鼻空肠置管和经皮内镜下胃造瘘术在老年患者肠内营养支持中的应用

Comparison of nasojejunal tube insertion and percutaneous endoscopic gastrostomy for enteral nutrition in elderly patients

目的评价经鼻空肠置管和经皮内镜下胃造瘘（PEG）术后长期肠内营养支持在改善老年患者营养状况中的应用。方法回顾性分析2010年1月至2014年11月在我院老年科住院的老年吞咽障碍患者65例，数字抽签分为鼻空肠组35例和PEG组30例，比较两组患者的营养指标、免疫学指标、并发症和病死率的差异。结果所有患者置管后上臂围、血清总蛋白、血清白蛋白、血清前白蛋白水平较置管前升高（均P〉0．05）；两组鼻空肠组、PEG组患者置管后营养风险筛查2002（NRS2002）评分均较置管前改善，分别为（3．72±0．91）分比（1．90±0．61）分（t=7．24，P〈0．01）、（3．52±1．23）分比（2．02±0．53）分（t=4．17，P〈0．01）；术后3个月NRS2002评分两组分别为（1．89±0．65）分、（1．91±0．62）分较术后1个月进一步改善（t值分别为5．21、4．40，均P〈0．01）；鼻空肠组和PEG组间比较，差异无统计学意义（均P〉0．05）；鼻空肠组和PEG组置管后CD3＋，CD4＋，CD8＋，CD4＋／CD8＋及IgA，IgG，IgM指标较置管前改善，但差异无统计学意义（均P〉0．05）；PEG组置管后1个月和3个月的感染发生率均较鼻空肠组高（P〈0．05）；鼻空肠组置管后1个月和3个月的腹泻发生率均较PEG组高（P〈0．05）；两组死亡原因及病死率相似。结论鼻空肠组和PEG组均能改善老年患者的营养状况，对于营养途径的选择需个体化。

Objective To evaluate the clinical application of enteral nutrition by nasojejunal tube insertion and by percutaneous endoscopic gastrostomy （PEG） in elderly patients. Methods A total of 65 elderly patients with dysphagia recruited at our department from January 2010 to November 2014 were divided into the nasojejunal tube feeding group （35 cases） and the PEG feeding group （30 cases）. Differences between these two groups in nutritional indexes, immunological indexes, complications and mortality were analyzed retrospectively. Results Serum total protein, albumin and prealbumin and upper arm circumferences all increased after treatment with nasojejunal tube feeding or percutaneous endoscopic gastrostomy （P〉0.05）. There was overall improvement in nutritional status, as assessed by Nutritional Risk Screening 2002 （NRS2002） ratio of scores was 3. 72±0.91/1.90±0.61 （t Specifically, the before/one month-after-treatment 7.24, P〈0.01） for the nasojejunal tube feeding group and 3.52±1.23/2.02±0.53 （t=4.17, P〈0.01） for the PEG feeding group. Compared with NRS2002 scores at one month post-operation, further improvement was achieved at 3 months post- operation both for the nasojejunal tube feeding group （1.89±0.65, t=5.21, P〈0.01） and for the PEG feeding group （1.91±0.62, t= 4.40, P〈0.01）. There was no difference in the indexes of nutrition, immune status or mortality between the two groups （P〉0.05）. Although improvement in CD3＋ , CD4＋ , CD8＋ , CD4＋/CD8＋ , IgA, IgG, and IgM was seen in both groups after operation, the differences did not reach statistical significance （P〉0.05）. The incidence of aspiration pneumonia was notably lower （P〈0.05） while the incidence of diarrhea was much higher （P〈0.05） in thenasojejunal tube feeding group than in the PEG feeding group at one month and three months. The two groups had similar causes of death and mortality rates. Conclusion Both nasojejunal tube and PEG feeding can improve the nutritional status of elderly patients with dysphagia. However, the choice for the route of nutrition should be individualized.