Mumakore achangopfuura, izwi rokuti "kudyisa kusashivirira" rave richishandiswa zvakanyanya muchipatara. Chero bedzi kutaurwa kwekudya kunovaka muviri, vazhinji vashandi vekurapa kana varwere nemhuri dzavo vanozobatanidza dambudziko rekushivirira uye kusashivirira. Saka, chii chaizvo chinonzi enteral nutrition kushivirira kunorevei? Mukuita kwekiriniki, ko kana murwere aine kusashivirira kwekudya kwemukati? Pa 2018 National Critical Care Medicine Annual Meeting, mutori wenhau akabvunzurudza Purofesa Gao Lan kubva kuDhipatimendi reNeurology yeChipatara Chekutanga cheJilin University.
Mukuita kwekiriniki, varwere vazhinji havagone kuwana chikafu chakakwana kuburikidza nekudya kwakajairika nekuda kwechirwere. Kune varwere ava, rubatsiro rwekudya kunodiwa kunodiwa. Zvisinei, kudya kunovaka muviri hakusi nyore sezvinofungidzirwa. Munguva yekudyisa, varwere vanofanira kutarisana nemubvunzo wekuti vanogona kushivirira.
Purofesa Gao Lan akataura kuti kushivirira chiratidzo chebasa remudumbu. Zvidzidzo zvakawana kuti isingasviki 50% yevarwere vemukati vemishonga vanogona kushivirira yakazara yekupinda chikafu panguva yekutanga; vanopfuura 60% yevarwere vari muintensive care unit vanokonzera kukanganisika kwekanguva kwekudya kunovaka muviri nekuda kwekusagadzikana kwegastrointestinal kana gastrointestinal motility disorder. Kana murwere akawedzera kusashivirira kwekudya, zvinogona kukanganisa huwandu hwekudyisa hunotarisirwa, zvichikonzera mhedzisiro yekiriniki yakaipa.
Saka, ungatonga sei kana murwere achishivirira kune chikafu chinovaka muviri? Purofesa Gao Lan akataura kuti ura hwemurwere hunonzwika, kana kune kurutsa kana kuti reflux, kana kune manyoka, kana kune intestinal dilatation, kana pane kuwedzera kwemudumbu masara, uye kana chinangwa chevhoriyamu chinosvika mushure memazuva maviri kusvika ku3 ekudya kwekudya, nezvimwewo.
Kana murwere asinganzwe kusagadzikana mushure mekushandiswa kwekudya kunovaka muviri, kana kana abdominal distension, manyoka, uye reflux zvikaitika mushure mekushandiswa kwekudya kwemukati, asi kuderedza mushure mekurapwa, murwere anogona kunzi anoshivirira. Kana murwere achirwara nekurutsa, kubuda mudumbu, uye manyoka mushure mekugamuchira kudya kunovaka muviri, anopiwa kurapwa kunoenderana uye ombomira kwemaawa gumi nemaviri, uye zviratidzo zvacho hazvisi nani mushure mehafu yekudya kunovaka muviri kunopiwa zvakare, izvo zvinoonekwa sekusagadzikana kwekudya kwemukati. Kusagadzikana kwekudya kwemukati kunogonawo kukamurwa kuita gastric kusagadzikana (gastric retention, kurutsa, reflux, aspiration, nezvimwewo) uye kusawirirana kwemukati (manyoka, kuputika, kuwedzera kwemukati-mudumbu).
Purofesa Gao Lan akataura kuti kana varwere vachinge vasingashiviriri kune kudya kunovaka muviri, ivo vanowanzobata nezviratidzo zvinoenderana nezvinotevera zviratidzo.
Indicator 1: Kurutsa.
Tarisa kana nasogastric chubhu iri munzvimbo chaiyo;
Deredza mwero wekudyarwa kwekudya ne50%;
Shandisa mushonga pazvinenge zvakakodzera.
Chiratidzo chechipiri: Manzwi emukati.
Rega kudya kunovaka muviri;
Ipa mishonga;
Dzokorora maawa maviri oga oga.
Index 3: abdominal distension/intra-abdominal pressure.
Intra-abdominal pressure inogona kunyatsoratidza mamiriro ezvinhu ekufamba kwehuta hudiki uye kuchinja kwekuita basa, uye chiratidzo chekusagadzikana kwekudya kune varwere vanorwara zvakanyanya.
Mune munyoro intra-abdominal hypertension, chiyero chemukati chekudya chikafu chinogona kuchengetedzwa, uye mukati-mudumbu kumanikidzwa kunogona kuyerwa zvakare maawa matanhatu;
Kana intra-abdominal pressure yakakwira zvine mwero, dzikamisa infusion rate ne50%, tora firimu remudumbu kuti ubvise kuvharika kwematumbo, uye dzokorora bvunzo maawa matanhatu ega ega. Kana murwere akaramba aine abdominal distension, gastrodynamic zvinodhaka zvinogona kushandiswa zvinoenderana nemamiriro acho. Kana iyo intra-abdominal pressure yakawedzera zvakanyanya, enteral nutrition infusion inofanira kumira, uye ipapo kuongororwa kwakadzama kwemimba kunofanira kuitwa.
Chiratidzo chechina: Manyoka.
Pane zvikonzero zvakawanda zvemanyoka, zvakadai semudumbu mucosal necrosis, kubuda, kuputika, kuderedzwa kwema enzymes ekudya, mesenteric ischemia, intestinal edema, uye kusaenzana kwemaruva emudumbu.
Nzira yekurapa ndeyekudzikisa chiyero chekudya, kuderedza tsika yezvokudya, kana kugadzirisa enteral nutrition formula; kuita kurapa kwakanangidzirwa zvichienderana nechakonzera manyoka, kana zvichienderana nehukuru hwemanyoka. Zvinofanira kucherechedzwa kuti kana manyoka akaitika muICU varwere, hazvikurudzirwi kumisa enteral nutrition supplementation, uye inofanira kuramba ichidyisa, uye panguva imwe chete kuwana chikonzero chechirwere chechirwere kuti uone chirongwa chakakodzera chekurapa.
Index shanu: dumbu rasara.
Pane zvikonzero zviviri zvegastric residue: zvikonzero zvechirwere uye maitiro ekurapa.
Zvirwere zvinokonzera kukwegura, kufutisa, chirwere cheshuga kana hyperglycemia, murwere akavhiyiwa mudumbu, nezvimwewo;
Mishonga yemishonga inosanganisira kushandiswa kwezvinonyaradza kana opioid.
Mazano ekugadzirisa zvisaririra zvedumbu anosanganisira kuita ongororo yakakwana yemurwere asati ashandisa kudya kunovaka muviri, kushandisa mishonga inokurudzira gastric motility kana acupuncture pazvinenge zvakakodzera, uye kusarudza gadziriro dzine kukurumidza kubuda mudumbu;
Duodenal uye jejunal feeding inopiwa kana kune yakawandisa gastric residue; chidimbu chiduku chinosarudzwa kutanga kudya.
Index nhanhatu: reflux/aspiration.
Kuti udzivise kushuvira, vashandi vezvokurapa vanotendeuka uye vanoyamwa mavhisi ekufema muvarwere vane ruzivo rwakaremara vasati vadyisa mhino; kana mamiriro acho achibvumira, simudza musoro nechipfuva chemurwere ne30 ° kana kupfuura panguva yekudyisa mhino, uye mushure mekudya kwemhino Chengetedza nzvimbo yakasara mukati mehafu yeawa.
Pamusoro pezvo, zvakakoshawo kutarisa kushivirira kwekudya kwemurwere zuva nezuva, uye kukanganisa kuri nyore kwekudya kwemukati kunofanirwa kudzivirirwa.
Nguva yekutumira: Jul-16-2021