Professional Documents
Culture Documents
I. AI CNG:
Dinh dng ng tnh mach hoan toan la a cac chat dinh dng qua
ng tnh mach vao mau e nuoi dng c the. Cac chat dinh dng bao
gom: protein, carbohydrate, lipid, nc, muoi khoang va cac chat vi lng.
II. CH NH:
Khi co chong ch nh dinh dng ng tieu hoa:
- Giai oan sm hau phau ng tieu hoa.
- Suy ho hap co ch nh giup th (giai oan au).
- Xuat huyet tieu hoa.
- Hon me kem co giat.
Khi dinh dng qua ng tieu hoa khong hieu qua: hoi chng ruot
ngan, hoi chng kem hap thu.
III. NGUYEN TAC:
Cung cap ay u nang lng va cac chat dinh dng.
Cac chat dinh dng c a vao c the phai cung luc, cham va eu
an trong ngay.
IV. CAC BC TIEN HANH:
1. anh gia benh nhan:
Dau hieu sinh ton.
Can nang.
Tnh trang dinh dng hien tai.
Benh ly hien tai va benh nen: suy gan, suy than, suy ho hap.
2. Xet nghiem: CTM, em tieu cau, ion o, ng huyet.
3. Tnh nhu cau nang lng can thiet
Nhu cau nang lng tre bnh thng
Can nang
Nhu cau nang lng
10 Kg
100 Kcal/kg
> 10 20 Kg 1000 + 50 Kcal moi Kg tren 10
> 20 Kg
1500 + 20 Kcal moi Kg tren 20
Nhu cau nang lng :
Trong nhng ngay au ch can cung cap 40 - 50% nhu cau nang lng
c ban (nhu cau c ban # 55 65 Kcalo/kg), tang dan trong nhng ngay
sau.
4. Tnh nhu cau dch can thiet (A):
Nhu cau dch hang ngay tre bnh thng :
Can nang
Nhu cau nang lng
Dch
10 Kg
100 Kcal/kg
100 ml/Kg
> 10 20 Kg 1000 + 50 Kcal moi Kg tren 10
1000 + 50 ml moi Kg tren 10
Can nang
> 20 Kg
Dch
1500 + 20 ml moi Kg tren 20
Tuy theo tnh trang benh ly, nhu cau dch thay oi so vi nhu cau c ban
(NCCB)
Benh ly
Khong hoat ong the lc
Suy than
Tang tiet ADH
Th may
Bong
Sot
Protein
Ngay 1
g/Kg/ng
1,5
Ngay 2
g/Kg/ng
2
Lipid
Glucose
1
5
2
10
T ngay 3 at t le
San pham
g/Kg/ng
%E
2,5 3
1016 % Aminoplasma 10%
Moriamin, Cavaplasma
3
40 %
Lipofuldin10%,20%
15
4450 % Dextrose 10%, 30%
San pham
NaCl 17.4%
Kalichlorua 10%
Calcichlorua 10%, Calcigluconate 10%
9. Tnh
Thc te hien nay viec dinh dng TM hoan toan qua ng TM trung
tam con rat nhieu han che, chu yeu la qua ng TM ngoai bien. V
the khi tnh toan phai am bao nong o Glucose trong chai dch truyen
la < 12,5%
T le the tch Glucose 30% va Glucose 10% e at nong o Glucose
tren la : 1/6
Trng hp co ng TM trung tam th co the truyen dung dch co
nong o Glucose cao hn.
Osmol cua hon hp dung dch Glucose Acid amin ien giai
Ch tnh Osmol cua hon hp dung dch Glucose Acid amin v Lipid
c truyen rieng
Cong thc:
ALTT (moms/L) = (% dextrose 50) + (% amino acid 100)
+ 2(Na mEq/L + K mEq/L + Ca mEq/L)
DD lipid phai c truyen rieng. Co the truyen cung luc dung dch
Lipid vi dung dch am-ng qua ba chia.
2. Chon tnh mach truyen:
Tnh mach ngoai bien (TM mu ban tay, TM co tay, TM khuyu tay, TM
co chan): truyen dung dch < 1100 mOsm/L.
Tnh mach trung tam (TM canh trong, canh ngoai, di on) : truyen
dung dch > 1100 mOsm/L hoac dung dch Dextrose >12,5%. Xem xet
ch nh at Implantrofix trong trng hp can dinh dng TM trung
tam dai ngay.
3. Toc o truyen:
DD am va ng, ien giai nen c truyen lien tuc suot 24 gi.
DD lipid thng c truyen t 12 18 gi (co thi gian ngh e anh
gia tnh trang hap thu cua c the).
4. Dinh dng TM ban phan :
Sm chuyen sang dinh dng TM ban phan khi benh nhan het chong
ch nh nuoi an ng tieu hoa, hoac dinh dng hoan toan ng
tieu hoa.
5. Yeu to vi lng va Vitamin :
Neu benh nhan c nuoi an tnh mach tren 2 tuan can bo sung cac
yeu to vi lng va vitamine qua ng tnh mach
Yeu to vi lng :
Yeu to
Sat
Kem
ong
Iodin
Manganese
Chlonium
Selenium
Nhu cau
0.1 0.2 mg/Kg
100 g/Kg
20 g/Kg
3 5 g/Kg
2 10 g/Kg
0.14 0.2 g/Kg
2 3 g/Kg
Vitamin
* Tan trong dau:
Vitamin A
Vitamin D
Vitamin E
Vitamin K
* Tan trong nc:
Vitamin C
Vitamin B1
Nhu cau
Vitamin :
700 g/Kg
10 g/Kg
7 g/Kg
40 g/Kg
80 mg/Kg
1.2 mg/Kg
Vitamin B6
Vitamin B12
Riboflavin
Niacin
Pantothenate
Biotin
Folate
1mg/Kg
1 g/Kg
1.4 mg/Kg
17 mg/Kg
5mg/Kg
20 g/Kg
140 g/Kg
Tnh Osmol
DD Glucose Acid amin
T ngay 3
600 -700
(6070% NLCB)
700
(NCCB 0,7)
20 g (200 ml)
(2 g/kg/ng)
20 g (100ml)
(2 g/kg/ng)
30 mEq :
*21 mEq
(7 ml NaCl 17,4%)
*9 mEq (AA 10%)
20 mEq :
*15 mEq
(11 ml KCl 10%)
*5 mEq (AA 10%)
10 mEq
(7ml CaCl2 10|%)
700
(NCCB 0,7)
25 g (250ml)
(2,5 g/kg/ng)
30 g (150 ml)
(3 g/kg/ng)
30 mEq :
*19 mEq
(6 ml NaCl 17,4%)
*11 mEq (AA 10%)
20 mEq :
*14 mEq
(10 ml KCl 10%)
*6 mEq (AA 10%)
10 mEq
(7ml CaCl2 10|%)
400 ml
300 ml
60
340
45
255
8,7%
7,1%
3,3%
885
4,5%
925
488 (48,8 %)
556 (55,6 %)
16,4%
18%
41%
54%
Glucose
(g/dL)
Protide
(g/dL)
Lipide
(g/dL)
ien giai
(mEq/dL)
Na Ka
Ca
Dextrose 30%
Dextrose 10%
Aminoplasma 10%
Lipofundine 20%
Natrichlorua 17,4%
30
10
10
20
4,3
Kalichlorua 10%
Calcichlorua 10%
2,5
30
0
13
4
ALTT
(mOsmol/L)
1500
1000
1000
380
180