Lin Li-Chan, Hsieh Pei-Chi, Wu Shiao-Chi
Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan.
J Clin Nurs. 2008 Apr;17(7):861-8. doi: 10.1111/j.1365-2702.2006.01883.x. Epub 2007 Apr 5.
The aim of this study was to investigate the prevalence rate and influencing factors of pneumonia associated with long-term tube feeding in special care units for patients with persistent vegetative states (PVS) in Taiwan.
Pneumonia is a significant cause of morbidity, hospitalization and mortality in the nursing home population. Tube feeding has been found as a risk factor for the occurrence of pneumonia.
Two hundred sixty subjects were chosen from three hospital-based special care units for patients with PVS and 10 nursing facilities for persons in PVS in Taiwan. All subjects, who were diagnosed with PVS, received either financial aid for institutional care or were means-tested from The Bureau of Social Welfare of cities and counties in Taiwan. Data were collected through chart review and observations.
The prevalence rate of pneumonia in nursing facilities for patients with PVS was 14.2%. The prevalence rate of tube-feeding in nursing facilities for PVS was 91.2%. The mean duration of tube-feeding was 73.21 SD 55.33 months. A total of 90.4% was fed with a nasogastric (NG) tube. Having a lower intake of food and fluids daily and having been institutionalized for a shorter period were three dominant factors associated with the occurrence of pneumonia.
Research findings reveal that the incidence of pneumonia is higher in patients who do not receive adequate food and water. Continuing in-service training to improve caregivers' knowledge and skill in providing care to patients in PVS and monitoring their skills in feeding is needed to decrease the occurrence of pneumonia in this population.
Staff needs to be taught to monitor laboratory data and signs and symptoms of malnutrition and hydration deficit, and also be alert to early indicators of pneumonia in patients with PVS.
本研究旨在调查台湾地区持续性植物状态（PVS）患者特殊护理单元中与长期管饲相关的肺炎患病率及影响因素。
肺炎是疗养院人群发病、住院和死亡的重要原因。已发现管饲是肺炎发生的一个危险因素。
从台湾地区三个医院的PVS患者特殊护理单元和10个PVS患者护理机构中选取260名受试者。所有被诊断为PVS的受试者，要么获得机构护理的经济援助，要么接受台湾市县社会福利局的经济状况调查。通过病历审查和观察收集数据。
PVS患者护理机构中肺炎的患病率为14.2%。PVS患者护理机构中管饲的患病率为91.2%。管饲的平均持续时间为73.21±55.33个月。共有90.4%的患者通过鼻胃管喂食。每日食物和液体摄入量较低以及在机构内居住时间较短是与肺炎发生相关的三个主要因素。
研究结果表明，未获得足够食物和水的患者肺炎发病率较高。需要持续进行在职培训，以提高护理人员对PVS患者的护理知识和技能，并监测他们的喂食技能，以减少该人群中肺炎的发生。
需要教导工作人员监测营养不良和水分缺乏的实验室数据以及体征和症状，同时警惕PVS患者肺炎的早期指标。
