Mohopolo oa motheo
Parenteral nutrition (PN) ke phepelo ea phepo e nepahetseng e tsoang ho intravenous e le tšehetso ea phepo e nepahetseng pele le ka mor'a ho buuoa le ho bakuli ba kulang haholo. Phepo eohle e fanoa ka parenterally, e bitsoang total parenteral nutrition (TPN). Litsela tsa phepo ea batsoali li kenyelletsa phepo e kenang ka har'a methapo le phepo e kenang ka har'a methapo. Phepo ea batsoali (PN) ke phepelo ea methapo ea limatlafatsi tse hlokoang ke bakuli, ho kenyelletsa lik'hilojule (lik'habohaedreite, li-emulsions tsa mafura), li-amino acid tse hlokahalang le tse seng tsa bohlokoa, livithamine, electrolyte le trace elements. Phepo ea botsoali e arotsoe ka phepo e felletseng ea botsoali le phepo e sa fellang ea botsoali. Sepheo ke ho nolofalletsa bakuli ho boloka boemo ba phepo e nepahetseng, boima ba 'mele le ho fola ha maqeba esita leha ba sa khone ho ja ka tsela e tloaelehileng,' me bana ba banyenyane ba ka tsoela pele ho hōla le ho hōla. Litsela tsa infusions le mekhoa ea infusion ke litiiso tse hlokahalang bakeng sa phepo ea batsoali.
Lipontšo
Lipontšo tsa mantlha tsa phepo ea botsoali ke ba nang le ho se sebetse hantle kapa ho hloleha ha mala, ho kenyelletsa le ba hlokang tšehetso ea phepo ea lapeng.
Phello ea bohlokoa
1. Tšitiso ea mala
2. Ho se sebetse hantle ha mala a manyane: ① Lefu la mala a makhutšoane: ho tsoa mala a manyane haholo >70%~80%; ② Lefu la mala a manyenyane: lefu la tsamaiso ea 'mele ea ho itšireletsa mafung, intestinal ischemia, li-fistula tse ngata tsa mala; ③ Radiation enteritis, ④ Letšollo le matla, ho hlatsa ka thobalano > matsatsi a 7.
3. Pancreatitis e matla: Infusion ea pele ho pholosa ho tsosoa kapa MODS, ka mor'a hore matšoao a bohlokoa a tsitsitse, haeba ho holofala ha mala ho sa tlosoe 'me phepo e nepahetseng e ke ke ea mamelloa ka ho feletseng, ke pontšo ea phepo ea batsoali.
4. Boemo bo phahameng ba catabolic: ho chesa ho hoholo, likotsi tse matla tsa metsoako, tšoaetso, joalo-joalo.
5. Khaello e matla ea phepo e nepahetseng: Khaello ea khaello ea protheine e nang le lik'halori hangata e tsamaisana le ho se sebetse hantle ha mala 'me ha e khone ho mamella phepo e kenang ka mpeng.
Tšehetso e nepahetse
1. Nako ea perioperative ea opereishene e kholo le ts'oaetso: Tšehetso ea phepo e nepahetseng ha e na phello e kholo ho bakuli ba nang le boemo bo botle ba phepo e nepahetseng. Ho fapana le hoo, e ka ’na ea eketsa mathata a tšoaetso, empa e ka fokotsa mathata a ka mor’a ho buuoa ho bakuli ba nang le khaello ea phepo e nepahetseng haholo. Bakuli ba nang le khaello e matla ea phepo e nepahetseng ba hloka tšehetso ea phepo bakeng sa matsatsi a 7-10 pele ho buuoa; bakeng sa bao ho lebeletsoeng hore ba hlōlehe ho tsosolosa tšebetso ea mala nakong ea matsatsi a 5-7 ka mor'a ho buuoa ka matla, tšehetso ea phepo ea batsoali e lokela ho qalisoa ka hare ho lihora tsa 48 ka mor'a ho buuoa ho fihlela mokuli a ka ba le phepo e nepahetseng. Phepo e kenang kapa ho ja lijo.
2. Enterocutaneous fistulas: Tlas'a boemo ba ho laola tšoaetso le ho ntša metsi a lekaneng le a loketseng, tšehetso ea phepo e nepahetseng e ka etsa hore karolo e fetang halofo ea li-fistulas tsa enterocutaneous li iphelise, 'me opereishene e tiileng e fetohile phekolo ea ho qetela. Tšehetso ea phepo ea batsoali e ka fokotsa ho ntšoa ha mokelikeli oa ka mpeng le phallo ea fistula, e leng molemo ho laola tšoaetso, ho ntlafatsa boemo ba phepo e nepahetseng, ho ntlafatsa sekhahla sa pheko, le ho fokotsa mathata a ho buuoa le lefu.
3. Maloetse a ho ruruha: Lefu la Crohn, ulcerative colitis, lefuba la mala le bakuli ba bang ba boemong bo sebetsang ba lefu, kapa ba rarahane ka ho ruruha ha mpa, mala a mala, ho thibela mala le ho tsoa mali, joalo-joalo, phepo ea batsoali ke mokhoa oa bohlokoa oa phekolo. E ka imolla matšoao, ea ntlafatsa phepo e nepahetseng, ea phomola mala, 'me ea thusa ho lokisoa ha mucosa ea mala.
4. Bakuli ba nang le khaello e matla ea hlahala: Bakeng sa bakuli ba nang le tahlehelo ea boima ba 'mele ≥ 10% (boima ba' mele bo tloaelehileng), tšehetso ea phepo ea batsoali kapa ea enteral e lokela ho fanoa matsatsi a 7 ho isa ho a 10 pele ho opereishene, ho fihlela phepo e nepahetseng kapa ho khutlela ho ja ka mor'a ho buuoa. ho fihlela.
5. Ho haella ha litho tsa bohlokoa:
① Ho se lekane ha sebete: bakuli ba nang le sebete sa sebete ba na le phepo e nepahetseng ka lebaka la ho se je lijo tse lekaneng. Nakong ea perioperative nako ea ho thatafala ha sebete kapa hlahala ea sebete, hepatic encephalopathy, le libeke tse 1 ho isa ho tse 2 kamora ho fetisoa ha sebete, ba sa khoneng ho ja kapa ho fumana phepo e nepahetseng ba lokela ho fuoa phepo ea batsoali.
② Ho haella ha renal: lefu le matla la catabolic (tšoaetso, ts'oaetso kapa ho hloleha ha litho tse ngata) ho kopantsoe le ho hloleha ha renal ho matla, bakuli ba nang le khaello ea phepo e nepahetseng, 'me ba hloka tšehetso ea phepo ea batsoali hobane ba sitoa ho ja kapa ho fumana phepo e nepahetseng. Nakong ea dialysis bakeng sa ho hloleha ho sa foleng ha renal, motsoako oa phepo ea batsoali o ka kenngoa nakong ea tšelo ea mali ka methapo.
③ Ho haella ha pelo le matšoafo: hangata ho kopantsoe le khaello ea phepo e tsoakiloeng ea protheine-eneji. Phepo e kenang ka hare e ntlafatsa boemo ba kliniki le ts'ebetso ea mala ho mafu a sa foleng a thibelang matšoafo (COPD) 'me a ka thusa bakuli ba nang le lefu la pelo (bopaki bo haella). Karo-karolelano e loketseng ea tsoekere ho mafura ho bakuli ba COPD ha e e-s'o tsejoe, empa karo-karolelano ea mafura e lokela ho eketseha, palo eohle ea tsoekere le tekanyo ea infusion e lokela ho laoloa, liprotheine kapa li-amino acid li lokela ho fanoa (bonyane lg / kg.d), 'me glutamine e lekaneng e lokela ho sebelisoa bakeng sa bakuli ba nang le lefu le tebileng la matšoafo. Ho molemo ho sireletsa alveolar endothelium le intestinal-associated lymphoid tissue le ho fokotsa mathata a matšoafo. ④ Tšitiso ea mala a ho ruruha: Tšehetso ea phepo ea perioperative ea parenteral bakeng sa 4 ho libeke tsa 6 e molemo bakeng sa ho hlaphoheloa ha mala le ho imolla tšitiso.
Contraindications
1. Ba nang le ts'ebetso e tloaelehileng ea mala, ho ikamahanya le phepo e nepahetseng kapa ho hlaphoheloa ha mala nakong ea matsatsi a 5.
2. E sa phekoleheng, ha ho na tšepo ea ho phela, ho shoa kapa ho ke keng ha phekolloa ha bakuli ba koma.
3. Ba hlokang ho buuoa ka tšohanyetso 'me ba ke ke ba kenya ts'ehetso ea phepo e nepahetseng pele ba buuoa.
4. Ts'ebetso ea methapo ea pelo kapa mathata a matla a metabolism a hloka ho laoloa.
Tsela ea phepo e nepahetseng
Khetho ea tsela e nepahetseng ea phepo ea botsoali e itšetlehile ka lintlha tse kang histori ea mokuli ea ho phunya methapo ea mali, venous anatomy, boemo ba coagulation, nako e lebeletsoeng ea phepo ea batsoali, boemo ba tlhokomelo (ho kena sepetlele kapa che), le mofuta oa lefu le ka sehloohong. Bakeng sa bakuli, khetho e tloaelehileng ka ho fetisisa ke peripheral venous kapa central venous intubation; bakeng sa bakuli ba phekolo ea nako e telele maemong a seng a sepetlele, peripheral venous kapa central venous intubation, kapa mabokose a subcutaneous infusion a sebelisoa haholo.
1. Peripheral intravenous parenteral phepo e nepahetseng
Lipontšo: ① Phepo ea nako e khuts'oane ea botsoali (<2 libeke), tharollo ea limatlafatsi khatello ea osmotic e ka tlase ho 1200mOsm/LH2O; ② Central venous catheter contraindication kapa e ke keng ea khoneha; ③ tšoaetso ea catheter kapa sepsis.
Melemo le melemo: Mokhoa ona o bonolo ebile o bonolo ho o kenya ts'ebetsong, o ka qoba mathata (mochine, tšoaetso) a amanang le catheterization ea venous bohareng, 'me ho bonolo ho lemoha ketsahalo ea phlebitis pele ho nako. Bothata ke hore khatello ea osmotic ea infusion ha ea lokela ho ba e phahameng haholo, 'me ho phunya khafetsa hoa hlokahala, e leng ntho e tloaelehileng ho phlebitis. Ka hona, ha e loketse ho sebelisoa nako e telele.
2. Phepo ea botsoali ka mothapo o bohareng
(1) Lipontšo: phepo e nepahetseng ea batsoali bakeng sa libeke tse fetang 2 le tharollo ea limatlafatsi ea osmotic e phahameng ho feta 1200mOsm/LH2O.
(2) Tsela ea catheterization: ka har'a mothapo o ka hare oa jugular, subclavia vein kapa peripheral vein of the top top to the superior vena cava.
Melemo le mathata: Catheter ea methapo ea subclavia e bonolo ho tsamaea le ho e hlokomela, 'me bothata bo ka sehloohong ke pneumothorax. Catheterization ka har'a mothapo o ka hare oa jugular e ile ea fokotsa motsamao oa jugular le ho apara, 'me ea baka mathata a mang a hematoma ea lehae, kotsi ea arterial le tšoaetso ea catheter. Peripheral vein-to-central catheterization (PICC): Mothapo oa bohlokoa o pharaletseng ebile o bonolo ho o kenya ho feta mothapo oa cephalic, o ka qobang mathata a tebileng a kang pneumothorax, empa o eketsa ts'oaetso ea thrombophlebitis le intubation dislocation le bothata ba ho sebetsa. Litsela tse sa lokelang tsa phepo ea batsoali ke mothapo o ka ntle oa jugular le mothapo oa botšehali. Ea pele e na le sekhahla se phahameng sa ho se be teng, ha ea morao-rao e na le sekhahla se phahameng sa mathata a tšoaetsanoang.
3. Infusion e nang le catheter e kentsoeng ka tlas'a letlalo ka catheter e bohareng ea venous.
Tsamaiso ea phepo e nepahetseng
1. Phepo ea botsoali ea litsamaiso tse fapaneng (li-multi-bottle serial, all-in-one le mekotla ea diaphragm):
① Phetiso ea serial ea libotlolo tse ngata: Libotlolo tse ngata tsa tharollo ea limatlafatsi li ka tsoakoa 'me tsa fetisoa ka serially ka "tsela e meraro" kapa e bopehileng joaloka Y. Le hoja e le bonolo ebile e le bonolo ho e kenya ts'ebetsong, e na le mathata a mangata 'me ha ea lokela ho buelloa.
②Kakaretso ea tharollo ea limatlafatsi (TNA) kapa tsohle-in-one (AIl-in-One): Theknoloji ea ho kopanya aseptic ea tharollo ea limatlafatsi tse feletseng ke ho kopanya metsoako eohle ea phepo ea batsoali letsatsi le leng le le leng (tsoekere, emulsion ea mafura, amino acid, electrolyte, divithamini le trace elements) ) e kopantsoeng ka mokotleng ebe e kenngoa. Mokhoa ona o etsa hore tlhahiso ea phepo ea batsoali e be bonolo haholoanyane, 'me ho kenya letsoho ka nako e le' ngoe ea limatlafatsi tse fapa-fapaneng ho utloahala haholoanyane bakeng sa anabolism. Ho qetela Hobane polasetiki e qhibilihang ka mafura ea polyvinyl chloride (PVC) mekotla e ka baka lintho tse itseng tse chefo, polyvinyl acetate (EVA) e sebelisitsoe e le thepa e ka sehloohong ea mekotla ea phepo ea batsoali hona joale. E le ho netefatsa botsitso ba karolo e 'ngoe le e' ngoe ea tharollo ea TNA, ho lokisoa ho lokela ho etsoa ka tatellano e boletsoeng (sheba Khaolo ea 5 bakeng sa lintlha tse qaqileng).
③Mokotla oa Diaphragm: Lilemong tsa morao tjena, ho sebelisitsoe mahlale a macha le lipolasetiki tse ncha (polyethylene/polypropylene polymer) ho hlahisa mekotla ea tharollo ea phepo e nepahetseng ea batsoali. Sehlahisoa se secha sa tharollo ea limatlafatsi (mokotla oa likamore tse peli, mokotla oa likamore tse tharo) se ka bolokoa mocheso oa kamore bakeng sa likhoeli tse 24, ho qoba bothata ba tšilafalo ea tharollo ea limatlafatsi e lokiselitsoeng sepetlele. E ka sebelisoa ka mokhoa o sireletsehileng le ka mokhoa o bonolo bakeng sa tšelo ea phepo ea batsoali ka har'a mothapo o bohareng kapa mothapo oa peripheral ho bakuli ba nang le litlhoko tse fapaneng tsa phepo. Phoso ke hore mokhoa oa motho ka mong o ke ke oa finyelloa.
2. Sebopeho sa tharollo ea phepo ea batsoali
Ho ea ka litlhoko tsa phepo ea mokuli le matla a metabolic, theha sebopeho sa litokisetso tsa phepo.
3. Matrix e khethehileng bakeng sa phepo ea batsoali
Phepo ea sejoale-joale ea kliniki e sebelisa mehato e mecha ho tsoela pele ho ntlafatsa metsoako ea phepo ho ntlafatsa mamello ea bakuli. E le ho finyella litlhoko tsa phekolo ea phepo e nepahetseng, li-substrates tse khethehileng tsa phepo li fanoa bakeng sa bakuli ba khethehileng ho ntlafatsa ts'ebetso ea 'mele ea ho itšireletsa mafung, ho ntlafatsa ts'ebetso ea thibelo ea mala, le ho ntlafatsa matla a' mele a antioxidant. Litokisetso tse ncha tse khethehileng tsa phepo ke:
①Fat emulsion: ho kenyelletsa emulsion ea mafura e hlophisitsoeng, ketane e telele, emulsion ea mafura a mahareng, le emulsion ea mafura e nang le omega-3 fatty acids, joalo-joalo.
② Litokisetso tsa amino acid: ho kenyelletsa arginine, glutamine dipeptide le taurine.
Letlapa la 4-2-1 Litlhoko tsa matla le liprotheine tsa bakuli ba buuoang
Boemo ba mokuli matla Kcal/(kg.d) protheine g/(kg.d) NPC: N
Khaello ea phepo e nepahetseng e tloaelehileng 20~250.6~1.0150:1
Khatello e itekanetseng 25 ~ 301.0 ~ 1.5120: 1
Khatello e phahameng ea metabolic 30~35 1.5~2.0 90~120:1
Chesa 35~40 2.0~2.5 90~120: 1
NPC: N khalori e se nang protheine ho tekanyo ea naetrojene
Tšehetso ea phepo ea batsoali bakeng sa lefu le sa foleng la sebete le ho fetisetsa sebete
Matla a senang protheine Kcal/(kg.d) protheine kapa amino acid g/(kg.d)
Tefellotsoe cirrhosis25~35 0.6~1.2
Ho thatafala ha sebete sa 25~35 1.0
Hepatic encephalopathy 25~35 0.5~1.0 (eketsa karo-karolelano ea li-amino acid tsa branched-chain)
25 ~ 351.0 ~ 1.5 ka mor'a ho fetisetsa sebete
Litaba tse hlokang ho hlokomeloa: Hangata ho khethoa phepo e nepahetseng ea molomo kapa ea molomo; haeba e sa mamellehe, phepo e nepahetseng ea batsoali e sebelisoa: matla a entsoe ka tsoekere [2g/(kg.d)] le emulsion ea mafura a bolelele bo mahareng [1g/(kg.d)], mafura a etsa karolo ea 35 ~ 50% ea lik’hilojule; Mohloli oa naetrojene o fanoa ke li-amino acid tse kopaneng, 'me hepatic encephalopathy e eketsa karolo ea li-amino acid tsa branched-chain.
Tšehetso ea phepo ea batsoali bakeng sa lefu le matla la catabolic le rarahaneng le ho hloleha ho matla ha renal
Matla a senang protheine Kcal/(kg.d) protheine kapa amino acid g/(kg.d)
20 ~ 300.8 ~ 1.21.2 ~ 1.5 (bakuli ba letsatsi le letsatsi ba dialysis)
Litaba tse hlokang ho hlokomeloa: Hangata ho khethoa phepo e nepahetseng ea molomo kapa ea molomo; haeba e sa mamellehe, phepo e nepahetseng ea batsoali e sebelisoa: matla a entsoe ka tsoekere [3 ~ 5g / (kg.d)] le emulsion ea mafura [0.8 ~ 1.0g / (kg.d))]; li-amino acid tseo e seng tsa bohlokoa (tyrosine, arginine, cysteine, serine) tsa batho ba phetseng hantle li fetoha li-amino acid tsa bohlokoa ka nako ena. Tsoekere ea mali le triglycerides li lokela ho beoa leihlo.
Lethathamo la 4-2-4 E khothaletsoa palo ea letsatsi le letsatsi ea phepo e nepahetseng ea botsoali
Matla 20~30Kcal/(kg.d) [Phepelo ea metsi 1~1.5ml ka 1Kcal/(kg.d)]
Glucose 2~4g/(kg.d) Mafura 1~1.5g/(kg.d)
Maemo a naetrojene 0.1~0.25g/(kg.d) Amino acid 0.6~1.5g/(kg.d)
Electrolyte (karolelano ea tlhoko ea letsatsi le letsatsi bakeng sa batho ba baholo ba phepo e nepahetseng) Sodium 80~100mmol Potassium 60~150mmol Chlorine 80~100mmol Calcium 5~10mmol Magnesium 8~12mmol Phosphorus 10~30mmol
Livithamini tse qhibilihang ka mafura: A2500IUD100IUE10mgK110mg
Livithamini tse qhibilihang ka metsing: B13mgB23.6mgB64mgB125ug
Pantothenic Acid 15mg Niacinamide 40mg Folic Acid 400ugC 100mg
Trace elements: koporo 0.3mg iodine 131ug zinki 3.2mg selenium 30~60ug
Molybdenum 19ug Manganese 0.2~0.3mg Chromium 10~20ug Iron 1.2mg
Nako ea poso: Aug-19-2022