Ma'anar asali
Abinci mai gina jiki na iyaye (PN) shine wadatar abinci mai gina jiki daga hanji azaman tallafin abinci mai gina jiki kafin da bayan tiyata da kuma ga marasa lafiya marasa lafiya. Ana ba da duk abinci mai gina jiki ta hanyar iyaye, wanda ake kira jimlar parenteral nutrition (TPN). Hanyoyin abinci mai gina jiki na mahaifa sun haɗa da abinci mai gina jiki na gefe da abinci mai gina jiki na tsakiya. Abinci mai gina jiki na iyaye (PN) shine wadataccen abinci mai gina jiki da marasa lafiya ke buƙata, gami da adadin kuzari (carbohydrates, emulsion mai mai), amino acid masu mahimmanci da marasa mahimmanci, bitamin, electrolytes, da abubuwan ganowa. An raba abinci mai gina jiki na iyaye zuwa cikakkiyar abinci mai gina jiki na mahaifa da ƙarin ƙarin abinci na mahaifa. Manufar ita ce don bawa marasa lafiya damar kula da yanayin abinci mai gina jiki, samun nauyi da warkar da raunuka ko da lokacin da ba za su iya cin abinci ba, kuma yara ƙanana na iya ci gaba da girma da girma. Hanyoyin jiko na jiko da dabarun jiko sune lamuni masu mahimmanci ga abinci mai gina jiki na mahaifa.
Alamomi
Alamu na asali don abinci mai gina jiki na mahaifa sune waɗanda ke da tabarbarewar gastrointestinal ko gazawa, gami da waɗanda ke buƙatar tallafin abinci na mahaifa na gida.
Mahimman tasiri
1. Ciwon ciki
2. Rashin aikin sha na gastrointestinal tract: ① Shortancin ciwon hanji: ƙananan ƙwayar hanji mai yawa> 70% ~ 80%; ② Ƙananan ciwon hanji: cututtuka na tsarin rigakafi, ischemia na hanji, fistulas na hanji da yawa; ③ Radiation enteritis, ④ Zawo mai tsanani, amai da ba za a iya jurewa ba> Kwana 7.
3. Mummunan pancreatitis: Jiko na farko don ceto girgiza ko MODS, bayan mahimman alamun sun tabbata, idan ba a kawar da gurɓatawar hanji ba kuma ba za a iya jurewa da abinci mai gina jiki gaba ɗaya ba, alama ce ta abinci mai gina jiki na parenteral.
4. High catabolic jihar: m konewa, m fili raunuka, cututtuka, da dai sauransu.
5. Mummunan rashin abinci mai gina jiki: Rashin abinci mai gina jiki na furotin-calorie sau da yawa yana tare da rashin aikin gastrointestinal kuma ba zai iya jure wa abinci mai gina jiki ba.
Tallafi yana da inganci
1. Lokacin aiki na babban tiyata da rauni: Taimakon abinci mai gina jiki ba shi da wani tasiri mai mahimmanci ga marasa lafiya da yanayin abinci mai kyau. Akasin haka, yana iya ƙara rikice-rikice na kamuwa da cuta, amma yana iya rage rikice-rikicen bayan tiyata ga marasa lafiya da rashin abinci mai gina jiki mai tsanani. Marasa lafiya masu tsananin rashin abinci mai gina jiki suna buƙatar tallafin abinci mai gina jiki na kwanaki 7-10 kafin tiyata; ga wadanda ake sa ran kasa dawo da aikin gastrointestinal cikin kwanaki 5-7 bayan babban tiyata, yakamata a fara tallafin abinci mai gina jiki na mahaifa a cikin sa'o'i 48 bayan tiyata har sai mara lafiya ya sami isasshen abinci mai gina jiki. Abinci mai gina jiki ko cin abinci.
2. Ciwon yoyon fitsari: A karkashin yanayin kula da kamuwa da cuta da isassun magudanar ruwa, tallafin abinci mai gina jiki na iya sa fiye da rabin yoyocutaneous fistulas su warke, kuma fitaccen tiyata ya zama magani na karshe. Tallafin abinci mai gina jiki na iyaye na iya rage fitar da ruwa na gastrointestinal fili da kwararar yoyon fitsari, wanda ke da fa'ida don sarrafa kamuwa da cuta, inganta yanayin abinci mai gina jiki, inganta yanayin warkewa, da rage rikice-rikicen tiyata da mace-mace.
3. Ciwon hanji mai kumburi: Cutar Crohn, ulcerative colitis, tarin fuka na hanji da sauran marasa lafiya suna cikin matakin cutar aiki, ko kuma masu rikitarwa tare da kumburin ciki, fistula na hanji, toshewar hanji da zub da jini, da sauransu, abinci mai gina jiki na mahaifa hanya ce mai mahimmancin magani. Yana iya sauƙaƙa alamun bayyanar cututtuka, inganta abinci mai gina jiki, huta na hanji, da sauƙaƙe gyaran ƙwayar hanji.
4.Masu fama da cutar tamowa mai tsanani: Ga marasa lafiya da nauyin jiki ya ragu ≥ 10% (nauyin jiki na yau da kullun), yakamata a ba da tallafin abinci mai gina jiki na mahaifa ko na ciki kwanaki 7 zuwa 10 kafin tiyata, har sai abinci mai gina jiki ko kuma komawa cin abinci bayan tiyata. har zuwa.
5. Rashin wadatar muhimman gabobi:
① Rashin wadatar hanta: marasa lafiya tare da hanta cirrhosis suna cikin ma'auni mara kyau na abinci mai gina jiki saboda rashin isasshen abinci. A lokacin aikin hanta cirrhosis ko ciwon hanta, ciwon hanta, da kuma makonni 1 zuwa 2 bayan dashen hanta, waɗanda ba za su iya ci ba ko samun abinci mai gina jiki na ciki ya kamata a ba su tallafin abinci mai gina jiki na mahaifa.
② Rashin gazawar koda: m cututtukan catabolic (kamuwa da cuta, rauni ko gazawar gabobin jiki da yawa) hade tare da gazawar renal mai tsanani, marasa lafiya na rashin abinci mai gina jiki na koda, kuma suna buƙatar tallafin abinci mai gina jiki na mahaifa saboda ba za su iya ci ko karɓar abinci mai gina jiki ba. A lokacin dialysis don gazawar koda na yau da kullun, ana iya shigar da cakuda abinci mai gina jiki na mahaifa yayin ƙarin jini a cikin jijiya.
③ Rashin wadatar zuciya da huhu: sau da yawa a hade tare da gina jiki-makamashi gauraye tamowa. Abinci mai gina jiki yana inganta yanayin asibiti da aikin gastrointestinal a cikin cututtuka na huhu na kullum (COPD) kuma yana iya amfanar marasa lafiya da ciwon zuciya (shaida ba ta da yawa). Ba a riga an ƙayyade madaidaicin rabo na glucose zuwa mai a cikin marasa lafiya na COPD ba, amma ya kamata a ƙara yawan kitsen, adadin adadin glucose da jiko ya kamata a sarrafa, ya kamata a samar da furotin ko amino acid (aƙalla lg/kg.d), kuma ya kamata a yi amfani da isasshen glutamine ga marasa lafiya da ke fama da cutar huhu. Yana da amfani don kare alveolar endothelium da ƙwayar lymphoid mai alaƙa da hanji da rage matsalolin huhu. Takaitaccen abun ciki na hanji: perarfafa tallafin abinci mai gina jiki na makonni 4 zuwa 6 yana da amfani ga murmurewa da aikin hanji da kuma taimako na toshewar.
Contraindications
1. Wadanda ke da aikin gastrointestinal na yau da kullun, daidaitawa zuwa abinci mai gina jiki ko dawo da aikin gastrointestinal cikin kwanaki 5.
2. Mara lafiya, babu bege na rayuwa, mutuwa ko marassa lafiya ta koma baya.
3. Wadanda suke buƙatar tiyata na gaggawa kuma ba za su iya aiwatar da tallafin abinci mai gina jiki ba kafin tiyata.
4. Ayyukan zuciya na zuciya ko rashin lafiya mai tsanani yana buƙatar sarrafawa.
Hanyar abinci mai gina jiki
Zaɓin hanyar da ta dace ta abinci mai gina jiki ta mahaifa ya dogara da dalilai kamar tarihin huda jijiyoyin bugun jini, yanayin jijiya, matsayin coagulation, tsawon lokacin da ake tsammani na abinci na mahaifa, saitin kulawa (a asibiti ko a'a), da yanayin cututtukan da ke ciki. Ga marasa lafiya, gajeriyar jijiya na ɗan gajeren lokaci ko shigar da jijiya ta tsakiya shine zaɓi na kowa; ga marasa lafiya na dogon lokaci a cikin wuraren da ba na asibiti ba, an fi amfani da jijiyoyi na gefe ko na tsakiya, ko akwatunan jiko na subcutaneous.
1. Hanyar abinci mai gina jiki ta mahaifa ta gefe
Alamomi: ① Abincin abinci na mahaifa na ɗan gajeren lokaci (<2 makonni), maganin osmotic matsa lamba ƙasa da 1200mOsm/LH2O; ② Tsakanin venous catheter contraindication ko rashin yiwuwar; ③ kamuwa da cutar catheter ko sepsis.
Abũbuwan amfãni da rashin amfani: Wannan hanya mai sauƙi ne kuma mai sauƙi don aiwatarwa, zai iya kauce wa rikitarwa (masu aikin injiniya, kamuwa da cuta) da suka shafi catheterization na tsakiya na tsakiya, kuma yana da sauƙin gano abin da ya faru na phlebitis da wuri. Rashin hasara shi ne cewa matsa lamba na osmotic na jiko bai kamata ya zama mai girma ba, kuma ana buƙatar huɗa mai maimaitawa, wanda ke da haɗari ga phlebitis. Saboda haka, bai dace da amfani na dogon lokaci ba.
2. Abincin mahaifa ta hanyar tsakiya
(1) Alamu: abinci mai gina jiki na parenteral na fiye da makonni 2 da maganin osmotic matsa lamba sama da 1200mOsm/LH2O.
(2) Hanyar catheterization: ta hanyar jijiya jugular ciki, jijiya na subclavian ko na gefe na babba zuwa ga mafi girma vena cava.
Abũbuwan amfãni da rashin amfani: Catheter subclavian vein catheter yana da sauƙi don motsawa da kulawa, kuma babban rikitarwa shine pneumothorax. Catheterization ta hanyar jijiya jugular na ciki yana iyakance motsi na jugular da sutura, kuma ya haifar da ɗan ƙara rikitarwa na hematoma na gida, raunin jijiya da kamuwa da cutar catheter. Peripheral vein-to-central catheterization (PICC): Jijiya mai daraja ya fi fadi da sauƙin sakawa fiye da jijiyar cephalic, wanda zai iya guje wa matsaloli masu tsanani kamar pneumothorax, amma yana ƙara yawan thrombophlebitis da raguwar intubation da wahalar aiki. Hanyoyin abinci mai gina jiki na iyaye marasa dacewa sune jijiya jugular waje da jijiyar femoral. Na farko yana da babban adadin ɓataccen wuri, yayin da na ƙarshe yana da yawan ƙwayar cuta.
3. Jiko tare da ƙwanƙwasa catheter a cikin ƙasa ta hanyar catheter ta tsakiya.
Tsarin abinci mai gina jiki
1. Abinci mai gina jiki na iyaye na tsarin daban-daban (serial na kwalba da yawa, duk-in-daya da jakunkuna na diaphragm):
①Multi-kwalba serial watsa: Multiple kwalabe na gina jiki bayani za a iya gauraye da serially daukar kwayar cutar ta hanyar "hanya uku" ko Y-dimbin yawa jiko tube. Ko da yake yana da sauƙi kuma mai sauƙi don aiwatarwa, yana da rashin amfani da yawa kuma bai kamata a ba da shawarar ba.
②Total nutrient solution (TNA) ko duk-in-daya (Ail-in-One): The aseptic hadawa fasaha na jimlar gina jiki bayani shi ne a hada parenteral abinci mai gina jiki kullum sinadaran (glucose, mai emulsion, amino acid, electrolytes, bitamin da alama abubuwa) ) gauraye a cikin jaka sa'an nan infused. Wannan hanya ta sa shigar da abinci mai gina jiki na parenteral ya fi dacewa, kuma shigarwar lokaci guda na nau'o'in abinci mai gina jiki ya fi dacewa ga anabolism. Ƙarshe Saboda filastik mai narkewa mai-mai narkewa na jaka na polyvinyl chloride (PVC) na iya haifar da wasu halayen guba, an yi amfani da polyvinyl acetate (EVA) azaman babban albarkatun jakunkunan abinci na parenteral a halin yanzu. Domin tabbatar da kwanciyar hankali na kowane bangare a cikin maganin TNA, ya kamata a gudanar da shirye-shiryen a cikin ƙayyadadden tsari (duba Babi na 5 don cikakkun bayanai).
③ Jakar diaphragm: A cikin 'yan shekarun nan, an yi amfani da sabbin fasahohi da sabbin kayan robobi (polyethylene/polypropylene polymer) a cikin samar da jakunkuna na maganin abinci na mahaifa. Za a iya adana sabon samfurin cikakken bayani na kayan abinci mai gina jiki (jakar gida biyu, jaka mai ɗaki uku) a cikin zafin jiki na tsawon watanni 24, don guje wa matsalar gurɓataccen kayan abinci mai gina jiki da aka shirya a asibiti. Ana iya yin amfani da shi cikin aminci da dacewa don jiko na abinci na mahaifa ta hanyar jijiya ta tsakiya ko na gefe a cikin marasa lafiya da buƙatun abinci daban-daban. Rashin hasara shi ne cewa ba za a iya cimma daidaitattun tsarin ba.
2. Haɗin gwiwar maganin abinci na mahaifa
Dangane da bukatun abinci mai gina jiki na mai haƙuri da ƙarfin rayuwa, tsara abubuwan da ke tattare da shirye-shiryen abinci mai gina jiki.
3. Matrix na musamman don abinci mai gina jiki na mahaifa
Abinci na asibiti na zamani yana amfani da sababbin matakan don ƙara inganta tsarin abinci mai gina jiki don inganta haƙurin haƙuri. Domin biyan buƙatun jiyya na abinci mai gina jiki, ana samar da kayan abinci na musamman ga marasa lafiya na musamman don haɓaka aikin garkuwar marasa lafiya, haɓaka aikin shingen hanji, da haɓaka ƙarfin antioxidant na jiki. Sabbin shirye-shiryen abinci na musamman sune:
①Fat emulsion: ciki har da tsarin mai emulsion, dogon sarkar, matsakaici-sarkar mai emulsion, da kuma mai emulsion mai arziki a omega-3 fatty acid, da dai sauransu.
②Amino acid shirye-shirye: ciki har da arginine, glutamine dipeptide da taurine.
Tebur 4-2-1 Makamashi da bukatun furotin na marasa lafiya na tiyata
Ƙarfin yanayin haƙuri Kcal/(kg.d) furotin g/(kg.d) NPC: N
Rashin abinci mai gina jiki-matsakaici 20 ~ 250.6 ~ 1.0150: 1
Matsakaicin matsakaici 25 ~ 301.0 ~ 1.5120: 1
Babban damuwa na rayuwa 30 ~ 35 1.5 ~ 2.0 90 ~ 120: 1
Ƙona 35 ~ 40 2.0 ~ 2.5 90 ~ 120: 1
NPC: N kalori maras furotin zuwa rabon nitrogen
Tallafin abinci mai gina jiki na iyaye don cututtukan hanta na yau da kullun da dashen hanta
Ƙarfin da ba na gina jiki ba Kcal/(kg.d) furotin ko amino acid g/ (kg.d)
Cirewar hanta25 ~ 35 0.6 ~ 1.2
Ciwon hanta mai lalacewa 25 ~ 35 1.0
Hepatic encephalopathy 25 ~ 35 0.5 ~ 1.0
25 ~ 351.0 ~ 1.5 bayan dashen hanta
Abubuwan da ke buƙatar kulawa: Abincin baki ko na ciki yawanci ana fifita su; idan ba a yarda da shi ba, ana amfani da abinci mai gina jiki na mahaifa: makamashi yana kunshe da glucose [2g/ (kg.d)] da matsakaici-dogon sarkar mai emulsion [1g/ (kg.d)], mai kitse na 35 ~ 50% na adadin kuzari; Ana samar da tushen nitrogen ta hanyar amino acid mai fili, kuma ciwon hanta yana ƙara yawan adadin amino acid ɗin da aka reshe.
Taimakon abinci mai gina jiki na iyaye don m cututtukan catabolic mai rikitarwa tare da gazawar koda
Ƙarfin da ba na gina jiki ba Kcal/(kg.d) furotin ko amino acid g/ (kg.d)
20 ~ 300.8 ~ 1.21.2 ~ 1.5 (masu ciwon dialysis na yau da kullum)
Abubuwan da ke buƙatar kulawa: Abincin baki ko na ciki yawanci ana fifita su; idan ba a yarda da shi ba, ana amfani da abinci mai gina jiki na mahaifa: makamashi ya ƙunshi glucose [3 ~ 5g / (kg.d)] da emulsion mai mai [0.8 ~ 1.0g / (kg.d))]; Amino acid marasa mahimmanci (tyrosine, arginine, cysteine, serine) na mutane masu lafiya sun zama amino acid masu mahimmanci a wannan lokacin. Ya kamata a kula da sukarin jini da triglycerides.
Tebur 4-2-4 An ba da shawarar adadin yau da kullun na jimlar abinci mai gina jiki na iyaye
Makamashi 20 ~ 30Kcal/(kg.d) [Ruwan ruwa 1 ~ 1.5ml da 1Kcal/(kg.d)]
Glucose 2 ~ 4g/(kg.d) mai 1 ~ 1.5g/(kg.d)
Nitrogen abun ciki 0.1 ~ 0.25g/(kg.d) Amino acid 0.6~1.5g/(kg.d)
Electrolytes (matsakaicin abin da ake buƙata na yau da kullun don manya abinci na mahaifa) Sodium 80 ~ 100mmol Potassium 60 ~ 150mmol Chlorine 80 ~ 100mmol Calcium 5 ~ 10mmol Magnesium 8 ~ 12mmol Phosphorus 10 ~ 30mmol
Vitamins mai narkewa: A2500IUD100IUE10mgK110mg
Vitamins masu narkewar ruwa: B13mgB23.6mgB64mgB125ug
Pantothenic Acid 15mg Niacinamide 40mg Folic Acid 400ugC 100mg
Abubuwan da aka gano: jan karfe 0.3mg aidin 131ug zinc 3.2mg selenium 30 ~ 60ug
Molybdenum 19ug manganese 0.2 ~ 0.3mg Chromium 10 ~ 20ug Iron 1.2mg
Lokacin aikawa: Agusta-19-2022