Kak Manisha, Issa Naoum P, Roos Raymond P, Sweitzer Bobbie Jean, Gottlieb Ori, Guralnick Amy, White Steven R, Semrad Carol E, Soliven Betty, Baroody Joumana, Rezania Kourosh
a Department of Neurology , The University of Chicago Medical Center , Chicago , IL , USA.
b Department of Anesthesiology , Northwestern Memorial Hospital , Chicago , IL , USA.
Neurol Res. 2017 Jan;39(1):16-22. doi: 10.1080/01616412.2016.1259028. Epub 2016 Nov 23.
To evaluate the safety and effect on survival of insertion of a gastrostomy tube (G-tube) in patients with amyotrophic lateral sclerosis (ALS) who have upright forced vital capacity (uFVC) ≤ 50% predicted. Current guidelines, which are based on higher rates of post-procedure complications in ALS patients with advanced respiratory dysfunction, have led to a recommendation to perform G-tube insertion before the FVC drops to <50% predicted, even when the patient has no significant dysphagia.
We assessed 41 ALS patients who received a G-tube, mostly by insertion of a percutaneous endoscopic gastrostomy (PEG) tube by a dedicated team that included a gastroenterologist and one of two anesthesiologists using Monitored Anesthesia Care with deep sedation, and 61 patients who did not receive a G-tube. uFVC was ≤50% predicted in 12 of 41 patients who received a G-tube and in 18 of 61 who did not.
The procedure was safe regardless of FVC status, with low rates of post-operative complications in both low and high FVC groups. There was no survival benefit for patients who received a G-tube when compared with those who did not.
PEG insertion is safe in ALS patients with significant respiratory muscle weakness when performed by a dedicated team, which suggests that the recommendation for G-tube placement should not be based on the patient's respiratory status.
评估在预测用力肺活量（uFVC）≤50%的肌萎缩侧索硬化症（ALS）患者中插入胃造瘘管（G管）的安全性及对生存的影响。当前指南基于晚期呼吸功能障碍的ALS患者术后并发症发生率较高，建议在用力肺活量降至预测值的<50%之前进行G管插入，即使患者没有明显吞咽困难。
我们评估了41例接受G管插入的ALS患者，大多数是由一个专业团队通过经皮内镜下胃造瘘术（PEG）插入，该团队包括一名胃肠病学家和两名麻醉医生中的一名，采用深度镇静的监护麻醉；以及61例未接受G管插入的患者。在接受G管插入的41例患者中有12例、未接受G管插入的61例患者中有18例uFVC≤预测值的50%。
无论用力肺活量状态如何，手术都是安全的，低用力肺活量组和高用力肺活量组术后并发症发生率均较低。与未接受G管插入的患者相比，接受G管插入的患者没有生存获益。
由专业团队为呼吸肌无力严重的ALS患者进行PEG插入是安全的，这表明G管放置的建议不应基于患者的呼吸状态。
