Kwiminyaka yakutshanje, igama elithi "ukunganyamezeli ukutya" lisetyenziswe ngokubanzi kwiikliniki. Ngethuba nje ukukhankanywa kwesondlo sokungena, abasebenzi abaninzi bezonyango okanye izigulane kunye neentsapho zabo baya kudibanisa ingxaki yokunyamezela kunye nokunyamezelwa. Ke, kuthetha ukuthini kanye ukunyamezelwa kwesondlo se-enteral? Kwinkqubo yeklinikhi, kuthekani ukuba isigulane sinokunyanyezelwa kwesondlo sokungena? KwiNtlanganiso yoNyaka ye-2018 yeSizwe ye-Critical Care Medicine, intatheli yadliwano-ndlebe noNjingalwazi uGao Lan ovela kwiSebe le-Neurology yeSibhedlele sokuqala seYunivesithi yaseJilin.
Kwinkqubo yeklinikhi, izigulane ezininzi azikwazi ukufumana isondlo esaneleyo ngokutya okuqhelekileyo ngenxa yezifo. Kwezi zigulana, inkxaso yesondlo sokungena iyafuneka. Nangona kunjalo, ukutya kwe-enteral akulula njengoko kucingelwa. Ngethuba lenkqubo yokutya, izigulane kufuneka zijongane nombuzo wokuba ziyakwazi ukunyamezela.
UNjingalwazi uGao Lan wabonisa ukuba ukunyamezela luphawu lomsebenzi wesisu. Uphononongo lufumene ukuba ngaphantsi kwe-50% yezigulane zeyeza zangaphakathi ziyakwazi ukunyamezela isondlo esipheleleyo sokungena kwinqanaba lokuqala; ngaphezu kwe-60% yezigulane ezikwiyunithi yokunyamekela kakhulu kubangela ukuphazamiseka okwethutyana kwisondlo sokungena ngenxa yokunganyamezeli kwesisu okanye ukuphazamiseka kwesisu. Xa isigulane sihlakulela ukunganyamezeli kokutya, kunokuchaphazela inani lokutya elijoliswe kuyo, elikhokelela kwiziphumo ezibi zeklinikhi.
Ke, ukugweba njani ukuba isigulana siyanyamezela kwisondlo sokungena? Unjingalwazi uGao Lan uthe i-bowel yesigulane iyavakala, nokuba kukho ukugabha okanye i-reflux, nokuba kukho isifo sohudo, nokuba kukho ukuhlanjululwa kwamathumbu, nokuba kukho ukwanda kwe-residu yesisu, nokuba umthamo ojoliswe kuyo ufikeleleke emva kweentsuku ezi-2 ukuya kwezi-3 zesondlo sokungena, njl.
Ukuba isigulane asifumani nakuphi na ukuphazamiseka emva kokusetyenziswa kwesondlo sokungena, okanye ukuba isisu esiswini, isifo sohudo, kunye ne-reflux kwenzeka emva kokusetyenziswa kwesondlo se-enteral, kodwa ukunciphisa emva kokunyanga, isigulane sinokuthathwa njengokunyamezela. Ukuba isigulana siphethwe kukugabha, ukudinwa kwesisu, kunye norhudo emva kokufumana isondlo se-enteral, unikwa unyango oluhambelanayo kwaye unqumame kangangeeyure ezili-12, kwaye iimpawu azibi ngcono emva kokuba isiqingatha sesondlo se-enteral sinikwa kwakhona, esithathwa njengokunganyamezeli kwesondlo se-enteral. Ukunganyamezeli kwesondlo sokungena kunokuthi kuhlulwe ekunyamezelweni kwesisu (ukugcinwa kwesisu, ukuhlanza, i-reflux, i-aspiration, njl.) kunye nokunyanzeliswa kwamathumbu (urhudo, ukuvuvukala, ukunyuka kwengcinezelo ye-intra-abdominal).
UNjingalwazi uGao Lan wabonisa ukuba xa izigulane zihlakulela ukunganyamezeli kwisondlo sokungena, ngokuqhelekileyo ziya kujongana neempawu ngokwezi zibonakaliso ezilandelayo.
Isalathisi 1: Ukugabha.
Khangela ukuba ityhubhu ye-nasogastric ikwindawo echanekileyo;
Nciphisa izinga lokufakwa kwezondlo nge-50%;
Sebenzisa amayeza xa kuyimfuneko.
Isalathisi 2: Izandi zamathumbu.
Yeka ukunyuswa kwesondlo;
Nika amayeza;
Phinda ujonge zonke iiyure ze-2.
Isalathiso sesithathu: ukunyuswa kwesisu / uxinzelelo lwangaphakathi lwesisu.
Uxinzelelo lwe-intra-abdominal lungabonakalisa ngokubanzi imeko yonke yentshukumo yesisu esincinci kunye nokutshintsha komsebenzi wokufunxa, kwaye luphawu lokunyamezela kwesondlo kwizigulane ezigula kakhulu.
Kwi-hypertension encinci ye-intra-abdominal, isantya se-enteral nutrition infusion singagcinwa, kwaye uxinzelelo lwe-intra-esiswini lunokuphinda lulinganiswe rhoqo kwiiyure ze-6;
Xa uxinzelelo lwangaphakathi lwesisu luphezulu ngokuphakathi, nciphisa izinga lokungena nge-50%, thatha ifilimu ecacileyo yesisu ukuze ukhuphe ukuphazamiseka kwamathumbu, kwaye uphinda uvavanyo rhoqo kwiiyure ezi-6. Ukuba isigulane siyaqhubeka sinokuphazamiseka kwesisu, iziyobisi ze-gastrodynamic zingasetyenziswa ngokwemeko. Ukuba uxinzelelo lwe-intra-esiswini luye lwanda kakhulu, ukunyanzeliswa kwe-enteral nutrition kufuneka kumiswe, kwaye emva koko kufuneka kwenziwe uvavanyo olunzulu lwesisu.
Isalathisi 4: Urhudo.
Kukho izizathu ezininzi zohudo, ezifana ne-intestinal mucosal necrosis, ukuchithwa, ukukhukuliseka, ukunciphisa i-enzymes yokugaya, i-mesenteric ischemia, i-edema yamathumbu, kunye nokungalingani kwezityalo zamathumbu.
Indlela yokonyango kukunciphisa izinga lokutya, ukuhlambulula inkcubeko yezondlo, okanye ukulungelelanisa i-enteral nutrition formula; ukwenza unyango olujoliswe kuyo ngokwesizathu sorhudo, okanye ngokomlinganiselo worhudo. Kufuneka kuqatshelwe ukuba xa isifo sohudo senzeke kwizigulane ze-ICU, akukhuthazwa ukuba umise ukuxhaswa kwesondlo se-enteral, kwaye kufuneka uqhubeke nokutya, kwaye kwangaxeshanye ufumane isizathu sohudo ukumisela isicwangciso sonyango esifanelekileyo.
Isalathiso sesihlanu: intsalela yesisu.
Kukho izizathu ezibini zokushiyeka kwesisu: imiba yesifo kunye nezinto zonyango.
Izifo zesifo zibandakanya ubudala, ukukhuluphala, isifo sikashukela okanye i-hyperglycemia, isigulane senze utyando lwesisu, njl.;
Izinto zonyango ziquka ukusetyenziswa kwe-tranquilizers okanye i-opioids.
Amaqhinga okusombulula iintsalela zesisu ziquka ukwenza uvavanyo olubanzi lwesigulana ngaphambi kokufaka isondlo sokungena, ukusebenzisa iziyobisi ezikhuthaza ukuhamba kwesisu okanye i-acupuncture xa kuyimfuneko, kunye nokukhetha amalungiselelo anokukhutshwa ngokukhawuleza kwesisu;
Ukutya kwe-Duodenal kunye nejejunal kunikwa xa kukho intsalela eninzi yesisu; idosi encinci ikhethwa kwisondlo sokuqala.
Isalathisi sesithandathu: i-reflux / aspiration.
Ukuze kuthintelwe ukulangazelela, abasebenzi bezonyango baya kuguqula kwaye bafunxe iimfihlo zokuphefumla kwizigulana ezinokuphazamiseka kwengqondo ngaphambi kokutyisa ngeempumlo; ukuba imeko iyavuma, phakamisa intloko yesigulane kunye nesifuba nge-30 ° okanye ngaphezulu ngexesha lokutyisa ngeempumlo, kwaye emva kokutyisa ngeempumlo Gcina indawo ehlala i-semi-recumbent kwisiqingatha seyure.
Ukongeza, kubaluleke kakhulu ukubeka iliso kwisondlo sokunyanzelwa kwesigulana yonke imihla, kunye nokuphazamiseka lula kwisondlo sokungena kufuneka kugwenywe.
Ixesha lokuposa: Jul-16-2021