Agustos 2019
Beslenme destegine yeni baslanan hastalari nazogastrik sondayla taburcu etmek uygun bir yaklasim mi?
Is it an appropriate approach to discharge patients, newly being fed, via the nasogastric tube?
- Ana Sayfa
- Sayılar
- Agustos 2019
- Beslenme destegine yeni baslanan hastalari nazogastrik sondayla taburcu etmek uygun bir yaklasim mi?...
Inönü Üniversitesi Tip Fakültesi, 3Gastroenteroloji Bilim Dali, Malatya
Özet
Giris ve Amaç: Basta geriatri, nöroloji ve onkoloji hasta gruplarindaolmak üzere çesitli nedenlerle oral yoldan beslenemeyen hastalar, nazogastrik sonda, perkütan endoskopik gastrostomi ve perkütan endoskopik jejunostomi gibi yapay yollarla enteral yoldan beslenmektedirler.Genel uygulama, hastalarin nazogastrik sondayla beslenmeye baslanip,daha sonra kalici beslenme yollari olan perkütan endoskopik gastrostomi veya jejunostomiye degistirilmesi seklindedir. Kalici beslenme yollarina geçilmesi zamanlamasi konusunda kilavuzlar olmasina ragmen, bukonuda kafa karisikligi vardir. Biz bu çalismamizda 6 aylik zaman dilimiiçerisinde nazogastrik sonda ile beslenmeye baslanarak taburcu edilen61 hastayi beslenme yolu degisiklikleri açisindan degerlendirmeyi amaç-ladik. Gereç ve Yöntem: Antalya Egitim ve Arastirma HastanesindeHaziran 2015-Aralik 2015 zaman dilimi içerisinde iç hastaliklari klinigi,tibbi onkoloji klinigi, nöroloji kliniklerinde yatan, altta yatan hastaliklarinedeniyle oral yoldan beslenemeyen ve nütrisyon ekibi tarafindan nazogastrik sonda ile beslenmeye baslanip, nazogastrik tüp ile taburcu edilen 61 hasta ardisik sirayla çalismaya dahil edildi. Bulgular: Çalismayaaldigimiz hastalarin 35’i (%57.4) erkek, 25’i (%42.6) kadindi. Çalismazaman dilimi sonunda 20 (%41.6) hasta exitus oldu. 12 (19.7) hastayaperkütan endoskopik gastrostomi açildi. 16 (%26.2) hasta nazogastriksondadan ayrilarak oral yoldan beslenmeye basladi. 13 (%21.3) hastanazogastrik sondayla beslenmeye devam ediyordu. Hastalarda nazogastrik sonda kalis süresi ortalama 34.93±40.98 gün, medyan 30.0 gün(min: 2 gün, max: 180 gün, aralik: 178 gün) olarak saptandi. Sonuç:Takip edilen 61 hastanin sadece 12 (19.7%) tanesine perkütan endoskopik gastrostomi açilmis olmasi, bunun yaninda hastalarin 16’sinin(26.2%) oral yoldan beslenmeye geçmis olmasi hastalarin nazogastriksondayla taburcu edilip beslenme yolu degisikliklerine takipte karar verilmesinin dogru bir yaklasim oldugu kanatine varmamiza neden oldu
Abstract
Background and Aims: Patients who cannot be fed orally due to various reasons, especially those comprising the geriatric, neurological, andoncological patient groups, are fed enterally via artificial routes such asnasogastric tube, percutaneous endoscopic gastrostomy, and percutaneous endoscopic jejunostomy. The general practice is to begin feeding via the nasogastric tube and then replace with permanent feedingroutes such as percutaneous endoscopic gastrostomy or jejunostomy.Although guidelines regarding the timing of placing permanent feedingroutes are available, confusion still exists in this regard. We conducted this study to evaluate feeding route changes among patients whowere discharged by feeding via the nasogastric tube during a 6-monthtime period. Materials and Method: A total of 61 patients who werehospitalized in the internal medicine clinic, the medical oncology clinic,and the neurology clinic in Antalya Training and Research Hospital fromJune 2015 to December 2015 were enrolled consecutively in this study.These patients could not be fed via the oral route due to their underlying diseases and were fed via the nasogastric tube by the nutritionalteam and then discharged with the nasogastric tube feeding route. Results: Of the 61 patients, 35 (57.4%) were males and 25 (42.6%) werefemales. At the end of the study period, 20 patients (41.6%) died. Atotal of 12 (19.7) patients were fed with the percutaneous endoscopicgastrostomy route, and 16 (26.2%) patients restarted feeding via theoral route. Nasogastric tube feeding was continued for 13 (21.3%) patients. The duration of nasogastric tube feeding was 34.93±40.98 days[median 30.0 days (min: 2 days, max: 180 days, range: 178 days)].Conclusion: Of the 61 patients who were evaluated in this study, 12(19.7%) were fed via the percutaneous endoscopic gastrostomy route,whereas 16 (26.2%) patients restarted feeding via the oral route. Thisresult suggests that the decision to discharge patients with feeding viathe nasogastric tube is an appropriate approach
