U-Isaac O. Opole, MD, PhD, ungudokotela ogunyazwe yibhodi onguchwepheshe kwezokwelapha zabadala.Usebenze iminyaka engaphezu kwe-15 e-University of Kansas Medical Center lapho futhi enguprofesa.
I-Percutaneous endoscopic gastrostomy yinqubo lapho ithubhu yokudla eguquguqukayo (ebizwa ngokuthi i-PEG tube) ifakwe ngodonga lwesisu esiswini.Ezigulini ezingakwazi ukugwinya ukudla ngokwazo, amashubhu e-PEG avumela izakhi, uketshezi kanye nemithi ukuthi ihanjiswe ngqo esiswini, isuse isidingo sokudlula emlonyeni kanye ne-esophagus yokugwinya.
Amashubhu okuncelisa awusizo kubantu abangakwazi ukuzondla ngenxa yokugula okuyingozi noma ukuhlinzwa kodwa abasethubeni elihle lokululama.Aphinde asize abantu abangakwazi ukugwinya okwesikhashana noma unomphela kodwa abasebenza ngendlela evamile noma abasondele kokujwayelekile.
Kulesi simo, ishubhu lokuphakelayo lingase libe ukuphela kwendlela yokunikeza ukudla okudingekile kakhulu kanye/noma imithi.Lokhu kubizwa ngokuthi i-enteral nutrition.
Ngaphambi kokuba wenze i-gastrostomy, umhlinzeki wakho wokunakekelwa kwezempilo uzodinga ukwazi ukuthi unanoma yiziphi izimo zempilo ezingapheli (ezifana nomfutho wegazi ophakeme) noma izinto ezingezwani nazo emzimbeni kanye nemithi oyiphuzayo.Kungase kudingeke ukuthi uyeke imithi ethile, efana ne-blood thinners noma i-non-steroidal anti-inflammatory drugs (NSAIDs), kuze kube sekupheleni kokuhlinzwa ukuze unciphise ingozi yokopha.
Ngeke ukwazi ukudla noma ukuphuza amahora ayisishiyagalombili ngaphambi kokuba inqubo namalungiselelo enziwe ukuthi kube khona ozokulanda futhi akuyise ekhaya.
Uma umuntu engakwazi ukudla futhi engakwazi ukukhetha ukusebenzisa ishubhu lokuphakela, uketshezi, ama-calories, nemisoco edingekayo ukuze umuntu aphile kunganikezwa ngomthambo wegazi. Ngokuvamile, ukuthola ama-calories nemisoco esiswini noma emathunjini kuyindlela engcono kakhulu yokuba abantu bathole imisoco edingwa imizimba yabo ukuze isebenze kahle, ngakho amashubhu okuphakelayo ahlinzeka ngemisoco engcono kune-IV fluids.
Ngaphambi kwenqubo yokubeka i-PEG, uzothola ukulaliswa komthambo kanye nokubulala izinzwa endaweni eduze kwesayithi lokusikwa.Ungase futhi uthole ama-antibiotics emithanjeni ukuze uvimbele ukutheleleka.
Umhlinzeki wezempilo uyobe esebeka ishubhu eliguquguqukayo elikhipha ukukhanya elibizwa ngokuthi i-endoscope phansi emphinjeni wakho ukuze lisize ukuqondisa ishubhu langempela odongeni lwesisu.Kucutshungulwa okuncane ukuze kufakwe idiski ngaphakathi nangaphandle kwembobo esiswini; lokhu kuvuleka kubizwa ngokuthi i-stoma.Ingxenye yeshubhu engaphandle komzimba ingamayintshi angu-6 kuya kwangu-12 ubude.
Ngemva kokuhlinzwa, udokotela wakho ohlinzayo uzofaka ibhandishi endaweni yokusikwa.Ungase uzwe ubuhlungu obuthile eduze kwendawo yokusikeka ngemva kokuhlinzwa, noma ukuminyanisa nokungakhululeki ngenxa yegesi.Kungase futhi kube khona ukuvuza okuthile okuwuketshezi endaweni yokusikwa.Le miphumela emibi kufanele yehle phakathi namahora angu-24 kuya kwangu-48. Ngokuvamile, ungakwazi ukususa ibhandishi ngemva kosuku noma ezimbili.
Ukujwayela ishubhu lokuphakelayo kuthatha isikhathi.Uma udinga ishubhu ngoba awukwazi ukugwinya, ngeke ukwazi ukudla nokuphuza ngomlomo wakho.(Ezimweni ezingavamile, abantu abanamashubhu e-PEG basengadla ngomlomo.) Imikhiqizo eklanyelwe ukuphakela amashubhu inikeza zonke imisoco oyidingayo.
Uma ungayisebenzisi, ungateyipha ishubhu esiswini sakho ngeteyiphu yezokwelapha.Isivalo noma isivalo esisekupheleni kweshubhu sivimbela noma iyiphi ifomula ukuthi ingavuzi engutsheni yakho.
Ngemva kokuba indawo ezungeze ishubhu lakho lokuphakela selipholile, uzohlangana nochwepheshe bezokudla noma isazi sokudla okunomsoco ozokubonisa ukuthi ungasebenzisa kanjani ishubhu le-PEG futhi uqale umsoco we-enteral. Nazi izinyathelo ozozilandela lapho usebenzisa amashubhu e-PEG:
Kwezinye izimo, kungase kube nzima ukunquma ukuthi ukupha umuntu ishubhu kuyinto efanele yini nokuthi iyini izimiso zokuziphatha.Izibonelo zalezi zimo zihlanganisa:
Uma wena noma othandekayo egula kakhulu futhi engakwazi ukudla ngomlomo, amashubhu e-PEG anganikeza umzimba okwesikhashana noma unomphela ukushisa nemisoco ukuze ululame futhi uchume.
Amashubhu e-PEG angasetshenziswa izinyanga noma iminyaka.Uma kunesidingo, umhlinzeki wakho wokunakekelwa kwezempilo angakwazi ukususa kalula noma ashintshe ishubhu ngaphandle kokusebenzisa ama-sedative noma ama-anesthetics ngokusebenzisa i-traction eqinile.Ngemva kokukhishwa kweshubhu, ukuvuleka kwesisu sakho kuvala ngokushesha (ngakho uma kuvela ngengozi, kufanele ushayele umhlinzeki wakho wezempilo ngokushesha.)
Kungakhathaliseki ukuthi ukuphakelwa kwe-tube kuthuthukisa izinga lokuphila (QoL) kuncike esizeni sokudla kwe-tube kanye nesimo sesiguli.Ucwaningo luka-2016 lwabheka iziguli eziyi-100 ezathola amashubhu okudla.Ngemva kwezinyanga ezintathu, iziguli kanye/noma abanakekeli baxoxwa.Ababhali baphetha ngokuthi nakuba amashubhu engazange athuthukise izinga lokuphila leziguli, awazange ehle.
Ishubhu lizoba nophawu olubonisa lapho okufanele liguqe khona ngembobo odongeni lwesisu.Lokhu kungakusiza uqinisekise ukuthi ishubhu lisendaweni efanele.
Ungakwazi ukuhlanza ishubhu le-PEG ngokukhipha amanzi afudumele ngeshubhu ngesirinji ngaphambi nangemuva kokuncelisa noma ukuthola imithi, futhi uhlanze iziphetho ngezisuli zokubulala amagciwane.
Okokuqala, zama ukusula ishubhu njengenjwayelo ngaphambi nangemuva kokuphakelwa. Uma ishubhu lingagezwanga noma ifomula yokuphakela iwugqinsi kakhulu, kungenzeka ukuvaleka. Shayela umhlinzeki wakho wezempilo uma ishubhu lingakwazi ukususwa.Ungalokothi usebenzise izintambo nanoma yini enye ukuzama ukuqaqa ishubhu.
Bhalisela iphephandaba lethu lansuku zonke lamathiphu ezempilo futhi uthole amathiphu nsuku zonke angakusiza uphile impilo yakho enempilo.
I-American Society of Gastrointestinal Endoscopy.Funda mayelana ne-percutaneous endoscopic gastrostomy (PEG).
U-Ojo O, u-Keaveney E, u-Wang XH, u-Feng P. Imiphumela ye-enteral tube feeding kwikhwalithi yokuphila ehlobene nempilo ezigulini: ukubuyekezwa okuhlelekile.nutrients.2019; 11 (5) .doi: 10.3390 / nu11051046
U-Metheny NA, u-Hinyard LJ, u-Mohammed KA.Isigameko se-sinusitis esihlobene noqhoqhoqho kanye namashubhu e-nasogastric: isizindalwazi se-NIS.Am J Crit Care.2018;27(1):24-31.doi:10.4037/ajcc2018978
I-Yoon EWT, Yoneda K, Nakamura S, Nishihara K. I-Percutaneous endoscopic gastrojejunostomy (PEG-J): ukuhlaziywa okubuyela emuva kokusetshenziswa kwayo ekugcineni ukondleka kwe-enteral ngemva kokuphakelwa kwesisu okungaphumelelanga.BMJ Open Gastroenterology.2016;3(1):e0000do98:e0000do98 10.1136/bmjgast-2016-000098
U-Kurien M, Andrews RE, Tattersall R, et al.I-Gastrostomy iyalondolozwa kodwa ayithuthukisi ikhwalithi yempilo yeziguli nabanakekeli.I-Clinical Gastroenterology and Hepatology.2017 Jul;15(7):1047-1054.doi:10.1016/j.cgh20.20160101
Isikhathi sokuthumela: Jun-28-2022