Kudya muchirwere cheitsvo

Kubva pakuona kwekiriniki, chirwere cheitsvo chinogona kunge chiri mamiriro ekukurumidza kukura uye kupararira kwechirwere chinoputika chinokonzera kukanganisa kwakanyanya kwetsvo, kana inogona kunge iri nzira inofambira mberi kubva pakutanga sechirwere chisingaperi chinoputika zvishoma nezvishoma uye zvisingagadzirisiki kukanganisa kushanda kwetsvo.

Kubva pakuona kwekudya, zvakakosha kuisa mvura, munyu, potasium uye mapuroteni muhosha yeitsvo. Paunenge uchironga kudya, uremu hwemuviri, kuenzanisa kwemvura uye kusanganiswa kwe electrolytes muropa kunofanira kuverengwa. Mukutadza kwerenal kutadza, kunyanya nekuwanda kweurea muropa, kudya kunorambidzwa neprotein kunokurudzirwa, nekupa simba zvakakwana 30-50 kcal / 1 kg yehuremu hwemuviri, kana chirwere chisina matambudziko. Iwe unofanirwa kusabvisa nyama, kuchekwa kunotonhora, chizi, mazai kubva mukudya, kumisa mukaka uye chikafu chakapfuma mu potassium uye phosphorus. Zvirambidzo zvinoshandawo pakupiwa kwemunyu nemvura. Iyo yakasarudzika ndiyo nhanho yekutanga polyuria nekurudziro yekunwa mvura yakawanda. Kudya kwakashata pamwe nekuwedzerwa kwerusks, yakaderera-protein furawa gorosi roll, yakabikwa michero puree, mashed compotes, mashed mbatatisi nebhotela inokurudzirwa. Mafuta anokurudzirwa kuve 1g / 1 kg yehuremu hwemuviri. Mukutadza kwerenal zvakanyanya, varwere vanogona kurapwa zvakachengetedza kana ne dialysis. Sezvo iwe uchipora, iwe unoshandura kune physiological kudya, zvishoma nezvishoma kuwedzera huwandu hwemvura uye mapuroteni zvigadzirwa.

Mukutadza kusingaperi kwerenal, mufananidzo wekliniki unoenderana nekuoma kwehutachiona. Kurudziro yezvekudya panguva ino inogona kukamurwa kuita 4 nguva: 0,6st nguva - kutadza kwakadzikama, uko pasina zvirambidzo zvekudya, 0,8nd nguva - kubhadharwa kusakwana, kune kuderedzwa kweprotein 1-0,4 g / 0,6, 1 kg yehuremu hwemuviri, phosphorus, munyu, Period III - yakaderedzwa kusakwana, mune yakaderera-protein yekudya ye20-25 g / 15 kg yehuremu hwemuviri inoiswa, yakaderera-sodium, yakaderera-potassium kudya, inofanira kazhinji kuve. yakafumiswa ne-high-calorie, yakaderera-protein gadziriro, nguva IV - kupera-danho kutadza, umo mapuroteni ekupa ari 20-XNUMX g / zuva kana dialysis, kuderedza sodium, potasium, phosphorus uye mvura, inodiwa kuwedzera yakakosha amino. acids XNUMX-XNUMX g / zuva kune ndiro, semuenzaniso Ketosteril.

General misimboti yekudya mune inochengetedza kurapwa: kudiwa kwesimba muvarwere vane uremu hwemuviri wakajairika pamusoro pemakore makumi matanhatu ezera vanofanirwa kupa 60 kcal / 35 kg yehuremu hwemuviri / zuva, uye muvarwere vari pasi pemakore makumi matanhatu ezera. inofanira kupa 1-60 kcal / 30 kg yehuremu hwemuviri / zuva, kureva nezve 35-1 kcal / zuva. Mune varwere vasingashande, kudya kwakakwana kuri 2000-2500 kcal / zuva. mapuroteni kumisa kunonoka kurapwa kwedialysis, huwandu hweprotein hunotarwa nekusangana kweurea uye creatinine muplasma yeropa uye creatine clearance (GFR). Iyo shoma protein yemukati mukudya ndeye 1800 g / zuva pamwe nekuwedzera kweakakosha amino acids. Mhedzisiro yakadaro inogona kuwanikwa nekushandisa chikafu chembatatisi muhuwandu hwe2000 kg yembatatisi + 20 g yemiriwo nemichero + 1 g yemafuta matsva nemafuta + 300 g yeshuga uye kuwedzera kwehupfu hwembatatisi kana yakaderera-protein starch. hupfu nemafuta matsva kana akaomeswa, pasina salting. Maitiro ekugadzira mbatatisi ndiro kubika, kubika, nepo frying isingabatanidzwe mune yemafuta metabolism kusagadzikana. Zvokudya zvinogona kugadzirwa ndezvinoodles, dumplings, dumplings, casseroles, stuffed mbatatisi, saladi. Iyo yepakati mapuroteni muganho ndeye 120-50 g / zuva uye diki muganho ndeye 40-50 g / zuva. Mapuroteni anofanira kuva akanaka, kubva kune zvigadzirwa zvemhuka: nyama yakaonda, mukaka wakadzika, cottage cheese, zai jena, kefir, yoghurt. kupihwa kwemafuta hakudi kudzikiswa kwe60 g / 70 kg yehuremu hwemuviri. Inofanira kubva muzvigadzirwa zvemiti, kureva mafuta emuorivhi, mafuta esoya, mafuta ezuva, mafuta echibharo. Contraindicated mafuta zvigadzirwa zvemhuka: mafuta, tallow, hard margarine, bhekoni, pamwe nemafuta nyama senge mutton, nyama yenguruve, offal, dhadha, hanzi, hove ine mafuta, yero uye yakagadzirwa chizi, bhekoni, pates, soseji. Saizvozvo, zvigadzirwa zve confectionery zvine mafuta akawanda, senge puffs nemakeke, hazvikurudzirwe. kurambidzwa kwemvura kunoenderana ne edema, hypertension uye huwandu hweweti inoburitswa mukati mezuva. Iwe unofanirwa kutarisisa kuhuwandu hwemvura mune zvigadzirwa, semuenzaniso sosi, miriwo, michero, ichipa avhareji ye1-1 ml. kudzikisira sodium munguva yekubhadharwa kusakwana hakudiwi, asi zvinokurudzirwa kudzika kusvika 400 g (500 teaspoon) yemunyu pazuva senzira yekudzivirira, nekuda kwekuwanda kwekushandisa zvakanyanya. Zvakakwana kuti usawedzera munyu mundiro, usasanganise zvigadzirwa zvine munyu mune tekinoroji, senge: chikafu chemumagaba, pickles, nyama inotonhora, nyama yakabikwa, cheese inosvuta, yellow cheese, silage, concentrates soups uye sosi, yakagadzirira-yakagadzirwa. zvinonhuwira, eg miriwo, miriwo, muto cubes. kuderedza phosphorus kubva muzvigadzirwa zvakapfuma mu phosphorus, zvakadai se: offal, cereal products, rennet uye cheese yakagadziriswa, mhodzi dze legume, hove, mazai evha, howa, masoseji, mukaka wose upfu.

Inokurudzirwawo kudya magadzirirwo anosunga phosphate mudumbu rekudya panguva yekudya. kudiwa kwe potassium munguva yekubhadhara kusakwana kunofanira kuwedzerwa, uye munguva yekutadza kwekupedzisira kunofanira kugumira kusvika 1500-2000 mg / zuva, kusasanganisa zvigadzirwa zvakapfuma mune iyi mineral: yakaoma legumes, bran, cocoa, chokoreti. , nzungu, michero yakaomeswa, mabhanana , makotapeya, matomatisi, mbatatisi, muriwo wemashizha, howa. Potassium inogona kuderedzwa nekunyika uye kubika chikafu, mvura ichichinjwa panguva yekubikira. kudiwa kwemamwe maminerari kunofanirwa kuwedzera kushomeka kwecalcium, nekuda kwekugumira kwezvigadzirwa zveprotein, kuwedzera kwekushomeka kwesimbi kunotungamira kuanemia. kudiwa kwevhitamini kunowedzera kushaikwa kwevhitamini. kubva kuboka B, folic acid, vit. C uye D nekuda kwekudya kwakaderera kwe potassium.

General misimboti yekudya panguva yedialysis: simba rinodiwa nekuda kwekugara uchishaya chikafu chevarwere vane dialysed rinofanira kunge riri 35-40 kcal / 1 kg yehuremu hwemuviri, kureva 2000-2500 kcal / zuva. Chinhu chikuru chemakhahydrates chinofanira kuva zvigadzirwa zvezviyo: pasta, groats, upfu hwesitashi, pasi-protein starch bread. Mune varwere vanorapwa ne peritoneal dialysis, ichi chinodiwa chinovharwa zvishoma neglucose mu dialysis fluid. kudiwa kweprotein nekuda kwekurasikirwa panguva yedialysis ndeye 1,2-1,4 g / 1 kg uremu hwemuviri muvarwere vane hemodialysed, uye 1,2-1,5 g / 1 kg uremu hwemuviri mu peritoneal dialysis, kureva 75-110 g / zuva. Chikafu chinogona kupfumiswa neprotein kubva kune zvinovaka muviri, semuenzaniso Protifar. kudiwa kwemafuta mu extracorporeal dialysis kunofanira kuva 30-35% yesimba, uye mu peritoneal dialysis 35-40%. simba rinobva muzvirimwa, kunyanya mafuta omuorivhi nemafuta. kudiwa kwe potassium kunofanirwa kugumira ku1500-2000 mg / zuva, nyama nemiriwo masheya hazvifanirwe kushandiswa. kudiwa kwephosphorous kunofanira kuderedza kushandiswa kwezvigadzirwa zvakapfuma muchikamu ichi uye kushandiswa kwemishonga inosunga phosphate mumugwagwa wegumbo. sodium restriction inoshanda. kudiwa kwemaminerari nemavhitamini kunoda kuwedzerwa kwecalcium, vit. D, A uye C. kuvharirwa kwemvura kunoverengwa pahuwandu hwekubuda kwemuti + 500 ml, iyo yakawedzerwa inoratidzirwa chete mumamiriro okunze anopisa, kupisa kwakanyanya, kurutsa uye manyoka.

Source: Sachigaro uye Dhipatimendi reNephrology, Hypertension uye Zvirwere Zvemukati, Collegium Medicum im. L. Rydygier muBydgoszcz

1. Ini nguva - kutadza kunonoka, uko pasina zvirambidzo zvekudya,
2. IV nguva - kupera-danho kutadza, umo kupihwa kweprotein kuri 20-25 g / zuva kana dialysis, kudzikiswa kwesodium, potasium, phosphorus uye mvura, inodiwa kuwedzera yakakosha amino acids 15-20 g / zuva kune ndiro, eg Ketosteril.
3. mapuroteni kumisa kunonoka kurapwa kwedialysis, huwandu hweprotein hunotarwa nekusangana kweurea uye creatinine muplasma yeropa uye creatine clearance (GFR). Iyo shoma protein yemukati mukudya ndeye 20 g / zuva pamwe nekuwedzera kweakakosha amino acids. Mhedzisiro yakadaro inogona kuwanikwa nekushandisa chikafu chembatatisi muhuwandu hwe1 kg yembatatisi + 300 g yemiriwo nemichero + 120 g yemafuta matsva nemafuta + 50 g yeshuga uye kuwedzera kwehupfu hwembatatisi kana yakaderera-protein starch. hupfu nemafuta matsva kana akaomeswa, pasina salting. Maitiro ekugadzira mbatatisi ndiro kubika, kubika, nepo frying isingabatanidzwe mune yemafuta metabolism kusagadzikana. Zvokudya zvinogona kugadzirwa ndezvinoodles, dumplings, dumplings, casseroles, stuffed mbatatisi, saladi. Iyo yepakati mapuroteni muganho ndeye 40-50 g / zuva uye diki muganho ndeye 60-70 g / zuva. Mapuroteni anofanira kuva akanaka, kubva kune zvigadzirwa zvemhuka: nyama yakaonda, mukaka wakadzika, cottage cheese, zai jena, kefir, yoghurt.
4. kurambidzwa kwemvura kunoenderana ne edema, hypertension uye huwandu hweweti inoburitswa mukati mezuva. Iwe unofanirwa kutarisisa kuhuwandu hwemvura mune zvigadzirwa, semuenzaniso sosi, miriwo, michero, ichipa avhareji ye400-500 ml.
5. kudzikisira sodium munguva yekubhadharwa kusakwana hakudiwi, asi zvinokurudzirwa kudzika kusvika 3 g (1 teaspoon) yemunyu pazuva senzira yekudzivirira, nekuda kwekuwanda kwekushandisa zvakanyanya. Zvakakwana kusawedzera munyu mundiro, kusabvisa zvigadzirwa zvine munyu mune tekinoroji, senge: chikafu chemumagaba, pickles, nyama, nyama yakabikwa, inoputa, yero cheese, silage, concentrates soups uye sosi, yakagadzirira-yakagadzirwa zvinonhuwira, eg miriwo, miriwo, muto cubes.
6. kuderedza phosphorus kubva muzvigadzirwa zvakapfuma muphosphorus, zvakadai se: offal, cereal products, rennet uye cheese yakagadziriswa, mhodzi dze legume, hove, mazai evha, howa, kuchekwa kwechando, mukaka wose wehupfu. Inokurudzirwawo kudya magadzirirwo anosunga phosphate mudumbu rekudya panguva yekudya.
7. kudiwa kwe potassium munguva yekubhadhara kusakwana kunofanira kuwedzerwa, uye munguva yekutadza kwekupedzisira kunofanira kugumira kusvika 1500-2000 mg / zuva, kusasanganisa zvigadzirwa zvakapfuma mune iyi mineral: yakaoma legumes, bran, cocoa, chokoreti. , nzungu, michero yakaomeswa, mabhanana , makotapeya, matomatisi, mbatatisi, muriwo wemashizha, howa. Potassium inogona kuderedzwa nekunyika uye kubika chikafu, mvura ichichinjwa panguva yekubikira.
8. kudiwa kwemamwe maminerari kunofanirwa kuwedzera kushomeka kwecalcium, nekuda kwekugumira kwezvigadzirwa zveprotein, kuwedzera kwekushomeka kwesimbi kunotungamira kuanemia.
9. kudiwa kwevhitamini kunowedzera kushaikwa kwevhitamini. kubva kuboka B, folic acid, vit. C uye D nekuda kwekudya kwakaderera kwe potassium.
10. kudiwa kwemafuta mu extracorporeal dialysis kunofanira kuva 30-35% yesimba, uye mu peritoneal dialysis 35-40%. simba rinobva muzvirimwa, kunyanya mafuta omuorivhi nemafuta.
11. kudiwa kwe potassium kunofanirwa kugumira ku1500-2000 mg / zuva, nyama nemiriwo masheya hazvifanirwe kushandiswa.
12. kudiwa kwephosphorous kunofanira kuderedza kushandiswa kwezvigadzirwa zvakapfuma muchikamu ichi uye kushandiswa kwemishonga inosunga phosphate mumugwagwa wegumbo.
13. sodium restriction inoshanda.
14. kudiwa kwemaminerari nemavhitamini kunoda kuwedzerwa kwecalcium, vit. D, A uye C.
15. kudziviswa kwemvura kunotarwa kubva kuhuwandu hwekubuda weti + 500 ml, chiyero chakawedzerwa chinoratidzwa chete mumamiriro okunze anopisa, kupisa kwakanyanya, kurutsa uye manyoka.

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