Ucwaningo lwakamuva mayelana nokudla okunomsoco kwangaphambi kwesikhathi ezigulini ezihlinzwa umdlavuza wesisu kuyachazwa. Leli phepha ngelenkomba kuphela
1. Izindlela, izindlela kanye nesikhathi sokudla okunomsoco
1.1 Ukudla okunomsoco
Izindlela ezintathu zokumnika zingasetshenziswa ukuze kuhlinzekwe ukwesekwa kokudla okunomsoco ezigulini ezinomdlavuza wesisu ngemva kokuhlinzwa: ukuphatha kanye nje, ukumpompa ngokuqhubekayo ngephampu yokumnika kanye ne-intermittent gravity drip. Ucwaningo lwezokwelapha zithole ukuthi umphumela wokujova okuqhubekayo ngephampu yokufaka ungcono kakhulu kunokufakwa ngezikhathi ezithile kwamandla adonsela phansi, futhi akulula ukuba nokusabela okungekuhle kwesisu. Ngaphambi kokusekelwa okunomsoco, u-50ml ka-5% we-glucose sodium chloride umjovo wawusetshenziswa ngokujwayelekile ukushaywa. Ebusika, thatha isikhwama samanzi ashisayo noma isifudumezi sikagesi bese usibeka ekugcineni kwepayipi lokungenisa eduze nendawo ephuma emlonyeni yepayipi le-fistula ukuze lifudumale, noma shisisa ipayipi lokungenisa ngebhodlela le-thermos eligcwele amanzi ashisayo. Ngokuvamile, izinga lokushisa lekhambi lezakhi kufanele libe ngama-37℃~ 40℃. Ngemva kokuvula i-Enteral Nutrition Bag, kufanele isetshenziswe ngokushesha. Isixazululo sezakhi ngu-500ml / ibhodlela, futhi isikhathi sokumiswa sokumiswa kufanele sigcinwe cishe ku-4H. Izinga lokwehla lingamaconsi angama-20 / iminithi imizuzu engama-30 ngaphambi kokuqala kokumnika. Ngemuva kokungabikho kokuphatheka kabi, lungisa izinga lokuwisa libe ngamaconsi angama-40 ~ 50/min. Ngemuva kokujova, hlambulula ishubhu ngomjovo ongu-50ml ka-5% we-glucose sodium chloride. Uma ukumnika kungadingeki okwamanje, isisombululo sezakhi kufanele sigcinwe endaweni yokugcina ebandayo engu-2℃~ 10℃, futhi isikhathi sokugcina esibandayo akumele sidlule ku-24h.
1.2 Indlela yokudla okunomsoco
Umsoco wangaphakathi ikakhulukazi uhlanganisaAma-Nasogastric Tubes, i-gastrojejunostomy tube, i-nasoduodenal tube, spiral naso intestinal tube kanyeI-Nasojejunal Tube. Esimeni sokuhlala isikhathi eside kweIshubhu Lesisu, kunamathuba amaningi okubangela uchungechunge lwezinkinga ezifana nokuvinjelwa kwe-pyloric, ukuphuma kwegazi, ukuvuvukala okungapheli kwe-gastric mucosa, isilonda nokuguguleka. I-Spiral naso intestinal tube ithambile ekuthunjweni, akulula ukugqugquzela umgodi wekhala nomphimbo wesiguli, ukugoba kalula, nokubekezelelana kwesiguli kuhle, ngakho-ke ingafakwa isikhathi eside. Kodwa-ke, isikhathi eside sokubeka ipayipi emakhaleni ngokuvamile sizobangela ukungakhululeki ezigulini, kwandise amathuba okuba ne-reflux yoketshezi olunomsoco, futhi kungase kwenzeke ukungaphefumuli kahle. Isimo sokudla okunempilo kweziguli ezihlinzwa izinhlungu zomdlavuza wesisu sibi, ngakho-ke zidinga ukusekelwa okunomsoco wesikhathi eside, kodwa ukukhishwa kwesisu kweziguli kuvinjwe kakhulu. Ngakho-ke, akunconywa ukukhetha ukubekwa kwepayipi elingaphandle kwe-nasal, futhi ukufakwa kwe-fistula ngaphakathi kokuhlinzwa kuyisinqumo esinengqondo. U-Zhang moucheng nabanye babika ukuthi kusetshenziswe ithubhu le-gastrojejunostomy, imbobo encane yenziwa ngodonga lwesisu sesiguli, ipayipi elincane (elinobubanzi obungu-3mm) lafakwa ngembobo encane, futhi langena ku-jejunum nge-pylorus ne-duodenum. Indlela ye-suture ye-double purse string yasetshenziswa ukuze kubhekwane nokusikeka kodonga lwesisu, futhi ishubhu le-fistula laligxilile emhubheni wodonga lwesisu. Le ndlela ifaneleka kakhulu ezigulini ezine-palliative. I-tube ye-Gastrojejunostomy inezinzuzo ezilandelayo: isikhathi sokuhlala isikhathi eside kunezinye izindlela zokufakelwa, ezingagwema ngokuphumelelayo umgudu wokuphefumula kanye nokutheleleka kwamaphaphu okubangelwa i-nasogastric jejunostomy tube; I-Suture kanye nokulungiswa nge-catheter yodonga lwesisu kulula, futhi amathuba okuba ne-gastric stenosis kanye ne-fistula yesisu aphansi; Isikhundla sodonga lwesisu siphakeme kakhulu, ukuze ugweme inani elikhulu lama-ascites avela ku-metastasis yesibindi ngemva kokuhlinzwa komdlavuza wesisu, cwilisa i-fistula tube futhi unciphise izehlakalo ze-fistula yamathumbu kanye nokutheleleka kwesisu; Isimo esingaphansi kwe-reflux, iziguli akulula ukukhiqiza umthwalo ongokwengqondo.
1.3 Isikhathi sokudla okunomsoco kanye nokukhethwa kwesixazululo sezakhi
Ngokwemibiko yezazi ezifuywayo, iziguli ezithola i-gastrectomy enkulu yomdlavuza wesisu ziqala ukudla okunomsoco nge-jejunal nutrition tube kusuka emahoreni angu-6 kuye kwayi-8 ngemva kokuhlinzwa, futhi zijove u-50ml wesixazululo se-glucose esingu-5% esifudumele kanye / 2h, noma zijove i-emulsion yokudla okunomsoco ngokusebenzisa i-jejunal nutrition tube ngesivinini esifanayo. Uma isiguli singenakho ukungahambi kahle okufana nobuhlungu besisu kanye nokuvuvukala kwesisu, kancane kancane ukwandisa inani, futhi uketshezi olunganele lwengezwe nge-vein. Ngemva kokuba isiguli sesiluleme ngokukhipha indunu, ishubhu lesisu lingakhishwa, futhi ukudla okuwuketshezi kungadliwa ngomlomo. Ngemuva kokuba inani eligcwele loketshezi lingangenwa ngomlomo, i-I-Enteral Feeding Tube ingasuswa. Abangaphakathi embonini bakholelwa ukuthi amanzi okuphuza anikezwa amahora angu-48 ngemuva kokuhlinzwa komdlavuza wesisu. Ngosuku lwesibili ngemva kokuhlinzwa, uketshezi oluhlanzekile lungadliwa ngesikhathi sokudla, uketshezi olugcwele lungadliwa ngesikhathi sesidlo sasemini ngosuku lwesithathu, futhi ukudla okuthambile kungadliwa ngesidlo sasekuseni ngosuku lwesine. Ngakho-ke, okwamanje, alikho izinga elihlanganisiwe lesikhathi kanye nohlobo lokuphakelwa kwangaphambi kokuhlinzwa komdlavuza wesisu. Kodwa-ke, imiphumela iphakamisa ukuthi ukwethulwa komqondo wokuvuselela ngokushesha kanye nokusekelwa kokudla okunomsoco ekuqaleni akukhulisi izehlakalo zezinkinga zangemva kokuhlinzwa, okusiza kakhulu ekubuyiseleni umsebenzi wamathumbu kanye nokumuncwa okusebenzayo kwezakhi ezigulini ezithola i-gastrectomy enkulu, ukuthuthukisa ukusebenza komzimba kweziguli futhi kukhuthaze ukuvuselelwa ngokushesha kweziguli.
2. Ubuhlengikazi bokudla okunomsoco kwangaphambi kwesikhathi
2.1 ubuhlengikazi ngokwengqondo
Ubuhlengikazi bengqondo iyisixhumanisi esibaluleke kakhulu ngemuva kokuhlinzwa komdlavuza wesisu. Okokuqala, izisebenzi zezokwelapha kufanele zethule izinzuzo zokudla okunomsoco ezigulini ngayinye ngayinye, zazise ngezinzuzo zokwelashwa kwesifo esiyinhloko, futhi zethule izimo eziphumelelayo nolwazi lokwelashwa ezigulini ukuze zizisize zakhe ukuzethemba futhi zithuthukise ukuthobela ukwelashwa. Okwesibili, iziguli kufanele zaziswe ngezinhlobo zokudla okunomsoco, izinkinga ezingenzeka kanye nezindlela zokugcoba. Kuyagcizelelwa ukuthi ukwesekwa kokudla okunomsoco kusenesikhathi kuphela okungabuyisela ukuphakelwa ngomlomo ngesikhathi esifushane futhi ekugcineni kubone ukululama kwesifo.
2.2 Enteral Nutrition tube nurse
Ipayipi lokufakela umsoco kufanele linakekelwe kahle futhi lilungiswe kahle ukuze kugwenywe ukucindezelwa, ukugoba, ukusonteka noma ukushelela kwepayipi. Ngeshubhu yokudla okunomsoco ebekwe futhi yalungiswa kahle, izisebenzi zabahlengikazi zingamaka indawo lapho zidlula esikhumbeni ngomaka obomvu, zibambe ukunikezwa kweshifti, zirekhode isikali seshubhu yokudla, futhi zibheke futhi ziqinisekise ukuthi ishubhu lisusiwe noma livaleleke ngephutha. Uma umuthi usetshenziswa ngeshubhu lokuphakelayo, abahlengikazi kufanele benze umsebenzi omuhle ekubulaleni amagciwane nasekuhlanzeni ishubhu lokuphakela. Ishubhu lokuphakelayo kufanele lihlanzwe kahle ngaphambi nangemva komuthi, futhi umuthi kufanele uchotshozwe ngokugcwele futhi uhlakazwe ngokwesilinganiso esimisiwe, ukuze kugwenywe ukuvaleka kwepayipi okubangelwa ukuxutshwa kwezingcezu ezinkulu zemithi ekhambisweni lomuthi, noma ukuhlanganiswa okunganele komuthi nesixazululo sezakhi, okuholela ekwakhekeni kwamahlule futhi kuvalwe ipayipi. Ngemuva kokufakwa kwesisombululo sezakhi, ipayipi lizohlanzwa. Ngokuvamile, u-50ml ka-5% we-glucose ye-sodium chloride umjovo ungasetshenziswa ukugeza, kanye ngosuku. Esimeni sokufakwa okuqhubekayo, abasebenzi abahlengikazi kufanele bahlanze ipayipi ngesirinji engu-50ml futhi bayishaye njalo ngo-4H. Uma ukumnika kudinga ukumiswa okwesikhashana phakathi nenqubo yokufaka, abasebenzi abahlengikazi kufanele futhi bageze i-catheter kusenesikhathi ukuze bagweme ukuqiniswa noma ukuwohloka kwesisombululo sezakhi ngemva kokubekwa isikhathi eside. Uma kwenzeka kuba ne-alamu yephampu yokumnika ngesikhathi sokumnika, qala ngokuhlukanisa ipayipi lezakhi kanye nepompo, bese ugeza ipayipi lezakhi kahle. Uma ipayipi lezakhi lingavinjelwa, hlola ezinye izizathu.
2.3 Ukunakekela izinkinga
2.3.1 izinkinga zesisu
Izinkinga ezivame kakhulu zokwesekwa komsoco we-enteral isicanucanu, ukuhlanza, isifo sohudo nobuhlungu besisu. Izimbangela zalezi zinkinga zihlobene eduze nokungcoliswa kokulungiswa kwesisombululo sezakhi, ukugxila okuphezulu kakhulu, ukumnika okusheshayo kanye nezinga lokushisa eliphansi kakhulu. Abahlengikazi kufanele banake ngokugcwele lezi zici ezingenhla, bagade njalo futhi bahlole njalo ngemva kwemizuzu engama-30 ukuze baqinisekise ukuthi izinga lokushisa kanye nesivinini sokwehla kwesisombululo sezakhi kujwayelekile yini. Ukumiswa nokugcinwa kwesixazululo sezakhi kufanele kulandele ngokuqinile izinqubo zokusebenza ze-aseptic ukuvimbela ukungcoliswa kwesisombululo sezakhi. Naka ukusebenza kwesiguli, uqinisekise ukuthi kuhambisana nokushintsha kwemisindo yamathumbu noma ukuphuma kwesisu, futhi ubheke ubunjalo bendle. Uma kunezimpawu zokungaphatheki kahle ezifana nesifo sohudo kanye nokuphazamiseka kwesisu, ukumnika kufanele kumiswe ngokwesimo esithile, noma isivinini sokumnika kufanele sehliswe ngokufanelekile. Ezimweni ezimbi kakhulu, ishubhu lokuphakelayo lingasetshenzwa ukuze kujove izidakamizwa ze-gastrointestinal motility.
2.3.2 ukulangazelela
Phakathi kwezinkinga ezihlobene nokudla okunomsoco, ukulangazelela yiyona eyingozi kakhulu. Izimbangela eziyinhloko ukungaqedi kahle kwesisu kanye ne-nutrient reflux. Ezigulini ezinjalo, abasebenzi abahlengikazi bangazisiza ukugcina indawo yokuhlala noma indawo yokuhlala, noma ukuphakamisa ikhanda lombhede ngama-30.° ukuze ugweme i-reflux yesisombululo sezakhi, futhi ugcine lesi sikhundla kungakapheli imizuzu engama-30 ngemuva kokumnika isisombululo sezakhi. Uma kwenzeka isifiso ngephutha, izisebenzi zabahlengikazi kufanele ziyeke ukumnika ngesikhathi, zisize isiguli sigcine indawo yokulala efanele, ukwehlisa ikhanda, ukuqondisa isiguli ukukhwehlela ngokuphumelelayo, ukumunca izinto eziphefumulayo emgwaqeni womoya ngesikhathi futhi ukuncela okuqukethwe kwesisu sesiguli ukuze kugwenywe ukuqhubeka kwe-reflux; Ngaphezu kwalokho, ama-antibiotic ajovwa nge-intravenously ukuvimbela nokwelapha izifo zamaphaphu.
2.3.3 ukopha emathunjini
Uma iziguli ezinomsoco we-enteral zinejusi yesisu esinsundu noma indle emnyama, kufanele kucatshangelwe ukuthi kungenzeka ukopha kwamathumbu. Abahlengikazi kufanele bazise udokotela kusenesikhathi futhi babhekisise ukushaya kwenhliziyo yesiguli, umfutho wegazi nezinye izinkomba. Ezigulini ezinokopha okuncane, ukuhlolwa kwejusi yesisu esihle kanye negazi le-fecal occult, izidakamizwa ezivimbela i-asidi zinganikezwa ukuze zivikele i-mucosa yesisu, futhi Ukudla kwe-Nasogastric kungaqhutshwa ngesisekelo sokwelashwa kwe-hemostatic. Ngalesi sikhathi, izinga lokushisa le-Nasogastric Feeding lingancishiswa libe ngu-28℃~ 30℃; Iziguli ezinokopha okukhulu kufanele zizile ukudla ngokushesha, zinikezwe izidakamizwa ze-antacid kanye nezidakamizwa ze-hemostatic ngomthambo, zigcwalise umthamo wegazi ngesikhathi, zithathe i-50ml ye-ice saline exutshwe ne-2 ~ 4mg ye-norepinephrine kanye nokudla kwekhala njalo nge-4h, futhi iqaphe ngokucophelela izinguquko zesimo.
2.3.4 ukuvinjwa kwemishini
Uma ipayipi lokumnika lihlanekezelwe, ligobile, livinjiwe noma ligudlukile, indawo yesiguli kanye nokuma kwe-catheter kufanele kulungiswe. Uma i-catheter ivinjiwe, sebenzisa isirinji ukuze udwebe inani elifanele lesaline evamile ukuze ukhiphe umfutho. Uma ukugungiswa kungasebenzi, thatha i-chymotrypsin eyodwa bese uyixuba no-20ml kasawoti ojwayelekile wokugungiswa, futhi ugcine isenzo esimnene. Uma ingekho kulezi zindlela ezingenhla esebenzayo, nquma ukuthi uzolibeka yini kabusha ishubhu ngokuvumelana nesimo esithile. Uma ishubhu ye-jejunostomy ivinjiwe, okuqukethwe kungampontshwa kuhlanzeke ngesirinji. Ungafaki intambo yomhlahlandlela ukuze udonse i-catheter ukuvimbela ukulimala nokugqabuka kwe-catheteri-catheter yokudla.
2.3.5 izinkinga ze-metabolic
Ukusetshenziswa kokwesekwa kokudla okunomsoco kungadala ukuphazamiseka kweglucose egazini, kanti isimo se-hyperglycemic somzimba sizoholela ekuzalweni kwamagciwane ngokushesha. Ngasikhathi sinye, ukuphazamiseka kwe-glucose metabolism kuzoholela ekunikezeni amandla anganele, okuzoholela ekwehleni kokungazweli kweziguli, kubangele ukutheleleka nge-enterogenous, kuholele ekungasebenzi kahle kwe-gastrointestinal, futhi futhi kuyimbangela eyinhloko yokwehluleka kwezitho eziningi zesistimu. Kumele kuqashelwe ukuthi iziguli eziningi ezinomdlavuza wesisu ngemva kokufakelwa kwesibindi zihambisana nokuphikiswa kwe-insulin. Ngesikhathi esifanayo, banikezwa i-hormone yokukhula, izidakamizwa zokulwa nokwenqaba kanye nenani elikhulu lama-corticosteroids ngemva kokuhlinzwa, okuqhubeka kuphazamisa i-glucose metabolism futhi kunzima ukulawula inkomba ye-glucose yegazi. Ngakho-ke, lapho sengeza i-insulin, kufanele siqaphe ngokucophelela izinga likashukela wegazi leziguli futhi silungise ukugcwala kweglucose egazini. Lapho beqala ukwesekwa kokudla okunomsoco, noma beshintsha isivinini sokumnika kanye nenani lokufakwayo lesisombululo sezakhi, abasebenzi abahlengikazi kufanele baqaphe inkomba yeglucose yomunwe kanye nezinga le-glucose yomchamo wesiguli njalo ngo-2 ~ 4H. Ngemuva kokuqinisekisa ukuthi i-glucose metabolism izinzile, kufanele ishintshwe ibe njalo emahoreni ama-4 ~ 6. Isivinini sokufakwa kanye nenani lokufakwayo kwe-islet hormone kufanele kulungiswe ngokufanele kuhlanganiswe nokushintsha kwezinga le-glucose yegazi.
Ukufingqa, ekusetshenzisweni kwe-FIS, kuphephile futhi kungenzeka ukwenza ukwesekwa kokudla okunomsoco ekuqaleni kwesigaba sokuqala ngemuva kokuhlinzwa komdlavuza wesisu, okusiza ekuthuthukiseni isimo somsoco womzimba, ukwandisa ukudla okushisa namaprotheni, ukuthuthukisa ibhalansi ye-nitrogen engemihle, ukunciphisa ukulahlekelwa komzimba nokunciphisa izinkinga ezihlukahlukene zangemva kokuhlinzwa, futhi kunomphumela omuhle wokuvikela i-gastrointe ye-gastrointestinal; Ingakhuthaza ukululama kokusebenza kwamathumbu eziguli, inciphise ukuhlala esibhedlela futhi ithuthukise izinga lokusetshenziswa kwezinsiza zezokwelapha. Kuwuhlelo olwamukelwa iziguli eziningi futhi ludlala indima enhle ekululameni kanye nokwelashwa okuphelele kweziguli. Ngocwaningo olujulile lomtholampilo lokwesekwa kwangaphambi kokuhlinzwa kokudla okunomsoco komdlavuza wesisu, amakhono awo obuhlengikazi nawo athuthukiswa ngokuqhubekayo. Ngobuhlengikazi bezengqondo bangemva kokuhlinzwa, ukuhlengikaza kwamashubhu okunomsoco kanye nokuhlengikaza okuhlosiwe okuhlosiwe, amathuba okuba nezinkinga zesisu, ukulangazelela, izinkinga ze-metabolic, ukopha emathunjini kanye nokuvinjwa kwemishini kuncipha kakhulu, okudala isisekelo esihle sokusebenza kwezinzuzo ezingokwemvelo zokusekela ukudla okunomsoco.
Umbhali wokuqala: Wu Yinjiao
Isikhathi sokuthumela: Apr-15-2022