Nyob hauv lub neej muaj cov xwm txheej sib txawv thaum tus neeg laus noj tsis tau li qub. Qhov no tshwm sim feem ntau tom qab phais. Thaum lub sijhawm rov qab los, tus neeg tsis tuaj yeem zom thiab nce mus zom zaub mov. Tab sis kuj nyob rau lub sij hawm no, tus neeg mob xav tau ib tug tas mus li ntawm cov as-ham rau lub cev rau kev ua hauj lwm ntawm tag nrho cov nruab nrog cev thiab lub restoration ntawm lub neej. Hauv qhov no, hom kev noj zaub mov zoo li kev noj zaub mov zoo yog siv.
khoom noj khoom haus - nws yog dab tsi?
Qhov no yog hom kev kho mob ntawm tus neeg mob, nws qhov tshwj xeeb yog tias cov khoom noj los ntawm kev sojntsuam lossis ib qho tshwj xeeb. Feem ntau, nrog rau hom khoom noj no, kev sib xyaw tshwj xeeb yog siv. Lawv txawv ntawm cov zaub mov ib txwm rau ib tug neeg laus, vim qee qhov xwm txheej tus neeg mob tsis tuaj yeem noj lwm yam khoom noj.
Cov txiaj ntsig ntawm kev noj zaub mov no
hom zaub mov no muaj txiaj ntsig rau cov neeg mob:
- Physiological - khoom noj khoom haus ncaj qha mus rau lub plab zom mov, uas tso cai rau nws yooj yim.yuav nqus tau thiab muab lub zog rau tus neeg mob tom qab ua haujlwm.
- khoom noj pheej yig - hom no tsis raug nqi ntau.
- Yooj yim siv cov khoom siv ntxiv - tsis muaj qhov yuav tsum tau ua kom muaj menyuam tsis taus raws li tsuas yog rov ua dua lub raj nkag lossis qhov ncauj qhov ncauj.
- Tsis ua rau muaj teeb meem loj - qhov kev sojntsuam tau muab tso rau yam tsis muaj teeb meem, yog li tsis muaj feem cuam tshuam txog kev loj hlob thiab tshwm sim ntawm kev ua phem rau tus neeg mob.
- Cia koj muab lub cev nrog txhua yam khoom tsim nyog, qhov no yog vim kev xaiv cov khoom sib xyaw uas zoo rau tus neeg.
- Pab tiv thaiv qhov tshwm sim ntawm atrophic phenomena hauv plab hnyuv.
Indications rau enteral khoom noj khoom haus
Txoj kev loj hlob ntawm cov tshuaj nyob rau hauv ob centuries dhau los tau ua rau nws muaj peev xwm txiav txim siab dab tsi yuav yog qhov zoo tshaj plaws rau ib tug neeg tom qab kev phais, cov txheej txheem uas yuav pab tau nws rov qab sai dua thiab tau txais lub zog tsim nyog nrog tsawg tshaj plaws. Yog li kev noj haus nrog kev sib tov tom qab kev ua haujlwm nrog kev pab ntawm cov cuab yeej kho mob ntxiv muaj nws qhov zoo thiab cov lus qhia. Muaj qee qhov kev qhia tshwj xeeb rau cov khoom sib xyaw uas tus neeg xav tau, nrog rau cov qauv ntawm kev noj mov. Khoom noj khoom haus yog muab yog:
- Tus neeg mob, vim nws mob, tsis tuaj yeem noj thaum nws tsis nco qab lossis nqos tsis tau.
- Tus neeg mob yuav tsum tsis txhob noj zaub mov - qhov no yog mob pancreatitis lossis los ntshav hauv plab.
- Siabib tug neeg tsis kam noj zaub mov, ces yuam kev nkag mus rau khoom noj khoom haus yog siv. Yuav ua li cas thaum lub xeev no tshwm sim? Qhov no tshwm sim nrog anorexia nervosa, nyob rau hauv uas nws yog tsis yooj yim sua kom tam sim ntawd thauj lub plab nrog cov zaub mov zoo tib yam, vim hais tias muaj kev txaus ntshai ntawm kev tuag tom qab ib tug ntev tsis noj mov. Tsis tas li ntawd, nrog rau ntau yam kab mob, tus neeg mob yuav tsis kam noj, nyob rau hauv rooj plaub uas cov khoom noj khoom haus nkag tau siv los ua kom lub cev muaj cov as-ham tsim nyog los tawm tsam tus kab mob no.
- Khoom noj tsis tau raws li qhov xav tau, qhov no tshwm sim nrog kev raug mob, catabolism, kub hnyiab.
hom khoom noj no kuj raug sau rau cov kab mob hauv qab no ntawm lub cev:
- tsis muaj protein ntau thiab lub zog hauv lub cev yog tias tsis muaj txoj hauv kev los xyuas kom tau txais cov tshuaj no hauv txoj hauv kev;
- nyob rau hauv cov xwm txheej ntawm ntau yam neoplasms hauv lub taub hau, plab thiab caj dab;
- yog tias muaj cov kab mob loj zuj zus ntawm lub hauv nruab nrab ntawm lub paj hlwb, xws li Parkinson's disease, cerebrovascular stroke, ntau lub xeev tsis nco qab;
- rau cov mob oncological tom qab hluav taws xob thiab tshuaj khomob;
- feem ntau cov zaub mov no tau muab rau cov kab mob loj ntawm txoj hnyuv: pancreatitis, cov txheej txheem pathological hauv daim siab thiab biliary tract, malabsorption thiab lub plab zom mov luv, nrog rau Crohn tus kab mob;
- tam sim tom qab kev phais ntawm lub cev;
- rau qhov kub hnyiab thiab mob hnyav;
- thaum fistulas, sepsis tshwm;
- if complexkab mob sib kis;
- rau kev nyuaj siab loj;
- nrog ntau qib ntawm hluav taws xob puas tsuaj rau tib neeg.
Txoj kev pub mis mis
Kev noj zaub mov hauv cov neeg mob sib txawv ntawm qhov lawv noj:
- Siv lub raj los qhia cov mis rau hauv plab.
- Txoj kev "sipping" ntawm kev noj cov zaub mov tshwj xeeb hauv qhov ncauj me me.
Cov txheej txheem no tseem hu ua passive thiab nquag. Thawj zaug yog kev pub mis rau hauv lub raj, infusion tshwm sim siv lub tshuab tshwj xeeb thiab lub tshuab xa tawm. Qhov thib ob yog active, phau ntawv, nqa tawm tsuas yog nrog ib tug syringe. Txhawm rau siv txoj kev no, nws yog ib qho tsim nyog los sau qee qhov sib xyaw thiab txhaj tshuaj maj mam rau hauv qhov ncauj kab noj hniav ntawm tus neeg mob. Txog hnub tim, qhov zoo dua yog muab rau cov twj infusor, uas tau muab cov khoom sib tov.
Nyob rau hauv lub raj mis
Ntau tus txheeb ze ntawm cov neeg mob nug: kev noj zaub mov nkag - nws yog dab tsi thiab txhais tau tias xav tau dab tsi rau qhov no? Tseeb, rau txoj kev no ntawm lub cev nrog zaub mov, kev sojntsuam sib txawv yog xav tau. Lawv muab faib ua:
- nasogastric (nasoenteric) - nyias yas sojntsuam uas muaj qhov ntawm ib theem, nrog rau qhov hnyav kom yooj yim ntawm kev ntxig;
- percutaneous - ntxig tom qab phais (pharyngoscopy, gastrostomy, esophagostomy, jejunostomy).
Kev noj zaub mov rau lub cev
Kev nkag siab txog qhov teeb meem no, kev noj zaub mov zoo - nws yog dab tsi, tseem tsis tau txaus rau nws qhov kev siv. Muaj ntau ntau nuances ntawm kev qhia zaub mov rau hauv lub cev nyob rau hauv txoj kev no, piv txwv li, pub tus nqi ntawm qhov sib tov. Muaj ntau hom kev tau txais khoom noj los ntawm tus neeg mob.
- Pub sib tov ntawm qhov ceev tsis tu ncua. Los ntawm kev sojntsuam, tus neeg mob tau txais zaub mov ntawm tus nqi, nws yog 40-60 ml / h. Tom qab ntawd tus kws kho mob tshwj xeeb saib xyuas cov tshuaj tiv thaiv ntawm tus neeg mob. Yog tias qhov sib xyaw ua kom zoo, qhov nrawm tuaj yeem maj mam nce. Qhov nruab nrab, nws nce los ntawm 25 ml / h rau 8-12 teev, tom qab ntawd thaum tib lub sijhawm koj tuaj yeem ntxiv tus nqi qub kom txog rau thaum qhov xav tau ceev. Yog tias qhov kev ua haujlwm tau dhau los thiab tus neeg mob tau mob hnyav, qhov sib tov yuav tsum tsis pub ntau tshaj 20-30 ml / h. Nws yog ib qho tsim nyog yuav tsum ua tib zoo saib xyuas tus neeg mob. Nrog xeev siab, raws plab, convulsions lossis ntuav, txawm tias tus nqi ntawm kev tswj hwm ntawm qhov sib xyaw lossis nws cov concentration txo qis. Nyob rau tib lub sijhawm, ib qho qhia tau hloov pauv kom tsis muaj kev ntxhov siab rau lub cev.
- Khoom noj khoom haus zoo tuaj yeem qhia txog cyclically. Xws li kev noj zaub mov cyclic yog tias tus neeg mob, tom qab noj zaub mov tas li, maj mam txo thaum hmo ntuj, txo nws mus rau ib hmos. Txoj kev no yooj yim rau tus neeg mob thiab tuaj yeem ua tiav los ntawm gastrostomy.
- Kev noj zaub mov zoo (ib ntus) tsis yog rau txhua tus. Nws yog qhia rau cov neeg mob uas mob raws plab lossis tau txais kev phais plab hnyuv. Xws li ib pluas mov yog hu ua periodic, raws li nws tau ua nyob rau hauv lub sij hawm ntawm 4-6 teev.
- Bolus pluas mov. Hom no zoo ib yam linoj mov. Cov sib tov yog txhaj nrog ib tug syringe los yog los ntawm ib tug sojntsuam, tab sis cov kev cai rau kev nkag mus yog nruj me ntsis soj ntsuam. Nyob rau tib lub sijhawm, qhov ceev tsis pub tshaj 240 ml ib nrab teev. Tus naj npawb ntawm cov pluas noj ib hnub twg 3-5 zaug. Tab sis nws yog tsim nyog pib qhov kev taw qhia ntawm qhov sib tov nrog ib puas ml. Yog tias tus neeg mob zam nws yam tsis muaj teeb meem, ces 50 ml yog maj mam ntxiv. Tab sis qhov kev tswj hwm no yog qhov txaus ntshai vim muaj qhov tshwm sim ntau zaus, yog li nws yuav tsum tau muab tshuaj thiab ua raws li kev saib xyuas ntawm tus kws tshaj lij.
Tau kawg, cov txheej txheem no tsis tuaj yeem hloov kho rau txhua tus neeg mob uas xav tau kev noj zaub mov zoo. Kev xaiv ntawm txoj kev, ceev thiab ntim ntawm xws li ib tug khoom noj khoom haus rau lub cev yuav siv sij hawm mus rau hauv tus account tus yam ntxwv ntawm tus kheej.
Txoj kev xaiv ntawm cov khoom sib xyaw
Cov qauv khoom noj khoom haus sab hauv yuav tsum tau ua raws li tus neeg xav tau kev pab ntawm cov neeg mob. Lawv xaiv nyob ntawm ntau yam.
- Khoom noj khoom haus zoo rau cov neeg mob tom qab phais yuav tsum muaj lub zog zoo. Nws tsis tsawg dua 1 kcal / ml.
- Cov mis yuav tsum yog lactose thiab gluten dawb. Cov tshuaj no tuaj yeem ua rau muaj kev fab tshuaj.
- Nws yuav tsum muaj qhov osmolarity tsis tshaj 340 mosm/L.
- Khoom noj khoom haus yuav tsum tsis khov kom tsis txhob muaj teeb meem kev nqus.
- Ib qho qauv zoo tsis ua rau lub plab zom mov ntau dhau.
- Nws yog qhov tsim nyog uas nws muaj cov ntaub ntawv hais txog cov chaw tsim khoom thiab muaj kev hloov pauv caj ces ntawm cov protein.
Nws yuav tsum tau muab sau tseg tias sib tov rau cov me nyuam, nrog rau cov kev daws teeb meem,npaj los ntawm tej yam ntuj tso khoom tsis haum rau enteral khoom noj khoom haus. Lawv tsis sib npaug rau cov neeg laus, yog li lawv tsis tuaj yeem nqa qhov xav tau. Rau cov neeg mob uas xav tau cov khoom noj khoom haus zoo li no, lawv cov hom kev sib tov tau tsim, uas peb yuav xav txog hauv qab no.
Monomer blends
Lub npe ntawm cov khoom sib xyaw txiav txim siab lawv lub hom phiaj. Lawv tsis muaj tag nrho cov txheej txheem tsim nyog, tab sis kuj tseem siv rau lub sijhawm tom qab phais. Xws li kev sib xyaw ua ke muaj cov piam thaj thiab ntsev, uas ua rau nws tuaj yeem rov ua haujlwm ntawm cov hnyuv me tam sim ntawd tom qab kev phais. Nyob rau hauv lub xub ntiag ntawm ntuav los yog raws plab, xws li kev noj haus zoo tswj cov dej thiab electrolyte tshuav nyob rau hauv tib neeg lub cev. Xws li cov khoom xyaw xws li Gastrolit, Mafusol, Regidron, Citroglucosolan, Orasan thiab lwm yam.
Khoom noj khoom haus sib xyaw
Cov khoom noj khoom haus no tus neeg mob yog tsim los ntawm cov khoom siv tshuaj lom neeg raug xaiv. Lawv siv rau hauv cov xwm txheej tshwj xeeb ntawm cov kab mob metabolic hauv lub cev nrog cov kab mob xws li daim siab thiab lub raum tsis ua haujlwm, ntshav qab zib mellitus thiab pancreatitis. Hauv qhov no, pancreas, daim siab thiab ob lub raum tsis tuaj yeem ua lawv cov haujlwm tshwj xeeb, yog li cov khoom sib xyaw no pab tib neeg tsawg kawg ib nrab rov ua haujlwm tseem ceeb. Cov khoom noj no suav nrog Vivonex, Flexical, Lofenalak thiab lwm yam.
Semi-Element Blends
Cov khoom noj muaj txiaj ntsigkev sib tov rau cov neeg mob feem ntau siv ntau dua li yav dhau los. Qhov no yog vim qhov tseeb tias lawv twb muaj kev sib npaug ntau dua thiab tsim nyog rau ntau yam ntawm cov neeg mob uas xav tau kev noj zaub mov zoo. Ntawm no, cov proteins twb nyob rau hauv daim ntawv ntawm cov amino acids thiab peptides, uas tso cai rau lawv yooj yim absorbed nyob rau hauv lub cev. Cov kev daws teeb meem zoo li no tau siv tam sim tom qab kev ua haujlwm hauv kev ua txhaum ntawm kev zom zaub mov ntawm lub cev. Cov no suav nrog Nutrien Elemental, Nutrilon Pepti TSC, Peptisorb, Peptamen.
qauv polymer sib xyaw
hom no yog siv rau ntau yam kab mob tom qab ua haujlwm, thaum tus neeg tsis nco qab. Lawv yog cov feem ntau haum rau ib tug neeg laus lub cev nyob rau hauv lawv muaj pes tsawg leeg. Cov kev daws teeb meem no muaj tag nrho cov zaub mov tsim nyog, kab kawm, proteins, rog, carbohydrates. Lawv muab faib ua peb hom.
- Qhuav, uas yuav tsum tau diluted thiab txhaj rau hauv lub cev los ntawm lub raj. Qhov no yog cov khoom noj khoom haus hauv qab no: "Nutrison", "Berlamin Modular", "Nutricomp Standard".
- Kua uas tuaj yeem tswj tau tam sim ntawd. Lawv tau tsim los rau cov xwm txheej uas tsis muaj ib feeb kom poob, muab khoom noj khoom haus tseem ceeb rau tus neeg. Cov no suav nrog Berlamin Modular, Nutricomp Liquid, Nutrizon Standard thiab lwm yam.
- sib tov uas siv qhov ncauj. Cov no yog "Berlamin Modular", "Nutridrink", "Forticrem" thiab lwm yam.
Txoj kev sib xyaws
hom khoom noj no zoo ib yam li lub hom phiaj rau lub ntsiab lushom kev sib tov. Lawv tau tsim los kho cov kev ua haujlwm ntawm lub cev hauv cov kab mob tshwj xeeb. Lawv kho cov kab mob metabolic hauv kev ua pa tsis ua haujlwm, ua rau lub raum tsis zoo thiab lub siab ua haujlwm, thiab tiv thaiv kab mob.
