Hattori Yukari, Kojima Taro, Komura Hiroaki, Ura Nobuyuki, Akishita Masahiro
Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Sapporo Nishimaruyama Hospital, Sapporo, Japan.
Ann Geriatr Med Res. 2019 Mar;23(1):27-30. doi: 10.4235/agmr.19.0006. Epub 2019 Mar 31.
Although the notion of percutaneous endoscopic gastrostomy (PEG) tube placement for patients with dementia has been changing, the number of cases of PEG placement remains high as Japan has become a super-aged society. However, there is insufficient research about the clinical course of dementia patients with PEG, especially regarding PEG extubation after regaining full oral intake. This case series aimed to reveal the demographic data of patients who successfully underwent PEG extubation and to identify clinical factors that might help predict eventual resumption.
This retrospective case series was identified in a private, community-based long-term care hospital in Sapporo, Japan. Inclusion criteria for the series were: 1) age, ≥75 years, 2) diagnosis of any type of dementia, and 3) resumption of full oral intake after removal of PEG tubes.
Eight female patients were identified. Decreased oral intake was triggered by acute medical conditions, such as infectious enteritis. A trial of oral intake was initiated mostly by speech therapists. A majority of the patients ate pureed food. The patients aged ≥85 years with advanced dementia could be weaned from PEG tubes.
The series indicates that even patients with limited life expectancy could recover swallowing function by receiving appropriate guidance and care. Constant evaluation for swallowing function even after PEG insertion may be important for PEG extubation.
尽管针对痴呆患者进行经皮内镜下胃造口术（PEG）置管的观念一直在变化，但随着日本进入超老龄化社会，PEG置管的病例数仍然居高不下。然而，关于PEG痴呆患者的临床病程，尤其是恢复完全经口进食后PEG拔管方面的研究不足。本病例系列旨在揭示成功进行PEG拔管患者的人口统计学数据，并确定可能有助于预测最终恢复经口进食的临床因素。
本回顾性病例系列来自日本札幌一家私立的、基于社区的长期护理医院。该系列的纳入标准为：1）年龄≥75岁；2）诊断为任何类型的痴呆；3）PEG管拔除后恢复完全经口进食。
共确定了8名女性患者。经口摄入量减少是由急性疾病引发的，如感染性肠炎。经口进食试验大多由言语治疗师发起。大多数患者食用泥状食物。年龄≥85岁且患有晚期痴呆症的患者可以拔除PEG管。
该系列表明，即使预期寿命有限的患者，通过接受适当的指导和护理也可以恢复吞咽功能。即使在PEG置管后持续评估吞咽功能对于PEG拔管可能也很重要。
