Nazarin kwanan nan game da abinci mai gina jiki na farko a cikin marasa lafiya da ke yin tiyatar ciwon daji na ciki an bayyana su. Wannan takarda don tunani ne kawai
1. Hanyoyi, hanyoyi da lokacin abinci mai gina jiki
1.1 abinci mai gina jiki
Ana iya amfani da hanyoyin jiko guda uku don ba da tallafin abinci mai gina jiki ga marasa lafiya da ciwon daji na ciki bayan aiki: gudanarwa na lokaci ɗaya, ci gaba da yin famfo ta famfon jiko da ɗigon nauyi na tsaka-tsaki. Nazarin asibiti sun gano cewa sakamakon ci gaba da jiko ta hanyar famfo jiko yana da matukar kyau fiye da jiko na tsaka-tsaki, kuma ba shi da sauƙi a sami mummunan halayen gastrointestinal. Kafin tallafin abinci mai gina jiki, 50ml na 5% glucose sodium chloride allura an yi amfani da shi akai-akai don zubar da ruwa. A lokacin hunturu, ɗauki jakar ruwan zafi ko na'urar wutar lantarki a ajiye shi a ƙarshen bututun jiko kusa da bangon bututun yoyon fitsari don dumama, ko kuma dumama bututun jiko ta kwalban thermos da aka cika da ruwan zafi. Gabaɗaya, zazzabi na maganin abinci ya kamata ya zama 37℃~ 40℃. Bayan budewaJakar Abincin Abinci, ya kamata a yi amfani da shi nan da nan. Maganin abinci mai gina jiki shine 500ml / kwalban, kuma ya kamata a kiyaye lokacin jiko na dakatarwa a kusan 4H. Matsakaicin faduwa shine saukowa 20 / min mintuna 30 kafin fara jiko. Bayan babu rashin jin daɗi, daidaita yawan faduwa zuwa 40 ~ 50 saukad da / min. bayan jiko, zubar da bututu tare da allurar 50ml na 5% glucose sodium chloride allura. Idan ba a buƙatar jiko na ɗan lokaci, za a adana maganin gina jiki a cikin yanayin ajiya mai sanyi na 2℃~ 10℃, kuma lokacin ajiyar sanyi ba zai wuce 24h ba.
1.2 Hanyar abinci mai gina jiki
Abincin ciki ya ƙunshiNasogastric Tubes, gastrojejunostomy tube, nasoduodenal tube, karkace naso bututun hanji daNasojejunal Tube. A cikin yanayin zama na dogon lokaciTubu mai ciki, akwai babban yuwuwar haifar da jerin rikice-rikice irin su toshewar pyloric, zub da jini, kumburin mucosa na ciki na yau da kullun, miki da yashwa. Karkataccen bututun hanji na naso yana da laushi a cikin rubutu, ba sauƙin motsa kogon hanci da makogwaron mara lafiya ba, mai sauƙin lanƙwasa, kuma haƙurin haƙuri yana da kyau, don haka ana iya sanya shi na dogon lokaci. Koyaya, tsawon lokacin sanya bututun ta hanci sau da yawa yana haifar da rashin jin daɗi ga marasa lafiya, yana ƙara yuwuwar sake dawo da ruwa mai gina jiki, kuma rashin fahimta na iya faruwa. Matsayin abinci mai gina jiki na marasa lafiya da ake yi wa tiyatar kwantar da hankali don ciwon daji na ciki ba shi da kyau, don haka suna buƙatar tallafin abinci mai gina jiki na dogon lokaci, amma zubar da ciki na marasa lafiya yana da matukar toshewa. Don haka, ba a ba da shawarar a zaɓi sanya bututun da ke wucewa ta hanci ba, kuma sanya ƙwanƙwasa a ciki shine zaɓi mafi dacewa. Zhang moucheng da sauransu sun ba da rahoton cewa, an yi amfani da bututun gastrojejunostomy, an yi wani ƙaramin rami ta bangon ciki na mara lafiya, an saka wani siririn tiyo (mai diamita na 3mm) ta cikin ƙaramin rami, kuma an shiga jejunum ta pylorus da duodenum. An yi amfani da hanyar suture kirtani na jakunkuna guda biyu don magance ƙaddamar da bangon ciki, kuma an gyara bututun yoyon fitsari a cikin rami na bangon ciki. Wannan hanya ta fi dacewa da marasa lafiya na palliative. Gastrojejunostomy tube yana da wadannan abũbuwan amfãni: lokacin zama ya fi sauran hanyoyin dasa shuki, wanda zai iya kauce wa tsarin numfashi da kuma kamuwa da cutar huhu wanda ya haifar da bututun jejunostomy nasogastric; Suture da gyare-gyare ta hanyar catheter bango na ciki ya fi sauƙi, kuma yiwuwar ciwon ciki da ƙumburi na ciki ya ragu; Matsayin bangon ciki yana da tsayi sosai, don kauce wa babban adadin ascites daga hanta metastasis bayan aikin ciwon daji na ciki, jiƙa bututun fistula da kuma rage yawan ƙwayar hanji da ciwon ciki; Karancin abin da ya faru na reflux, marasa lafiya ba su da sauƙi don haifar da nauyin tunani.
1.3 lokacin abinci mai gina jiki da zaɓin maganin gina jiki
A cewar rahotanni na malaman gida, marasa lafiya da ke jurewa gastrectomy na ciwon daji na ciki sun fara abinci mai gina jiki ta hanyar bututun abinci mai gina jiki daga sa'o'i 6 zuwa 8 bayan aiki, kuma a yi musu allurar 50 ml na ruwan dumi na 5% na glucose sau ɗaya / 2h, ko allurar emulsion na ciki ta hanyar jejunal abinci mai gina jiki a cikin sauri. Idan majiyyaci ba shi da rashin jin daɗi kamar ciwon ciki da kumburin ciki, a hankali ƙara adadin, kuma rashin isasshen ruwa yana ƙara ta hanyar jijiya. Bayan majiyyaci ya warke shaye-shaye na dubura, za a iya cire bututun ciki, kuma za a iya cin abincin ruwa ta baki. Bayan cikakken adadin ruwa za a iya sha ta baki, daBututun Ciyarwar Shiga za a iya cire. Masu binciken masana'antu sun yi imanin cewa ana ba da ruwan sha awanni 48 bayan aikin ciwon daji na ciki. A rana ta biyu bayan tiyata, za a iya cin abinci mai tsabta a lokacin abincin dare, za a iya cin cikakken ruwa a abincin rana a rana ta uku, kuma za a iya cin abinci mai laushi da karin kumallo a rana ta hudu. Sabili da haka, a halin yanzu, babu wani ƙa'ida ɗaya don lokaci da nau'in ciyar da ciwon daji na ciki da wuri. Duk da haka, sakamakon ya nuna cewa gabatarwar ra'ayi na farfadowa da sauri da kuma tallafin abinci mai gina jiki na farko ba ya kara yawan abubuwan da suka faru na rikice-rikice na baya-bayan nan, wanda ya fi dacewa don dawo da aikin gastrointestinal da tasiri mai mahimmanci na abubuwan gina jiki a cikin marasa lafiya da ke fama da gastrectomy mai tsattsauran ra'ayi, inganta aikin rigakafi na marasa lafiya da kuma inganta saurin farfadowa na marasa lafiya.
2. Jinyar da abinci mai gina jiki da wuri
2.1 Ilimin jinya
Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ciki. Da farko, ma'aikatan kiwon lafiya ya kamata su gabatar da fa'idodin abinci mai gina jiki ga marasa lafiya ɗaya bayan ɗaya, sanar da su fa'idodin maganin cututtukan farko, da gabatar da shari'o'in nasara da ƙwarewar jiyya ga marasa lafiya don taimaka musu haɓaka kwarin gwiwa da haɓaka yarda da jiyya. Abu na biyu, ya kamata a sanar da marasa lafiya nau'ikan abinci mai gina jiki, yiwuwar rikitarwa da hanyoyin lalata. An jaddada cewa tallafin abinci mai gina jiki da wuri ne kawai zai iya dawo da ciyarwar baki cikin kankanin lokaci kuma a karshe ya gane farfadowar cutar.
2.2 Ciwon ciki mai gina jiki tube reno
Dole ne a kula da bututun jiko na abinci mai gina jiki da kyau kuma a gyara shi yadda ya kamata don gujewa matsewa, lankwasa, karkatarwa ko zamewar bututun. Don bututun abinci mai gina jiki wanda aka sanya kuma an gyara shi yadda ya kamata, ma'aikatan jinya na iya yiwa wurin da ke wucewa ta fata alama da jajayen alama, su rike aikin mikawa, yin rikodin ma'aunin bututun abinci mai gina jiki, kuma su lura da tabbatar da ko bututun ya ƙaurace ko kuma an ware shi da gangan. Lokacin da aka ba da maganin ta hanyar bututun ciyarwa, ma'aikatan jinya yakamata suyi aiki mai kyau wajen kawar da cututtuka da tsaftace bututun ciyarwa. Ya kamata a tsaftace bututun ciyarwa sosai kafin magani da kuma bayan magani, sannan a datse maganin gaba daya a narkar da shi gwargwadon yadda aka tsara, ta yadda za a kaucewa toshewar bututun da ake samu sakamakon hada gutsuttsuran magunguna masu yawa a cikin maganin maganin, ko rashin isassun maganin da maganin na gina jiki, wanda hakan ya haifar da samuwar jini da toshe bututun. Bayan jiko maganin abinci mai gina jiki, za a tsabtace bututun. Gabaɗaya, ana iya amfani da allurar 50ml na 5% glucose sodium chloride allura don wankewa, sau ɗaya a rana. A cikin ci gaba da jiko, ma'aikatan jinya yakamata su tsaftace bututun tare da sirinji na 50ml kuma a zubar dashi kowane 4H. Idan jiko yana buƙatar dakatar da shi na ɗan lokaci yayin aikin jiko, ma'aikatan jinya suma yakamata su watsar da catheter a cikin lokaci don gujewa ƙarfafawa ko lalacewar maganin gina jiki bayan an sanya shi na dogon lokaci. Idan akwai ƙararrawa na famfo jiko yayin jiko, da farko raba bututun abinci da famfo, sannan a wanke bututun abinci mai gina jiki sosai. Idan bututu mai gina jiki ba ya toshe, duba wasu dalilai.
2.3 jinya na rikitarwa
2.3.1 matsalolin gastrointestinal
Mafi yawan rikitarwa na tallafin abinci mai gina jiki na ciki shine tashin zuciya, amai, gudawa da ciwon ciki. Abubuwan da ke haifar da waɗannan rikice-rikice suna da alaƙa da alaƙa da gurɓatar shirye-shiryen maganin abinci mai gina jiki, da yawa mai yawa, jiko da sauri da ƙarancin zafin jiki. Ya kamata ma'aikatan jinya su ba da cikakkiyar kulawa ga abubuwan da ke sama, su yi sintiri akai-akai kuma su duba kowane minti 30 don tabbatar da ko yanayin zafi da raguwar saurin maganin abinci na al'ada ne. Tsarin tsari da adana kayan abinci yakamata ya bi tsarin aikin aseptic sosai don hana gurɓataccen bayani na gina jiki. Kula da aikin mai haƙuri, tabbatar da ko yana tare da canje-canje a cikin sautin hanji ko kumburin ciki, kuma lura da yanayin stool. Idan akwai alamun rashin jin daɗi kamar gudawa da kumburin ciki, ya kamata a dakatar da jiko bisa ga takamaiman yanayin, ko kuma a rage saurin jiko da kyau. A lokuta masu tsanani, ana iya amfani da bututun ciyarwa don allurar magungunan motsa jiki.
2.3.2
Daga cikin matsalolin da ke da alaƙa da abinci mai gina jiki, buri shine mafi tsanani. Babban abubuwan da ke haifar da su shine rashin zubar da ciki da kuma reflux na gina jiki. Ga irin waɗannan marasa lafiya, ma'aikatan jinya na iya taimaka musu su kula da matsakaicin zama ko matsayi, ko ɗaga kan gadon da 30.° don kauce wa reflux na gina jiki bayani, da kuma kula da wannan matsayi a cikin minti 30 bayan jiko na gina jiki bayani. Idan akwai buri bisa kuskure, ma'aikatan jinya yakamata su dakatar da jiko cikin lokaci, taimaki majiyyaci don kiyaye matsayin da ya dace, rage kai, shiryar da mara lafiya don tari yadda ya kamata, tsotse abubuwan da aka shaka a cikin iska cikin lokaci kuma su tsotse abubuwan cikin cikin mara lafiya don guje wa sake sakewa; Bugu da kari, an yi allurar rigakafin rigakafi ta cikin hanji don rigakafi da kuma magance kamuwa da cutar huhu.
2.3.3 zubar jini na ciki
Da zarar marasa lafiya tare da jiko na abinci mai gina jiki sun sami ruwan 'ya'yan itace na ciki ko kuma baƙar fata, ya kamata a yi la'akari da yiwuwar zubar da jini na ciki. Ya kamata ma'aikatan jinya su sanar da likita a cikin lokaci kuma su kula da bugun zuciyar mai haƙuri, hawan jini da sauran alamomi. Ga marasa lafiya da ƙananan jini, ingantaccen gwajin ruwan ciki da jinin haila, za a iya ba da magungunan hana acid don kare mucosa na ciki, kuma ana iya ci gaba da Ciyarwar Nasogastric bisa tushen maganin hemostatic. A wannan lokacin, ana iya rage yawan zafin jiki na ciyarwar Nasogastric zuwa 28℃~ 30℃; Marasa lafiya masu yawan zubar jini ya kamata su gaggauta yin azumi, a ba su magungunan antacids da magungunan hemostatic a cikin jijiyar jiki, su cika karfin jini a kan lokaci, a rika shan ruwan kankara 50ml gauraye da 2 ~ 4mg norepinephrine da norepinephrine na hanci da kuma ciyar da hanci kowane sa'o'i 4, sannan a sa ido sosai kan yadda yanayin ke faruwa.
2.3.4 toshewar inji
Idan bututun jiko ya lalace, lanƙwasa, toshe ko ɓatacce, ya kamata a gyara matsayin majiyyaci da matsayi na catheter. Da zarar an toshe catheter, yi amfani da sirinji don zana adadin salin da ya dace na al'ada don matsa lamba. Idan flushing ɗin bai yi tasiri ba, ɗauki chymotrypsin guda ɗaya a haɗa shi da saline na al'ada 20ml don yin ruwa, sannan a ci gaba da aiki a hankali. Idan babu ɗayan hanyoyin da ke sama da ke da tasiri, yanke shawarar ko za a sake sanya bututu bisa ga takamaiman yanayin. Lokacin da aka toshe bututun jejunostomy, ana iya fitar da abin da ke ciki da tsabta tare da sirinji. Kar a saka wayar jagora don cire catheter don hana lalacewa da fashewar na'urarciyar da catheter.
2.3.5 rikitarwa na rayuwa
Yin amfani da tallafin abinci mai gina jiki na ciki na iya haifar da rikicewar glucose na jini, yayin da yanayin hyperglycemic na jiki zai haifar da haɓakar haifuwa na kwayan cuta. A lokaci guda kuma, rashin daidaituwar glucose metabolism zai haifar da rashin wadataccen makamashi, wanda zai haifar da raguwar juriya ga marasa lafiya, haifar da kamuwa da cuta, yana haifar da rashin aiki na gastrointestinal, kuma shine babban abin da ke haifar da gazawar tsarin gabobin jiki. Ya kamata a lura cewa yawancin marasa lafiya da ciwon daji na ciki bayan dashen hanta suna tare da juriya na insulin. A lokaci guda kuma, ana ba su hormone girma, magungunan anti rejections da adadi mai yawa na corticosteroids bayan an yi aiki, wanda ke kara yin tsangwama ga glucose metabolism kuma yana da wuyar sarrafa ma'aunin glucose na jini. Don haka, lokacin da ake ƙara insulin, ya kamata mu sa ido sosai kan matakin glucose na marasa lafiya da daidaita matakan glucose na jini a hankali. Lokacin fara tallafin abinci mai gina jiki, ko canza saurin jiko da adadin shigar da sinadarin gina jiki, ma'aikatan jinya yakamata su kula da ma'aunin glucose na jini da matakin glucose na fitsari kowane 2 ~ 4H. Bayan tabbatar da cewa glucose metabolism yana da ƙarfi, ya kamata a canza shi zuwa kowane 4 ~ 6h. Ya kamata a daidaita saurin jiko da adadin shigar da hormone tsibiri daidai a hade tare da canjin matakin glucose na jini.
Don taƙaitawa, a cikin aiwatar da FIS, yana da aminci kuma mai yiwuwa don aiwatar da tallafin abinci mai gina jiki a farkon matakin bayan tiyata na ciwon daji na ciki, wanda ke da amfani don inganta yanayin abinci mai gina jiki, ƙara yawan zafin jiki da furotin, inganta ma'aunin nitrogen mara kyau, rage asarar jiki da rage rikice-rikice daban-daban na postoperative, kuma yana da tasiri mai kyau na kariya ga mucosa na ciki na marasa lafiya; Zai iya inganta farfadowar aikin hanji na marasa lafiya, rage zaman asibiti da inganta yawan amfani da albarkatun likita. Makirci ne da yawancin marasa lafiya suka yarda da shi kuma yana taka rawa mai kyau a cikin farfadowa da cikakkiyar jiyya na marasa lafiya. Tare da zurfin bincike na asibiti akan tallafin abinci mai gina jiki na farko bayan tiyata don ciwon daji na ciki, ƙwarewar reno kuma ana ci gaba da inganta. Ta hanyar postoperative m reno, abinci mai gina jiki tube reno da niyya rikitarwa reno, da yiwuwar na gastrointestinal rikitarwa, aspiration, na rayuwa rikitarwa, gastrointestinal zub da jini da kuma inji toshewa ne ƙwarai rage, wanda halitta m jigo ga exertion na muhimmi abũbuwan amfãni na enteral abinci mai gina jiki goyon baya.
Asalin marubuci: Wu Yinjiao
Lokacin aikawa: Afrilu-15-2022