Ingcamango esisiseko
Isondlo sabazali (PN) kukubonelela ngesondlo esivela kwi-intravenous njengenkxaso yesondlo ngaphambi nasemva kotyando kunye nezigulana ezigula kakhulu. Yonke isondlo ibonelelwa ngabazali, ebizwa ngokuba yi-total parenteral nutrition (TPN). Iindlela zesondlo sabazali ziquka i-peripheral intravenous nutrition kunye nesondlo esisembindini se-intravenous. Isondlo sabazali (PN) kukubonelelwa nge-intravenous yezondlo ezifunekayo kwizigulane, kubandakanywa neekhalori (i-carbohydrates, i-emulsions ye-fat), i-amino acids eyimfuneko kwaye ingabalulekanga, iivithamini, i-electrolytes, kunye ne-trace elements. Isondlo sabazali sahlulwe kwisondlo esipheleleyo sabazali kunye nenxalenye yesondlo somzali. Injongo kukwenza izigulane zikwazi ukugcina isimo sesondlo, ukufumana ubunzima kunye nokuphulukiswa kwamanxeba nangona bengenakudla ngokuqhelekileyo, kwaye abantwana abancinci banokuqhubeka bekhula kwaye baphuhlise. Iindlela zokungena kwi-intravenous kunye nobuchule bokufakelwa ziqinisekiso eziyimfuneko kwisondlo sabazali.
Iimpawu
Iimpawu ezisisiseko zesondlo sabazali zezo zinokungasebenzi kakuhle kwesisu okanye ukungaphumeleli, kubandakanywa nabo bafuna inkxaso yesondlo sasekhaya.
Isiphumo esibalulekileyo
1. Ukuphazamiseka kwesisu
2. Ukungasebenzi kakuhle kokufunxa kwindlela yesisu: ① Isifo samathumbu amafutshane: ukuqhambuka okukhulu kwamathumbu amancinci > 70% ~ 80%; ② Isifo esincinci: isifo se-immune system, intestinal ischemia, i-fistula yamathumbu amaninzi; ③ Imitha ye-enteritis, ④ Urhudo oluqatha, ukugabha ngokwesondo okungenakuchaphazeleka > iintsuku ezisi-7.
3. I-pancreatitis enzima: I-infusion yokuqala yokuhlangula ukutshitshiswa okanye i-MODS, emva kokuba iimpawu ezibalulekileyo zizinzile, ukuba ukukhubazeka kwamathumbu emathunjini akupheli kwaye isondlo se-enteral asikwazi ukunyamezela ngokupheleleyo, luphawu lwesondlo sabazali.
4. I-catabolic state ephezulu: ukutshisa okubanzi, ukulimala kobunzima obunzima, izifo, njl.
5. Ukungondleki kakhulu: Ukungondleki kweprotheyini-ikhalori ihlala ihamba kunye nokungasebenzi kakuhle kwesisu kwaye ayikwazi ukunyamezela isondlo se-enteral.
Inkxaso iyasebenza
1. Ixesha lexesha lotyando olukhulu kunye nokulimala: Inkxaso yesondlo ayinayo impembelelo ebalulekileyo kwizigulane ezinesimo esihle sesondlo. Ngokuchasene noko, kunokunyusa iingxaki zosulelo, kodwa kunokunciphisa iingxaki emva kokuhlinzwa kwizigulane ezinokungondleki kakhulu. Izigulane ezingondlekanga kakhulu zifuna inkxaso yesondlo kwiintsuku ze-7-10 ngaphambi kokuhlinzwa; kwabo balindeleke ukuba bangaphumeleli ukubuyisela umsebenzi wesisu phakathi kweentsuku ze-5-7 emva kokuhlinzwa okukhulu, inkxaso yesondlo somzali kufuneka iqalwe kwiiyure ze-48 emva kokuhlinzwa de isigulane sibe nesondlo esaneleyo. Isondlo sokungena okanye ukutya okudliwayo.
2. I-Enterocutaneous fistulas: Ngaphantsi kwemeko yokulawula ukusuleleka kunye nokukhupha okwaneleyo kunye nokufanelekileyo, ukuxhaswa kwesondlo kunokwenza ngaphezu kwesiqingatha se-enterocutaneous fistulas ziphilise ngokwabo, kwaye utyando oluchanekileyo lube lonyango lokugqibela. Inkxaso yesondlo sabazali inokunciphisa ukukhutshwa kwe-gastrointestinal fluid kunye nokuhamba kwe-fistula, okuluncedo ekulawuleni usulelo, ukuphucula isimo sesondlo, ukuphucula izinga lokunyanga, kunye nokunciphisa iingxaki zotyando kunye nokufa.
3. Izifo ezivuthayo ezivuthayo: Isifo sikaCrohn, i-ulcerative colitis, isifo sofuba samathumbu kunye nezinye izigulane zikwinqanaba lesifo esisebenzayo, okanye ziyinkimbinkimbi kunye ne-abscess yesisu, i-intestinal fistula, ukuvinjelwa kwamathumbu kunye nokuphuma kwegazi, njl., Isondlo sabazali yindlela ebalulekileyo yokonyango. Iyakwazi ukukhulula iimpawu, iphucule isondlo, iphumle i-intestinal tract, kwaye iququzelele ukulungiswa kwe-intestinal mucosa.
4. Izigulane ze-tumor ezingondlekanga kakhulu: Kwizigulane ezinokulahlekelwa kwesisindo somzimba ≥ 10% (ubunzima bomzimba obuqhelekileyo), inkxaso yesondlo somzali okanye ye-enteral kufuneka ibonelelwe nge-7 kwiintsuku ze-10 ngaphambi kokuhlinzwa, kude kube yisondlo sokungena okanye ukubuyela ekutyeni emva kokuhlinzwa. de.
5. Ukungoneli kwamalungu abalulekileyo:
① Ukungoneli kwesibindi: izigulane ezine-cirrhosis yesibindi zikwi-balance balance yezondlo ngenxa yokungoneli kokutya. Ngexesha le-perioperative ye-cirrhosis yesibindi okanye i-tumor yesibindi, i-hepatic encephalopathy, kunye ne-1 ukuya kwiiveki ze-2 emva kokutshintshwa kwesibindi, abo bangakwaziyo ukutya okanye ukufumana isondlo se-enteral kufuneka banikwe isondlo somzali Inkxaso yesondlo.
② Ukungaphumeleli kwezintso: isifo se-catabolic esiyingozi (usulelo, ukwenzakala okanye ukungaphumeleli kwamalungu amaninzi) kudityaniswe nokungaphumeleli kwe-renal, ukusilela kwe-renal okungapheliyo kwi-dialysis izigulane ezinokungondleki, kwaye zifuna inkxaso yesondlo sabazali ngenxa yokuba abakwazi ukutya okanye ukufumana isondlo sokungena. Ngexesha le-dialysis yokusilela kwezintso okungapheliyo, umxube wesondlo somzali unokungeniswa ngexesha lokutofelwa igazi.
③ Ukungoneli kwentliziyo nemiphunga: ihlala idityaniswa nokungondleki okuxutyiweyo kweprotheyini-amandla. Isondlo sokungena siphucula isimo seklinikhi kunye nomsebenzi wesisu kwisifo esingapheliyo se-pulmonary (COPD) kwaye sinokuzuza izigulane ezinokukhubazeka kwentliziyo (ubungqina abukho). Umlinganiselo ofanelekileyo we-glucose kwi-fat kwizigulane ze-COPD awukacaciswanga, kodwa umlinganiselo we-fat kufuneka unyuswe, inani elipheleleyo le-glucose kunye ne-infusion rate kufuneka ilawulwe, iprotheni okanye i-amino acids kufuneka inikezelwe (ubuncinci i-lg / kg.d), kwaye i-glutamine eyaneleyo kufuneka isetyenziswe kwizigulane ezinezifo ezinzima zemiphunga. Kuyinzuzo ukukhusela i-alveolar endothelium kunye ne-intestinal-associated lymphoid tissue kunye nokunciphisa iingxaki ze-pulmonary. ④I-inflammatory adhesive intestinal obstruction: i-perioperative parenteral isondlo senkxaso ye-4 kwiiveki ze-6 luncedo ekubuyiseleni umsebenzi wamathumbu kunye nokukhululeka kokuphazamiseka.
Contraindications
1. Abo banomsebenzi oqhelekileyo wesisu, ukulungelelanisa kwisondlo se-enteral okanye ukubuyisela umsebenzi wesisu phakathi kweentsuku ezi-5.
2. Okunganyangekiyo, akukho themba lokusinda, ukusweleka okanye ukugula okungenakulungiseka.
3. Abo bafuna utyando olungxamisekileyo kwaye abanako ukuphumeza inkxaso yesondlo ngaphambi kokuhlinzwa.
4. Umsebenzi we-cardiovascular okanye ukuphazamiseka okukhulu kwe-metabolic kufuneka kulawulwe.
Indlela yesondlo
Ukukhethwa kwendlela efanelekileyo yesondlo sabazali kuxhomekeke kwizinto ezifana nembali ye-vascular puncture yesigulane, i-anatomy ye-venous, isimo se-coagulation, ixesha elilindelekileyo lesondlo sabazali, ukusetwa kononophelo (esibhedlele okanye hayi), kunye nohlobo lwesifo esisisiseko. Kwizigulane ezilaliswayo, i-peripheral venous yexesha elifutshane okanye i-central intubation ye-venous lolona khetho luqhelekileyo; kwizigulane zonyango lwexesha elide kwiindawo ezingekho esibhedlele, i-peripheral venous okanye i-central venous intubation, okanye iibhokisi ze-infusion ye-subcutaneous zisetyenziswa kakhulu.
1. Umzila wesondlo somzali we-peripheral
Iimpawu: ① Isondlo sexesha elifutshane sabazali (<2 iiveki), isisombululo sezondlo soxinzelelo lwe-osmotic ngaphantsi kwe-1200mOsm/LH2O; ② Ukuchasana kwe-catheter ye-venous okanye akunakwenzeka; ③ Usulelo lweCatheter okanye i-sepsis.
Izinto eziluncedo kunye nezingeloncedo: Le ndlela ilula kwaye kulula ukuyisebenzisa, inokuphepha iingxaki (umatshini, usulelo) ezinxulumene ne-catheterization ye-venous ephakathi, kwaye kulula ukubona ukwenzeka kwe-phlebitis kwangoko. Ukungalungi kukuba uxinzelelo lwe-osmotic lwe-infusion akufanele lube luphezulu kakhulu, kwaye i-puncture ephindaphindiweyo iyadingeka, ehambelana ne-phlebitis. Ngoko ke, ayifanelekanga ukusetyenziswa kwexesha elide.
2. Isondlo sabazali ngokusebenzisa umthambo ophakathi
(1) Izibonakaliso: isondlo sabazali ngaphezu kweeveki ze-2 kunye nesisombululo sezondlo ze-osmotic uxinzelelo oluphezulu kune-1200mOsm / LH2O.
(2) Indlela ye-Catheterization: ngokusebenzisa i-jugular vein yangaphakathi, i-subclavian vein okanye i-peripheral vein of the top to the superior vena cava.
Izinto eziluncedo kunye nokungalunganga: I-catheter ye-subclavia ye-vein kulula ukuyihambisa kunye nokunyamekela, kwaye ingxaki ephambili yi-pneumothorax. Ukwenziwa kweCatheterization ngomthambo wangaphakathi wejugular kuthintele intshukumo yejugular kunye nokunxiba, kwaye kubangele iingxaki ezingakumbi ze-hematoma yendawo, ukwenzakala komthambo kunye nosulelo lwe-catheter. I-Peripheral vein-to-central catheterization (PICC): I-vein exabisekileyo ibanzi kwaye kulula ukuyifaka kune-cephalic vein, enokuphepha iingxaki ezinzulu ezifana ne-pneumothorax, kodwa yandisa iziganeko ze-thrombophlebitis kunye ne-intubation dislocation kunye nobunzima bokusebenza. Iindlela ezingafanelekanga zondlo zabazali ziyi-jugular vein yangaphandle kunye ne-femoral vein. Eyangaphambili inezinga eliphezulu lokungahambi kakuhle, ngelixa lo mva unomlinganiselo ophezulu weengxaki ezosulelayo.
3. Ukufakwa ngecatheter efakwe ngaphantsi kwesikhumba ngecatheter yevenous esembindini.
Inkqubo yesondlo
1. Isondlo sabazali seenkqubo ezahlukeneyo (i-multi-bottle serial, zonke-in-one kunye neengxowa ze-diaphragm):
① Ukuhanjiswa kwe-serial yeebhotile ezininzi: Iibhotile ezininzi zesisombululo sezondlo zinokuxutywa kwaye zisasazwe ngokulandelelana "ngeendlela ezintathu" okanye ityhubhu yokufakela efana noY. Nangona ilula kwaye kulula ukuyiphumeza, ineziphene ezininzi kwaye akufuneki ithethelelwe.
②Isisombululo esipheleleyo sezondlo (TNA) okanye zonke-kwinye (i-AIl-in-One): I-teknoloji yokuxuba i-aseptic yesisombululo sesondlo esipheleleyo kukudibanisa zonke isondlo sabazali bemihla ngemihla (i-glucose, i-fat emulsion, i-amino acids, i-electrolytes, iivithamini kunye ne-trace elements) ) ixutywe kwisikhwama kwaye emva koko ifakwe. Le ndlela yenza ukuba igalelo lesondlo sabazali lilungele ngakumbi, kwaye igalelo elifanayo lezondlo ezahlukeneyo linengqiqo ngakumbi kwi-anabolism. Ukugqiba Ngenxa yokuba i-plasticizer e-soluble fat-soluble ye-polyvinyl chloride (PVC) iingxowa zingabangela ukusabela okuthile okunetyhefu, i-polyvinyl acetate (EVA) isetyenziswe njengeyona nto iphambili yeengxowa zesondlo sabazali ngoku. Ukuze kuqinisekiswe ukuzinza kwecandelo ngalinye kwisisombululo se-TNA, ukulungiswa kufuneka kuqhutywe ngomyalelo ochaziweyo (jonga iSahluko 5 ngeenkcukacha).
③Ingxowa ye-diaphragm: Kwiminyaka yakutshanje, ubugcisa obutsha kunye neeplastiki zemathiriyeli entsha (i-polyethylene/polypropylene polymer) zisetyenzisiwe kwimveliso yeengxowa zesisombululo sesondlo sabazali. Imveliso entsha yesisombululo sezondlo (isikhwama samagumbi amabini, isikhwama samagumbi amathathu) sinokugcinwa kwiqondo lokushisa kweenyanga ezingama-24, ukuphepha ingxaki yokungcola kwesisombululo sezondlo esilungiselelwe esibhedlele. Ingakhuseleka ngakumbi kwaye isetyenziswe ngokufanelekileyo kwisondlo sabazali ngokungena kwi-vein esembindini okanye kwi-peripheral vein kwizigulane ezineemfuno ezahlukeneyo zesondlo. Ukungalungi kukuba ukwenziwa komntu ngamnye kwifomula akunakufezekiswa.
2. Ukuqulunqwa kwesisombululo sesondlo sabazali
Ngokweemfuno zesondlo zesigulane kunye nomthamo we-metabolic, yenza ukubunjwa kwamalungiselelo okutya.
3. I-matrix ekhethekileyo yesondlo sabazali
Isondlo seklinikhi yanamhlanje sisebenzisa amanyathelo amatsha ukuqhubela phambili ukuphucula ukwakhiwa kwesondlo sokuphucula ukunyamezela isigulane. Ukuze kuhlangatyezwane neemfuno zonyango lwesondlo, ii-substrates ezikhethekileyo zesondlo zinikezelwa kwizigulane ezikhethekileyo zokuphucula umsebenzi wokuzivikela wesigulane, ukuphucula umsebenzi we-intestinal barrier, kunye nokuphucula amandla omzimba we-antioxidant. Amalungiselelo amatsha esondlo akhethekileyo ngala:
①I-emulsion yamafutha: kubandakanya i-emulsion yamafutha ehleliweyo, ikhonkco elide, i-emulsion ye-fat chain, kunye ne-fat emulsion etyebileyo kwi-omega-3 fatty acids, njl.
②Amalungiselelo e-amino acid: kuquka i-arginine, i-glutamine dipeptide kunye ne-taurine.
Itheyibhile 4-2-1 iimfuno zamandla kunye neeprotheyini zezigulane ezityandwayo
Amandla emeko yesigulana Kcal/(kg.d) protein g/(kg.d) NPC: N
Ukungondleki okuqhelekileyo 20 ~ 250.6 ~ 1.0150: 1
Uxinzelelo oluphakathi 25 ~ 301.0 ~ 1.5120: 1
Uxinzelelo lwe-metabolic oluphezulu 30 ~ 35 1.5 ~ 2.0 90 ~ 120: 1
Tshisa 35~40 2.0~2.5 90~120: 1
I-NPC: I-N engeyiyo iprotheni yekhalori kumlinganiselo wenitrogen
Inkxaso yesondlo sabazali kwisifo esingapheliyo sesibindi kunye nokutshintshwa kwesibindi
Amandla angeyoprotheni Kcal/(kg.d) protein okanye amino acid g/(kg.d)
Imbuyekezo ye-cirrhosis25~35 0.6~1.2
I-cirrhosis ethotyiweyo 25~35 1.0
I-Hepatic encephalopathy 25 ~ 35 0.5 ~ 1.0 (ukwandisa umlinganiselo we-branched-chain amino acids)
25 ~ 351.0 ~ 1.5 emva kokutshintshwa kwesibindi
Imiba efuna ukuqwalaselwa: Isondlo somlomo okanye somzimba ngokuqhelekileyo sikhethwa; ukuba ayinyamezelwanga, isondlo sabazali sisetyenzisiweyo: amandla akhiwe nge-glucose [2g / (kg.d)] kunye ne-medium-long-long-chain fat emulsion [1g / (kg.d)], i-akhawunti ye-fat 35 ~ 50% yeekhalori; umthombo we-nitrogen unikezelwa yi-amino acids edibeneyo, kunye ne-hepatic encephalopathy yonyusa umlinganiselo we-branched-chain amino acids.
Inkxaso yesondlo sabazali kwisifo se-catabolic esinzima esintsonkothileyo ngokusilela kwezintso
Amandla angeyoprotheni Kcal/(kg.d) protein okanye amino acid g/(kg.d)
20 ~ 300.8 ~ 1.21.2 ~ 1.5 (izigulane ze-dialysis zemihla ngemihla)
Imiba efuna ukuqwalaselwa: Isondlo somlomo okanye somzimba ngokuqhelekileyo sikhethwa; ukuba ayinakunyamezelwa, isondlo sabazali sisetyenzisiweyo: amandla ahlanganiswe ne-glucose [3 ~ 5g / (kg.d)] kunye ne-emulsion yamafutha [0.8 ~ 1.0g / (kg.d))]; ii-amino acids ezingabalulekanga (tyrosine, arginine, cysteine, serine) zabantu abasempilweni ziba zii-amino acid eziyimfuneko ngokwemeko ngeli xesha. Iswekile yegazi kunye ne-triglycerides kufuneka ibekwe esweni.
Itheyibhile 4-2-4 Kucetyiswa inani lemihla ngemihla lesondlo esipheleleyo sabazali
Amandla 20~30Kcal/(kg.d) [Unikezelo lwamanzi 1~1.5ml nge-1Kcal/(kg.d)]
IGlucose 2~4g/(kg.d) Amafutha 1~1.5g/(kg.d)
Umxholo we-nitrogen 0.1~0.25g/(kg.d) I-amino acid 0.6~1.5g/(kg.d)
Electrolytes (avareji imfuneko yemihla ngemihla isondlo parenteral abadala) Sodium 80 ~ 100mmol Potassium 60 ~ 150mmol Chlorine 80 ~ 100mmol Calcium 5 ~ 10mmol Magnesium 8 ~ 12mmol Phosphorus 10 ~ 30mmol
Iivithamini ezinyibilikayo kumafutha: A2500IUD100IUE10mgK110mg
Iivithamini ezinyibilikayo emanzini: B13mgB23.6mgB64mgB125ug
Pantothenic Acid 15mg Niacinamide 40mg Folic Acid 400ugC 100mg
Trace elements: copper 0.3mg iodine 131ug zinc 3.2mg selenium 30~60ug
Molybdenum 19ug Manganese 0.2~0.3mg Chromium 10~20ug Iron 1.2mg
Ixesha lokuposa: Aug-19-2022