经皮内镜下胃造瘘和空肠造瘘术在神经外科重症病人中的应用
摘要
目的探讨经皮内镜下胃造瘘和空肠造瘘术(PEG/J)在神经外科重症病人中的应用效果。方法回顾性分析2015年6月至2017年12月PEG/J处理的105例神经外科重症病人的临床资料。结果 105例均成功完成手术。术后营养状况均有改善,85%(55/65)肺炎得到控制,出院前GCS由平均8.7恢复到13.1分。术后出现4例空肠造瘘口脱入胃腔、20例造瘘口皮肤感染、4例堵管、3例包埋综合征。86.6%病人拔除PEJ管出院,其中60例拔除PEG管,平均拔管时间118 d。住院期间4例因原发病加重死亡,6例出院后平均10个月死亡。结论 PEG/J安全、有效,对神经外科重症病人的营养状况、肺部感染有很好的临床效果。
引文
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[9] Yong T, Hanggen D, Chengpu F, et al. Clinical significanceof percutaneous endoscopic gastrostomy for patients withsevere craniocerebral injury[J]. Chin J Traumatol, 2014, 17(6):341-344.
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[11] Monteleoni C. Using rapid-cycle quality improvementmethodology to reduce feeding tubes in patients withadvanced dementia:before and after study[J]. BMJ, 2004,329(7464):491-494.
[12] Chrser L, Aschl G, Hébuterne X, et al. ESPEN guidelineson artificial enteral nutrition--percutaneous endoscopicgastrostomy(PEG)[J]. Clin Nutr, 2005, 24(5):848-861.
[13] Vanis N, Saray A, Gornjakovic S, et al. Percutaneous endo-scopic gastrostomy(PEG):retrospective analysis of a 7-year clinical experience[J]. Acta Informatica Medica, 2012,20(4):235-237.
[14] Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R,et al. Percutaneous endoscopic gastrostomy:indications,technique, complications and management[J]. World JGastroenterol, 2014, 20(24):7739-7751.
[15] Biswas S, Dontukurthy S, Rosenzweig MG, et al. BuriedBumper Syndrome Revisited:A Rare but Potentially FatalComplication of PEG Tube Placement[J]. Case Rep CritCare, 2014, 2014(6):634953.
[16] Chaudhry R, Batra S, Mancillas OL, et al. In-Hospital Mor-tality with Use of Percutaneous Endoscopic Gastrostomy inTraumatic Brain Injury Patients:Results of a NationwidePopulation-Based Study[J]. Neurocrit Care, 2017, 26(2):232-238.
[17] Minard G, Kudsk K, Melton S, et al. Early versus delayedfeeding with an immune-enhancing diet in patients withsevere head injuries[J]. J Parent Ent Nutr, 2000, 24(3):145-149.
[2] Gariballa SE, Parker SG, Taub N, et al. Nutritional status ofhospitalized acute stroke patients[J]. Br J Nutr, 1998, 79(6):481.
[3]武建军,秦二平,吕艳萍,等.经皮胃造瘘在重症胰腺炎治疗中的应用价值研究[J].内蒙古医学杂志,2009,41(1):7-8.
[4] MagnéN, Marcy PY, Foa C, et al. Comparison betweennasogastric tube feeding and percutaneous fluoroscopicgastrostomy in advanced head and neck cancer[J]. EurArchives Oto-Rhino-Laryngol, 2001, 258(2):892.
[5] Alshekhlee A, Ranawat N, Syed TU, et al. National Insti-tutes of Health Stroke Scale Assists in Predicting the Needfor Percutaneous Endoscopic Gastrostomy Tube Placementin Acute Ischemic Stroke[J]. J Stroke Cerebrovasc Dis,2010, 19(5):340-352.
[6] Kiphuth IC, Kuramatsu JB, Lücking H, et al. Predictive fac-tors for percutaneous endoscopic gastrostomy in patientswith spontaneous intracranial hemorrhage[J]. Eur Neurol,2011, 65(1):32-38.
[7] Roche V. Percutaneous endoscopic gastrostomy:clinicalcare of PEG tubes in older adults[J]. Geriatrics, 2003, 58(11):22-26.
[8]郑丰平,林显艺,梁艳娉,等.经皮内镜下胃造瘘在神经性吞咽障碍患者中的应用[J].现代消化及介入诊疗,2011,16:245-247.
[9] Yong T, Hanggen D, Chengpu F, et al. Clinical significanceof percutaneous endoscopic gastrostomy for patients withsevere craniocerebral injury[J]. Chin J Traumatol, 2014, 17(6):341-344.
[10]卢杰夫,姜海行,覃山羽.内镜下经皮胃造瘘术对患者营养及生活质量的改善[J].世界华人消化杂志,2012,20(33):3272-3276.
[11] Monteleoni C. Using rapid-cycle quality improvementmethodology to reduce feeding tubes in patients withadvanced dementia:before and after study[J]. BMJ, 2004,329(7464):491-494.
[12] Chrser L, Aschl G, Hébuterne X, et al. ESPEN guidelineson artificial enteral nutrition--percutaneous endoscopicgastrostomy(PEG)[J]. Clin Nutr, 2005, 24(5):848-861.
[13] Vanis N, Saray A, Gornjakovic S, et al. Percutaneous endo-scopic gastrostomy(PEG):retrospective analysis of a 7-year clinical experience[J]. Acta Informatica Medica, 2012,20(4):235-237.
[14] Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R,et al. Percutaneous endoscopic gastrostomy:indications,technique, complications and management[J]. World JGastroenterol, 2014, 20(24):7739-7751.
[15] Biswas S, Dontukurthy S, Rosenzweig MG, et al. BuriedBumper Syndrome Revisited:A Rare but Potentially FatalComplication of PEG Tube Placement[J]. Case Rep CritCare, 2014, 2014(6):634953.
[16] Chaudhry R, Batra S, Mancillas OL, et al. In-Hospital Mor-tality with Use of Percutaneous Endoscopic Gastrostomy inTraumatic Brain Injury Patients:Results of a NationwidePopulation-Based Study[J]. Neurocrit Care, 2017, 26(2):232-238.
[17] Minard G, Kudsk K, Melton S, et al. Early versus delayedfeeding with an immune-enhancing diet in patients withsevere head injuries[J]. J Parent Ent Nutr, 2000, 24(3):145-149.