Choudhry U, Barde C J, Markert R, Gopalswamy N
Wright State University School of Medicine, Dayton, Ohio, USA.
Gastrointest Endosc. 1996 Aug;44(2):164-7. doi: 10.1016/s0016-5107(96)70134-7.
It has been customary to initiate feeding through percutaneous endoscopic gastrostomy (PEG) tubes 24 hours or more after placement of these tubes. Recent changes in practice environment and emphasis on early discharge of hospitalized patients prompted us to evaluate early PEG feeding in a randomized prospective manner.
Forty-one patients were included in the study. After an informed consent, the patients were randomly assigned to two groups. Groups I (21 patients) received tube feedings 3 hours and Group II (20 patients) received feedings 24 hours after PEG placement. All patients received an Iso-osmolar formula by continuous infusion at 30 ml/hour for the first 24 hours of feeding. The rates were then increased to 70 ml/hour. Residual volumes, tube length, peristomal leakage, and vital signs were checked, and a global assessment was done every 4 hours. Evaluation by a physician was done every 24 hours for 72 hours. If the residual volume was more than 60 ml (significant residual volume), the tube feedings were held for 2 hours. Patients exited the study at 72 hours from the time of procedure. All deaths were recorded to calculate 30-day mortality.
One patient (Group 2) died during the study period. Three patients (two in Group 1 and one in Group 2) had a significant residual volume. One patient (Group 1) had local skin infection requiring treatment. None of the patients had any signs of peritonitis or systemic infection.
Early PEG tube feeding (3 hours after tube placement) is as safe as next day feeding in elderly patients.
经皮内镜下胃造口术（PEG）置管后24小时或更长时间开始经该管喂养已成为惯例。实践环境的近期变化以及对住院患者早期出院的重视促使我们以随机前瞻性方式评估早期PEG喂养。
41例患者纳入本研究。在获得知情同意后，将患者随机分为两组。第一组（21例患者）在PEG置管后3小时开始管饲，第二组（20例患者）在PEG置管后24小时开始管饲。所有患者在喂养的前24小时以30毫升/小时的速度持续输注等渗配方奶。然后速度增至70毫升/小时。每4小时检查残余量、导管长度、造口周围渗漏情况及生命体征，并进行全面评估。在72小时内每24小时由医生进行一次评估。如果残余量超过60毫升（显著残余量），则停止管饲2小时。患者在手术72小时后退出研究。记录所有死亡情况以计算30天死亡率。
1例患者（第2组）在研究期间死亡。3例患者（第1组2例，第2组1例）有显著残余量。1例患者（第1组）发生局部皮肤感染需要治疗。所有患者均无腹膜炎或全身感染迹象。
在老年患者中，早期PEG管饲（置管后3小时）与次日喂养一样安全。
