经皮内镜下胃造口对吞咽障碍老年患者误吸和吸入性肺炎的预防作用观察

摘要

目的 观察比较经皮内镜下胃造口(percutaneous endoscopic gastrostomy,PEG)喂养和鼻胃管(nasogastric tube,NGT)喂养对吞咽障碍老年患者误吸和吸入性肺炎的预防作用.方法 选取2013年1月—2014年12月因脑卒中后存在吞咽障碍行管饲营养的老年患者共97例,分为两组:PEG组32例,其中男性18例,女性14例,年龄65 ～85岁,平均(74.4±5.2)岁,中位喂养时间429(190,906)d;NGT组65例,其中男性36例,女性29例,年龄65～89岁,平均(75.6±6.2)岁,中位喂养时间431 (157,868)d.分别进行长期随访,比较两组吞咽功能的改善、吸入性肺炎的发生和治疗结果.结果 PEG组吞咽功能改善率为40.6％,显著高于NGT组的10.8％ (P＜0.05);PEG组吸入性肺炎发生17次,明显少于NGT组92次,PEG组吸入性肺炎发生频率1次/907 d,明显低于NGT组1次/328 d,差异均有统计学意义(P＜0.05);因吸入性肺炎死亡,PEG组1例,NGT组4例.结论 对于脑卒中后吞咽障碍需长期肠内营养的老年患者,PEG喂养有利于改善患者的吞咽功能,降低误吸和吸入性肺炎的发生频率.%Objective To compare the preventive effect of percutaneous endoscopic gastrostomy (PEG) feeding with that of nasogastric tube (NGT) feeding on aspiration and aspiration pneumonia in senile patients with dysphagia.Methods 97 senile patients of tube feeding due to dysphagia after stroke were selected and divided into 2 groups:PEG group (n =32,18 males and 14 females,aged from 65 to 85 years old with the average of (74.4±5.2),the median feeding time of 429 (190,906) days) and NGT group (n=65,36 males and 29 females,aged from 65 to 89 years old with the average of (75.6 ±6.2),the median feeding time of 431 (157,868) days);long-term follow-up was performed in both groups;a comparative study was made in the improvement of swallowing function,the occurrence of aspiration pneumonia and the therapeutic outcome between the 2 groups.Results The improving rate of swallowing function in PEG group was 40.6％,much higher than that in NGT group (10.8％) (P＜0.05);the occurrence of aspiration pneumonia in PEG group was 17 times,much less than that in NGT group (92 times);the frequency of aspiration pneumonia occurrence in PEG group was once/907 days,much lower than that in NGT group (once/328 days);the difference between the 2 groups was of statistical significance (P＜0.05);1 case in PEG group and 4 cases in NGT group died of aspiration pneumonia.Conclusions PEG feeding is helpful in improving the swallowing function and in decreasing the occurrence frequency of aspiration and aspiration pneumonia in senile patient with dysphagia after stroke in need of long-term enteral nutrition.