Uphononongo lwakutsha nje kwisondlo sokungena kwangethuba kwizigulane ezenza utyando lomhlaza wesisu zichazwe. Eli phepha lenzelwe ireferensi kuphela
1. Iindlela, iindlela kunye nexesha lesondlo sokungena
1.1 isondlo somzimba
Iindlela ezintathu zokufakela zingasetyenziselwa ukubonelela ngenkxaso yesondlo kwizigulane ezinomhlaza wesisu emva kokusebenza: ulawulo lwexesha elinye, ukumpompa ngokuqhubekayo ngempompo yokufakelwa kunye ne-intermittent gravity drip. Uphononongo lweklinikhi lufumanise ukuba isiphumo sokufakwa ngokuqhubekayo ngempompo yokufakwa ingcono kakhulu kunokufakwa komxhuzulane wethutyana, kwaye akukho lula ukuba neentshukumo ezimbi zesisu. Ngaphambi kwenkxaso yesondlo, i-50ml ye-5% ye-glucose ye-sodium chloride inaliti yayisetyenziswa rhoqo ukugungxula. Ebusika, thatha isikhwama samanzi ashushu okanye isifudumezi sombane kwaye usibeke kwelinye icala lombhobho wokufakela kufutshane ne-orifice yetyhubhu ye-fistula yokufudumeza, okanye shushu umbhobho wokufakela kwibhotile ye-thermos ezaliswe ngamanzi ashushu. Ngokuqhelekileyo, ubushushu besisombululo sezondlo kufuneka sibe ngama-37℃~ 40℃. Emva kokuvula iIngxowa yeSondlo ye-Enteral, kufuneka isetyenziswe ngokukhawuleza. Isisombululo sezondlo yi-500ml / ibhotile, kwaye ixesha lokumiswa kokumiswa kufuneka ligcinwe malunga ne-4H. Izinga lokuhla liyi-20 yehla / min imizuzu engama-30 ngaphambi kokuqala kokufakwa. Emva kokuba kungabikho ukuphazamiseka, lungisa izinga lokuhla ukuya kwi-40 ~ 50 yehla / min. emva kokufakwa, gubha ityhubhu nge-50ml ye-5% yesitofu se-glucose ye-sodium chloride. Ukuba ukufakwa akufuneki okwangoku, isisombululo sezondlo siya kugcinwa kwindawo yokugcina ebandayo ye-2℃~ 10℃, kwaye ixesha lokugcina elibandayo aliyi kudlula i-24h.
1.2 isondlo esingena emlonyeni
Isondlo sangaphakathi sibandakanya ikakhuluImibhobho yeNasogastric, ityhubhu ye-gastrojejunostomy, ityhubhu ye-nasoduodenal, i-spiral naso intestinal tube kunyeUmbhobho weNasojejunal. Kwimeko yokuhlala ixesha elide leUmbhobho wesisu, kukho ithuba eliphezulu lokubangela uchungechunge lweengxaki ezifana nokuphazamiseka kwe-pyloric, ukuphuma kwegazi, ukuvuvukala okungapheliyo kwe-gastric mucosa, isilonda kunye nokuguguleka. I-Spiral naso intestinal tube ithambile kwi-texture, akukho lula ukuvuselela i-pathological cavity kunye nomqala wesigulane, kulula ukugoba, kunye nokunyamezela kwesigulane kulungile, ngoko kunokubekwa ixesha elide. Nangona kunjalo, ixesha elide lokubeka umbhobho ngeempumlo kuya kuhlala kubangele ukungonwabi kwizigulana, kwandise amathuba okuba nesondlo solwelo lwe-reflux, kunye nokungaphefumli kakuhle kunokwenzeka. Imeko yesondlo kwizigulana ezenza utyando lokuthomalalisa umhlaza wesisu imbi, ngoko ke zidinga inkxaso yexesha elide yesondlo, kodwa ukukhupha isisu kwezigulana kuthintelwe kakhulu. Ngoko ke, akukhuthazwa ukuba ukhethe ukufakwa kwepayipi ye-transnasal, kwaye ukufakwa kwe-intraoperative ye-fistula kukhetho olufanelekileyo. UZhang moucheng kunye nabanye baxela ukuba ityhubhu ye-gastrojejunostomy isetyenzisiwe, umngxuma omncinci wenziwa ngodonga lwesisu sesigulane, i-hose encinci (enobubanzi obuyi-3mm) yafakwa ngomngxuma omncinci, kwaye yangena kwi-jejunum ngepylorus kunye ne-duodenum. I-double purse string suture method yayisetyenziselwa ukujongana ne-incision yodonga lwesisu, kwaye ityhubhu ye-fistula yayigxininiswe kwi-tunnel wall yesisu. Le ndlela ifaneleke ngakumbi kwizigulane ezithomalalisayo. I-tube ye-Gastrojejunostomy ineenzuzo ezilandelayo: ixesha lokuhlala lide kunezinye iindlela zokufakelwa, ezinokuthi zigweme ngokufanelekileyo indlela yokuphefumula kunye nokusuleleka kwi-pulmonary ebangelwa yi-nasogastric jejunostomy tube; I-Suture kunye nokulungiswa nge-catheter yodonga lwesisu kulula, kwaye amathuba okuba ne-gastric stenosis kunye ne-fistula yesisu iphantsi; Isikhundla sodonga lwesisu siphezulu kakhulu, ukwenzela ukuba ugweme inani elikhulu le-ascites ukusuka kwi-metastasis yesibindi emva kokusebenza komhlaza wesisu, i-fistula ityhubhu ye-soak kunye nokunciphisa iziganeko ze-intestinal fistula kunye nosulelo lwesisu; Ngaphantsi kwe-reflux phenomenon, izigulane azilula ukuvelisa umthwalo wengqondo.
1.3 ixesha lokutya kwe-enteral kunye nokukhethwa kwesisombululo sezondlo
Ngokutsho kweengxelo zabaphengululi basekhaya, izigulane ezifumana i-gastrectomy enzulu yomhlaza wesisu ziqala isondlo se-enteral ngokusebenzisa i-jejunal yesondlo se-tube ukusuka kwiiyure ezi-6 ukuya kwezi-8 emva kokusebenza, kunye nokutofa i-50ml yesisombululo se-glucose efudumeleyo ye-5% kanye / 2h, okanye ukutofa i-emulsion ye-enteral yesondlo nge-tube ye-jejunal yesondlo ngesantya esifanayo. Ukuba isigulane asinakho ukungahambi kakuhle njengentlungu yesisu kunye nokuphazamiseka kwesisu, ngokukhawuleza ukwandisa inani, kwaye ulwelo olunganeleyo longezwa nge-vein. Emva kokuba isigulana sifumene umbhobho ophuma ezimpundu, ityhubhu yesisu inokususwa, kwaye ukutya okungamanzi kunokutyiwa ngomlomo. Emva kokuba isixa esipheleleyo solwelo sinokuginywa ngomlomo, iItyhubhu yokutyisa yangaphakathi inokususwa. Abangaphakathi kwishishini bakholelwa ukuba amanzi okusela anikwa iiyure ezingama-48 emva kotyando lomhlaza wesisu. Ngosuku lwesibini emva kotyando, ulwelo olucacileyo lunokutyiwa ngesidlo sangokuhlwa, ulwelo olupheleleyo lunokutyiwa ngesidlo sasemini ngosuku lwesithathu, kwaye ukutya okuthambileyo kunokutyiwa kwisidlo sakusasa ngosuku lwesine. Ke ngoko, okwangoku, akukho mgangatho umanyeneyo wexesha kunye nohlobo lokutyisa kwangoko emva kokuhlinzwa komhlaza wesisu. Nangona kunjalo, iziphumo zibonisa ukuba ukuqaliswa kwengcamango yokubuyisela ngokukhawuleza kunye nenkxaso yesondlo sokungena kwangethuba akunyusi iziganeko zeengxaki zasemva kokuhlinzwa, okulungele ngakumbi ukubuyiswa komsebenzi wesisu kunye nokufunxa okusebenzayo kwezondlo kwizigulane ezithatha i-gastrectomy enkulu, ukuphucula umsebenzi wokuzivikela wezigulane kunye nokukhuthaza ukuvuselelwa ngokukhawuleza kwezigulane.
2. Ukongiwa kwesondlo sangethuba
2.1 ukonga ngokwasengqondweni
Ukonga ngokwasengqondweni likhonkco elibaluleke kakhulu emva kotyando lomhlaza wesisu. Okokuqala, abasebenzi bezonyango kufuneka bazise iingenelo zesondlo sokungena kwizigulane nganye nganye, babazise ngeenzuzo zonyango lwesifo sokuqala, kwaye bazise iimeko eziyimpumelelo kunye namava okunyanga kwizigulane ukubanceda bakhe ukuzithemba nokuphucula ukuthotyelwa konyango. Okwesibini, izigulane kufuneka zixelelwe ngeentlobo zesondlo se-enteral, iingxaki ezinokwenzeka kunye neendlela ze-perfusion. Kugxininiswa ukuba kuphela ukuxhaswa kwesondlo sokuqala kwe-enteral kunokubuyisela ukutya komlomo ngexesha elifutshane kwaye ekugqibeleni kuqaphele ukubuyiswa kwesi sifo.
2.2 i-enteral nutrition tube nursing
Umbhobho wokufakwa kwesondlo uya kukhathalelwa kwaye ulungiswe kakuhle ukuthintela ukucinezelwa, ukugoba, ukujijeka okanye ukutyibilika kombhobho. Kuba ityhubhu yesondlo ebekwe kwaye ilungiswe ngokufanelekileyo, abasebenzi abahlengikazi banokumakisha indawo apho idlula khona elukhumbeni ngophawu olubomvu, baphathe i-shift handover, barekhode isikali sombhobho wesondlo, kwaye bajonge kwaye baqinisekise ukuba ityhubhu iyasuswa okanye ikhutshwe ngengozi. Xa iyeza lilawulwa ityhubhu yokutya, abasebenzi abahlengikazi kufuneka benze umsebenzi omhle kwi-disinfection kunye nokucoca ityhubhu yokutya. Umbhobho wokutyisa kufuneka ucocwe kakuhle phambi nasemva kweyeza, kwaye iyeza kufuneka lityunyuzwe ngokupheleleyo kwaye linyibilike ngokomlinganiselo omiselweyo, ukuze kuthintelwe ukuvaleka kombhobho obangelwa kukuxutywa kwamaqhekeza echiza elikhulu kakhulu kwisisombululo samayeza, okanye ukudityaniswa okungonelanga kweyeza kunye nesisombululo sezondlo, okukhokelela ekwakhekeni kwamahlwili kunye nokuthintela umbhobho. Emva kokufakwa kwesisombululo sezondlo, umbhobho uya kucocwa. Ngokubanzi, i-50ml ye-5% yeswekile yesodium chloride inaliti ingasetyenziselwa ukugungxulwa, kanye ngemini. Kwimeko yokufakwa ngokuqhubekayo, abasebenzi abongikazi kufuneka bacoce umbhobho ngesirinji eyi-50ml kwaye bayigungxule rhoqo nge-4H. Ukuba i-infusion idinga ukunqunyanyiswa okwethutyana ngexesha lokufakwa kwe-infusions, abasebenzi abahlengikazi kufuneka baphinde bahlambe i-catheter ngexesha lokuphepha ukuqina okanye ukuwohloka kwesisombululo sezondlo emva kokubekwa ixesha elide. Kwimeko ye-alarm yempompo yokufakelwa ngexesha lokungena, okokuqala ukwahlula umbhobho wezondlo kunye nempompo, uze uhlambe umbhobho wezondlo kakuhle. Ukuba umbhobho wezondlo awuphazamiseki, khangela ezinye izizathu.
2.3 Ukonga iingxaki
2.3.1 iingxaki zesisu
Ezona ngxaki zixhaphakileyo zenkxaso yesondlo se-enteral yi-nausea, ukuhlanza, urhudo kunye neentlungu zesisu. Izizathu zezi ngxaki zihambelana ngokusondeleyo nongcoliseko lokulungiswa kwesisombululo sezondlo, ukugxila okuphezulu kakhulu, ukufakwa ngokukhawuleza kunye nobushushu obuphantsi kakhulu. Abasebenzi abongikazi kufuneka banikele ingqalelo epheleleyo kwezi zinto zingasentla, bajikeleze rhoqo kwaye bajonge yonke i-30min ukuze baqinisekise ukuba ubushushu kunye nesantya sokuhla kwesisombululo sezondlo ziqhelekileyo. Ukucwangciswa kunye nokugcinwa kwesisombululo sezondlo kufuneka kulandele ngokungqongqo iinkqubo zokusebenza ze-aseptic ukuthintela ukungcoliseka kwesisombululo sezondlo. Nika ingqalelo kwintsebenzo yesigulana, uqinisekise ukuba ihamba kunye nokutshintsha kwezandi zamathumbu okanye ukukhutshwa kwesisu, kwaye uqaphele ubume be-stool. Ukuba kukho iimpawu ezingathandekiyo ezifana nesifo sohudo kunye nokuphazamiseka kwesisu, ukunyuswa kufuneka kumiswe ngokwemeko ethile, okanye isantya sokufakelwa kufuneka sincitshiswe ngokufanelekileyo. Kwiimeko ezimandundu, ityhubhu yokutyisa inokusetyenzwa ukuze itofwe ngamachiza okuhamba emathunjini.
2.3.2 umnqweno
Phakathi kweengxaki ezinxulumene nesondlo somzimba, ukulangazelela yeyona nto inzima kakhulu. Oonobangela abaphambili kukungaphumi kakuhle kwesisu kunye ne-reflux yezondlo. Kwizigulana ezinjalo, abongikazi banokubanceda bagcine indawo yokuhlala okanye indawo yokuhlala, okanye baphakamise intloko yebhedi ngama-30.° ukuphepha i-reflux yesisombululo sezondlo, kwaye ugcine le ndawo ngaphakathi kwemizuzu engama-30 emva kokufakwa kwesisombululo sezondlo. Kwimeko ye-aspiration ngempazamo, abasebenzi abahlengikazi kufuneka bayeke ukuxilwa ngexesha, bancede isigulane sigcine isikhundla sokulala esifanelekileyo, ukunciphisa intloko, ukukhokela isigulane ukukhohlela ngokufanelekileyo, ukufunxa izinto ezifakwe kwi-airway ngexesha kunye nokufunxa iziqulatho zesisu somguli ukuze ugweme i-reflux eqhubekayo; Ukongezelela, amayeza okubulala iintsholongwane ayetofwa ngomthambo ukukhusela nokunyanga usulelo lwemiphunga.
2.3.3 ukopha emathunjini
Nje ukuba izigulana ezinesondlo sokungeniswa zinejusi yesisu esimdaka okanye isitulo esimnyama, ukubanakho ukopha kwesisu kufuneka kuqwalaselwe. Abasebenzi abongikazi kufuneka baxelele ugqirha ngexesha kwaye baqwalasele ngokusondeleyo izinga lentliziyo yesigulane, uxinzelelo lwegazi kunye nezinye izikhombisi. Kwizigulane ezinokopha okuncinci, uviwo oluhle lwejusi yesisu kunye negazi le-fecal occult, i-acid inhibiting drugs inokunikwa ukukhusela i-gastric mucosa, kunye ne-Nasogastric Feeding inokuqhutyelwa ngesiseko sonyango lwe-hemostatic. Ngeli xesha, ubushushu beNasogastric Feeding bunokuncitshiswa ukuya kuma-28℃~ 30℃; Izigulane ezinomlinganiselo omkhulu wokuphuma kwegazi kufuneka zikhawuleze ngokukhawuleza, zinikwe iziyobisi ze-antacid kunye neziyobisi ze-hemostatic nge-intravenously, zizalise umthamo wegazi ngexesha, zithathe i-50ml ye-ice saline exutywe kunye ne-2 ~ 4mg i-norepinephrine kunye ne-norepinephrine kunye ne-nasal feeding yonke i-4h, kwaye ubeke iliso ngokusondeleyo utshintsho lwemeko.
2.3.4 Ukuphazamiseka koomatshini
Ukuba umbhobho wokufakelwa ugqwethiwe, ugobile, uvalekile okanye ugxothiwe, indawo yomzimba wesigulane kunye nendawo yecatheter kufuneka ilungiswe. Nje ukuba i-catheter ivalwe, sebenzisa isirinji ukuzoba isixa esifanelekileyo sesaline eqhelekileyo yokugungxulwa ngoxinzelelo. Ukuba ukugungxula akusebenzi, thatha ichymotrypsin enye kwaye uyixube ne-20ml yetyuwa eqhelekileyo yokugungxula, kwaye ugcine isenzo esithambileyo. Ukuba akukho nanye yeendlela ezingentla apha, gqiba ekubeni uphinde ubeke ityhubhu ngokwemeko ethile. Xa ityhubhu yejejunostomy ivaliwe, iziqulatho zinokupompa zicoceke ngesirinji. Musa ukufaka isikhokelo socingo lokudonsa i-catheter ukunqanda umonakalo kunye nokugqabhukaukondla i-catheter.
2.3.5 iingxaki ze-metabolic
Ukusetyenziswa kwenkxaso yesondlo sokungena kunokubangela ukuphazamiseka kweglucose yegazi, ngelixa imeko ye-hyperglycemic yomzimba iya kukhokelela ekuzalweni kwebhaktheriya ngokukhawuleza. Kwangaxeshanye, ukuphazamiseka kwemetabolism ye-glucose kuya kukhokelela ekuboneleleni kwamandla okwaneleyo, okuya kukhokelela ekwehleni kokunganyangeki kwezigulana, kubangele usulelo lwe-enterogenous, kukhokelela kukungasebenzi kakuhle kwesisu, kwaye yeyona nto ibangela ukusilela kwamalungu enkqubo ezininzi. Kufuneka kuqatshelwe ukuba izigulane ezininzi ezinomhlaza wesisu emva kokutshintshwa kwesibindi zihamba kunye nokuxhatshazwa kwe-insulin. Ngexesha elifanayo, banikwa i-hormone yokukhula, iziyobisi ezichasayo kunye nenani elikhulu le-corticosteroids emva kokusebenza, ephazamisa ngakumbi i-glucose metabolism kwaye kunzima ukulawula i-glucose index index. Ke ngoko, xa songeza i-insulin, kufuneka sibeke iliso elibukhali izinga leswekile yegazi kwizigulana kwaye sihlengahlengise ngokufanelekileyo ukuxinana kweglucose yegazi. Xa uqala ukuxhaswa kwesondlo se-enteral, okanye ukuguqula isantya se-infusion kunye nesixa segalelo lesisombululo sezondlo, abasebenzi abahlengikazi kufuneka babeke iliso kwi-index ye-glucose yegazi yomnwe kunye nenqanaba le-glucose yomchamo wesigulane rhoqo nge-2 ~ 4H. Emva kokuqinisekisa ukuba i-glucose metabolism izinzile, kufuneka itshintshwe yonke i-4 ~ 6h. Isantya se-infusion kunye nesixa segalelo se-islet hormone kufuneka sihlengahlengiswe ngokufanelekileyo ngokudityaniswa notshintsho lwenqanaba leglucose yegazi.
Ukushwankathela, ekuphunyezweni kweFIS, kukhuselekile kwaye kuyenzeka ukuba kuqhutywe inkxaso yesondlo sokungena kwinqanaba lokuqala emva kotyando lomhlaza wesisu, olunceda ekuphuculeni imeko yesondlo somzimba, ukwandisa ubushushu kunye neprotheni, ukuphucula ibhalansi ye-nitrogen engalunganga, ukunciphisa ilahleko yomzimba kunye nokunciphisa iingxaki ezininzi emva kokuhlinzwa, kunye nefuthe elihle lokukhusela izigulane ze-gastrosastinal; Inokukhuthaza ukubuyiswa kokusebenza kwamathumbu ezigulane, ukunciphisa ukuhlala esibhedlele kunye nokuphucula izinga lokusetyenziswa kwezixhobo zonyango. Sisikimu esamkelwe luninzi lwezigulane kwaye sidlala indima entle ekuchacheni nasekunyangweni ngokubanzi kwezigulane. Ngophando olunzulu lweklinikhi malunga nenkxaso yesondlo sangemva kotyando kumhlaza wesisu, izakhono zabo zokonga nazo ziphuculwa ngokuqhubekayo. Ngomongikazi wengqondo emva kokuhlinzwa, ukongiwa kwetyhubhu yesondlo kunye nonyango olujoliswe kuyo, ukubakho kweengxaki zesisu, ukulangazelela, iingxaki ze-metabolic, ukopha kwesisu kunye nokuphazamiseka kwemishini kuncitshiswa kakhulu, nto leyo eyenza indawo efanelekileyo yokusebenza kweenzuzo zendalo zenkxaso yesondlo sokungena.
Umbhali wokuqala: Wu Yinjiao
Ixesha lokuposa: Apr-15-2022