Manaʻo kumu
ʻO ka meaʻai makua (PN) ka hāʻawi ʻana i ka meaʻai mai ka intravenous e like me ke kākoʻo meaʻai ma mua a ma hope o ke ʻoki ʻana a no nā maʻi maʻi koʻikoʻi. Hāʻawi ʻia nā meaʻai āpau ma ka makua, i kapa ʻia ʻo Total Parenteral Nutrition (TPN). ʻO nā ala o ka meaʻai makua e pili ana i ka meaʻai intravenous peripheral a me ka meaʻai intravenous kikowaena. ʻO ka meaʻai makua (PN) ʻo ia ka hāʻawi intravenous o nā meaʻai e pono ai e nā mea maʻi, me nā calorie (carbohydrates, fat emulsions), nā amino acids pono a me nā mea pono ʻole, nā huaora, nā electrolytes, a me nā mea ʻala. Hoʻokaʻawale ʻia ka meaʻai makua i loko o ka meaʻai makua piha a me ka ʻai meaʻai parenteral hapa. ʻO ke kumu e hiki ai i nā poʻe maʻi ke mālama i ke kūlana meaʻai, ka piʻi ʻana o ke kaumaha a me ka ho'ōla ʻana i ka ʻeha ʻoiai ʻaʻole hiki iā lākou ke ʻai maʻamau, a hiki i nā keiki liʻiliʻi ke hoʻomau i ka ulu a ulu. ʻO nā ala infusion intravenous a me nā ʻenehana infusion nā hōʻoia pono no ka meaʻai makua.
Nā hōʻailona
ʻO nā hōʻailona kumu no ka meaʻai makua ʻo ia ka poʻe me ka maʻi gastrointestinal a i ʻole ka hemahema, me ka poʻe e pono ai ke kākoʻo meaʻai makua home.
Ka hopena nui
1. Keakea o ka ʻōpū
2. ʻO ka absorption dysfunction o ka ʻōpū ʻōpū: ① Short bowel syndrome: nui ka ʻoki ʻana o ka ʻōpū liʻiliʻi> 70% ~ 80%; ② ʻO ka maʻi ʻōpū liʻiliʻi: ka maʻi ʻōnaehana pale, ischemia ʻōpū, nā fistulas ʻōpū he nui; ③ Radiation enteritis, ④ ʻO ka maʻi maʻi nui, ʻaʻole hiki ke hoʻopaʻa ʻia.
3. ʻO ka maʻi pancreatitis koʻikoʻi: ʻO ka infusion mua e hoʻopakele i ka haʻalulu a i ʻole MODS, ma hope o ka paʻa ʻana o nā hōʻailona koʻikoʻi, inā ʻaʻole i hoʻopau ʻia ka maʻi ʻōpū a ʻaʻole hiki ke ʻae ʻia ka meaʻai enteral, he hōʻailona ia no ka meaʻai makua.
4. Ke kūlana catabolic kiʻekiʻe: nā wela nui, nāʻeha hui nui, nā maʻi, a pēlā aku.
5. ʻAʻole ʻai nui: ʻAʻole hiki ke ʻae i ka meaʻai enteral ʻaʻole hiki ke ʻae ʻia ka ʻai ʻole o ka protein-calorie deficiency.
Pono ke kākoʻo
1. ʻO ka wā perioperative o ka ʻoki nui a me ka ʻeha: ʻAʻohe hopena koʻikoʻi o ke kākoʻo meaʻai i nā maʻi me ke kūlana meaʻai maikaʻi. ʻO ka mea ʻē aʻe, hiki ke hoʻonui i nā pilikia o ka maʻi, akā hiki iā ia ke hōʻemi i nā pilikia postoperative no nā maʻi me ka ʻai nui. Pono nā poʻe maʻi ʻino nui i ke kākoʻo meaʻai no 7-10 mau lā ma mua o ke ʻoki ʻana; no ka poʻe i manaʻo ʻia ʻaʻole hiki ke hoʻihoʻi hou i ka hana o ka ʻōpū i loko o 5-7 mau lā ma hope o ka ʻoki nui ʻana, pono e hoʻomaka ʻia ke kākoʻo ʻai meaʻai makua i loko o 48 mau hola ma hope o ka ʻoki ʻana a hiki i ka mea maʻi ke loaʻa ka meaʻai kūpono. ʻO ka meaʻai komo a i ʻole ka ʻai ʻana i ka meaʻai.
2. Enterocutaneous fistulas: Ma lalo o ke kūlana o ka ho'omalu 'ana i ka ma'i a me ka ho'okahe 'ana i ka wai kūpono, hiki i ke kāko'o mea'ai ke ho'ōla 'oi aku ma mua o ka hapalua o nā fistula enterocutaneous, a ua lilo ke 'oki kino 'ana i mea lapa'au hope loa. Hiki i ke kākoʻo meaʻai makua ke hoʻemi i ka huna ʻana o ka wai o ka ʻōpū a me ke kahe fistula, he mea maikaʻi ia no ka mālama ʻana i ka maʻi, hoʻomaikaʻi i ke kūlana meaʻai, hoʻomaikaʻi i ka lāʻau lapaʻau, a hōʻemi i nā hoʻopiʻi ʻoki a me ka make.
3. ʻO nā maʻi ʻeha o ka ʻōpū: ʻO ka maʻi o Crohn, ka ulcerative colitis, ka maʻi tuberculosis a me nā mea maʻi ʻē aʻe aia i ka maʻi maʻi hana, a i ʻole paʻakikī me ka abscess o ka ʻōpū, fistula ʻōpū, keakea a me ke koko, etc. Hiki iā ia ke hōʻoluʻolu i nā hōʻailona, hoʻomaikaʻi i ka meaʻai, hoʻomaha i ka ʻāpana ʻōpū, a hoʻomaʻamaʻa i ka hoʻoponopono ʻana i ka mucosa intestinal.
4. ʻO nā poʻe maʻi maʻi ʻaʻai nui ʻole: No nā poʻe maʻi me ke kaumaha o ke kino ≥ 10% (ke kaumaha maʻamau o ke kino), pono e hāʻawi ʻia ke kākoʻo meaʻai makua a i ʻole enteral ma mua o 7 a 10 mau lā ma mua o ka ʻoki ʻana, a hiki i ka meaʻai enteral a hoʻi hou i ka ʻai ma hope o ke ʻoki ʻana. a hiki i.
5. Ka lawa ole o na kino nui:
① ʻAʻole lawa ka ate: ʻo ka poʻe maʻi me ka cirrhosis o ke akepaʻa i loko o kahi kaulike kūpono ʻole ma muli o ka lawa ʻole o ka ʻai. I loko o ka manawa perioperative o ka ate cirrhosis a i ʻole ka maʻi ate, hepatic encephalopathy, a me 1 a 2 mau pule ma hope o ka hoʻololi ʻana i ke akepaʻa, pono e hāʻawi ʻia i ka poʻe ʻaʻole hiki ke ʻai a loaʻa i ka meaʻai enteral ka meaʻai makua.
② ʻAʻole lawa o ka renal: maʻi catabolic acute (infection, trauma or multiple organ failure) hui pū ʻia me ka hōʻino ʻole o ka renal, nā maʻi maʻi maʻi maʻi maʻi renal failure me ka ʻai ʻole, a makemake i ke kākoʻo meaʻai makua no ka mea ʻaʻole hiki iā lākou ke ʻai a loaʻa i ka meaʻai enteral. I ka wā o ka dialysis no ka hōʻino ʻole ʻana o ka renal, hiki ke hoʻokomo ʻia ka hui ʻai meaʻai makua i ka wā o ka hoʻokahe koko intravenous.
③ ʻAʻole lawa ka naʻau a me ka māmā: hoʻohui pinepine ʻia me ka protein-energy i hui pū ʻia me ka ʻai ʻole. Hoʻomaikaʻi ka meaʻai enteral i ke kūlana lapaʻau a me ka hana o ka ʻōpū i loko o ka maʻi pulmonary obstructive maʻi (COPD) a hiki ke hoʻopōmaikaʻi i nā poʻe maʻi me ka hāʻule ʻole o ka naʻau (ʻaʻole nā hōʻike). ʻAʻole i hoʻoholo ʻia ka ratio kūpono o ka glucose i ka momona i nā poʻe maʻi COPD, akā pono e hoʻonui ʻia ka nui o ka momona, pono e mālama ʻia ka nui o ka glucose a me ka infusion rate, pono e hāʻawi ʻia ka protein a i ʻole nā waikawa amino (ma ka liʻiliʻi loa lg/kg.d), a pono e hoʻohana ʻia ka glutamine no nā poʻe maʻi me ka maʻi ʻeha nui. He mea maikaʻi ka pale ʻana i ka endothelium alveolar a me ka ʻiʻo lymphoid pili i ka ʻōpū a hoʻemi i nā pilikia pulmonary. ④Hoʻopili i ka ʻōpū o ka ʻōpū: ʻo ke kākoʻo meaʻai makua perioperative no 4 a 6 mau pule he mea pono i ka hoʻihoʻi ʻana i ka hana o ka ʻōpū a me ka hoʻomaha ʻana i ke keakea.
Contraindications
1. ʻO ka poʻe me ka hana maʻamau o ka ʻōpū, hoʻololi i ka meaʻai enteral a i ʻole ka hoʻihoʻi ʻana i ka hana ʻōpū i loko o 5 mau lā.
2. ʻAʻole hiki ke hoʻōla ʻia, ʻaʻohe manaʻolana o ke ola, make a i ʻole nā maʻi coma irreversible.
3. ʻO ka poʻe e pono ai ke ʻoki ʻoki a ʻaʻole hiki ke hoʻokō i ke kākoʻo meaʻai ma mua o ka ʻoki ʻana.
4. Pono e ho'omalu 'ia ka hana pu'uwai a i 'ole nā ma'i metabolic ko'iko'i.
Alanui meaʻai
ʻO ke koho ʻana i ke ala kūpono o ka meaʻai makua e pili ana i nā mea e like me ka moʻolelo o ka maʻi vascular puncture, venous anatomi, coagulation status, i manaʻo ʻia ka lōʻihi o ka meaʻai makua, ke kau ʻana o ka mālama (maʻi a ʻaʻole paha), a me ke ʻano o ka maʻi kumu. No ka poʻe maʻi maʻi, ʻo ka venous peripheral pōkole a i ʻole ke kikowaena venous intubation ka koho maʻamau; no nā poʻe maʻi lapaʻau lōʻihi i loko o ka hale maʻi ʻole, hoʻohana pinepine ʻia ka peripheral venous a i ʻole ke kikowaena venous intubation, a i ʻole nā pahu infusion subcutaneous.
1. ʻO ke ala ʻai ʻai o ka makua
Nā hōʻailona: ① ʻO ka meaʻai makua no ka wā pōkole (<2 mau pule), ʻoi aku ka nui o ke kaomi osmotic ma lalo o 1200mOsm/LH2O; ② ʻAʻole hiki ke hoʻokō ʻia ka catheter venous waena; ③ ʻO ka maʻi catheter a i ʻole sepsis.
Nā pōmaikaʻi a me nā pōʻino: He maʻalahi kēia ala a maʻalahi hoʻi e hoʻokō, hiki ke pale i nā pilikia (mechanical, infection) e pili ana i ka catheterization venous central, a maʻalahi ke ʻike i ka hiki ʻana o ka phlebitis i ka wā mua. ʻO ka hemahema, ʻaʻole i kiʻekiʻe ke kiʻekiʻe o ka osmotic pressure o ka infusion, a pono e hoʻopaʻa hou ʻia ka puncture, kahi e pili ana i ka phlebitis. No laila, ʻaʻole kūpono ia no ka hoʻohana lōʻihi.
2. ʻO ka meaʻai makua ma o ke aʻa waena
(1) Nā hōʻailona: ka meaʻai makua no ka ʻoi aku ma mua o 2 mau pule a me ka hopena nutrient osmotic pressure kiʻekiʻe ma mua o 1200mOsm/LH2O.
(2) ʻO ke ala hoʻopaʻa ʻana: ma o ke aʻa jugular kūloko, ke aʻa subclavian a i ʻole ke aʻa peripheral o ka ʻaoʻao o luna a hiki i ka vena cava kiʻekiʻe.
Nā pōmaikaʻi a me nā pōʻino: He maʻalahi ka neʻe a mālama ʻana i ka catheter vein subclavian, a ʻo ka pilikia nui ʻo ia ka pneumothorax. ʻO ka hoʻopaʻa ʻana ma o ke aʻa ʻaʻa kūloko i kaupalena ʻia ka neʻe ʻana a me ka ʻaʻahu ʻana, a ua hoʻopiʻi hou aʻe i nā pilikia o ka hematoma kūloko, ka ʻeha arterial a me ka maʻi catheter. Peripheral vein-to-central catheterization (PICC): ʻOi aku ka laulā a me ka maʻalahi o ka vein makamae e hoʻokomo ma mua o ka vein cephalic, hiki ke pale i nā pilikia koʻikoʻi e like me ka pneumothorax, akā hoʻonui ia i ka ulu ʻana o ka thrombophlebitis a me ka intubation dislocation a me ka paʻakikī o ka hana. ʻO nā ala ʻai ʻai makua kūpono ʻole ʻo ia ka vein jugular waho a me ka vein femoral. ʻO ka mua he kiʻekiʻe kiʻekiʻe o ka misplacement, aʻo ka hope he kiʻekiʻe kiʻekiʻe o nā pilikia infectious.
3. Infusion me ka catheter i hoʻokomo ʻia ma lalo o ke kino ma o ka catheter venous central.
Pūnaehana meaʻai
1. ʻO ka meaʻai makua o nā ʻōnaehana like ʻole (nui-bottle serial, all-in-one a me nā ʻeke diaphragm):
①Multi-bottle serial transmission: Hiki ke hui pū ʻia nā ʻōmole he nui o ka meaʻai meaʻai a hoʻouna ʻia ma o ka "ʻekolu-ala" a i ʻole Y-shaped infusion tube. ʻOiai he maʻalahi a maʻalahi hoʻi e hoʻokō, he nui nā hemahema a ʻaʻole pono e kākoʻo ʻia.
②Total nutrient solution (TNA) or all-in-one (AIl-in-One): ʻO ka ʻenehana hoʻohuihui aseptic o ka solution nutrient a pau, ʻo ia ka hoʻohui ʻana i nā meaʻai meaʻai makua a pau i kēlā me kēia lā (glucose, fat emulsion, amino acids, electrolytes, vitamina a me nā trace elements) ) i hui ʻia i loko o kahi ʻeke a laila hoʻokomo ʻia. ʻO kēia ʻano hana e ʻoi aku ka maʻalahi o ka hoʻokomo ʻana o ka meaʻai makua, a ʻoi aku ka maʻalahi o ka hoʻokomo ʻana o nā meaʻai like ʻole no ka anabolism. Hoʻopau No ka mea hiki i ka plasticizer momona momona o nā ʻeke polyvinyl chloride (PVC) ke hoʻoulu i kekahi mau hopena ʻawaʻawa, ua hoʻohana ʻia ka polyvinyl acetate (EVA) ma ke ʻano he kumu nui o nā ʻeke meaʻai makua i kēia manawa. I mea e hōʻoiaʻiʻo ai i ka paʻa o kēlā me kēia ʻāpana i ka hopena TNA, pono e hana ʻia ka hoʻomākaukau ʻana ma ke ʻano i kuhikuhi ʻia (e ʻike i ka Mokuna 5 no nā kikoʻī).
③Peke diaphragm: I nā makahiki i hala iho nei, ua hoʻohana ʻia nā ʻenehana hou a me nā mea plastik hou (polyethylene/polypropylene polymer) i ka hana ʻana i nā ʻeke hoʻonā meaʻai makua. Hiki ke mālama ʻia ka ʻeke piha piha piha (ʻeke ʻelua keʻena, ʻeke ʻekolu keʻena) ma ka lumi wela no 24 mau mahina, e pale aku i ka pilikia haumia o ka hopena nutrient i hoʻomākaukau ʻia i ka haukapila. Hiki ke ʻoi aku ka palekana a me ka maʻalahi o ka hoʻohana ʻana no ka infusion meaʻai parenteral ma o ka vein waena a i ʻole peripheral vein i nā maʻi me nā pono meaʻai like ʻole. ʻO ka hemahema, ʻaʻole hiki ke hoʻokō ʻia ka hoʻohālikelike ʻana o ke ʻano.
2. Hoʻohui ʻia o ka ʻai meaʻai makua
Wahi a ka mea maʻi e pono ai ka meaʻai a me ka hiki ke metabolic, e hoʻokumu i ka hoʻonohonoho ʻana o nā hoʻomākaukau meaʻai.
3. Matrix kūikawā no ka meaʻai makua
Hoʻohana ka meaʻai lāʻau lapaʻau hou i nā hana hou e hoʻomaikaʻi hou aku i nā meaʻai meaʻai e hoʻomaikaʻi ai i ka hoʻomanawanui ʻana o ka maʻi. I mea e hoʻokō ai i nā pono o ka meaʻai meaʻai, hāʻawi ʻia nā substrate meaʻai kūikawā no nā maʻi kūikawā e hoʻomaikaʻi i ka hana pale ʻana o ka mea maʻi, hoʻomaikaʻi i ka hana pale ʻōpū, a hoʻomaikaʻi i ka mana antioxidant o ke kino. ʻO nā hoʻomākaukau meaʻai kūikawā hou:
①Fat emulsion: me ka emulsion momona i kūkulu ʻia, ka kaulahao lōʻihi, ka emulsion momona waena, a me ka emulsion momona waiwai i nā ʻakika momona omega-3, etc.
②Amino acid hoʻomākaukau: me ka arginine, glutamine dipeptide a me ka taurine.
Papa 4-2-1 Kokoke ikehu a me ka protein o na ma'i oki
ikehu kūlana maʻi Kcal/(kg.d) protein g/(kg.d) NPC: N
ʻAiʻai maʻamau-maʻalahi 20~250.6~1.0150:1
ʻO ke kaumaha haʻahaʻa 25~301.0~1.5120:1
High metabolic stress 30~35 1.5~2.0 90~120:1
Puhi 35~40 2.0~2.5 90~120: 1
NPC: N ʻaʻole protein ka nui o ka calorie i ka ratio nitrogen
Kākoʻo meaʻai makua no ka maʻi ate mau a me ka hoʻololi ʻana o ke ake
ʻO ka ikehu paʻa ʻole Kcal/(kg.d) pūmua a i ʻole ʻakika amino g/(kg.d)
ʻO cirrhosis i uku ʻia25~35 0.6~1.2
Decompensated cirrhosis 25~35 1.0
Hepatic encephalopathy 25~35 0.5~1.0 (hoʻonui i ka lakio o nā ʻakika amino branched-chain)
25~351.0~1.5 ma hope o ka hoʻololi ʻana o ke ake
Nā mea e pono ai ka nānā ʻana: ʻO ka meaʻai waha a i ʻole enteral ka mea maʻamau e makemake ʻia; inā ʻaʻole i ʻae ʻia, hoʻohana ʻia ka meaʻai makua: ʻo ka ikehu i haku ʻia me ka glucose [2g/(kg.d)] a me ka medium-long-chain fat emulsion [1g/(kg.d)], ʻo ka momona ka helu no 35 ~ 50% o nā calorie; Hāʻawi ʻia ke kumu nitrogen e nā waikawa amino pūhui, a hoʻonui ka encephalopathy hepatic i ka nui o nā ʻakika amino branched-chain.
Kākoʻo meaʻai makua no ka maʻi catabolic paʻakikī me ka hiki ʻole o ka renal
ʻO ka ikehu paʻa ʻole Kcal/(kg.d) pūmua a i ʻole ʻakika amino g/(kg.d)
20~300.8~1.21.2~1.5 (nā maʻi dialysis i kēlā me kēia lā)
Nā mea e pono ai ka nānā ʻana: ʻO ka meaʻai waha a i ʻole enteral ka mea maʻamau e makemake ʻia; inā ʻaʻole ʻae ʻia, hoʻohana ʻia ka meaʻai makua: ʻo ka ikehu i haku ʻia me ka glucose [3~5g/(kg.d)] a me ka emulsion momona [0.8~1.0g/(kg.d) )]; ʻAʻole pono nā amino acids (tyrosine, arginine, cysteine, serine) o nā kānaka olakino e lilo i mau amino acid i kēia manawa. Pono e nānā ʻia ke kō koko a me nā triglycerides.
Papa 4-2-4 Manaʻo ʻia ka nui o kēlā me kēia lā o ka nui o ka meaʻai makua
Ka ikehu 20~30Kcal/(kg.d) [Lawai wai 1~1.5ml no 1Kcal/(kg.d)]
Glucose 2~4g/(kg.d) Ka momona 1~1.5g/(kg.d)
ʻO ka maʻiʻo Nitrogen 0.1~0.25g/(kg.d) ʻAmino acid 0.6~1.5g/(kg.d)
Electrolytes (ke koi maʻamau i kēlā me kēia lā no nā mākua hānai makua) Sodium 80~100mmol Potassium 60~150mmol Chlorine 80~100mmol Calcium 5~10mmol Magnesium 8~12mmol Phosphorus 10~30mmol
Nā huaora hoʻoheheʻe momona: A2500IUD100IUE10mgK110mg
ʻO nā huaora hoʻoheheʻe wai: B13mgB23.6mgB64mgB125ug
Pantothenic Acid 15mg Niacinamide 40mg Folic Acid 400ugC 100mg
Nā mea hoʻoheheʻe: keleawe 0.3mg iodine 131ug zinc 3.2mg selenium 30~60ug
Molybdenum 19ug manganese 0.2~0.3mg Chromium 10~20ug hao 1.2mg
Ka manawa hoʻouna: ʻAukake-19-2022