猫肠道强饲和总肠外营养应用feeding tube placement

ClinicofSmallAnimalLudwigilianUniversityofApplicationsofenteralforcefeedingandtotalparenteralnutritionincatsħĵ肠Ƣ强饲d总肠y营.ĵ应StefanClinicofSmallAnimalLudwigilianUniversityof principlesofenteralandparenteralnutritionclinicalimportance肠/N肠y营.ĵK则—临ƫƌ³patientselection¶ĭfeedingtechniques饲hÚadequaterouteofadministrationƒ够ĵ饲hƝdifferentfeedingtubes&placingXĵ饲œ&ÕŜÚcareoffeedingtubes饲œ护feedingplan饲h计specialfeaturesofparenteralnutrition肠y营.ĵģClinicofSmallAnimalLudwigilianUniversityofCase DSHĽă9years9spayed绝ŧƱHistoryıT

inflammatoryboweldiseasediagnosed1yearago诊Ù5г肠Ƣİıñvomitingandanorexiastarted2weeksb5现aZd厌ƵIJ-prednisolonetreatment泼ñ龙ċ疗$lethargyandanorexiaprogresseduntil ĹçiĻN厌ƵƜþBhistoryıT(2livesin-andĪďn/-çLvaccination)Į:currentƖèworming驱ƆcurrentƖèphysical ødepressedĥenlargedabdomenŵƤuyellowskinandĶŤNŖŸƺproblemlistĥ19●●●●CBCƈ细UnitsMŝžredbloodcells红细x5-Hemoglobinƈ红Ƈ5.6–0.3-Plaetsƈx180-LeucocytesĴ细x6-x0.04--mcsx1--band ³íx0--seg. ³6x3--EosinophilsiƧ³x0.04--Basophilsiŀx0-remarks备enzymesUnitsMŝžASTƎ0-0–APŀ³ŁƧ0-APresistantŀ³ŁƧ酶Å0GLDHƎąƧŲ氢0--GTƎą酰转ņ0–Cholinesteraseũŀ酯2280--Amylaseēŕ0-LipaseŰŦ0- ƧŲ氢0-CKŢƧĝ0-stratesUnitsreferencerangeMŝžBilirubinũ红0-NH30-SBA{Ə4ư0-Cholesterolũmƨ1.8-TriglyceridesĩĊ Ƨ0.57-totalprotein总Ƈ57-AlbuminĴƇĴ26-BUNƈĖŚ5-CreatinineŢ0-GlucoseƄƂŘ3.7-Fructosamineąrô0-单referenceMŝžP0.97-Cl100-Na146-K3.5-Ca2.3-Fe12.5–0.6-furtherexaminationĕ*abdominalultrasoundŵƤƑwliverţenlargeduhomogenoushyperechogenicjwobileductsnotdilatedandgallbladernotũƢé扩张ŷŭžéuEnteral/parenteralnutrition肠ƢŨ肠y营Clinicalrelevance临Ÿĺ,assuresenergyrequirementsĿ"ůƬƲĈfacilitatesrecovery进µpreservesintestinalstructure&functionÊ肠Ƣ结óNA(enteralnutrition肠营.decreasesintestinalpermeabilityforbacteria&toxins3肠Ƣ对细ƁdĂŚĵƛ过³(enteralnutrition肠营. petenceu强)ĮLoCW,WalkerWA.NutrRev1989,47:193.ChandraRK.NutritionReviews1981,39:225-231.Enteral/parenteralnutritionIndications肠ƢŨ肠y营.ƙ应证厌ƵƑ>

3–5days2dayssevereunderlyingdisease严ƫĵĜnİ sepsis败ƈIJ,peritonitisŵŸĞ,pancreatitisŬŶĞÛÓƍ?¾Aů¤严ƫĵůƬ¾ƇĴ丢Enteral/parenteralnutrition肠Ƣ/肠y营FirstthoughtsƶƌŝintactGItract?Ũ肠Ƣã×WithfunctionalGItractALWAYSpursueenteralnutrition!Ũ肠Aůýšƌ ī肠/营.ǁProƽsofenteralnutrition肠/营.ĵ优preservesintestinalstructure&"护肠ƢAůd结complicationsless Ž费Enteral/parenteralnutrition肠肠y营Firstthoughtsƶƌŝ¶ĭ稳¾çƹƩ风险nasoesophagealtubeƻƵœ饲peripheralparenteralnutritionybĵ肠y营esophagealƵœ,gastricŨDŽPEG经Ķ/镜ŨƠ术jejunostomytubeʼn肠+centralvenouscatheter}Ƴű导Enteral/parenteralnutrition肠肠y营Indicationsƙ应hepaticlipidosisŰŦţprogressiveliverduetofattydegenerationof ţ细ūŰ质ƭƍ¦Ɛĵ渐Ɖ³ţƋincitingcauses诱发Kstress应ĝ,otherdiseases İ (esp.anorexia厌+/-obesecatsťŪSymptomsIJĥlethargyiĻ,jaundiceƺį,anorexia厌ƵweightlossƫEnteral/parenteralnutrition肠肠y营Indicationsƙ应patientswithobviousreasonsforprolongedçà显Kk导Ż长è厌Ƶĵ¶neurologicpatientsçŃ经³İıĵ¶traumatizedpatientsP ĵ¶severelydiseasedpatients¶ç严ƫİıĵ动Enteral/parenteralnutrition肠肠y营Indicationsƙ应upperGItractƴAů³đEƢ6headtrauma头ƤEsophagitisƵœĞstenoticesophagusƵœĦŋesophagealƵœƕ动Examplesofenteralnutrition肠/营 Ũ经Ķ/ŨƠijjejunostomytubeʼn肠NasoesophagealtubeƻƵƢ饲 noanesthesianeededƲƹrarecomplications现发canberemovedimmedia yS 时ÑNasoesophagealtubeƻƵƢ饲short-termnutritionĽè营.(<10days|)healthy ,%¢ĵƻnasopharynxƻfƤ,VomitusaComaáƘabsentgagreflexfOđNasoesophagealtubeƻƵœ饲MaterialîØ:polyurethaneşąŰ,siliconeľ树Űpolyvinylchlorideşmeasuretubelength测Ƭ饲œ长 (nosetiptorib;markƻŐ8šƷdž标记tubeshouldendinlowerthirdofesophagus饲œ终ünƵœĵ DiameterŬ:app1.52mm约1.5-2Ąlidocainesolution/dropsinnose:zHk/ěƻ forincooperativeanimals对ƥ Wĵ动Ģsedationwith +midazolameiv./im.ī氯Ů酮de唑Ƴű¾ŢŠč进Ɖ镇ƳNasoesophagealtubeƻƵœ饲headinphysiologicposition头Ƥ"ÊýĪĨinserttubeventromedially( 侧Ð导œǂ²Ɵǁǃpushforwardgentlywaitfordeglutitionª>轻轻Ï进DŽő\fsecuretube(suture,glue)m饲œǂ缝checkcorrectlocation检查ý (inofcardia!n贲门ǁaspirate10mlNaCl,X-raysÇ_DŽ10mlNaCl,X线EsophagealtubeƵœÐœ优 immediateŌJ营 补easytoremoveÚÑEsophagealtubeƵœÐœlong-termnutrition长è营diseasedƻŴ/QŴçİnoesophagealdiseaseÝƵœİVomitusaComaáƘnodeglutitionÝfOEsophagealtubeƵœ饲MaterialîØ:polyurethaneşąŰ,siliconeľŰ,PVCşmeasuretubelength(midneckto8thrib;测Ƭ饲œ长 ǂ颈Ƥ;Ő8šƷdž标记diameterapp4mmŬDž约shortanesthesianecessaryƲƌĽ时间rightlateralrecumbencyU侧Ɠshaveandsurgicallyprepleftneck侧颈Ƥ=进ƉÀ术2EsophagealtubeƵœ饲esophagus§onmidneckpushclamptipagainst 颈Ƥī钳 Ķcutthroughskin&muscle7£ĶŤdŢpushclampforward,openupesophageal继续[>Ï进钳DŽ£Ƶœvgrasptubepullthrough 饲œDŽŊQ (secureend!mêŎǁ)pushtubetipbackintoesophagus饲œ头ƤÐƵEsophagealtubeƵœ饲pushasfaraspossibleintoƬz[Ƶœ/ÏpulloutuntilmarkthroughopeningonneckyÈ5Ĺź颈Ƥ£Qĵ标记处securetube(„chinesefinger饲œǂ ¥Ë样checkcorrectlocation检查ŜãýĿaspirateÇ_,10mlNaCl,X-raysX线检查)BandageDÁPEGtubeŨtechniques3ŅÚblindĸ/窥镜SurgicallyÀ术优reallylongterm-nutrition(weeks–长èĵ营.ǂzb-zæǃPEGtubeŨlong-termnutrition长è营diseasednose,oralcavitiy,pharynx,ƻŴǀQŴǀfƤǀƵœçİ-notwithvomitus,coma,aszitesĉçaZǀáƘǀŵ-dogs>20kg(onlywithĤ>20kg(仅īŨm术-tubecanbepulledearliestafter7-107-10|Y饲œ®âÈPEGtubeŨBlindpercutaneoustechniqueĸŊČMaterialîØ:siliconeľ树DiameterŬ:6.6mm(20shortanesthesiaĽ时间rightlateralrecumbencyU侧shave&surgicallyprepfromlastribtomidåYšƷ; Ƥ=ă&À术F2PEGtubeŨBlindpercutaneoustechniqueĸŊČpushlongcurvedpipevia intostomachƞ过QŴÏ*§œĹźŨpushagainstskincaudallastribÏźåYš Y ĶPEGtubeŨBlindpercutaneoustechniqueĸŊČpushneedlethroughskinintopipelumen针Ŋ*ĶŤ<*pushwireorfishinglinethroughneedleandpiperetrogradeintooral,removepipe细绳¾鱼线ƞ过针dœƚQŴŊ5DŽÑÍœPEGtubeŨBlindpercutaneoustechniqueĸŊČthreadandattach线d连Îpullwire/tubeopencutuntiltubecanbepulledthrough(remembertosecureend!!!)È线/œDŽ£7QĹźœSƞ过ǂ记ƌmêŎǁǁǁǃPEGtubeŨBlindpercutaneoustechniqueĸŊČ pulltubeuntilonecanfeelmushroomtipÈœĹźSº觉ƅƀ securetubewithflange,sutureandbandage(careful:necrosis)īļ©挡òmœDŽWDÁǂč¹DžpÿPEGtubeŨ

PEGtubeŨbleeding(accidentalsplenicpunctureinobeseĐƈǂťŪ动Ģĵ¹yų脏localinfectionƤºmushroomtipslipsout&foodgetsintoabdominal(largedogs–tube&gastropexy!)ƅƀ顶Ě5&ƵĢ进*ŵŴǂqĤ—œ&Ũm术vomitingwithrapidfeeding饲h过 ariskofaspirationwithfunctional/neurologickAů³/Ń经³İ 误_风Tubecare饲œ护check,clean&maintainplacementareaonceā|检查ûDŽ净&维ÊnmŜbandagechangeoncedailyā|ä换ûbeforeeachfeedingnāû饲 checktubeplacementmark)检查饲œĵÕŜǂ标记aspirateÇ5before&aftereachfeeding饲 > flushwith10-20mltapwaterī10-20mlŹðć0

Tubefeeding饲œ饲nasoesophageal&esophagealtube yplacementÕŜY ŌJīƻƵœ&Ƶœ饲œǂĖƪLJǃ24bolusvs.constantrate{ vs.´Ɵ缓¼uB饲h(1stday |25%,2ndday |50%,3rdday 75Tubefeeding饲œ饲smalldiametertubeŬ饲œ:liquiddietĒƵlargediametertubeŬ饲œ:pureeddiet浓ňƵspecialveterinary专ī兽G产carefulwithhuman» ī产espincatsģ别对notaurineÝġłinsufficientproteinƇ Tubefeeding饲œ饲计ŒůƬƲenergyrequirement维ÊrëĪďĵůƬƲRER=restingenergyrequirementƳüůƬƲĈRERinkcal/day=(30xkgBW)+ y:reallyheavypatientsģ别ƫĵ动ĢRERequalsenergyrequirementofrestingpatientinthermoneutralenvironment.RERĺ nĘ¡较为´ĵ环 ü动ĢĵůƬƲTubefeeding饲œ饲startintensivecarepatientson£ÌĠRER对动Ģ进ƉĠavoidexcessivecaloriesƣ)过zůwithinadequatecaloricnutrition(weightloss)switchillnessenergyôůƬ营.ƒ 态ĵůƬƲIERillnessenergyrequirement 态ůƬƲdogĤ: RERx1.2–catħ: RERx1.1–Parenteralnutrition肠y营venousaccessƳűƝ¬peripheralveinybƳcentralvein(Vjugularis)}Ƴűǂ颈Parenteralnutrition肠y营patientswho¶needparenteralnutritionƲƌ肠y营donƽthaveafunctionalGItractĉçýĵŨ肠ƢAOtherwiseALWAYSpreferenteral]则ƶ选肠/营.ī肠y营 记ƤĵŨ肠营.Parenteralnutrition肠y营patientselection¶ĭGItractdiseaseŨ肠Ƣİmalabsorption,e.g.severe_ żDŽ严ƫĵĞproteinloosingenteropathy肠ƇĴśmotilitydisorder动@¤Vomitusapatientswithhighanestheticrisk动ĢƹƩ风险e.gseveredyspnea严ƫc_lParenteralnutrition肠y营Conƽsśğtime-consumingŞExpensiveßapp.7–10xmorethanenteral 约ã肠/营.ĵ7-10ComplcationsintensivecarenecessaryƲƌƫIJ护atrophyofintestinalvilli肠绒ăƃParenteralnutrition肠y营PPNperipheralparenteralnutritionyb肠y营viaperipheralveinsƞ过ybƳosmolalityėƛ压800dailyenergyrequirementsalwaysmetžŏWāÞĵůƬƲComposition½6dextrose20%UÜŘ20%aminoacidsolution10%ąrƧęĒ10lipidemulsion10Ű Parenteralnutrition肠y营onlyviacentralveinRƞ过}ƳOsmolalityėƛapp约1500dailyenergyrequirementalwaysmetāÞůƬƲĈrë`Composition½6dextrose40%UÜŘ40%aminoacidsolution10%ąrƧęĒ10%lipidemulsion20%Ű 剂Supplyforcentralvenous }ƳűÐœ2备MsterilescrubbinglotionÝƁÒÉMAlcoholƦMsterilegloves,drapes灭ƁÀDŽ创Mcatheter导Minjectioncap,three-way-stopcockč*DŽƞMheparinizedNaClţŚNaCMSwabsÒɃMsuturemateria缝WîØMbandagematerialDÁîCathetertypesÐœ类over-the-needle带针导œ(Cava

Seldinger øÃ Parenteralnutrition肠y营ķ标DžƔrëůƬ