Thèse d'exercice : Médecine : Nancy 1 : 2008. / Titre provenant de l'écran-titre.

Die perkutane endoskopische Gastrostomie (PEG) hat sich seit ihrer Erstbeschreibung im Jahre 1980 als einfache Technik zur künstlichen enteralen Langzeiternährung bewährt. Das Vorgehen ist relativ komplikationsarm und die Vorgehensweise weit verbreitet. Dennoch kann die PEG mit ernsthaften Komplikationen behaftet sein und selbst Todesfälle werden in der Literatur beschrieben. In der retrospektiven Studie wurden die Indikationen, Komplikationen und die Mortalitätsraten untersucht. Im Zeitraum 1.1.1999 bis 31.12.2005 wurde bei 439 Patienten erfolgreich eine PEG-Sonde gelegt. 69% der Patienten waren weiblich, 31% männlich mit einem Durchschnittsalter von 81,5 Jahren. Bei den Indikationen waren die neuropsychiatrischen Erkrankungen mit 89,9% führend, danach folgten mit 8,3% maligne Neoplasien und an 3 Stelle mit 1,8% andere Erkrankungen. Während der PEG-Anlage fanden sich Blutungen (5,4%), sowohl endoluminal als auch Nachblutungen aus dem Stichkanal, und eine Magenperforation (0,2%) Als Frühkomplikation fanden sich 6,3% lokale Wundinfektionen, bei 4,3% peristomale Schmerzen, bei 3,6% Pneumonien und bei 2,2% eine Peritonitis. 5 Sonden mussten bei konservativ nicht zu beherrschender Peritonitis entfernt werden. Es starben dennoch 3 Patienten, was einer methodenbedingten Letalität von 0,7% entspricht. Bei 65,1% fand die Anlage unter Antibiotikaschutz statt, bei 34,9% ohne. Bemerkenswert war, dass eine Antibiotikaprophylaxe bzw. eine antibiotische Therapie das Auftreten von Komplikationen wie Wundinfektionen , Peritonitis und Pneumonien nicht positiv beeinflusst hat. Die 30-Tage-Mortalität betrug 16,6%. / Percutaneous endoscopic gastrostomy (PEG) is a simple technique for the endoscopic placement of a permanent feeding access. The procedure is relatively safe an the technique well established. PEG can, however, be associated with serious complications and death. In our retrospective study was undertaken to evaluate the indications, complications and the mortality rate. Between 1.1.1999 and 31.12.2005 PEG tubes were implanted in 439 patients, 69% female and 31% male. The mean age of the patients was 81,5 years. The most frequent indications were neurological disease (89,9%). 8,3% had a PEG-placement because of malignancies and 1,8% because of other disaeses. During the implantation of the PEG tube there were hemorrhage(5,4%) was observed. One patient had laparotomy because of perforation of the stomach. The most early complication was the local wound infection in 6,3% of the cases, 4,3% peristomal pain, 3,6% pneumonia after aspiration and 2,2% peritonitis. The overall procedure-related mortality was 0,7%. The 30-day mortality rate was 16,6%.

Zugl.: Hamburg, Univ., Diss., 2007

Universiẗat, Diss.--Hamburg, 2007.

Gastrostomy is one of the access routes enabling enteral nutrition support to children with eating disorders. It is a method of choice in situations where real assumption of enteral feeding by a nasogastric probe longer than six weeks exists and with undamaged functional digestive system. The possibility to perform enteral feeding outside health care facilities is the most advantageous aspect of gastrostomy for children and their parents. Optimum nursing care is one of the main preconditions of long term functional gastrostomy. This why suitable education of parents and their children in the nutrition support method is necessary. The aim of the work was to map awareness of the issues of gastrostomy in children patients among parents and to propose a unified educational programme aimed at easier insight into the issues. Qualitative research method was applied to the problems. The techniques of study of healthcare documentation and semi standardized interviews with respondents in their home environment were used for data collection. The results of the healthcare documentation studies, which defined the sample of the children with applied gastrostomy, were processed into graphic form for better transparency. The interviews with the respondents in the form of audio recording were transposed into written form and quantified by means of tables enabling the research conclusion to be drawn. The research results showed that practical training of gastrostomy treatment and awareness of possible complications and their solution was the weak point of the education. The above results have confirmed the necessity to elaborate a unique educational programme related to the issues of feeding tube insertion, the care for gastrostomy, support of food, medicines, and possible related complications in terms of learning the ability to prevent complications, identify and solve them.

0BABSTRACT This thesis is focused on enteral nutrition. This issue is an integral part of intensive and resuscitation care, but it is also a part of standard and follow-up care. There are more and more new resources and the products for enteral nutrition are improving. The theoretical part deals with malnutrition, discusses the different components of nutrition. Much of the thesis forms ways of application of nutrition. The issue is a nasogastric tube, a nasojejunal tube, percutaneous endoscopic gastrostomy, percutaneous endoscopic jejunostomy, feeding button or sipping. There are further expanded the introductions, nursing care, indications and contraindications of these options. The following chapters analyse the modes of enteral feeding, advantages and disadvantages of enteral nutrition compared to parenteral. The practical part is focused on research using anonymous questionnaires in the area of enteral nutrition. The survey was conducted in four departments of three teaching hospitals in Prague. It was focused on nurses and paramedics in medical intensive metabolic care units. The survey had 73 respondents. The aim was to identify the mode of feeding that nurses prefer and how they apply it, analyze the extent to which the nurses actively involve themselves in this, how they are oriented in...