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首都医科大学附属北京佑安医院 重症医学科,北京 100069
Published Online:08 February 2023,
Received:28 October 2022,
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Xin LIU, Yanmei GU, Haixia LIU, et al. Nutritional nursing of a mechanically ventilated elderly patient with advanced liver cirrhosis and uremia. [DB/OL].Clinical Archives of Integrative Medicine (2023)
Xin LIU, Yanmei GU, Haixia LIU, et al. Nutritional nursing of a mechanically ventilated elderly patient with advanced liver cirrhosis and uremia. [DB/OL].Clinical Archives of Integrative Medicine (2023) DOI: 10.12209/CAIM202210280011.
针对1例反复脱机失败的肝硬化失代偿期的尿毒症、TIPS术后出现意识障碍的机械通气的重度营养不良老年患者,首先对患者进行营养风险评估,确定营养供给的必要性。然后针对导致肠内营养摄入不足的腹胀、腹泻、胃潴留等常见问题,实施腹部按摩促进胃肠蠕动、根据腹胀及食道反流情况及时调整肠内营养的滴入速度、减少不必要的肠内营养中断等护理措施保证肠内营养的足量供给。此外加强翻身拍背、积极机械装置辅助肢体功能锻炼减少院内感染的发生率、促进肌力的恢复。经过优化护理,每日都能够满足目标肠内营养量摄入,患者营养状态及病情明显改善,顺利脱机并恢复转出监护室。
For a severely malnourished elderly patient with decompensated cirrhosis and uremia and mechanical ventilation with disturbance of consciousness after TIPS, the nutritional risk of the patient was first assessed to determine the necessity of nutritional supply. Then, according to the common problems of abdominal distension, diarrhea, and gastric retention that lead to insufficient enteral nutrition intake, the nursing measures such as abdominal massage to promote gastrointestinal motility, timely adjustment of enteral nutrition infusion rate according to the situation of abdominal distention and esophageal reflux, and reduction of unnecessary enteral nutrition interruption were carried out to ensure adequate supply of enteral nutrition. In addition, strengthening the back patting, active mechanical device auxiliary limb function exercise to reduce the incidence of nosocomial infection, promote the recovery of muscle strength. After optimized nursing, the target enteral nutrition intake could be met every day, the nutritional status and condition of the patients were significantly improved, and the patients were successfully weaned and transferred out of the intensive care unit.
肝硬化: 尿毒症营养不良老年患者营养护理
liver cirrhosisuremiamalnutritionelderly patientsnutrition care
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