Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia
Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia
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DOI：
10.1111/j.1572-0241.2000.02079.x
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发表时间：
2000-06-01
影响因子：
9.8
通讯作者：
Bardhan, KD
中科院分区：
文献类型：
--
作者：
Sanders, DS;Carter, MJ;Bardhan, KD
目的：经皮内镜胃造口术（PEG）喂养已在特定的临床情况下得到验证，如急性卒中伴吞咽困难和口咽恶性肿瘤。胃造口插入安全且技术简单的观点导致对PEG插入的需求增加，包括临床应用，例如痴呆患者。它在其中的作用没有得到证明。本研究的目的是比较的死亡率与痴呆患者谁是由PEG喂养的其他亚组的患者需要胃造口术feeding.METHODS：该研究集中在一个队列的361例连续患者需要PEG喂养1992年8月至1997年7月从两个地区综合医院（罗瑟勒姆区综合医院和唐卡斯特皇家医院）在南约克郡。采用Kaplan-Meier生存方法和考克斯比例风险分析进行回顾性队列生存分析。结果：在所有需要胃造口术喂养的患者中，30天的初始死亡率为28%。然而，与其他亚组相比，痴呆患者的预后更差，54%的患者在1个月内死亡，90%的患者在1年内死亡（对数秩检验p < 0.0001）。在调整了PEG插入时的年龄后，这种差异仍然显着（对数秩p < 0.0001）。结论：这是英国首次证明，通过胃造口术喂养的痴呆患者的死亡率相当高。因此，我们可能希望建议在这种临床环境中对选定的患者进行胃造口术喂养。(Am胃肠病学杂志2000;95：1472-1475. (C)2000年，我胃肠病学）。
OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) feeding has been validated in specific clinical situations such as acute stroke with dysphagia and oropharyngeal malignancy. The perception that gastrostomy insertion is safe and technically simple has led to an increase in the demands for PEG insertion, encompassing clinical applications such as in patients with dementia. in whom its role has not been justified. The purpose of this study was to compare the mortality of patients with dementia who were fed by PEG to that of other subgroups of patients requiring gastrostomy feeding.METHODS: The study focused on a cohort of 361 consecutive patients requiring PEG feeding between August 1992 and July 1997 from two District General Hospitals (Rotherham District General Hospital and Doncaster Royal Infirmary) in South Yorkshire. A retrospective cohort survival analysis was performed using the Kaplan-Meier survival method and Cox proportional hazards analysis.RESULTS: In all patients requiring gastrostomy feeding there is a high initial mortality of 28% at 30 days. However, patients with dementia have a worse prognosis compared to other subgroups, with 54% having died at 1 month and 90% at 1 yr (log rank test p < 0.0001). This difference remained significant (log rank p < 0.0001) after adjusting for age at the time of PEG insertion.CONCLUSIONS: This is the first demonstration in the United Kingdom that the mortality of patients with dementia who are fed by gastrostomy is considerable. Consequently, we may wish to advise against gastrostomy feeding in selected patients within this clinical setting. (Am J Gastroenterol 2000;95:1472-1475. (C) 2000 by Am. Coll. of Gastroenterology).