Banfi Paolo, Volpato Eleonora, Valota Chiara, D'Ascenzo Salvatore, Alunno Chiara Bani, Lax Agata, Nicolini Antonello, Ticozzi Nicola, Silani Vincenzo, Bach John R
IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
Respir Care. 2017 Nov;62(11):1474-1484. doi: 10.4187/respcare.05031. Epub 2017 Aug 14.
Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tube (RIG), and percutaneous radiologic gastrostomy (PRG) in patients with ALS, performed with or without noninvasive ventilation (NIV). We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the EBSCO Online Research Database, and Scopus up to December 2015. A priori selection included all randomized controlled trials (RCTs), quasi-randomized trials, and prospective and retrospective studies. The primary outcome was 30-d survival. We found no RCTs or quasi-RCTs. Seven studies about the implementation of the PEG/RIG procedure during the use of NIV and 5 studies without NIV were included. In another study of 59 subjects undergoing open gastrostomy, all with vital capacity < 30% of normal, 18 of whom were dependent on continuous NIV at full ventilatory support settings, there were no respiratory complications. Thus, the use of NIV during the implementation of these procedures, especially when used at full ventilatory support settings of pressure preset 18-25 cm HO, can support alveolar ventilation before, during, and after the procedures and prevent respiratory complications. The procedures investigated appear equivalent, but the methodological quality of the studies could be improved. Possible benefits with regard to nutrition parameters, quality of life, and psychological features need to be further investigated.
当肌萎缩侧索硬化症（ALS）患者出现吞咽困难、食欲不振和气道保护困难，导致营养不良、严重体重减轻、脱水以及吸入性肺炎风险增加时，需采用肠外营养。本综述的目的是比较经皮内镜下胃造口术（PEG）、放射介入下胃造口管置入术（RIG）和经皮放射胃造口术（PRG）在有或无无创通气（NIV）的ALS患者中的应用情况。我们检索了截至2015年12月的PubMed、MEDLINE、EMBASE、Cochrane对照试验中心注册库（CENTRAL）、EBSCO在线研究数据库和Scopus。预先设定的入选标准包括所有随机对照试验（RCT）、半随机试验以及前瞻性和回顾性研究。主要结局指标为30天生存率。我们未找到RCT或半RCT。纳入了7项关于在使用NIV期间实施PEG/RIG手术的研究以及5项未使用NIV的研究。在另一项针对59例接受开放式胃造口术患者的研究中，所有患者肺活量均<正常的30%，其中18例在完全通气支持设置下依赖持续NIV，未发生呼吸并发症。因此，在实施这些手术过程中使用NIV，尤其是在预设压力为18 - 25 cm H₂O的完全通气支持设置下使用时，可在手术前、手术中和手术后支持肺泡通气并预防呼吸并发症。所研究的手术似乎效果相当，但研究的方法学质量有待提高。关于营养参数、生活质量和心理特征方面可能的益处需要进一步研究。
