Expectations and outcomes of gastric feeding tubes
Expectations and outcomes of gastric feeding tubes
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DOI：
10.1016/j.amjmed.2005.11.021
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发表时间：
2006-06-01
影响因子：
5.9
通讯作者：
Jackman, Anne
中科院分区：
文献类型：
--
作者：
Carey, Timothy S.;Hanson, Laura;Jackman, Anne
目的：比较成人患者管饲的预期结果与实际结果。对象和方法：这项前瞻性队列研究在北卡罗来纳州的两家医院进行。在插入饲管后不久以及3个月和6个月随访时对代孕母亲进行访谈；并进行了图表提取和死亡证明复核。参与者是连续接受新饲管的成年患者的代理决策者。结果：共纳入288例代决策者。平均年龄65岁；30%的人最初诊断为中风，16%为神经退行性疾病，20%为头颈癌，30%为其他诊断。3个月时，21%的患者死亡，6个月死亡率为30%。3个月时，38%的幸存者住在养老院，27%的人拔掉了喂食管。患者在大多数日常生活活动（ADLs）中受损，随时间变化不大。医学并发症很常见：25%的患者在3个月时出现褥疮溃疡，24%的患者至少有一次肺炎发作。在基线时，感知到的全球生活质量很差，为4.6（0-10分），代理人预计这将在管饲后改善到8.0。家庭代孕母亲对饲管改善的期望在基线时非常高，在3个月和6个月时仍然如此。结论：家庭对管饲获益的高期望与临床结果相反。提供者和家庭需要更好地了解这种常见手术的结果。(c) 2006爱思唯尔公司版权所有。
PURPOSE: To compare expected outcomes with actual outcomes from tube feeding in adult patients.SUBJECTS AND METHODS: This prospective cohort study was conducted in two North Carolina hospitals. Surrogates were interviewed shortly after feeding tube insertion and at 3- and 6-month follow-up; chart abstraction and death certificate review also were carried out. Participants were surrogate decision-makers for consecutive adult patients who received new feeding tubes.RESULTS: There were 288 patients with surrogate decision-makers enrolled. Mean age was 65 years; 30% had a primary diagnosis of stroke, 16% neurodegenerative disorder, 20% head and neck cancer, and 30% other diagnoses. At 3 months, 21% of patients had died, and 6-month mortality was 30%. At 3 months, 38% of survivors were residing in a nursing home, and 27% had the feeding tube removed. Patients were impaired in most activities of daily living (ADLs) with little change over time. Medical complications were common: 25% of patients had decubitus ulcers at 3 months, and 24% had at least one episode of pneumonia. Perceived global quality of life was poor at 4.6 (on a 0-10 scale) at baseline, and surrogates anticipated this would improve to 8.0 with tube feeding. Family surrogates' expectations for improvement from the feeding tube were very high at baseline and remained so at 3 and 6 months.CONCLUSIONS: Families' high expectations of benefit from tube feeding are in contrast to clinical outcomes. Providers and families need better information about the outcomes of this common procedure. (c) 2006 Elsevier Inc. All rights reserved.