Douzinas Emmanuel E, Tsapalos Andreas, Dimitrakopoulos Antonios, Diamanti-Kandarakis Evanthia, Rapidis Alexandros D, Roussos Charis
Department of Critical Care, Evangelismos Hospital, Athens 10675, Greece.
World J Gastroenterol. 2006 Jan 7;12(1):114-8. doi: 10.3748/wjg.v12.i1.114.
To investigate the effect of percutaneous endoscopic gastrostomy (PEG) on gastroesophageal reflux (GER) in mechanically-ventilated patients.
In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilator-associated pneumonia (VAP) and GER > 6% were divided into PEG group (n = 16) or non-PEG group (n = 20). Another 11 ventilated patients without reflux (GER < 3%) served as control group. Esophageal pH-metry was performed by the "pull through" method at baseline, 2 and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue.
A significant decrease of median (range) reflux was observed in PEG group from 7.8 (6.2 - 15.6) at baseline to 2.7 (0 - 10.4) on d 7 post-gastrostomy (P < 0.01), while the reflux increased from 9 (6.2 - 22) to 10.8 (6.3 - 36.6) (P < 0.01) in non-PEG group. A significant correlation between GER (%) and the stay of nasogastric tube was detected (r = 0.56, P < 0.01).
Gastrostomy when combined with semi-recumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.
探讨经皮内镜下胃造口术（PEG）对机械通气患者胃食管反流（GER）的影响。
在一项前瞻性、随机、对照研究中，将36例复发性或持续性呼吸机相关性肺炎（VAP）且GER>6%的患者分为PEG组（n = 16）和非PEG组（n = 20）。另外11例无反流（GER<3%）的机械通气患者作为对照组。在PEG术前、术后2天和7天采用“牵拉法”进行食管pH测定。严格随访患者的半卧位情况及胃内营养残渣情况。
PEG组胃造口术后7天，反流中位数（范围）从基线时的7.8（6.2 - 15.6）显著降至2.7（0 - 10.4）（P<0.01），而非PEG组反流从9（6.2 - 22）增至10.8（6.3 - 36.6）（P<0.01）。检测到GER（%）与鼻胃管留置时间之间存在显著相关性（r = 0.56，P<0.01）。
胃造口术联合半卧位及胃内无营养残渣可减少机械通气患者的胃食管反流。
