Iizuka Masayuki, Reding Mike
Department of Rehabilitation Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Arch Phys Med Rehabil. 2005 May;86(5):1049-52. doi: 10.1016/j.apmr.2004.09.021.
To compare the morbidity, mortality, and functional recovery of patients who require percutaneous endoscopic gastrostomy (PEG) placement for the management of dysphagia after stroke.
Retrospective case-matched controlled study.
Acute stroke rehabilitation inpatient unit.
Patients (N=193) who were admitted for stroke rehabilitation with a PEG tube in place from January 1, 1993, to December 31, 2002, were matched with 193 case controls without PEG. Patients and controls were within 90 days of stroke onset, and were matched for age, sex, type of stroke, FIM instrument score, duration from onset to stroke unit admission, and year of admission.
Not applicable.
Length of rehabilitation hospital stay, improvement in FIM scores, FIM efficiency score, need for transfer back to acute care hospital, diagnosis for which transfer was required, final discharge destination, and survival status.
Significant differences were found between the 2 groups, PEG versus control, respectively, in the following variables: FIM efficiency (.42+/-.57 vs .56+/-.55, P =.016); need for transfer back to acute hospital (58/193 vs 23/193, P =.001); and survival status dead/alive (14/179 vs 3/190, P =.006). Nonsignificant differences were as follows: length of rehabilitation hospital stay (46.9+/-24.8d vs 43.3+/-19.7d, P =.11), improvement in total FIM score from admission to discharge (16.9+/-17.9 vs 21.0+/-15.5, P =.72), and final discharge destination home/institutional care (96/83 vs 101/89, P =.93). Pneumonia was the most frequent reason for transfer to acute care for patients with PEG.
Patients who meet criteria for admission to a stroke rehabilitation unit and who have a PEG in place are at increased risk for medical complications and death. Those who survive, however, show similar functional recovery and rate of home discharge as case-matched controls.
比较因中风后吞咽困难而需要进行经皮内镜下胃造口术（PEG）置管的患者的发病率、死亡率和功能恢复情况。
回顾性病例匹配对照研究。
急性中风康复住院单元。
1993年1月1日至2002年12月31日期间因中风康复而住院且已置入PEG管的患者（N = 193）与193例未置入PEG管的对照病例相匹配。患者和对照病例均在中风发病90天内，且在年龄、性别、中风类型、FIM工具评分、从发病到入住中风单元的时长以及入院年份方面进行了匹配。
不适用。
康复住院时长、FIM评分的改善情况、FIM效率评分、转回急性护理医院的需求、转回所需的诊断、最终出院去向以及生存状态。
在以下变量方面，PEG组与对照组之间分别存在显著差异：FIM效率（0.42±0.57对0.56±0.55，P = 0.016）；转回急性医院的需求（58/193对23/193，P = 0.001）；以及生存状态死亡/存活（14/179对3/190，P = 0.006）。无显著差异的情况如下：康复住院时长（46.9±24.8天对43.3±19.7天，P = 0.11）、从入院到出院FIM总分的改善情况（16.9±17.9对21.0±15.5，P = 0.72）以及最终出院去向回家/机构护理（96/83对101/89，P = 0.93）。肺炎是PEG管置入患者转回急性护理的最常见原因。
符合中风康复单元入院标准且已置入PEG管的患者发生医疗并发症和死亡的风险增加。然而，存活下来的患者与病例匹配的对照组相比，功能恢复情况和回家出院率相似。
