Parker T, Neale G, Elia M
Department of Dietetics, Addenbrooke's Hospital, Cambridge, UK.
Eur J Clin Nutr. 1996 Jan;50(1):47-53.
To establish the profile of patients receiving home enteral tube feeding (HETF) in East Anglia, to assess the adequacy of care, and to consider the causes and implications of differences in the geographic prevalence of HETF.
A 1-year prospective study.
Eight independently funded districts within East Anglia.
Basic clinical data were available from 234 patients, 191 of which were tube-fed in the same district as that which initiated treatment, with detailed data obtained from 126.
Prevalence, complications in relation to the dietetic support available, and standards of care in relation to those set in the reports of the King's Fund and the British Association of Parenteral and Enteral Nutrition.
The patients, who were usually elderly subjects or children, had severe disabilities: 40% were unable to walk: 39% were unable to speak; and 20% were housebound. In all cases enteral tube feeding had been initiated in hospital but in this survey we found inadequate training for home care in 23%, inadequate support and follow-up in 20%, inadequate equipment in 41%, uncertainties regarding organisation, and various clinical problems such as feed regurgitation, in 22%, aspiration pneumonia in 13% , which occasionally led to hospitalization (4%), and frequent but usually minor peristomal problems in patients with gastrostomies. There was a direct correlation between the prevalence of HETF (which varied fourfold between districts) and the number of NHS dieticians per head of population; and in inverse correlation with respect to requests by patients for more support (r = 0.97), complaints of blocked tubes (r = 0.82) and the need for hospital help.
HETF provides an important form of support to a small group of severely disabled patients. There are important differences between districts in the prevalence of HETF which may be related to variation in local expertise and available support staff. The standards of care did not always conform to those set in the King's Fund report and BAPEN report on Enteral and Parenteral Nutrition in the community.
确定东安格利亚地区接受家庭肠内管饲（HETF）的患者概况，评估护理的充分性，并探讨HETF地理患病率差异的原因及影响。
为期1年的前瞻性研究。
东安格利亚地区8个独立资助的区。
可获取234例患者的基本临床数据，其中191例在开始治疗的同一区接受管饲，从126例患者获取了详细数据。
患病率、与现有营养支持相关的并发症以及与国王基金和英国肠外与肠内营养协会报告中设定的护理标准。
患者通常为老年或儿童，有严重残疾：40%无法行走；39%无法说话；20%居家不出。所有病例的肠内管饲均在医院开始，但在本次调查中，我们发现23%的家庭护理培训不足，20%的支持和随访不足，41%的设备不足，22%存在组织方面的不确定性以及诸如饲管反流等各种临床问题，13%发生误吸性肺炎，偶尔导致住院（4%），胃造口术患者有频繁但通常较轻微的造口周围问题。HETF的患病率（各区之间相差四倍）与每人口中NHS营养师数量呈直接相关；与患者要求更多支持（r = 0.97）、饲管堵塞投诉（r = 0.82）以及对医院帮助的需求呈负相关。
HETF为一小部分严重残疾患者提供了重要的支持形式。各区之间HETF的患病率存在重要差异，这可能与当地专业知识和可用支持人员的差异有关。护理标准并非总是符合国王基金报告以及BAPEN关于社区肠内与肠外营养的报告中设定的标准。
