A Clinical Study Of Elderly Patients With Long-term Nasogastric Tube Feeding In 63 Cases

Objective: The author aimed to summary the clinical data in 63 cases of underlying diseases, nutritional status and incidence of various complications with long-term nasogastric tube feeding among elderly patients, and to discuss the mortality and its risk factors in elderly patients with long-term nasogastric tube feeding, which designed to sum up the clinical experience of nutrition support for long-term nasogastric tube feeding in elderly patients.Methods: This study retrospectively analysised 63 cases of patients aged 60 years and older, who were with long-term nasogastric tube feeding more than one month in Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, between January 2014 to January 2016. Clinical data was collected and descriptive analysised, including demographic data, underlying diseases, nutritional index and nasal feeding complications, and to discuss the risk factors of hospital mortality associated with long-term nasal feeding, and using multivariate logistic regression analysis to identify the independent risk factors for mortality in elderly patients with long-term nasogastric tube feeding.Results:1. Among the 63 cases, most patients had two or more underlying diseases, accounted for 85.71%, the majority of which were chronic diseases such as hypertension(50 cases, accounted for 79.37%), dementia(39 cases, accounting for 61.90%), and cerebrovascular diseases(21 cases, 31.75%).2. Dysphagia was the major indication for long-term nasogastric tube indwelling(46 cases, accounted for 73.02%).3. The prevalence of nutrition risk was 87.30%(55/63), and the the incidence rate of malnutrition was 63.49%.4. The incidence of gastrointestinal complications was 84.13%, constipation is the most common, which accounted for 58.73%. Mechanical complication rate was 17.46%, stomach bleeding was more common, which accounted for15.87%. The metabolic complication rate was 93.65%, electrolyte disorder was common, while the incidence of hyponatremia was 69.84%, and the incidence of hypokalemia was 55.56%.5. The incidence rate of aspiration pneumonia was 28.57%. But the clinical symptoms were untypical, while the main performers were tachypnea(61.11%). The sputum culture results of aspiration pneumonia patients showed that Gram-negative bacilli were high, which accounted for 77.14%. Pseudomonas aeruginosa was more common(25.71%). After treatment, the mortality of aspiration pneumonia was 72.22%.6. The mortality of long-term nasogastric tube feeding among elderly patients was 46.03%. The aspiration pneumonia(OR=6.353, P = 0.007) and albumin < 35 g / L(OR=5.177, P = 0.012) were the independent risk factors of hospital mortality for elderly patients with long-term nasogastric tube feeding.Conclusion:1. An overwhelming majority of the elderly patients with long-term enteral nutrition support by nasogastric tube had underlying diseases. Dysphagia was the most common indication for long-term nasogastric tube indwelling.2. Most of these patients with long-term nasogastric tube feeding were suffering from malnutrition,we suggested it is recommended regular nutrition screening and assessment,and to adjust the dietary pattern timely.3. The complications of long-term nasal feeding in the elderly patients were rarely high,which including gastrointestinal complications, electrolyte disorders and aspiration pneumonia.4. The mortality of elderly patients with long-term nasogastric tube feeding was high,aspiration pneumonia and low albumin level(< 35 g / L) are the independent predictors for mortality,which should pay more attention to control the probable risk factors of occuring aspiration pneumonia,elevate the level of diagnosis and treatment, and to strengthen the correction of malnutrition,which in order to improve quality of life of the elderly patients.5. We should Pay attention to assess the nutritional status regularly and prevent the complications, to improve the understanding of long-term nasal feeding nutrition support, which also need strengthening the clinical experience of long-term nutrition support with the PEG or PEJ approach.