McCarter T L, Condon S C, Aguilar R C, Gibson D J, Chen Y K
Department of Medicine, Loma Linda University Medical Center, CA 92354, USA.
Am J Gastroenterol. 1998 Mar;93(3):419-21. doi: 10.1111/j.1572-0241.1998.00419.x.
By convention, most clinicians delay feeding through the gastrostomy tube until 24 h after placement. However, evidence is lacking to support the rationale for such a delay in PEG use. This randomized, prospective study was designed to assess the safety of early feeding after PEG placement.
One hundred-twelve patients referred for PEG were randomized to begin tube feedings at 4 h (group A) or at 24 h (group B) after placement. All patients received prophylactic antibiotics. Full-strength Isocal was administered with the following schedule: day 1, 100 ml every 4 h for six feedings; day 2, 200 ml every 4 h for six feedings. Immediately before each scheduled feeding, gastric residual volume was recorded and the next feeding was withheld if the residual volume was > 50 percent (gastric retention). Patients were evaluated on day 1, day 2, day 7, and day 30 for major and minor complications.
The two groups were similar with regard to age, gender, baseline nutritional status, and indications for PEG placement. On the first day of feeding, 14 of 57 patients (25%) in group A, but only five of 55 patients (9%) in group B, had evidence of gastric retention, p = 0.029. The proportion of patients with high gastric residual volumes was not significantly different on day two. In group B, one death occurred because of aspiration of gastric contents on day 2. All other complications were minor and did not differ significantly between the two groups.
Early initiation of PEG feedings is safe, well tolerated, and reduces cost by decreasing hospital stay.
按照惯例，大多数临床医生会将经皮内镜下胃造口术（PEG）置管后通过胃造口管喂食的时间推迟至24小时后。然而，缺乏证据支持PEG使用中这种延迟的理论依据。本随机、前瞻性研究旨在评估PEG置管后早期喂食的安全性。
112例接受PEG治疗的患者被随机分为两组，A组在置管后4小时开始管饲，B组在置管后24小时开始管饲。所有患者均接受预防性抗生素治疗。全强度的益力佳按照以下方案给药：第1天，每4小时100毫升，共喂食6次；第2天，每4小时200毫升，共喂食6次。在每次预定喂食前，记录胃残余量，如果残余量>50%（胃潴留），则暂停下一次喂食。在第1天、第2天、第7天和第30天对患者进行主要和次要并发症评估。
两组在年龄、性别、基线营养状况和PEG置管指征方面相似。在喂食的第一天，A组57例患者中有14例（25%）有胃潴留证据，而B组55例患者中只有5例（9%）有胃潴留证据，p = 0.029。第二天，胃残余量高的患者比例在两组之间无显著差异。在B组，第2天有1例患者因胃内容物误吸死亡。所有其他并发症均为轻微并发症，两组之间无显著差异。
PEG喂食的早期开始是安全的，耐受性良好，并且通过缩短住院时间降低了成本。
