Zvinoenderana nebasa rayo, Iyo Edhiyo Bhodhi yeMedTvoiLokony inoedza neparinogona napo kupa yakavimbika zvekurapa zvemukati zvinotsigirwa neruzivo rwazvino rwesainzi. Mureza wekuwedzera "Zvakatariswa Zvemukati" zvinoratidza kuti chinyorwa chakaongororwa kana kunyorwa zvakananga nachiremba. Iyi nhanho-mbiri yekusimbisa: mutori wenhau wezvekurapa uye chiremba anotitendera kuti tipe zvemhando yepamusoro zvemukati zvinoenderana neruzivo rwekurapa rwazvino.
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Kuvhiya mutoro unorema kumuviri. Zvinogona kutaurwa kuti chinangwa chayo ndechokukuvadza muviri nemaune kuitira kuti murwere awane rubatsiro. Asi ramba uchifunga kuti mhinduro yemuviri wako pakukuvadzwa kwekuvhiya inogona kushandura metabolism yako kuita catabolism - maitiro ayo muviri wako unotanga kutora uye kushandisa mapuroteni. Kana vasina kupihwa chikafu, muviri unovasvikira mumhasuru.
Nyaya yacho yakagadzirwa mukubatana neNutramil Complex.
Maitiro ekudzoreredza akagadzirirwa kudzoreredza kushungurudzika-induced catabolism kune anabolism. Kudya kwakakodzera, simba uye mapuroteni ekupa chikamu chakakosha chekurapa kweperioperative.
Kurapa kunovaka muviri zvechokwadi kunokurumidza kupora. Nhamba yakakosha yevarwere vanogona kudya uye vanofanirwa kubvumidzwa kuita kudaro. Chinangwa chekurapa kunovaka muviri chinofanira kunge chiri chekugadzirisa kunwa kwemvura, kuve nechokwadi chekupihwa kwakakwana kwesimba uye mapuroteni.
Chii chinonzi kudya kunovaka muviri?
Kurapa kwekudya kunovaka muviri - ndeyekuvandudza nekuchengetedza hutano hwakakwana. Izvo zvinokanganisawo kufungidzira uye mhedzisiro yekurapa.
Zvokudya zvekurapa zvinobva pakugadzira chikafu chemurwere nenzira yekumupa zvese zvinodiwa zvekuvaka uye simba rekudya (mapuroteni, shuga, mafuta, zvicherwa nemavhitamini). Mukurapa kwekudya kunovaka muviri, yakagadzirira-yakagadzirwa maindasitiri kudya (eg Nutramil Complex) kana intravenous fluid inoshandiswa, iyo kuumbwa kwayo kunotemerwa nekuenderera mberi zvichienderana nezvido zvemurwere.
Nutrition isati yavhiyiwa
Parizvino, zvinokurudzirwa kuti vanhu vane kudya kwakakwana vadye zvokudya zvavo zvenguva dzose kusvikira usiku vasati vavhiyiwa. Kusvikira kumaawa 2 - 3 pamberi peanesthesia, unogona kutora chero huwandu hwemvura yakachena, iyo inobatsira kudzivisa kupera kwepreoperative.
Yakave zvakare ichangobva kuratidzwa kuti kupa chinwiwa chine carbohydrate kune murwere asati atanga kuvhiyiwa kunokurumidza kunyangarika kubva mudumbu, uye kuwedzera kwemakhahydrates kunoderedza preoperative nzara uye kufunganya. Kupiwa kwemakhahydrates kusati kwavhiyiwa kunoderedzawo postoperative insulin resistance.
Preoperative nutrition inonyanya kukosha muvarwere vasina kudya kwakakwana. Zvave zvichiratidzwa kuti muboka iri revarwere, enteral uye kunyange parenteral chikafu chinoshandiswa 1-2 mavhiki asati avhiyiwa anovandudza zvakanyanya migumisiro yekuvhiya.
Nhungamiro yeEuropean Society yeAnaesthesiology pakutsanya kweperioperative muvakuru nevana
Oral carbohydrates:
- Kushandisa zvinwiwa zvine carbohydrate kusvika maawa maviri kuvhiyiwa kwakarongwa kusati kwakachengeteka kune varwere (zvakare kune vane chirwere cheshuga),
- Kunwa zvinwiwa zvine makhahydrates musati mavhiyiwa akasarudzwa anovandudza kugara zvakanaka, kunoderedza kunzwa kwenzara uye kunoderedza postoperative insulin kuramba.
Nutrition mushure mekuvhiyiwa
Chinhu chinonyanya kukosha kumurwere wega wega ndechekudzokera kukushanda kwakajairika nekukurumidza mushure mekuvhiyiwa kuitira kuti kuve nematambudziko mashoma sezvinobvira uye kuti abudiswe kumba nekukurumidza. Kuti uite izvi, zvinodikanwa kuderedza catabolism uye kubvumira muviri wemurwere kuti udzokere kumamiriro eanabolism. Kudya kunovaka muviri kunoita basa guru muzvirongwa izvi. Kudya kwemvura kunogona kuva chikamu chakakosha chekurapa kwekudya pano. Mune zvimwe zviitiko zvakanyanya, enteral uye parenteral chikafu chinotorawo basa rakakosha.
Pasinei nzira yekudya inokurudzirwa nachiremba (inopinda kuburikidza nechubhu kana stoma, parenteral), inofanira kushandiswa kusvikira murwere akwanisa kushandisa zvishoma 70% yesimba uye mapuroteni zvinodiwa kuburikidza nemuromo nzira.
Huwandu hwesimba hunodiwa nemurwere hunofanirwa kusarudzwa mumwe nemumwe, asi paavhareji hunobva ku25 kusvika ku35 kcal / kg bw. Mushure mekuita, murwere anodawo mapuroteni akawanda kupfuura munhu ane hutano kuti avakezve matishu akakanganisika uye kuve nechokwadi chekushanda kwakaringana kwesimba rekudzivirira muviri. Huwandu hweprotein inofanirwa kudyiwa nemurwere ndeye 1,2 kusvika 1,5 g / kg bw, chero bedzi itsvo dzichishanda nemazvo.
Wytyczne ESPEN - European Society for Clinical Nutrition uye Metabolism
- Varwere vakawanda havadi kutsanya vasati vavhiyiwa usiku. Vanhu vasina njodzi yakawedzera yekushuvira vanogona kunwa zvinwiwa kusvika maawa maviri isati yatanga anesthesia. Kushandiswa kwezvokudya zvakasimba kunobvumirwa kusvika maawa matanhatu isati yatanga anesthesia.
- Iyo yakasarudzika nzira yekudya ndeye kuburikidza nedumbu remukati, kunze kwechokwadi kana ichipokana.
- Kusakwana kwekudya kwemukanwa kwekudya kwemazuva anopfuura gumi nemana kunobatanidzwa nekuwedzera kwekufa. Kana nguva inotarisirwa yekutsanya munguva yeperioperative yakareba kudarika mazuva manomwe, kudya kwemukati kunokurudzirwa zvakare kune varwere vasina zviratidzo zvekushaya zvokudya zvinovaka muviri.
- Chikafu chemukati chinoratidzwa zvakare muvarwere mune izvo zvinotarisirwa zvekudya zvemuromo hazvipfuure 10% yezvinodiwa kwemazuva anopfuura makumi matanhatu.
- Kudya kwechubhu kunofanirwa kutangwa mukati maawa makumi maviri nemana mushure mekuita, inokurudzirwa kune varwere: mushure mekuvhiyiwa kwakanyanya nekuda kwekenza yemusoro, yemutsipa uye yemudumbu, mushure mekukuvadzwa kwakanyanya, kushaikwa kwekudya pazuva rekuvhiyiwa, mune inotarisirwa kuwanikwa kwekudya. ichave <24% yezvinodiwa kwemazuva anopfuura gumi.
- Zvokudya zvakajairika zvine mapuroteni akakwana zvakakwana kune varwere vazhinji.
- Chinangwa chekurapa kweperioperative ndechekuderedza nitrogen yakashata, kudzivirira kushaya zvokudya zvinovaka muviri, kuchengetedza mhasuru, kuchengetedza hutachiona hwemazuva ose, uye kukurumidza kupora mushure mekuvhiyiwa.
- Varwere vanodyiswa zvakafanira havabatsirwi nekudya kunovaka muviri, izvo zvingava bviro yezvinetso kwavari.
- Postoperative parenteral nutrition inokurudzirwa kune varwere vasingakwanisi kuita zvavanoda nemuromo kana nzira yekupinda kwemazuva 7-10 mushure mekuvhiyiwa. Yakasanganiswa parenteral-enteral nutrition inofanira kufungwa pano.
- Kazhinji, zvinokurudzirwa kupa 25 kcal / kg yehuremu hwemuviri hwakakodzera. Mune varwere vari pasi pekunetseka kwakanyanya, kupa kunogona kuwedzerwa kusvika ku30 kcal / kg yehuremu hwemuviri hwakanaka.
- Mune varwere vasingakwanisi kudyiswa kuburikidza nemudumbu, chikafu chevabereki chinofanira kunge chakakwana.
Zvokudya zvinovaka muviri vasati vavhiyiwa zvinovandudza migumisiro yekuvhiya muvarwere vasina kudya zvakakwana, uye preoperative carbohydrate administration inoderedza insulin resistance uye protein catabolism mushure mekuvhiyiwa kwakasarudzwa. Mukuwedzera, ine simba rakanaka pahutano hwemurwere uye inoderedza kushungurudzika kunobatanidza nehurongwa hwakarongwa.
Vanhu vazhinji vari kuvhiyiwa havana contraindications yekukurumidza kudzoka kune yakajairika kudya kwemukanwa uye vanofanirwa kudzokera kwairi nekukurumidza sezvinobvira. Postoperative gastrointestinal nutrition inoderedza nhamba yematambudziko epashure. Zvokudya zvinovaka muviri zvinofanira kuva chikamu chehutungamiri hwakabatanidzwa munguva yose yekurapa kwemurwere.
Bibliography:
1. Szczygieł B., Kushaikwa kwezvokudya zvinovaka muviri, Warsaw 2012, PZWL, mapeji 157-160
2. Sobotka L. et al., Nheyo dzekudya kwekiriniki, Warsaw 2008, PZWL, mapeji 296-300
Nyaya yacho yakagadzirwa mukubatana neNutramil Complex.