Chesoni Sandra A, Bach John R, Okumura Erica Mie
From the Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark (SAC, JRB); and Camargo Cancer Center, Saō Paulo, Brazil (EMO).
Am J Phys Med Rehabil. 2015 Jan;94(1):e6-9. doi: 10.1097/PHM.0000000000000239.
To the authors' knowledge, fatal postgastrostomy aspiration within 2 days of enteral nutrition has not been reported. The authors report consecutive cases of severe postgastrotomy aspiration with one being fatal for a 26-yr-old with Duchenne muscular dystrophy 2 days after initiation of gastrostomy feedings. Previous to these consecutive radiographically inserted gastrostomies, all gastrotomies at the institution were percutaneous endoscopic gastrostomies or open gastrostomies. Radiographically inserted gastrostomy tubes have an increased likelihood of being oriented toward the esophagus as opposed to the duodenum, which may increase the risk for reflux. Elimination of invasive airway tubes should be delayed until after gastrostomy feedings are documented to be well tolerated. Oximetry and repeated measurements of vital capacity can suggest changes in the status of airway clearance.
据作者所知，肠内营养开始后2天内发生的胃造口术后致命性误吸尚未见报道。作者报告了连续发生的严重胃造口术后误吸病例，其中1例26岁的杜氏肌营养不良患者在胃造口喂养开始2天后死亡。在这些连续的经放射学插入的胃造口术之前，该机构所有的胃造口术均为经皮内镜下胃造口术或开放式胃造口术。与十二指肠相比，经放射学插入的胃造口管更有可能朝向食管，这可能会增加反流风险。在记录到胃造口喂养耐受性良好之前，应推迟拔除侵入性气道导管。血氧饱和度测定和肺活量的重复测量可提示气道清除状态的变化。
