腦中風伴長期吞嚥障礙患者使用胃造廔管進食之長期預後

Long-Term Outcome of Gastrostomy Feeding in Dysphagic Stroke Patients

李棟洲(Tung-Chou Li) ； 許美慧(Mei-Hue Hsu) ； 李宗熙(Tzong-Hsi Lee)

《中華民國復健醫學會雜誌》 29卷4期 (2001/12) Pp. 205-212

https://doi.org/10.6315/JRMA.200112.0205

摘要

近年來國內已有少數長期吞嚥困難的腦中風患者願意接受胃造廔術來改善其營養需求。過去多數研究主要在於探討患者手術後急性期的變化，至於患者出院後的長期追蹤報告則較為缺乏。本研究的目的即在探討因長期吞嚥功能障礙接受胃造廔術的腦中風患者之特性及其術後的情形，希望藉此研究做為日後照顧此類患者的參考。本研究採回溯法並利用電話追蹤訪問的方式收集自民國87年1月至89年5月間住院接受胃造廔術的42位腦中風病患，其中32位接受經皮內視鏡胃造廔術，10位接受外科手術胃造廔術，其最近一次腦中風到接受胃造廔術的時間為3-1504天。患者接受胃造廔術的三個主要原因為反覆吸入性肺炎( 29%)、長期吞嚥困難(24%)及癡呆症併營養不良(19%)。在術後到訪問時的75.4人年期間共有21人次(36%)曾因肺炎住院，而其他須住院的相關病症包括胃出血(6人次)、造廔口感染 (5人次)、便秘(2人次)、腹膜炎(1人次)及自拔胃造廔管(5人次)等。在訪問時有4人(9.5%)已拔除胃造廔管而完全經口進食，1人(2.4%)改用鼻胃管，30人(71.4%)持續使用胃造廔管，有7人(16.7%)則已死亡。在完全改為經口進食的4人，他們使用胃造廔管餵食的平均時間為333天且全部患者可獨立外出或室內行走。而持續使用胃造廔管患者中則30%患者可獨立外出或室內行走，70%患者需輪椅代步或長期臥床。我們認為胃造廔術是一個比鼻胃管在餵食及照顧上更方便的方法，且經長期吞嚥訓練及追蹤之患者仍有機會拔除胃造廔管而經囗進食，故胃造廔術可成為腦中風伴長期吞嚥障礙患者進食一個較佳的選擇。

關鍵字

腦中風 ； 吞嚥障礙 ； 胃造廔術

並列摘要

Dysphagia is a common reason for long-term enteral feeding in stroke patients. It has been shown that gastrostomy feeding provides better nutrition for stroke patients than nasogastric tube feeding in short term period. However, little is known about the long-term outcome of gastrostomy-assisted feeding in them. In recent years, some of the dysphagic stroke patients began to accept gastrostomy feeding in Taiwan. We herein conducted this study to find and analyze the characteristics and long-term outcome of dysphagic stroke patients who had underwent gastrostomy. Forty-two stroke patients underwent gastrostomy between Jan. 1998 and May 2000 were enrolled in this study. Retrospective design via medical record review and telephone survey was conducted. Of these patients, thirty-two received endoscopic gastrostomy and ten received surgical gastrostomy. The timing of gastrostomy after the last stroke varied with a mean interval of 283 days: 14% within one month, 17% between 1 and 6 months, 43% between 6 months and one year, and 26% beyond one year after onset of stroke. The common indications for gastrostomy included recurrent aspiration pneumonia (29%), prolonged nasogastric tube feeding (24%) and dementia with malnutrition (19%). Pneumonia complicated in 15 patients (35.7%) and resulted in 21 hospitalizations during 75.4 person-years of follow-up after gastrostomy. Other associated problems included six gastrointestinal bleedings, five local infections, five tube-dislodgements, two constipations and one peritonitis. During follow-up, 4 patients (9.5%) regained swallowing function and had gastrostomy removed, 1 patient (2.4%) resumed nasogastric tube feeding after self-extubation of gastrostomy tube, 30 patients (71.4%) kept on gastrostomy feeding, while 7 patients (16.7%) died. Regarding the four patients who resumed oral intake, the mean interval of gastrostomy feeding was 333 days, and they all ambulated independently. Of those who remained gastrostomy feeding, only 30% ambulated independently while the other 70% were wheel-chair bound or bed-ridden. We concluded that gastrostomy feeding was not shown to reduce the incidence of aspiration pneumonia. However, these did not prevent it from being a better option for caring such patients. First, it would make feeding and caring more convenient than those by nasogastric tube. Second, chance for removing gastrostomy was still there once recovery from dysphagia or success in swallowing training was achieved.

並列關鍵字

stroke ； dysphagia ； gastrostomy