Ubushakashatsi buherutse gukorwa ku mirire yo mu nda hakiri kare ku barwayi barimo kubagwa kanseri yo mu nda. Uru rupapuro rugenewe gusa
1. Inzira, inzira hamwe nigihe cyimirire yimbere
1.1 imirire yimbere
Uburyo butatu bwo gushiramo burashobora gukoreshwa mugutanga infashanyo yintungamubiri kubarwayi barwaye kanseri yigifu nyuma yo kubagwa: ubuyobozi bwigihe kimwe, kuvoma ubudahwema binyuze muri pompe ya infusion hamwe nigitonyanga cya rukuruzi. Ubuvuzi bwa Clinical bwerekanye ko ingaruka zo guhora ziterwa na pompe ya infusion ari nziza cyane kuruta kwinjiza rukuruzi rimwe na rimwe, kandi ntibyoroshye kugira ingaruka mbi zo mu gifu. Mbere yo gushyigikira imirire, 50ml ya 5% glucose sodium ya chloride inshinge yakoreshwaga muburyo bwo koza. Mu gihe cy'itumba, fata igikapu cy'amazi ashyushye cyangwa umushyushya w'amashanyarazi hanyuma ubishyire ku mpera imwe y'umuyoboro wa infusion hafi ya orifice y'umuyoboro wa fistula kugirango ushushe, cyangwa ushushe umuyoboro winjiza ukoresheje icupa rya termos ryuzuyemo amazi ashyushye. Mubisanzwe, ubushyuhe bwumuti wintungamubiri bugomba kuba 37℃~ 40℃. Nyuma yo gufunguraUmufuka wimirire, igomba gukoreshwa ako kanya. Igisubizo cyintungamubiri ni 500ml / icupa, kandi igihe cyo guhagarika guhagarika kigomba kugumaho nka 4H. Igipimo cyo guta ni 20 gitonyanga / min iminota 30 mbere yo gutangira kwinjiza. Nyuma yuko nta kibazo kibabaje, hindura igipimo cyo kugabanuka kuri 40 ~ 50 ibitonyanga / min. nyuma yo gushiramo, oza umuyoboro hamwe na 50ml ya 5% glucose sodium ya chloride. Niba infusion idakenewe mugihe gito, igisubizo cyintungamubiri kigomba kubikwa ahantu hakonje 2℃~ 10℃, kandi igihe cyo kubika gikonje ntigishobora kurenza 24h.
1.2 inzira yimirire yimbere
Imirire yimbere irimo ahaniniImiyoboro ya Nasogastric, gastrojejunostomy tube, nasoduodenal tube, spiral naso intestinal tube naNasojejunal Tube. Kubijyanye no gutura igihe kirekireIgifu, haribishoboka byinshi byo gutera urukurikirane rwibibazo nko guhagarika pyloric, kuva amaraso, gutwika karande ya mucosa gastrica, ibisebe nisuri. Umuyoboro wa spiral naso wo munda woroshye muburyo bworoshye, ntabwo byoroshye kubyutsa umurwayi wizuru ryamazuru numuhogo, byoroshye kunama, kandi kwihanganira umurwayi nibyiza, kuburyo bishobora gushyirwa mugihe kirekire. Nyamara, umwanya muremure wo gushyira umuyoboro unyuze mumazuru akenshi bizatera abarwayi uburwayi, byongera amahirwe yo gutembera kwintungamubiri, kandi bishobora kubaho nabi. Imirire y’abarwayi barimo kubagwa kanseri yo mu gifu irakennye, bityo bakeneye ubufasha bwigihe kirekire bwimirire, ariko gusiba gastrici byabarwayi birahagaritswe cyane. Kubwibyo, ntabwo byemewe guhitamo gushyira transnasal gushyira umuyoboro, kandi gushyira hamwe kwa fistula ni amahitamo meza. Zhang moucheng n'abandi batangaje ko hakoreshejwe umuyoboro wa gastrojejunostomy, hakozwe umwobo muto unyuze mu rukuta rwa gastrica rw'umurwayi, shitingi yoroheje (ifite diameter ya 3mm) yinjizwa mu mwobo muto, yinjira muri jejunum binyuze muri pylorus na duodenum. Uburyo bubiri bwa suture ya suture bwakoreshejwe mugukemura ikibazo cyurukuta rwa gastric, kandi umuyoboro wa fistula washyizwe mumurongo wa gastric. Ubu buryo burakwiriye kubarwayi ba palliative. Umuyoboro wa Gastrojejunostomy ufite ibyiza bikurikira: igihe cyo gutura ni kirekire kuruta ubundi buryo bwo gutera, bushobora kwirinda neza inzira z'ubuhumekero n'indwara zifata ibihaha ziterwa na nasogastric jejunostomy; Gutema no gukosora binyuze mu rukuta rwa gastriche biroroshye, kandi amahirwe yo kwandura gastric na fistula gastric ni make; Umwanya wurukuta rwa gastrica ni muremure cyane, kugirango wirinde umubare munini wa asitite kuva metastasis yumwijima nyuma yo kubagwa kanseri yo mu gifu, koga umuyoboro wa fistula kandi ugabanye kwandura fistula yo munda no kwandura munda; Kugabanuka gake, abarwayi ntabwo byoroshye kubyara umutwaro wa psychologiya.
1.3 igihe cyimirire yimbere no guhitamo igisubizo cyintungamubiri
Nk’uko raporo z’intiti zo mu rugo zibitangaza, abarwayi batewe na gastrectomie ya kanseri yo mu gifu batangira imirire y’inda binyuze mu muyoboro w’imirire ya jjunal kuva amasaha 6 kugeza 8 nyuma yo kubagwa, hanyuma bagatera 50ml yumuti ushushe wa 5% glucose rimwe / 2h, cyangwa bagatera emulisiyo yimirire yimbere binyuze mumiyoboro yimirire ya jejunal kumuvuduko umwe. Niba umurwayi adafite ikibazo nko kubabara munda no kwaguka mu nda, ongera wongere umubare, kandi amazi adahagije yuzuzwa binyuze mumitsi. Umurwayi amaze gukira umunaniro wa anal, umuyoboro wa gastric urashobora gukurwaho, kandi ibiryo byamazi birashobora kuribwa mumunwa. Nyuma yubwinshi bwamazi arashobora kwinjizwa mumunwa ,.Kugaburira Imbere irashobora gukurwaho. Abashinzwe inganda bemeza ko amazi yo kunywa atangwa nyuma yamasaha 48 nyuma yo gukora kanseri yo mu gifu. Ku munsi wa kabiri nyuma yo kubagwa, amazi meza arashobora kuribwa nimugoroba, amazi yuzuye arashobora kuribwa saa sita kumunsi wa gatatu, naho ibiryo byoroshye birashobora kuribwa mugitondo cya mugitondo kumunsi wa kane. Kubwibyo, kuri ubu, ntamahame ahuriweho yigihe nubwoko bwo kugaburira hakiri kare kanseri yo munda. Nyamara, ibisubizo byerekana ko gushyiraho igitekerezo cyihuse cyo gusubiza mu buzima busanzwe no gushyigikira imirire hakiri kare bitongera umubare w’ingaruka ziterwa na nyuma yo kubagwa, ibyo bikaba bifasha cyane kugarura imikorere ya gastrointestinal no kwinjiza neza intungamubiri ku barwayi barimo gastrectomie ikabije, biteza imbere imikorere y’umubiri y’abarwayi no guteza imbere abarwayi vuba.
2. Ubuforomo bwimirire yimbere
2.1 Ubuforomo bwo mu mutwe
Ubuforomo bwo mu mutwe ni ihuriro rikomeye nyuma yo kubagwa kanseri yo mu gifu. Ubwa mbere, abakozi b’ubuvuzi bagomba kumenyekanisha ibyiza by’imirire y’imbere ku barwayi umwe umwe, bakabamenyesha ibyiza byo kuvura indwara z’ibanze, bakanamenyesha abarwayi intsinzi n’uburambe bwo kuvura kugira ngo bibafashe kwigirira icyizere no kunoza iyubahirizwa ry’ubuvuzi. Icya kabiri, abarwayi bagomba kumenyeshwa ubwoko bwimirire yimbere, ingorane zishoboka nuburyo bwo kwisiga. Hashimangiwe ko gutera inkunga imirire hakiri kare gusa bishobora kugarura ibiryo byo mu kanwa mugihe gito kandi amaherezo bikamenya ko indwara yakize.
2.2 imirire yimbere munda
Umuyoboro winjiza imirire ugomba kwitabwaho neza kandi ugashyirwaho neza kugirango wirinde kwikanyiza, kunama, kugoreka cyangwa kunyerera. Kubijyanye nimirire yashyizwe kandi ikosorwa neza, abakozi b’ubuforomo barashobora kwerekana aho inyura mu ruhu hamwe n’ikimenyetso gitukura, bagakora ihererekanyabubasha, bakandika igipimo cy’imirire y’imirire, bakareba kandi bakemeza niba umuyoboro wimuwe cyangwa utabishaka. Iyo imiti itanzwe binyuze mu kugaburira ibiryo, abakozi b’ubuforomo bagomba gukora akazi keza mu kwanduza no gusukura umuyoboro ugaburira. Umuyoboro ugaburira ugomba gusukurwa neza mbere na nyuma yimiti, kandi imiti igomba guhonyorwa neza kandi igashonga ukurikije igipimo cyagenwe, kugirango hirindwe guhagarika umuyoboro uterwa no kuvanga ibice binini by’ibiyobyabwenge mu muti w’imiti, cyangwa guhuza imiti idahagije hamwe n’umuti w’intungamubiri, bikaviramo kwibumbira hamwe no guhagarika umuyoboro. Nyuma yo gushiramo intungamubiri, umuyoboro ugomba gusukurwa. Mubisanzwe, 50ml ya 5% glucose sodium ya chloride inshinge irashobora gukoreshwa mugukaraba, rimwe kumunsi. Muburyo bukomeza bwo gushiramo, abakozi b'abaforomo bagomba gusukura umuyoboro ukoresheje siringi ya 50ml hanyuma bakayisukura buri 4H. Niba infusion ikeneye guhagarikwa by'agateganyo mugihe cyo kwinjiza, abakozi b'abaforomo nabo bagomba guhanagura catheter mugihe kugirango birinde gukomera cyangwa kwangirika k'intungamubiri nyuma yo gushyirwa igihe kirekire. Mugihe habaye impungenge zo kuvoma pompe mugihe cyo gushiramo, banza utandukane umuyoboro wintungamubiri na pompe, hanyuma ukarabe intungamubiri neza. Niba umuyoboro wintungamubiri utabujijwe, reba izindi mpamvu.
2.3 ubuforomo bwibibazo
2.3.1 ingorane zo munda
Ingorane zikunze kugaragara mu gushyigikira imirire yo mu nda ni isesemi, kuruka, impiswi no kubabara mu nda. Impamvu zitera izo ngorane zifitanye isano rya hafi no kwanduza intungamubiri zintungamubiri, kwibanda cyane, kwinjiza vuba nubushyuhe buke. Abakozi b'abaforomo bagomba kwitondera byimazeyo ibintu byavuzwe haruguru, bakajya bakora amarondo buri gihe kandi bakagenzura buri 30min kugirango bamenye niba ubushyuhe n'umuvuduko ukabije w'intungamubiri ari ibisanzwe. Iboneza no kubungabunga igisubizo cyintungamubiri bigomba gukurikiza byimazeyo uburyo bwo gukora aseptic kugirango birinde kwanduza intungamubiri. Witondere imikorere yumurwayi, wemeze niba iherekejwe nimpinduka zijwi ry amara cyangwa intera yinda, kandi urebe imiterere yintebe. Niba hari ibimenyetso bitameze neza nko gucibwamo no kwaguka mu nda, kwinjiza bigomba guhagarikwa ukurikije ibihe byihariye, cyangwa umuvuduko wo kwinjiza bigomba gutinda neza. Mu bihe bikomeye, umuyoboro ugaburira urashobora gukoreshwa kugirango utere imiti igifu.
2.3.2
Mu mirire yimbere ifitanye isano ningorane, icyifuzo nicyo gikomeye cyane. Impamvu nyamukuru zitera ni ugusiba gastricike no kugaburira intungamubiri. Ku barwayi nk'abo, abakozi b'abaforomo barashobora kubafasha gukomeza imyanya yo kwicara cyangwa imyanya yo kwicara, cyangwa kuzamura umutwe w'igitanda kuri 30° kugirango wirinde guhinduka kwintungamubiri, kandi ukomeze uyu mwanya muminota 30 nyuma yo gushiramo intungamubiri. Mugihe ibyifuzo byikosa, abakozi b'abaforomo bagomba guhagarika kwinjiza mugihe, bagafasha umurwayi kugumana umwanya mwiza wo kubeshya, kumanura umutwe, kuyobora umurwayi gukorora neza, kunyunyuza ibintu byashizwemo mumyuka mugihe kandi bakanyunyuza ibiri munda yumurwayi kugirango batongera kugaruka; Byongeye kandi, antibiyotike zatewe inshinge kugirango birinde no kuvura indwara zifata ibihaha.
2.3.3 kuva amaraso gastrointestinal
Iyo abarwayi bafite intungamubiri zo mu nda bafite umutobe wa gastrica wijimye cyangwa intebe yumukara, hagomba gutekerezwa amahirwe yo kuva amaraso gastrointestinal. Abakozi b'abaforomo bagomba kumenyesha muganga mugihe kandi bagakurikiranira hafi umuvuduko wumutima wumurwayi, umuvuduko wamaraso nibindi bipimo. Ku barwayi bafite amaraso make, kwisuzumisha umutobe wa gastrica hamwe namaraso ya fecal fecal, aside ibuza aside irashobora gutangwa kugirango irinde mucosa gastrica, kandi Kugaburira Nasogastric birashobora gukomeza hashingiwe ku kuvura indwara ya hemostatike. Muri iki gihe, ubushyuhe bwo Kugaburira Nasogastrici burashobora kugabanuka kugera kuri 28℃~ 30℃; Abarwayi bafite amaraso menshi bagomba kwisonzesha ako kanya, bagahabwa imiti igabanya ubukana hamwe n’imiti ya hemostatike, bakuzuza ubwinshi bwamaraso mugihe, bagafata saline ya 50ml ivanze na 2 ~ 4mg norepinephrine hamwe nizuru bagaburira buri 4h, kandi bagakurikiranira hafi impinduka zimiterere.
2.3.4
Niba umuyoboro wa infusion ugoretse, wunamye, uhagaritswe cyangwa wimuwe, imyanya yumubiri wumurwayi hamwe na catheter bigomba guhinduka. Catheter imaze guhagarikwa, koresha syringe kugirango ushushanye urugero rwumunyu usanzwe kugirango uhindure umuvuduko. Niba koza bidafite akamaro, fata chymotrypsin imwe hanyuma ubivange na 20ml umunyu usanzwe kugirango usukure, kandi ukomeze ibikorwa byoroheje. Niba nta bumwe muri ubwo buryo bwavuzwe haruguru bufite akamaro, hitamo niba ugomba gushyira umuyoboro ukurikije ibihe byihariye. Iyo umuyoboro wa jejunostomy uhagaritswe, ibirimo birashobora kuvomwa neza hamwe na syringe. Ntugashyiremo umugozi wo kuyobora kugirango ucukure catheter kugirango wirinde kwangirika no guturika kwakugaburira catheter.
2.3.5
Gukoresha infashanyo yintungamubiri zirashobora gutera indwara ya glucose yamaraso, mugihe hyperglycemic imiterere yumubiri bizatuma imyororokere yihuta. Muri icyo gihe, ihungabana rya metabolisme ya glucose rizatuma habaho ingufu zidahagije, ibyo bigatuma kugabanuka kw'abarwayi bigabanuka, gutera indwara zandurira mu mitsi, biganisha ku mikorere mibi ya gastrointestinal, kandi ni nacyo gitera imbaraga nyinshi zo kunanirwa kw'ingingo nyinshi. Twabibutsa ko abarwayi benshi barwaye kanseri yo mu gifu nyuma yo guhindurwa umwijima baherekejwe no kurwanya insuline. Muri icyo gihe, bahabwa imisemburo ikura, imiti igabanya ubukana hamwe na corticosteroide nyinshi nyuma yo kubagwa, ibyo bikabangamira metabolisme ya glucose kandi bigoye kugenzura indangagaciro ya glucose. Kubwibyo, mugihe twuzuza insuline, dukwiye gukurikiranira hafi urwego rwamaraso glucose yabarwayi kandi tugahindura muburyo bwuzuye glucose yamaraso. Mugihe utangiye inkunga yimirire yimbere, cyangwa guhindura umuvuduko winjiza nigisubizo cyintungamubiri zintungamubiri, abakozi b'abaforomo bagomba gukurikirana urutonde rwamaraso ya glucose yintoki hamwe nurwego glucose yinkari yumurwayi buri 2 ~ 4H. Nyuma yo kwemeza ko metabolism glucose ihagaze neza, igomba guhinduka kuri buri 4 ~ 6h. Umuvuduko wo kwinjiza no kwinjiza imisemburo ya islet igomba guhindurwa uko bikwiye hamwe no guhindura urwego rwamaraso glucose.
Mu ncamake, mu ishyirwa mu bikorwa rya FIS, ni byiza kandi birashoboka gukora inkunga y’imirire y’imbere mu cyiciro cya mbere nyuma yo kubagwa kanseri yo mu gifu, ifasha mu kuzamura imirire y’umubiri, kongera ifumbire mvaruganda na poroteyine, kunoza imitekerereze mibi ya azote, kugabanya gutakaza umubiri no kugabanya ibibazo bitandukanye nyuma yo kubaga, kandi bigira ingaruka nziza zo kurinda abarwayi ba gastrointestinal; Irashobora guteza imbere imikorere yimara yabarwayi, kugabanya ibitaro no kunoza imikoreshereze yumutungo wubuvuzi. Ni gahunda yemerwa nabarwayi benshi kandi igira uruhare runini mugukiza no kuvura byimazeyo abarwayi. Hamwe n’ubushakashatsi bwimbitse bw’amavuriro ku nkunga ya nyuma yo gutangira kuvura imirire ya kanseri yo mu gifu, ubuhanga bw’ubuforomo nabwo burakomeza kunozwa. Binyuze mu buforomo bwa psychologiya nyuma yuburwayi, imirire yubuforomo hamwe nubuforomo bugoye, amahirwe yo guterwa na gastrointestinal, ibyifuzo, ingorane ziterwa na metabolike, kuva amaraso gastrointestinal hamwe no guhagarika imashini bigabanuka cyane, ibyo bikaba byerekana ko ari byiza ko hashyirwaho inyungu zisanzwe ziterwa no gutunga indyo yuzuye.
Umwanditsi wumwimerere: Wu Yinjiao
Igihe cyo kohereza: Apr-15-2022