Rabeneck L, McCullough L B, Wray N P
Department of Veterans Affairs, Houston, Texas, USA.
Lancet. 1997 Feb 15;349(9050):496-8. doi: 10.1016/S0140-6736(96)07369-2.
Guidelines for the placement of percutaneous endoscopic gastrostomy (PEG) tubes are not available. We developed a decision-making algorithm by integrating the medical and ethical dimensions of the decision. According to our algorithm, physicians should not offer PEG tubes to patients with anorexia-cachexia syndromes. For patients with permanent vegetative states, physicians should offer and recommend against the procedure. For patients who have dysphagia without other deficits in quality of life, physicians should offer and recommend the procedure. For the the remaining patients who have dysphagia with other deficits in quality of life, the physician's role is to provide non-directive counselling regarding the short and long-term consequences of a trial of PEG tube feeding.
经皮内镜下胃造口术（PEG）置管指南尚不存在。我们通过整合该决策的医学和伦理维度制定了一种决策算法。根据我们的算法，医生不应为患有厌食 - 恶病质综合征的患者提供PEG管。对于处于永久性植物状态的患者，医生应提供并建议不进行该手术。对于有吞咽困难但生活质量无其他缺陷的患者，医生应提供并建议进行该手术。对于其余有吞咽困难且生活质量有其他缺陷的患者，医生的职责是就试行PEG管饲的短期和长期后果提供非指导性咨询。
