Zvidzidzo zvenguva pfupi yapfuura nezvekudya kwekudya kwekutanga muvarwere vari kuvhiyiwa kenza yemudumbu zvinotsanangurwa. Iri bepa nderekunongedza chete
1. Nzira, nzira uye nguva yekudya kwemukati
1.1 kudya kunovaka muviri
Nzira nhatu dzekupinza dzinogona kushandiswa kupa rubatsiro rwekudya kuvarwere vane gomarara remudumbu mushure mekuvhiyiwa: kutonga-kamwe chete, kuenderera mberi nekupomba kuburikidza nekupinza pombi uye kudonha kwemagetsi. Ongororo dzekiriniki dzakaona kuti mhedzisiro yekuenderera mberi infusion nepombi yekupinza iri nani pane inopindirana infusion yegiravhiti, uye hazvisi nyore kuve neakaipa gastrointestinal maitiro. Pamberi pekutsigirwa kwekudya, 50ml ye5% glucose sodium chloride jekiseni yaigara ichishandiswa pakutsvaira. Munguva yechando, tora bhegi remvura inopisa kana heater yemagetsi uye woiisa kune imwe mugumo wepombi yekupinza pedyo nehove yefistula chubhu yekudziya, kana kupisa iyo infusion pombi kuburikidza nebhodhoro rethermos rakazadzwa nemvura inopisa. Kazhinji, tembiricha yemushonga unovaka muviri inofanira kunge iri 37℃~ 40℃. Mushure mekuvhura iyoEnteral Nutrition Bag, inofanira kushandiswa pakarepo. Mushonga wezvekudya ndeye 500ml / bhodhoro, uye iyo yekumisikidza yekumisikidza nguva inofanirwa kuchengetedzwa panenge 4H. Kudonhedza mwero ndeye makumi maviri madonhwe / min 30 maminetsi isati yatanga infusion. Mushure mekunge pasina kusagadzikana, gadzirisa kudonha kusvika ku40 ~ 50 madonhwe / min. mushure mekuiswa, geza chubhu ne50ml ye5% glucose sodium chloride jekiseni. Kana infusion isiri kudikanwa panguva iripo, mushonga wekudya unochengeterwa munzvimbo inotonhora yekuchengetera 2℃~ 10℃, uye nguva yekuchengetedza inotonhora haifaniri kudarika 24h.
1.2 nzira yekudya kunovaka muviri
Kudya kwemukati kunonyanya kusanganisiraNasogastric Tubes, gastrojejunostomy tube, nasoduodenal tube, spiral naso intestinal chubhu uyeNasojejunal Tube. Panyaya yekugara kwenguva refu kweDumbu Tube, kune mukana mukuru wekukonzera matambudziko akawanda akadai sepyloric obstruction, kubuda ropa, kusingaperi kuzvimba kwegastric mucosa, chironda uye kuputika. Spiral naso intestinal chubhu yakapfava mukugadzirwa, haisi nyore kukurudzira mhango yemhino yemurwere uye huro, nyore kukotama, uye kushivirira kwemurwere kwakanaka, saka inogona kuiswa kwenguva yakareba. Zvisinei, nguva yakareba yekuisa pombi kuburikidza nemhino inowanzokonzera kusagadzikana kune varwere, kuwedzera mukana wezvinovaka muviri reflux, uye misinhalation inogona kuitika. Chikafu chevarwere vari kuvhiyiwa chirwere chegomarara remudumbu hachina kunaka, saka vanoda rutsigiro rwekudya kwenguva refu, asi kubuda kwegastric kwevarwere kwakavharwa zvakanyanya. Naizvozvo, hazvikurudzirwe kusarudza transnasal kuiswa kwepombi, uye intraoperative kuiswa kwefistula isarudzo inonzwisisika. Zhang moucheng nevamwe vakashuma kuti gastrojejunostomy tube yakashandiswa, gomba duku rakagadzirwa kuburikidza nemadziro emudumbu remurwere, hose yakaonda (ine dhayamita ye 3mm) yakaiswa mukati megomba duku, ndokupinda mujejunamu kuburikidza nepylorus uye duodenum. Iyo kaviri chikwama tambo suture nzira yakashandiswa kubata nekucheka kwegastric wall, uye iyo fistula chubhu yakagadziriswa mugastric wall tunnel. Iyi nzira inonyanya kukodzera kune varwere vane palliative. Gastrojejunostomy tube ine zvinotevera zvinobatsira: nguva yekugara yakareba kupfuura dzimwe nzira dzekudyara, iyo inogona kunyatsodzivisa kufema kwekufema uye hutachiona hwemapapu hunokonzerwa nasogastric jejunostomy tube; Suture uye kugadzirisa kuburikidza negastric wall catheter iri nyore, uye mukana wegastric stenosis uye gastric fistula yakaderera; Nzvimbo ye gastric wall inenge yakakwirira, kuitira kuti udzivise nhamba yakawanda yeascites kubva pachiropa metastasis mushure mekushanda kwekenza yemudumbu, soak fistula chubhu uye kuderedza kuitika kwechirwere chemudumbu uye chirwere chemudumbu; Zvishoma reflux chiitiko, varwere havasi nyore kuburitsa mutoro wepfungwa.
1.3 nguva yekudya kunovaka muviri uye kusarudzwa kwezvinovaka muviri mhinduro
Zvinoenderana nemishumo yenyanzvi dzemumba, varwere vari kuita radical gastrectomy yegomarara remudumbu vanotanga kudya kunovaka muviri kuburikidza nejejunal Nutrition chubhu kubva maawa matanhatu kusvika masere mushure mekuvhiyiwa, uye jekiseni 50ml yekudziya 5% glucose solution kamwe / 2h, kana jekiseni enteral nutrition emulsion kuburikidza nejejunal nutrition chubhu pa yunifomu kumhanya. Kana murwere asina kusagadzikana kwakadai sekurwadziwa kwepamuviri uye kuputika kwepamuviri, zvishoma nezvishoma kuwedzera huwandu, uye mvura isina kukwana inowedzerwa kuburikidza nemutsinga. Mushure mekunge murwere awana kubuda kwetsvina, gastric chubhu inogona kubviswa, uye chikafu chemvura chinogona kudyiwa nemuromo. Mushure mekunge huwandu hwakazara hwemvura hunogona kuiswa kuburikidza nemuromo, iyoEnteral Feeding Tube inogona kubviswa. Vemaindasitiri vanotenda kuti mvura yekunwa inopiwa maawa makumi mana nemasere mushure mekuvhiyiwa kwegomarara remudumbu. Pazuva rechipiri mushure mekuvhiyiwa, mvura yakachena inogona kudyiwa pakudya kwemanheru, mvura yakazara inogona kudyiwa masikati pazuva rechitatu, uye zvokudya zvinyoro zvinogona kudyiwa pamangwanani ezuva rechina. Naizvozvo, pari zvino, hapana chiyero chakabatana chenguva uye rudzi rwekutanga postoperative kudya kwegomarara remudumbu. Zvisinei, zvigumisiro zvinoratidza kuti kuiswa kwekukurumidza kugadzirisa pfungwa uye kutsigirwa kwekutanga kwekudya kwekudya kwekudya hakuwedzere kuitika kwemashure ekuvhiyiwa, izvo zvinobatsira pakugadzirisa basa remimba uye kunwa kwakanaka kwezvokudya muvarwere vane radical gastrectomy, kuvandudza kushanda kwezvirwere zvevarwere uye kukurudzira kukurumidza kugadziriswa kwevarwere.
2. Nursing of early enteral nutrition
2.1 mukoti wepfungwa
Psychological nursing ishamwari yakakosha mushure mekuvhiyiwa kenza yemudumbu. Chekutanga, vashandi vekurapa vanofanirwa kusuma zvakanakira kudya kunovaka muviri kuvarwere mumwe nemumwe, kuvazivisa nezvezvakanakira kurapwa kwechirwere chekutanga, uye kusuma zviitiko zvakabudirira uye ruzivo rwekurapa kuvarwere kuti vavabatsire kuvaka chivimbo nekuvandudza kutevedza kurapwa. Chechipiri, varwere vanofanirwa kuziviswa nezvemhando dzekudya kunovaka muviri, zvinogoneka zvinonetsa uye nzira dzekupfavisa. Zvinosimbiswa kuti chete kutanga kwekupinda chikafu chekubatsira kunogona kudzoreredza kudya kwemuromo munguva pfupi uye pakupedzisira kuona kupora kwechirwere.
2.2 enteral nutrition tube nursing
Iyo pombi yekuisirwa chikafu ichachengetedzwa uye yakamisikidzwa zvakanaka kudzivirira kudzvanywa, kukotama, kumonyoroka kana kutsvedza pombi. Nokuda kwechubhu yezvokudya iyo yakaiswa uye yakanyatsogadziriswa, vashandi vanoyamwisa vanogona kuisa nzvimbo iyo inopfuura nepakati peganda nemucherechedzo mutsvuku, kubata shanduko yekuchinja, kurekodha chiyero chechubhu chekudya, uye cherechedza uye usimbise kana chubhu ichibviswa kana kuvharwa netsaona. Kana mushonga wacho uchishandiswa kuburikidza nechubhu yekudyisa, vashandi vanoyamwisa vanofanira kuita basa rakanaka mukuuraya utachiona uye kuchenesa pombi yekudyisa. Iyo chubhu yekudyisa inofanira kunyatsocheneswa pamberi uye mushure memushonga, uye mushonga unofanirwa kunyatsopwanyika uye kunyungudutswa zvichienderana nechikamu chakatarwa, kuitira kudzivirira kuvharika kwepombi kunokonzerwa nekusanganiswa kwezvidimbu zvakakura zvemishonga mumushonga wemushonga, kana kusakwana kwemusanganiswa wemushonga nemhinduro yezvikafu, zvichikonzera kuumbwa kwemagwamba uye kuvhara pombi. Mushure mekuiswa kwemushonga unovaka muviri, pombi inofanira kucheneswa. Kazhinji, 50ml ye5% glucose sodium chloride jekiseni inogona kushandiswa pakutsvaira, kamwe chete pazuva. Mumamiriro ezvinhu anoramba achiiswa, mukoti anofanira kuchenesa pombi nejekiseni ine 50ml voikwesha 4H yega yega. Kana iyo infusion ichida kumiswa kwechinguva panguva yekupinza, vashandi vanoyamwisa vanofanirawo kugezesa catheter nenguva kuti vadzivise kusimba kana kuparara kwemushonga wekudya mushure mekuiswa kwenguva yakareba. Kana paine alarm yepombi yekupinza panguva yekuiswa, tanga wapatsanura pombi inovaka muviri nepombi, wozogeza pombi inovaka muviri zvakanaka. Kana pombi inovaka muviri isina kuvharwa, tarisa zvimwe zvikonzero.
2.3 kurapwa kwematambudziko
2.3.1 matambudziko emudumbu
Matambudziko anonyanyozivikanwa erutsigiro rwekudya kunovaka muviri kusvotwa, kurutsa, manyoka uye kurwadziwa nemudumbu. Izvo zvinokonzeresa matambudziko aya zvine hukama zvakanyanya nekusvibiswa kwegadziriro yezvikafu zvinovaka muviri, kunyanya kuwanda, kukurumidza kupinza uye tembiricha yakaderera. Vashandi vevanamukoti vanofanirwa kutarisisa zvizere kune izvo zviri pamusoro, kugara vachitenderera uye kutarisa 30min yega yega kuti vaone kana tembiricha nekudonha kwekumhanya kwemushonga wekudya zvakajairwa. Kugadziriswa uye kuchengetedzwa kwemushonga wezvinovaka muviri kunofanirwa kunyatsotevera maitiro ekushandisa aseptic kudzivirira kusvibiswa kwemhinduro yekudya. Chenjerera kushanda kwemurwere, simbisa kana ichiperekedzwa nekuchinja kwehuturu kana kubuda kwedumbu, uye tarisa chimiro chechigaro. Kana paine zviratidzo zvekusagadzikana senge manyoka uye kutsemuka kwedumbu, iyo infusion inofanirwa kumiswa zvinoenderana nemamiriro chaiwo, kana iyo infusion kumhanya kunofanirwa kudzikiswa zvakakodzera. Muzviitiko zvakakomba, chubhu yekudyisa inogona kuvhiyiwa kubaya gastrointestinal motility zvinodhaka.
2.3.2 chido
Pakati pezvinetso zvine chokuita nekudya kunovaka muviri, aspiration ndiyo yakakomba zvikuru. Zvikonzero zvikuru kusakwana kwegastric uye kudya kwekudya. Kune varwere vakadai, mukoti vanogona kuvabatsira kuchengetedza semi yekugara kana chinzvimbo chekugara, kana kusimudza musoro wemubhedha ne30.° kudzivirira reflux yezvinovaka muviri mhinduro, uye chengetedza chinzvimbo ichi mukati memaminitsi makumi matatu mushure mekuiswa kwemushonga wekudya. Muchiitiko chekushuva nekukanganisa, vashandi vanoyamwisa vanofanira kumisa kupinza munguva, kubatsira murwere kuchengetedza nzvimbo yakarurama yekurara, kuderedza musoro, kutungamirira murwere kuti akosore zvinobudirira, kusveta zvinhu zvakaputirwa mumhepo yemhepo munguva uye kusveta zviri mukati medumbu remurwere kuti arege kuwedzera reflux; Pamusoro pezvo, mishonga inorwisa mabhakitiriya yaibayiwa mutsinga kudzivirira nekurapa utachiona hwemapapu.
2.3.3 kubuda ropa mudumbu
Kana varwere vane enteral nutrition infusion vaine brown gastric juice kana dema stool, mukana wekubuda ropa mudumbu unofanirwa kutariswa. Vashandi vanoyamwisa vanofanira kuzivisa chiremba nenguva uye kunyatsocherechedza kurova kwemwoyo wemurwere, kuwedzera kweropa uye zvimwe zviratidzo. Kune varwere vane shoma shoma yekubuda ropa, yakanaka gastric muto kuongorora uye fecal occult ropa, asidhi inhibiting mishonga inogona kupiwa kudzivirira gastric mucosa, uye Nasogastric Kudya kunogona kupfuuridzirwa pahwaro hemostatic kurapwa. Panguva ino, tembiricha yeNasogastric Feeding inogona kudzikiswa kusvika pa28℃~ 30℃; Varwere vane huwandu hwekubuda ropa vanofanira kunge vachitsanya pakarepo, vachipiwa antacid zvinodhaka nemishonga yehemostatic intravenously, kuzadza huwandu hweropa munguva, kutora 50ml ice saline yakasanganiswa ne 2 ~ 4mg norepinephrine uye kudya kwemhino yega yega 4h, uye kunyatsocherechedza kuchinja kwemamiriro acho ezvinhu.
2.3.4 kuvharirwa kwemagetsi
Kana iyo infusion pombi yakakanganiswa, yakakotama, yakavharika kana kubviswa, nzvimbo yemuviri wemurwere nenzvimbo yecatheter inofanira kugadziridzwa. Kana catheter yavharwa, shandisa sirinji kudhirowa huwandu hwakakodzera hwesaline yakajairwa yekudzvinyirirwa. Kana kugezesa kusingashande, tora chymotrypsin imwe woisanganisa ne 20ml yakajairika saline yekugezesa, uye ramba wakapfava. Kana pasina imwe yenzira dziri pamusoro apa inoshanda, sarudza kana uchidzorera chubhu maererano nemamiriro chaiwo. Kana jejunostomy chubhu yakavharwa, zviri mukati zvinogona kupomba zvakachena nejekiseni. Usaise waya wegwara kuti udonhe catheter kudzivirira kukuvara uye kuputika kweiyokudyisa catheter.
2.3.5 metabolic matambudziko
Kushandiswa kwekudya kunovaka muviri kunobatsira kunogona kukonzera kusagadzikana kweglucose yeropa, nepo hyperglycemic mamiriro emuviri achizotungamira kukurumidza kubereka kwebhakitiriya. Panguva imwecheteyo, kukanganiswa kweglucose metabolism kuchaita kuti kuve nekusakwana kwesimba rekupa, izvo zvinozoita kuti kuderera kwekurwisa kwevarwere, kukonzeresa hutachiona hwe enterogenous, kukonzeresa kusashanda zvakanaka kwegastrointestinal, uye zvakare iri kukurudzira kukuru kwekutadza kwenhengo dzakawanda. Zvinofanira kucherechedzwa kuti varwere vazhinji vane gomarara remudumbu mushure mekuisirwa chiropa vanoperekedzwa ne insulin kuramba. Panguva imwecheteyo, vanopiwa kukura kwehomoni, anti-rejection drugs uye nhamba huru ye corticosteroids mushure mekushanda, iyo inowedzera kukanganisa glucose metabolism uye yakaoma kudzora ropa glucose index. Nokudaro, kana tichiwedzera insulini, tinofanira kunyatsocherechedza chiyero cheglucose yeropa yevarwere uye nekugadzirisa zvine musoro kuiswa kweglucose yeropa. Paunenge uchitanga kutsigira kwekudya kunovaka muviri, kana kushandura iyo infusion yekumhanyisa uye huwandu hwekupinza hwemhinduro yezvikafu, mukoti anofanira kutarisa munwe weropa glucose index uye weti glucose yemurwere yega yega 2 ~ 4H. Mushure mekusimbisa kuti iyo glucose metabolism yakagadzikana, inofanirwa kuchinjirwa kune yega yega 4 ~ 6h. Iyo infusion yekumhanyisa uye huwandu hwekupinza hweislet hormone inofanirwa kugadziridzwa zvakafanira pamwe nekushandurwa kweropa glucose level.
Kupfupisa, mukuitwa kweFIS, zvakachengeteka uye zvinogoneka kuita rubatsiro rwekudya kunovaka muviri mukutanga mushure mekuvhiyiwa kwegomarara remudumbu, izvo zvinobatsira kuvandudza hutano hwemuviri, kuwedzera kudyiwa kwekupisa uye mapuroteni, kuvandudza nitrogen yakashata, kuderedza kurasikirwa kwemuviri uye kuderedza akasiyana-siyana mushure mekuvhiyiwa, uye ine yakanaka yekudzivirira yevarwere mugastrointest; Inogona kukurudzira kudzoreredza kwevarwere' intestinal function, kupfupisa kugara muchipatara nekuvandudza mwero wekushandiswa kwezviwanikwa zvekurapa. Icho chirongwa chinogamuchirwa nevarwere vazhinji uye chinoita basa rakanaka mukupora uye kurapwa kwakakwana kwevarwere. Nekutsvagisa kwakadzama kwekiriniki kwekutanga postoperative enteral nutrition tsigiro yegomarara remudumbu, hunyanzvi hwayo hwekuyamwisa huri kuramba huchivandudzwa. Kuburikidza ne postoperative yehukoti hwepfungwa, chikafu chehuhubhu yehukoti uye yakanangwa complication yekuyamwisa, mukana wekunetsekana kwemudumbu, aspiration, metabolic complication, kubuda ropa kwegastrointestinal uye kuvharika kwemagetsi kunodzikiswa zvakanyanya, izvo zvinogadzira chimiro chakanaka chekushandiswa kwezvakanakira zvazvakanakira zvekudya kunovaka muviri.
Munyori wekutanga: Wu Yinjiao
Nguva yekutumira: Kubvumbi-15-2022