Manatu faavae
Mea'ai fa'amatua (PN) o le tu'uina atu lea o mea'ai mai i totonu o le toto e fai ma fesoasoani mo mea'ai a'o le'i mae'a le taotoga ma mo gasegase tigaina. O mea'ai uma e tu'uina atu fa'amatua, e ta'ua o le aofa'i o mea'ai matua (TPN). O auala o mea'ai fa'amatua e aofia ai mea'ai fa'apitonu'u ma mea'ai totonugalemu. O mea'ai a matua (PN) o le tu'uina atu lea o mea'ai e mana'omia e tagata mama'i, e aofia ai kalori (carbohydrates, fat emulsions), amino acids taua ma le le taua, vitamini, electrolytes, ma elemene elemene. O mea'ai fa'amatua ua vaevaeina i mea'ai fa'amatua atoa ma mea'ai fa'aopoopo fa'aopoopo a matua. O le fa'amoemoe ia mafai e tagata gasegase ona fa'atumauina le tulaga o mea'ai, fa'atupuina o le mamafa ma fa'amalolo manu'a e tusa lava pe le mafai ona 'ai masani, ma fa'aauau pea ona tutupu ma tuputupu a'e tamaiti laiti. O auala fa'atosina ma auala fa'atosina o ni fa'amaoniga talafeagai mo mea'ai a matua.
Fa'ailoga
O fa'ailoga fa'avae mo mea'ai fa'amatua o i latou ia e fa'aletonu le manava po'o fa'aletonu, e aofia ai ma i latou o lo'o mana'omia le fesoasoani i mea'ai a matua.
Aafiaga taua
1. Fa'alavelave gastrointestinal
2. Fa'aletonu o le manava o le manava: ① Fa'ama'i pupuu: fa'amama tele le manava la'ititi> 70% ~ 80%; ② Fa'ama'i o le manava la'ititi: fa'ama'i fa'ama'i puipuia, ischemia intestinal, tele fistula intestinal; ③ Ma'i fa'avevela, ④ Matata tele, fa'alavelave Su'i feusua'iga > 7 aso.
3. Pancreatitis ogaoga: Fa'atosina muamua e laveai ai le te'i po'o le MODS, pe a mae'a fa'ailoga taua e mautu, pe afai e le fa'aumatia le pipili o le intestinal ma e le mafai ona talia atoatoa mea'ai, o se fa'ailoga mo mea'ai a matua.
4. Tulaga maualuga catabolic: mu tele, manu'a tu'ufa'atasi tuga, fa'ama'i, ma isi.
5. Tulaga le lelei o mea'ai: Fa'apolotini-calorie deficiency le lelei o mea'ai e masani ona fa'atasi ma le fa'aletonu o le manava ma e le mafai ona fa'afeiloa'i mea'ai i totonu.
Lagolago e aoga
1. Vaitaimi perioperative o taotoga tele ma manu'a: E leai se aafiaga taua o le tausiga o mea'ai i tagata mama'i e lelei le tulaga tau taumafa. I se isi itu, e mafai ona faʻateleina faʻafitauli faʻamaʻi, ae e mafai ona faʻaitiitia faʻafitauli pe a maeʻa le taotoga mo tagata mamaʻi e ogaoga le le paleni. E mana'omia e tagata mama'i e matua'i le lelei le tausiga o mea'ai mo le 7-10 aso a'o le'i taotoga; mo i latou o loʻo faʻamoemoe e le mafai ona toe faʻaleleia le gaioiga o le manava i totonu o le 5-7 aso pe a maeʻa le taotoga tele, e tatau ona amata le tausiga o meaʻai a matua i totonu ole 48 itula pe a uma le taotoga seia mafai e le tagata maʻi ona lava meaʻai. Mea'ai fa'aulufale po'o mea'ai.
2. Fistula Enterocutaneous: I lalo o le tulaga o le faʻamaʻi pipisi ma alavai lelei ma talafeagai, lagolago taumafa e mafai ona sili atu ma le afa o fistulas enterocutaneous faamalolo i latou lava, ma o le taotoga mautinoa ua avea ma togafitiga mulimuli. E mafai ona faʻaitiitia le faʻaogaina o meaʻai a matua e faʻaitiitia ai le sua o le manava ma le tafe o fistula, lea e aoga e pulea ai faʻamaʻi, faʻaleleia le tulaga o meaʻai, faʻaleleia le fua o togafitiga, ma faʻaitiitia ai faʻalavelave faʻalavelave ma le oti.
3. Faʻamaʻi faʻamaʻi: Crohn's disease, ulcerative colitis, intestinal tuberculosis ma isi gasegase o loʻo i ai i le tulaga faʻamaʻi malosi, poʻo le faʻalavelave i le manava o le manava, fistula o le intestinal, faʻalavelave intestinal ma le toto, ma isi, meaʻai matua o se auala taua togafitiga. E mafai ona faʻamalolo faʻamaoniga, faʻaleleia meaʻai, malolo le intestinal tract, ma faafaigofie le toe faaleleia o le intestinal mucosa.
4. Ma'i mama'i mama'i mama: Mo tagata mama'i e pa'u le mamafa o le tino ≥ 10% (mamafa masani o le tino), e tatau ona tu'uina atu le lagolago fa'amatua po'o le enteral 7 i le 10 aso a'o le'i faia le taotoga, se'ia o'o i mea'ai i totonu pe toe fo'i e 'ai pe a uma le taotoga. seia.
5. Le lava o totoga taua:
① Le atoatoa o le ate: o tagata mama'i e maua i le ate cirrhosis o lo'o i ai i se paleni le lelei o mea'ai ona o le le lava o taumafa. A'o faagasolo taimi ole ate cirrhosis po'o le ate tuma, hepatic encephalopathy, ma le 1 i le 2 vaiaso talu ona sui le ate, oi latou e le mafai ona 'ai pe maua mea'ai e tatau ona tu'uina atu i le matua mea'ai.
② Fa'aletonu o le tino: fa'ama'i mata'utia catabolic (fa'ama'i, manu'a po'o le tele o okeni faaletonu) tu'ufa'atasia ma le fa'aletonu o le tino, ma'i fa'amama fa'amama fa'amama fa'amamago ma mana'omia le lagolago a matua ona e le mafai ona latou 'ai pe maua mea'ai totonu. A'o fa'amama toto mo le faaletonu o fatuga'o, e mafai ona fa'asusu le paluga o mea'ai a matua i le tuiina o le toto.
③ Le lava le fatu ma le mama: e masani ona tu'ufa'atasia ma le polotini-malosi fefiloi le paleni. O mea'ai fa'atosina e fa'aleleia atili ai le tulaga o le falema'i ma le ga'ina o le manava i fa'ama'i fa'ama'i fa'ama'i fa'ama'i (COPD) ma e ono fa'amanuiaina ai tagata mama'i e faaletonu fatu (e leai ni fa'amaoniga). Ole fua fa'atatau ole kulukose ile ga'o ile COPD e le'i fa'amauina, ae e tatau ona fa'ateleina le ga'o, e tatau ona fa'atonutonu le aofa'i o le kulukose ma le fua fa'ainu, e tatau ona tu'uina atu le porotini po'o amino acids (a itiiti ifo lg/kg.d), ma ia lava le glutamine e tatau ona fa'aoga mo tagata mama'i ma'i ogaoga mama. E aoga le puipuia o le alveolar endothelium ma le intestinal-sociated lymphoid tissue ma faʻaitiitia ai faʻalavelave faʻalavelave. ④ Fa'agata fa'apipi'i fa'alavelave fa'alavelave: lagolago fa'ameamea fa'amatua perioperative mo le 4 i le 6 vaiaso e aoga i le toe fa'aleleia o galuega ole intestinal ma fa'amalieina le fa'alavelave.
Contraindications
1. O i latou o loʻo i ai galuega masani o le manava, fetuutuunai i meaʻai i totonu poʻo le toe faʻaleleia o le manava i totonu ole 5 aso.
2. E le mafai ona togafitia, leai se faʻamoemoe e ola ai, oti poʻo maʻi koma e le mafai ona toe faʻafoʻisia.
3. O i latou e mana'omia se taotoga fa'afuase'i ma e le mafai ona fa'atinoina le tausiga o mea'ai a'o le'i faia le taotoga.
4. E mana'omia le fa'atonutonuina ole gaioioiga fatu po'o fa'aletonu tuga o le metabolic.
Auala taumafa
Filifilia o le ala talafeagai o meaai a matua e faalagolago i mea e pei o le tagata maʻi vascular puncture talafaasolopito, venous anatomy, coagulation tulaga, faamoemoe umi o meaai faamatua, tulaga o le tausiga (falemaʻi pe leai), ma le natura o le maʻi autu. Mo ma'i i totonu, pupu'u peripheral venous po'o totonugalemu venous intubation o le filifiliga sili ona taatele; mo togafitiga umi o gasegase i nofoaga e le o se falemaʻi, faʻaoga venous peripheral poʻo totonugalemu venous intubation, poʻo pusa faʻapipiʻi i lalo e masani ona faʻaaogaina.
1. Orpheral intravenous parrenteral taumafa auala
Fa'ailoga: ① Mea'ai fa'amatua pupuu (<2 vaiaso), vaifofo paleni osmotic pressure itiiti ifo i le 1200mOsm/LH2O; ② Fa'atonuga o le fa'a'au'au fa'a'ave'a tutotonu pe le mafai; ③ Fa'ama'i pipisi po'o sepsis.
Tulaga lelei ma le le lelei: O lenei metotia e faigofie ma faigofie ona faʻatinoina, e mafai ona aloese mai faʻalavelave (inisinia, faʻamaʻi) e fesoʻotaʻi ma le catheterization venous tutotonu, ma faigofie ona iloa vave le tupu mai o le phlebitis. O le le lelei o le osmotic pressure o le infusion e le tatau ona maualuga tele, ma e manaʻomia le tuʻi faʻasolosolo, lea e faigofie ona maua i le phlebitis. O le mea lea, e le talafeagai mo le faʻaaogaina umi.
2. Mea'ai faamatua e ala ile vein tutotonu
(1) Fa'ailoga: mea'ai matua mo le sili atu i le 2 vaiaso ma vaifofo paleni osmotic pressure maualuga atu nai lo le 1200mOsm/LH2O.
(2) Auala fa'asa'o: e ala i le vein jugular i totonu, le vein subclavian po'o le vein peripheral o le pito i luga i le vena cava maualuga.
Tulaga lelei ma le le lelei: O le subclavian vein catheter e faigofie ona gaoioi ma tausia, ma o le faʻalavelave autu o le pneumothorax. O le fa'ateteina e ala ile vein jugular i totonu na fa'atapula'aina ai le fe'avea'i ma le fa'aofuina o le toto, ma i'u ai i fa'alavelave sili atu o le hematoma i le lotoifale, manu'a alatoto ma fa'ama'i fa'ama'i. Peripheral vein-to-central catheterization (PICC): O le vein taua e lautele ma faigofie ona faʻaofiina nai lo le vein cephalic, lea e mafai ona aloese mai faʻalavelave matuia e pei o le pneumothorax, ae faʻateleina ai le aʻafiaga o le thrombophlebitis ma le intubation dislocation ma le faigata o le taotoga. O auala e le talafeagai mo taumafa a matua o le vein i fafo ma le vein femoral. O le muamua e maualuga le maualuga o le faʻaogaina, ae o le mea mulimuli e maualuga le maualuga o faʻafitauli faʻamaʻi.
3. Fa'ainu fa'atasi ma le fa'apalapala fa'apipi'i i lalo o le pa'u e ala atu i le fa'amama toto.
Faiga taumafa
1. Mea'ai faamatua o faiga eseese (tele-fagu serial, ato uma-i-tasi ma diaphragm taga):
①Matele-fagu fa'asalalau fa'asologa: E tele fagu vaifofo mea'ai e mafai ona fa'afefiloi ma fa'asalalau fa'asolosolo e ala i le "tolu-ala" po'o le Y-foliga fa'apipi'i. E ui lava e faigofie ma faigofie ona faʻatinoina, e tele mea faʻaletonu ma e le tatau ona fautuaina.
②Total nutrient solution (TNA) poo all-in-one (AIl-in-One): O le aseptic mixing technology of total nutrient solution o le tuʻufaʻatasia uma o meaʻai a matua i aso taitasi (glucose, fat emulsion, amino acids, electrolytes, vitamins and trace elements) ) faʻafefiloi i totonu o se ato ona faʻapipiʻi lea. O lenei metotia e sili atu ona faigofie le faʻaogaina o meaʻai a matua, ma o le faʻaogaina tutusa o meaʻai eseese e sili atu ona talafeagai mo anabolism. Fa'ai'uga Talu ai ona o le fa'ama'i ga'o o taga polyvinyl chloride (PVC) e mafai ona mafua ai ni fa'alavelave oona, o le polyvinyl acetate (EVA) ua fa'aaogaina e fai ma mea'ai autu o ato meaai matua i le taimi nei. Ina ia faʻamautinoa le mautu o vaega taʻitasi i le fofo TNA, e tatau ona faia le sauniuniga i le faʻatonuga faʻapitoa (silasila i le Mataupu 5 mo faʻamatalaga).
③Diaphragm taga: I tausaga talu ai nei, o tekinolosi fou ma mea fou palasitika (polyethylene / polypropylene polymer) ua faʻaaogaina i le gaosiga o ato faʻamaeʻaina meaʻai paleni. Ole mea fou fou ole vaifofo vaifofo (lua potu, ato tolu potu) e mafai ona teuina i le vevela o le potu mo le 24 masina, aloese mai le faʻafitauli o le filogia o vaifofo paleni saunia i le falemaʻi. E mafai ona sili atu le saogalemu ma le faʻaogaina mo le faʻaogaina o meaʻai a matua e ala i vein tutotonu poʻo vein peripheral i tagata mamaʻi ma manaʻoga taumafa eseese. O le fa'aletonu e le mafai ona ausia le fa'avasegaina o le fua fa'atatau.
2. Fa'avasegaina o vaifofo taumafa fa'amatua
E tusa ai ma manaʻoga o le tagata maʻi ma le gafatia o le metabolic, faʻatulagaina le tuʻufaʻatasiga o sauniuniga taumafa.
3. Matrix fa'apitoa mo taumafa fa'amatua
O mea'ai a le falema'i fa'aonaponei e fa'aogaina ai faiga fou e fa'aleleia atili ai mea'ai taumafa e fa'aleleia ai le fa'apalepale o ma'i. Ina ia mafai ona faʻamalieina manaʻoga o le togafitiga o meaʻai, e tuʻuina atu meaʻai faʻapitoa mo tagata maʻi faʻapitoa e faʻaleleia ai le puipuiga o le tagata maʻi, faʻaleleia le gaioiga o le intestinal, ma faʻaleleia le malosi o le antioxidant o le tino. O tapenaga fou o taumafa fa'apitoa e:
①Fat emulsion: e aofia ai le faʻaogaina o le gaʻo faʻapipiʻiina, filifili umi, faʻafefeteina gaʻo, ma le gaʻo gaʻo e mauoa i omega-3 fatty acids, ma isi.
②Amino acid sauniuniga: e aofia ai arginine, glutamine dipeptide ma taurine.
Fuafuaga 4-2-1 Malosiaga ma polotini mana'omia o gasegase tipitipi
Malosiaga tulaga ma'i Kcal/(kg.d) polotini g/(kg.d) NPC: N
Fa'aleaogaina masani-le lelei 20~250.6~1.0150:1
Fa'anoanoaga feololo 25~301.0~1.5120:1
mamafa metabolic maualuga 30~35 1.5~2.0 90~120:1
Mu 35~40 2.0~2.5 90~120: 1
NPC: N e le o se polotini kaloli i le fua faatatau o le nitrogen
Lagolago mea'ai a matua mo le ma'i tumau o le ate ma le fa'atupuina o le ate
Malosi ole polotini Kcal/(kg.d) polotini po'o le amino acid g/(kg.d)
Taui cirrhosis25~35 0.6~1.2
Cirrhosis decompensated 25~35 1.0
Hepatic encephalopathy 25~35 0.5~1.0 (fa'ateleina le fua faatatau o so'o amino fa'alafua lala)
25~351.0~1.5 ina ua mae'a fa'aliliuga ate
Mataupu e mana'omia le fa'alogoina: O mea'ai tu'ugutu po'o mea'ai e masani ona fa'asili; afai e le faʻatagaina, e faʻaaogaina meaʻai a matua: o le malosi e aofia ai le kulukose [2g / (kg.d)] ma le emulsion gaʻo medium-long-chain [1g / (kg.d) ], faʻamatalaga gaʻo mo le 35 ~ 50% o kalori; O le puna o le nitrogen e maua mai i vailaʻau amino faʻapipiʻi, ma o le encephalopathy o le ate e faʻateleina ai le aofaʻi o vailaʻau amino lala.
Lagolago mea'ai fa'amatua mo fa'ama'i mata'utia catabolic lavelave ma le faaletonu o le fatu
Malosi ole polotini Kcal/(kg.d) polotini po'o le amino acid g/(kg.d)
20~300.8~1.21.2~1.5 (ma'i fa'amama toto i aso uma)
Mataupu e mana'omia le fa'alogoina: O mea'ai tu'ugutu po'o mea'ai e masani ona fa'asili; afai e le taliaina, e faʻaaogaina meaʻai a matua: o le malosi e aofia ai le kulukose [3 ~ 5g / (kg.d)] ma le gaʻo emulsion [0.8 ~ 1.0g / (kg.d) )]; ole amino acids e le taua (tyrosine, arginine, cysteine, serine) o tagata soifua maloloina e avea ma amino acids taua ile taimi nei. E tatau ona mataituina le suka toto ma le triglycerides.
Fuafuaga 4-2-4 Fautuaina ole aofa'i ole aofa'i ole taumafa a matua
Malosiaga 20~30Kcal/(kg.d) [Suavai 1~1.5ml i le 1Kcal/(kg.d)]
Kulukose 2~4g/(kg.d) Ga'o 1~1.5g/(kg.d)
Nitrogen anotusi 0.1~0.25g/(kg.d) Amino acid 0.6~1.5g/(kg.d)
Electrolytes (tulaga mana'omia i aso taitasi mo matua'i taumafa matua) Sodium 80~100mmol Potassium 60~150mmol Chlorine 80~100mmol Calcium 5~10mmol Magnesium 8~12mmol Phosphorus 10~30mmol
Vaitamini e so'ona ga'o: A2500IUD100IUE10mgK110mg
Vaitamini so'o le vai: B13mgB23.6mgB64mgB125ug
Pantothenic Acid 15mg Niacinamide 40mg Folic Acid 400ugC 100mg
Su'ega elemene: kopa 0.3mg iodine 131ug zinc 3.2mg seleni 30~60ug
Molybdenum 19ug Manganese 0.2~0.3mg Chromium 10~20ug Uamea 1.2mg
Taimi meli: Aukuso-19-2022