PEG与NGT肠内喂养在颅脑损伤后昏迷伴吞咽困难患者中的应用

Clinical Study on Percutaneous Endoscopic Gastrostomy( PEG) and Nasogastric Tube( NGT) Enteral Feeding for the Patients of Brain Injury with Coma and Dysphagia

目的 探讨经皮胃镜下胃造瘘术（PEG）与经鼻胃管（NGT）肠内喂养在颅脑损伤后昏迷伴吞咽困难患者中的效果和安全性.方法 选择笔者医院神经外科2004年1月～ 2013年6月230例颅脑损伤后昏迷患者,其中148例行PEG,为观察组,82例行NGT,为对照组,观察术前和术后7天和30天患者的营养状况及并发症.结果 两组入院时两组肱三头肌皮褶厚度,血清白蛋白、血清总蛋白、血红蛋白等各项结果比较,差异无统计学意义（P＞0.05）;第7天时,各项指标均低于入院时,差异具有统计学意义（P＜0.05）;观察组第30天两组肱三头肌皮褶厚度,血清白蛋白、血清总蛋白、血红蛋白结果分别为9.76 ±0.74mm、35.82±1.96g/L、64.01±1.77g/L和123.25±9.06g/L,均高于对照组第30天各项指标,且高于观察组第7天的指标值,差异均具有统计学意义（P＜0.05）;观察组并发肺炎、反流性食管炎、消化道出血6.76％ （10/148）、12.84％ （19/148）和8.11％（12/148）,低于对照组28.05％ （23/82）、43.90％（36/82）和30.49％（25/82）,差异具有统计学意义（P＜0.05）.结论 PEG肠内喂养可明显改善患者营养状况,效果较管饲好且并发症少,是安全、可行、较好的肠内营养选择方法.

Objective To study on percutaneous endoscopic gastrostomy （PEG） and nasogastric tube（NGT） enteral feeding for the patients of brain injury with coma and dysphagia and evaluate its effect and safety.Methods A total of 230 patients of brain injury with coma and dysphagia were selected in hospital from January 2004 to June 2013 as observation group,which 148 cases were performed by PEG as the observation group,and 82 patients underwent NGT as control group.The nutritional status and complications of patients were observed before operation and after 7 days and 30 days.Results There were no significant difference brachial triceps skinfold thickness,serum albumin,serum total protein,hemoglobin between two group,（P ＞ 0.05）.The indicators of two group after 7 days were lower than those of before the operation,and the difference was significant （P ＜ 0.05）.The triceps skin skinfold thickness,serum albumin,serum total protein,hemoglobin results of observation group after 30 days were 9.76 ± 0.74mm,35.82 ± 1.96g/L,64.01 ± 1.77g/L and 123.25 ± 9.06g/L,which were higher than the control group after 30 days and higher than those of the observation group of 7 days,and the differences were significant statistically（P ＜ 0.05）.The patients complicated with pneumonia,reflux esophagitis,gastrointestinal bleeding of observation group were of 6.76％ （10/148）,12.84％ （19/148） and 8.11％ （12/148）,lower than those of the control group 28.05％ （23/82）,43.90％ （36/82） and 30.49％ （25/82）,and the difference was significant （P ＜0.05）.Conclusion PEG enteral feeding could improve the patients nutritional status significantly,and its effect was better than the NGT method with fewer complications.So it was a safe,feasible,good enteral nutrition method.