Umqondo oyisisekelo
I-Parenteral Nutrition (PN) wukunikezwa kokudla okunomsoco okuvela emithanjeni njengokwesekwa kokudla okunempilo ngaphambi nangemuva kokuhlinzwa kanye neziguli ezigula kakhulu. Konke ukudla okunomsoco kunikezwa ngabazali, okubizwa ngokuthi i-total parenteral nutrition (TPN). Izindlela zokudla okunomsoco zibandakanya ukondleka kwe-peripheral emithanjeni kanye nokudla okuphakathi komthambo. Ukondliwa komzali (PN) ukuhlinzekwa ngemithambo kwezakhamzimba ezidingwa iziguli, okuhlanganisa ama-calories (ama-carbohydrate, ama-emulsions amafutha), ama-amino acid abalulekile nangabalulekile, amavithamini, ama-electrolyte, nezici zokulandelela. Ukondleka kwabazali kuhlukaniswe ngokudla okuphelele kwabazali kanye nokudla okuyingxenye komzali okwanelisayo. Inhloso iwukwenza iziguli zikwazi ukugcina isimo somsoco, isisindo somzimba kanye nokuphola kwesilonda ngisho nalapho zingakwazi ukudla ngendlela evamile, futhi izingane ezincane zingaqhubeka zikhula futhi zithuthuke. Imizila yokufakwa emthanjeni nezindlela zokumnika ziyiziqinisekiso ezidingekayo zokudla okunomsoco.
Izinkomba
Izinkomba eziyisisekelo zokudla okunomsoco yilezo ezinenkinga yokungasebenzi kahle kwamathumbu noma ukwehluleka, okuhlanganisa nalabo abadinga ukwesekwa kwabazali basekhaya.
Umphumela obalulekile
1. Ukuvinjwa kwamathumbu
2. Ukungasebenzi kahle kokumuncwa kwepheshana lamathumbu: ① Isifo samathumbu amafushane: ukuphuma kwamathumbu amancane kakhulu >70%~80%; ② Isifo samathumbu amancane: isifo sesimiso sokuzivikela komzimba, i-ischemia yamathumbu, i-fistula yamathumbu amaningi; ③ I-radiation enteritis, ④ Uhudo olunzima, ukuhlanza ngokocansi okungalawuleki > izinsuku eziyi-7.
3. I-pancreatitis enzima: Ukuniselwa kokuqala ukuze kuhlenge ukushaqeka noma i-MODS, ngemva kokuba izimpawu ezibalulekile zizinzile, uma ukukhubazeka kwamathumbu kungaqediwe futhi ukudla okunomsoco akukwazi ukubekezelelwa ngokugcwele, kuyinkomba yokudla kwabazali.
4. Isimo esiphezulu se-catabolic: ukushisa okukhulu, ukulimala okuhlangene okunzima, izifo, njll.
5. Ukungondleki okukhulu: Ukungondleki kahle kwamaprotheni kuvame ukuhambisana nokungasebenzi kahle kwamathumbu futhi akukwazi ukubekezelela ukudla okunomsoco.
Ukusekela kuvumelekile
1. Isikhathi sokuhlinzwa sokuhlinzwa okukhulu nokuhlukumezeka: Ukusekelwa kokudla okunomsoco akunawo umthelela obalulekile ezigulini ezinesimo esihle somsoco. Ngokuphambene nalokho, kungase kwandise izinkinga zokutheleleka, kodwa kunganciphisa izinkinga zangemva kokuhlinzwa ezigulini ezinokungondleki okunzima. Iziguli ezingondlekile kakhulu zidinga ukwesekwa kokudla okunomsoco izinsuku ezingu-7-10 ngaphambi kokuhlinzwa; kulabo okulindeleke ukuthi bahluleke ukubuyisela ukusebenza kwamathumbu phakathi kwezinsuku ezingu-5-7 ngemva kokuhlinzwa okukhulu, ukwesekwa komsoco kwabazali kufanele kuqalwe phakathi kwamahora angu-48 ngemva kokuhlinzwa kuze kube yilapho isiguli singaba nokudla okwanele. Ukudla okungenamsoco noma ukudla okudlayo.
2. I-Enterocutaneous fistulas: Ngaphansi kwesimo sokulawula ukutheleleka kanye nokugeleza kwamanzi okwanele nokufanelekile, ukwesekwa kokudla okunomsoco kungenza ngaphezu kwesigamu se-enterocutaneous fistulas zipholise, futhi ukuhlinzwa okuqinisekile sekuyindlela yokugcina yokwelapha. Ukwesekwa kokondliwa kwabazali kunganciphisa ukuphuma koketshezi emathunjini kanye nokugeleza kwe-fistula, okuzuzisa ukulawula ukutheleleka, ukuthuthukisa isimo somsoco, ukuthuthukisa izinga lokwelapha, nokunciphisa izinkinga zokuhlinzwa nokufa.
3. Izifo zamathumbu okuvuvukala: Isifo sikaCrohn, i-ulcerative colitis, isifo sofuba samathumbu nezinye iziguli zisesimweni sesifo esisebenzayo, noma ziyinkimbinkimbi ngethumba lesisu, i-fistula yamathumbu, ukuvinjelwa kwamathumbu kanye nokopha, njll., ukondliwa kwabazali kuyindlela yokwelapha ebalulekile. Ingakwazi ukukhulula izimpawu, ithuthukise umsoco, iphumule umgudu wamathumbu, futhi yenze kube lula ukulungiswa kwe-mucosa yamathumbu.
4. Iziguli ezingondlekile kakhulu zesimila: Ezigulini ezinokuncipha kwesisindo somzimba ≥ 10% (isisindo somzimba esivamile), ukwesekwa komsoco kwabazali noma kwe-enteral kufanele kuhlinzekwe ezinsukwini ezingu-7 kuya kweziyi-10 ngaphambi kokuhlinzwa, kuze kube yilapho ukudla okunomsoco noma ukubuyela ekudleni ngemva kokuhlinzwa. kuze.
5. Ukuntuleka kwezitho ezibalulekile:
① Ukwehluleka kwesibindi: iziguli ezine-cirrhosis yesibindi zisesilinganisweni esibi somsoco ngenxa yokungatholi ukudla okwanele. Ngesikhathi sokusebenza kwesibindi se-cirrhosis noma isimila sesibindi, i-hepatic encephalopathy, kanye neviki eli-1 kuye kwayi-2 ngemuva kokufakelwa kwesibindi, labo abangakwazi ukudla noma ukuthola ukondliwa okungenamsoco kufanele banikezwe umsoco womzali.
② Ukungasebenzi kahle kwezinso: isifo esibi kakhulu (ukutheleleka, ukuhlukumezeka noma ukwehluleka kwezitho eziningi) kuhlanganiswe nokwehluleka okukhulu kwezinso, ukwehluleka kwezinso okungapheli i-dialysis iziguli ezingondlekile, futhi zidinga ukwesekwa komsoco ngenxa yokuthi azikwazi ukudla noma ukuthola ukudla okunomsoco. Phakathi ne-dialysis yokwehluleka kwe-renal okungapheli, ingxube ye-parenteral nutrition ingafakwa ngesikhathi sokumpontshelwa igazi nge-intravenous.
③ Ukwehluleka kwenhliziyo namaphaphu: ngokuvamile kuhlanganiswe nokungondleki okuxubile kwamaprotheni-energy. Ukudla okunomsoco kwangaphakathi kuthuthukisa isimo somtholampilo kanye nokusebenza kwesisu ku-chronic obstructive pulmonary disease (COPD) futhi kungase kuzuze iziguli ezinokwehluleka kwenhliziyo (ubufakazi abukho). Isilinganiso esifanelekile se-glucose kumafutha ezigulini ze-COPD akukakanqunywa, kodwa isilinganiso samafutha kufanele senyuswe, inani eliphelele le-glucose nesilinganiso sokumnika kufanele lilawulwe, amaprotheni noma ama-amino acids kufanele anikezwe (okungenani lg/kg.d), futhi i-glutamine eyanele kufanele isetshenziselwe iziguli ezinesifo esibucayi samaphaphu. Kuyasiza ukuvikela i-alveolar endothelium kanye nezicubu ze-lymphoid ezihambisana namathumbu futhi kunciphise izinkinga zamaphaphu. ④Ukuvimba kwamathumbu okunamathelayo okuvuvukala: Ukwesekwa komsoco kwabazali be-perioperative kumaviki angu-4 kuya kwangu-6 kunenzuzo ekululameni kokusebenza kwamathumbu kanye nokukhululeka kokuvinjwa.
Contraindications
1. Labo abanomsebenzi ovamile wamathumbu, ukuzivumelanisa nokudla okungenamsoco noma ukululama ukusebenza kwamathumbu phakathi kwezinsuku ezingu-5.
2. Okungelapheki, alikho ithemba lokusinda, iziguli ezifayo noma ezingenakulungiseka.
3. Labo abadinga ukuhlinzwa okuphuthumayo futhi abakwazi ukusebenzisa ukwesekwa okunomsoco ngaphambi kokuhlinzwa.
4. Ukusebenza kwenhliziyo nemithambo yegazi noma ukuphazamiseka okukhulu kwe-metabolic kudinga ukulawulwa.
Indlela yokudla okunomsoco
Ukukhethwa komzila ofanele wokudla okunomsoco kwabazali kuncike ezicini ezifana nomlando wokubhoboza kwemithambo yegazi yesiguli, i-venous anatomy, isimo sokuqunjelwa, ubude besikhathi esilindelekile sokudla komzali, ukulungiselelwa kokunakekelwa (esibhedlela noma cha), kanye nesimo sesifo esiwumsuka. Ezigulini ezilalisiwe, ukujova kwe-venous yesikhashana esifushane noma i-central veous intubation yiyona ndlela evamile kakhulu; ezigulini zokwelashwa isikhathi eside ezilungiselelweni ezingekho esibhedlela, i-peripheral venous noma i-central venous intubation, noma amabhokisi okumnika angaphansi kwesikhumba asetshenziswa kakhulu.
1. Umzila wokudla okunomsoco we-peripheral
Izinkomba: ① Ukondleka komzali wesikhathi esifushane (<2 amaviki), isisombululo se-osmotic pressure ngaphansi kuka-1200mOsm/LH2O; ② Ukuphikisana kwe-catheter ye-venous noma okungenakwenzeka; ③ Ukutheleleka nge-catheter noma i-sepsis.
Izinzuzo kanye nokubi: Le ndlela ilula futhi kulula ukuyisebenzisa, ingagwema izinkinga (umshini, ukutheleleka) ezihlobene ne-central catheterization ye-venous, futhi kulula ukubona ukuvela kwe-phlebitis kusenesikhathi. Okubi ukuthi ingcindezi ye-osmotic ye-infusion akufanele ibe phezulu kakhulu, futhi ukubhoboza okuphindaphindiwe kuyadingeka, okuvame ukuba ne-phlebitis. Ngakho-ke, akufanelekile ukusetshenziswa isikhathi eside.
2. Ukondliwa kwabazali ngomthambo omaphakathi
(1) Izinkomba: umsoco womzali isikhathi esingaphezu kwamaviki angu-2 kanye nesixazululo sezakhi zokucindezela kwe-osmotic ephakeme kune-1200mOsm/LH2O.
(2) Umzila we-Catheterization: ngokusebenzisa i-jugular vein yangaphakathi, i-subclavia vein noma i-peripheral vein yomkhawulo ongaphezulu ukuya e-vena cava ephakeme.
Izinzuzo kanye nokubi: I-subclavia vein catheter kulula ukuyihambisa nokunakekela, futhi inkinga enkulu i-pneumothorax. Ukufakwa kwe-cathetering ngomthambo we-jugular wangaphakathi kwanciphisa ukunyakaza nokugqoka kwe-jugular, futhi kwaholela ezinkingeni ezithe xaxa ze-hematoma yendawo, ukulimala komthambo kanye nokutheleleka nge-catheter. I-peripheral vein-to-central catheterization (PICC): Umthambo oyigugu ubanzi futhi kulula ukuwufaka kunomthambo we-cephalic, ongagwema izinkinga ezinkulu ezifana ne-pneumothorax, kodwa wandisa izehlakalo ze-thrombophlebitis kanye ne-intubation dislocation kanye nobunzima bokusebenza. Izindlela zokondleka kwabazali ezingafaneleki umthambo we-jugular wangaphandle kanye nomthambo wesifazane. Okwakuqala kunezinga eliphezulu lokungahambi kahle, kanti lokhu kwakamuva kunezinga eliphezulu lezinkinga ezithathelwanayo.
3. Ukufakwa nge-catheter eshumekwe ngaphansi kwesikhumba ngokusebenzisa umbhobho we-venous omaphakathi.
Uhlelo lokudla okunempilo
1. Ukondliwa kwabazali kwamasistimu ahlukene (i-multi-bottle serial, all-in-one kanye nezikhwama ze-diaphragm):
① Ukudluliswa kwe-serial yamabhodlela amaningi: Amabhodlela amaningi esixazululo sezakhi angaxutshwa futhi adluliselwe uchungechunge ngeshubhu lokumnika elimise okuka-Y. Nakuba ilula futhi kulula ukuyisebenzisa, inobubi obuningi futhi akufanele ikhuthazwe.
②Isamba sesixazululo sezakhi (TNA) noma konke-kokukodwa (i-AIl-in-One): Ubuchwepheshe bokuxuba i-aseptic besixazululo sezakhi eziphelele ukuhlanganisa zonke izithako zansuku zonke zokudla okunomsoco (ushukela, i-fat emulsion, ama-amino acid, ama-electrolyte, amavithamini kanye nezakhi zokulandelela) ) ezixutshwe esikhwameni bese zifakwa. Le ndlela yenza okokufaka kokudla okunomsoco kube lula, futhi okokufaka ngesikhathi esisodwa kwezakhi ezihlukahlukene kunengqondo ngokwengeziwe ku-anabolism. Iyaqeda Ngenxa yokuthi i-plasticizer encibilika ngamafutha yezikhwama ze-polyvinyl chloride (PVC) ingabangela ukusabela okuthile okunobuthi, i-polyvinyl acetate (EVA) isetshenziswe njengempahla eluhlaza eyinhloko yezikhwama zokudla okunomsoco okwamanje. Ukuze kuqinisekiswe ukuzinza kwengxenye ngayinye kwisixazululo se-TNA, ukulungiswa kufanele kwenziwe ngokulandelana okucacisiwe (bheka iSahluko sesi-5 ukuze uthole imininingwane).
③Isikhwama se-diaphragm: Eminyakeni yakamuva, ubuchwepheshe obusha namapulasitiki amasha (i-polyethylene/polypropylene polymer) kusetshenziswe ekukhiqizweni kwezikhwama zesixazululo sokudla okunomsoco okuqediwe. Umkhiqizo omusha wesixazululo somsoco ogcwele (isikhwama esinamakamelo amabili, isikhwama samakamelo amathathu) ungagcinwa ekamelweni lokushisa izinyanga ezingu-24, ukugwema inkinga yokungcoliswa kwesisombululo sezakhi ezilungiselelwe esibhedlela. Ingasetshenziswa ngokuphepha nangokufaneleka kakhudlwana ekufakweni komsoco wabazali ngokusebenzisa umthambo omaphakathi noma umthambo we-peripheral ezigulini ezinezidingo ezihlukile zokudla okunempilo. Okubi ukuthi ukwenziwa komuntu ngamunye kwefomula akukwazi ukufezwa.
2. Ukwakhiwa kwesixazululo sokudla okunomsoco kwabazali
Ngokusho kwezidingo zokudla okunomsoco wesiguli kanye namandla omzimba, yakha ukwakheka kwamalungiselelo okudla okunomsoco.
3. I-matrix ekhethekile yokudla kwabazali
Ukondleka komtholampilo kwanamuhla kusebenzisa izinyathelo ezintsha ukuze kuthuthukiswe ukwakheka kokudla okunomsoco ukuze kuthuthukiswe ukubekezelelana kwesiguli. Ukuze kuhlangatshezwane nezidingo zokwelapha okunomsoco, ama-substrates akhethekile okudla okunomsoco anikezwa iziguli ezikhethekile ukuze kuthuthukiswe umsebenzi wokuzivikela wesiguli, ukuthuthukisa umsebenzi wokuvinjelwa kwamathumbu emathunjini, nokuthuthukisa amandla omzimba we-antioxidant. Amalungiselelo amasha okunomsoco akhethekile yilawa:
①I-emulsion yamafutha: kufaka phakathi i-emulsion yamafutha ehlelekile, i-long-chain, i-emulsion yamafutha e-medium-chain, ne-fat emulsion ecebile nge-omega-3 fatty acids, njll.
②Amalungiselelo e-amino acid: kufaka phakathi i-arginine, i-glutamine dipeptide ne-taurine.
Ithebula 4-2-1 Izidingo zamandla namaprotheni eziguli ezihlinzayo
Isimo sesiguli amandla Kcal/(kg.d) amaprotheni g/(kg.d) NPC: N
Ukungondleki okumaphakathi-okumaphakathi 20~250.6~1.0150:1
Ingcindezi emaphakathi 25~301.0~1.5120:1
Ukucindezeleka okuphezulu kwe-metabolic 30~35 1.5~2.0 90~120:1
Shisa 35~40 2.0~2.5 90~120: 1
I-NPC: N ikhalori elingewona amaprotheni kuya kusilinganiso se-nitrogen
Ukwesekwa komsoco womzali wezifo zesibindi ezingapheli kanye nokufakelwa kwesibindi
Amandla angewona amaprotheni i-Kcal/(kg.d) amaprotheni noma i-amino acid g/(kg.d)
I-cirrhosis enxeshezelwe25~35 0.6~1.2
I-cirrhosis encishisiwe 25~35 1.0
I-Hepatic encephalopathy 25~35 0.5~1.0 (khuphula isilinganiso sama-amino acid e-branched-chain)
25~351.0 ~ 1.5 ngemva kokufakelwa kwesibindi
Izindaba ezidinga ukunakwa: Ukondleka komlomo noma ukudla okungenamsoco ngokuvamile kuyathandwa; uma kungabekezelelwa, umsoco wabazali usetshenziswa: amandla akhiwa i-glucose [2g/(kg.d)] kanye ne-emulsion yamafutha e-medium-long-long-chain [1g/(kg.d)], ama-akhawunti amafutha angu-35 ~ 50% wamakholori; Umthombo we-nitrogen uhlinzekwa ngama-amino acid ayinhlanganisela, futhi i-hepatic encephalopathy inyusa ingxenye yama-branched-chain amino acid.
Ukwesekwa kokondliwa kwabazali kwesifo esibuhlungu se-catabolic esiyinkimbinkimbi nokwehluleka kwezinso okukhulu
Amandla angewona amaprotheni i-Kcal/(kg.d) amaprotheni noma i-amino acid g/(kg.d)
20~300.8~1.21.2~1.5 (iziguli ze-dialysis zansuku zonke)
Izindaba ezidinga ukunakwa: Ukondleka komlomo noma ukudla okungenamsoco ngokuvamile kuyathandwa; uma kungabekezelelwa, umsoco wabazali usetshenziswa: amandla akhiwa i-glucose [3~5g/(kg.d)] kanye ne-emulsion yamafutha [0.8~1.0g/(kg.d))]; ama-amino acid angabalulekile (tyrosine, arginine, cysteine, serine) yabantu abanempilo aba ama-amino acid abalulekile ngokwemibandela ngalesi sikhathi. Ushukela wegazi kanye ne-triglycerides kufanele kuqashelwe.
Ithebula 4-2-4 Inani elinconyiwe lansuku zonke lokudla okuphelele komzali
Amandla 20~30Kcal/(kg.d) [Amanzi 1~1.5ml nge-1Kcal/(kg.d)]
IGlucose 2~4g/(kg.d) Amafutha 1~1.5g/(kg.d)
Okuqukethwe kwe-nitrogen 0.1~0.25g/(kg.d) Amino acid 0.6~1.5g/(kg.d)
Ama-Electrolyte (isilinganiso sesidingo sansuku zonke sabantu abadala abadla umsoco) I-Sodium 80~100mmol Potassium 60~150mmol Chlorine 80~100mmol Calcium 5~10mmol Magnesium 8~12mmol Phosphorus 10~30mmol
Amavithamini ancibilikayo kumafutha: A2500IUD100IUE10mgK110mg
Amavithamini ancibilikayo emanzini: B13mgB23.6mgB64mgB125ug
I-Pantothenic Acid 15mg Niacinamide 40mg Folic Acid 400ugC 100mg
Trace izakhi: ithusi 0.3mg iodine 131ug zinc 3.2mg selenium 30~60ug
Molybdenum 19ug Manganese 0.2~0.3mg Chromium 10~20ug Iron 1.2mg
Isikhathi sokuthumela: Aug-19-2022