帕金森病及相关病症经皮内镜下胃造瘘术后的死亡率和机构收容情况
Mortality and Institutionalization After Percutaneous Endoscopic Gastrostomy in Parkinson's Disease and Related Conditions.
作者信息
Brown Lisa, Oswal Michelle, Samra Amrit-Deep, Martin Hannah, Burch Nicola, Colby Joe, Lindahl Andrea, Skelly Rob
机构信息
Department of Neurology, Royal Derby Hospital, University Hospitals of Derby and Burton Derby DE22 3NE United Kingdom.
Department of Neurology, University Hospitals of Coventry and Warwickshire Coventry CV2 2DX United Kingdom.
出版信息
Mov Disord Clin Pract. 2020 Jun 9;7(5):509-515. doi: 10.1002/mdc3.12971. eCollection 2020 Jul.
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) can facilitate feeding and medication administration in dysphagic patients with Parkinson's disease and related disorders. Information on survival, institutionalization, and complications post PEG might inform feeding decisions.
METHOD
A total of 93 patients with Parkinson's disease and related disorders were identified by review of PEG registers and by searching the administrative databases in 2 large UK university hospitals (2005-2017); 83 case notes were available for retrospective review. Care processes and outcomes were assessed.
RESULTS
The following were the diagnoses: 58 (70%) had Parkinson's disease, 10 (12%) had progressive supranuclear palsy, 5 (6%) had multiple system atrophy, 3 (4%) had dementia with Lewy bodies, and 7 (8%) had vascular parkinsonism. The median age was 78 years (interquartile range 72-82); 29 (35%) were women. Care processes included a future care plan in place prior to admission for 18 patients (22%), and PEG was placed during emergency admission in 68 patients (82%). The outcomes included median survival at 422 days; 30-day mortality rate was 6% (5 patients); and of 56 patients admitted from home, 18 (32%) were discharged to institutions (nursing or care homes). The most common complication was aspiration pneumonia for 18 (22%) of patients. Age, sex, diagnosis, admission type, comorbidities, and place of residence did not predict survival. Discharge to own home and follow-up by the home enteral feeding team were associated with longer survival.
CONCLUSION
We recommend markers of advanced disease should prompt advanced care planning. Discussions about PEG feeding should include information about post-PEG survival, complications, and risk of institutionalization. Further research is needed on quality-of-life post PEG and ways to reduce aspiration pneumonia. All PEG patients should have nutrition team follow-up.
背景
经皮内镜下胃造口术（PEG）有助于帕金森病及相关疾病吞咽困难患者的进食和用药。PEG术后的生存情况、入住机构情况及并发症信息可能有助于进食决策。
方法
通过查阅PEG登记册及检索英国2家大型大学医院的管理数据库（2005 - 2017年），共识别出93例帕金森病及相关疾病患者；83份病例记录可供回顾性分析。评估护理过程及结果。
结果
诊断情况如下：58例（70%）患有帕金森病，10例（12%）患有进行性核上性麻痹，5例（6%）患有多系统萎缩，3例（4%）患有路易体痴呆，7例（8%）患有血管性帕金森综合征。中位年龄为78岁（四分位间距72 - 82岁）；29例（35%）为女性。护理过程包括18例患者（22%）入院前制定了未来护理计划，68例患者（82%）在紧急入院期间进行了PEG置管。结果包括中位生存期为422天；30天死亡率为6%（5例患者）；56例居家入院患者中，18例（32%）出院后入住机构（养老院或护理院）。最常见的并发症是18例（22%）患者发生吸入性肺炎。年龄、性别、诊断、入院类型、合并症及居住地点均不能预测生存情况。出院回家及接受家庭肠内营养团队随访与生存期延长相关。
结论
我们建议疾病晚期的标志物应促使进行高级护理计划。关于PEG喂养的讨论应包括PEG术后生存情况、并发症及入住机构风险的信息。需要进一步研究PEG术后的生活质量及降低吸入性肺炎的方法。所有PEG患者均应由营养团队进行随访。
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