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Rehabilitation Practice and Science

Translated Title

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

Abstract

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.

Language

Traditional Chinese

First Page

205

Last Page

212

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