Ibihe byihutirwa bya Ostomy: Umukara cyangwa Umutuku Ischemic Stoma, Gusenyuka gukabije, hamwe no gusohora cyane Ileostomy Dehydration¶

Ostomy yo munda (colostomy, ileostomy, cyangwa urostomy) izana uruziga rwiza cyangwa iherezo ry amara binyuze murukuta rwinda kugirango imyanda ishobore ubusa mumufuka wo hanze. Kuberako stoma mubyukuri ari mucose yimbere yimbere yamara yahindutse imbere, ntabwo ifite uruhu rwinyuma rwo kurinda kandi rwishingikiriza rwose kumitsi ikungahaye cyane ya mesenteric yambukiranya umuyoboro ukomeye mumitsi yinda. Niba stoma ihindutse umukara wijimye, umukara wijimye, cyangwa umukara, irabyimba kugeza igihe izinizwe nimpeta ya wafer ya plastike, telesikopi ivuye munda nububabare bukabije, cyangwa igasuka mililitiro zirenga 1.500 kugeza 2000 (kimwe cya kane kugeza kuri 2) byamazi yamazi kumunsi, hamagara aho utuye nimero yihutirwa cyangwa ushake ubuvuzi bwihutirwa. Kubijyanye ninda ninda byihutirwa, reba kumara amara, kuniga hernia, na volvulus, acute mesenteric ischemia na infara, na uburozi bwibiryo, gastroenteritis ikaze, hamwe no kubura umwuma.

Kumenya kugenzura ibara nubushyuhe bwa stoma, mugihe cyo guhita ukata inzitizi yinzitizi yuruhu, uburyo bwo gukoresha isukari yumye yumye kugirango ugabanye stoma yanduye na osmose mugihe uryamye neza, nimpamvu kunywa amazi asanzwe byangiza umwanda mwinshi wa ileostomy birashobora gukiza igice cyamara nubuzima bwumurwayi.

Kora ubu¶

1. ** Kugenzura ibara rya stoma ako kanya ukuramo cyangwa ukareba mu mufuka usobanutse. Niba stoma ihindutse ** imvi zijimye, zijimye z'ubururu, umukara wijimye-wijimye, umukara, cyangwa umukara wijimye , cyangwa ukumva ukonje kandi wumye / flaccid kurutoki rwa kashe, amaraso ya arterial arahagarara ( stoma ischemia cyangwa necrosis **). Hamagara nomero yawe yihutirwa (911 muri Amerika / Kanada, 112 muri EU, 999 mubwongereza) kugirango usuzume vuba.
2. ** Niba stoma irimo kubyimba cyangwa telesikopi hanze (prolaps), kura wafer ikaze cyangwa ukate kuri bariyeri ifungura mugari ako kanya. Impeta ya pulasitike ikomeye ikora nkuruziga ruzengurutse amara, ikaniga imitsi n'imitsi mu minota mike. Kuramo wafer yose ku nda (cyangwa uhindukire umufuka munini wigice kimwe gishobora kumenwa hamwe nu mwobo uciwe byibura milimetero 3 kugeza kuri 6 [0,12 kugeza 0,25 santimetero] ubugari kuruta stoma yabyimbye).
3. ** Kubintu bitagoranye, byijimye byijimye, saba umurwayi kuryama ku mugongo hanyuma yambike stoma cyane hamwe nisukari yumye yumye yumye. kugeza ku gikombe 1 cyibisanzwe byumye byera granuline sucrose (isukari yo kumeza) ** hejuru yumucyo utose wagaragaye muminota 15 kugeza kuri 20. Isukari yibanze ikuramo amazi kurukuta rwabyimbye na osmose (** Desai osmotic kugabanya manuver **), kugabanya stoma kuburyo akenshi isubira inyuma yonyine.
4. ** Niba umusaruro wa ileostomy urenze 1.500 kugeza 2000 mL (1.5 kugeza kuri 2 quarti) mumasaha 24, REKA kunywa amazi asanzwe, icyayi, cyangwa umutobe wimbuto ziryoshye hanyuma uhite uhindukira kuri sodium-sodium yo mu kanwa ka ORD). Sip World Health Organisation (OMS) yagabanije-osmolarite ORS cyangwa igisubizo cya electrolyte cyakozwe na Mutagatifu Mariko (kirimo ibipimo nyabyo byumunyu, soda yo guteka, na glucose muri litiro 1 yamazi).
5. ** Reba neza ko inzitizi zuzuye zifatanije nububabare bwo munda hamwe no kuruka. ** Ntuzigere ufata ibiyobyabwenge ** ukekwaho guhagarika stoma.
6. ** Kugenzura ibibyimba biva mumaraso hamwe nigitutu cyoroheje, cyangwa ukajya mubitaro kugirango biva mu maraso biva mu nda. icyakora, niba amaraso atemba cyangwa yuzuza umufuka byihuse (cyane cyane kubarwayi barwaye umwijima cirrhose na ** parastomal varices **), kanda compress ikonje cyangwa gaze yometse mumazi ya oxymetazoline yatewe mumazi hanyuma uhamagare ubutabazi.

Igiti cyemezo: ostomy byihutirwa triage¶

flowchart TD
    A["Ibihe byihutirwa bya Ostomy (Ileostomy, Colostomy, cyangwa Urostomy)"] --> B{"Kugenzura ibara rya stoma no kugaragara"}
    B -->|"Umukara, umukara wijimye, ibara ryijimye, imbeho, cyangwa yumye"| C["ACUTE STOMA ISCHEMIA / NECROSIS: Kuraho wafer byihuse"]
    C --> D["Komeza umurwayi NPO (ntakintu kumunwa) hanyuma uhamagare EMS kugirango ugenzure byihutirwa"]
    B -->|"Stoma telesikopi ya cm 5 kugeza kuri 20 (Prolapse)"| E{"Amara yaguye yijimye / ashyushye cyangwa yijimye / arababaza?"}
    E -->|"Ubururu bwijimye / umukara, bukomeye, cyangwa ububabare bukabije bwinda"| C
    E -->|"Beefy umutuku / umutuku, woroshye, kandi utababara"| F["Kuraho wafer / flange byihuse kugirango impeta idashobora kuniga ishingiro"]
    F --> G["Shyira umurwayi inyuma + usuke isukari yumye yumye hejuru ya stoma kuminota 20"]
    B -->|"Ibisohoka byamazi> 1.500 kugeza 2000 mL / kumunsi + kuzunguruka / inkari zijimye"| H["HIGH-OUTPUT STOMA DEHYDRATION: Hagarika amazi meza n'ibinyobwa birimo isukari"]
    H --> I["Sipa Mutagatifu Mariko cyangwa OMS Igisubizo cyo Kuvugurura umunwa; jya kuri ER niba uzunguye, ucuramye, cyangwa oliguric"]
    B -->|"Ibisohoka bya zeru kumasaha 4 kugeza kuri 6 (ileostomy) + kubabara / kuruka"| J["ACUTE STOMA OBSTRUCTION: Shyira kuri wafer yagutse, ntunywe ikintu cyose niba kuruka, NTA miti igabanya ubukana"]
    J --> K["Gerageza kwiyuhagira ushyushye no kumavi-ku gituza; jya kuri ER kubworoheje catheter decompression"]

Amabara yerekana amabara: gutandukanya mucosa nzima na ischemia arterial na necrosis¶

Kuberako mucosa yo munda idafite keratinize y'uruhu rwo hanze (stratum corneum), uburiri bwa capillary bugaragara neza mumaso. Kugenzura ibara rya stoma nuburyo bwihuse bwo gusuzuma amaraso ya mesenteric.

Kuki stoma ischemia ibaho¶

Iyo umuganga ubaga akoze ileostomie cyangwa colostomie, bakangurira uruziga cyangwa iherezo ry amara hamwe namaraso ya mezenteric yo mu bwoko bwa fanente hanyuma bakayakurura mu gufungura kubaga (** trephine **) mumitsi ya rectus abdominis imitsi, fassiya, nuruhu. Amaraso ya arterial kuri stoma arashobora kunanirwa kubwimpamvu enye:

1. ** Intangiriro ya nyuma yuburwayi bwa mesenteric tension cyangwa arterial trombose (amasaha 24 kugeza 72 nyuma yo kubagwa): ** Niba ubutumwa bwarambuye cyane, bugoretse (volvulus), cyangwa gukomeretsa nyuma yo kubagwa mu nda nyuma yo kubagwa, cyangwa niba umuvuduko ukabije w'amaraso (hypotension) n'imiti ya vasopressor yicisha inzara imitsi ya splanchnic, isonga ya kure ya stoma itakaza parufe.
2. ** Kunanirwa kumashini no gufungura wafer ntoya: ** Stoma mubisanzwe irabyimba mugihe cibyumweru 6 kugeza 8 byambere nyuma yo kubagwa, kandi ikabyimba byigihe gito mugihe cya episode ya gastroenteritis, kugabanuka, cyangwa kubura amara. Niba umurwayi akomeje gukoresha inzitizi y'uruhu yabanje gukata ubu ikaba ntoya kurenza diameter ya stoma, hydrocolloid ikomeye cyangwa impeta ya pulasitike ikata ikata mu nsi ya stoma nk'umugozi wa reberi.
3. ** Hernia ifunzwe na parastomal: ** Umuzingo w'inda unyeganyega hamwe na stoma unyuze mu gufungura fassiyale mu mavuta yo munsi y'ubutaka hanyuma ugafatwa ugahita.
4. ** Sisitemu ya tromboembolism cyangwa ischemia idasanzwe ya mesenteric: ** Nyuma mubuzima, uturemangingo twa fibrillation atriyale, kunanirwa k'umutima gukabije, cyangwa gutandukana kwa Aortic birashobora gukuramo imiyoboro ihanitse cyangwa iri munsi ya mesenteric (reba acute mesenteric ischemia).

Ibirenze (hejuru-fassiya) na byimbitse (munsi-fascia) stoma necrosis¶

Iyo abaganga byihutirwa basuzumye stoma yijimye cyangwa yirabura, imbibi zikomeye za anatomique ni ** imbere ya rectus fascia ** (icyuma gikomeye cyimitsi ya fibrous cyicaye kuri santimetero 2 kugeza kuri 4 [santimetero 0.8 kugeza kuri 1.5] munsi yuruhu rwinda):

• ** Ischemia yo mu bwoko bwa mucosal superficial (ifungiwe hejuru ya fassiya): ** Gusa umutwe usohoka wa stoma hanze yimitsi yinda ni bwije cyangwa bwijimye, mugihe amara yimbitse yimbere mumitsi yimitsi akomeza kuba umutuku. Izi manza akenshi zinaniza igice cyapfuye kandi zigakira neza (nubwo zikunze gutinda ** stomal stenosis ** cyangwa kugabanuka).
• ** Necrosis yanduye cyane (igera munsi ya fassiya mu cyuho cya peritoneyale): ** Niba ibara ry'umukara, umutuku, cyangwa imvi ryagutse cyane kurenza urwego rwa fassiya imbere mu rukuta rw'inda, urukuta rw'inda rwapfuye imbere mu nda ruzahita rwinjira kandi rusuke intebe mu mwobo wa peritoneya (** fecal peritonitis **), bisaba guhita byihuta.

Ikizamini-tube ("ikirahure") igenzura rimurika rikoreshwa muri ER¶

Mu ishami ryihutirwa, abaganga basize buhoro buhoro amavuta meza yo gukusanya amaraso (Vacutainer). Niba mucosa y'imbere ihindutse ibara ryijimye rya santimetero 1 munsi yumutwe, ischemia irarenze. Niba mucosa ikomeje kuba umukara wijimye, imvi, cyangwa umutuku munsi yurwego rwurukuta rwinda fassiya, umurwayi ahita ajyanwa mubyumba. ** Ntuzigere winjiza ibirahuri cyangwa ibintu bikarishye muri stoma murugo **; kureka ubugenzuzi bwimbere kubaganga byihutirwa.

Kugabanuka kwa Stoma hamwe nisukari yo murugo (kugabanya osmotic)¶

** Kwangirika kwa Stoma ** bibaho mugihe igice cyuzuye cyubugari bwintangangore zo munda (telesikopi imbere yacyo) hanyuma ikanyerera hanze ikingura stoma, ikamanikwa hanze yinda nkigiti cyinzovu gipima ahantu hose kuva kuri santimetero 5 kugeza kuri 25 (santimetero 2 kugeza kuri 10). Kurimbuka bikunze kugaragara cyane muri ** loop colostomies ** (cyane cyane transvers loop colostomies, aho telesikopi ya "idakora" ya telesikopi yo hanze) ikarangiza ileostomie mugihe umuvuduko winda uzamutse ukorora, guterura cyane, kurira mubana, cyangwa umubyibuho ukabije.

Kuki stoma yaguye igwa hanze yumubiri¶

Iyo santimetero 10 kugeza kuri 15 (santimetero 4 kugeza kuri 6) zo munda zisohoka zinyuze mu mpeta ifunganye ya fassiyale mu rukuta rw'inda, impeta y'imitsi ifatanye hamwe na wafitiki ya ostomy wafer ikanda imitsi ya mesenteric umuvuduko ukabije mu gihe imiyoboro y'umuvuduko ukabije ikomeza kumena amaraso mu mara asohoka. Amazi atemba vuba mumitsi (** interstitial edema **). Mu minota 30 kugeza kuri 60, amara yagabanutse arabyimba inshuro ebyiri cyangwa eshatu z'ubugari busanzwe, ahinduka ibinure cyane kandi binini cyane ku buryo bidashobora gusubira inyuma mu mwobo w'inda. Iyo isize itize, kubyimba amaherezo bigabanya imiyoboro ya arterial, bigahinduka ibara ryijimye ryijimye muburyo bwihutirwa bwo kubaga gangrenous, banizwe.

Intambwe ku yindi kugabanya urugo ukoresheje uburyo bwa isukari ya Desai¶

Niba stoma yaguye ari ** yijimye cyangwa umutuku, ishyushye, yoroshye, kandi idatera ububabare bukabije bwo munda **, urashobora gukoresha imiti isanzwe yibitaro osmotic murugo mugihe utegura isuzuma ryubuvuzi:

1. ** Kuramo wafer igabanya cyangwa fungura ako kanya umufuka wibice bibiri.
2. ** Shyira umurwayi ku mugongo (supine). ** Shira umusego munsi y'amavi yabo kugirango imitsi yo munda iruhuke kandi uburemere bureke gukurura amara hepfo.
3. ** Suka isukari yumye yumye isukari yameza (sucrose) ubuntu hejuru ya stoma yose yagaragaye. **
4. Suka ** ½ kugeza ku gikombe 1 (garama 100 kugeza 200) z'isukari isanzwe yumye yera isukuye ** ku buryo butaziguye, hejuru ya mucosal yabyimbye hejuru y'amara yangiritse bityo iba yuzuye neza. .
5. ** Uburyo physics ya osmose ikora: ** Mucosa yo munda yabyimbye ni membrane idasembuye yuzuyemo hypotonic edema fluid. Kirisiti yumye yumye ikora hypertonic osmotic gradient hejuru yumusemburo, ikuramo vuba amazi yafashwe mumukuta wabyimbye mu rukuta rwisukari.
6. ** Tegereza iminota 15 kugeza kuri 20 mugihe umurwayi agumye neza. Kurenza iminota 15 kugeza kuri 20, amara yuzuye, yabyimbye bigaragara neza kandi agabanuka kuri 30 kugeza 50% bya diameter.
7. ** Emerera kugabanuka kwizana cyangwa kuyobora neza-imikindo. **
8. Kenshi na kenshi, iyo indurwe ikimara kugabanuka kandi umurwayi agashiramo umwuka aryamye, amara yagabanutse asubira inyuma imbere mu nda wenyine.
9. Niba warahawe amabwiriza na muganga wawe ubaga cyangwa umuforomo wa ostomy, urashobora gushyiramo intoki zidafite amazi, zishushe-lubricant-zometseho imikindo yoroheje witonze ugana ku ntera ya kure ya stoma yangiritse hanyuma ugashyira imbere imbere imbere mugihe umurwayi asohotse. ** Ntuzigere usunika ku mbaraga, ntuzigere utera urutoki mu rukuta rw'inda, kandi uhite uhagarara niba wumva urwanya cyangwa ububabare. **
10. ** Koresha umufuka munini, woroshye igice kimwe gishobora gukururwa nyuma yo kugabanuka. Menyesha umuganga wawe ubaga cyangwa ibikomere, Ostomy, hamwe nu muforomo wa WOC.

Umusaruro mwinshi ileostomy dehydrasi: kuki amazi asanzwe atera nabi¶

Kubera ko amara manini (colon) ashinzwe gusubiramo mililitiro 1.000 kugeza 1.500 (kimwe cya kane kugeza kuri 1.5) y'amazi na sodiumi buri munsi, umurwayi ufite ** colostomy ** muri rusange akora igice kinini cyakozwe cyangwa cyaremye gifite intebe nkeya. Ibinyuranye, umurwayi ufite ** ileostomy ** (cyangwa jejunostomy / syndrome yo munda magufi) yarenze cyangwa akuraho inkondo yose.

Ubusanzwe vs ibyago ileostomy isohoka ingano¶

• ** Ibisohoka bisanzwe bya ileostomy: ** ** 500 kugeza kuri mililitiro 1,200 (0,5 kugeza kuri 1,2)
• ** Ibicuruzwa byinshi bisohoka cyane (HOS): ** Ibisohoka birenga ** mililitiro 1.500 (1.5 quarti) mumasaha 24 ** muminsi ibiri, cyangwa birenga ** mililitiro 2000 (quarti 2) mugihe cyamasaha 24 ** (gusiba umufuka wuzuye wamazi buri masaha 1 kugeza kuri 2, cyangwa inshuro 8 kugeza 12+ kumunsi).

Umutego wa jejuno-ileal sodium-glucose cotransport (Kuki amazi asanzwe asohora umunyu)¶

Buri litiro y'amazi ya ileostomy yuzuye amazi arimo milimetero ** 90 kugeza 120 (miligarama 2000 kugeza 2700) za sodium **, hamwe na potasiyumu, magnesium, na bicarbonate.

Bitandukanye n'umura, amara yo hejuru yo hejuru (jejunum.

• ** Bigenda bite iyo umurwayi wa ileostomy anywa amazi asanzwe, icyayi kidakomeye, ikawa, soda y'ibiryo, cyangwa ibinyobwa bya siporo byubucuruzi: ** Amazi yo mu kibaya afite mmol / L ya sodium 0, hamwe n’ibinyobwa bisanzwe bya siporo (nka Gatorade cyangwa Powerade) bifite mm 18/20 gusa bya sodium hamwe na sukari nyinshi. Iyo aya mazi make ya sodiumi yinjiye muri jejunum, sodium ikwirakwiza vuba ** mumaraso yumurwayi yinjira munda ya lumen ** kugirango bangane na osmotic gradient, kandi ubwinshi bwamazi yose wongeyeho sodium yumubiri yihishe isuka neza mumufuka wa ileostomy nyuma yiminota 20. Inyota umurwayi abona hamwe namazi meza basukuye, niko byihuta cyane (** gutakaza ibanga rya net fluid **).
• ** Bigenda bite iyo banyweye umutobe wimbuto ziryoshye, soda isanzwe, cyangwa ibinyamisogwe byintungamubiri: ** Isukari ya Hyperosmolar ikuramo amazi menshi mumaraso mumaraso yinjira mumara na osmose (osmotic diarrhea), gukuba kabiri stoma isohoka mu isaha imwe.

Nigute wavanga igisubizo cya Mutagatifu Mariko cyangwa OMS Igisubizo cyo munwa murugo¶

Kugira ngo ihindagurika ry’amazi menshi ileostomy mu rugo, amabwiriza yatanzwe n’umuryango w’abongereza w’ubuvuzi bwa Gastroenterology (BSG), ESPEN, n’ishami ry’ibitaro byitiriwe Mutagatifu Mariko agaragaza ko kugabanya amazi ya hypotonike asanzwe (amazi asanzwe, icyayi, ikawa) kugeza munsi ya mL 500 kugeza ku munsi no gusimbuza igihombo hamwe na sodium yo mu bwoko bwa sodium-60).

1. ** Ubucuruzi OMS Yagabanije-Osmolarity Umunwa wo Kunyunyuza umunwa: ** Kuvanga paki imwe isanzwe ya OMS ORS (cyangwa amasaketi abiri ya Dioralyte imbaraga ebyiri nkuko byerekanwa nitsinda rya stoma, cyangwa CeraLyte 70/90, DripDrop, cyangwa Pedialyte Sport) mubunini bwuzuye bwamazi meza (mubisanzwe litiro 1).
2. ** St. Ikimenyetso cya Electrolyte ya Mark (Imiterere y'ibitaro byemewe bya litiro 1 [Ibikombe bya Amerika 4.2] by'amazi): **
3. ** Ikiyiko 6 cyo murwego (garama 20) yifu ya glucose ** (cyangwa ikiyiko 6 cyurwego rwisukari yameza niba ifu ya glucose / dextrose itaboneka, nubwo ifu ya glucose ihitamo osmolarite nziza)
4. ** Ikiyiko 1 cyurwego (garama 3,5) yumunyu wameza (sodium chloride) **
5. ** ½ ikiyiko cyo murwego (garama 2,5) za soda yo guteka (sodium bicarbonate) ** (cyangwa citrate ya trisodium)
6. Shonga rwose muri ** litiro 1 (1.000 mL) y'amazi akonje **. Kunywa buhoro buhoro umunsi wose (kuyikonjesha cyangwa kongeramo agace gato k'indimu idafite isukari / indimu itoshye uburyohe bwumunyu byoroshye kwihanganira).
7. ** Tandukanya ibintu bikomeye hamwe namazi mugihe cyo kurya: ** Ntunywe amazi mbere yiminota 30 mbere, mugihe, cyangwa iminota 30 nyuma yo kurya amafunguro akomeye, bityo ibiryo bikomeye bigenda buhoro buhoro binyuze mumara mato. Kurya ibiryo bikungahaye kuri krahisi byongera umusaruro wa ileostomy: umuceri wera, pasta isanzwe, ibirayi bitetse, umutsima wera, ibitoki, amavuta y'ibishyimbo byoroshye, pome, n'ibishanga.

Guhagarika stoma ikaze (ibiryo bolus cyangwa inzitizi ya mashini)¶

Kuberako ileostomy inyura mu gufungura kwagutse kurukuta rwimitsi yinda yinda, fibrous, ibiryo bitetse neza (popcorn, ibihumyo, imigozi ya seleri, cocout, imbuto zumye, imbuto, cyangwa citrus pith) birashobora guhurira hamwe mugucomeka gukomeye inyuma ya fassiya yinda (** ibiryo bya bolus inzitizi **). Gufatanya, kugoreka (volvulus), cyangwa hernia ya parastomal irashobora kandi gukuramo amara imbere.

Kumenya igice na viza yuzuye stoma¶

• ** Guhagarika igice cya stoma: ** Stoma ihagarika kunyuza paste isanzwe yijimye hanyuma igasohora ** impumuro mbi, amazi yamazi ** munsi yigitutu hamwe nijwi ryinshi ritontoma, kuribwa mu nda byoroheje, hamwe numubumbe wa stoma wabyimbye.
• ** Guhagarika stoma yuzuye: ** ** Intebe ya zeru na gaze ya zeru ** winjire mumufuka kumasaha ** kugeza kuri 6 muri ileostomy ** (cyangwa amasaha 24 kugeza 48 ufite ububabare muri colostomy). Inda iba ndende, imiraba yububabare bukabije bwa colicky ikubita buri minota mike, stoma irabyimba, umurwayi atangira kuruka icyatsi kibisi cyangwa cyijimye cyijimye.

Ingamba zo murugo zifite umutekano kubiryo byoroheje-bolus (niba umurwayi Atari kuruka)¶

1. ** Kuraho wafer iriho hanyuma ushyireho umufuka ufunguye nini ** kugirango ubashe kubyimba stoma.
2. ** Hagarika kurya ibiryo bikomeye byose ako kanya. ** Niba umurwayi ** atarutse **, barashobora kunywa igisubizo cya rehydration yo mu kanwa. Niba isesemi cyangwa kuruka, komeza ** nil kumunwa (NPO) **.
3. ** Shira mu bwogero bushyushye muminota 15 kugeza kuri 20 ** cyangwa ushire padi ishyushye hejuru yinda kugirango woroshye imitsi yinda.
4. ** Kora ikivi kugeza ku gituza kandi ukore massage yoroheje ya peristomale: ** Kuryama kuruhande ukoresheje amavi yakuwe mu gituza, cyangwa urutare witonze ku biganza no ku mavi mugihe ukanda inda ikikije stoma kugirango wirukane ibiryo inyuma ya fassiya.
5. ** NTUKIGERE ufata imiti igabanya ubukana bwa ileostomy.
6. ** Jya mu ishami ryihutirwa niba umusaruro udasubukuwe mu masaha 4 kugeza kuri 6 cyangwa niba kuruka bitangiye.

Parastomal hernia kuniga, varices yo kuva amaraso, no gutandukana kwa mucocutaneous¶

Gufungwa kwa parastomal hernia v¶

Abagera kuri 30 kugeza kuri 50 ku ijana by'abarwayi ba ostomy amaherezo barwara ** parastomal hernia **, igisebe munsi y'uruhu iruhande rwa stoma aho uruziga rwinshi rw'amara rusunika iruhande rwa stoma binyuze mu gufungura imitsi yagutse.

• ** Ibibyimba bitagaragara bigabanuka: ** Igibyimba gisohoka iyo gihagaze cyangwa gikorora, cyumva cyoroshye kandi kidafite ububabare, kiryoshye iyo uryamye, kandi stoma iguma yijimye hamwe nibisohoka bisanzwe.
• ** Hernia parastomal / ifunzwe (Surgical Emergency): ** Igicucu kuruhande rwa stoma gihinduka ** urutare rukomeye, ruteye ubwoba, rwuje ubwuzu, kandi ntirushobora gusibanganya iyo uryamye **; uruhu hejuru yigituba ruhinduka umutuku cyangwa umutuku; stoma ihinduka umukara wijimye cyangwa ihagarika gutanga umusaruro; kandi umurwayi agira ububabare bukabije bwo munda no kuruka. Kuraho wafer ako kanya, kuryama neza, ntugasunike ibibyimba imbere, hanyuma uhamagare ubutabazi.

Amaraso ava munda: guteranya mucosal na portal-hypertension parastomal varices¶

• ** Mucosal ntoya: Kanda padi ikonje, itose ya gauze gahoro gahoro hejuru yiminota 2 kugeza kuri 3 irahagarika burundu.
• ** Parastomal variceal hemorhage (Ubuzima-Bwangiza Ubuzima): ** Ku barwayi barwaye umwijima cirrhose cyangwa portal hypertension , imiyoboro yumuvuduko ukabije wibice bigize impeta yimitsi ya varicose neza aho stoma ihurira nuruhu rwinda ( caput medusae **, bikunze kugaragara nkubururu bwumutuku kuri ruhu rwa peristomal). Iyi varices irashobora guturika ubwayo hanyuma igapompa ** mililitiro amagana yamaraso yumutuku wijimye cyangwa yijimye mumufuka wa ostomy muminota mike **, bigatera ihungabana.
• ** Ubutabazi bwihuse: ** Kuramo umufuka, shakisha aho uhurira kumupaka wuruhu-stoma, hanyuma ukande kamwe kamwe ka ** gafunze sterile gauze padi (cyangwa gauze yahujwe na over-konte ya oxymetazoline 0.05% spray yamazuru) ** itaziguye kandi ushikamye kumwanya wamaraso ukoresheje urutoki rumwe mugihe uhamagaye 911/112/999. Komeza umurwayi hejuru n'amaguru hejuru (reba Esophageal varices hamwe no kuva amaraso ya cirrhose).

Gutandukana kwa Mucocutaneous no gukuramo stoma¶

Mugihe cibyumweru 2 kugeza 4 byambere nyuma yo kubagwa, ubudodo bufashe inkombe ya stoma kuruhu rwinda birashobora gutandukana (** mucocutaneous gutandukana ), cyangwa stoma irashobora kurohama munsi yuruhu ( retraction **).

• ** Gutandukanya akaga: ** Kureka gutandukana kurwego rwo hejuru rwuruhu ruyoborwa numuforomokazi WOC ukoresheje calcium ya alginate cyangwa ifu ya hydrofiber. Ariko, niba stoma ** itandukanije rwose na dogere 360 ​​hanyuma ikamanuka munsi yimitsi ya fassiya mumyanya ya peritoneal , intebe isuka neza munda ( peritonite **). Niba ubonye umwobo wimbitse ufite ububabare bukabije bwo munda n'umuriro, hamagara ambulance ako kanya.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

• ** Amerika na Kanada: ** Hamagara ** 911 ** kuri ischemia yumukara / umutuku wijimye, hernia ya parastomal ifunzwe, kuva amaraso menshi munda, cyangwa umwuma mwinshi hamwe na syncope. Umuryango w'abaforomo Wound, Ostomy, na Continence (WOCN) hamwe na Sosiyete y'Abanyamerika y'Abaganga ba Colon na Rectal Surgeons (ASCRS) baremeza ko hakurwaho bidatinze waferi igabanya ubukana, kugabanuka kwa osmotic hamwe na sucrose ya granose ya stoma ishobora gukomera, hamwe no kuvura umunwa wa ileostomie.
• ** UK: Umuryango w’Abongereza wa Gastroenterology (BSG) n’amabwiriza y’ibitaro bya Mutagatifu Mariko ushyira mu bikorwa igisubizo cya electrolyte ya Mutagatifu Mariko no kugabanya amazi ya hypotonique kuri stoma nyinshi.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi: ** Hamagara ** 112 **. Umuryango w’ubumwe bw’ibihugu by’i Burayi ushinzwe imirire n’ubuvuzi (ESPEN) hamwe n’umuryango w’ibihugu by’i Burayi Crohn na Colitis (ECCO) uyobora isotonic hakiri kare / sodium-ORS (90 mmol / L sodium), loperamide / antisecretory titre ikurikiranwa n’ubuvuzi, no gusuzuma byihutirwa kubaga ischemic cyangwa inzitizi.
• ** Australiya na Nouvelle-Zélande: ** Hamagara ** 000 ** muri Ositaraliya cyangwa ** 111 ** muri Nouvelle-Zélande. Ishyirahamwe rya Australiya ry’abaforomo ba Stomal Therapy (AASTN) ryibanda ku kwagura ibikoresho byihuse kugira ngo umuntu yandurwe / yangirika kandi byihutirwa byinjira mu maraso kugira ngo ileostomy isohoka cyane hamwe na oliguriya.
• ** Ubuhinde na Aziya-Pasifika: ** Hamagara ** 112 ** mu Buhinde, ** 995 ** muri Singapuru, ** 119 ** mu Buyapani na Koreya y'Epfo, cyangwa ** 999 ** muri Maleziya na Hong Kong. Reba urutonde rwuzuye rwa nimero mpuzamahanga yihutirwa.

Ibibazo bikunze kubazwa¶

Kuki gusuka isukari isanzwe yameza yumweru kuri stoma yagabanutse bituma igabanuka?¶

Ubuso bugaragara bwa stoma ni ururenda rwimbere rwimbere rw amara, rukora nkinzitizi ya semipermeable. Iyo stoma yikuye mu nda, ubwinshi bwimitsi ifata amazi arenze imbere mumyanya, bigatuma byabyimba cyane kuburyo bidashobora gusubira inyuma binyuze mumitsi. Gupfundikanya mucosa itose hamwe na kirisiti ya sucrose yumye ikora gradient ikomeye ya hypertonic osmotic gradient ikuramo vuba amazi yafashwe mumukuta wibyimba wabyimbye mukisukari, ugahindura ingirangingo muminota 15 kugeza kuri 20 kugirango ishobore kunyerera neza imbere imbere uryamye neza.

Kuki umuntu udafite ileostomy adashobora kunywa amazi menshi mugihe igikapu cye cyuzuyemo amazi?¶

Bitandukanye na colon nzima, amara yo hejuru ntashobora gukuramo amazi yonyine wenyine; ingirabuzimafatizo zayo zisaba ubunini bwa sodiumi (milimetero 60 kugeza kuri 90 kuri litiro) hamwe na glucose nkeya kugirango ikure amazi hejuru y'urukuta rw'amara mu maraso. Iyo umurwayi wa ileostomy anywa amazi asanzwe, icyayi, cyangwa ibinyobwa bya siporo nkeya ya sodium, sodium mubyukuri isohoka mumaraso yabo ikinjira munda kugirango igereranye umunyu mwinshi, usukamo amazi banyoye gusa hamwe numunyu wumubiri wabo uhita usohoka mumufuka wa ostomy kandi bikabije bikabura umwuma.

Nigute nshobora kuvuga itandukaniro riri hagati ya beterave / ibiryo byanduye n'amaraso nyayo cyangwa stoma ipfa?¶

Kurya beterave itukura, gelatine itukura, irangi ryibiryo bitukura, ibinyomoro, cyangwa ibinini byicyuma akenshi bihindura intebe cyangwa amazi imbere mumufuka wa ostomy umufuka utukura cyangwa umukara wijimye, bishobora kugaragara biteye ubwoba. Nyamara, ibiryo nicyuma gusa bisiga amabara ibisohoka imbere mumufuka; ntibigera bahindura ibara ryimyenda nzima ubwayo. Ihanagura witonze hejuru yikibabi cya stoma hamwe nuduce twose: stoma nzima iracyagaragara neza yinka yijimye yijimye-umutuku, itose, nubushyuhe, mugihe stoma ischemic izaba ifite ibara ryijimye ryijimye, umukara, cyangwa umukara neza kurukuta rwinda.

Kuki ibinini by'imiti rimwe na rimwe bisohoka imbere mu gikapu cya ileostomy, kandi ni ibiki binini bishobora guteza akaga?¶

Kuberako ileostomy ikuraho cyangwa ikazenguruka amara manini yose kandi ikagabanya igihe cyo gutembera munda, kwaguka-kurekurwa (ER, XR, SR, XL) hamwe na tableti yometse kuri enteric akenshi inyura mu mufuka wa ostomy udakemutse rwose, bigatera gukuramo imiti iteje akaga cyangwa kunanirwa kuvura. Ntuzigere ufata ibinini byongerewe cyangwa bisizwe na enteric hamwe na ileostomie keretse iyo byahanaguwe neza na farumasi (saba ibinini byihuse, amazi, cyangwa ibishishwa), kandi ntuzigere ufata imiti yangiza umunwa, ishobora gutera ubuzima bwa electrolyte.

Nibisanzwe ko stoma nshya ihindura ingano mumezi abiri yambere nyuma yo kubagwa?¶

Yego. Ako kanya nyuma yo kubagwa, stoma yose yabyimbye bivuye kubagwa hanyuma igenda igabanuka buhoro buhoro muri diameter mugihe cibyumweru 6 kugeza 8 byambere kugeza igeze mubunini bwayo buhoraho. Muri ayo mezi abiri yambere, ugomba gupima diameter ya stoma hamwe nubuyobozi bwo gupima kuri buri mpinduka ya wafer kugirango gufungura ntago ari binini cyane (byerekana uruhu rwa peristomale kuri enzymes zifungura igifu) cyangwa ngo bikomere cyane (bishobora kuniga stoma niba byabyimbye byigihe gito).

Inkomoko nubuyobozi¶

• ** Umuryango w’abaforomo bakomeretse, Ostomy, na Continence (WOCN, Amerika): ** * Amabwiriza y’ubuvuzi ya Sosiyete ya WOCN: Ubuyobozi bw’umurwayi ukuze hamwe na Ostomy ya Fecal cyangwa Urina *
• ** Sosiyete y'Abanyamerika y'Abaganga n'Abaganga (ASCRS, Amerika): ** * Amabwiriza ngenderwaho y’ubuvuzi bwo kubaga Ostomy * (Isuzumabumenyi rya super-fascial stomal necrosis, kuniga parastomal hernia, no guhagarika stoma).
• ** Sosiyete y'Abongereza ya Gastroenterology (BSG) & Ibitaro byitiriwe Mutagatifu Mark ishami rishinzwe kunanirwa mu mara (Ubwongereza): ** * Amabwiriza yo gucunga abarwayi bafite amara magufi hamwe n’ibisohoka cyane * (Nightingale J n'abandi.
• ** Umuryango w’ibihugu by’i Burayi ushinzwe imirire n’ubuvuzi (ESPEN, Uburayi): ** * Amabwiriza ya ESPEN ku mirire y’amavuriro mu kunanirwa gukabije kw’amara * (Amazi menshi ya ileostomy fluid na magnesium / potassium resuscitation protocole).
• ** Myers JO & Rothenberger DA / Desai DC (* Indwara za Colon & Rectum * / * Ikinyamakuru cyo muri Amerika cyo kubaga *): ** * Osmotic Kugabanuka kwa Edematous Prolapsed Stoma ukoresheje Topical Granulated Sucrose *.

Kuyobora¶

• Kubura amara, kuniga hernia, hamwe nibimenyetso byihutirwa bya volvulus
• Ischemia ikaze ya mesenteric, infarction yo munda, hamwe na catastrophe yo munda nyuma yinyuma
• Uburozi bwibiryo, gastroenteritis ikaze, hamwe no kubura amazi
• Esophageal varices guturika, kuva cirrhose kuva, hamwe na encephalopathie hepatike
• Inda yo mu nda no gufungura ibikomere byo mu gifu