Hayashi Tetsuro, Matsushima Masato, Wakabayashi Hidetaka, Bito Seiji
1Division of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902 Japan.
2Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan.
BMC Nutr. 2020 Jan 14;6:2. doi: 10.1186/s40795-019-0318-3. eCollection 2020.
The physical status of patients who received enteral nutrition is still unclear. We aimed to compare the physical functional status among older adult patients who underwent percutaneous endoscopic gastrostomy (PEG) and those with nasogastric feeding.
We conducted a retrospective cohort study in an acute care hospital from August 1, 2009 to March 31, 2015. We included older adult patients (age ≥ 65 years) who were administered PEG or nasogastric feeding during hospitalization and received enteral nutrition for ≥14 days. We excluded patients who were completely bedridden at the administration of enteral nutrition. The primary outcome was death or becoming bedridden at discharge. The incidence of being bedridden among the patients who survived and received enteral nutrition at discharge was also compared according to the enteral nutrition method used.
Among the 181 patients who were administered enteral nutrition during hospitalization, 40 patients (22%) died and 66 patients (36%) were bedridden at discharge. The proportions of patients who fully resumed oral intake were 30% in the nasogastric group and 2.3% in the PEG group. The adjusted odds ratios comparing PEG feeding to nasogastric feeding were 0.38 (95% CI, 0.16-0.93) for death or being bedridden and 0.09 (95% CI, 0.02-0.40) for being bedridden among the patients who were receiving enteral nutrition at discharge.
Among older adult patients who were administered enteral nutrition, more than half of these patients died or became bedridden. PEG feeding could be associated with a lower risk of becoming bedridden or death in comparison with nasogastric feeding, although PEG feeding may be offered to the most mobile/ambulatory patients within clinical decision-making. Clinicians should carefully consider the administration and choice of enteral nutrition methods, when considering the prognosis of the patients.
接受肠内营养患者的身体状况仍不明确。我们旨在比较接受经皮内镜下胃造口术（PEG）的老年患者与鼻饲患者的身体功能状况。
我们于2009年8月1日至2015年3月31日在一家急症医院进行了一项回顾性队列研究。纳入住院期间接受PEG或鼻饲且接受肠内营养≥14天的老年患者（年龄≥65岁）。排除在给予肠内营养时完全卧床的患者。主要结局是出院时死亡或卧床。还根据所使用的肠内营养方法比较了出院时存活并接受肠内营养患者的卧床发生率。
在住院期间接受肠内营养的181例患者中，40例（22%）死亡，66例（36%）出院时卧床。鼻饲组完全恢复经口进食的患者比例为30%，PEG组为2.3%。与鼻饲相比，PEG喂养的校正比值比在出院时接受肠内营养的患者中，死亡或卧床为0.38（95%CI，0.16 - 0.93），卧床为0.09（95%CI，0.02 - 0.40）。
在接受肠内营养的老年患者中，超过一半的患者死亡或卧床。与鼻饲相比，PEG喂养可能与较低的卧床或死亡风险相关，尽管在临床决策中PEG喂养可能提供给活动能力最强/能行走的患者。在考虑患者预后时，临床医生应仔细考虑肠内营养方法的实施和选择。
