Park Jung Hyun, Kang Seong-Woong
Department of Rehabilitation Medicine, Eulji University College of Medicine, Daejeon, Korea.
Arch Phys Med Rehabil. 2009 Jun;90(6):1026-9. doi: 10.1016/j.apmr.2008.12.006.
To determine the safety and feasibility of percutaneous radiologic gastrostomy (PRG) tube placement in patients with amyotrophic lateral sclerosis (ALS) with too low a vital capacity to be weaned off noninvasive positive pressure ventilation (NPPV).
Five-year follow-up cohort study.
Inpatient pulmonary rehabilitation hospital.
Patients with ALS (N=25) with dysphagia on NPPV.
PRG tube placement was performed. During the procedure, all subjects used NPPV via nasal masks. No sedatives or narcotics were administered for premedication.
Success and complication rates after PRG tube placement, and mean survival after the procedure.
For the 25 patients enrolled, mean percent forced vital capacity (FVC) was 33.3+/-17.8% seated (n=19) and 25.3+/-12.0% supine (n=18). FVCs could not be measured in patients who could not tolerate being off NPPV. PRG placement was 100% successful technically. Mean survival for the 25 patients was 32.1 months.
The application of NPPV during PRG was found to be a successful, safe means of providing nutritional care for patients with ALS with too low an FVC to be off NPPV. We advocate that PRG be considered the treatment of choice for nutritional care in patients with ALS on NPPV.
确定经皮放射学胃造口术（PRG）管置入术在肌萎缩侧索硬化症（ALS）患者中的安全性和可行性，这些患者肺活量过低，无法脱离无创正压通气（NPPV）。
五年随访队列研究。
住院肺部康复医院。
接受NPPV治疗且有吞咽困难的ALS患者（N = 25）。
进行PRG管置入术。在手术过程中，所有受试者通过鼻面罩使用NPPV。术前未使用镇静剂或麻醉剂。
PRG管置入术后的成功率和并发症发生率，以及术后平均生存期。
对于纳入的25例患者，坐位时平均用力肺活量（FVC）百分比为33.3±17.8%（n = 19），仰卧位时为25.3±12.0%（n = 18）。无法耐受脱离NPPV的患者无法测量FVC。PRG置入术在技术上100%成功。25例患者的平均生存期为32.1个月。
在PRG过程中应用NPPV被发现是为FVC过低而无法脱离NPPV的ALS患者提供营养护理的一种成功、安全的方法。我们主张PRG应被视为接受NPPV治疗的ALS患者营养护理的首选治疗方法。
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