Wake waya esibhedlela ukuyobona isiguli esingakwazi ukudla ngomlomo, futhi sinikezwa uketshezi ngesikhwama esikhulu ngomthambo? Sivame ukukucabanga njengosawoti. Kodwa akulona njalo usawoti kuphela. Ngezinye izikhathi luwuketshezi olukhethekile oluqukethe zonke izakhamzimba umuntu azidingayo ukuze aphile. Yilokho esikubiza ngokuthi 'ukudla okunomsoco ngaphakathi kwemithambo yegazi', noma ngokwezokwelapha, i-Parenteral Nutrition .
Kalula nje, kuyini i-Parenteral Nutrition?
Kalula nje, lokhu kwenzeka lapho udlula uhlelo lwakho lokugaya ukudla (lonke uhlelo kusukela emlonyeni wakho kuya endunu yakho) ngokuphelele bese uletha izakhamzimba ngqo emzimbeni wakho ngomthambo wegazi. Igama elithi "parenteral" lisho "ngaphandle kohlelo lokugaya ukudla."
Kungenzeka ukuthi uke wezwa ngokudla okunomsoco kwamathumbu. Lokhu kuhilela ukunikeza ukudla okumanzi ngqo esiswini noma emathunjini amancane ngepayipi elifakwe ngekhala noma ngomngxuma omncane esiswini. Kodwa ngokudla okunomsoco kwabazali, lonke lolu hlelo luyadlula futhi izakhamzimba zengezwa ngqo egazini. Kwezinye izimo zezokwelapha, le ndlela ingadingeka isikhathi esifushane noma eside. Abanye abantu banikezwa lokhu ukuze bangeze ekudleni abakudla ngomlomo. Abanye badinga ukuthola wonke amakhalori abo ngalokhu kudla okunomsoco ngemithambo yegazi.
Yiziphi izinhlobo eziyinhloko zale ndlela?
Le ndlela yokondla i-parenteral ingahlukaniswa ngezinhlobo ezimbili eziyinhloko. Enye isekelwe enanini lokondla elinikeziwe, kanti enye isekelwe ohlotsheni lomthambo osetshenziswayo ukunikeza ukondla. Ake siziqonde kahle zombili lezi zinto.
1. Ukuhlunga ngenani lokudla okunomsoco okunikeziwe
Kunezinhlobo ezimbili eziyinhloko zalokhu.
| Uhlelo lokudla okunempilo | Kalula nje... |
|---|---|
| Ukudla Okungaphelele Kwabazali (PPN) | Lokhu kunikezwa ngaphezu kwezinye izindlela zokudla okunempilo. Cabanga ukuthi umuntu angadla kancane ngomlomo, kodwa akwanele ukunikeza umzimba izakhamzimba ozidingayo, futhi uhlushwa ukungondleki kahle. Ezimweni ezinjalo, le ndlela isetshenziselwa ukuhlinzeka ngezinye zezakhamzimba ezilahlekile noma amakhalori engeziwe. |
| Ukudla Okuphelele Kwabazali (TPN) | Lena indlela yokunikeza ukudla okunempilo okuphelele ngomthambo. Lokhu kuyadingeka kubantu abangakwazi nhlobo ukusebenzisa uhlelo lwabo lokugaya ukudla. Ngenxa yezinye izimo zezokwelapha, abakwazi ukugaya ukudla nokumunca izakhamzimba. Ngezinye izikhathi, kuyadingeka ukunikeza uhlelo lokugaya ukudla ukuphumula okuphelele futhi uluvumele luphole. Ezimweni ezinjalo, kusetshenziswa i-TPN. |
2. Ukuhlukaniswa ngohlobo lomthambo osetshenzisiwe
| Uhlobo lomthambo | Incazelo |
|---|---|
| Ngokusebenzisa umthambo oyinhloko (i-Central Parenteral Nutrition - CPN) | Lokhu kuhilela ukondla umthambo omkhulu, oyinhloko emzimbeni. Lokhu kuvame ukuba yi-Superior Vena Cava, umthambo omkhulu ngaphansi kwethambo lentamo oya ngqo enhliziyweni. Ngenxa yokuthi lo mthambo mkhulu, ungaletha isakhi esimanzi esigxilile, esinamakhalori amaningi ngokushesha. Yingakho usetshenziselwa ukuhlinzeka ngokudla okuphelele kwe-parenteral (TPN). |
| Ngokusebenzisa umthambo omncane, ongaphandle (i-Peripheral Parenteral Nutrition - PPN) | Lokhu kuhilela ukuphakela emthanjeni omncane engalweni, emlenzeni, noma entanyeni. Ngenxa yokuthi kulula ukukwenza, le ndlela isetshenziselwa ukunikeza ukudla okuyingxenye yesikhashana (PPN). |
Luquketheni lolu ketshezi olunomsoco?
Lena ifomula yamakhemikhali. Kodwa lokhu akuyona into enikezwa wonke umuntu ngendlela efanayo. Ngokwezidingo zomzimba wakho, ngokusekelwe emiphumeleni yokuhlolwa kwegazi lakho, unikezwa ikhambi lokudla okunempilo elenziwe ngokwezifiso .
Ingaqukatha zonke izakhamzimba eziyisithupha ezibalulekile emzimbeni ngamanani ahlukene:
- Amanzi
- Ama-carbohydrate (amandla)
- Amaprotheni (okukhula nokulungiswa komzimba)
- Amafutha (amandla nama-fatty acid abalulekile)
- Amavithamini
- Usawoti wamaminerali
Le fomula yokudla okunempilo iphelele kangangokuthi, uma uthanda, umuntu angaphila ngalesi simiso impilo yakhe yonke ngaphandle kokuthatha noma yini ngomlomo.
Kuziphi izimo lapho lezi zindlela zisetshenziswa khona?
Kunini lapho kudingeka khona ukudla okunomsoco okungaphelele (PPN)?
I-PPN ivame ukusetshenziswa okwesikhashana. Isibonelo, isetshenziselwa ukunikeza umuntu amandla ngokushesha ngaphambi kokumshintshela kancane kancane ekudleni ngamapayipi noma ekunceliseni ngomlomo. Futhi, iziguli ezilaliswe esibhedlela isikhathi eside zingase zingondlekile ngenxa yezizathu ezahlukene. I-PPN ivame ukusetshenziswa futhi ukubanikeza ukudla okwengeziwe.
Kudingeka nini ukudla okunempilo okuphelele kwe-parenteral (TPN)?
Uma uhlelo lwakho lokugaya ukudla lungasebenzi nhlobo, noma uma unesifo sokugaya ukudla esidinga ukuphumula okuphelele kwalolo hlelo, ungase udinge i-TPN.
Nazi ezinye izimo ezithile lapho i-TPN ingadingeka khona:
- Ukuhlinzwa okukhulu kwesisu
- Ukwelashwa ngamakhemikhali komdlavuza
- Ukwehla kokugeleza kwegazi emathunjini (i-intestinal ischemia)
- Ukuvinjelwa kwamathumbu emathunjini amancane noma amakhulu
- Ukungasebenzi kahle kwamathumbu (i-ileus ende)
- Ukopha kwamathumbu
- Ukulimala kwamathumbu ngenxa yokwelashwa ngemisebe (i-radiation enteritis)
- Ukuzalwa ngaphambi kwesikhathi kakhulu
- I-necrotizing enterocolitis ezinganeni
- Uhudo oluhlala isikhathi eside
- Izifo zamathumbu ezivuvukalayo njengesifo sikaCrohn
- I-Short Bowel Syndrome (isimo esenzeka ngemva kokususwa kwengxenye yamathumbu ngokuhlinzwa)
- Isifo samathumbu esibangelwa yi-graft-versus host
Ukulungiswa nokuqaliswa kwalokhu kwelashwa kwenziwa kanjani?
Lona umzamo ohleliwe kakhulu futhi ohlanganyelwe yithimba lodokotela.
Ukulungiselela ukwelashwa
Ithimba lakho lezokwelapha (odokotela, abahlengikazi, kanye nochwepheshe bezokudla) lizobuyekeza ngokucophelela umlando wakho wezempilo, inkomba yesisindo somzimba (i-BMI), kanye nemiphumela yokuhlolwa kwegazi ukuze kutholakale ifomula yokudla okudingayo. Lolu ketshezi olunomsoco lulungiswa uchwepheshe ngemithamo eyanele amahora angama-24. Kufanele lubekwe efrijini kuze kube usuku oludinga ngalo. Lukhishwa emahoreni ambalwa ngaphambi kokusetshenziswa futhi luvunyelwe ukuthi lufike ekushiseni kwegumbi.
Indlela yokufaka i-catheter emzimbeni
Ukufaka ipayipi, elibizwa ngokuthi i-catheter, emzimbeni wakho kuyinqubo encane yokuhlinzwa. Ngaphambi kokuthi lokhu kwenziwe, uzonikezwa umuthi wokuqeda izinhlungu nokuzola. Ngemuva kwalokho, indawo lapho i-catheter izofakwa khona izohlanzwa kahle futhi ihlanzwe ngamagciwane.
Udokotela ufaka ucingo oluqondisayo emthanjeni esebenzisa inaliti, bese esusa inaliti bese efaka i-catheter ngentambo emthanjeni. Kungasetshenziswa i-ultrasound noma i-X-ray ukuhlola ukuthi isendaweni efanele.
Kusetshenziswa izinhlobo ezintathu eziyinhloko zama-catheter:
- I-catheter yangaphandle "enemihubhe": Lokhu kuklanyelwe ukuhamba ibanga elifushane ngaphansi kwesikhumba futhi kuphume endaweni ehlukile.
- I-catheter efakwe ngokuphelele: Lokhu kungaphansi kwesikhumba ngokuphelele. Uma kudingeka ukuphakelwa, inaliti ifakwa endaweni ekhethekile ngaphansi kwesikhumba bese ixhunywa kuyo.
- I-catheter ephakathi efakwe eceleni (i-PICC): Lokhu kufakwa ngomthambo ongalweni ongaphezulu bese kufakwa umthambo oyinhloko eduze kwenhliziyo. Lokhu kuvame ukusetshenziselwa abantu abadinga ukudla okunempilo isikhathi esingaphansi kwamasonto ayisithupha.
Into ebaluleke kakhulu ukwenza yonke le nqubo ngaphansi kwezimo ezihlanzekile kakhulu, ezihlanzekile, njengoba kunengozi yokutheleleka.
Ukudla okunomsoco kuhlinzekwa futhi kuqashwe kanjani?
Ukondla ngokuvamile kuyinqubo yamahora ayi-10-12, ngakho abantu abaningi bakwenza ebusuku lapho beyolala. Lokhu kwelashwa kungenziwa esibhedlela, esikhungweni sokunakekelwa kwesikhathi eside, noma ngisho nasekhaya .
Uma ukwenza lokhu ekhaya, ithimba lezokwelapha lizokunikeza wena noma umnakekeli wakho ukuqeqeshwa okugcwele, okuhlanganisa nendlela yokubona izimpawu zokutheleleka, indlela yokugcina imishini ihlanzekile, kanye nendlela yokushintsha amapayipi.
Ithimba lezokwelapha lizokuqapha njalo ngesikhathi sokwelashwa.
- Ilinganisa inani loketshezi olungena noluphuma emzimbeni wakho.
- Isisindo nokuphakama kuhlolwa njalo.
- Ukuhlolwa kwegazi kwenziwa njalo ngezikhathi ezithile ukuze kubonakale ukuthi kudingeka yini izinguquko kufomula yokudla okunempilo.
Ikakhulukazi, bagxila kulezi zinto:
- Ama-electrolyte kanye nomsebenzi wezinso (BUN/Creatinine)
- Amazinga kashukela egazini (gwema i-hyperglycemia noma i-hypoglycemia)
- Amazinga amaminerali
- Izinkomba zokusebenza kwesibindi (ama-Aminotransferases, i-Bilirubin)
Yiziphi izinzuzo kanye nezingozi eziyingozi zale ndlela?
Njenganoma yiluphi uhlobo lokwelashwa, lolu lunezinzuzo kanye nezingozi.
Izinzuzo
Inzuzo eyinhloko yale ndlela ukuthi inikeza uhlelo lwakho lokugaya ukudla konke okudingayo ukuze luphulukiswe ngemva kokugula noma ukuhlinzwa okukhulu.. Kuphinde kusize ekuqiniseni umzimba ngokunikeza ukudla okunomsoco okudingekayo ezigulini ezilaliswe esibhedlela isikhathi eside, ikakhulukazi asebekhulile. Kuyindlela yokwelapha esindisa impilo kulabo abanezinhlelo zokugaya ukudla ezilimele unomphela kanye nezingane ezizalwa ngaphambi kwesikhathi ezingakwazi ukudla ngendlela evamile.
Izingozi Nezinkinga
Le ndlela inengozi enkulu yezinkinga kunokudla okudliwayo esiswini. Izinkinga ezimbili eziyinhloko ingozi yokuthi amagciwane angene egazini nge-catheter kanye nokuba buthaka kohlelo lokugaya ukudla ngenxa yokungasetshenziswa isikhathi eside.
| Inkinga evamile | Incazelo elula |
|---|---|
| Ukutheleleka | Amabhaktheriya angangena egazini nge-catheter. Uma lokhu kutheleleka kusakazeka emzimbeni wonke, kungabangela isimo esisongela ukuphila esibizwa ngokuthi i-sepsis . |
| Amahlule egazi | Amahlule egazi angakheka lapho i-catheter ixhuma khona emthanjeni. |
| Ubuthakathaka besistimu yokugaya ukudla (i-GI atrophy) | Ngemva kwamasonto amabili ungasebenzisi uhlelo, ukusebenza kwalo kuqala ukwehla. Kodwa-ke, kancane kancane kubuyela esimweni esijwayelekile uma uqala ukudla futhi. |
| Ukungalingani kwezinga likashukela | I-Hyperglycemia noma i-hypoglycemia kuvamile futhi kungalawulwa ngokushintsha i-insulin kanye nezindlela zokudla okunempilo. |
| Izinkinga zesibindi | Cishe abantu abangu-50% abathatha lokhu kwelashwa isikhathi eside bangase babe nesifo sesibindi (i-PNALD) zingakapheli iminyaka emi-5-7. Imbangela eqondile yalokhu ayaziwa. |
| Izinkinga zenyongo | Ngenxa yokuthi uhlelo lokugaya ukudla alusebenzi, i-bile enyongweni ayikwazi ukukhishwa futhi inganqwabelana, yakhe amatshe. |
| Ukususwa kwamaminerali emathanjeni | Abantu abathola lokhu kwelashwa isikhathi eside bangase babe nezifo zokuncipha kwamathambo njenge- osteoporosis ngenxa yokushoda kwamavithamini namaminerali (i-calcium, i-magnesium, i-vitamin D). |
Ngaphezu kwalokho, kunezinye izingozi ezifana nokulimala ngesikhathi sokufakwa kwe-catheter, uketshezi oluningi kakhulu, kanye nokuzizwa ulambile.
Uqala kanjani ukudla ngomlomo futhi?
Nakuba ukudla okunomsoco okusekelwe kubazali kungenziwa isikhathi eside, odokotela bahlala bezama ukukubuyisela ekunceliseni ngepayipi noma ekunceliseni ngomlomo ngokushesha okukhulu. Isizathu salokhu ukugwema izinkinga zesikhathi eside.
Lolu shintsho lwenziwa kancane kancane ngoba, njengesimo sakho sezempilo esiyisisekelo, uhlelo lokugaya ukudla obelulokhu "lulele" isikhathi eside ngeke luqale ukusebenza ngokuzumayo.
1. Qala ngokudla okuhlanzekile okuwuketshezi .
2. Uma umzimba usabela kahle kukho, shintshela ekudleni okugcwele okuwuketshezi .
3. Ekugcineni, kancane kancane faka ukudla okuqinile .
Ngisho nangemva kokuyeka lokhu kwelashwa, ithimba lezokwelapha lizoqhubeka nokuqapha isisindo sakho kanye namazinga okudla okwanele isikhathi esithile.
Ukudla Okunomsoco Kwabazali kuyindlela yokwelapha esetshenziswa ezimweni ezinzima kakhulu, kodwa ngezinye izikhathi kuyadingeka ukusindisa impilo. Uma lokhu kudingeka kuwe noma kothandekayo wakho, kungaba yinto enzima futhi entsha. Kodwa ngemva kwesikhathi esithile, kuzoba yingxenye yenqubo yakho yansuku zonke. Into ebaluleke kakhulu ukulandela imiyalelo enikezwe yithimba lezokwelapha ngqo nokubazisa nganoma yiziphi izinkinga.
Umlayezo Wokuya Nawe Ekhaya
- I-Parenteral Nutrition iyindlela yokuletha ukudla okunomsoco ngqo egazini ngomthambo lapho uhlelo lokugaya ukudla lungasetshenziswa.
- Kunezinhlobo ezimbili eziyinhloko: i-PPN, enikezwa njengokudla okungeziwe, kanye ne-TPN, enikeza ukudla okunempilo okuphelele.
- Nakuba lokhu kuyindlela yokwelapha esindisa impilo, kunezingozi ezinkulu, njengokutheleleka, amahlule egazi, nezinkinga zesibindi.
- Lokhu kwelashwa kufanele kwenziwe njalo ngaphansi kokuqashwa okuseduze kwethimba lodokotela, abahlengikazi kanye nochwepheshe bezokudla.
- Uma wena noma othandekayo wakho kufanele nithole lolu hlobo lokwelashwa ekhaya, kubalulekile ukuthola ukuqeqeshwa okufanele futhi niqaphele kakhulu ngokuhlanzeka. Uma unemibuzo noma ukukhathazeka, khuluma nodokotela wakho ngokushesha.
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