BACKGROUND Percutaneous Endoscopic Gastrostomy(PEG)tubes are often placed for dysphagia following a stroke in order to maintain sufficient caloric intake.The 2011 ASGE guidelines recommend delaying PEG tube placement ...BACKGROUND Percutaneous Endoscopic Gastrostomy(PEG)tubes are often placed for dysphagia following a stroke in order to maintain sufficient caloric intake.The 2011 ASGE guidelines recommend delaying PEG tube placement for two weeks,as half of patients with dysphagia improve within 2 wk.There are few studies comparing outcomes based on timing of PEG tube placement,and there is increasing demand for early PEG tube placement to meet requirements for timely discharge to rehab and skilled nursing facilities.AIM To assess the safety of early(≤7 d post stroke)vs late(>7 d post stroke)PEG tube placement and evaluate whether pre-procedural risk factors could predict mortality or complications.METHODS We performed a retrospective study of patients undergoing PEG tube placement for dysphagia following a stroke at two hospitals in Saint Louis,MO between January 2011 and December 2017.Patients were identified by keyword search of endoscopy reports.Mortality,peri-procedural complication rates,and post-procedural complication rates were compared in both groups.Predictors of morbidity and mortality such as protein-calorie malnutrition,presence of an independent cardiovascular risk equivalent,and presence of Systemic inflammatory response syndrome(SIRS)criteria or documented infection were evaluated by multivariate logistic regression.RESULTS 154 patients had a PEG tube placed for dysphagia following a stroke,92 in the late group and 62 in the early group.There were 32 observed deaths,with 8 occurring within 30 d of the procedure.There was an increase in peri-procedural and post-procedural complications with delayed PEG placement which was not statistically significant.Hospital length of stay was significantly less in patients with early PEG tube placement(12.9 vs 22.34 d,P<0.001).Protein calorie malnutrition,presence of SIRS criteria and/or documented infection prior to procedure or having a cardiovascular disease risk equivalent did not significantly predict mortality or complications.CONCLUSION Early PEG tube placement following a stroke did not result in a higher rate of mortality or complications and significantly decreased hospital length of stay.Given similar safety outcomes in both groups,early PEG tube placement should be considered in the appropriate patient to potentially reduce length of hospital stay and incurred costs.展开更多
目的探讨经皮肝穿刺抽吸硬化介入治疗肝包虫病的临床效果及其对患者生活质量的影响。方法选取2016年5月至2018年3月青海红十字医院收治的100例Ⅰ、Ⅱ期肝包虫病患者为研究对象,将其随机抽样分为研究组和对照组,每组各50例。对照组患者...目的探讨经皮肝穿刺抽吸硬化介入治疗肝包虫病的临床效果及其对患者生活质量的影响。方法选取2016年5月至2018年3月青海红十字医院收治的100例Ⅰ、Ⅱ期肝包虫病患者为研究对象,将其随机抽样分为研究组和对照组,每组各50例。对照组患者采用常规内囊切除术治疗,研究组患者在超声引导下采用经皮肝穿刺抽吸硬化介入治疗。比较两组患者的疗效、生活质量评分(quality of life score,QoL)和不良反应发生率。结果研究组患者临床治疗有效率和QoL各项评分均显著高于对照组(均P<0.05),不良反应发生率显著低于对照组(P<0.05)。结论经皮肝穿刺抽吸硬化能够提高肝包虫病的治疗效果和患者的生活质量,且安全性较高,可进一步推广。展开更多
文摘BACKGROUND Percutaneous Endoscopic Gastrostomy(PEG)tubes are often placed for dysphagia following a stroke in order to maintain sufficient caloric intake.The 2011 ASGE guidelines recommend delaying PEG tube placement for two weeks,as half of patients with dysphagia improve within 2 wk.There are few studies comparing outcomes based on timing of PEG tube placement,and there is increasing demand for early PEG tube placement to meet requirements for timely discharge to rehab and skilled nursing facilities.AIM To assess the safety of early(≤7 d post stroke)vs late(>7 d post stroke)PEG tube placement and evaluate whether pre-procedural risk factors could predict mortality or complications.METHODS We performed a retrospective study of patients undergoing PEG tube placement for dysphagia following a stroke at two hospitals in Saint Louis,MO between January 2011 and December 2017.Patients were identified by keyword search of endoscopy reports.Mortality,peri-procedural complication rates,and post-procedural complication rates were compared in both groups.Predictors of morbidity and mortality such as protein-calorie malnutrition,presence of an independent cardiovascular risk equivalent,and presence of Systemic inflammatory response syndrome(SIRS)criteria or documented infection were evaluated by multivariate logistic regression.RESULTS 154 patients had a PEG tube placed for dysphagia following a stroke,92 in the late group and 62 in the early group.There were 32 observed deaths,with 8 occurring within 30 d of the procedure.There was an increase in peri-procedural and post-procedural complications with delayed PEG placement which was not statistically significant.Hospital length of stay was significantly less in patients with early PEG tube placement(12.9 vs 22.34 d,P<0.001).Protein calorie malnutrition,presence of SIRS criteria and/or documented infection prior to procedure or having a cardiovascular disease risk equivalent did not significantly predict mortality or complications.CONCLUSION Early PEG tube placement following a stroke did not result in a higher rate of mortality or complications and significantly decreased hospital length of stay.Given similar safety outcomes in both groups,early PEG tube placement should be considered in the appropriate patient to potentially reduce length of hospital stay and incurred costs.
文摘目的探讨经皮肝穿刺抽吸硬化介入治疗肝包虫病的临床效果及其对患者生活质量的影响。方法选取2016年5月至2018年3月青海红十字医院收治的100例Ⅰ、Ⅱ期肝包虫病患者为研究对象,将其随机抽样分为研究组和对照组,每组各50例。对照组患者采用常规内囊切除术治疗,研究组患者在超声引导下采用经皮肝穿刺抽吸硬化介入治疗。比较两组患者的疗效、生活质量评分(quality of life score,QoL)和不良反应发生率。结果研究组患者临床治疗有效率和QoL各项评分均显著高于对照组(均P<0.05),不良反应发生率显著低于对照组(P<0.05)。结论经皮肝穿刺抽吸硬化能够提高肝包虫病的治疗效果和患者的生活质量,且安全性较高,可进一步推广。
