Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.
Département de Recherche en Ethique, Université Paris Sud/Paris Saclay EA 1610 : Etude des sciences et techniques, Pr Emmanuel Hirsch, Paris, France.
Sci Rep. 2020 Sep 15;10(1):15117. doi: 10.1038/s41598-020-70422-2.
Due to the expanding use of non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS), the question of enteral nutrition is increasingly raised in NIV users ALS patients. Here, we aimed to determine the prognostic factors for survival after gastrostomy placement in routine NIV users, taking into consideration ventilator dependence. Ninety-two routine NIV users ALS patients, who underwent gastrostomy insertion for severe dysphagia and/or weight loss, were included. We used a Cox proportional hazards model to identify factors affecting survival and compared time from gastrostomy to death and 30-day mortality rate between dependent (daily use ≥ 16 h) and non-dependent NIV users. The hazard of death after gastrostomy was significantly affected by 3 factors: age at onset (HR 1.047, p = 0.006), body mass index < 20 kg/m at the time of gastrostomy placement (HR 2.012, p = 0.016) and recurrent accumulation of airway secretions (HR 2.614, p = 0.001). Mean time from gastrostomy to death was significantly shorter in the dependent than in the non-dependent NIV users group (133 vs. 250 days, p = 0.04). The 30-day mortality rate was significantly higher in dependent NIV users (21.4% vs. 2.8%, p = 0.03). Pre-operative ventilator dependence and airway secretion accumulation are associated with worse prognosis and should be key decision-making criteria when considering gastrostomy tube placement in NIV users ALS patients.
由于非侵入性通气（NIV）在肌萎缩侧索硬化症（ALS）中的应用不断扩大，NIV 使用者 ALS 患者的肠内营养问题日益突出。在这里，我们旨在确定常规 NIV 使用者胃造口术放置后的生存预后因素，同时考虑到呼吸机依赖。我们纳入了 92 例行胃造口术的常规 NIV 使用者 ALS 患者，这些患者因严重吞咽困难和/或体重减轻而接受胃造口术。我们使用 Cox 比例风险模型来确定影响生存的因素，并比较了呼吸机依赖（每天使用≥16 小时）和非呼吸机依赖 NIV 使用者的胃造口术后时间和 30 天死亡率。胃造口术后死亡的风险显著受 3 个因素的影响：发病年龄（HR 1.047，p=0.006）、胃造口术时的体重指数（BMI）<20kg/m2（HR 2.012，p=0.016）和气道分泌物的反复积聚（HR 2.614，p=0.001）。依赖型 NIV 使用者从胃造口到死亡的平均时间明显短于非依赖型 NIV 使用者组（133 天比 250 天，p=0.04）。依赖型 NIV 使用者的 30 天死亡率明显更高（21.4%比 2.8%，p=0.03）。术前呼吸机依赖和气道分泌物积聚与预后不良相关，应成为考虑 NIV 使用者 ALS 患者胃造口术置管的关键决策标准。
