经皮内窥镜引导下胃造口术在脑卒中和脑外伤后患者家庭喂养中的应用价值

Percutaneous Endoscopic Gastrostomy for Home Nutrition Support in Patients with Stroke and Post-traumatic Brain

目的评估经皮内窥镜引导下胃造口术(PEG)在脑卒中和脑外伤后患者家庭喂养中的应用价值。方法回顾性分析了16例无法经口进食、在我院实施PEG的脑卒中或脑外伤后患者的临床资料,其中脑梗塞9例,脑出血5例,蛛网膜下腔出血1例,脑外伤1例。结果出院后第30、60和120天,患者的体重、肱三头肌皮褶厚度、上臂肌围、血清白蛋白、血红蛋白和淋巴细胞计数等指标均明显高于出院时(P<0.05或P<0.01)。出院后第30、60和120天的NHISS评分分别为14.0±1.3、14.0±1.1和3.0±1.2,均明显低于出院时的16.0±1.2(P均<0.05)。1例患者发生胃内容物潴留,1例发生反流,1例发生吸入性肺炎,1例发生内垫综合征。结论PEG人工家庭肠内营养对脑卒中或脑外伤后吞咽困难、长期昏迷和营养不良患者有显著治疗作用,可避免患者营养状况进一步恶化,提高患者生活质量。

Objective To evaluate the application value of percutaneous endoscopic gastrostomy （PEG） for home nutrition support in patients with stroke and post-traumatic brain. Methods We retrospectively analyzed the clinical data of the 16 patients with stroke and post-traumatic brain, including cerebral infarction （ n = 9 ） , cerebral hemorrhage （ n = 5 ） , subaraehnoid hemorrhage （ n = 1 ） , and cerebral trauma （ n = 1 ）. All these patients underwent PEG in our hospital because they were not able to be orally fed. Results The weight, triceps skinfold thickness, mid-upper arm muscle circumference, and serum albumin, hemoglobin, and lympholeukocyte cell counts 30, 60, and 120 days after hospital discharge were significantly higher than those at hospital discharge （P 〈 0.05 or P 〈 0.01 ）. The NIHSS scores 30, 60, and 120 days after hospital discharge were 14.0 ± 1.3, 14.0 ± 1.1, and 3.0 ± 1.2, respectively, which were significantly lower than 16.0 ± 1.2 at hospital discharge （all P 〈 0.05）. Complications included gastric contents retention （n = 1 ） , baekstreaming （n = 1 ） , aspirated pneumonia （ n = 1 ） , and intra-eushion syndrome （ n = 1 ）. Conclusions PEG for home nutrition support is useful for the treatment of patients with stroke and post-traumatic brain with dysphagia and malnutrition after long-term coma. It can help to avoid the deterioration of nutritional status and improve the quality of life.