The importance of enteral nutrition in gastrointestinal surgery. The importance of nutrition has long been known to people. The requirement for nutritional support is no longer limited to maintaining the collective nitrogen balance and maintaining the patient's lean material. (lean body mass), but to maintain cell metabolism, maintain the structure and function of tissues and organs, and then regulate immune, endocrine and other functions and repair tissues, and promote patient recovery. Clinical nutritional support has participated in or become a major treatment method. Some also have pharmacological effects, which some scholars call pharmacological nutrition. Clinical applications have shown its effectiveness. It is not only an important treatment measure for intestinal fistulas, short bowel syndrome, intestinal inflammatory diseases, etc., but also is an important treatment for severe pancreatic diseases. It is an indispensable treatment measure for inflammation, organ transplantation, tumors and critically ill patients.
Establishment of enteral nutrition nutrition route, nasogastric tube, nasojejunal tube, gastrostomy, jejunostomy. The American Gastroenterological Association believes that if EN is expected to be implemented for <30 days, a nasojejunal tube may be placed due to the nature or treatment requirements. Those who require long-term enteral nutritional support for >30 days need gastrostomy or jejunostomy. Conventional placement method:
The patient should be in a semi-sitting or semi-recumbent position, measure the length of the nasointestinal tube (take the distance from the xiphoid process of the sternum to the tip of the nose to the earlobe, add 10' to 15 cm), and mark it When this length is on the nasointestinal tube, inject about 20 ml of normal saline into the nasointestinal tube lumen to activate the guide wire surface lubricant (Hydromer patent), insert the guide wire into the nasointestinal tube, and make the spiral nasointestinal tube head With the head straightened, the head of the nasointestinal tube is dipped in a little saline to activate the lubricant on it, and then the tube is slowly inserted from the nasal cavity. When inserting it into the throat, ask the patient to swallow, so that the tube can enter the esophagus smoothly. When the tube is inserted to the marked length After aspirating the gastric juice with an empty needle, inject 10 ml of normal saline into the tube, then Little L withdrew the guide wire and fixed it with tape 30 cm outside the nasal cavity under the earlobe to keep the tube naturally curved and relaxed. Because the material has special spiral memory properties (Folcare Beng Mark patent), its distal end can automatically restore its spiral shape. After 8-12 hours in the stomach, the nasointestinal tube will enter the duodenum through the pylorus on its own under the action of gastric peristalsis. and jejunum. X-rays were taken 24 hours after intubation to confirm that the front end of the nasoenteric tube reached the upper jejunum, and it was fixed under the nostril with tape to prevent slippage.
Due to severe SAP and gastric cancer patients, gastrointestinal paralysis usually occurs, so in many cases the spiral gastric tube cannot reach the jejunum on its own. Therefore, placing a spiral gastric tube under X-ray is a good method. The study found:
Advantages:
1 Properly operated, this method can quickly establish an enteral nutrition channel
2 Solve the problem that in patients with poor gastrointestinal motility, the spiral gastric tube cannot reach the jejunum on its own problem.
3 The trauma and patient's pain are significantly less than gastroscopic nasointestinal tube placement
Disadvantages:
1 The success rate is lower than gastroscopic nasointestinal tube placement
2 The operation time is longer than that of endoscopic tube insertion, and it needs to be performed in the radiology department, which is not suitable for critically ill patients.
Notes:
1 During the operation, the patient may experience nausea or even vomiting, so avoid inhaling.