内镜下经皮胃造瘘术对患者营养及生活质量的改善

Improvement in nutritional status and quality of life in patients after percutaneous endoscopic gastrostomy

目的:评价内镜下经皮胃造瘘术(percutaneous endoscopic gastrostomy,PEG)对患者营养及生活质量的改善作用.方法:对73例行PEG患者进行回顾性分析,观察患者PEG置管前、置管后1、3及6mo的营养指标结果,包括白细胞、淋巴细胞计数、血浆血红蛋白、总蛋白、白蛋白及转铁蛋白变化及体质量、体质量指数的改变.记录置管前后患者并发肺炎、反流性食管炎情况.同时采用SF-36生活质量量表调查患者PEG术前后生活质量的变化.结果:73例患者共完成PEG操作107例次,患者术后体质量增加,营养状况明显改善,肠内营养1mo、3mo及6mo后血红蛋白、总蛋白、白蛋白及转铁蛋白及体质量、体质指数均有不同程度的改善,置管前、后组内比较差异有统计学意义(P<0.05).肺部感染的发生率由PEG术前的63.0%(46/73),术后降低至16.7%(11/66);反流性食管炎由PEG术前的27.4%(20/73)降至术后的7.6%(5/66).PEG置管术后1mo、3mo及6mo患者的生理健康和心理健康均较术前有明显改善,生理功能、社会功能明显高于PEG术前.结论:PEG术后患者营养状况明显改善,体质量指数增加,血红蛋白、总蛋白、白蛋白及转铁蛋白明显改善.同时PEG可减少因留置鼻胃管引起的反流性食管炎及肺部感染,患者耐受性好,生活质量提高.

AIM： To evaluate the nutritional status and qual- ity of life in patients after percutaneous endo- scopic gastrostomy （PEG）. METHODS： Seventy-three patients who had un- dergone PEG were followed at 1 mo, 3 mo and 6 mo after feeding tube placement to determine the changes in white blood cell count, lympho- cyte count, plasma hemoglobin, total protein, albumin, transferrin protein, body weight, and body mass index （BMI）. The incidence of com- plications such as pneumonia and reflux esopha- gitis was also recorded. Changes in quality of life before and after PEG were measured with the Short Form 36 Health Survey questionnaire.RESULTS： A total of 107 PEG procedures were performed in 73 patients. Nutritional status and weight loss were significantly improved after PEG. The levels of hemoglobin, total protein, al- bumin, transferrin, and body mass index signifi- cantly improved at 1 mo, 3 mo and 6 mo after enteral nutrition, showing significant differences before and after PEG （all P 〈 0.05）. The incidence of pulmonary infection decreased from 63.0% preoperatively to 16.7% postoperatively, and that of reflux esophagitis decreased from 27.4% to 7.6%. At 1 mo, 3 mo and 6 mo after feeding tube placement, there was a significant improve- ment in patients＇ physical health and mental health, as well as physiological function, social function. CONCLUSION： The nutritional status, levels of hemoglobin, total protein, albumin and trans- ferrin, as well as body mass index significantly improved in patients after PEG. The incidence of complications and quality of life also improved in patients after PEG.