Li Ina
Family Medicine Department, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Am Fam Physician. 2002 Apr 15;65(8):1605-10, 1515.
Patients with advanced dementia are among the most challenging patients to care for because they are often bedridden and dependent in all activities of daily living. Difficulty with eating is especially prominent and distresses family members and health care professionals. Health care professionals commonly rely on feeding tubes to supply nutrition to these severely demented patients. However, various studies have not shown use of feeding tubes to be effective in preventing malnutrition. Furthermore, they have not been demonstrated to prevent the occurrence or increase the healing of pressure sores, prevent aspiration pneumonia, provide comfort, improve functional status, or extend life. High complication rates, increased use of restraints, and other adverse effects further increase the burden of feeding tubes in severely demented patients. Feeding tubes should be avoided in many situations in which they are currently used. The preferable alternative to tube feeding is hand feeding. Though it may not be effective in preventing malnutrition and dehydration, hand feeding allows the maintenance of patient comfort and intimate patient care.
晚期痴呆患者是最难护理的患者群体之一，因为他们常常卧床不起，日常生活的所有活动都需要依赖他人。进食困难尤为突出，这让家庭成员和医护人员都感到苦恼。医护人员通常依靠鼻饲管为这些重度痴呆患者提供营养。然而，多项研究表明，使用鼻饲管并不能有效预防营养不良。此外，也没有证据表明鼻饲管能预防压疮的发生或促进其愈合、预防吸入性肺炎、提供舒适感、改善功能状态或延长生命。高并发症发生率、更多地使用约束措施以及其他不良反应，进一步加重了重度痴呆患者使用鼻饲管的负担。在目前许多使用鼻饲管的情况下，都应避免使用。鼻饲的首选替代方法是手工喂食。虽然手工喂食可能无法有效预防营养不良和脱水，但它能让患者保持舒适，并给予患者贴心的护理。
