Norton B, Homer-Ward M, Donnelly M T, Long R G, Holmes G K
Derbyshire Royal Infirmary, Derby.
BMJ. 1996 Jan 6;312(7022):13-6. doi: 10.1136/bmj.312.7022.13.
To compare percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke.
Randomised prospective study of inpatients with acute stroke requiring enteral nutrition.
One university hospital (Nottingham) and one district general hospital (Derby).
30 patients with persisting dysphagia at 14 days after acute stroke: 16 patients were randomised to gastrostomy tube feeding and 14 to nasogastric tube feeding.
Six week mortality; amount of feed administered; change in nutritional state; treatment failure; and length of hospital stay.
Mortality at 6 weeks was significantly lower in the gastrostomy group with two deaths (12%) compared with eight deaths (57%) in the nasogastric group (P < 0.05). All gastrostomy fed patients (16) received the total prescribed feed whereas 10/14 (71%) of nasogastric patients lost at least one day's feed. Nasogastric patients received a significantly (P < 0.001) smaller proportion of their prescribed feed (78%; 95% confidence interval 63% to 94%) compared with the gastrostomy group (100%). Patients fed via a gastrostomy tube showed greater improvement in nutritional state, according to several different criteria at six weeks compared with the nasogastric group. In the gastrostomy group the mean albumin concentration increased from 27.1 g/l (24.5 g/l to 29.7 g/l) to 30.1 g/l (28.3 g/l to 31.9 g/l). In contrast, among the nasogastric group there was a reduction from 31.4 g/l (28.6 g/l to 34.2 g/l) to 22.3 g/l (20.7 g/l to 23.9 g/l) (P < 0.003). In addition, there were fewer treatment failures in the gastrostomy group (0/16 versus 3/14). Six patients from the gastrostomy group were discharged from hospital within six weeks of the procedure compared with none from the nasogastric group (P < 0.05).
This study indicates that early gastrostomy tube feeding is greatly superior to nasogastric tube feeding and should be the nutritional treatment of choice for patients with acute dysphagic stroke.
比较急性吞咽困难性卒中后经皮内镜下胃造口术和鼻胃管喂养的效果。
对需要肠内营养的急性卒中住院患者进行随机前瞻性研究。
一家大学医院（诺丁汉）和一家地区综合医院（德比）。
30例急性卒中后14天仍存在吞咽困难的患者：16例患者被随机分配接受胃造口管喂养，14例接受鼻胃管喂养。
六周死亡率；喂养量；营养状态变化；治疗失败情况；以及住院时间。
胃造口术组六周时的死亡率显著低于鼻胃管组，胃造口术组有2例死亡（12%），而鼻胃管组有8例死亡（57%）（P<0.05）。所有接受胃造口术喂养的患者（16例）均接受了全部规定的喂养量，而14例鼻胃管喂养患者中有10例（71%）至少有一天未接受喂养。与胃造口术组（100%）相比，鼻胃管喂养患者接受的规定喂养量比例显著更低（P<0.001）（78%；95%置信区间63%至94%）。根据几种不同标准，六周时经胃造口管喂养的患者营养状态改善程度大于鼻胃管喂养组。胃造口术组白蛋白平均浓度从27.1g/L（24.5g/L至29.7g/L）升至30.1g/L（28.3g/L至31.9g/L）。相比之下，鼻胃管组白蛋白平均浓度从31.4g/L（28.6g/L至34.2g/L）降至22.3g/L（20.7g/L至23.9g/L）（P<0.003）。此外，胃造口术组治疗失败情况更少（0/16对比3/14）。胃造口术组有6例患者在手术后六周内出院，而鼻胃管组无患者出院（P<0.05）。
本研究表明，早期胃造口管喂养远优于鼻胃管喂养，应作为急性吞咽困难性卒中患者营养治疗的首选方法。
