内镜下经皮胃造瘘对老年患者生活质量的影响

目的:评价内镜下经皮胃造瘘(PEG)在老年患者的应用、安全性及对生活质量的影响.方法:对32例PEG老年患者进行回顾性分析,采用同组对照的方法比较PEG与鼻胃管饲对患者的影响.结果:32例老年患者均在局麻下成功进行了PEG,仅1例发生造瘘口周围皮肤感染,抗生素治疗后短期内恢复.PEG较鼻胃管饲患者更易于接受,导管不易堵塞,能降低吸入性肺炎及反流性食管炎(15.6% vs 46.8%,P＜0.05)的发生率,提高生活质量.结论:PEG是一种安全有效的治疗方法,较鼻胃管饲能明显降低吸入性肺炎、反流性食管炎的发生率.     

肌萎缩侧索硬化患者体内氧化压力的定量分析

目的检测肌萎缩侧索硬化(ALS)患者尿液中8-异前列腺素F_(2a)(8-iso-PGF_(2a))浓度和LDL体外氧化延迟时间的变化,评价ALS患者体内的氧化压力及抗氧化能力情况。方法根据EL Escorial诊断标准选择ALS患者19例为ALS组,同时选择年龄、影响因素相匹配的健康成年男性19例为对照组。通过铜氧化共轭双烯法检测LDL体外氧化延迟时间,酶联免疫吸附法检测尿液中8-iso-PGF_(2a)浓度。结果与对照组比较,ALS组尿液中8-iso-PGF_(2a)浓度虽有升高趋势[(48.28±4.78)ng/mmol肌酐vs(47.25±2.32)ng/mmol肌酐],但差异无统计学意义(P>0.05),而LDL体外氧化延迟时间明显缩短[(59.32±8.65)min vs(83.16±8.37)min],差异有统计学意义(P<0.01)。结论增高的氧化压力与降低的抗氧化能力在ALS的发病机制中具有一定作用。提示有效的抗氧化治疗可能对控制ALS的发展及改善预后有一定的临床意义。     

老年冠状动脉3支病变PCI血运重建策略对预后的影响

目的:探究老年冠状动脉(冠脉)3支病变患者接受完全血运重建与不完全血运重建的远期预后差异。方法:入选我院2008-01-01-2013-06-30就诊、就诊年龄≥70岁,冠脉造影发现未处理3支病变,并在我院接受PCI治疗患者,记录基线数据,并根据血运重建方式分为完全血运重建(complete revascularization,CR)组68例与非完全血运重建(incomplete revascularization,IR)组251例,随访时详细记录患者主要心脑血管不良事件(MACCE)发生情况,采用单因素、多因素分析探究血运重建程度对患者远期预后影响。结果:平均随访(4.40±1.49)年,两组MACCE发生差异无统计学意义(IR组29.48%,CR组29.41%,P=0.9910)。CR组患者全因死亡率低于IR组(5.88%∶17.93%,P=0.0076),多因素分析显示完全血运重建是全因死亡的保护因素(HR=0.29,P=0.0204)。结论:老年冠心病3支病变患者PCI行完全血运重建预后较好。     

对比剂相关急性肾损伤对缺血性脑卒中患者近期预后的影响

目的:观察缺血性卒中患者脑血管造影后对比剂相关急性肾损伤(CI-AKI)对住院死亡率及1年死亡率的影响。方法:回顾性纳入2009-01-01~2013-12-31在广东省人民医院接受脑血管造影介入术的缺血性脑卒中患者,收集患者造影前、造影过程中及造影后相关临床资料,通过多因素回归模型分析CI-AKI对住院死亡率及1年死亡率的影响。结果:共有1 820例接受脑血管造影的缺血性脑卒中患者纳入本研究,其中81例(4.5%)患者发生了CI-AKI。多因素Logistic回归模型显示脑血管造影后CI-AKI增加患者住院死亡风险(优势比OR=3.99;95%CI 1.43~11.14;P=0.008),同时多因素COX回归模型显示CI-AKI也是1年死亡的独立危险因素(风险比HR=1.96;95%CI 1.18~3.26;P=0.009)。结论:脑血管造影后CI-AKI是缺血性卒中患者住院死亡及1年死亡的独立危险因素,对接受脑血管造影患者采取有效措施预防CI-AKI十分必要。     

我国冠状动脉旁路移植术地区和各医院间存在明显差异

阜外心血管病医院应用中国心脏外科注册研究(CCSR)中的数据,对我国13个省和4个直辖市的43家医院2007-01至2008-12接受单纯冠状动脉旁路移植术(CABG)的8739例患者进行了评估。CCSR中纳入的患者约占我国接受单纯CABG手术患者的1/4。(Circ Cardiovasc Qual Outcomes,2012,5:214-     

血浆肾素活性水平和降压药物的使用

为了评估相关高血压的异质性和与之相关的用药情况,该研究调查在一个大的包含多族裔的保健计划中高血压患者的血浆肾素活性(plasma renin activity,PRA)和与其相关药物的使用情况。方法 :分析1998-01-01-2009-1     

置管7天内启动腹膜透析患者的预后分析

目的:探讨置管后7d内启动腹膜透析(PD)的安全性及预后.方法:本研究回顾性分析了四川省人民医院PD中心2008-01-01～2016-12-31的腹膜置管后早期启动PD患者的并发症及导管存活情况,随访3年.根据置管后开始PD时间将患者分为三组,P1组(≤7d)、P2组(8～13d)、P3组(≥14d).所有患者均使用...     

聚卡波非钙联合西甲硅油与聚乙二醇电解质散在慢性便秘患者肠镜检查肠道准备中的应用

目的:探讨聚卡波非钙联合西甲硅油与聚乙二醇电解质散(PEG)在慢性便秘患者肠镜检查前肠道准备中的有效性和安全性.方法:采用随机、单盲、前瞻性的研究方法,将2020年3月-12月于徐州医科大学附属医院接受肠镜检查的慢性便秘患者共252例随机均分为A、B、C3个组,分别采用聚卡波非钙+西甲硅油+PEG(A组)、聚卡波非钙+...     

高剂量复方聚乙二醇电解质散对便秘患者结肠镜肠道准备的效果分析

目的:探讨高剂量(4 L)复方聚乙二醇电解质散(PEG)对便秘患者进行肠道准备的效果、患者的不良反应及耐受情况。方法:根据罗马Ⅳ便秘诊断标准,纳入2020年4月—2021年4月在青岛市第八人民医院行结肠镜检查的便秘患者180例,随机分成A、B、C组,每组60例。A组：于检查前1日晚上8:00服用1 L PEG,当日早上7:00再服用2 L PEG,即3(1+2) L方案;B组：于检查前1日晚上8:00服用2 L PEG,当日早上7:00再服用2 L PEG,即4(2+2) L方案;C组：分别于检查前2日、检查前1日晚上8:00各服用1 L PEG,当日早上7:00再服用2 L PEG,即4(1+1+2) L方案。采用波士顿肠道准备量表(BBPS)评估肠道清洁度,比较各组患者的结肠息肉及小息肉检出率。对每位患者进行问卷调查,记录各组患者的不良反应及耐受情况。结果:A组有3例、B组有2例、C组有2例患者因发现结肠占位,C组有1例患者因无法耐受肠镜而被剔除,最终纳入A组57例、B组58例、C组57例。3组患者在年龄、性别、身体质量指数方面的差异均无统计学意义(P>0.05)。A组患者右...     

主动脉内球囊反搏在急性冠状动脉综合征治疗中的临床应用及并发症情况分析

目的:对急性冠状动脉综合征患者置入主动脉内球囊反搏(IABP)治疗的临床情况和并发症情况进行分析,为IABP的临床应用总结相关临床经验。方法:本研究回顾分析2011-01至2012-12在我院急诊及冠心病监护病房置入IABP的急性冠状动脉综合征患者共238例,其中急性ST段抬高型心肌梗死患者159例,非急性ST段抬高型心肌梗死患者30例,不稳定性心绞痛患者49例。收集患者临床资料,分析治疗效果,并对IABP治疗后血小板减少、出血、发热及血栓等并发症发生情况进行分析。结果:在使用IABP的238例急性冠状动脉综合征患者中,仅23例(9.7%)未接受冠状动脉介入治疗或冠状动脉旁路移植手术,118例(49.6%)为急性ST段抬高型心肌梗死患者在IABP支持下行介入治疗。死亡和并发症发生情况:死亡21例(8.8%)、血小板减少55例(23.1%)、出血49例(20.5%)、下肢缺血4例(1.7%)。有18例患者发生严重血小板减少(50×109/L),其中11例拔除IABP后血小板逐渐恢复,5例给予补充了血小板治疗。有12例患者发热,均发生于长时间使用IABP治疗患者,平均置入时间(10.3±7.8)天,有4例患者血培养阳性。结论:IABP是急性冠状动脉综合征高危患者的重要过渡辅助装置。血小板减少和出血是最常见并发症。     

Decreasing use of percutaneous endoscopic gastrostomy tube feeding for veterans with dementia-racial differences remain

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) tube placement is a widely used method for long-term enteral feeding of demented patients unable to take sufficient food by mouth. National time trends in PEG tube use over the last decade have not been previously reported. The objective of this study was to determine whether use of PEG tubes for patients with dementia has changed over time and by race. DESIGN: Retrospective cohort study. SETTING: All Veterans Affairs hospitals. PARTICIPANTS: Using an administrative database of the Veterans Health Administration, all veterans with dementia and all veterans who received a PEG tube were identified between fiscal years 1990-2001. MEASUREMENTS: Proportion of PEG tube placement for dementia patients over time and by race. RESULTS: Four hundred thirteen thousand six hundred twenty-seven dementia patients aged 60 and older were identified, of whom 6,464 (1.6%) received a PEG tube. Use of PEG tubes for dementia patients increased during the first half of the decade but subsequently decreased almost to baseline after peaking in 1996 (1990: 1.2%, 1996: 1.8%, 2001: 1.3%). Time trends in the use of PEG tube feeding for dementia patients varied by race. Specifically, the relative risk for PEG tube placement in African-American dementia patients increased from 1.65 (95% confidence interval (CI)=1.25-2.17, FY 1990) to 1.97 (95% CI=1.62-2.4, FY 2001). CONCLUSION: Although the overall use of PEG tube feeding for dementia patients decreased over time, rates in use and changes in use over time varied significantly by race. Reasons for the differential use of this procedure should be explored.     

The safe use of percutaneous gastrostomy for enteral nutrition in patients with Crohn's disease

OBJECTIVE: To determine the safety of percutaneous endoscopic gastrostomy (PEG) tube placement for nutritional support and/or defined therapeutic enteral nutrition (TEN) in adult patients with Crohn's disease. DESIGN: A prospective, observational study of patients with Crohn's disease in whom PEG tubes were placed for nutritional support or TEN. SETTING: A specialist nutrition clinic at a gastroenterology tertiary referral centre in Harrow, UK. PARTICIPANTS: Nine patients with Crohn's disease. Seven patients had nutritional failure and were unable to tolerate nasogastric feeding, and two patients were recruited in whom TEN therapy for active disease was indicated. The age range was 21-52 years (median, 30 years). Five patients were female; all had had previous ileo-colonic resections, one had a gastro-enterostomy and one had a non-healing Crohn's-related gastric ulcer. INTERVENTIONS: PEG insertion (Fresenius, Frecka 9 Fr) was performed at endoscopy with intravenous sedation. Follow-up with tubes in situ was for a median of 37 weeks (range, 4-276 weeks), and for a further median of 80 weeks (range, 52-120 weeks) in those whose tubes have been removed. MAIN OUTCOME MEASURES: The level of disease activity, nutritional status/body mass index and any complications associated with PEG tube placement were recorded. RESULTS: PEG was achieved in all patients; the only complication was a minor superficial entry site infection. Five patients continue to use PEG feeding to good effect, including healing of the Crohn's-associated ulcer. One patient now eats normally having regained target weight, and three require parenteral nutrition, having failed to achieve nutritional sufficiency despite an optimal enteral regimen via the PEG. An adverse body image in one of these patients (an opiate abuser with a long psychiatric history) was probably contributory to PEG failure. There was no peristomal or fistulous disease. CONCLUSIONS: Although nutrition via PEG is not always successful, failures are of enteral nutrition, and not of the means. PEG use in selected patients with Crohn's disease appears safe and can prove a useful addition to therapeutic options.     

Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke.

OBJECTIVE: investigation of length of survival, complications, level of dependence and recovery of swallow in patients who received percutaneous endoscopic gastrostomy (PEG) feeding for dysphagia due to stroke. DESIGN: a retrospective case note analysis of patients treated between 1991 and 1995 and telephone survey of modified Barthel index in October 1996. SETTING: Cardiff Royal Infirmary and the University Hospital of Wales in Cardiff. SUBJECTS: 126 patients who had PEG inserted after dysphagic stroke. MAIN OUTCOME MEASURES: complications of PEG, length of survival, duration of PEG feeding, recovery of swallow and modified Barthel index score. RESULTS: median length of follow-up was 31 months (range 4-71). Median duration of PEG use was 127 days (range 1-1372). For patients with PEG inserted within 2 weeks the median duration was 52 days (range 2-1478). At follow up 36 (29%) had had PEG removed, 72 (57%) had died with PEG in use, 10 (8%) still had PEG and were nil by mouth and five (4%) had PEG in use with swallow recovered. The median survival was 305 days. Thirty-five (28%) patients died in hospital. Aspiration pneumonia was the commonest complication. Thirty-three patients were alive in October 1996. The modified Barthel index for nursing home patients was 4 (range 0-13) and for patients at home 11 (range 2-20). CONCLUSION: PEG feeding is safe and well tolerated in patients with dysphagic stroke. Early PEG placement (within 2 weeks) is worthwhile with many going on to have long-term feeding. Although overall mortality is high, some patients have a long-term survival and a few attain a reasonable level of function in daily living activities. Late recovery of swallow occurs and patients should have follow-up swallowing assessment.     

Application of percutaneous endoscopic gastrostojejunostomy in a case of amyotrophic lateral sclerosis associated with the superior mesenteric artery syndrome

A 64‐year‐old woman who was diagnosed as suffering from amyotrophic lateral sclerosis (ALS) of bulbar type was admitted to our hospital for long‐term care. After admission, she underwent percutaneus endoscopic gastrostomy (PEG) and enteral feeding was initiated. However, the PEG alimentation was disrupted by aspiration pneumonia owing to the superior mesenteric artery syndrome (SMAS), diagnosed by gross anatomy and endoscopic studies. Conservative treatment for SMAS was not successful and sepsis developed. After recovery from this, an operation was recommended, but it was rejected by her and her family members. We therefore selected the method of placing a thin jejunostomy tube through the PEG, called percutaneous endoscopic gastrojejunostomy (PEGJ) and pulling it endoscopically into the proximal jejunum, thereby allowing delivery of nutrients. Thereafter, she was well and showed gradual improvement of nutritional parameters such as serum albumin and total cholesterol, as well as the lymphocyte subset. It is concluded that PEGJ is effective for long‐term enteral nutrition in ALS patients complicated with SMAS.     

The acid-labile subunit of the ternary insulin-like growth factor complex in cirrhosis: relation to liver dysfunction

BACKGROUND/AIMS: In the circulation, insulin-like growth factor-I (IGF-I) is bound in a trimeric complex of 150 kDa with IGF binding protein-3 (IGFBP-3) and the acid-labile subunit (ALS). Whereas circulating IGF-I and IGFBP-3 are reported to be low in patients with chronic liver failure, the level of ALS has not been described in relation to hepatic dysfunction. The aim of the present study was therefore to measure circulating and hepatic venous concentrations of ALS in relation to hepatic function and the IGF axis. METHODS: Twenty-five patients with cirrhosis (Child class A/B/C:5/10/10) and 30 controls with normal liver function were studied. During a haemodynamic investigation, blood samples were collected from the hepatic vein and femoral artery, and the plasma concentrations of ALS, IGF-I and IGFBP-3 were determined. RESULTS: Hepatic venous and arterial concentrations of ALS were significantly decreased in the cirrhotic patients compared with the controls (-69% and -68%, respectively, both p<0.001). IGF-I and IGFBP-3 were similarly decreased in the cirrhotic patients (-51%,p<0.001). A significant hepatic extraction of ALS was found in the controls (6%, p<0.01) and in the cirrhotic patients (8%, p=0.08). ALS correlated significantly with indicators of liver dysfunction, including the Child-Turcotte score (r=-0.69, p<0.0001), IGF-I (r=0.82, p<0.0001) and IGFBP-3 (r=0.74, p<0.0001). CONCLUSIONS: Circulating and hepatic venous ALS are decreased in patients with cirrhosis with significant relations to liver dysfunction and other components of the IGF complex. A small hepatic extraction was found in controls, which suggests extrahepatic production of ALS. Future studies should focus on organ-specific removal of ALS.     

Supramaximal inflation improves lung compliance in subjects with amyotrophic lateral sclerosis

RATIONALE: Lung compliance has been found to be low in patients with chronic diaphragmatic weakness or paralysis but has not been well-studied in patients with amyotrophic lateral sclerosis (ALS). Noninvasive positive-pressure ventilation (NPPV) prolongs survival in ALS patients but may also have additional beneficial effects. OBJECTIVES: This study evaluated static expiratory lung compliance (CL) in subjects with ALS and determined the effect of lung inflation with supramaximal inflation on CL. DESIGN: This was a prospective trial comparing CL before and after supramaximal lung inflation via mouthpiece-delivered positive pressure. SETTING: A single university medical center with an multidisciplinary ALS center. PARTICIPANTS: Fourteen subjects with ALS were compared to 4 healthy volunteers. INTERVENTIONS: Subjects underwent a battery of pulmonary function tests including for CL. Then they used positive pressure administered via a mouthpiece set to 10 cm H2O above their maximal static recoil pressure for 5 min. The CL measurement was then repeated. RESULTS: The mean (+/- SD) baseline CL was reduced (164.1 +/- 82.1 mL/cm H2O) in subjects with ALS and was significantly lower than that in healthy volunteers (237.5 mL/cm H2O; p = 0.04). CL increased significantly in subjects with evidence of diaphragm weakness (change in CL, 11.3 +/- 16.7 mL/cm H2O; p = 0.03). Healthy volunteers did not have an increase in CL. CONCLUSIONS: Patients with ALS and diaphragmatic weakness have reduced CL, and brief supramaximal inflation increases CL. These findings suggest that atelectasis or increased alveolar surface forces are present in ALS patients and that these patients will have increased work of breathing. Some of the beneficial effects demonstrated with NPPV therapy may be through its effects on CL and the work of breathing.     

The Use of Botulinum Toxin Injections to Manage Drooling in Amyotrophic Lateral Sclerosis/Motor Neurone Disease: A Systematic Review

Difficulty in managing oral secretions is commonly experienced by patients with amyotrophic lateral sclerosis (ALS)/motor neurone disease (MND) and associated bulbar weakness including dysphagia. There are no definitive evidence-based treatment guidelines to manage the distressing symptom of drooling. We reviewed the evidence for the effectiveness of botulinum toxin injections to reduce saliva in ALS/MND. The search strategy was conducted in four stages: (1) electronic search of relevant databases, (2) hand searches of all international ALS/MND symposium journals, (3) email request to MND care centres in the UK and Ireland, and (4) hand searching of reference lists. All studies were critically appraised and relevant data extracted. Botulinum toxin type A and type B were analysed separately. Due to heterogeneity, it was not possible to calculate a pooled estimate of effect. Twelve studies met the inclusion criteria (9 for type A and 3 for type B). Only two randomised controlled trials were identified. Study sample sizes were small with a mean of 12.5 subjects. The most frequently reported outcomes were weight of cotton rolls and number of tissues used. All studies claimed the intervention tested was effective, but only seven studies (4 for type A and 3 for type B) reported statistically significant differences. Although there is evidence to suggest that botulinum toxin B can reduce drooling, the evidence base is limited by a lack of randomized controlled trials. Evidence to support the use of botulinum toxin A is weaker. Larger trials will help remove the uncertainty practitioners face in treating this disabling symptom.     

Percutaneous Endoscopic Gastrostomy (PEG) for Enteral Nutrition in Patients with Stroke

Background: The use of percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in patients admitted for stroke is difficult, varying and needs specific consideration. There is therefore need for more data on this patient group. We examined the indications, survival, tube removal and time with PEG in stroke patients and in other patients with PEG with the aim of providing guidance for the management of enteral nutrition via PEG in stroke patients. Methods: Retrospective assessment of data from all stroke patients and patients with other diseases (control group) who had received PEG for enteral nutrition during a period of 8.5 years. Results: Eighty-three stroke patients with dysphagia received PEG after unsuccessful use of nasogastric tubes or long-term tube feeding. Early mortality rate was 19% in the stroke group, 26% in the older group (>74 years) and 12% in the younger group (60-74 years). The PEG tubes were later removed due to swallowing recovery in 20% of the older group and in 31% of the younger group. At 90 days, 50%-60% still needed PEG. The stroke patients were older compared to the control group ( n &#114 = &#114 115); 30-day mortality was similar but more patients recovered the ability to swallow. Conclusions: Stroke patients are older than other patients who receive PEG; 27% have swallowing recovery and more than 75% have long-term need for PEG. Nasogastric tubes often fail, and the need for early PEG placement (within 2 weeks) must be assessed in appropriate patients. The patient's prognosis, the objective of nutritional treatment, duration of dysphagia, age and comorbidity should all be taken into consideration.     

Percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in patients with stroke

BACKGROUND: The use of percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in patients admitted for stroke is difficult, varying and needs specific consideration. There is therefore need for more data on this patient group. We examined the indications, survival, tube removal and time with PEG in stroke patients and in other patients with PEG with the aim of providing guidance for the management of enteral nutrition via PEG in stroke patients. METHODS: Retrospective assessment of data from all stroke patients and patients with other diseases (control group) who had received PEG for enteral nutrition during a period of 8.5 years. RESULTS: Eighty-three stroke patients with dysphagia received PEG after unsuccessful use of nasogastric tubes or long-term tube feeding. Early mortality rate was 19% in the stroke group, 26% in the older group (>74 years) and 12% in the younger group (60-74 years). The PEG tubes were later removed due to swallowing recovery in 20% of the older group and in 31% of the younger group. At 90 days, 50%-60% still needed PEG. The stroke patients were older compared to the control group (n = 115); 30-day mortality was similar but more patients recovered the ability to swallow. CONCLUSIONS: Stroke patients are older than other patients who receive PEG; 27% have swallowing recovery and more than 75% have long-term need for PEG. Nasogastric tubes often fail, and the need for early PEG placement (within 2 weeks) must be assessed in appropriate patients. The patient's prognosis, the objective of nutritional treatment, duration of dysphagia, age and comorbidity should all be taken into consideration.     

Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts？

AIM： To investigate whether percutaneous endoscopic gastrostomy （PEG） tube placement is safe in patients with ventriculoperitoneal （VP） shunts. METHODS： This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long- term follow-up were also investigated. RESULTS： Fifty-five patients qualified for the study. Seven patients （12.7%） had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG （PEG/VP group） and non-VP shunt patients undergoing PEG （control group） [1 （14.3%） vs 6 （12.5%）, P = 1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d （range, 65-831 d）. The mean follow-up duration in the PEG/VP group was 6.4 mo （range, 1-15 mo）. There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up. CONCLUSION： Complications following PEG placement in patients with VP shunts were infrequent in this study.