經皮內視鏡胃造廔術：長期管灌飲食患者的另一種選擇

Percutaneous Endoscopic Gastrostomy: An Alternative for Long-Term Tube Feeding Individuals

倪昊白(Hao-Pai Ni) ； 李宗熙(Tzong-Hsi Lee) ； 王亭貴(Tyng-Guey Wang)

《中華民國復健醫學會雜誌》 28卷3期 (2000/09) Pp. 139-144

摘要

吞嚥障礙是復健醫療常需面對的問題，對於無法經由復健訓練而達經口進食的患者，必需長期依賴管灌飲食以維持其營養。本研究的目的在於探討經皮內視鏡胃造廔術，術後之急性合併症及患者長期滿意度，以當作臨床家處理此類患者之參考。本研究採用病歷回溯及電話追蹤的方式，收集的患者為1年間因吞嚥障礙於台灣某醫學中心接受經皮內視鏡胃造廔術的30名患者。在30名患者中，接受經皮內視鏡胃造廔術的理由以腦中風最多，占60%，其次為鼻咽癌之13%。於急性住院期所發生的合併症以傷口感染為主，有4名病患；其他依次為，吸入性肺炎1名，腹膜炎1名，上消化道出血1名等。在造廔管的長期照顧方面，於出院後，有73%病人每天只需換藥一次。患者使用經皮內視鏡胃造廔自覺最不方便的地方依次為常於傷口有分泌物產生（20%）、傷口的疼痛（13.3%）、胃造廔管路滑脫（13.3%）、便秘（10%）、腹瀉（3%）、管路塞住（3%）等。在主觀的感覺方面，有73%患者覺得經皮內視鏡胃造廔比傳統鼻胃管方便，只有一名患者覺得較不方便，而且有20%患者接受經皮內視鏡胃造廔後他們的生活圈有明顯擴大。整體的評估，有60%患者在使用經皮內視鏡胃造廔後覺得滿意或很滿意。我們認為經皮內視鏡胃造廔少有嚴重的短期或長期合併症，病患一般而言接受度不錯，且部分患者因之而擴展其生活圈，故經皮內視鏡胃造廔是長期仰賴灌食飲食患者的另一種選擇。

關鍵字

吞嚥障礙 ； 經皮內視鏡胃造廔術 ； 合併症

並列摘要

Dysphagia is a common problem in rehabilitation service. Tube feeding is mandatory for patients unable to achieve the goal of oral feeding despite comprehensive rehabilitation training. Percutaneous endoscopic gastrostomy (PEG) has been widely used for patients requiring tube feeding in the past 20 years; however, its long-term complications and satisfaction have seldom been mentioned in Taiwan. The purpose of this study was to investigate the acute complications and long-term problems in pat-ients who received PEG. The result might provide the clinicians valuable information in managing the patients requiring long-term tube feeding. This study was a retrospective case note analysis and tele-phone survey of 30 patients receiving PEG within a period of one year in a teaching hospital. The maj-ority of these patients receiving PEG were due to stroke (60%) and nasopharyngeal carcinoma (13%). Of the 30 patients, 4(13.3%) developed wound infection during their hospitalization following PEG, one developed aspiration pneumonia, one developed peritonitis, and one had upper gastrointestinal bleeding. 73% of the patients required changing dressing only once daily after discharge from the hospital. The problems of the PEG described by the patients included discharge around PEG stoma (20%), wound pain (13.3%), tube extrusions (13.3%), constipation (10%), diarrhea (3%), and clogged tubes (3%). Subjectively, 73% of the patients considered that the PEG was more convenient than the nasogastric tube, and 20% of the patients increased their social activities after instituting PEG. Generally speaking, 60% of the patients felt satisfactory or very satisfactory with usage of PEG. We concluded that there were few acute or long-term major complications in PEG placement. The patients with swallowing disorders could tolerate PEG well, and might further increase their social activities after PEG. We believe that PEG is another choice for patients with long-term tube feeding.

並列關鍵字

dysphagia ； percutaneous endoscopic gastrostomy ； complication