Ðe nèyi kɔdzi kpɔ be yeakpɔ dɔnɔ aɖe si mete ŋu ɖua nu to nu me o, eye wole tsi nam wo to kotoku gã aɖe me to ʋuka aɖe mea? Zi geɖe la, míebunɛ be enye dzetsi. Gake menye ɣesiaɣie wònyea dze dzro aɖe ko o. Ɣeaɖewoɣi la, enyea tsi tɔxɛ aɖe si me nunyiame siwo katã ame hiã be wòanɔ agbe le. Emae nye nusi míeyɔna be ‘nunyiame si wodona ɖe ʋuka me’, alo le atikewɔwɔ me la, Nuɖuɖu si Wotsɔna Toa Ʋuka me .
Kpuie ko la, nukae nye Parenteral Nutrition?
Kpuie ko la, esiae nye ne èto wò nuɖuɖumeŋusẽ (si nye nuɖuɖumeŋusẽ bliboa tso wò nu me va ɖo wò aɖuɖɔtoe me) keŋkeŋ eye nèto ʋuka aɖe dzi tsɔ nunyiamewo yi wò ŋutilã gbɔ tẽ. Nya "parenteral" gɔmee nye "nuɖuɖumeŋusẽ godo."
Ðewohĩ èse nu tso dɔgbo me nunyiame ŋu nya kpɔ. Esia bia be woatsɔ nuɖuɖu si me tsi le ana ɖe dɔgboa alo dɔgbo suea me tẽ to mɔ̃ aɖe si wotsɔ de ŋɔti me alo do sue aɖe si le dɔgboa me me. Gake ne wotsɔ nunyiame si wotsɔa dɔgbo wɔe la, wotoa ɖoɖo sia katã ŋu eye wotsɔa nunyiamewo dea ʋukawo me tẽ. Le atikewɔwɔ ƒe nɔnɔme aɖewo me la, mɔnu sia ate ŋu ahiã hena ɣeyiɣi kpui aɖe alo ɣeyiɣi didi aɖe. Wotsɔa esia naa ame aɖewo be woatsɔ akpe ɖe nuɖuɖu si woɖuna to nu me ŋu. Ele be ame bubuwo nakpɔ woƒe nuɖuɖumeŋusẽ katã to nunyiame sia si wodona ɖe ʋuka me dzi.
Mɔnu sia ƒomevi vevi kawoe?
Woate ŋu ama nunyiame si wotsɔa dɔgbo wɔe ƒe mɔnu sia ɖe hatsotso vevi eve me. Ðeka nɔ te ɖe nunyiame agbɔsɔsɔme si wona dzi, eye evelia nɔ te ɖe ʋuka si ƒomevi wozãna tsɔ naa nunyiame dzi. Mina míase nusiawo evea siaa gɔme nyuie.
1. Ðoɖowɔwɔ ɖe nunyiame agbɔsɔsɔme si wona nu
Esia ƒomevi vevi evee li.
| Nunyiame ƒe ɖoɖo | Kpuie ko la,... |
|---|---|
| Nuɖuɖu Si Wotsɔna Toa Nu Me ƒe Akpa aɖe (PPN) . | Wotsɔa esia kpena ɖe nunyiamemɔnu bubuwo ŋu. Tsɔe be ame ate ŋu aɖu nu vi aɖe to nu me, gake mesɔ gbɔ be wòana nunyiame siwo ŋutilãa hiã o, eye nunyuimakpɔɖui le fu ɖem nɛ. Le nɔnɔme mawo me la, wozãa mɔnu sia tsɔ naa nunyiame siwo bu alo nuɖuɖumeŋusẽ bubu siwo bu la dometɔ aɖewo. |
| Nuɖuɖu Si Wotsɔna Toa Nu Me Katã (TPN) . | Esia nye mɔnu si dzi woato ana nunyiame blibo to ʋuka me. Esia hiã na amesiwo mate ŋu azã woƒe nuɖuɖumeŋusẽ kura o. Le atikewɔwɔ ƒe nɔnɔme aɖewo ta la, womete ŋu ɖua nuɖuɖu hexɔa nunyiamewo o. Ɣebubuɣiwo la, ehiã be woana nuɖuɖumeŋusẽa nagbɔ ɖe eme bliboe eye wòana wòahaya. Le nɔnɔme mawo me la, wozãa TPN. |
2. Woda wo ɖe hatsotsowo me le vein ƒomevi si wozã nu
| Vein ƒomevi aɖe | Nuɖᴐɖᴐ |
|---|---|
| To ʋuka vevi aɖe me (Central Parenteral Nutrition - CPN) . | Esia bia be woaɖu nu ayi ʋuka gã aɖe si le ŋutilãa me me. Zi geɖe la, esiae nye Superior Vena Cava, si nye ʋuka gã aɖe si le kɔmeƒu te si yia dzia gbɔ tẽ. Esi ʋuka sia lolo ta la, ate ŋu atsɔ tsi si me nunyiame le si me nunyiame sɔ gbɔ ɖo si me nunyiame sɔ gbɔ ɖo wu la ana kabakaba. Esia tae wozãnɛ tsɔ naa nunyiame blibo si wotsɔa dɔgbo wɔe (TPN). |
| To ʋuka sue aɖe si le gota (Peripheral Parenteral Nutrition - PPN) me . | Wowɔa esia to nunyiame nana ɖe ʋuka sue aɖe me le alɔ, afɔ, alo kɔ me. Esi wònye be ewɔwɔ le bɔbɔe ta la, wozãa mɔnu sia tsɔ naa nunyiame ƒe akpa aɖe hena ɣeyiɣi aɖe (PPN). |
Nukae le tsi si me nunyiame le sia me?
Esia nye atikewo ƒe mɔnu. Gake esia menye nusi wotsɔ na amesiame le mɔ ɖeka nu o. Le wò ŋutilã ƒe nuhiahiãwo nu la, le wò ʋudodokpɔ me tsonu nu la, wonaa nunyiametike si wowɔ ɖe ɖoɖo nu wò .
Nunyiame ade siwo katã le vevie na ŋutilãa ate ŋu anɔ eme le agbɔsɔsɔ vovovowo me:
- Tsi
- Carbohydrates (hena ŋusẽ) .
- Protein (hena ŋutilã ƒe tsitsi kple edzadzraɖo) .
- Ami (hena ŋusẽ kple ami veviwo) .
- Vitamin siwo le lãme na ame
- Dze siwo me mineral le
Nunyiame ƒe mɔnu sia de blibo ale gbegbe be ne edi la, ame ate ŋu anɔ agbe ɖe ɖoɖo sia nu le eƒe agbemeŋkekewo katã me evɔ mano naneke to nu me o.
Nɔnɔme kawo mee wozãa mɔnu siawo le?
Ɣekaɣie nunyiame ƒe akpa aɖe (PPN) hiã?
Zi geɖe la, wozãa PPN hena ɣeyiɣi aɖe. Le kpɔɖeŋu me, wozãnɛ tsɔ naa ŋusẽ ame aɖe kaba hafi trɔa wo vivivi yia nuɖuɖu nana ame to mɔ̃ me alo nuɖuɖu nana ame to nu me. Azɔ hã, dɔnɔ siwo woxɔ ɖe kɔdzi ɣeyiɣi didi aɖe ate ŋu azu nunyuimakpɔɖu le susu vovovowo ta. Wozãa PPN hã zi geɖe tsɔ naa nunyiame bubuwo wo.
Ɣekaɣie wòhiã be woana nunyiame blibo si wotsɔa dɔgbo wɔe (TPN)?
Ne wò nuɖuɖumeŋusẽ mele dɔ wɔm kura o, alo ne dɔgbo ƒe dɔléle aɖe le ŋuwò si hiã be nàgbɔ ɖe eme bliboe na nuɖuɖumeŋusẽ ma la, àte ŋu ahiã TPN.
Nɔnɔme tɔxɛ aɖewo siwo me TPN ate ŋu ahiã le lae nye esi:
- Amekoko gã aɖe le ƒodo ŋu
- Atikewɔwɔ na kansa
- Ʋu ƒe sisi yi dɔgboa me dzi ɖe kpɔtɔ (Intestinal ischemia) .
- Dɔgbo ƒe mɔxenuwo le dɔgbo sue alo gã me
- Dɔgbo ƒe dɔmawɔmawɔ nyuie (Ileus didi) .
- Ʋu si dona le dɔgboa me
- Nusiwo gblẽ le dɔgboa ŋu le keklẽŋusẽ ƒe atikewɔwɔ ta (Radiation enteritis) .
- Vidzidzi kaba ŋutɔ
- Necrotizing enterocolitis le vidzĩwo me
- Aɖuɖɔtoe si nɔa anyi didi
- Dɔgbo ƒe dɔléle siwo naa dɔdzẽ abe Crohn ƒe dɔléle ene
- Short bowel syndrome (nɔnɔme si dzɔna ne woɖe dɔgboa ƒe akpa aɖe ɖa vɔ) .
- Dɔgbo ƒe dɔléle si nye graft-versus-host
Aleke wowɔa atike sia dzadzraɖo kple edziwɔwɔe?
Esia nye agbagbadzedze si ŋu ɖɔktawo ƒe ƒuƒoƒo aɖe wɔ ɖoɖo ɖo ŋutɔ eye wowɔa nu aduadu.
Dzadzraɖo ɖe atikewɔwɔ ŋu
Wò atikewɔlawo ƒe ƒuƒoƒo (ɖɔktawo, dɔnɔdzikpɔlawo, kple nuɖuɖuŋutinunyalawo) alé ŋku ɖe wò lãmesẽ ŋutinya, ŋutilã ƒe lolome ƒe dzesi (BMI), kple ʋudodokpɔ me tsonu ŋu nyuie be woakpɔ nunyiame si nèhiã. Eŋutinunyala bibi aɖee dzraa nunyiametsi sia ɖo le agbɔsɔsɔ si sɔ gbɔ gaƒoƒo 24 me. Ele be woatsɔe ade nufamɔ̃ me vaseɖe gbesigbe nàhiãe. Woɖenɛ doa goe gaƒoƒo ʋɛ aɖewo hafi wozãnɛ eye woɖea mɔ wòva ɖoa xɔme ƒe dzoxɔxɔ gbɔ.
Alesi woatsɔ catheter ade ŋutilãa me
Tube, si woyɔna be catheter, dede wò ŋutilã me nye amekoko sue aɖe. Hafi woawɔ esia la, woana atike aɖe si ana nàtsi dzodzodzoe be wòaɖe vevesesea dzi akpɔtɔ eye wòana wò dzi nadze eme. Emegbe, woakɔ teƒe si woatsɔ catheter la ade la ŋu nyuie ahawu dɔlékuiwoe.
Ðɔktaa tsɔa aŋe dea mɔfianu ʋukaa me, emegbe eɖea aŋea ɖa eye wòtsɔa ka la toa ka la me yia ʋukaa me. Woate ŋu azã ultrasound alo X-ray atsɔ akpɔe ɖa be ele teƒe nyuitɔ hã.
Wozãa ka ƒomevi vevi etɔ̃:
- Gotagome “tunneled” catheter: Wotrɔ asi le esia ŋu be wòazɔ didiƒe kpui aɖe le ŋutigbalẽa te eye wòado tso teƒe bubu.
- Catheter si wodo bliboe: Esia le ŋutigbalẽa te keŋkeŋ. Ne ehiã be woana nuɖuɖu la, wotsɔa aŋe dea melidzeƒe tɔxɛ aɖe si le ŋutigbalẽa te me hedoa ka kplii.
- Peripherally inserted central catheter (PICC): Wotsɔa esia toa ʋuka aɖe si le abɔta ƒe akpa si le etame me eye wotsɔa ka dea ʋuka gã aɖe si te ɖe dzia ŋu me. Zi geɖe la, wozãa esia na amesiwo hiã nunyiame si mede kwasiɖa 6 o.
Nu vevitɔe nye be woawɔ dɔ sia katã le nɔnɔme siwo le dzadzɛ ŋutɔ, siwo me dɔlékui mele o me, elabena afɔku le eme be woaxɔ dɔlékuiwo.
Aleke wonaa nunyiame eye woléa ŋku ɖe eŋu?
Zi geɖe la, nuɖuɖu nana nyea gaƒoƒo 10-12 ƒe dɔwɔwɔ, eyata ame geɖe wɔa esia le zã me ne womlɔ anyi. Woate ŋu awɔ atikewɔwɔ sia le kɔdzi, afisi wokpɔa dɔnɔwo gbɔ le ɣeyiɣi didi aɖe me, alo le aƒeme gɔ̃ hã .
Ne èle esia wɔm le aƒeme la, atikewɔlawo ƒe ƒuƒoƒoa ana hehe blibo wò alo wò dzikpɔla, siwo dometɔ aɖewoe nye alesi nàde dzesi dɔlékui ƒe dzesiwo, alesi nàna dɔwɔnuawo nanɔ dzadzɛ, kple alesi nàtrɔ mɔ̃awoe.
Atikewɔlawo ƒe ƒuƒoƒoa alé ŋku ɖe ŋuwò ɣesiaɣi le atikewɔwɔ me.
- Edzidzea tsi agbɔsɔsɔme si gena ɖe wò ŋutilã me kple esi dona le eme.
- Woléa ŋku ɖe kpekpeme kple kɔkɔme ŋu edziedzi.
- Wodoa ʋu kpɔna edziedzi be woakpɔe ɖa be ehiã be woawɔ tɔtrɔ le nunyiametikea ŋu hã.
Vevietɔ la, woƒe susu nɔa nu siawo ŋu:
- Elektrikŋusẽ kple ayiku ƒe dɔwɔwɔ (BUN/Creatinine) .
- Sukli ƒe agbɔsɔsɔ le ʋu me (ƒo asa na suklidɔ alo suklidɔ ƒe ɖiɖi) .
- Tomenukuƒe ƒe agbɔsɔsɔ
- Aklã ƒe dɔwɔwɔ ƒe dzesiwo (Aminotransferases, Bilirubin) .
Viɖe kawo kple afɔku siwo le mɔnu sia ŋu?
Abe atikewɔwɔ ɖesiaɖe ene la, viɖe kple afɔku siaa le esiawo ŋu.
Viɖe
Viɖe vevitɔ si le mɔnu sia ŋue nye be enaa wò nuɖuɖumeŋusẽ ƒe gbɔdzɔe si wòhiã be wòahaya le dɔléle sesẽ alo amekoko vɔ megbe.. Ekpena ɖe ametia hã ŋu wòdoa ŋusẽ ame to nunyiame si hiã nana dɔnɔ siwo woxɔ ɖe kɔdzi ɣeyiɣi didi, vevietɔ ame tsitsiwo me. Enye atike si xɔa ame ɖe agbe na amesiwo ƒe nuɖuɖumeŋusẽ gblẽ tegbee kple na vidzĩ siwo wodzi do ŋgɔ na ɣeyiɣi si me womete ŋu ɖua nu nyuie o.
Afɔkuwo Kple Kuxiwo
Mɔnu sia hea kuxiwo ƒe afɔku geɖe vɛ wu nuɖuɖu nana to dɔgboa me. Kuxi vevi eveawoe nye afɔku si le dɔlékuiwo ƒe gege ɖe ʋukawo me to ʋuka me kple nuɖuɖumeŋusẽ ƒe gbɔdzɔgbɔdzɔ le esi womegazãnɛ ɣeyiɣi didi o ta.
| Kuxi si bɔ | Numeɖeɖe bɔbɔe aɖe |
|---|---|
| Dɔdzedze | Dɔlékuiwo ate ŋu ato ʋuka si me ʋu sina tona me age ɖe ʋukawo me. Ne dɔlékui sia kaka ɖe ŋutilã bliboa me la, ate ŋu ahe nɔnɔme aɖe si ate ŋu ade ame ƒe agbe afɔku me si woyɔna be sepsis vɛ. |
| Ʋu ƒe sisi | Ʋu ƒe sisi ate ŋu adzɔ le afisi ʋukaa do ƒome kple ʋukaa le. |
| Nuɖuɖumeŋusẽ ƒe gbɔdzɔgbɔdzɔ (GI atrophy) . | Le mɔ̃a zazã abe kwasiɖa eve ene megbe la, eƒe dɔwɔwɔ dzea ɖiɖi gɔme. Gake vivivi la, egatrɔna va nɔa nɔnɔme si sɔ me ne ègadze nuɖuɖu gɔme ake. |
| Sukli ƒe agbɔsɔsɔ ƒe masɔmasɔ | Suklidɔ alo suklidɔ ƒe dzidziɖedzi bɔ eye woate ŋu akpɔ egbɔ to asitɔtrɔ le insulin kple nunyiame ƒe ɖoɖowo ŋu me. |
| Aklã me kuxiwo | Ame siwo zãa atike sia ɣeyiɣi didi la dometɔ siwo ade 50% ate ŋu axɔ aklãdɔ (PNALD) le ƒe 5-7 me. Womenya nusi tututu gbɔ esia tso o. |
| Gallbladder ƒe kuxiwo | Esi nuɖuɖumeŋusẽ mele dɔ wɔm o ta la, ʋumenugbagbeviɣi si le aɖuɖɔtoea me mate ŋu ado o eye ate ŋu aƒo ƒu, awɔ kpewo. |
| Ƒuwo ƒe mineral ɖeɖeɖa | Ame siwo xɔa atike sia ɣeyiɣi didi la ate ŋu axɔ ƒu ƒe ʋuʋu ƒe dɔlélewo abe ƒumeŋuɖui ene le vitamin kple mineral (calcium, magnesium, vitamin D) ƒe anyimanɔmanɔ ta. |
Tsɔ kpe ɖe eŋu la, afɔku bubuwo hã li siwo ate ŋu ado mo ɖa, abe abixɔxɔ le catheter dede ame me, tsi ƒe agbɔsɔsɔ fũ, kple dɔwuame ƒe seselelãme ene.
Aleke nègadzea nuɖuɖu to nu me gɔme ake?
Togbɔ be woate ŋu awɔ nunyiame to dɔgboa me ɣeyiɣi didi hã la, ɖɔktawo dzea agbagba ɣesiaɣi be yewoatrɔ wò atrɔ ɖe mɔ̃memi nana alo nu me nana ŋu kaba ale si woate ŋui. Nusitae nye be woaƒo asa na kuxi siwo anɔ anyi ɣeyiɣi didi.
Wowɔa tɔtrɔ sia vivivi ŋutɔ eye wowɔa esia blewu elabena abe wò atikewɔwɔ ƒe nɔnɔme si le ete ene la, nuɖuɖumeŋusẽ si "dɔ alɔ̃" hena ɣeyiɣi aɖe la madze dɔwɔwɔ gɔme zi ɖeka o.
1. Dze egɔme kple tsi si me kɔ nyuie .
2. Ne ŋutilãa wɔa nu ɖe eŋu nyuie la, ekema trɔ ɖe tsi si me tsi le ɖuɖu ŋu .
3. Mlɔeba la, tsɔ nuɖuɖu sesẽwo de eme vivivi .
Ne atikewɔha la dzudzɔ atikewɔwɔ sia gɔ̃ hã la, ayi edzi anɔ ŋku lém ɖe wò kpekpeme kple nunyiame ƒe agbɔsɔsɔ ŋu hena ɣeyiɣi aɖe.
Nunyiame si Wotsɔna Toa Nu me nye atikewɔwɔ si wozãna le dɔléle sesẽtɔwo kekeake me, gake ɣeaɖewoɣi la, ehiãna be woaɖe ame ƒe agbe. Ne esia hiã na wò alo wò lɔlɔ̃tɔ aɖe la, ate ŋu anye nuteƒekpɔkpɔ sesẽ kple nu yeye vie. Gake le ɣeyiɣi aɖe megbe la, ava zu wò gbesiagbedɔwo ƒe akpa aɖe. Nu vevitɔe nye be nàwɔ ɖe mɔfiame siwo atikewɔlawo ƒe ƒuƒoƒoa na dzi pɛpɛpɛ eye nàna woanya kuxi ɖesiaɖe.
Gbedasi si Wotsɔ Yi Aƒeme
- Parenteral Nutrition nye mɔnu si dzi woato atsɔ nunyiame ayi ʋuka me tẽ to ʋuka me ne womate ŋu azã nuɖuɖumeŋusẽ o.
- Wole ƒomevi vevi eve: PPN, si wonana abe nunyiame kpeɖeŋutɔ ene, kple TPN, si naa nunyiame blibo.
- Togbɔ be esia nye atike si xɔa ame ɖe agbe hã la, afɔku sesẽwo li, abe dɔlékuiwo xɔxɔ, ʋu ƒe sisi, kple aklã me kuxiwo ene.
- Ele be woawɔ atikewɔwɔ sia le ɖɔktawo, dɔnɔdzikpɔlawo, kple nuɖuɖuŋutinunyalawo ƒe ƒuƒoƒo aɖe ƒe dzikpɔkpɔ te ɣesiaɣi.
- Ne ele be wò ŋutɔ alo wò ame vevi aɖe nawɔ atike sia le aƒeme la, ele vevie be nàxɔ hehe nyuie eye nàlé be na dzadzɛnyenye geɖe. Ne dzimaɖitsitsi alo nya aɖe le ŋuwò la, ƒo nu kple wò ɖɔkta enumake.
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