| Abstract | Ciljevi: Cilj ovog istraživanja bio je utvrditi iskustva s perkutanim gastroenterostomama (PEG) u Klinici za dječje bolesti KBC-a Split.
Ispitanici i metode: Istraživanje je provedeno retrospektivnom analizom medicinske dokumentacije bolesnika liječenih u Klinici za dječje bolesti i Klinici za dječju kirurgiju KBC-a Split u periodu od 2010. - 2020. Ispitanicima kojima je u tom periodu postavljen PEG analizirani su: dob, spol, z- vrijednosti za tjelesnu masu, tjelesnu visinu i indeks tjelesne mase (ITM), osnovne i prateće dijagnoze (bolesti), vrijeme korištenja nazogastrične sonde prije postavljanja PEG-a, mjesto izvođenja operacije i korišteni lijekovi te vijek trajanja, komplikacije i konačni ishodi PEG-a. Prikupljeni podaci analizirani su korištenjem programa Microsoft Office Excel 2013 te statističkog paketa MedCalc, a prikazani su pomoću tablica i grafikona.
Rezultati: Analizirani su podaci za 40 ispitanika, od toga 40% djevojčica i 60% dječaka. Medijan životne dobi svih ispitanika iznosi 110 mjeseci. U trenutku postavljanja PEG-a većina ispitanika je imala odstupanja tjelesne mase i visine u odnosu na očekivane vrijednosti za dob i spol. Medijani z-vrijednosti tjelesne mase, tjelesne visine i ITM-a u ispitanika čiji su podaci bili dostupni iznose -2,28 (P=0,427), -1,5 (P=0,367) i -1,65 (P=0,971). Najzastupljenije osnovne dijagnoze (bolesti) ispitanika su bolesti središnjeg živčanog sustava (57,5%), potom neuromišićne bolesti (17,5%), genetske bolesti (7,5%), metaboličke bolesti (7,5%) te politraumatizirani bolesnici (10%). Kroničnu respiracijsku insuficijenciju i višestruko odstupanje u razvoju kao prateće dijagnoze imalo je više od petine ispitanika. Medijan vremena korištenja nazogastrične sonde prije postavljanja PEG-a iznosi 6,5 mjeseci, a većina zahvata (77%) izvedena je u operacijskoj dvorani. Najčešće korišten lijek za vrijeme zahvata je fentanil, primijenjen u 90% ispitanika. U 35% ispitanika razvile su se minor komplikacije, a utvrđena je statistički značajna povezanost potrebe za zamjenom PEG-a s komplikacijama. Prosječni vijek trajanja PEG-a prije potrebe za zamjenom je 33 mjeseca.
Zaključci: Većina ispitanika, čija je najčešća osnovna dijagnoza bolest središnjeg živčanog sustava, je u trenutku postavljanja PEG-a imala negativna odstupanja z-vrijednosti tjelesne mase, tjelesne visine i ITM-a. To ukazuje na potrebu eventualno ranijeg postavljanja PEG-a, a o čemu su potrebna dodatna istraživanja. PEG se može smatrati sigurnom terapijskom opcijom u djece obzirom da su u manjeg broja ispitanika nađene komplikacije vezane uz PEG, većinom minor oblika. |
| Abstract (english) | Subjects and methods: The research was conducted by retrospective analysis of the medical records of patients treated at the Department of Pediatrics and the Department of Pediatric Surgery of the University Hospital of Split in the period from 2010 to 2020. The following were analyzed: age, sex, Z-score for body weight, body height and body mass index (BMI), main and secondary diagnoses, duration of nasogastric tube use before PEG placement, place of operation and medicines used during operation, PEG duration, complications and outcomes. The collected data were analyzed using Microsoft Office Excel 2013 and the statistical package MedCalc, and presented using tables and graphs.
Results: Data for 40 patients were analyzed, of which 40% were girls and 60% were boys. The median age of all patients was 110 months. At the time of PEG placement, most patients had deviations in body weight and height compared to expected values for age and sex. The median Z-scores of body mass, body height, and BMI in patients whose data were available were -2.28 (P = 0.427), -1.5 (P = 0.367) and -1.65 (P = 0.971). The most common basic diagnoses were diseases of the central nervous system (57.5%), followed by neuromuscular diseases (17.5%), genetic diseases (7.5%), metabolic diseases (7.5%) and polytraumatized patients (10%). Over a fifth of the patients had chronic respiratory insufficiency and multiple developmental disorders as secondary diagnoses. The median time of nasogastric tube usage before PEG placement was 6.5 months, and most procedures (77%) were performed in the operating room. The most commonly used drug was fentanyl, used in 90% of patients. Minor complications were found in 35% of patients, and statistically significant association between the need of changing PEG and complications was found. The average duration of PEG before the need for replacement was 33 months.
Conclusions: The majority of patients, whose most common primary diagnosis was central nervous system disease, had negative deviations of z-score body weight, body height, and BMI. This indicates the need for possible earlier placement of PEG, and further research is needed. PEG can be considered as safe therapeutic option in children since PEG-related complications, mostly minor forms, were found in a small number of patients. |
