Enteral nutrition support for critically ill patie -

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Enteral nutrition support for critically ill patients in the surgical application of re-

TPN patients, the virtual try to give TPN + EN for joint support and making the majority of total parenteral nutrition TPN patients from oral ingestion to complete the transition mode. Jejunostomy is the most common clinical applications of EN input channels. Its advantages are: ① reflux liquid diet caused less vomiting and aspiration occurred. ⑦ EN and gastroduodenal decompression could be conducted. ⑧ feeding tube can be long-term placement. ④ oral feeding of patients simultaneously. ⑤ and psychological burden in patients with small body. Jejunostomy in two ways: needle catheter 121 with the cut made jejunum jejunum tube made 121, the former is by 2mm diameter polyethylene tube catheter needle into the intestine, small diameter of the catheter 121,[link widoczny dla zalogowanych], to avoid clogging the lumen, liquid diet for high quality requirements, and the need to provide infusion infusion pump power. 48 patients in this group of patients jejunostomy towel,[link widoczny dla zalogowanych], 46 pure lines with open tube method. According to our experience, if the appropriate surgical procedure and postoperative management, jejunum tube can be cut to achieve satisfactory long-term ~ and no significant complications. To prevent the feeding tube dislocation, surgery must be emphasized that intestinal plasma catheter embedded muscular tunnel, and catheter out of 121 fixed jejunum with peritoneal suspension. Most of the jejunum in this group made 121 surgical treatment of primary disease in the attached completed on non-surgical or post-surgical treatment of cases, usually chosen by the nose 121 of the stomach or intestinal fistula and two non-traumatic intubation EN path. EN asked the most common complication of bowel habits are changing, and diarrhea usually occurs in the beginning and the use of hypertonic EN diet. Clinically important reason is to make the correct assessment of diarrhea, abdominal cavity to avoid the oversight of potential disease, diarrhea, as I can use to determine the clinical ● EN quantitative ceiling. Diarrhea are usually easy to correct, in addition to the preparation and preservation of diet, the lower food concentration and slow infusion rate, and the towels in the diet can control the diarrhea added astringent. Only l patient in this group due to severe diarrhea and t can not control the way towels were forced to disable EN. Therefore, we believe that although some of its catheter EN, infectious and metabolic complications, but complications and severity of prison were significantly lower than TPN. Nutritional support in critical patients with surgical complications of therapy can not only lead to worse,[link widoczny dla zalogowanych], affect the treatment and recovery process, even those who endanger the life of loyalty. Therefore, contraindications to non-surgical re-EN risk patients, in considering nutritional support should be preferred EN support. Meanwhile, the EN input to select the best way, the ideal formula and strict diet title II monitoring and nursing care beds, is to ensure that EN support successful rehabilitation of patients necessary for the smooth expansion. Report of 16 cases of primary duodenal adenocarcinoma fire Shanghai Medical School surgical towel Hill Hospital (20oO32) Zhulin Fu Chao-Han Yao Liqing stay of primary duodenal adenocarcinoma is relatively rare, I_11 the lack of the typical peak performance ai bed The often delayed treatment. L969 ~ 1989 in our hospital from the total of treated patients (not including the lack of special periampullary cancer) in 16 patients. Are as follows. . Clinical data of the group 9 males and 7 females, male to female ratio was 1.3:1. Age 31 to 71 years, mean 53.6 years, 5o ~ 70 years old accounted for 65%. Papillary tumor located in the duodenum or the upper part of the first paragraph of 3 cases (18.8%), and the second, or around the nipple department in 8 patients (5o%), the lower part of the third paragraph or nipple 5 patients (31 .2%). Il Fou-bed performance are abdominal pain (10/16), postprandial epigastric fullness or vomiting (7 / 16), and jaundice (6/l6 'the cO3 cases with high fever), loss of appetite with weight loss (5 / 16) abdominal mass (3 / 16), anemia (2 / 16) and vomiting (1 / 16). The group of 9 patients who had fecal occult blood test, the positive rate was 88.9% (8 / 9). In addition to the clinical diagnosis of the performance of the above I, the need to X-ray barium meal and endoscopy. 8 patients had intestinal surgery before the meal X-ray examination Soap II,[link widoczny dla zalogowanych], consistent with the results of surgical exploration in 5 patients. 3 cases of missed diagnosis or misdiagnosis, the towel l misdiagnosed as duodenal ulcer, endoscopic treatment fails and then review before being diagnosed. Endoscopy in 3 cases towels, 2 cases diagnosed. 1 case of duodenal tumors missed the third paragraph. 16 patients underwent surgical exploration and pathology of primary duodenal adenocarcinoma. Pancreaticoduodenectomy in 6 cases, the towel l operative death cases (biliary fistula); pathological lymph node metastasis in 2 cases suggest, the towel after l6 months l patients died of tumor recurrence, l patients were lost; other 3 patients without lymph node metastasis and postoperative 8,3 l, 32 months, is still alive. l0 patients with advanced stage cancer surgery, 6 cases were gastrojejunostomy, the towel after 2 ~ 4 patients died 8 months, 2 patients were lost; exploration biopsy only in 4 cases, both in the surgery ●

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