Igitekerezo cyibanze
Imirire y'ababyeyi (PN) ni ugutanga imirire iva mu mitsi nk'inkunga y'imirire mbere na nyuma yo kubagwa ndetse n'abarwayi barembye cyane. Imirire yose itangwa kubabyeyi, bita imirire yababyeyi (TPN). Inzira zimirire yababyeyi zirimo imirire ya periferique imirire hamwe nimirire yo hagati. Imirire y'ababyeyi (PN) ni itangwa ry'imyunyu ngugu ikenerwa n'abarwayi, harimo karori (karubone, amavuta y’amavuta), aside amine y'ingenzi kandi idakenewe, vitamine, electrolytite, hamwe na mikorobe. Imirire y'ababyeyi igabanijwemo imirire yuzuye y'ababyeyi hamwe nimirire yinyongera yababyeyi. Ikigamijwe ni ugushoboza abarwayi gukomeza imirire, kongera ibiro no gukira ibikomere nubwo badashobora kurya bisanzwe, kandi abana bato barashobora gukomeza gukura no gukura. Inzira zo kwinjiza imiyoboro hamwe nubuhanga bwo gushiramo ni ingwate zikenewe mu mirire y'ababyeyi.
Ibyerekana
Ibimenyetso by'ibanze ku mirire y'ababyeyi ni abafite imikorere mibi ya gastrointestinal cyangwa bananiwe, harimo n'abakeneye inkunga y'imirire y'ababyeyi.
Ingaruka zikomeye
1. Guhagarika igifu
2. Gukuramo nabi kwa gastrointestinal tract: syndrome Indwara ngufi yo munda: kwaguka kwinshi mu mara> 70% ~ 80%; Dise Indwara ntoya yo munda: indwara z'umubiri, ischemia yo munda, fistula nyinshi zo munda; Ent Imirasire enteritis, di Impiswi ikabije, kuruka kudahuza igitsina> iminsi 7.
3. Indwara ya pancreatite ikabije: Kwinjiza bwa mbere gutabara ihungabana cyangwa MODS, nyuma yibimenyetso byingenzi bihamye, niba ubumuga bwo munda budakuweho kandi imirire yimbere ntishobora kwihanganira byimazeyo, ni ikimenyetso cyimirire yababyeyi.
4. Imiterere ya catabolike: gutwika cyane, gukomeretsa bikabije, kwandura, nibindi.
5. Imirire mibi ikabije: Imirire mibi ya protein-calorie ikunze guherekezwa no kudakora neza kwa gastrointestinal kandi ntishobora kwihanganira imirire yimbere.
Inkunga iremewe
1. Igihe cyigihe cyo kubaga no guhahamuka: Inkunga yimirire nta ngaruka nini igira ku barwayi bafite imirire myiza. Ibinyuranye na byo, birashobora kongera ibibazo byanduye, ariko birashobora kugabanya ibibazo nyuma yo kubagwa kubarwayi bafite imirire mibi ikabije. Abarwayi bafite imirire mibi ikenera inkunga yimirire muminsi 7-10 mbere yo kubagwa; kubateganijwe ko bananiwe gukira imikorere yigifu mugihe cyiminsi 5-7 nyuma yo kubagwa gukomeye, infashanyo yimirire yababyeyi igomba gutangira mumasaha 48 nyuma yo kubagwa kugeza umurwayi ashobora kugira imirire ihagije. Imirire yimbere cyangwa gufata ibiryo.
2. Inkunga yimirire yababyeyi irashobora kugabanya igifu cya gastrointestinal fluid na fistula itemba, ifasha mukurwanya kwandura, kunoza imirire, kunoza imiti, no kugabanya ibibazo byo kubaga nimpfu.
3. Irashobora kugabanya ibimenyetso, kunoza imirire, kuruhuka inzira yo munda, no koroshya gusana mucosa yo munda.
4. Abarwayi bafite ibibyimba bikabije bafite imirire mibi: Ku barwayi bafite ibiro byumubiri ≥ 10% (ibiro bisanzwe byumubiri), inkunga yimirire yababyeyi cyangwa iyinjira munda igomba gutangwa iminsi 7 kugeza 10 mbere yo kubagwa, kugeza imirire yimbere cyangwa gusubira kurya nyuma yo kubagwa. kugeza.
5. Kubura ingingo zingenzi:
① Kubura umwijima: abarwayi barwaye umwijima cirrhose bari mubiryo bituzuye kubera gufata ibiryo bidahagije. Mugihe cya perioperative yumwijima cirrhose cyangwa ikibyimba cyumwijima, hepatike encephalopathie, nicyumweru 1 kugeza 2 nyuma yo guterwa umwijima, abadashobora kurya cyangwa kwakira imirire yimbere bagomba guhabwa imirire yababyeyi Inkunga yimirire.
Ins Kubura impyiko: indwara ya catabolike ikaze (kwandura, guhahamuka cyangwa kunanirwa kw'ingingo nyinshi) ifatanije no kunanirwa gukabije kw'impyiko, abarwayi ba dialyse idakira idakira bafite ikibazo cy'imirire mibi, kandi bakeneye ubufasha bw'imirire y'ababyeyi kuko badashobora kurya cyangwa kwakira indyo yuzuye. Mugihe cya dialyse yo kunanirwa kwimpyiko zidakira, imirire yababyeyi irashobora guterwa mugihe cyo guterwa amaraso.
③ Umutima n'ibihaha bidahagije: akenshi bihujwe na protein-ingufu zivanze nimirire mibi. Imirire yo mu nda iteza imbere ivuriro n'imikorere ya gastrointestinal mu ndwara zidakira zifata ibihaha (COPD) kandi birashobora kugirira akamaro abarwayi bafite ikibazo cy'umutima (ibimenyetso birabura). Ikigereranyo cyiza cya glucose n’ibinure ku barwayi ba COPD ntikiramenyekana, ariko igipimo cy’ibinure kigomba kongerwa, igipimo cya glucose na infusion kigomba kugenzurwa, hagomba gutangwa poroteyine cyangwa aside amine (byibuze lg / kg.d), kandi glutamine ihagije igomba gukoreshwa ku barwayi bafite indwara z’ibihaha zikomeye. Nibyiza kurinda endotelium ya alveolar hamwe ninda zifitanye isano ninda zifata lymphoide no kugabanya ibibazo byimpyiko. Inzitizi zifata amara zifata: gutera inkunga imirire yababyeyi ibyumweru 4 kugeza kuri 6 ni ingirakamaro mugusubirana imikorere y amara no kugabanya inzitizi.
Kurwanya
1. Abafite imikorere isanzwe ya gastrointestinal, bahuza nimirire yimbere cyangwa kugarura imikorere ya gastrointestinal muminsi 5.
2. Ntibikize, nta byiringiro byo kubaho, gupfa cyangwa abarwayi ba koma bidasubirwaho.
3. Abakeneye kubagwa byihutirwa kandi badashobora gushyira mubikorwa imirire mbere yo kubagwa.
4. Imikorere yumutima cyangwa imitsi ikabije igomba kugenzurwa.
Inzira y'imirire
Guhitamo inzira iboneye yimirire yababyeyi biterwa nibintu nkamateka yumutima wumurwayi wamaraso, anatomiya yimitsi, imiterere ya coagulation, igihe giteganijwe kumirire yababyeyi, igihe cyo kwitabwaho (mubitaro cyangwa kutabikora), hamwe nimiterere yindwara yanduye. Ku barwayi, igihe gito cya periferique ya venus cyangwa intubation yo hagati ni yo ihitamo cyane; kubarwayi bamara igihe kirekire bavurwa mubitaro bitari ibitaro, imitsi ya periferique cyangwa hagati yimitsi yo hagati, cyangwa udusanduku twa infusion munsi yubusa.
1. Inzira ya periferique yimitsi yababyeyi
Ibyerekana: nutrition Imirire yigihe gito cyababyeyi (
2. Imirire yababyeyi ikoresheje imitsi yo hagati
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Ibyiza n'ibibi: Subclavian vein catheter iroroshye kwimuka no kuyitaho, kandi ingorane nyamukuru ni pneumothorax. Catheterisation binyuze mumitsi yimbere yagabanije kugenda no kwambara, kandi byaviriyemo izindi ngorane nkeya za hematoma yaho, gukomeretsa kwa arterial no kwandura catheter. Peripheral vein-to-central catheterisation (PICC): Umuyoboro w'agaciro ni mugari kandi byoroshye kuwushyiramo kuruta umutsi wa cephalic, ushobora kwirinda ingorane zikomeye nka pneumothorax, ariko byongera indwara ya trombophlebitis hamwe na disubation ya intubation hamwe nikibazo cyo gukora. Inzira zimirire yababyeyi idakwiye ninzira yo hanze ya jugular nu mitsi. Iyambere ifite umuvuduko mwinshi wo gusimburwa, mugihe iyanyuma ifite umuvuduko mwinshi wibibazo byanduye.
3. Kwinjiza hamwe na catheter yashyizwemo munsi ya catheter hagati.
Sisitemu yimirire
1. Imirire yababyeyi ya sisitemu zitandukanye (serial nyinshi-icupa, byose-muri-imwe na diaphragm):
TransMulti-icupa ryuruhererekane: Amacupa menshi yumuti wintungamubiri arashobora kuvangwa no kwanduzwa muburyo bwa "inzira-eshatu" cyangwa Y. Nubwo byoroshye kandi byoroshye kubishyira mubikorwa, bifite ibibi byinshi kandi ntibigomba kunganirwa.
SolutionIbisubizo byintungamubiri byuzuye (TNA) cyangwa byose-muri-kimwe (AIl-in-One): Ikoranabuhanga ryo kuvanga aseptic ryumuti wuzuye wintungamubiri ni uguhuza imirire yababyeyi buri munsi (glucose, emulsiyo yamavuta, aside amine, electrolytite, vitamine nibintu bya trike)) bivanze mumufuka hanyuma bigashyiramo. Ubu buryo butuma ibitekerezo byimirire yababyeyi byoroha, kandi icyarimwe kwinjiza intungamubiri zitandukanye birumvikana cyane kuri anabolism. Kurangiza Kuberako ibinure byamavuta ya elegitoronike ya polyvinyl chloride (PVC) bishobora gutera uburozi bumwe na bumwe, acetate ya polyvinyl (EVA) yakoreshejwe nkibikoresho fatizo byimifuka yimirire yababyeyi muri iki gihe. Kugirango tumenye neza ko buri kintu kigize igisubizo cya TNA, imyiteguro igomba gukorwa muburyo bwateganijwe (reba Umutwe wa 5 kubirambuye).
Bag Igikapu cya Diafragm: Mu myaka yashize, tekinolojiya mishya hamwe n’ibikoresho bishya bya plastiki (polyethylene / polypropilene polymer) byakoreshejwe mu gukora imifuka yuzuye y’imirire y’ababyeyi. Ibicuruzwa bishya byuzuye byintungamubiri (umufuka wibyumba bibiri, umufuka wibyumba bitatu) birashobora kubikwa mubushyuhe bwicyumba mumezi 24, birinda ikibazo cyumwanda wumuti wintungamubiri wateguwe mubitaro. Irashobora gukoreshwa neza kandi byoroshye mugutunga imirire yababyeyi binyuze mumitsi yo hagati cyangwa imitsi ya periferique kubarwayi bafite imirire itandukanye. Ingaruka ni uko kwishyira ukizana kwa formula bidashobora kugerwaho.
2. Ibigize igisubizo cyimirire yababyeyi
Ukurikije ibyo umurwayi akeneye mu mirire n'ubushobozi bwa metabolike, kora ibice bigize imyiteguro.
3. Matrix idasanzwe yo kugaburira ababyeyi
Imirire yubuvuzi bugezweho ikoresha ingamba nshya kugirango irusheho kunoza imirire kugirango irusheho kwihanganira abarwayi. Mu rwego rwo guhaza ibikenerwa mu kuvura imirire, hatangwa insimburangingo zihariye z’imirire ku barwayi badasanzwe kugira ngo barusheho kunoza imikorere y’umubiri w’umurwayi, kunoza imikorere y’inzitizi zo mu mara, no kongera ubushobozi bwa antioxydants y’umubiri. Imyiteguro mishya idasanzwe yimirire ni:
Em Amavuta yo kwisiga: harimo ibinure byamavuta byubatswe, urunigi rurerure, amavuta yo mu bwoko bwa emulioni yo hagati, hamwe na emulsiyo yibinure ikungahaye kuri acide ya omega-3, nibindi.
Preparaments Aminide acide: harimo arginine, glutamine dipeptide na taurine.
Imbonerahamwe 4-2-1 Ibisabwa ingufu na proteyine kubarwayi babaga
Imbaraga zumurwayi Kcal / (kg.d) protein g / (kg.d) NPC: N.
Imirire mibi isanzwe-iringaniye 20 ~ 250.6 ~ 1.0150: 1
Guhangayikisha mu rugero 25 ~ 301.0 ~ 1.5120: 1
Guhangayikishwa cyane na metabolike 30 ~ 35 1.5 ~ 2.0 90 ~ 120: 1
Gutwika 35 ~ 40 2.0 ~ 2.5 90 ~ 120: 1
NPC: N calorie N itari protein ku kigereranyo cya azote
Imirire y'ababyeyi ifasha indwara zumwijima zidakira no guhinduranya umwijima
Ingufu zitari poroteyine Kcal / (kg.d) proteyine cyangwa aside amine g / (kg.d)
Indwara ya cirrhose25 ~ 35 0.6 ~ 1.2
Indwara ya cirrhose 25 ~ 35 1.0
Hepatique encephalopathie 25 ~ 35 0.5 ~ 1.0 (kongera igipimo cya aminide acide amashami)
25 ~ 351.0 ~ 1.5 nyuma yo guterwa umwijima
Ibintu bikeneye kwitabwaho: Ubusanzwe imirire yo mu kanwa cyangwa munda irahitamo; niba itihanganirwa, imirire yababyeyi irakoreshwa: ingufu zigizwe na glucose [2g / (kg.d)] hamwe na emulioni yamavuta maremare maremare [1g / (kg.d)], ibinure bingana na 35 ~ 50% bya karori; isoko ya azote itangwa na aside amine acide, hamwe na hepatike encephalopathie yongerera igipimo cya aminide acide amashami.
Imirire y'ababyeyi ifasha indwara ikaze ya catabolika igoye no kunanirwa gukabije kw'impyiko
Ingufu zitari poroteyine Kcal / (kg.d) proteyine cyangwa aside amine g / (kg.d)
20 ~ 300.8 ~ 1.21.2 ~ 1.5 (abarwayi ba dialyse ya buri munsi)
Ibintu bikeneye kwitabwaho: Ubusanzwe imirire yo mu kanwa cyangwa munda irahitamo; niba itihanganirwa, imirire yababyeyi ikoreshwa: ingufu zigizwe na glucose [3 ~ 5g / (kg.d)] hamwe na emulioni yamavuta [0.8 ~ 1.0g / (kg.d))]; acide ya aminide idakenewe (tyrosine, arginine, cysteine, serine) yabantu bazima bahinduka aside amine ya ngombwa muri iki gihe. Isukari mu maraso na triglyceride igomba gukurikiranwa.
Imbonerahamwe 4-2-4 Basabwe buri munsi ingano yimirire yababyeyi
Ingufu 20 ~ 30Kcal / (kg.d) [Gutanga amazi 1 ~ 1.5ml kuri 1Kcal / (kg.d)]
Glucose 2 ~ 4g / (kg.d) Ibinure 1 ~ 1.5g / (kg.d)
Azote irimo 0.1 ~ 0.25g / (kg.d) Acide Amino 0,6 ~ 1.5g / (kg.d)
Electrolytes (ikigereranyo gisabwa buri munsi kubantu bakuze bafite imirire yababyeyi) Sodium 80 ~ 100mmol Potasiyumu 60 ~ 150mmol Chlorine 80 ~ 100mmol Kalisiyumu 5 ~ 10mmol Magnesium 8 ~ 12mmol Fosifore 10 ~ 30mmol
Vitamine zishushe amavuta: A2500IUD100IUE10mgK110mg
Vitamine zishonga mumazi: B13mgB23.6mgB64mgB125ug
Acide Pantothenique 15mg Niacinamide 40mg Acide Folike 400ugC 100mg
Kurikirana ibintu: umuringa 0.3mg iyode 131ug zinc 3.2mg selenium 30 ~ 60ug
Molybdenum 19ug Manganese 0.2 ~ 0.3mg Chromium 10 ~ 20ug Iron 1.2mg
Igihe cyo kohereza: Kanama-19-2022