Cobell William J, Hinds Alisha M, Nayani Rahul, Akbar Syed, Lim Roxanne G, Theivanayagam Shoba, Matteson-Kome Michelle L, Choudhary Abhishek, Puli Srinivas R, Bechtold Matthew L
From the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, and the OSF Medical Group Gastroenterology, University of Illinois, Peoria.
South Med J. 2014 May;107(5):308-11. doi: 10.1097/SMJ.0000000000000104.
Multiple studies have demonstrated that feeding ≤4 hours after placement of a percutaneous endoscopic gastrostomy (PEG) tube is a reasonable option. Many physicians, however, continue to delay feedings until the next day or 24 hours; therefore, we evaluated the safety and effect of early feeding (≤4 hours) after PEG placement in our tertiary care center.
A retrospective study of 444 patients who underwent PEG between June 2006 and December 2011 was performed. Early feeding was defined as feeding ≤4 hours and delayed feeding was defined as feeding >4 hours. Statistical analysis was performed using the Fisher exact test and the Student t test.
A total of 444 patients underwent PEG between June 2006 and December 2011. A majority of PEGs were performed on inpatients by gastroenterologists. The mean time of feeding after PEG was 3.2 ± 0.9 hours for the early group (n = 197) and 17.0 ± 10.0 hours for the delayed group (n = 247). No statistically significant differences were noted between the early (≤4 hours) feedings versus the delayed (>4 hours) feedings for overall morality within 30 days (P = 0.72) and overall complications (P = 1.00). Furthermore, no statistically significant differences were noted between early versus delayed feeding for 24-hour mortality (P = 1.00), 24- to 72-hour mortality (P = 0.20), and 3-30 days mortality (P = 0.86). For each complication, there were no statistically significant differences noted between the two groups for wound infection (P = 0.52), melena (P = 0.26), vomiting (P = 0.42), leakage (P = 0.41), stomatitis (P = 0.13), aspiration pneumonia (P =1.00), and other complications (P = 0.47).
Feeding ≤4 hours after PEG appears to be as safe as delayed feeding. Based on this study and the literature, strong consideration for the majority of patients should be undertaken to begin feeding within 4 hours after PEG.
多项研究表明，经皮内镜下胃造口术（PEG）置管后4小时内开始喂养是一种合理的选择。然而，许多医生仍会将喂养推迟到第二天或24小时后；因此，我们在我们的三级医疗中心评估了PEG置管后早期喂养（≤4小时）的安全性和效果。
对2006年6月至2011年12月期间接受PEG的444例患者进行了回顾性研究。早期喂养定义为喂养≤4小时，延迟喂养定义为喂养>4小时。采用Fisher精确检验和Student t检验进行统计分析。
2006年6月至2011年12月期间共有444例患者接受了PEG。大多数PEG手术由胃肠病学家对住院患者进行。早期组（n = 197）PEG后喂养的平均时间为3.2±0.9小时，延迟组（n = 247）为17.0±10.0小时。PEG置管后早期（≤4小时）喂养与延迟（>4小时）喂养在30天内的总体死亡率（P = 0.72）和总体并发症（P = 1.00）方面无统计学显著差异。此外，早期喂养与延迟喂养在24小时死亡率（P = 1.00）、24至72小时死亡率（P = 0.20）和3至30天死亡率（P = 0.86）方面也无统计学显著差异。对于每种并发症，两组在伤口感染（P = 0.52）、黑便（P = 0.26）、呕吐（P = 0.42）、渗漏（P = 0.41）、口腔炎（P = 0.13）、吸入性肺炎（P = 1.00）和其他并发症（P = 0.47）方面均无统计学显著差异。
PEG置管后4小时内喂养似乎与延迟喂养一样安全。基于本研究及文献，对于大多数患者，应充分考虑在PEG置管后4小时内开始喂养。
