Sumіshі for parenteral feeding. Enteral and parenteral feeding is an effective way of intestinal elimination

Parenteral feeding (PP) is considered to be ailment, because we don’t need to accept it on its own, but for a precooked food. PP preparations are stagnant for injection into a vein, bypassing the herbal tract. The stench to come to the roof and to produce the porridge to the shimmering usunenny.

The number of amino acids to be administered for parenteral feeding is necessary to provide for the skin people individually, in cases of seriousness, problems, specific pathologies. Nadal іх number and warehouse to be corrected. Victory of parenteral feeding in the warehouse of complex therapy will significantly improve self-esteem.

Enteral harchuvannya mensh road, lower parenteral, as vyklikak more accelerated, driving immunity, meaningfully advancing the development of infections.

What is parenteral feeding?

PP transmission through the vein of all the necessary nutrients (components) to relieve the patient from the lack of adequate performance of the necessary proteins, fat in carbohydrates, vitamins and minerals. Tim himself adapts to internal homeostasis - the persistence of acid-puddle and water-electrolyte storage of blood. Organism with a lot of otrimu needs a number of all living talk.

Particularly significant is the PP for patients who are affected by the organs in the herbal tract, as they require reanimation assistance. The important pathology of supervising the situation is the lack of blood cells, especially when the transfer is carried out. To see the increase in protein growth through:

• high consumption of organisms in energy;
• great rubbed through the surface of the wound and drainage;
• a low number of proteins, which should come from a person - because of the operation of ailments, it is not possible to harchuvate, and the destruction of them is wet;
• It is possible to vibrate during the operation of hormones in measles supra-nirkoval infections in the event of an injury.

With chronic ailments, the soaking of all grub components will break down.

The clinical approach of parenteral feeding is aimed at the correction of all wineries. With PP, all the components are introduced into the finished viewer in sufficient quantity and immediately become used. In case of a bad blood loss with great second blood and in cancer patients, a blood-loser and an inaccurate preparation of zaliz (Likferr, Ferinzhekt) will be stagnant. When the child is born, the order is introduced from the safety through high rhiziku allergic reactions.

Basic principles and types of parenteral feeding

For a successful complex therapy, before the warehouse, which includes the PP, the following principle of introducing lively breakdowns will be fixed:

• the freedom of the ear;
• without interruption of the introduction to the residual renewal of damaged functions;
• the adequacy of the warehouse, the amount of production, how to enter, the allocation of components, their energy values.

Classification is stagnant, but all PPs are subject to:

• on the outside - all components are introduced into the vessel channel, the patient does not need to move water;
• chastkovo - parenteral injected without any components (amino acids or carbohydrates);
• additional - hyperalimation - necessary oversized feeding of important ailments, either enterally (through the mouth) or parenterally, if there is a particular lack of nutrition and the introduction of problems;
• combinovans - a day with a probe.

Most often, eating through a vein is required for a non-trivial hour (from 2-3 months up to 3 months), a little more intestinal pathology can weaken an organism, especially a childish one. The term of the registration of the PP will increase for 3 months.

Provide for parenteral feeding

Preparations for vykoristovytsya for internal food, guilty:

• mother needs a lot of nutrition and nutrition;
• instantly replenish organism;
• give detoxification, detoxification and stimulation;
• but not shy and handy for the introduction.

For parenteral feeding, the amount of money is stagnant, including all consumed drinks, fat and carbohydrates.

Oscillations of protein will be used in a split viglyad, the main dummy of a bottle at PP is to serve as amino acids of hydrolyzates of a bottle: Polyamin, Levamin-70, Vamin.

Fat emulsions: Intralipid, Lipofundin, Liposin.

in carbohydrates:

• glucose - with a concentration of 5-50%;
• fructose (10 and 20%), yak, sometimes with glucose, in the smallest world it teases the veins.

There is an incomplete list of ready-made piece sums, as you can get in the pharmacy for the signs of the drug.

Shown and counter-shown

Parenteral introduction of nutritives is the main method of grubbing in the first place for surgery. PP is recognized in case of negative nitrogen balance. During the operation of the wine, add 15-32 g of a bottle to the add, which will result in 94-200 g of tissue proteins or 375-800 g of a bottle of ointment. Tse danі for rozrakhunku kharchuvannya from ailments, who require reanimation. It is shown on the outside of PP through a negative balance of nitrogen and unhappiness that is eliminated by the natural way, in addition to being able to improve catabolism (tissue loss) and drive anabolism (induce new clitins).

The limit of the operating period, shown by the additional PP є:

• hunger abo urazhennya organs in the herbal tract;
• great opics;
• pathology of the liver, nirok, podshlunkovoy zalozi, intestines, hyperthermia, if there is a rise in strength;
• іnfektsії with sharp fever and damage caused by wetness with damaged intestines (cholera, dysentery);
• mental ailments (anorexia);
• coma abo trivial nesvіdomy stan.

According to the rule "7 days or 7% of mass", the PP is assigned to a patient who is not 7 days old, but if it is already well-known in the stationary display, it is used to consume 7% of the amount. at the expense masi tila more than 10%, cachexia develops as a result of the consumption of calories and alcohol.

The process of change and chemotherapy is used to designate PP for the advancement of adaptation and acceptance of the school's inherited inheritance from these methods of treatment. Appropriate PP is seen individually in a skin ailment.

In general, it is shown to the PP to be built up to three points:

• the unhappiness of eating a natural way among stable patients lasting 7 days, among women - in more short terms;
• the need for a root of functional tranquility in case of a lesion of any herbal organ (fodder, intestines, shlunk);
• hypermetabolism, in case of any normal eating, it does not cover the consumer's organisms in the necessary nutrients.

PP is not carried out in vipads:

• vidmovi patient;
• visibility of the forecast in case of vicorian PP;
• Possibilities introduced by the grunting of the shlyakhs, which are curved for consumption in the necessary speeches.

Parenteral feeding through veni

The main path of the introduction of the PP is internal. Manipulation goes through the peripheral or central vessel.

In the first case, the infusion will be followed by an additional dribble - through a cannula or a catheter inserted into the vessel, a cannula. Stagnate, if necessary, PP by pulling it out or in times of stagnation of PP yak preadatkovo method grabbing.

In another, the infusion must be made through a catheter, inserted into the central vessel. Such is the need for a trivial PP, if ailments are found in an important country abo comi. Sumіshі is introduced through the pіdclavicular vein, more - stegnova, more - the jarp.

For the introduction of hypertonic concentrations, it is not possible to pick up peripheral veins. Їх small diameter, low fluidity of blood flow, fleshness of stems to produce phlebitis or thrombosis. At the great highways, the sums through big size Veni and high quality blood are added and do not wipe out any other changes.

The osmolarity of the dehydration with the internal introduction of the dehydration. In the peripheral shelter, guilt is introduced, according to its schilality it is close to physiological. The normal osmolarity of blood plasma becomes 285-295 mOsm / l, and in the greater number of differences for PP, the number of digits is significantly transformed - 900 mOsm / l. The infusion of such streams (to translate the indicators of 900 mosm / l) into the peripheral vessel is categorically hardened.

When carrying out PP, it is necessary to follow these rules:

1. Proteins, lipids, carbohydrates are introduced only at the warehouses, which are immediately supplied to textiles: amino acids, fat emulsions, monosaccharides.
2. It’s crazy with a high osmolarity to be introduced only in great times.
3. The system for the introduction of the drug changes for a new time.
4. Before the reduction of infusion and fat loss, for those who are sick, there is a sick person: 30 ml / kg with a stable stan. For an important patient, the numbers grow.
5. All indispensable components of PP freeze overnight.

Infusion internally introduced differences for the triviality of distribution:

• on cyclic (lasting 8 years);
• promoted (12-18 years old);
• Finish with a stretch.

placement of a catheter

For trivial PP, the recognition and sums are introduced through a large central vein, for example, a switch. Widely stagnate її catheterization according to Seldinger.

Algorithm for installing a venous catheter:

• the punctuation of the judge by a barefoot;
• conduction of the guide through the head into the vein with the vision of the head;
• stringing the catheter onto the guide;
• the introduction of the catheter into the vessel, as seen by the provider.

An antiseptic treatment of the operative field is carried out in advance. Before the procedure, the processing should be carried out again. With a large patient, lie on your back with your head down for the prevention of obstructive embolism.

energy balance

Schemes of PP kharchuvannya rorakhovoyutsya with urahuvannya energy consumption. The stench lays down all the way, stat, a step to catabolism.

Isnu is a special formula for rosrakhunku - Garrice-Benedict. According to the new pidrahovuєtsya the main exchange - energovitrati calm (EZP). With a little-destructive way of living, or a small growth and mass, the indicators become envious.

Formula for energy exchange:

• for cholovikiv: 66 + (13.7 x B) + (5 x P) - (6.8 x Vik);
• for women: 655 + (9.6 x B) + (1.8 x P) - (4.7 x Vik).

B - weight in kg, P - height in cm.

To increase the consumption of energy for additional EZP, multiply by the factor of activity of metabolism: the numbers are ready, and if there is a developmental pathology:

• surgical (1-1.1);
• one hour splinter fractures (1.1-1.3);
• infectious (1.2-1.6);
• opik (1.5-2.1).

The ORIntovna rozrakhunkova value of the EZP becomes 25 kcal / kg / day. When the metabolic activity factor is multiplied (in the middle - 1.2-1.7), the consumption is 25-40 kcal / kg / day.

Requirement for bilka

Be-yaka Lyudin is guilty to live 0.8 g / kg vagi bіlka in doba. The need for a protein to lie down because of the severity of the patient's camp: it grows up to 2.5 g / kg of weight in case of pathology.

When the PP is carried out, amino acids, such as components of the bottle, are used as a main ingredient in anabolic processes, and not as energy. Only in case of detection and sepsis of the block, the organism will be victorious at once for two purposes. The price is tied to the low indices of lipids and carbohydrates in such patients. In case of marked pathology (important injuries, septic conditions), they overcome catabolic processes, which is effectively the introduction of solutions from the amino acid warehouse with the use of a lance:

• leucine;
• isoleucine;
• valin.

Zavdyaki їkh vikoristannyu:

• blood indicators are more normal;
• decrease in the number of allergies to the type.

nitrogen balance

The balance of nitrogen will start with a blend and vitrified nitrogen. Apparently, the balance can be:

• zero - with a good supply and vitrati nitrogen in the body;
• negative - when there is a drop in nitrogen over its proper value;
• positive - with adequate nitrogen, yak more vitrati.

A positive balance is to be taken into account when there is a strong need for an organism in energy. Have great people Such a camp spasters to navigate at zero energy supply through the reserves in the organisms of the living words.

Negative nitrogen balance of vinikє:

• in case of important stress (inodi win does not change to zero, unaffected by low vitra of energy);
• at the sick.

The principle of parenteral administration of lively words: 1 g of nitrogen is taken in 6.25 g of bottle (16%). Having found a quantity of nitrogen, it is necessary to insure a quantity of protein in terms of the nitrogen seen.

Living speech

Before the warehouse of the PP, the guilt includes all the necessary components:

• in carbohydrates;
• lipid;
• proteina;
• electrical solutions;
• vitamіnnі drugs;
• microelement.

The food storage facilities are responsible for the control.

Supplements for parenteral feeding

For PP, there will be a difference, so as not to take revenge on the other components. Їх add in the sum if necessary, go out from the patient, for homeostasis training. Electrolytes, which are responsible for being present, for internal infusion: sodium, calcium, calcium, phosphorus. If necessary, add also vitamins and microelements.

electricity

Introduced a sum of guilty mothers, a mineral warehouse, which includes the main necessary elements.

Kaliy take revenge at the great number of all the middle class. Vin is destroyed with forced duresis, with the activation of metabolism, the need to move rapidly. With PP, a number of calories increase - hyperglycemia begins. Through explicit glucose in the PP warehouse, a small amount of insulin is added to the blood. Tsektivuє K + Na + - ATPase and the proper delivery of ions K + from the microscopic line in the cell.

Sodium is the main element of the middle age. Yogo viznachayut at the blood plasma. Introduced into a vein in the presence of salts: chloride, bicarbonate, acetate. Acetate is necessary for the development of acidosis, when bicarbonate is established in the body.

Magnesium takes part in the stem of the meat cells and the structure of the basket. It is important for the organism to grow in great numbers from the cross, so it is important to develop a duresis when you improve and restore blood circulation. Magnesium deficiency develops with alcoholism, visceral, pathology parathyroid vines, Accepting aminoglycosides in conjunction with increasing visions of magnesium with a cross section on one another. In case of a severe shortage, it is injected internally in the range, some of the hypomagnification of the disease is reduced in the amount of calcium in the blood.

Calcium can also be included in the sum, especially in case of sepsis and injuries, if it is possible to recover from it. Calcium stains, which take place in the cysts, are reduced in case of hypoalbuminosis D. It is also observed in case of hypoalbuminemia, some calcium dressings from a whole fraction (about 50% of bleach.

Phosphates are present in the erythrocytes, enter the storage of amino acids, phosphate proteins and lipids, take part in the exchange processes in knitted fabric... In case of important pathology and trivial starvation, visceral growth develops, and leads to hypophosphatemia. Parenteral harvesting of the process of feeding, dropping glucose, as well as in the form of calories, transfer phosphorus from the past to the middle of the cell.

vіtamіni

At the PP, vitamins A, D, E are added in their water-susceptible forms, group B, ascorbin, folic acid, biotin. The stench is stagnant in dosuvannyah, scho to translate the need in the instruction indicated in the instruction. Vitamin Before is administered once every 7-10 days, except for quiet patients, which are indicative of anticoagulants. A patient on hemodialysis is guilty of trimming folic acid - to be supplied in a generalized order, some of them will be taken into account during the procedure. When transferring to the enteral route, I will take polyvitamini in tablets.

microelement

The main microelements (chromium, manganese, min, selenium and zinc) are supplied to the living room for internal introduction of the day.

heparin

Heparin is supplied for the improvement of the passage of veins and catheters in a dose of 1000 odds per 1 liter of retail.

albumin

Albumin vikoristovuyutsya in case of important bleak deficiencies< 2,0 г/л).

insulin

Insulin does not need to provide patients with non-skipped carbohydrate consumption. Wine is needed in case of reddish diabetics.

Parenteral feeding program for pancreatitis

PP vikoristovutsya in reanimatology for, oncological new pancreas, for conducting surgical operations.

The value of high-alcohol consumption, fat and carbohydrates is robbed by a nutritionist, which is the source of:

• calorie;
• warehouse;
• dobova number of necessary lively speeches.

Parenteral feeding does not podsilyuє viroblennya, by the very fact that it is functional to the organ. That PP is included in the complex therapy of pancreatitis, as it is repaired immediately by renewing homeostasis and giving shock. Lipid emulsions ignition process in parenchymal diseases and contraindications for gastric pancreatitis.

Ear of PP, introduced change and increase

A basic basic protocol for the nutritional training of patients for submissions drugs and the number of, as it is necessary to introduce the patients in the fallowness of the degree of severity and basic living indicators. Lіkuvannya in minds statsіonaru carried zgіdno of nayavnim kerіvnitstvu of methodically vkazіvkami, yak mіstit Opis terapії іz zastosuvannyam PP of days in zalezhnostі od viyavlenoї patologії, trivalostі zastosuvannya pozhivnih rozchinіv, zmіni in їh vvedennі at doses i obsyagom, i minds pripinennya, vіdpovіdno to pokaznikіv homeostasis ... The methodology of PP is also described, the yaka is based on the principles:

• transfusion from small capacities;
• technologies "all in one".

The remains are broken up in two options:

• “Two in one” - a two-chamber toy with glucose, electrolytes and amino acid preparations (nutriflex);
• "Three in one" - one little thing to take away all 3 warehouses: in carbohydrates, lipids, components of proteins (Cabiven): such a container can provide the opportunity for introducing vitamins and microelements - the cost of saving balances of warehouses.

Caution for the ailment

Pislya vipiski from the stationary of ailments spontaneously try to keep up with the place of living. At the same period, you need:

• organizing the rational mode of food;
• monitoring of biochemistry.

І child, і grown-ups guilty periodically passes and medical look... When I have a quick burn, if I have a pain or a high temperature, it is recommended to take a doctor to home.

It's a trivial hour for a patient to be:

• on zhorstkiy after Pevzner (vklyuchatsya fatty, gostre, greased, smoked; їzha take often and often in a warm viglyadі);

Folding for parenteral feeding

With PP, the possible development is accelerated:

• technical (nadriv vene, embolism, pneumothorax);
• infectious (thrombosis in a catheter or infection in a new one, scho viklikayut sepsis);
• metabolic (impaired homeostasis through improperly introduced PP, producing up to the appearance of phlebitis, impaired functions dichotomous systems, Pechinki);
• organopathological (early and early).

Early inheritances appear:

• allergyu;
• hyperhidrosis;
• zadishka;
• zamorochennyam, thin weakness;
• hypertherm;
• transverse pain;
• fired at misci the introduction of the drug.

Diseases of organopathological acceleration of PP є as a result of improper absorption of fatty emulsions:

• cholestasis;
• hepatosplenomegaly;
• thrombocytopenia and leukopenia.

It is necessary to unicuten it quickly before consuming a vial or a packet with a dry preparation, the date of the release, the date of delivery, the pharmacology and the sense of confusion, the possibility of penetrating the brain is easy,

Only at the time of the retardation of all indications and the rules of the introduction of the PP routine to pass successfully and the patient to step by step transfer to the special mode.

Until quietly leave the country and electrolytes, intended for a different or adaptable therapy, but not be adequate to the change in calories, the stench does not take a normal development. Їx can, however, be introduced by stretching further than the nontrivial period. For good children, they are especially uncomfortable, so they are given surgical involvement and with trivial diarrhea, parenteral feeding it is necessary to prodzhuvati dovgo. The mode, the indications for the criterion of the harvesting deficiency, can be effective in providing a positive balance of nitrogen and normal development of the child, if it is carried out for 60 days or more.

Standard infusion solutions are prepared with an amino acid preparation, which will take 20% of glucose and electrical energy. Polyvitamin preparations, which are unique in the case of a large amount of vitamins E. Zinc, honey, chromium and magnesium, are added to the recommended microdoses. Rozchin should be injected into the central vein drip from the post-shvidkistyu through a catheter. To reduce the risk of introducing infection, the catheter head should be inserted from the catheter to the sign of the entrance to the vein. Rozchin should be administered at a dose of 135 ml / kg for dobu, which will bring about 120 cal / kg for dobu into the body. The price should be consumed in a bottle, as it should be estimated in between 2.0-3.0 g / kg for extra. Fat can be injected daily, but most effectively internally introduced 20 mg / kg fat, so that linoleic and linolenic acids can be removed through the skin for 10 days, so that an adequate amount of essential fatty acids will not be provided.

Individuals who find it difficult to insert a catheter into the central vein, and new neoplastic parenteral dissection can be carried out through the peripheral veins. The concentration of glucose in the range in cich vipadki is to blame, but it is reduced by up to 10%. For partial compensation by a decrease in calorie content, the amount of amino acids should be increased to 30 g / l for older children. Oscillations of new-born women are impatient to tolerate the introduction of solutions containing amino acids; In cich vipadkah new people are guilty of eating fat.

When this often develops accelerated, for example, sepsis, hypertrophic hypertension, especially in the early stages of the development of children, who were born with a low mass of death, which cluttered the life of hypophosphatemia, most often in case of intestinal discomfort, swelling, acidosis and failure of the electrolyte rinovagi. For unique purposes, the installation of a catheter and replacement of the system for infusion of the blame is carried out only by specially trained and advised personnel; it is necessary to constantly support the sick and periodically assess the steps in the process of getting rid of it, regularly start the level of glucose in the section, especially in the first period of time. Before a cob of alcohol, one-time per week in the process of treatment, followed by the initiation of concentration in syrovatts of electrolytes, phosphate, glucose, sechovine, hemoglobin. In often larger intervals, one can use equal calcium, nitrogen and albumin. Behind the key shows, there is a functional stove mill, a number of microelements and vitamins.

piece of food This is one of the basic types of illnesses in the minds of the stationary. Practically not іsnu medicine, in which case it would not be stagnant. Most relevant is the provision of piece food (or piece of nutritional support) for surgical, gastroenterological, oncological, nephrological and geriatric contingents of ailments.

nutritional support- a complex of dietary visits, straightening on the appearance and correction of the nutritional status of the body with the use of nutritional therapy methods (enteral and parenteral nutrition). The whole process of securing the body with food words (nutrients) for additional methods, according to the type of food intake.

"The lack of care of a sick person is guilty of roztsinuvatisya, as the decision to starve him to death. The decision, for those who in a large number of cases, it is important to accept the truth" - wrote to Arvin.

Timely and adequate to the nutritive response, allowing the frequency in the world of speed infectious diseases and lethality of ailments, seeking to increase the quality of life of patients and speed up their rehabilitation.

A piece of nutritious food can be used more often, if everything (or the main part) is consumed by a sick person in food

Shown before carrying out a piece nutritional training. In general, it is possible to describe how to be ill, when the need of the ailing in nutrients cannot be taken care of by the natural path. Call tse zhvoryuvannya shlunkovo-intestinal tract, Scho does not allow patients to eat adequately. Also, a piece of equipment may be necessary for patients with metabolic problems, such as hypermetabolism and catabolism, a high second nutritive.

The rule is "7 days for a decrease in mass by 7%". This means that a piece of food needs to be carried out in quiet areas, if ailments are 7 days and it is no longer possible to eat a natural way, if ailments have been consumed more than 7% of the recommended amount of food.

Evaluation of the efficiency of nutritional response includes onset indicators: dynamics of parameters in the nutritional status; mill nitrogen balance; overcame the main ailment, the camp of the surgical wound; I will give birth to the dynamism of the patient, turn and stretch of organ dysfunction.

Two main forms of piece nutritional supplementation are developed: enteral (probe) and parenteral (intravascular) feeding.

• The peculiarities of the metabolism of humans during hunger

  The primary reaction of the body in response to the improvement of the nutritional value of the nutrients from the recovery of the glycogen and glycogen depots in the role of dzherel energy (glycogenoliz). However, the supply of glycogen in the organism is not great and is hanging out with a stretch of the first two or three days. Given the lightest and most affordable energy source, it builds up structural proteins for the body (gluconeogenesis). In the process of gluconeogenesis, glucose-depleted tissue vibrates ketone, which, according to the reaction of the vocal ring, is responsible for the basic exchange and repair of oxidized stocks of lipids in the quality of energy. It is a step for the organism to switch to a protein-saving mode of functioning, and gluconeogenesis will be renewed if there is an increased supply of fat. So, even if in the first days of hunger you spend 10 -12 g for doba, then on the fourth day - less than 3-4 g at the time of extreme stress.

  Ailments in a critical state are faced with a straining wikid of stress hormones - catecholamines, glucagon, which are volodiut in a catabolic state. At the same time, the viral activity will be destroyed, or it will be blocked from such hormones with an anabolic effect, such as somatotropic hormone and insulin. Yak tse often buzzes with critical stuns, a preoccupied reaction, it is straightforward to the ruining of the cells and the safety in the organism of substrates in order to induce new tissues and to start wounds, to go out from the control and start purely. Through catecholaminemias, one is able to move from organisms to vicious fat in the capacity of dzherela energy. In a wide range of conditions (in case of bends of fever, polytrauma, opiak), you can burn up to 300 m of the structural block in the dob. Such a camp was called autocanniballism. Energy will increase by 50-150%. For an hour, the body can adapt its consumption in amino acids and energy, while the stocks of a small amount of food and consuming 3-4 kg of a structural bottle can be used by non-vats.

  The principle of physiological adaptation to starvation due to pre-sensory reactions in thermal camps is that, in the first place, there is an adaptive decrease in energy consumption, and in another - the reduction of energy consumption. Moreover, in post-aggressive countries, there is a negative nitrogen balance, as it is necessary to bring the body to death, as it is infused with more than 30% nitrogen to the body.

  • Shlunkovo-intestinal tract in case of starvation and in a critical state

    In critical countries, organism is often diagnosed, if they fail, perfusion and oxygenation of the intestinal tract is adequate. Tse vede to the pockenny of intestinal food with the deterioration of the bar'ernoy function. Loss of grief, as if it was a trivial hour in the middle of the day in the education of the slunk-intestinal tract (in case of starvation), so as the slime of the clit would be able to find hunger in the meaning of the world without mediocrity.

    It is important to use the ear-jaw herbal tract as a factor є be-yak centralization of blood circulation. With the centralization of blood circulation, there is a change in the perfusion of the intestine and parenchymal organs. In critical countries, adrenomimetic drugs for the treatment of systemic hemodynamics are becoming more frequent. During the hour of renewal of the normal perfusion of the intestine, the life of the vital organs is renewed as the renewal of the normal perfusion. The viscosity of chemus in intestinal education will destroy the adequate antioxidants and precursors in the enterocyte and due to reperfusion damage. Pechinka for rakhunok autoregulatory mechanisms are less expensive because of a decrease in blood flow, but all the same, perfusion changes.

    In case of starvation, microbial translocation develops, so that microorganisms penetrate through the luminal-intestinal tract through the mucus bar into the blood and lymphocytes. In the main, in translocation take the role of Escherihia coli, Enterococcus and the genus Candida. Singing numbers have a microbial translocation of the presence of the head. The bacteria that penetrate into the subsurface are filled with macrophages and transported to the systemic lymph nodes. When the stench penetrates into the bloodstream, the stinks start to grow in Kupffer's patches of the liver. The urinary tract collapses with uncontrolled growth of intestinal microflora and changes normal warehouse(Tobto with the development of dysbacteriosis), impaired penetration of mucus, impaired muscle immunity of the intestine. It has been reported that the microbial translocation is poor in critical ailments. You can do it with the presence of factors in the disease (indications and importance of trauma, systemic antibiotics of a wide range, pancreatitis, hemorrhagic shock, reperfusion disorders, vignettes of solid diseases, etc.) and often the cause of severe infections. In the United States, 10% of hospitalized patients develop nosocomial infection. As many as 2 million people, 580 thousand deaths and vitrati for a period of about 4.5 billion dollars.

    The deterioration of the intestinal bar'ernoy function, which rotates in the atrophy of mucous and the deterioration of penetration, in critical ailments develop to finish early and turn around already at the 4th stage of hunger. Bagatma has shown a splendid effect of early enteral feeding (first 6 years old) to prevent atrophy of mucous membrane.

    When there is a lack of enteric feeding, there is not only atrophy of the mucous intestine, but atrophy of the so-called gut-associated lymphoid tissue (GALT). Cycle of Peyerous plaques, mesenteric lymph nodes, lymphocytes of the epithelium and basal membrane. Pidtrimka of normal eating through the intestines with the pidtrims of immunity of all organisms in a normal state.

• Principles of Nutritional Education

  One of the founders of the day about piece food Arvid Wretlind (A. Wretlind) has formulated the principle of an inner approach:

  • Chastity.

    The piece of food must be repaired earlier, before the development of the nutritious damage. It is not possible to check the development of high-energy deficiencies, some of the cachexia on the other hand, it is simpler to pass, lower to likuvati.

  • Optimality.

    A piece of food needs to be carried out to stabilize the nutritive status.

  • Adequacy.

    Kharchuvannya is able to pokritan energy consumption to the body and to the balance for the warehouse of living words and meet the needs of the sick in them.

• enteral feeding

  Enteral food (EP) - a type of nutritional therapy, with yak lively speeches administered orally, or through a shlunkovy (internal intestinal) probe.

  It is not easy to carry on to the types of piece harvesting, but not to go through the natural paths. For carrying out the enteral feeding, the necessary access is necessary, as well as special prescription for the introduction of the living sums.

  Deyakі authorize to carry only methods, minuschіe before enteral feeding empty mouth... These include those who are taken orally by sums, as seen from the usual. In this case, there are two main options: probe feeding - the introduction of enteral sums into the probe abnormally, and "sipping" (sipping, sip feeding) - the oral intake of a special bag for enteral feeding through a small tube (as a rule).

  • Perevagi enteral feeding

    Enteral feeding a number of perevag before feeding parenteral:

    • Enteral food is more physiological.
    • Enteral feeding is more economical.
    • Enteral harchuvannya is not practical for the wickedness of those who are not safe for life, not for the purpose of catching the minds of the suvoroi sterility.
    • Enteral feeding allows the larger world to protect the body with the necessary substrates.
    • Enteral feeding for the development of atrophic processes in the intestinal tract.
  • Shown before enteral feeding

    Shown before the EP, є practically all situations, if patients with a functional shlunkovo-intestinal tract, it is unfortunate that they are consumed in a bottle and energy with an extraordinary, oral route.

    Generalized tendencies є stasis of enteral feeding in all types of patients, as much as possible, if the part is lower, lower than parenteral, and the effectiveness of food.

    For the first time, it is shown for the enteral feeding of boules clearly formulated by A. Wretlind, A. Shenkin (1980):

    • It is shown enterally if the patient is unable to live (the visibility of the information, the loss of communication, etc.).
    • Enteral feeding is shown if the patient does not live (pancreatitis, intestinal bleeding, etc.).
    • It is shown enterally if the patient does not want to eat (anorexia nervosa, infection and in.).
    • Enteral feeding is shown if the feeding is not adequate to the needs (trauma, oxymorphy, catabolism).

    The Ministry of Health of the Russian Federation sees the offensive nosological evidence before the intake of enteral feeding:

    • Bіlkovo-energetic lack in case of unhappiness of sickness of adequate proper nutrition of nutrition in a natural oral route.
    • New food, especially localized in the area of ​​the head, shoulder and slunk.
    • Disturbances of the central nervous system: I will become comatose, cerebrovascular insults or Parkinson's ailments, as a result of which a deterioration of the grub status develops.
    • Promeneva and chemotherapy for oncological illnesses.
    • Indigestion of the intestinal tract: Crohn's ailment, malabsorption syndrome, short bowel syndrome, chronic pancreatitis, Virazkovy kolit, ailment of the stove and zhovchnyh nobles.
    • Harchuvannya before the early period of operation.
    • Injury, medical problems, hospitals.
    • Folding of the operative period (fistula of the intestinal tract, sepsis, inability of the anastomoses).
    • Infectious disease.
    • Psychic problems: neuropsychic anorexia, the importance of depression.
    • Statements and chronicle radioactivity.
  • Prototype indication before enteral feeding

    Enteral feeding є using a methodology, as it intensively lasts and becomes stagnant in all the larger groups of people with disabilities. There is a break in the stereotypes of the drive of obstructive starvation in ailments of the field of operations on the intestinal tract, in ailments without a mediocre loss of shock and in patients with pancreatitis. In addition, there is no single thought for the drive of absolute counter-indications for enteral feeding.

    Absolute contraindications prior to enteral feeding:

    • Klinichno bends shock.
    • Ischemia of the intestine.
    • povna intestinal imperfection(Ileus).
    • The patient is ill, or he is receiving an enteral feeding.
    • Trivial shlunkovo-intestinal bleeding.

    Prescribed before enteral feeding:

    • Particle obstruction of the intestine.
    • The importance of loose diarrhea.
    • The name of the small bowel fistula with visions of 500 ml / day.
    • Gostriy pancreatitis and cyst of pancreatic disease. However, it is possible to treat patients with pancreatitis distally when the probe is positioned distally, and there is no need for nutritional support.
    • To an obvious contraindication, there is also the appearance of great excess grubs (feces) mass in the intestine (by day - intestinal paresis).
  • General recommendations for carrying out enteral feeding
    • Enteral food should be spent so early, as it is possible. Carry out the feeding through a nasogastric tube, which is mute until a counter-indication.
    • To fix an enteral food slid with a shvidkistu 30 ml / year.
    • It is necessary to make a surplus of 3 ml / kg.
    • It is necessary to aspirate in place of the skin probe for 4 years and if the excess amount does not change 3 ml / year, then the step is to increase the amount of food until it reaches the rosary (25-35 kcal / kg / dobu).
    • In vipads, if the excess amount is 3 ml / kg, then it will signify the development of prokenetikami.
    • If after 24-48 years, through a lot of surplus treatments, it is not even possible for a sick person to have enough capacity, then the probe should be inserted into the club's intestine using the method (endoscopic or by X-ray control).
    • Slid all the sisters, like to carry out an enteral meal, but if you can't do it with a proper rank, then it means that you can't help a sick person.
  • If you fix the enteral feed

    In the literature about the guesswork of the "early" parenteral feeding. It’s hoped that the sick with multiple injuries will not immediately begin to stabilize, in the first 6 years since the beginning, they have repaired the enteral feeding. In the case of the control group, if the eating has been repaired for 24 years from now, it means that there is less deterioration in the penetration of the intestinal wall and less deterioration in the penetration of the intestinal wall.

    At the reanimation centers, an offensive tactic has been adopted: it is necessary to take care of it so early, as it is only possible - not only for the sake of secretly asking for the reserve of the patient's energy, but in order to get ahead of the intestines. introduced їzhі.

    Theoretically obruntuvannya early enteral feeding.

    Daily intake of enteral food produce up to:
    Atrophy of the mucous membrane.	Brought in experiments on critters.
    Superfluous colonization of the small intestine.	Enteral feeding of zapobіgєtse in the experiment.
    Translocation of bacteria and endotoxins into the portal bloodstream.	In people, there is impaired penetration of mucous in cases of illnesses, injuries and in critical camps.

  • Enteral feeding modes

    Vibir to the mode of eating will start with the camp of a sick person, the main and other pathological conditions and the possibilities of a lucrative mortgage. The vibrating method is used individually for a skin ailment.

    Check out the different modes of performing the enteral feeding:

    • Kharchuvannya with post-shvidkistyu.

      Harchuvannya through a slurry probe is repaired from izotonic sums of 40-60 ml / year. In case of hardened tolerance, the consistency can be increased by 25 ml / year of skin for 8-12 years until the supplementation is reached. When harvested through a jejunostomy tube, the cob injection rate is 20-30 ml / year, especially in the lowest period of time.

      In case of tediousness, blues, ordeals, or diarrhea, it is necessary to change the speed of the introduced or the concentration of the difference. At the end of the uniqueness of the one-hour change of quickness of food and concentration of lively sums.

    • Cyclic harachuvannya.

      Bezperervne droplen introduced step by step "squeeze" up to 10-12-year-old period. Také kharchuvannya, for a sick person, can be carried out through a gastrostomy tube.

    • Periodic, abo session eating.

      Harchuvannya sessions for 4-6 years to carry out only when there is a history of diarrhea, malabsorption syndrome and operations on the intestinal tract.

    • Bolus feeding.

      It is a very special way of living, which will make it more natural for the gastrointestinal tract to function. Carried out only with transgastric access. Inject no more than a syringe with a syringe of no more than 240 ml for 30 minutes 3-5 times a day. The cob bolus is not guilty of overhanging 100 ml. In case of hardened tolerance of the volume, 50 ml should be injected. During the last bolus year, diarrhea develops more often.

    • Make a name for any ailments without cutting off the food with a stretch of decilkoh days, post-drip the introduction of the sum is more beautiful than the periodic one. Uninterrupted 24-year-old eating is more beautiful than storing in vapors, if є sumnivi also saves the functions of etching and soaking.
  • Sumіshі for enteral feeding

    Vibir of madness for enteral feeding is to lay down all of the powerless factors: discomfort and backwardness of a sick person, manifestation of damage to the patient's herbal tract, which is necessary for the regime of enteric feeding.

    • Zagalny vimogs, scho are presented to enteral summaries.
      • The enteral sum is responsible for the sufficient energy supply (not less than 1 kcal / ml).
      • The enteral sum is not guilty of revenge of lactose and gluten.
      • The enteral sum is responsible for the low osmolarity (not more than 300-340 mosm / l).
      • The enteral sum is responsible for the low viscosity.
      • The enteral sum is not guilty of viciousness overworldly stimulation of intestinal motility.
      • The enteral sum is guilty of revealing sufficient data about the warehouse and the vyrobnik of the living sum, as well as the clues on the manifestation of genetic modification of the nutritive (bilkiv).

    There is no reason for the general EP not to take revenge on the sufficient amount of fresh water necessary for securing good consumption of the sick in the country. Dobova need in rіdinі let you estimate yak 1 ml per 1 kcal. A large amount of energy cost of 1 kcal / ml will replace approximately 75% of the required water. To that, for the duration of the show to the interconnection of birth, the number of children who have been brought up to date by the patient leads to approximately 25% of the total amount of food.

    In the given hour, it is not necessary to go for an enteral meal of the sum, prepared from natural products, or it is recommended for a child to eat through the lack of balance and inadequacy of the needs of older patients.

  • Folding enteral feeding

    Prophylaxis accelerated є suvore dottrimannya rules for carrying out enteral feeding.

    Visoka frequency of accelerated enteral feeding is one of the main factors, which lasts a wide range of patients with critical ailments. Evidence of acceleration of the rate to frequent reduction of enteral feeding. For such a high frequency, the acceleration of enteral feeding is a whole lot of active reasons.

    • Enteral feeding is carried out in important categories of ailments, in all organs and systems of the body, including the gastrointestinal tract.
    • Enteral eating is necessary to deprive us of the ailment, for those who already have intolerance to natural eating for reasons.
    • Enteral food is not a natural food, but a piece, specially prepared sums.
    • Classification of accelerated enteral feeding

      The following are the types of acceleration of the enteral feeding:

      • Infectious diseases (aspirating pneumonia, sinusitis, otitis, infection of wounds with gastroenterostomy).
      • Gastrointestinal acceleration (diarrhea, fix, abdominal swelling, regurgitation).
      • Metabolic acceleration (hyperglycemia, metabolic alkalosis, hypocaliemia, hypophosphatemia).

      The given classification does not include acceleration, it is connected with the technique of enteric feeding - self-extraction, migration and blockage of probes and tubes for feeding. In addition, gastrointestinal acceleration, such as regurgitation, can be treated with such infectious acceleration, such as pneumonia. Mostly the most frequent and significant ones.

      In literature, the frequency of early acceleration appears. A wide spread of data will be explained by the fact that there is no single diagnostic criterion for the designation of the same speed-up and speed-up protocol.

      • High surplus obsyagi - 25% -39%.
      • Constipation - 15.7% With trivial enteral malnutrition, the frequency of constipation can be reduced to 59%.
      • Diarrhea - 14.7% -21% (from 2 to 68%).
      • Abdominal pain - 13.2% -18.6%.
      • Blues - 12.2% -17.8%.
      • Regurgitation - 5.5%.
      • Aspiracy pneumonia - 2%. According to the authors, the frequency of aspiracy pneumonia is reported from 1 to 70 times.
  • About sterility in case of enteral feeding

    In the capacity of one of the transition of the enteral feeding before the parenteral one, it is not called the necessity of the sterility. However, it is necessary to remember, from one side, the sum for the enteral feeding є the ideal middle ground for the propagation of microorganisms from the other side, in the case of intensive mental therapy for all the intensive. It is not safe to become like the possibility of a sick person being infected with microorganisms from a living sum, so it’s rejection of endotoxin. It is necessary to take it up to the respect, that the enteral feeding should be carried out in bypassing the bactericidal bar of the oropharynx, as, as a rule, the enteral sum is not allowed to be processed slunk juice, Yakiy maє vyrazhenі bactericidal power. In the capacity of other supportive development of infectious factors, they call antibacterial therapy, adherence to immunity, adolescent infection acceleration and elimination.

    Great recommendations for keeping bacterial contamination є: victorious meals cooked on a cake of no more than 500 ml. The 1st victorian lasts no more than 8 years (for sterile factory razchiniv - 24 years). Practically in the literature, there are no experimentally grounded recommendations on the frequency of replacement of probes, microbes, and drips. It looks like a primed one, which for dribblers and mice should not be older than once every 24 years.

• parenteral feeding

  Parenteral nutrition (PP) is a special type of beneficial therapy, in case of any lively speech for replenishing energy, plastic vitrates and for the normal course of metabolic processes to be introduced into the body, without the middle of the intestinal tract. ...

  The essence of parenteral feeding of polyagons in the unhealthy organisms is all necessary for normal living with substrates, which take part in the regulation of protein, carbohydrate, fatty, water-electrolyte, vitamins and minerals.

  • Classification of parenteral feeding
    • Povny (totally) parenteral feeding.

      The additional (total) parenteral feeding will preserve the entire volume of additional consumer organisms in plastic and energetic substrates, as well as the creation of the necessary routine for communication processes.

    • Nepovne (chastkovo) parenteral feeding.

      Not completely (partly) parenteral feeding є by ancillary і is aimed at vibrating the deficiency of quiet ingredients, as well as being able to acquire those who cannot be provided with an enteral route. Not altogether parenterally grubbing is seen as a supplement to grubbing, when it is impossible to get stuck in a single probe or oral introduction of grubs.

    • Zm_shane piece of food.

      One piece of food is a combination of enteral and parenteral feeding in vipads, if they are not fertile.

  • Main department of parenteral feeding
    • Renovation and adaptation of water-electrolyte and acid-pool water.
    • Bezpechennya organizmu energetic and plastic substrates.
    • Provision of the organism with all the necessary vitamins, macro- and microelements.
  • Parenteral feeding concept

    Two basic concepts of PP have been broken up.

    1. "American Concept" - a system of hyperalimation according to S. Dudrick (1966) - it is possible to introduce different solutions in carbohydrates to electrolytes and to nitrogen.
    2. "The European concept", launched by A. Wretlind (1957), the introduction of plastic, carbohydrate and fatty substrates. The newest version is the concept of "three in one" (Solasson C, Joyeux H.; 1974), which includes all the necessary components of food (amino acids, monosaccharides, fat emulsion, electrolysis and energy consumption).

       In the rest of the rocks in Bagatioi counties, they began to use the method of parenteral feeding "all in one" with three-liter containers for mixing in one plastic bag of all Ingredients. In case of unpleasantness, the change of three-in-one solutions, the infusion of plastic and energetic substrates is guilty of being carried out in parallel (bazhano through a V-subdivision).

       In the rest of the rock, there are also ready-made sums of amino acids and fat emulsions. The overwhelming method is brought up to a minimum of manipulation with powers, to avenge lively speech, to change its information, to decrease the risk of hypeglicemia and hyperosmolar non-ketone comi. Shortcomings: gluing fatty particles and setting large globules, which may not be safe for a sick person, the problem of catheter occlusion is not violated, it is not possible that it can be safely stored in the refrigerator.

  • The basic principle of parenteral feeding
    • A quick ear of parenteral feeding.
    • Optimal term for parenteral feeding (until normal trophic status is restored).
    • Adequacy (balance) of parenteral feeding for the number of injected living words and the stage of their development.
  • Rules for parenteral feeding
    • Nutrient is to be administered in the form of adequate metabolic needs of the clitin, so that it is analogous to the entry of nutrients into the bloodstream for the passage of the enteric bar. As a matter of fact: bites are found in amino acids, fat - in fat emulsions, in carbohydrates - in monosaccharides.
    • It is necessary to take advantage of the added value of the introduction of livestock substrates.
    • Plastic and energetic substrates are to be introduced one hour. Obov'yazkove stasis of all indispensable nutrients.
    • Infusion of high-osmolar changes (especially in excess of 900 mosmol / l) is guilty of being carried out only in the central vein.
    • Infusion systems for PP change skin for 24 years.
    • When a repeated PP is carried out, the sum of glucose concentrates is included in the warehouse until it is viscous.
    • For a stable patient, the need for ridin should be 1 ml / kcal or 30 ml / kg of weight. With pathological camps, the need for water growth.
  • Shown before parenteral feeding

    When provedennі parenteral harchuvannya vazhlivo vrahovuvati scho in minds pripinennya abo obmezhennya nadhodzhennya pozhivnih rechovin ekzogennim Shlyakhov vstupaє in dіyu nayvazhlivіshy pristosuvalny mehanіzm: vitrachannya mobіlnih zapasіv vuglevodіv, zhirіv organіzmu i іntensivne rozscheplennya bіlka to amіnokislot of peretvorennyam їh away from vuglevodi. Such metabolic activity, being a collection of pre-social, non-protective life, in the long run to end up negatively associated with the interruption of all life processes. To do this, thoroughly criticize the consumer's body not for the rakhunok of the growth of vlast fabrics, but for the rakhunok of the exogenous hopefulness of the living rhymes.

    The main objective criterion for the intake of parenteral feeding є bends is a negative balance of nitrogen, which does not enter the coriguvati with the enteral route. The average amount of nitrogen injected in patients with a reanimation profile in the warehouse is from 15 to 32 g, which is reduced to 94-200 g of tissue paper or 375-800 g of textile tissue.

    The main indications before the PP can be divided into several groups:

    • The inconvenience of oral or enteral reception for a period of at least 7 days in a stable patient, or in a longer short term in a patient who is susceptible (a group of indications is impaired due to the impaired function of the shlunkovo-intestinal tract).
    • Variations of hypermetabolism, either because of the loss of a bottle, if only enterally eating is not allowed to fit in with the deficiency of nutrients (a classic butt of a disease).
    • The need for a time-consuming treatment of intestinal poisoning "mode of intestinal repair" (for example, with swelling colitis).
    • Shown before re-parenteral feeding

      Outside, parenteral feeding is shown in all types of diseases, if it is uncomfortable to take a natural route, or through a probe, to supervise more catabolic and anabolic processes, as well as a negative balance of nitrogen:

      • In the preoperative period in ailments with symptoms of general abnormal hunger in case of congestion of the slunk-intestinal tract in cases of functional abnormalities organic exercise from the damage of etching and resorption.
      • In the period of operation during the great operations on the organs of the black emptying or an accelerated leak (lack of anastomoses, fistulas, peritonitis, sepsis).
      • In the post-traumatic period (important conditions, many injuries).
      • With a hardened drop, there is a deteriorated synthesis (hyperthermia, lack of functions of the liver, nirok and in.).
      • Reanimation ailments, if ailments take a trivial hour not to come to you, or the activity of the intestinal tract is severely damaged (damage to the central nervous system, right, state of the art, comatose will become meager.).
      • With infectious diseases (cholera, dysentery).
      • In case of neuropsychic illnesses in anorexia, blues, vidmov and vid izhi.
  • Prototype indication before parenteral feeding
    • Absolute contraindication before PP
      • Period of shock, hypovolemia, electrolysis breakdowns.
      • Possibility of adequate enteral and oral feeding.
      • Allergic reactions to the components of parenteral feeding.
      • Vidmova sick (abo yogo opikun).
      • However, in some PPs I will not change the forecast of the disease.

      For those who are overwhelmed with the elements of PP, they can be victorious in the course of complex intensive therapy of patients.

    • Prototype okremich drugs for parenteral feeding

      The prototype is indicated until the consumption of medicinal products for parenteral feeding. pathological changes in organism, zumovleni with the main and supportive ailments.

      • In case of pecinous abnormalities, there are indications of amino acid amount and fatty emulsion.
      • With hyperlipidemia, lipoid nephrosis, signs of post-traumatic fatty embolism, myocardial infarction, cerebral congestion, diabetic diabetes, in the first 5-6 days of post-resuscitation blood protrusion and complications
      • It is necessary to take care of the ailments with allergic ailments.
  • Protection of parenteral feeding
    • infusion technology

      The main method of parenteral feeding is the introduction of energetic, plastic substrates and іnshіngredієntіv in the vessel bed: in the peripheral veins; in the central vein; into the recanalized umbilical vein; through the shunt; intra-arterial.

      When carrying out parenteral feeding, use infusion pumps, electronic regulators of the specks. Infusion is guilty of being carried out for 24 years with a shred of blood, or no more than 30-40 drops in a chilin. With such a speed, the introduction does not lead to the re-entanglement of the enzyme systems with nitrogen-mixed fluids.

    • access

      In the Danish hour, the availability of access options is available:

      • Through a peripheral vein (behind an auxiliary cannula or a catheter), it is possible to stagnate during the initiation of parenteral feeding in the term up to 1, or with additional PP.
      • Through the central vein behind the thigh-clock central catheters. In the middle of the central veins of the perevaga, there is a clavicular vein. The interior of the jar and the stegnova vein is about to be victorious.
      • Through the central vein behind the auxiliary central catheters.
      • Through alternative vascular access and post-vascular access (for example, peritoneal emptying).
  • Parenteral feeding regimes
    • Tsіlodobove introduction of lively midst.
    • Continued infusion (18-20 years).
    • Cyclic mode (infusion for 8-12 years).
  • Preparations for parenteral feeding
    • The main vimogas, which are presented before use for parenteral feeding

      Take advantage of the principles of parenteral feeding, and for parenteral feeding, consider the following:

      • Volodya lively life, so that mothers in their own warehouse all the necessary for the organism of speech in sufficient quantity and good spirits one to one.
      • Popovnuvati organizm in a native way, so as I will be richly supravodzhuvatsya vnevodnenny organizmu.
      • In the region, there is evidence of a detoxification and stimulating action in people who have been stagnant.
      • Bazhano substitutional and protishokova diyu stasovuvanih zasobіv.
      • It is necessary to change to a certain amount of money.
      • Warehouse storage is important - efficiency of storage.
    • Characteristics of inputs for parenteral feeding

      For the competent storage of living decisions for parenteral feeding, it is necessary to assess the characteristics:

      • Osmolarity of solutions for parenteral feeding.
      • Energy value of the solutions.
      • Between maximum infusions - the rate of infusion.
      • When planning parenteral nutrition, the necessary doses of energy substrates, minerals and vitamins are needed, and are used for additional consumption and energy supply.
    • Components of parenteral feeding

      The main warehouses of parenteral food were distributed in two groups: energy donors (products in carbohydrates - monosaccharides and alcohols and fat emulsions) and plastic materials donators (amino acids). Provide for parenteral feeding with the following components:

      • In carbohydrates and alcohols are the main energy sources for parenteral nutrition.
      • Sorbite (20%) and xylitic acid are formed as a supplement to dzherel energy with glucose and fatty emulsions.
      • Fat is the most effective energy substrate. Introduced at viglyadi fatty emulsions.
      • Bilki - є available storage part for stimulating tissues, blood, synthesis of proteohormones, enzymes.
      • Salt solutions: simple and folding, introduced for the normalization of water-electrolyte and acid-pool water.
      • Vitamin, microelements, anabolic hormones can also be included in the complex of parenteral nutrition.
    More details: Pharmacological group - Prepare for parenteral feeding.
  • Assessment of the patient's size, if necessary, for parenteral feeding

    When carrying out parenteral feeding, it is necessary to determine the individual characteristics of the sick person, the nature of the illness, the exchange of words, as well as the energy consumption of the organism.

    • Evaluation of feeding and control of the adequacy of parenteral feeding.

      I mark the type of that step for the destruction of food, and also consume it in the living room.

      Stan kharchuvannya in the rest of the rock to assess the status of trophic abnormal trophological status, how to look at the indicator physical development and health. Trophical shortage arises in the history of somatometric, laboratory and clinical and functional indicators.

      • Somatometric indicators are the most accessible and include measurement of body mass, shoulder circumference, skin fat folds and calculation of body mass index.
      • Laboratory tests.

        Syrovatkovy albumin. When the decrease is lower than 35 g / l, the number of accelerated increases by 4 times, the lethality is 6 times.

        Syrovatkovy transferin. Decrease in the reduction of visceral balance (norm 2 g / l or more).

        Excretion to creatine, sechovini, 3-methylgistidin (3-MG) with a cross. The change instead of creatine and 3-MG excreted from the section, depending on the deficiency of the ointment bottle. The ratio of 3-MG / creatine is shown directly to the metabolic processes in the direction of anabolism or catabolism and the effectiveness of parenteral malnutrition in the correction of blood deficiency (visualization in the 3rd section is 4.2 μM)

        Control of glucose concentration in the blood and in the section: increasing the sugar in the section and increasing the glucose concentration in the blood more than 2 g / l.

      • Clinical and functional indicators: lowering of tissue turmoil, the appearance of troughs, napryak and іn.
  • Control over the performance of parenteral feeding

    Parameters for the monitoring of homeostasis indicators during the repeated PP boulevard in Amsterdam in 1981

    Control is carried out over the camp of metabolism, the manifestation of infectious acceleration and efficiency of harassment. Such indicators, such as temperature, heart rate, arterial grip and frequency of dichotomy start in patients today. The value of the main laboratory indicators in unstable patients is mainly carried out 1-3 times per day, with the maintenance in the additional period of 1-3 times per week, with trivial PP - 1 time per day.

    It is especially important to be indicators that characterize the adequacy of the food - white (nitrogen of the seed, albumin and prothrombin hour), carbohydrate (

    Alternatively, parenteral feeding of vikoristovy is only in case of ill-feeling of the enteral (intestinal fistula due to significant visions, short bowel syndrome or malabsorption, intestinal laxity, etc.).

    Parenteral harchuvannya for vartisti in a kilka developed overturned enteral. When it is carried out, it is necessary to ensure the sterility and efficiency of the introduction of the ingredients, which are not connected with the singing technical difficulties. Parenteral feeding is enough for a few hours. Є Orders for those who parenterally eat can bring power immunity.

    In any case, during a general parenteral harassment, the onset of intestinal atrophy occurs - atrophy due to inactivity. Atrophy of mucous veins before її virazki, atrophy of secreting worms ’wedges up to the appearance of an enzymatic deficiency;

    Enteral food is more physiological. It's not about sterility. The sum for the enteral feeding is to revenge all the necessary components. Rozrakhunok Potebny in enteral feeding and the technique of its carrying out is significantly simpler, not for parenteral feeding. Enteral feeding allows the preparation of the intestinal tract in a normal physiological station, and it helps to get a lot of acceleration, which can be diagnosed with ailments in a critical state. Enteral maintenance of blood circulation in the intestine and normal connection of anastomoses during operations on the intestine. In such a rank, in all kinds of cases, if it is possible, the vibrating method of nutritional supplementation is guilty of getting used to enteral feeding.

Enteral feeding is a type of addictive or supplementary feeding with special sums, when it is soaked (if it is appropriate through the mouth, through a probe into the slurry or the intestines), the intestines are physiologically adequate, so that it is covered with an adequate shell. On the contrary, they develop parenteral feeding, with any amount of money it is introduced through a vein into the blood.

Ridke or harchuvannya through a probe (enteral harchuvannya) is also called an elementary or a harchuvannya of cosmonauts. There are about the wild sums of the warehouse, such as the bullets that were broken up for use in space. Because of the technology, it has become established in the development of special preparations for distilled food.

The basis of such an acceptable warehouse is the sum of products, such as slags (cottons, cakes, with good fabrics), Subdivided to a powder-like mill, balanced behind a chemical warehouse.

They have a place for small products from monomers, dimar and private polymers. Behind the physical and chemical mill - a lot of chastkovo reference, and chastkovo coloïdnі razchini. In addition to this port, you want to meet all the necessities for the living of food: wine, fat, carbohydrates, mineral salts, microelements and vitamins in the boundaries of physiological norms.

With a whole kind of food, the principle of mechanic goodness of the intestine is realized as much as possible. For some elementary children, food is consumed, and intolerance has been established to some of them (cereals, dairy products, others).

Infected the madness with the delicious tastes and with the appearance of the presence of the ballast speeches (klitkovini). In reality, in the confusion of the intestines, it is necessary to respect the stenoses (ulcers) of the small intestine, so as you can clog the intestinal lumen.

It is also meant, so called, elementary (low molecular) children. It’s easy to swallow the madness, as it gets wet at the upper part of the small intestine. The stench stagnates when the intestines are very hot, which is more intense, the more the process of getting wet will break down more.

In the elementary sums of speech, speech is presented in an already "digested" viglyad. For example, the block is in the view of amino acids. Such a camp of elements of robbing them is unacceptable for gusto.

In addition, it’s crazy because of the ample fat. The stench will get sick of the change.

If you get stuck enteral food?

Qia therapy is recognized in the period of a swollen zagostrennya in case of fiery intestinal diseases and in case of ailments of damaged skin.

In case of acute Crohn's ailments in children, it has been reported that the consumption of enteral feeding (elementary children) for 6-8 years is more effective, less corticosteroids (cortisone). To that, when the children of the Perevag are caught up, they see a day. There are no indications of efficiency for both low-molecular and high-molecular-weight drugs.

In pre-older people, it is not far beyond the reach of children to get over the cortisone therapy. In addition, I have grown up with less discipline and do not have to catch up with the suvorian children.

The Ministry of Health of the Russian Federation has broken down "Instructions for the organization of enteral feeding ..."

1. Bіlkovo-energetic lack in case of unhappiness of sickness of adequate proper nutrition of nutrition in a natural oral route.
2. New food, especially localized in the area of ​​the head, shoulder and slunk.
3. Disturbances of the central nervous system: I will become comatose, cerebrovascular insults or Parkinson's ailments, as a result of which a deterioration of the grub status develops.
4. Promeneva and chemotherapy for oncological illnesses.
5. Injury to the intestinal tract: Crohn's ailment, malabsorption syndrome, short bowel syndrome, chronic pancreatitis, swollen colitis, liver disease and gut disease.
6. Harchuvannya before the early period of operation.
7. Injury, medical problems, hospitals.
8. Folding of the operative period (fistula of the intestinal tract, sepsis, inability of the anastomoses).
9. Infectious disease.
10. Psychic problems: neuropsychic anorexia, the importance of depression.
11. Statements and chronicle radioactivity.

Prototype

At the same instruction there is a contraindication:

• intestinal imperfection;
• gostry pancreatitis;
• important form of malabsorption.

The principle of vibrating sums

Data on guidance from the instructions of the Ministry of Health of the Russian Federation.

The vibe of summons for adequate enteral feeding is guilty of the knowledge on the basis of clinical, instrumental and laboratory conditions of ailments, of tying with the character and heavy interruption of the disease and steps of preserving the function of the intestinal tract.

• With normal needs and preservation of the functions of the gastrointestinal tract, standard life-saving sums are recognized.
• In case of special needs in bills and energy or interchange of origin, a high-calorific life is recognized.
• Vigorous and one-year-old females need to acknowledge the lively sums that are assigned to the whole group.
• In case of critical and immunodeficient states, it is recognized that there is a lively sum with a high volume of biologically active protein, containing microelements, glutamine, arginine, omega-3 fatty acids.
• We are averse to type I and type II diabetes mellitus, which means a healthy amount of less fat and carbohydrates, which is to replace grubby fibers.
• In case of impaired lung functions, it is recognized that there is a lot of fat and low weight in carbohydrates.
• In case of deterioration of the functions of nirok, a lively sum is recognized with a rather high biological value and amino acids.
• In case of deterioration of the function of the stove, it is recognized that there is a lively sum with a low amount of aromatic amino acids and a high amount of amino acids with a lance.
• In case of partial impairment of the functions of the intestinal tract, it is recognized that living sums on the basis of oligopeptides are recognized.

Harchuvannya rules

When such a system is victorious, there is a series of rules that follow.

• Fix it with a small amount of money (250-500 ml per day). With the harmony of portability, it is common to grow.
• She is guilty of accepting every now and then, using other coats through the tube.
• In case of food intolerance, I respect the presence of many kinds of elements in the warehouse of the sum (for example, lactose, gluten).
• In case of an interdependent child of animals, I respect the balance of food.
• It is necessary to supplement the life of the child.
• Cooking summ can take more than 24 years. Take it in the refrigerator, then drink it before implantation.
• In case of depleted soaked fat, it is necessary to take in the fat of the sum, or the sum of the easily digestible fats.
• In case of severe damage to moisture, it is recommended to use a low molecular weight diet.
• If all the same intolerance is manifested (diarrhea, boring and bluishness is accelerated), then a few changes in the number of happy lives and changes were interrupted by the reception. May be brown and replace high molecular weight for low molecular weight.

Yak zasosovyut sumіshі?

Sumy breeding with boiled water and vikoristovy to eat for food in the middle, as well as in the middle of the plant, in the middle of the plant (we are seriously ill during the period of sharp fire, often with Crohn's ailment), for as before the intestine was defunct in the midst of life anemia, hypoproteinemia.

Regardless of the triviality of the course of enteral feeding and saving the functional camp of the small intestinal tract, see the advances introduced by the elderly sums:

• Vzhivannya zhivanny sumіshi viglyadі vodoїv through a tube with other kovtki;
• Probe feeding for the additional help of nasogastric, nasoduodenal, nasojejunal and double-channel probes (for aspirating the intestinal slurry and intravenous introduction of the elderly, it is important for the sick).
• Shlyakhom overlay stoma: gastro-, duodeno, jejuno-, iliostom. Stomy can be applied by surgical or endoscopic methods.

When you take in all the middle of the disease (gozilat, Therapy), diarrhea can become stricken in connection with the appearance of hyperosmolarity in the place of the intestine due to the implantation of the sum. Introduced through a probe, it is easy to carry it well, so that it can enter the intestine in small portions. Naybіlsh sphivanі onset sumіshі: Izocal, Kozilat, Terapin, Enshur, Alfarek і ін.

If you use parenteral feeding?

In especially important cases, for example, with great stenosis, fistulas, it is necessary to remove the intestine during the process of etching. In cich vipadkah, it is necessary to inject infusion into a vein. At the same time, the heat in the shlunkovo-intestinal tract quickly subsides, so it’s like there’s no navantazhennya.

In addition, the whole therapy is meant for the purpose of improving the balance of grub speeches, we are sick with important damages when we get wet (for example, for a great resection of the small intestine) and fired up in vipadkakh, a nasty zagalny camp, anorexia, with repeated vomiting.

However, in case of trivial parenteral (internal) harchuvanny, there is a change in the mucous membrane of the small intestine (villi atrophy). That is why it is not necessary to go to the parenteral feeding after the vivity and the power of the non-neteral feeding.

When going out from parenteral feeding, the patient is guilty of taking small amounts of small amounts of small amounts of small amounts of money, and more of the mucus membrane of the intestine.

See parenteral feeding

• Nepovne (chastkovo) parenteral feeding.
• The additional (total) parenteral feeding will preserve the entire volume of additional consumer organisms in plastic and energetic substrates, as well as the creation of the necessary routine for communication processes.

Nepovne (chastkovo) parenteral feeding

The aim of the preoccupation with the auxiliary is aimed at replenishing quiet Ingredients, hoping, for the mastery of those who cannot be taken care of by the enteral route. In addition, it’s like a dodatkove, it’s like it’s stuck in the mouths of the grub’s introduced through a probe or orally.

Preparations for parenteral feeding

Є to supply a wide range of drugs for parenteral feeding.
For the introduction of nitrogen into the body, such as the range of amino acids:

The range of amino acids without additives:

• aminosteril II (concentration in new amino acids in the eye, ale vin є hypertonic growth, to the same extent thrombophlebitis);
• aminosteril III (in a new concentration of amino acids, it is not possible to produce thrombophlebitis in a lower concentration of amino acids, since it is physiological);
• Wamin-9, Wamin-14, Wamin-18, Intrafuzil, Poliamin.

The range of amino acids combined:

• the range of amino acids and ions: Vamin-N, Infezol-40, Aminosteril KE 10%;
• the range of amino acids, carbohydrates and ions: Aminoplasmal 10%, Vamin-glucose;
• the solution of amino acids with ions and vitamins: aminosteril L 600, L 800, aminosteril KE forte.

For the introduction of fat and the maintenance of an energetic balance, the use of fat emulsions: intralipid 10%, 20%, 30%, lipovenosis 10%, 20%, lipofundin MCT / LST.

Supplements are also used before preparations for parenteral feeding:

• additives with microelements: Addamel;
• additives with vitamins: Vitalipid of growths, soluvit.

The stock of races for parenteral feeding also includes 5% glucose solutions such as dzherelo in carbohydrates, vitamins, calcium salts, calcium, magnesium and sodium. The need for food consumption is rorakhoyutyat fallen from mass tila for the formula of balanced food.

Enteral and parenteral eating - is it more beautiful?

Reversals of enteral feeding before parenteral:

• the natural form of kharchuvannya;
• cheaper;
• less acceleration;
• It’s easier to turn around until the very products, so as the atrophy of the villi is visible on the day.

The main objective criterion for the intake of PP є bends is a negative balance of nitrogen, which does not compensate for the enteral path. Enteral harchuvannya is more beautiful, for wash, if it is in the form of changes in metabolism. As soon as it appears, it is necessary to eat parenterally.

Shown to PP can be absolute and definite.

absolute show They come out in quiet vapors, if the body in the minds of the mind is about the abysmal intercourse, the hopefulness of the living speeches. Such metabolism is straightforward, poklikana to prevent the health of the body, quickly consumes its first priority and starts negatively for interrupting all life processes.

Absolute indications before the detection of PP in trauma and surgical disabilities:

1. Important mechanical traumas, gnarly-ignited organs of empty emptying in the active phase of the process;

2. The catabolic reaction is widespread in case of great problems, combined injuries, severe septic-septic processes;

3. Risk of obsession or the discomfort of oral feeding as a result of the deterioration of the function of the herbal tract of traumatic, ignition abnormal functional walking ( chronic diarrhea, Short bowel syndrome, pancreatic necrosis and in.);

4. Timchasov vyklyuchennya shlunkovo-intestinal tract for injuries and surgical engagement on the stravohode, slunker, intestines, in the area of ​​hepatopancreatoduodenal zone;

5. The appearance in children of a thoracic lymph duct with a line of chylothorax.

shown until the sign of PP is found, if the enteric path is taken care of, however, metabolic disorders are not suspected (sepsis, intestinal damage, intestinal fistulas).

In quiet vipadkah, since mova ide about the absolute is shown, parenteral feeding will be guilty, tobto. E. Include all the necessary engineering: plastic, energy, electrical and in. In case of certain indications of PP, it may be incomprehensible: the nitrogen content of the speech should be administered parenterally, and the ingredinteral solution should be administered enterally.

PP pidrozdіlyaєtsya on 3 views: outside, part, dodatkov.

Outside PP - the internal introduction of all the necessary for the safety of the living organisms of speech in numbers, which meet the needs of the child.

Chastkovo PP - the introduction of such a number of all the words necessary for the prevention of metabolic processes, which will add to the lack of input by the other routes (through the mouth, through the probe).

Dodatkovo PP - the introduction of additional living words when the child's body is consumed in them.

From the point of view of biochemistry, the main insight of PP from a fatty field is that, for the first phase of transformation of polymers of grub words in monomerism, for the first time, it is not necessary to carry out a lot of fat in the diet. Intrinsic metabolism of monomers in living speech, which was needed in the body by means of a parenteral path, or parenterally, there are not any differences.

Parenteral feeding systems.

In the given hour, two fundamental development systems will be stagnant: balanced PP and hyperactivity, or the Dadrika system. In the first case, when parenteral feeding is carried out, all the necessary living words, amino acids, carbohydrates (glucose), fat are injected into the child's organism; In the last resort, for the replenishment of the energy needs of the child's body, it is necessary to inject a dose of glucose, which will change the normal requirement by 2 times.

Components of parenteral feeding.

In the carbohydrate.

All processes of biosynthesis in organisms є reactions, which counter to the life of energy. It has been established that 150-200 kcal are required for the synthesis of a protein in organisms on the dermal gram of nitrogen of various substances. Dzherelami energy є in the main carbohydrates and fat. The organisms are protected with the necessary energy, the stench preserves the endogenous block from the burning, and immediately produces a nitrogen-saving effect. On dermal supplementation, 10 kcal is injected at the viglyad of energetic substance with nitrogen change, changes by 3-15 mg. Nitrogen-saving effect of dzherel energy initiation is manifested in case of proper organismism not less than 600 kcal for doba.

It is quite obvious that in case of parenteral feeding, it is necessary to ensure that there is sufficient supply in the organism of speech, which is importantly with energy. For a wide range of vicious substances, use preparations in carbohydrates in water-based liquors and alcohols, as well as fats in the form of fatty emulsions.

I’ll look at how the main role of carbohydrates in the nutritional needs in satisfying energy needs is impossible to ignore the fact that the stench may have a plastic meaning that enter the storehouse of organisms in the activity of structural elements of chemical substances. Dobova demand for carbohydrates in children is presented in table. 20.2.

glucoseє the most widespread in nature with a six-carbohydrate monosaccharide. Molecules D-glucose serve as the main species of the cultic "fire" and act in the role of awake blocks or, alternatively, the most extended oligo- and polysaccharides. Glucose is a classic form of an energetic substrate for parenteral feeding. The zavdyak is that, that otrimanі high-purified sorts of glucose, do not wick side reactions Preparing them for any kind of breakdown, sterilization, cleaning does not reveal any technical difficulties. Even before the end of the day, the organism's tolerance to this natural product is even worse (it is practically not possible to prevent allergic, non-toxic reactions, and the drug isn’t only lively, but it’s not toxic to the brain), then it’s often for infusion therapy.

An important specialty of glucose is those that oxidize in the body to residual products - in carbon dioxide and water. Glucose is one of the storage parts of RNA molecules and is generally used directly before the synthesis of the protein. The introduction of glucose allows you to preserve the loss of blood. One hour glucose is needed for anabolism for the exchange of amino acids, which is, for the newest, for the increase in the increased production of insulin in the form of a nutritive plant in the form of an increase in the level of glucose in the blood. With the introduction of glucose, the same effect is observed as with the introduction of insulin - the process of incorporating amino acids into the ointment bottles is strengthened when the liver is replaced by amino acids for one hour. For many reasons, with the introduction of a large amount of glucose, it follows that the introduction of amino acids should be made more viscous at once. The anabolic effect of glucose in relation to the introduction of amino acids is manifested in the case of alcoholic injections, even if it is allowed to be consumed at 4-5 years of age, the nitrogen-saving effect may not appear. The introduction of glucose at once with insulin has a greater strong anabolic effect, but not separately. In the presence of insulin, glucose is efficiently in advance of the development of ketoacidosis and normal growth of calcium and sodium in the body. The reduction of glucose 5% is lower than the isotonic blood plasma and it is widely used to improve the water balance, food, disintoxication and other purposes. Unfortunately, there is a small amount of glucose in a small amount of insignificant infusion on the caloric balance of the body. A liter is given a total of 200 kcal, and in order to preserve the body with the necessary energy, you need to enter 10 liters of such a range, which is unacceptable from a physiological point of view.

The energy value of glucose products is increased, increased by a concentration of up to 10-50%. Hypertonic glucose levels are often applied to the venous wall, producing phlebitis, and in connection with it, do not inject 10% into the peripheral veins.

In the rest of the rocky, filling up a wide extension of the method is so called hyperactivity glucose, in which case the parenteral feeding is carried out with high-concentration glucose (30-50%), it should be administered through continuous catheters, held in the basin of the upper empty vein. In case of glucose infusion, the upper interdose is not guilty of overshooting 1.5 g / kg / add.

It is important to carry out combined parenteral feeding with hypertonic glucose and nitrogenous drugs. In order to increase the hyperglycemia with the introduction of significant amounts of glucose in hypertensive patients, inject insulin with a dose of 1 OD per 4-5 g of glucose.

In mіru nakopichennya sposterezhen schodo zastosuvannya gіperalіmentatsіya z'yasuvalosya scho tsogo vikoristannya monosaccharide in yakostі єdinogo nonprotein dzherela energії pogіrshuє metabolіchnu camp pechіnki, viklikaє zbіdnennya її amіnokislotami, znizhuє іntensivnіst synthesis albumіnu, will only be sold to zhirovoї іnfіltratsії pechіnki. In connection with the cimes, there is a great urgency of nutrition about the vyshukuvannya of those carbohydrates, an adjunct for parenteral feeding.

fructose(Levulose, fruit tsukor) є monosaccharide, which should lie up to a group of hexoses. For high-quality glucose. Fructose is screwed on to yak speech for parenteral feeding in conjunction with a number of positive features. In the organism of fructose, it can be phosphorylated without insulin and exchange, in cob stages, there is a posture of fallowness due to the hormone. Fructose is mainly metabolized in the liver, and the metabolism of products (glucose, lactic acid and lipid) can be utilized by other tissues. Fructose is faster, less glucose, eliminuyutsya from the court and to spend less. With the introduction of fructose, the establishment of a glucogen in the liver is more efficient, there is more energy protein-preserving and hepatoprotective effect. Especially vivid is the introduction of fructose in post-aggressive periods (surgery, surgery, trauma, shock), if, as it happens, the glucose level drops rapidly and glucose levels can be promoted.

At the same hour, it will mean that glucogenosynthesis in meat with the introduction of fructose is more powerful than with the introduction of glucose. The independence of the exchange of fructose from the insulin is not correct, since the main mass of fructose is converted into glucose into the oven, the exchange of which is stored in the form of insulin. When fructose is introduced, it grows instead of glucose in the blood and blood glucose. Re-planting with fructose, like other monosaccharides, prevents unpleasant inheritances. Zokrem, through the insecurity of lactation and hyperuricemia, in the basis of which is the vitraction of ATP on phosphorylated zucru, fructose can be administered in small doses.

For infusions, take 10% fructose range. Naturally, at such a concentration, the amount of energy delivered to the body is somewhat small and cannot be of independent significance.

Fructose is consumed in additives until some preparations and included in the warehouse of rich component solutions for parenteral feeding. The rationality of the stem of the remaining ones is based on the fact that the utilization of the substances should be taken up to the storehouse of carbohydrates (monosaccharides and alcohols) in different ways, so that in the case of high calorie rejuvenation, the elimination of the oxidizing substances is allowed. The versatility of industrial nutrition and viscosity The versatility of fructose is greater than the widespread use in the practice of parenteral nutrition. The dosage of fructose is 0.25 g / kg / year and not more than 1.5 g / kg / add.

sorbitol- six-atomic sucrose alcohols, for the energetic value of glucose and fructose. In organism, it is established in the case of reconstituted glucose from the sorbite dehydrogenase to fructose, which is a natural product. It can be utilized in the body without the participation of insulin, at the connection with the indications in case of deterioration in carbohydrate metabolism. It is necessary, however, to respect that the exchange of the sorbitol in the body must be taken into the fructose plant, as it is often converted into glucose, however, the neutrality of utilization from the insulin is not absolute.

Antiketogenic sorbitol is also tied, apparently, to its transformation in fructose and glucose. The dose for a single injection is 0.5 - 2.0 g / kg of oil. To eliminate the osmodiuretic effect, the drug should be injected strumminally, in the same droplets - dropwise from shvidkistyu 20-40 drops for 1 min. The frequency of local thrombophlebitis in the presence of sorbite velmi is insignificant, perhaps it is possible to explain that the pH of the thrombophlebitis is close to neutral - 5.8-6.0. For parenteral feeding, the dosage is 5-6%, i.e., approximately izotonic dosage of sorbitol. Rozchin can be introduced into a combination with other means for parenteral feeding - alcoholic hydrolysates, amino acids sums, fat emulsions, and monosugar ranges. It means that the solution to the sorbitol will reduce the rheological power of the blood, prevent the aggregation of erythrocytes, change the tissue hypoxia, and inflate the normal flow to the hemostasis system.

With the infusion of hypertonic changes in sorbitol with great swiftness, we have an osmodiuretic effect, analogous to Manita, i.e. E. nirkovy tubulesі pidsilu dіures. For stimulation of dyuresis, it is necessary to consume 20% of sorbitol, which is to inject internally strumenevium at a dose of 1-2 g / kg of mass. Hypertensive (20%) drug stasis is also used to improve peristalsis in case of intestinal paresis. At the same time, it is administered in drops of 50-100 ml of skin 6-8 years before lіkuvalnogo efectu... Sorbitol Ned with amino acids of the so-called Maylard reaction (the establishment of toxic spoluks), in connection with which it is often vicious as a caloric supplement to the sum of amino acids, fat emulsions, and a component of folding carbohydrates, glucose compounds, . NS.

Ethyl alcohol(Ethanol) creates a history of internal storage for livelihood and personal goals.

The calorific value of 1 g of speech becomes 7.1 kcal, i.e. Significantly more, lower in carbohydrates. Yak vikhidny product zasosovuyt medicinal 96% ethyl alcohol. Intra-intravenously inject water solution with alcohol in a concentration of 5 to 30%. In organism, ethylovium alcohol is oxidized mainly in ovens, included in the Krebs cycle. In the middle, up to 10% ethanol can be transported from the cross section and 50% by the lungs. Dispose of wine to finish quickly, protesting to the extent of being stuck in children.

xyliteє polyalcohol with antiketogenic effect, metabolizes directly as insulin and does not spoil diuretic activity. Win vikoristovuєtsya in the quality of additives to amino acids. As a result of a special method of degradation of the pentose-phosphate cycle, xylitol is independently of glucose-6-phosphate dehydrogenase;

For a normal feeding of babies, it should be consumed in protein. Deficiency stagnation before and after the population can be severely affected by the development of the central nervous system. Minimally safe amount of food for parenteral nutrition, necessary for children of a healthy diet, are presented in table. 20.3

Amino acids. Biosynthesis of blood cells is the leading rank in the ribosomes of the kin and is under the control of genes, which used an element of deoxyribonucleic acid, which is the genetic information, which is the origin of the human genotype. As of now, the last information will be given to the amino acids of polypeptide lancers. The quantity of amino acids in the molecule of a bottle and the order of its growth begins with organo-tissue, types, individual power and specificity of the bottles.

As it is seen, taken from foreign alien cells in the process of etching, they are split into amino acids and the simplest peptides, and in this form are absorbed by the intestines, and then come into the blood and transported in the tissue to de-vixose. With parenteral administration of amino acids, a different stage of etching of bile acids is created in pieces, and the most appropriate in the blood of products of intra-intestinal cleavage. It is a fact that all the bottles are prompted and synthesized in the cells only with amino acids, and the theoretical treatment of monomeric monomeric food with amino acids. Introduced parenteral amino acids to the organism of the building vikoristovuvati for the creation of vlast white structures and in the whole introduced stench є with an adequate replacement of the natural wine consumption.

Amino acid residues - nitrogenous speech that serve as the main source of organic nitrogen absorbed by the organism, parenteral feeding with drugs, which is taken to revenge, is taken to use nitrogenous parenteral feeding. Qia name nabulo expanded yak synonymic parenteral bicarbonate.

For nitrogenous parenteral feeding, in the Danish hour, it is necessary to consume alcoholic hydrolyzate and synthetic sums of crystalline amino acids. Potentially є hydrolyzate, which can be stored in a warehouse of a new set of amino acids, especially all essential amino acids. Introduce electrolysis to the warehouse of white hydrolysis devices for securing the normalization of the flow for the water-electrolytic exchange. At the warehouses, during the day, preparations are made in amino acid sums of the amount of money. The proponation has been made for the characteristic of the total amount of essential and replacement amino acids H / O, which represents a part of the essential (H) nitrogen in the non-essential (O) nitrogen (in the earth literature E / T). The high value of the performance N / A is necessary for parenteral feeding of children and in the presence of ailments. Yaksho same parenteral feeding is carried out to supplement a slightly damaged nitrogen balance, the H / O value can be lower. However, at the same time, with the same values ​​of N / A, the amount of amino acids in the preparations can be cheap, but the efficiency is not sufficient for the nutritional awareness of the anabolic efficacy of the drug and the indication for the indication for the preparation.

Yak rule in modern drugs The sum of amino acids for parenteral feeding includes a semi-substitute amino acid - arginin and histidine. Well, if there are substitute amino acids, then it is possible to adapt options with the inclusion of one additional set of substituted amino acids.

A lot of the authors give rise to the great value of histidine, which is an indispensable amino acid for children and ailments from uremia, which reduces the level of excess nitrogen in the blood. It is especially significant to be included in the sum of the arginine and those of the urine formation intermediators, which will help to develop the hypermonia. I think that alanine and proline are behind the step of indispensability, but they have put the order with arginine and histidine. Proline spriyak bilsh quick fire wounds. In the organism of ailing ailments, the need for amino acids is reduced, and, perhaps, there is a lack of adequate amino acids.

The warehouse of amino acid solutions also includes energy (sorbitol, xylitol) and electricity. It is especially important to get some calories and magnesium, a bit of a stench, head clinker cations, and are necessary for the "budding" fabric.

Seemingly, it’s not just a deficiency, but the surplus of alcoholic consumption is a negative inheritance for the body. The introduction of a large amount of amino acids leads to the reintroduction of the existing catabolic and anabolic enzyme systems to the body and accumulation of end products in nitrogenous metabolism (amicos, those that are unstable for nitrogen metabolism)

Moreover, in case of parenteral feeding, it is practically impossible to introduce a large number of amino acids into the body. Such a mind є the need for a general introduction, so as not to suffer aminoaciduria, aminoaciduria, and not to safely overwhelm the court bed by a child.

Practically, it is unwise to achieve an ideal balance of amino acids in the range for parenteral feeding; To that in pererakhunks, amino acids are injected into the washing unit and for experimental installations with a coefficient of 1.23.

Dzherela fat.

Preparation of fat є highly dispersed emulsion of neutral fats (triglycerides) in water. In the body, the stench is included in the exchange processes and vykoristoyuyutsya yak rich dzherelo energy. 1 g of fat, when burned in the body, equals 9.3 Kcal of energy. Dobova demand in fats with balanced parenteral hypertension in children is presented in table. 20.4.

The size of fatty particles is even smaller, as a rule, not more than 0.5 microns - as natural chylomicroni. Fat emulsion is a valuable essential fatty acid essential oil, which is especially important in weak and young children. The presence of glucerin in fatty emulsions will not give an izotone and an antiketogenic effect. Fat supplies essential fatty acids, especially linoleic and lenolenic acids, which improve the functional health of cell membranes and stimulate the healing of wounds. The concentration of fat emulsion in viglyadas is 10-20% of the calorific value of 1.1 and 2 Kcal / ml, as appropriate. Recommended doses of fat emulsions:

a) 5-10 ml / kg per 10 kg of oil,

b) 2.5-5 on the offensive 10 kg of oil up to 20 kg,

c) 1.25-2.5 ml / kg per skin kilogram of oil for 20 kg.

Maximum dobova dose 4 g / kg.

For the introduction of fatty emulsions, a Y-like connection of the venous catheter and infusion systems should be used. Fat emulsion is injected in one amount, glucose-amino acid solution with electrolytes is injected in the same amount. Tsya vimoga is necessary for the change in the hour of the change in fat emulsions from other preparations, since at the same time the structure of fat in the emulsion can change.