Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Curr Opin Gastroenterol. 2010 Mar;26(2):156-9. doi: 10.1097/MOG.0b013e3283346fae.
Patients suffering from dementia or significant cognitive impairment (SCI) due to neurologic injury routinely receive percutaneous endoscopic gastrostomy (PEG) due to swallowing difficulty or lack of appetite. This review discusses current data and opinion regarding the risks and benefits of PEG in these populations.
The current data regarding PEG placement in patients with dementia or SCI due to neurologic injury do not confirm either improvement or worsening of survival. Significant risk factors for poor prognosis after PEG include sex, hypoalbuminemia, age, chronic heart failure, and subtotal gastrectomy. Complications associated with enteral nutrition are minor and easily controlled when managed by a nutritional team. Alternative options for feeding elderly demented patients are available for family members considering PEG.
In contrast to previously published data regarding worse clinical outcomes in the dementia and SCI populations receiving PEG, recent data suggest that clinical outcomes in this population are no different than in other patient populations receiving PEG. A prospective, randomized study is needed to ascertain whether PEG is appropriate and beneficial in the dementia/SCI populations.
因神经损伤而患有痴呆或严重认知障碍（SCI）的患者，由于吞咽困难或食欲不振，通常会接受经皮内镜下胃造口术（PEG）。本文讨论了目前关于该人群接受 PEG 的风险和益处的数据和观点。
目前关于因神经损伤而患有痴呆或 SCI 的患者接受 PEG 的数据并不能确定其生存是否得到改善或恶化。PEG 后预后不良的显著危险因素包括性别、低白蛋白血症、年龄、慢性心力衰竭和全胃切除术。当由营养团队管理时，与肠内营养相关的并发症是轻微且易于控制的。对于考虑接受 PEG 的老年痴呆患者的家属，有可供选择的替代喂养方案。
与之前发表的关于痴呆和 SCI 人群接受 PEG 后临床结局更差的数据相反，最近的数据表明，该人群的临床结局与接受 PEG 的其他患者人群没有不同。需要进行前瞻性、随机研究以确定 PEG 是否适用于痴呆/SCI 人群并对其有益。
