Beggs Kathleen, Choi Marcia, Travlos Andrew
Vancouver Coastal Health ALS Centre, Canada.
Amyotroph Lateral Scler. 2010;11(1-2):203-6. doi: 10.3109/17482960903207377.
This study reviews feeding tube placement outcomes in 69 ALS outpatients seen at an outpatient interdisciplinary ALS clinic in British Columbia, Canada. The objective was to determine at which point the risks outweigh the benefits of tube placement by reviewing outcomes against parameters of respiratory function, nutritional status and speech and swallowing deterioration. The study was a retrospective review of tube placements between January 2000 and 2005, analysing data on respiratory function (forced vital capacity and respiratory status), weight change from usual body weight (UBW) and speech/swallowing deterioration using ALS Severity Score ratings (Hillel et al., 1989) at time of tube placement. Results show a statistically significant association between nutritional status and successful tube placement outcomes (p=0.003), and none between respiratory status, speech/swallowing variables, or number of deteriorated variables in each patient. Study findings were impacted by lack of available respiratory data. The only study variable that predicted successful tube placement outcome was a body weight greater than or equal to 74% UBW at time of tube placement. In the absence of access to respiratory testing, the relatively simple assessment of weight may assist patients and caregivers in appropriate decisions around tube placement.
本研究回顾了加拿大不列颠哥伦比亚省一家门诊跨学科肌萎缩侧索硬化症（ALS）诊所中69例ALS门诊患者的饲管置入结果。目的是通过对照呼吸功能、营养状况以及言语和吞咽功能恶化等参数来回顾结果，以确定在哪个时间点置管的风险超过益处。该研究是对2000年1月至2005年间的饲管置入情况进行的回顾性研究，分析了置管时呼吸功能（用力肺活量和呼吸状况）、相对于平时体重（UBW）的体重变化以及使用ALS严重程度评分（希勒尔等人，1989年）评估的言语/吞咽功能恶化的数据。结果显示，营养状况与成功的饲管置入结果之间存在统计学上的显著关联（p = 0.003），而呼吸状况、言语/吞咽变量或每位患者中恶化变量的数量之间均无关联。研究结果受到缺乏可用呼吸数据的影响。预测成功饲管置入结果的唯一研究变量是置管时体重≥74% UBW。在无法进行呼吸测试的情况下，相对简单的体重评估可能有助于患者和护理人员围绕置管做出适当决策。
