半坐位的手术方式能减少吸入性肺炎的发生。Objective A retrospective study was conducted to investigate the safety of Percutaneous Endoscopic Gastrostomy(PEG)in elderly patients with Amyotrophic Lateral Sclerosis(ALS)and to identify the factors influencing major complications.The aim is to establish a more robust foundation for optimizing both the procedure and its timing,thereby enhancing the evidence base for refining the surgical approach.MethodsWe retrospectively collected clinical data from elderly ALS patients(≥60 years old)who underwent PEG at Peking University Third Hospital between January 2006 and January 2024.This dataset includes information on general health conditions,the progression of ALS,comorbidities,surgical details,and related complications.Additionally,we analyzed the postoperative complications experienced by the included patients,focusing specifically on the risk factors associated with aspiration pneumonia.ResultsA total of 140 patients were included in the study,with a mean age of 68.2±5.9 years.Among these,69 were male(49.3%)with a mean age of 68.4±6.5 years,and 71 were female(50.7%)with a mean age of 67.7±6.0 years.Successful outcomes were observed in 139 cases(99.3%).One case was not completed due to respiratory arrest caused by intraoperative aspiration.Postoperative complications occurred in 36 cases(25.7%),which included 9 cases of wound infection(6.4%),1 case of abdominal infection(0.7%),21 cases of aspiration pneumonia(15.0%),1 case of local fistula leakage(0.7%),2 cases of transient fever(1.4%),and 2 cases of death during hospitalization(1.4%).Both univariate and multivariate analyses indicated that an onset duration of≤1 year(P=0.020)and a half-sitting position(P=0.022)significantly influenced the occurrence of aspiration pneumonia,acting as protective factors(β<0,OR<1).ConclusionsPEG is a safe method for providing enteral nutrition to elderly patients with ALS.While most complications associated with the procedure are mild and can be managed,Aspiration pneumonia remains a common and serious complication.However,

关 键 词：经皮内镜下胃造瘘术 肌萎缩侧索硬化症 老年 吸入性肺炎 

分 类 号：R47[医药卫生—护理学]