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Chế độ này cần được quản lý trong khoảng thời gian 12hour, tốt hơn thông qua một dòng Hickman. Nó phải cung cấp sau đây: • calo 40 kcal / kg trọng lượng cơ thể • nitơ 300 mg / kg trọng lượng cơ thể • vitamin, nguyên tố vi lượng và chất điện giải. | 114 8 UPPER GASTROINTESTINAL SURGERY minimum is advocated. A second look operation should be performed within 24-48 hours to allow demarcation of the ischaemic region. Early treatment includes total parenteral nutrition control of diarrhoea fluid and electrolyte replacement. Total Parenteral Nutrition The regime should be administered over a 12hour period preferably via a Hickman line. It must provide the following calorie 40 kcal kg body weight nitrogen 300 mg kg body weight vitamins trace elements and electrolytes. Fluid and Electrolytes Fluid loss in excess of 5 litres day is not uncommon in the early period. Strict input and output records must be maintained and replacement of the losses must be instituted. H2 blockers or proton pump inhibitors are useful in reducing gastric secretion and by implication the need for nasogastric tube. Diarrhoea may be controlled by judicious use of antidiarrhoeal agents e.g. loperamide codeine Lomotil. These agents inhibit gut motility thereby worsening ileus. Reintroduction of Oral Feeding When adaptation has occurred usually 4-6 weeks after the resection oral diet can be reintroduced in those with adequate length of residual small bowel. In those with residual length greater than 1 m normal or near-normal oral diet can be commenced but these patients are unlikely to have the normal number and consistency of stool. In those with less than 100 cm of residual bowel long-term enteral feeding is required. Commonly enteral feeding is commenced gradually initially in iso-osmolar concentration. Afterwards either an elemental Vivonex or polymeric feed Ensure Isocal is introduced. Enteral feeding is administered via a nasogastric tube and gradually increased to full strength. Milk products should be avoided as they worsen the diarrhoea. During the early period of introduction of enteral feeds diarrhoea is a significant problem and often requires treatment with antidiar-rhoeal agents. Somatostatin may be useful in those with intractable