Azzopardi Neville, Ellul Pierre
Mater dei Hospital, Department of Gastroenterology, Tal Qroqq, Malta.
Turk J Gastroenterol. 2013;24(2):109-16. doi: 10.4318/tjg.2013.0512.
BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy feeding provides enteral nutrition to patients with neurological dysphagia. Thirty-day mortality rates of 4-26% have been reported, with pneumonia being the common cause post-percutaneous endoscopic gastrostomy insertion.
This retrospective analysis of percutaneous endoscopic gastrostomy tube insertions in Malta (January 2008 - June 2010) compares the incidence of pneumonia in patients fed through a nasogastric tube versus in those fed via a percutaneous endoscopic gastrostomy tube. We analyzed the indications, poor prognostic factors and mortality for percutaneous endoscopic gastrostomy insertion.
Ninety-seven patients underwent percutaneous endoscopic gastrostomy insertion. Fifty-four patients received nasogastric feeds before percutaneous endoscopic gastrostomy feeds. Patients on nasogastric feeds developed 32 episodes of pneumonia over a total of 7884 days of feeds (1 every 246 days). Patients with percutaneous endoscopic gastrostomy feeds after a period of nasogastric feeds developed 48 pneumonia episodes over 36,238 days (1 every 755 days). Patients with percutaneous endoscopic gastrostomy feeds without previous nasogastric feeds developed 28 pneumonia episodes over 23,983 days (1 every 856 days), and this was statistically significant (χ 2 test p value <0.005). Forty-seven patients had died at the time of data collection, with 29 patients dying from pneumonia. One-week mortality was 3%, 30-day mortality was 8% and 1-year mortality was 39%. All patients dying within the first week and 50% of those dying within 30 days of the procedure died following pneumonia.
There was a statistically significant decrease in the number of pneumonia episodes among patients receiving percutaneous endoscopic gastrostomy feeds versus nasogastric feeds. However, pneumonia is still the major cause of death among percutaneous endoscopic gastrostomy patients.
背景/目的：经皮内镜下胃造口术喂养为患有神经性吞咽困难的患者提供肠内营养。据报道，30天死亡率为4%-26%，肺炎是经皮内镜下胃造口术后的常见死因。
对马耳他2008年1月至2010年6月期间的经皮内镜下胃造口管插入术进行回顾性分析，比较经鼻胃管喂养患者与经皮内镜下胃造口管喂养患者的肺炎发生率。我们分析了经皮内镜下胃造口术插入的适应证、不良预后因素和死亡率。
97例患者接受了经皮内镜下胃造口术插入。54例患者在经皮内镜下胃造口术喂养前接受鼻胃管喂养。接受鼻胃管喂养的患者在总共7884天的喂养期间发生了32次肺炎（每246天1次）。在经过一段时间鼻胃管喂养后接受经皮内镜下胃造口术喂养的患者在36238天内发生了48次肺炎（每755天1次）。未经过鼻胃管喂养直接接受经皮内镜下胃造口术喂养的患者在23983天内发生了28次肺炎（每856天1次），这具有统计学意义（χ²检验p值<0.005）。在数据收集时，47例患者死亡，其中29例死于肺炎。1周死亡率为3%，30天死亡率为8%，1年死亡率为39%。所有在术后第一周内死亡的患者以及30天内死亡患者中的50%死于肺炎。
与鼻胃管喂养患者相比，接受经皮内镜下胃造口术喂养的患者肺炎发作次数有统计学意义的减少。然而，肺炎仍然是经皮内镜下胃造口术患者的主要死因。
