精心手喂可降低重症痴呆患者肺炎风险，优于鼻胃管喂养。

Reduced Pneumonia Risk in Advanced Dementia Patients on Careful Hand Feeding Compared With Nasogastric Tube Feeding.

机构信息

Division of Geriatrics, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.

Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, Hong Kong SAR, China.

出版信息

J Am Med Dir Assoc. 2022 Sep;23(9):1541-1547.e2. doi: 10.1016/j.jamda.2022.03.011. Epub 2022 Apr 27.

DOI:10.1016/j.jamda.2022.03.011

PMID:35489380

Abstract

OBJECTIVES

To compare survival and pneumonia risk among hospitalized patients with advanced dementia on nasogastric tube feeding (NGF) vs careful hand feeding (CHF) and to examine outcomes by feeding problem type.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Advanced dementia patients aged ≥60 years with indication for tube feeding admitted to 2 geriatric convalescent hospitals between January 1, 2015, and June 30, 2019.

METHODS

Comparison on the effect of NGF and CHF on survival and pneumonia risk using Kaplan Meier survival analysis and Cox proportional hazards models.

RESULTS

Of the 764 patients (mean age 89 years, 61% female, 74% residential care home residents), 464 (61%) were initiated on NGF and 300 (39%) on CHF. The primary feeding problem types were dysphagia (50%), behavioral feeding problem (33%), or both (17%). There was no difference in 1-year survival rate between NGF and CHF groups (36% vs 37%, P = .71) and survival did not differ by feeding problem type. Nasogastric tube feeding was not a significant predictor for survival (adjusted hazard ratio 1.15, 95% CI 0.94-1.39). Among 577 (76%) patients who survived to discharge, pneumonia rates were lower in the CHF group (48% vs 60%, P = .004). After adjusting for cofounders, NGF was a significant risk factor for pneumonia (adjusted hazard ratio 1.41, 95% CI 1.08-1.85). In subgroup analyses, NGF was associated with increased pneumonia risk for patients with both dysphagia and behavioral feeding problem (P = .01) but not in patients with behavioral feeding problem alone (P = .24) or dysphagia alone (P = .30).

CONCLUSIONS AND IMPLICATIONS

For advanced dementia patients with feeding problems, there is no difference in survival between NGF and CHF. However, NGF is associated with a higher pneumonia risk, particularly for patients with both dysphagia and behavioral feeding problem. Further research on how the feeding problem type impacts pneumonia risk for patients on NGF is needed.

摘要

目的

比较经鼻胃管喂养（NGF）与精心手喂（CHF）对住院晚期痴呆患者的生存和肺炎风险的影响，并按喂养问题类型检查结果。

设计

回顾性队列研究。

地点和参与者

2015 年 1 月 1 日至 2019 年 6 月 30 日期间，在 2 家老年疗养院因需要管饲而住院的年龄≥60 岁、有晚期痴呆的患者。

方法

采用 Kaplan-Meier 生存分析和 Cox 比例风险模型比较 NGF 和 CHF 对生存和肺炎风险的影响。

结果

在 764 名患者（平均年龄 89 岁，61%为女性，74%为居住在养老院的患者）中，464 名（61%）开始接受 NGF，300 名（39%）接受 CHF。主要喂养问题类型为吞咽困难（50%）、行为性喂养问题（33%）或两者兼有（17%）。NGF 组和 CHF 组的 1 年生存率无差异（36%比 37%，P=0.71），且生存情况不因喂养问题类型而异。鼻胃管喂养不是生存的显著预测因素（调整后的危险比 1.15，95%CI 0.94-1.39）。在 577 名（76%）存活至出院的患者中，CHF 组的肺炎发生率较低（48%比 60%，P=0.004）。在调整混杂因素后，NGF 是肺炎的显著危险因素（调整后的危险比 1.41，95%CI 1.08-1.85）。在亚组分析中，NGF 与同时存在吞咽困难和行为性喂养问题的患者的肺炎风险增加相关（P=0.01），但与仅存在行为性喂养问题的患者（P=0.24）或仅存在吞咽困难的患者（P=0.30）无关。