Richter T, Meier C, Steppberger K, Knorrek G, Lietz T
Klinik und Poliklinik für Kinder und Jugendliche der Universität Leipzig, Germany.
Klin Padiatr. 2001 Nov-Dec;213(6):325-8. doi: 10.1055/s-2001-18460.
We wanted improve the nutritional status of patients with cystic fibrosis with enteral feeding via a percutaneous endoscopic gastrostomy (PEG).
In a period of 8 years 11 patients underwent a percutaneous endoscopic gastrostomy (PEG), 4 males and 7 females, in the median 14,9 years of age (7,4/20,8). So far we overlook a median duration of enteral feeding therapy of 19,5 months (10/53).
In 9 of the 11 patients we found a distinct increase of the predicted anthropometrical values,e.g. the weight for height value increased statistically significant in the first 3 months by 10,3 % from 84,7 % to 95,5 % and showed a further increase to 97,8 % after 10 months of nocturnal enteral feeding (p < 0,05). The predicted values of the lung function got stabilized too, with an increase by 9 % of the FEV1 and 3 % of the vital capacity after 10 months. Here was no statistically significance found. In one patient with a poor social-economic background and a lack of compliance the PEG had to be removed surgically because of an abscess formation. Another patient developed an acute gastric ulcer which responded very well onto conservative therapy. In the other patients there were no further complications.
We can conclude that in the treatment of patients with cystic fibrosis showing an unsatisfying nutritional status the long-term nocturnal enteral feeding via a PEG is a good and well tolerated method. The best results we achieved when the gastrostomy was placed at an early state of the disease. That's why we demand an early mentioning of this option of enteral feeding to the patients and their families since the involved mostly need a long time for their decision for that invasive procedure.
我们希望通过经皮内镜下胃造口术(PEG)进行肠内喂养来改善囊性纤维化患者的营养状况。
在8年期间,11例患者接受了经皮内镜下胃造口术(PEG),其中4例男性,7例女性,年龄中位数为14.9岁(7.4/20.8)。到目前为止,我们观察到肠内喂养治疗的中位持续时间为19.5个月(10/53)。
11例患者中有9例的预测人体测量值明显增加,例如身高体重值在最初3个月内从84.7%显著增加至95.5%,夜间肠内喂养10个月后进一步增加至97.8%(p<0.05)。肺功能的预测值也趋于稳定,10个月后第一秒用力呼气容积(FEV1)增加9%,肺活量增加3%。但未发现统计学意义。1例社会经济背景差且依从性差的患者因脓肿形成不得不手术移除PEG。另1例患者发生急性胃溃疡,保守治疗效果良好。其他患者未出现进一步并发症。
我们可以得出结论,对于营养状况不佳的囊性纤维化患者,通过PEG进行长期夜间肠内喂养是一种良好且耐受性良好的方法。在疾病早期进行胃造口术时我们取得了最佳效果。这就是为什么我们要求在疾病早期就向患者及其家属提及这种肠内喂养选择,因为大多数患者需要很长时间来决定是否接受这种侵入性手术。