Effect of percutaneous endoscopic gastrostomy on gastroesophageal reflux in mechanically-ventilated patients

AIM： To investigate the effect of percutaneous endoscopic gastrostomy （PEG） on gastroesophageal reflux （GER） in mechanically-ventilated patients. METHODS ： In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilatorassociated pneumonia （VAP） and GER 〉 6% were divided into PEG group （n=16） or non-PEG group （n = 20）. Another 11 ventilated patients without reflux （GER 〈 3%） served as control group. Esophageal pH-metry was performed by the ＂pull through＂ method at baseline, 2 and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue. RESULTS： A significant decrease of median （range） reflux was observed in PEG group from 7.8 （6.2-15.6） at baseline to 2.7 （0-10.4） on d 7 post-gastrostomy （P 〈 0.01）, while the reflux increased from 9 （6.2-22） to 10.8 （6.3-36.6） （P〈 0.01） in non-PEG group. A significant correlation between GER （%） and the stay of nasogastric tube was detected （r= 0.56, P〈 0.01）. CONCLUSION： Gastrostomy when combined with semi- recumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

急性冠脉综合征治疗的区域化：需要更多的证据

目前已有越来越多的人提倡急性冠脉综合征（acute coronary syndromes，ACS）的治疗应该在具有专门设施的区域性治疗中心进行。支持者声称，区域化ACS治疗可以提供更多的新技术，更好的专科医生，更高质量的医疗服务，因此会挽救更多的生命，这些都是其他中心所没有的。马里兰州已经开始计划实施ACS患者的区域化治疗。最近，区域化治疗的讨论热点集中于其潜在获益上。