Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Front Immunol. 2022 Feb 2;12:800029. doi: 10.3389/fimmu.2021.800029. eCollection 2021.
Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization.
We performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization.
Multivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11-0.63, = 0.003).
For older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
经鼻胃管（NGT）和经皮内镜下胃造口术（PEG）是广泛用于喂养有口咽吞咽困难的老年患者的技术。吸入性肺炎是这些患者死亡的最常见原因。本研究旨在评估口咽吞咽困难在长期肠内喂养的老年患者中的作用，以对需要住院治疗的肺炎进行风险分层。
我们对老年口咽吞咽困难患者进行改良的灵活内镜吞咽评估，并对需要住院治疗的肺炎进行前瞻性随访。共纳入 664 例经口喂养患者和 155 例经管喂养患者。采用多变量 Cox 分析确定需要住院治疗的肺炎的危险因素。
多变量分析显示，老年患者、神经障碍患者、管饲和口咽吞咽困难患者发生需要住院治疗的肺炎的风险显著增加。亚组分析显示，在有口咽吞咽困难的患者中，与 NGT 相比，PEG 的肺炎需要住院治疗的风险显著降低（调整后的危险比 0.26，95%置信区间：0.11-0.63， = 0.003）。
对于需要长期肠内管饲的有口咽吞咽困难的老年患者，PEG 是比 NGT 更好的选择。需要进一步研究阐明口咽吞咽困难在老年患者肠内喂养中的作用。
