摘要目的 探讨不同时期经皮内镜胃造瘘术(PEG)在神经外科长期昏迷鼻饲患者中的应用价值.方法 将51例长期昏迷鼻饲患者随机分为25～39 d造瘘组和40～60 d造瘘组,在相应时间内行PEG术.对两组患者造瘘前后的上消化道出血率、出血患者的平均出血次数及平均止血时间、误吸率和吸入性肺炎发生率进行分析比较.结果 造瘘后上消化道出血率、误吸率和吸人性肺炎发生率均明显低于造瘘前(P<0.05).25～39 d造瘘组造瘘前上消化道出血率、出血患者平均出血次数、误吸率及吸入性肺炎发生率均明显低于40～60 d造瘘组(P<0.05),两组出血患者平均止血时间的差异无统计学意义(P>0.05).造瘘后两组患者的上消化道出血率、误吸率及吸入性肺炎发生率的差异无统计学意义(P>0.05).结论 在神经外科长期昏迷患者中,PEG能减少因长期置鼻胃管所致的上消化道出血、误吸和吸人性肺炎的发生,发病后25～39 d行PEG比发病≥40 d行PEG对患者更有利.如无PEG禁忌证,发病后25～39 d可能是行PEG的合适时机.

abstractsObjective To evaluate percutaneous endoscopic gastrostomy (PEC) in long-term coma patients at different phases who received trans-nasal feeding in Department of Neurosurgery. Methods A total of 51 patients who received trans-nasal feeding because of long-term coma were randomly divided into 2 groups to undergo PEG at 25-39 days after coma (n =24) or at 40-60 days (n = 27) , respectively. The rates of upper gastrointestinal bleeding, average episodes of bleeding, average hemostatic time, the rates of aspiration and aspiration pneumonia were compared between the 2 groups. Results The rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in post-PEG patients were significantly lower than those in pre-PEG patients (P < 0.05). Before the procedure of PEG, the rates of upper gastrointestinal hemorrhage,average episodes of bleeding, rates of aspiration and aspiration pneumonia in 25-39-day group were significantly lower than those in 40-60-day group (P < 0.05). There was no significant difference between 2 groups, in regarding of either hemostatic time, or rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia after PEG (P > 0. 05). Conclusion PEG may decrease the rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in neurosurgical patients receiving trans-nasal feeding because of long-term coma. PEG is preferably performed on 25-39 days of onset to 40-60 days. If there is no contraindication, 25-39 days after coma is likely to be the optimal time for PEG.