经皮内镜下胃造口患者家庭肠内营养的护理

Application of Percutaneous Endoscopic Gastrostomy in Long-term Enteral Nutrition Support of Disphagic Patients and Their Nursing

目的探讨经皮内镜下胃造口术(percutaneous endoscopic gastrostomy,PEG)在吞咽障碍患者家庭肠内营养中的临床应用价值及护理要点。方法前瞻性观察28例采用鼻饲营养的吞咽障碍患者实施PEG术后行家庭肠内营养支持的一般情况、并发症情况及营养状态的变化。结果28例患者均无PEG相关的严重并发症发生,2例患者出现轻微造口周围炎症,1例肉芽组织形成,1例导管脱出;所有患者和家属对PEG的评价为舒适、安全、方便;术后肺部感染发生率显著下降(由60.7%降至3.6%);术后营养状况迅速改善,术后3个月体重[由(45.75±8.09)kg升至(50.3±7.78)kg]、血浆白蛋白[由(35.19±2.70)g/L升至(39.83±3.04)g/L]、血红蛋白[由(89.48±15.49)g/L至(113.21±9.54)g/L]水平均有显著增长,P<0.01。结论PEG是舒适、安全的肠内营养途径,能显著降低肺部并发症,改善营养状况,适用于需要长期家庭肠内营养的吞咽障碍患者。

Objective To evaluate the application of percutaneous endoscopic gastrostomy （PEG） in long-term enteral nutrition support for disphagic patients and their nursing. Methods PEG was performed in 28 patients with disphagia who used naso-gastric tube before. Their general state of health,complications and nutritional states were observed prospectively. Results No major PEG-related complication was found in the 28 cases. There were 2 cases of slight inflammation around the incision, one case of hyperplasia,and one case of catheter withdrawing. All patients and their care-givers were satisfied with PEG. Aspirated pneumonia was decreased dramatically after operation（ from 60.7% to 3.65）. Three month later, the body weight and serum concentrations of albumin and hemoglobin increased significantly [- （51. 1 ±5.56 ） kg vs （45. 9 ± 5. 09 ） kg, （39. 21 ± 2.44）g/L vs （35.19±2.70）g/L, （113.21±9.54）g/L vs （89.48±15.49）g/L,respectively, P 0. 01）-]. Conclusion PEG is a comfortable, safe and convenient nutritional support; it can obviously decrease aspirated pneumonia and improve nutritional status, making it suitable for patients who need long-term home enteral nutrition support.