Eminyakeni yamuva nje, igama elithi "ukungabekezelelani kokudla" liye lasetshenziswa kabanzi emtholampilo. Uma nje kukhulunywa ngokudla okunomsoco, izisebenzi eziningi zezokwelapha noma iziguli kanye nemindeni yazo zizohlobanisa inkinga yokubekezelelana nokungabekezelelani. Ngakho-ke, kusho ukuthini ngempela ukubekezelelana kokudla okunomsoco? Emisebenzini yomtholampilo, kuthiwani uma isiguli sinokungabekezelelani kokudla okunomsoco? Emhlanganweni Wonyaka Kazwelonke Wokunakekelwa Okubalulekile Kwezokwelapha ka-2018, intatheli yaxoxa noProfessor Gao Lan ovela eMnyangweni Wezezinzwa zeSibhedlela Sokuqala saseJilin University.
Emitholampilo, iziguli eziningi azikwazi ukuthola ukudla okwanele ngokudla okuvamile ngenxa yezifo. Kulezi ziguli, ukwesekwa kokudla okunomsoco kuyadingeka. Nokho, ukudla okunomsoco akulula njengoba kucatshangwa. Phakathi nenqubo yokondla, iziguli kufanele zibhekane nombuzo wokuthi zingakwazi yini ukubekezelela.
USolwazi uGao Lan waveza ukuthi ukubekezelelana kuwuphawu lomsebenzi wamathumbu. Ucwaningo luye lwathola ukuthi ngaphansi kwe-50% yeziguli zemithi yangaphakathi zingakwazi ukubekezelela ukudla okungenamsoco okuphelele ngesikhathi sokuqala; ngaphezu kuka-60% weziguli egunjini labagula kakhulu kubangela ukuphazamiseka kwesikhashana kokudla okunomsoco ngenxa yokungabekezelelani emathunjini noma ukuphazamiseka kokuhamba kwesisu. Lapho isiguli siqala ukungabekezeleli ukudla, kungathinta inani lokudla okuhlosiwe, okuholela emiphumeleni yomtholampilo emibi.
Ngakho-ke, ungahlulela kanjani ukuthi isiguli siyakubekezelela ukudla okunomsoco? UProfesa Gao Lan uthe ithumbu lesiguli lizwakala, kungakhathaliseki ukuthi kukhona ukuhlanza noma ukuguquguquka, kungakhathaliseki ukuthi kukhona isifo sohudo, ukuthi kukhona ukuvuleka kwamathumbu, noma ngabe kukhona ukwanda kwezinsalela zesisu, nokuthi umthamo ohlosiwe ufinyelelwa ngemva kwezinsuku ezingu-2 kuya kwezi-3 zokudla okunomsoco, njll Njengenkomba yokwahlulela ukuthi isiguli sinokubekezelelana kokudla okunomsoco.
Uma isiguli singakutholi ukuphatheka kabi ngemva kokusetshenziswa kokudla okunomsoco, noma uma isisu, isifo sohudo, kanye ne-reflux kwenzeka ngemva kokusetshenziswa kokudla okunomsoco, kodwa kunciphisa ngemva kokwelashwa, isiguli singabhekwa njengokubekezeleleka. Uma isiguli siphethwe ukuhlanza, ukuvuvuka kwesisu, kanye nesifo sohudo ngemva kokuthola ukudla okunomsoco, sinikezwa ukwelashwa okuhambisanayo futhi simiswe isikhashana amahora angu-12, futhi izimpawu azibi ngcono ngemva kokunikezwa kwesigamu sokudla okunomsoco, okubhekwa njengokungabekezelelani kokudla okunomsoco. Ukungabekezelelani kokudla okunomsoco kwangaphakathi kungabuye kuhlukaniswe ukungezwani kwesisu (ukugcinwa kwesisu, ukuhlanza, i-reflux, i-aspiration, njll.) nokungabekezelelani kwamathumbu (uhudo, ukuqunjelwa, ukwanda kwengcindezi yangaphakathi kwesisu).
USolwazi uGao Lan uveze ukuthi lapho iziguli ziba nokungabekezelelani kokudla okunomsoco, ngokuvamile zizobhekana nezimpawu ngokwalezi zinkomba ezilandelayo.
Inkomba 1: Ukuphalaza.
Hlola ukuthi ishubhu le-nasogastric lisendaweni efanele yini;
Yehlisa izinga lokumnika izakhi ngo-50%;
Sebenzisa imithi uma kudingeka.
Inkomba 2: Imisindo yamathumbu.
Misa ukumnika okunomsoco;
Nikeza imithi;
Phinda uhlole njalo emahoreni ama-2.
Inkomba yesithathu: i-abdominal distension/intra-abdominal pressure.
Ukucindezela kwangaphakathi kwesisu kungabonisa ngokuphelele isimo sokunyakaza kwamathumbu amancane kanye nezinguquko zokusebenza kokumuncwa, futhi kuyinkomba yokubekezelela ukudla okunomsoco ezigulini ezigula kakhulu.
Ngomfutho wegazi ophakeme we-intra-abdominal, izinga lokungeniswa kokudla okunomsoco lingagcinwa, futhi ukucindezela kwangaphakathi kwesisu kungaphinde kukalwe njalo emahoreni ayi-6;
Uma umfutho wangaphakathi wesisu uphakeme ngokusesilinganisweni, yehlisa izinga lokumnika ngo-50%, thatha ifilimu yesisu engenalutho ukuze ukhiphe ukuvimbeka kwamathumbu, futhi ukuphinda ukuhlolwa njalo emahoreni ayisi-6. Uma isiguli siqhubeka nokuba nokuphazamiseka kwesisu, izidakamizwa ze-gastrodynamic zingasetshenziswa ngokuvumelana nesimo. Uma ingcindezi ye-intra-abdominal ikhuphuka kakhulu, ukumnika okunomsoco we-enteral kufanele kumiswe, bese kwenziwa ukuhlolwa okuningiliziwe kwamathumbu emathunjini.
Inkomba 4: Uhudo.
Ziningi izimbangela zohudo, njenge-intestinal mucosal necrosis, ukuchitheka, ukuguguleka, ukuncipha kwama-enzyme okugaya ukudla, ischemia ye-mesenteric, i-edema yamathumbu, nokungalingani kwezitshalo zamathumbu.
Indlela yokwelapha ukunciphisa izinga lokudla, ukunciphisa isiko lokudla, noma ukulungisa ifomula yokudla okunomsoco; ukwenza ukwelashwa okuhlosiwe ngokwembangela yohudo, noma ngokwezinga lohudo. Kumele kuqashelwe ukuthi lapho isifo sohudo senzeka ezigulini ze-ICU, akukhuthazwa ukuyeka ukufakwa kokudla okunomsoco, futhi kufanele uqhubeke nokudla, futhi ngesikhathi esifanayo uthole imbangela yokuhuda ukuze unqume uhlelo olufanele lokwelapha.
Inkomba yesihlanu: izinsalela zesisu.
Kunezizathu ezimbili zezinsalela zesisu: izici zesifo kanye nezici zokwelapha.
Izici zezifo zihlanganisa iminyaka yobudala, ukukhuluphala, isifo sikashukela noma i-hyperglycemia, isiguli sihlinzwe isisu, njll.;
Izici zomuthi zihlanganisa ukusetshenziswa kwezidambisi gciwane noma ama-opioid.
Amasu okuxazulula izinsalela zesisu ahlanganisa ukuhlolwa okuphelele kwesiguli ngaphambi kokufaka ukudla okunomsoco, ukusebenzisa izidakamizwa ezikhuthaza ukuhamba kwesisu noma i-acupuncture lapho kudingekile, nokukhetha amalungiselelo anokukhishwa kwesisu ngokushesha;
Ukudla kwe-Duodenal kanye ne-jejunal kunikezwa uma kunensalela yesisu esiningi; umthamo omncane ukhethwa ukuphakelwa kokuqala.
Inkomba yesithupha: i-reflux/aspiration.
Ukuze kuvinjelwe ukulangazelela, abasebenzi bezokwelapha bazophenduka futhi bancele uketshezi lokuphefumula ezigulini ezinenkinga yokuqaphela ngaphambi kokuncelisa amakhala; uma isimo sivuma, phakamisa ikhanda nesifuba sesiguli ngo-30° noma ngaphezulu ngesikhathi sokuncelisa amakhala, futhi ngemva kokuncelisa amakhala Gcina indawo egobile phakathi kwesigamu sehora.
Ngaphezu kwalokho, kubaluleke kakhulu ukuqapha ukubekezelelana kokudla okunomsoco kwesiguli nsuku zonke, futhi ukuphazamiseka okulula kokudla okunomsoco kufanele kugwenywe.
Isikhathi sokuthumela: Jul-16-2021