Yuav ua li cas yog txhais los ntawm "plab plab noj mov intolerance" nyob rau hauv cov tshuaj?

Yuav ua li cas yog txhais los ntawm "plab plab noj mov intolerance" nyob rau hauv cov tshuaj?

Yuav ua li cas yog txhais los ntawm "plab plab noj mov intolerance" nyob rau hauv cov tshuaj?

Nyob rau hauv xyoo tas los no, lo lus "kev pub noj tsis haum" tau siv dav hauv kev kho mob.Tsuav yog hais txog kev noj zaub mov zoo, ntau tus neeg ua haujlwm kho mob lossis cov neeg mob thiab lawv tsev neeg yuav koom nrog qhov teeb meem ntawm kev kam rau siab thiab tsis kam lees.Yog li, dab tsi tiag tiag yog enteral noj zaub mov kam rau siab txhais tau li cas?Hauv kev kho mob, yuav ua li cas yog tias tus neeg mob muaj kev noj zaub mov tsis haum?Ntawm lub rooj sib tham National Critical Care Medicine 2018, tus neeg sau xov xwm tau xam phaj xibfwb Gao Lan los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm Thawj Tsev Kho Mob ntawm Jilin University.

Hauv kev kho mob, ntau tus neeg mob tsis tuaj yeem tau txais khoom noj txaus los ntawm kev noj zaub mov zoo vim muaj kab mob.Rau cov neeg mob no, xav tau kev txhawb nqa khoom noj khoom haus enteral.Txawm li cas los xij, kev noj zaub mov tsis zoo tsis yooj yim li xav.Thaum lub sijhawm pub mis, cov neeg mob yuav tsum tau ntsib cov lus nug ntawm seb lawv puas tuaj yeem zam tau.

Xib fwb Gao Lan tau taw qhia tias kev ua siab ntev yog ib qho cim ntawm kev ua haujlwm ntawm plab hnyuv.Cov kev tshawb fawb tau pom tias tsawg dua 50% ntawm cov neeg mob cov tshuaj sab hauv tuaj yeem zam tag nrho cov khoom noj nkag mus rau theem pib;Ntau tshaj 60% ntawm cov neeg mob hauv chav saib xyuas mob hnyav ua rau muaj kev cuam tshuam ib ntus ntawm cov khoom noj nkag mus rau hauv cov khoom noj vim kev noj zaub mov tsis haum lossis mob plab zom mov.Thaum tus neeg mob tsim kev noj zaub mov tsis txaus, nws tuaj yeem cuam tshuam rau lub hom phiaj pub mis, ua rau muaj qhov tshwm sim tsis zoo.

Yog li, yuav ua li cas txiav txim seb tus neeg mob puas kam rau cov khoom noj khoom haus enteral?Xib fwb Gao Lan tau hais tias tus neeg mob lub plab zom mov, txawm tias ntuav lossis rov qab los, txawm tias muaj raws plab, txawm tias muaj plab hnyuv loj, seb puas muaj cov plab hnyuv ntxiv, thiab seb lub hom phiaj ntim tau mus txog tom qab 2 mus rau 3 hnub. enteral khoom noj khoom haus, thiab lwm yam. Raws li ib qho kev ntsuas los txiav txim seb tus neeg mob puas muaj kev noj qab haus huv txaus.

Yog tias tus neeg mob tsis muaj qhov tsis xis nyob tom qab siv cov khoom noj nkag mus, lossis yog mob plab, raws plab, thiab reflux tshwm sim tom qab siv cov khoom noj nkag mus, tab sis txo qis tom qab kev kho mob, tus neeg mob tuaj yeem suav tias yog kev zam.Yog tias tus neeg mob mob ntuav, mob plab, thiab raws plab tom qab tau txais cov khoom noj nkag mus, nws tau txais kev kho mob sib xws thiab nres rau 12 teev, thiab cov tsos mob tsis zoo tom qab ib nrab ntawm cov khoom noj nkag mus ntxiv, uas suav tias yog enteral. khoom noj khoom haus intolerance.Kev noj zaub mov tsis txaus kuj tuaj yeem faib ua rau lub plab tsis haum (zais plab, ntuav, reflux, aspiration, thiab lwm yam) thiab plab hnyuv (zaub mov, tsam plab, nce siab hauv plab).
Xib fwb Gao Lan tau taw qhia tias thaum cov neeg mob tsim kev tsis haum rau kev noj zaub mov zoo, lawv feem ntau yuav cuam tshuam nrog cov tsos mob raws li cov ntsuas hauv qab no.
Qhov taw qhia 1: ntuav.
Xyuas seb lub raj nasogastric puas nyob hauv txoj hauj lwm raug;
Txo cov as-ham infusion li 50%;
Siv tshuaj thaum tsim nyog.
Qhov taw qhia 2: Lub plab zom mov.
Tsis txhob noj zaub mov noj;
Muab tshuaj;
Rov kuaj xyuas txhua 2 teev.
Index peb: mob plab / intra-abdominal siab.
Intra-abdominal siab tuaj yeem ua rau muaj kev cuam tshuam tag nrho cov xwm txheej ntawm lub plab zom mov me thiab kev hloov pauv ntawm kev nqus, thiab yog qhov qhia txog kev noj zaub mov zoo rau cov neeg mob hnyav.
Nyob rau hauv me me intra-abdominal hypertension, tus nqi ntawm cov khoom noj khoom haus infusion tuaj yeem tswj tau, thiab qhov siab ntawm lub plab tuaj yeem rov ntsuas txhua 6 teev;

Thaum lub plab hauv plab yog siab me ntsis, txo qis ntawm qhov infusion ntawm 50%, noj cov yeeb yaj kiab hauv plab los txiav cov hnyuv, thiab rov kuaj dua txhua 6 teev.Yog tias tus neeg mob tseem muaj mob plab, cov tshuaj gastrodynamic tuaj yeem siv raws li tus mob.Yog tias qhov siab ntawm lub plab hauv plab yog nce hnyav, cov khoom noj khoom haus nkag mus rau hauv lub plab yuav tsum tau nres, thiab tom qab ntawd yuav tsum tau kuaj xyuas plab hnyuv kom ntxaws.
Qhov taw qhia 4: Mob plab.
Muaj ntau yam ua rau mob raws plab, xws li plab hnyuv mucosal necrosis, shedding, yaig, txo cov digestive enzymes, mesenteric ischemia, plab hnyuv edema, thiab imbalance ntawm plab hnyuv flora.
Txoj kev kho mob yog kom txo qis tus nqi noj, dilute cov as-ham kab lis kev cai, los yog kho cov mis nyuj noj enteral;nqa tawm kev kho mob raws li qhov ua rau mob raws plab, lossis raws li qhov ntsuas ntawm qhov mob raws plab.Nws yuav tsum raug sau tseg tias thaum mob raws plab tshwm sim hauv ICU cov neeg mob, nws tsis pom zoo kom txwv tsis pub noj zaub mov ntxiv, thiab yuav tsum tau noj ntxiv, thiab tib lub sijhawm nrhiav qhov ua rau mob raws plab los txiav txim siab txog kev kho mob uas tsim nyog.

Index tsib: plab residue.
Muaj ob qho laj thawj rau kev mob plab hnyuv: kab mob thiab cov yam ntxwv kho mob.
Cov kab mob muaj xws li hnub nyoog siab, rog rog, ntshav qab zib lossis hyperglycemia, tus neeg mob tau phais plab, thiab lwm yam.;

Cov tshuaj muaj xws li kev siv tshuaj tranquilizers lossis opioids.
Cov tswv yim los daws cov kab mob plab hnyuv muaj xws li ua qhov kev ntsuam xyuas dav dav ntawm tus neeg mob ua ntej siv cov khoom noj nkag mus, siv cov tshuaj uas txhawb lub plab zom mov lossis acupuncture thaum tsim nyog, thiab xaiv cov kev npaj uas muaj cov plab zom mov sai;

Duodenal thiab jejunal pub mis yog muab thaum muaj ntau dhau ntawm plab hnyuv;ib koob me me yog xaiv rau thawj zaug pub mis.

Index six: reflux/aspiration.
Txhawm rau tiv thaiv kev aspiration, cov neeg ua haujlwm kho mob yuav tig rov qab thiab nqus cov pa ua pa hauv cov neeg mob uas tsis nco qab ua ntej noj qhov ntswg;Yog tias tus mob tso cai, tsa tus neeg mob lub taub hau thiab lub hauv siab los ntawm 30 ° lossis siab dua thaum noj qhov ntswg, thiab tom qab noj qhov ntswg tuav txoj hauj lwm semi-recumbent hauv ib nrab teev.
Tsis tas li ntawd, nws tseem ceeb heev uas yuav tsum tau saib xyuas tus neeg mob qhov kev noj qab haus huv ntawm kev noj qab haus huv txhua hnub, thiab kev cuam tshuam yooj yim ntawm cov khoom noj nkag mus yuav tsum zam.


Post lub sij hawm: Lub Xya hli ntuj-16-2021