Taylor C A, Larson D E, Ballard D J, Bergstrom L R, Silverstein M D, Zinsmeister A R, DiMagno E P
Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1992 Nov;67(11):1042-9. doi: 10.1016/s0025-6196(12)61118-5.
Percutaneous endoscopic gastrostomy (PEG) is used to provide nutrition for patients who are unable to eat but have a functionally intact gut. Clinical guidelines for PEG are uncertain and have been derived mainly from referral practices. We performed a population-based cohort study in 97 residents of Olmsted County, Minnesota, referred for PEG between January 1982 and December 1988 to determine complications, duration of tube feeding, and survival. Follow-up continued until death or February 1990. Inpatient and outpatient records were reviewed to determine indications, comorbid conditions, level of consciousness, and limitations in activities of daily living. Outcomes determined after referral for PEG included type and number of complications, tube removal, and survival. Statistical methods used included Kaplan-Meier and proportional hazards regression analyses. PEG placement was successful in 94% of patients. Although complications occurred in 70% of patients, they usually were minor (88%) and most occurred within 3 months. In 24 patients, tubes were removed because eating was resumed. The probability of surviving 30 days, 1.5 years, and 4 years after referral for PEG was 78%, 35%, and 27%, respectively. The major causes of death within and after 30 days were pneumonia, heart disease, and vascular disease of the central nervous system. An increased risk of death after referral for PEG placement was associated with older age, male gender, diabetes, and specific indications for PEG. If validated in other population-based studies, these predictors of survival after referral for PEG placement could be used to identify patients with a low probability of survival who may not benefit from PEG.
经皮内镜下胃造口术（PEG）用于为无法进食但肠道功能完好的患者提供营养。PEG的临床指南并不明确，且主要源自转诊实践。我们对明尼苏达州奥尔姆斯特德县的97名居民进行了一项基于人群的队列研究，这些居民在1982年1月至1988年12月期间被转诊接受PEG，以确定并发症、管饲持续时间和生存率。随访持续至死亡或1990年2月。审查住院和门诊记录以确定适应证、合并症、意识水平和日常生活活动受限情况。PEG转诊后的结局包括并发症的类型和数量、拔管情况和生存率。使用的统计方法包括Kaplan-Meier法和比例风险回归分析。94%的患者PEG放置成功。虽然70%的患者发生了并发症，但通常较轻微（88%），且大多数发生在3个月内。24例患者因恢复进食而拔管。PEG转诊后30天、1.5年和4年的生存概率分别为78%、35%和27%。30天内及之后的主要死亡原因是肺炎、心脏病和中枢神经系统血管疾病。PEG放置转诊后死亡风险增加与年龄较大、男性、糖尿病以及PEG的特定适应证有关。如果在其他基于人群的研究中得到验证，这些PEG放置转诊后的生存预测因素可用于识别生存概率较低、可能无法从PEG中获益的患者。
