Iimeko eziNgxamisekileyo ze-Ostomy: I-Ischemic Stoma emnyama okanye emfusa, i-Severe Prolapse, kunye ne-High-Output ye-Ileostomy Dehydration¶

I-ostomy yamathumbu (i-colostomy, ileostomy, okanye urostomy) izisa i-loop esempilweni okanye ukuphela kwamathumbu kudonga lwesisu ukuze inkunkuma ikhuphe kwisingxobo sangaphandle. Ngenxa yokuba i-stoma eneneni ilulwelo oluthambileyo lwangaphakathi lwe-mucosal olujike ngaphakathi ngaphandle, alunalusu lwangaphandle olukhuselayo kwaye luxhomekeke ngokupheleleyo kwimithambo ye-mesenteric etyebileyo etyhutyha itonela eqinileyo kwisihlunu sesisu. Ukuba i-stoma ijika ibemfusa, emnyama, okanye emnyama, idumba de ikrwitshwe yintsimbi yeplastiki, iiteleskopu eziphuma esiswini ngeentlungu eziqatha, okanye zigalele ngaphezulu kwe-1,500 ukuya kwi-2,000 yeemililitha (1.5 ukuya kwi-2 yeelitha) zolwelo lwamanzi ngosuku, fowunela indawo ohlala kuyo amanani kaxakeka okanye ufune unyango olungxamisekileyo ngoko nangoko. Malunga nonxunguphalo olunxulumene nesisu kunye nolwelo, bona ukuvalwa kwamathumbu, i-hernia ekrwitshiweyo, kunye ne-volvulus, i-acute mesenteric ischemia kunye ne-infarction ye-bowel, kwaye ityhefu yokutya, i-gastroenteritis ebukhali, kunye nokuphelelwa ngamanzi emzimbeni.

Ukwazi indlela yokuhlola umbala kunye nokufudumala kwe-stoma, nini ukusika ngokukhawuleza isithintelo se-skin barrier, indlela yokufaka iswekile eyomileyo etafileni ukucutha i-stoma ye-edematous prolapsed stoma nge-osmosis ngelixa ulele tyaba, kwaye kutheni ukusela amanzi angenanto kuyingozi enkulu-imveliso ye-ileostomy dehydration kunokusindisa zombini ubomi bomzimba wesigulana.

Yenza oku ngoku¶

1. Hlola umbala westoma ngoko nangoko ngokususa okanye ujonge kwisingxobo esicacileyo. Istoma esisempilweniekhazimlayo senyama yenkomo ebomvu okanye enzulu irozi-pinki, efumileyo, ecwebezelayo, kwaye eshushu (efana nongaphakathi esidleleni sakho). Ukuba i-stoma ijika i-grey, iblue mottled, iplam-purple emnyama, ibrown, okanye imnyama emnyama*, okanye ivakala ibanda kwaye yomile/ithambile kumnwe weglavu, unikezelo lwegazi lwaso lwe-arterial lunqunyulwa (stoma ischemia okanye necrosis). Fowunela inombolo yakho yexesha likaxakeka (911 e-US/Canada, 112 e-EU, 999 e-UK) ukuze uvavanye utyando olukhawulezileyo.
2. Ukuba i-stoma siyadumba okanye sijonga ngaphandle (iprolapse), susa iwafer eyomeleleyo okanye usike isithinteli esivuleka sibe banzi ngokukhawuleza. Ungaze ushiye i-wafer yeconvex eqinileyo, iflange yokutshixa ngeplastiki, okanye isithinteli esiqinileyo solusu esijikeleze ukudumba okanye ukuqhambuka kwestoma. Iringi yeplastiki eqinile isebenza njenge-tourniquet ejikeleze isiseko sesisu, ikrwitsha imithambo kunye nemithambo ngaphakathi kwemizuzu. Khulula i-wafer yonke kwisisu (okanye utshintshele kwisingxobo esikhulu esineqhekeza elinye elikhupha amanzi ngomngxuma osikwe ubuncinane kangangeemilimitha ezi-3 ukuya kwezisi-6 ububanzi kunestoma esidumbileyo).
3. Kwistoma esingantsonkothanga, esipinki esinabileyo, cela isigulana silale sicaba ngomqolo kwaye sombese i-stoma ngesisa ngeswekile emhlophe yetafile eyomileyo. Ukuba icandelo elide lepinki, amathumbu ashushu aphumile kwi-stoma ngaphandle kweentlungu ezibuhlungu okanye ukuguquka kombala omnyama, beka isigulana sibe sicaba ngamadolo agobile kancinci ukuthoba i-intramp ebandayo ngelaphu lomkhenkce. itawuli ngobunono phezu kwesingxobo imizuzu eli-10, okanye ugalele ½ ukuya 1 ikomityi yesiqhelo eyomileyo emhlophe granulated sucrose (iswekile etafileni) ngqo phezu mucosa emanzi eveziweyo imizuzu 15 ukuya 20. Iswekile exineneyo itsala amanzi ngaphandle kodonga lwamathumbu adumbileyo nge-osmosis (Desai osmotic reduction maneuver), icutha i-stoma ukuze ihlale ibuyela ngaphakathi ngokwayo.
4. Ukuba imveliso ileostomy idlula 1,500 ukuya 2,000 mL (1.5 ukuya 2 quarts) kwiiyure ezingama-24, YEKA ukusela amanzi alula, iti, okanye ijusi yeziqhamo eziswiti kwaye utshintshele ngoko nangoko kwi-high-sodium Oral Rehydration Solution (ORS). Kwisigulana esinesisu esincinci okanye ileostomy, ukusela amanzi aneswekile eninzi okanye i-sodium ecacileyo okanye i-sodium ecacileyo. ibhegi**, ukukhawulezisa ukothuka kwe-hypovolemic kunye nokusilela kwezintso. I-Sip World Health Organization (WHO) iyancipha-osmolarity ORS okanye isisombululo se-electrolyte yaseSt. Mark yasekhaya (equlethe umlinganiselo ochanekileyo wetyuwa, i-baking soda, kunye ne-glucose kwi-1 ilitha yamanzi).
5. Khangela uthintelo olupheleleyo lwestoma oludityaniswe neentlungu zesisu esibuhlungu kunye nokugabha. Ukuba i-ileostomy ivelisa ulwelo ongunothi okanye igesi kangangeeyure* ezi-4 ukuya kwezi-6** (okanye i-colostomy ayivelisi nto kangangeeyure ezingama-24 ukuya kwezingama-48 ecaleni kwamaza abukhali okukrala kwesisu, ukudumba kwesisu esiqinileyo, ukuqunjelwa kwesisu, isicaphucaphu, isicaphucaphu okanye isicaphucaphu. ibhafu efudumeleyo okanye ukuma kwesifuba, kwaye uye kwigumbi likaxakeka. Ungaze uthathe amayeza okuthoba xa ukrokrela ukuvaleka kwestoma.
6. Lawula ukopha kumphezulu we-mucosal ngoxinzelelo oluthe ngqo oluthambileyo, okanye uye esibhedlele ukuze ufumane ukopha okukhulu kwe-stomal variceal. Ithontsi legazi elibomvu eliqaqambileyo xa usosula i-stoma liyinto eqhelekileyo; nangona kunjalo, ukuba igazi likhupha okanye lizalise isikhwama ngokukhawuleza (ngokukodwa kwizigulane ezine-cirrhosis yesibindi kunye ** i-varices parastomal **), cinezela i-compress ebandayo okanye i-gauze efakwe kwi-oxymetazoline nasal spray ngokuqinileyo ngokubhekiselele kwindawo yokuphuma kwegazi kwaye ubize iinkonzo eziphuthumayo.

Umthi wesigqibo: i-ostomy triage yongxamiseko¶

flowchart TD
    A["I-Ostomy Emergency (Ileostomy, Colostomy, okanye Urostomy)"] --> B{"Hlola umbala we-stoma kunye nenkangeleko"}
    B -->|"Imnyama, imfusa emnyama, ingwevu, ibanda, okanye yomile"| C["I-ACUTE STOMA ISCHEMIA / NECROSIS: Susa i-wafer eqinile ngokukhawuleza"]
    C --> D["Gcina i-NPO yesigulana (akukho nto ngomlomo) kwaye ubize i-EMS ukuba ihlolwe ngokukhawuleza"]
    B -->|"I-Stoma telescoped ngaphandle kwe-5 ukuya kwi-20 cm (Prolapse)"| E{"Ngaba ithumba eliphumayo lipinki/lishushu okanye limnyama/libuhlungu?"}
    E -->|"Umnyama omfusa / omnyama, oqinileyo, okanye obuhlungu besisu esibuhlungu"| C
    E -->|"I-beefy ebomvu / epinki, ithambile, kwaye ayinabuhlungu"| F["Susa iwafer eqinileyo/iflange kwangoko ukuze iringi ingakwazi ukukrwitsha isiseko"]
    F --> G["Lala isigulane ngasemva + ugalele iswekile emhlophe eyomileyo etafileni phezu kwe-stoma ye-20 min"]
    B -->|"Imveliso yamanzi> 1,500 ukuya kwi-2,000 mL / imini + nesiyezi / umchamo omnyama"| H["OKUPHAKAMILEYO UKUDE UKWENZIWA KWESIMAYO: Yeka amanzi aqhelekileyo neziselo ezineswekile"]
    H --> I["Sip St. Mark's okanye WHO Oral Rehydration Solution; yiya ku-ER ukuba unesiyezi, uxinezelekile, okanye u-oliguric"]
    B -->|"Ukukhutshwa kwe-Zero kwi-4 ukuya kwi-6 hr (ileostomy) + i-cramps / ukuhlanza"| J["UKUTHINJWA KWESIFO ESIQHELEKILEYO: Nxiba iwafa ebanzi, ungarhabuli nto xa uyagabha, AKUKHO izinto zokuthambisa"]
    J --> K["Zama ukuhlamba okufudumeleyo kunye nokuma kwedolo ukuya esifubeni; yiya ku-ER ukuze ufumane i-catheter decompression"]

Isikhokelo sombala we-stoma: ukwahlula i-mucosa enempilo kwi-arterial ischemia kunye ne-necrosis¶

Ngenxa yokuba i-intestinal mucosa ayinayo i-keratinized yangaphandle yesikhumba (stratum corneum), ibhedi yayo ye-capillary ibonakala ngokuthe ngqo kwiso lenyama. Ukujonga umbala we-stoma yeyona ndlela ikhawulezayo yokuvavanya ukuhamba kwegazi kwe-mesenteric.

Kutheni i-stoma ischemia isenzeka¶

Xa ugqirha wenza i-ileostomy okanye i-colostomy, bahlanganisa i-loop okanye isiphelo samathumbu kunye negazi le-mesenteric elifana ne-fan kwaye bayitsale ngokuvula okwenziwe ngotyando (** trephine **) kwi-rectus abdominis muscle, fascia, kunye nesikhumba. Ukunikezelwa kwegazi kwi-stoma kunokusilela ngenxa yezizathu ezine:

1. Uxinzelelo lwemesenteric kwangoko lwasemva kotyando okanye i-arterial thrombosis (iyure zokuqala ezingama-24 ukuya kwezingama-72 emva kotyando): Ukuba i-mesentery yoluliwe yaqina kakhulu, ijijekile (volvulus), okanye icinezelwe kukudumba kodonga lwesisu emva kotyando, okanye ukuba uxinzelelo lwegazi luphantsi (hypotension) kunye neyeza ze-vasopressor zilambile i-arteries ye-splanchnic, i-distal tip ye-stoma ilahlekelwa yi-perfusion.
2. Ukukrwitshwa koomatshini ngokuvuleka kwewafer encinci: Istoma siyadumba ngokwendalo kwisithuba seeveki ezi-6 ukuya kwezisi-8 emva kotyando, kwaye sikwadumba okwexeshana ngeziganeko zegastroenteritis, prolapse, okanye ukuvaleka kwamathumbu. Ukuba isigulana sihlala sisebenzisa isithinteli se-wafer esisikwe kwangaphambili esincinci kune-stoma diameter, i-hydrocolloid eqinile okanye iringi yeplastiki inqumla kwisiseko se-stoma njengebhanti yerabha.
3. I-hernia yeparastomal evalelweyo: Ilophu yamathumbu icudisa ecaleni kwe stoma ngembobo yefascial ukuya kumanqatha angaphantsi kwesikhumba kwaye ibanjiswa kwaye iqatywe.
4. I-Systemic thromboembolism okanye i-mesenteric ischemia engekho-occlusive: Kamva ebomini, amahlule e-atrial fibrillation, ukungaphumeleli kwentliziyo, okanye i-aorta dissection inokuvala umthambo ophezulu okanye ongaphantsi we-mesenteric (bona Ischemia eyingozi kakhulu ye-mesenteric).

I-Superficial (phezulu-fascia) vs. nzulu (ngezantsi-fascia) stoma necrosis¶

Xa oogqirha bexesha likaxakeka bevavanya i-stoma emnyama okanye emnyama, umda obalulekileyo we-anatomical yi-** anterior rectus fascia ** (i-fibrous muscle sheath eqinile ehleli kwi-2 ukuya kwi-4 centimeters [0.8 ukuya kwi-intshi ye-1.5] phantsi kwesikhumba sesisu):

• Iischemia ye-mucosal engaphezulu (evalelwe ngentla kwe-fascia): Kuphela yincam ephumayo yestoma ngaphandle kwesihlunu sesisu esimnyama okanye simnyama, ngelixa umngxuma wamathumbu onzulu ngaphakathi kwitonela yezihlunu uhlala upinki. Ezi meko zihlala zicotha umaleko ongaphandle ofileyo kwaye ziphilise ngokujongwa ngononophelo (nangona zihlala zikhula kade i-stomal stenosis okanye incipha).
• I-deep transmural necrosis (eyongeza ngaphantsi kwe-fascia kwi-peritoneal cavity): Ukuba umbala omnyama, omfusa, okanye ongwevu udlulela nzulu kunenqanaba le-fascial ngaphakathi kudonga lwesisu, udonga lwamathumbu afileyo ngaphakathi kwesisu luya kugqobhoza ngokukhawuleza kwaye luchithe isitulo ngqo kwi-peritoneal cavity (***temediatomy perirotomy) uhlaziyo.

Ityhubhu yovavanyo ("ityhubhu yeglasi") yokukhanyisa isetyenziswe kwi-ER¶

Kwisebe likaxakeka, oogqirha bathambisa ngobunono ityhubhu yeglasi yokuqokelela igazi (Vacutainer), umbhobho we-syringe yeplastiki ecacileyo, okanye i-anoscope yabantwana / i-otoscope speculum, yifake kwi-3 ukuya kwi-5 centimeters (1.2 ukuya kwi-2 intshi) kwi-lumen ye-stoma, kwaye ukhanyise ukukhanya okukhanyayo kwicala lombhobho. Ukuba i-mucosa yangaphakathi ijika i-pink ekhanyayo i-1 isentimitha phantsi kwe-shaft, i-ischemia iphezulu. Ukuba i-mucosa ihlala imnyama emnyama, engwevu, okanye emfusa ngaphantsi kwinqanaba le-fascia yodonga lwesisu, isigulane sithathwa ngokukhawuleza kwigumbi lokusebenza. Ungaze ufake iityhubhu zeglasi okanye izinto ezibukhali kwistoma ekhaya; shiya ukuhlolwa kwangaphakathi koogqirha bexakeka.

I-Stoma prolapse kunye ne-sugar table yasekhaya (ukunciphisa i-osmotic) ukuqhuba¶

I-stoma prolapse yenzeka xa icandelo elityebileyo lamathumbu lingena ngaphakathi (iiteleskopu ngaphakathi ngokwalo) kwaye lityibela ngaphandle ngembobo yestoma, lijinga ngaphandle kwesisu njengomboko wendlovu ometa naphi na ukusuka kwi-5 ukuya kwi-25 yeesentimitha ubude (ii-intshi ezi-2 ukuya kwezi-10) ubude. I-prolapse ixhaphake ngakumbi kwi-loop colostomies (ingakumbi i-loop colostomies, apho i-distal "engasebenziyo" i-telescopes yelungu elingaphandle) kunye nokuphelisa i-ileostomies xa uxinzelelo lwesisu lunyuka ngenxa yokukhohlela, ukuphakamisa ubunzima, ukukhala kwiintsana, okanye ukutyeba.

Kutheni i-stoma ephumayo ibanjiswa ngaphandle komzimba¶

Xa i-10 ukuya kwi-15 yeesentimitha (ii-intshi ezi-4 ukuya kwezi-6) zamathumbu zityibilika ngaphandle ngeringi emxinwa ye-fascial kudonga lwesisu, i-tight muscle ring kunye ne-plastic ostomy wafer zicudisa imithambo ye-mesenteric yoxinzelelo oluphantsi ngelixa imithambo yoxinzelelo oluphezulu iqhubeka nokumpompa igazi kwi-bowel ephumayo. I-Fluid ivuza ngokukhawuleza kwizicubu ze-mucosal (** interstitial edema **). Kwimizuzu engama-30 ukuya kwengama-60, izibilini eziqhekekileyo ziyadumba ukuya kutsho kabini okanye kathathu ubukhulu balo obuqhelekileyo, lityebe kakhulu kwaye libe lukhuni ukutyibilika libuyele kumngxuma wodonga lwesisu. Ukuba kuyekwa kungancitshiswanga, ukudumba ekugqibeleni kutyumza unikezelo lwemithambo, ukuguqula iprolapse ebomvu epinki ibe sisigebenga, esikrwitshiweyo sikaxakeka sotyando.

Inyathelo-nge-nyathelo lokunciphisa ikhaya usebenzisa indlela yeDesai yetafile yeswekile yegranulated¶

Ukuba i-stoma ekhulayo i-*pinki okanye ibomvu, ishushu, ithambile, kwaye ayibangeli ubuhlungu obukhulu besisu **, ungasebenzisa unyango oluqhelekileyo lwesibhedlele lwe-osmotic ekhaya ngelixa ulungiselela uvavanyo lwezonyango:

1. *Khulula isingxobo esiqhotyoshelweyo okanye uvule isingxobo esineziqhekeza ezibini ngoko nangoko.
2. Lalisa isigulane emqolo waso (supine). Beka umqamelo phantsi kwamadolo ukuze izihlunu zesisu ziphumle kwaye umxhuzulane uyeke ukutsalela amathumbu ezantsi.
3. Thela iswekile yetafile emhlophe eyomileyo (sucrose) ngesisa phezu kwayo yonke i-stoma eveziweyo.
4. Galela ½ ukuya kwi-1 ikomityi (i-100 ukuya kwi-200 grams) yeswekile eqhelekileyo emhlophe egranulated eyomileyo ngqo kumphezulu omanzi, odumbileyo womathumbu oqhambileyo ukuze uqatywe ngokupheleleyo. (Su**** usebenzise iswekile engumgubo, equlethe i-cornstarch, kwaye musa ukuyinyibilikisa iswekile emanzini kuqala; kufuneka ibe ziikristale ezomileyo.)
5. Isebenza njani i-osmosis physics: I-intestinal mucosa edumbileyo yinwebu engakwazi ukungena ngaphakathi ezaliswe lulwelo lwe-hypotonic edema. Iikristale ezomileyo ze-sucrose zidala i-hypertonic osmotic gradient engaphaya komphezulu we-mucosal, ngokukhawuleza ukutsala amanzi avalelekileyo ewakhupha kudonga lwamathumbu adumbileyo ukuya kwityabeka yeswekile.
6. Linda imizuzu eli-15 ukuya kwengama-20 ngelixa ugcina isigulana sithe tyaba. Iswekile eyomileyo emhlophe iyanyibilika ibe isiraphu ecacileyo njengoko amanzi ephuma kudonga lwestoma. Ngaphezulu kwemizuzu eyi-15 ukuya kwengama-20, amathumbu arhabaxa, adumbileyo abonakala egqabhuka aze acutheke ngama-30 ukuya kuma-50 ekhulwini ububanzi.
7. Vumela ukucuthwa okuzenzekelayo okanye isikhokelo esithambileyo sesundu esicaba.
8. Kwiimeko ezininzi, ngokukhawuleza ukuba i-edema iyancipha kwaye isigulane siphuma ngelixa silele phantsi, i-bowel ephukileyo iyancipha ngokukhawuleza ngaphakathi kwesisu ngokwayo.
9. Ukuba uyalelwe ngaphambili ngugqirha wakho okanye umongikazi we-ostomy, unokubeka iglavu, i-lubricant-coated-coated palm flat ngobunono ngokuchasene nencam ekude ye-stoma ehluthiweyo kwaye usebenzise isikhokelo sokukhanya sangaphakathi ngelixa isigulane sikhupha. Ungaze utyhale ngamandla, ungaze ufake umnwe kudonga lwamathumbu, kwaye uyeke kwangoko ukuba uziva uxhathisa okanye uqaqanjelwa.
10. *Faka isingxobo esikhulu, esithambileyo esineqhekeza elinye emva kokucuthwa. Hlanza isiraphu yeswekile ngamanzi etephu afudumeleyo, wome ulusu olujikelezileyo, uze usebenzise isingxobo esithambileyo esisikwe ukuba silingane i-stoma kunye neemilimitha ezi-2 ukuya kwezi-3 (ii-intshi eziyi-0.1) zococeko. Qhagamshelana nogqirha wakho wotyando okanye Inxeba, i-Ostomy, kunye ne-Continence (WOC) umongikazi.

I-high-output ileostomy dehydration: kutheni amanzi alula enza kube nzima ngakumbi¶

Ngenxa yokuba amathumbu amakhulu (ikholoni) inoxanduva lokubuyisela kwakhona i-1,000 ukuya kwi-1,500 milliliters (1 ukuya kwi-1.5 quarts) yamanzi kunye ne-sodium yonke imihla, isigulane esine-**colostomy ** ngokubanzi sivelisa i-semi-formed okanye i-stool ebunjiweyo kunye nomngcipheko ophantsi wokuphelelwa ngamanzi emzimbeni. Ngokwahlukileyo, isigulane esine-ileostomy (okanye i-jejunostomy / i-bowel syndrome emfutshane) siye sadlula okanye sasusa ikholoni yonke.

Eqhelekileyo vs. imiqulu yemveliso ileostomy eyingozi¶

• Imveliso ileostomy eqhelekileyo eqolileyo: 500 ukuya 1,200 milliliters (0.5 ukuya 1.2 quarts) ngeeyure ezingama-24 of oatmeal-thick okanye toothpaste-consistency output (ukuthulula isingxobo esiqhelekileyo 4 ukuya kumaxesha ama-6 ngosuku).
• I-High-Output Stoma (HOS) threshold: Imveliso edlula 1,500 mililitha (1.5 quarts) kwiiyure ezingama-24 iintsuku ezimbini, okanye ngaphezulu kwe 2,000 millilitres (2 quarts) kwisithuba seyure ezingama-24* (ukuthulula iiyure eziyi-1 ukuya kwi-2 esigcwele amanzi usuku).

Ijejuno-ileal sodium-glucose cotransport trap (Kutheni amanzi angenanto ekhupha ityuwa)¶

Yonke ilitha yamanzi amdaka e-ileostomy iqulethe malunga ne-*90 ukuya kwi-120 millimoles (2,000 ukuya kwi-2,700 milligrams) yesodium **, kunye ne-potassium, i-magnesium, kunye ne-bicarbonate.

Ngokungafaniyo nekholoni, amathumbu amancinci aphezulu (jejunum) ine-"leaky" ye-intercellular intercellular junctions engakwazi ukufunxa amanzi ngaphandle kokuba i-sodium kunye ne-glucose zihanjiswa ngenkuthalo kunye ngaphaya kwe-brush-border membrane nge- **SGLT1 (i-Sodium-Glucose Linked Transporter 1) ** iprotheni, efuna i-concentration ye-sodium ubuncinane ** 60 ukuya kwi-90 mmol / L ** ngaphakathi kwe-lumen yamathumbu.

• Kwenzeka ntoni xa isigulana se-ileostomy sisela amanzi aqhelekileyo, iti ebuthathaka, ikofu, isoda yokutya, okanye iziselo zemidlalo zorhwebo: Amanzi aqhelekileyo ane-0 mmol/L yesodium, kunye neziselo zemidlalo eziqhelekileyo (ezifana neGatorade okanye iPowerade) zine-18 kuphela ukuya kwi-20 mmol/L yesodium ecaleni kwemithwalo ephezulu yeswekile. Xa olulwelo lunesodium ephantsi lungena kwijejunum, isodiyam isasazeka ngokukhawuleza iphuma egazini lomguli iye kwilumen yamathumbu ukuze ilingane ne-osmotic gradient, kunye nomthamo wonke wamanzi kunye nesodium evundiweyo yomzimba igalela ngqo kwingxowa ye-ileostomy emva kwemizuzu engama-20. Xa sinxanwa isigulana kwaye kokukhona sifumana amanzi alula, kokukhona sikhupha amanzi emzimbeni (secretory net net loss).
• Kwenzeka ntoni xa besela ijusi yeziqhamo enencasa, isoda eqhelekileyo, okanye iinyikima ezinolwelo olunesondlo: Iswekile yeHypererosmolar itsala umthamo omkhulu wamanzi iwakhuphe egazini ukuya kwilumen yamathumbu ngeosmosis (osmotic diarrhea), ukuphinda kabini ukuphuma kwe-stoma ngaphakathi kweyure.

Ungaxutywa njani iSt. Mark's Solution okanye iWHO Oral Rehydration Solution ekhaya¶

Ukuguqula i-high-output ileostomy fluid loss ekhaya, izikhokelo ezivela kwiBritish Society of Gastroenterology (BSG), ESPEN, kunye neSibhedlele saseSt Mark's Intestinal Failure Unit icacisa ukukhawulelana nolwelo olucacileyo lwe-hypotonic (amanzi alula, iti, ikofu) ukuya ngaphantsi kwe-500 ukuya kwi-1,000 mL / imini ye-glucose kunye nokubuyisela i-hydrrolyte ilahleko ye-hydrrolyte (75 ukuya 90 mmol/L isodiyam)**:

1. I-WHO yoRhwebo i-Osmolarity Reduced-Osmolarity Oral Rehydration Salts: Xuba ipakethe enye eqhelekileyo ye-WHO ORS (okanye iingxowa ezimbini ze-Dioralyte zamandla aphindwe kabini njengoko kuyalelwe liqela le-stoma, okanye i-CeraLyte 70/90, iDripDrop, okanye i-Pedialyte Sport) kumthamo ochanekileyo ochaziweyo we-1 litre3 yamanzi acocekileyo.
2. ISt. Mark's Electrolyte Mix (Ifomula yaseSibhedlele esemthethweni yeLitha e-1 [4.2 iikomityi zase-US] zaManzi):
3. Iitispuni zenqanaba ezi-6 (iigram ezingama-20) zomgubo weglucose (okanye iitipuni zenqanaba le-6 zeswekile etafileni ukuba i-glucose ecocekileyo/umgubo wedextrose awukho, nangona umgubo weglucose ukhethwa kwi-osmolarity efanelekileyo)
4. inqanaba letisipuni eli-1 (3.5 grams) letyuwa yetafile (sodium chloride)
5. ½ inqanaba itispuni (2.5 grams) yesoda yokubhaka (sodium bicarbonate) (okanye i-trisodium citrate)
6. Yinyibilike ngokupheleleyo ku 1 ilitha (1,000 mL) yamanzi abandayo. Gcoba kancinci yonke imini (ukuyipholisa okanye ukongeza i-splash encinci ye-lemon engenaswekile / i-lime flavour yenza incasa enetyuwa ibe lula ukuyinyamezela).
7. Ukwahlula izinto eziqinileyo kunye nolwelo ekutyeni: Musa ukusela ulwelo kwimizuzu engama-30 phambi, ngexesha, okanye imizuzu engama-30 emva kokutya ukutya okuqinileyo, ngoko ke ukutya okuqinileyo kuhamba kancinane ngakumbi kwizibilini ezincinci. Yitya ukutya okubophelelayo okunesitatshi okutyebisa i-ileostomy: irayisi emhlophe, ipasta, iitapile eziphekiweyo, isonka esimhlophe, iibhanana, ibhotolo yepeanut egudileyo, iapileauce kunye nemarshmallows.

Ukuvaleka kwe-stoma ebukhali (i-bolus yokutya okanye isithintelo ngoomatshini)¶

Ngenxa yokuba i-ileostomy idlula kwindawo emxinwa kudonga lwesihlunu esiswini, i-fibrous, ukutya okuhlafunwa kakubi (i-popcorn, amakhowa, imitya ye-celery, i-coconut, iziqhamo ezomisiweyo, amandongomane, okanye i-citrus pith) inokudityaniswa ibe yiplagi eqinileyo ngasemva kwe-fascia yesisu (** i-bolus obstruction **). Ukuncamathela, ukujija (volvulus), okanye i-hernia ye-parastomal inokuphinda ikhuphe isisu ngaphakathi.

Ukuqaphela ngokuyinxenye vs. isithintelo esipheleleyo se-stoma¶

• Ukuvaleka kwe stoma kancinci: I stoma siyayeka ukudlula intlama eshinyeneyo eqhelekileyo kwaye siphume ulwelo olunuka kakubi, olunamanzi phantsi koxinzelelo ecaleni kwezandi zokugragrama, ukukrazuka kwesisu okungephi, kunye nokudumba, i-stoma ephumayo.
• Gqibezela ukuvaleka kwe-stoma: Isitulo esiziro kunye nerhasi enguziro faka kwisingxobo se-4 ukuya kwiiyure ezi-6 kwi-ileostomy* (okanye iiyure ezingama-24 ukuya kwezingama-48 ngentlungu kwicolostomy). Isisu siyavuleka, amaza eentlungu ezibuhlungu abetha rhoqo kwimizuzu embalwa, i-stoma iyadumba, kwaye isigulane siqala ukugabha ulwelo oluluhlaza okanye olumnyama olumdaka.

Imilinganiselo yekhaya ekhuselekileyo yeplagi yokutya-bolus ephakathi (ukuba isigulana ASIHLANZI)¶

1. **Susa i-wafer yangoku kwaye usebenzise isingxobo esinokuvulwa okukhulu ** ukulungiselela ukudumba kwe-stoma.
2. Yeka ukutya konke ukutya okuqinileyo ngoko nangoko. Ukuba isigulana asigabhi, sinokurhabula i-oral rehydration solution. Ukuba uyacaphukela okanye uyagabha, zigcine kungekho ngomlomo (NPO).
3. Yicwilise kwibhafu efudumeleyo kangangemizuzu eyi-15 ukuya kwengama-20 okanye ubeke iphedi efudumeleyo enqumla isisu ukuze uphumle ukuqhawuka kwezihlunu zesisu.
4. Yenza ukuma kwedolo ukuya esifubeni kunye ne-peristomal massage: Lala ngecala amadolo atsalele ngasesifubeni, okanye uguqe ngobunono ezandleni nasemadolweni ngelixa uphulula isisu ujikeleze i-stoma ukukhupha iplagi yokutya emva kwe-fascia.
5. UNGAZE uthathe iilaxatives zomlomo ukwenzela ukuvaleka kwe-ileostomy. Izinto zokuthambisa zibangela i-peristalsis enobundlobongela kwiplagi evaliweyo, oko kuyingozi yokugqobhoza kwamathumbu kunye nokuphelelwa ngamanzi emzimbeni.
6. Yiya kwisebe likaxakeka ukuba imveliso ayiqalisi kwakhona kwiiyure ezi-4 ukuya kwezi-6 okanye ukuba ukuhlanza kuqalile. Oogqirha baya kwenza uvavanyo oluthambileyo lwe-stoma yedijithali kwaye bafake i-lubricated 14-French okanye i-16-French i-catheter yerabha ebomvu iisentimitha ezimbalwa kwi-stoma ukunkcenkceshela i-bolus yokutya nge-saline eqhelekileyo efudumeleyo.

I-Parastomal hernia strangulation, ukopha i-varices, kunye nokwahlukana kwe-mucocutaneous¶

Ukuvalelwa kweParastomal hernia vs¶

Ukuya kuthi ga kwi-30 ukuya kwi-50 yepesenti yezigulane ze-ostomy ekugqibeleni zenza i- **parastomal hernia **, iqhuma ngaphantsi kwesikhumba ecaleni kwe-stoma apho i-loop eyongezelelweyo yamathumbu ityhala ecaleni kwe-stoma ngokuvuleka kwemisipha.

• Iqhuma elingaphumiyo elinokuncipha: Iqhuma liyaphuma xa umile okanye ukhohlela, livakala lithambile kwaye lingenantlungu, liba mcaba xa lilele, kwaye i-stoma ihlala ipinki kunye nemveliso eqhelekileyo.
• Ekrwitshiweyo / evalelwe i-parastomal hernia (Imeko eNgxamisekileyo yoTyando): Iqhuma elisecaleni kwestoma liya kuba lilukhuni, liqine, lithembe, kwaye alinakuba mcaba xa lilele; ulusu phezu kwe-bulge lujika lube bomvu okanye lube mfusa; i-stoma ijika i-dusky purple okanye iyeke ukuvelisa imveliso; kwaye isigulane sivelisa iintlungu ezibuhlungu zesisu kunye nokugabha. Susa i-wafer ngokukhawuleza, lala phantsi, musa ukutyhala iqhuma elibuhlungu ngaphakathi, kwaye ubize iinkonzo zikaxakeka.

Ukopha kwesisu: i-mucosal friction vs. portal-hypertension parastomal varices¶

• Ukuphuma kwe-mucosal encinci: Ukosula ngamandla ngexesha lokutshintsha ingxowa okanye i-wafer edge eqinayo ehlikihla i-stoma kudla ngokubangela igazi elibomvu eliqaqambileyo kwi-gauze. Ukucofa iphedi ye-gauze epholileyo, emanzi ngobunono ngokuchasene nebala kangangemizuzu emi-2 ukuya kwemi-3 kuyimisa ngokupheleleyo.
• I-Parastomal variceal hemorrhage (I-Life-Treatening): Kwizigulane ezine-isibindi se-cirrhosis okanye i-portal hypertension, i-high-pressure portal veins yenza isangqa semithambo ye-varicose apho i-stoma idibana khona nolusu lwesisu (**caput medusae **, edla ngokubonakala njenge-bluish yesikhumba e-bluish). Ezi zihlunu zinokugqabhuka ngokuzenzekelayo kwaye zimpompe **amakhulu eemililitha zegazi elimnyama okanye elibomvu elikhanyayo kwi-ostomy bag ngaphakathi kwemizuzu **, ekhokelela kwi-hemorrhagic shock.
• ** Uncedo lokuqala olukhawulezileyo:** Khulula isingxobo, jonga indawo ekuphuma kuyo kumda we-stoma yesikhumba, kwaye ucinezele enye iphedi ye-gauze egotyiweyo egotyiweyo (okanye i-gauze emanziswe nge-oxymetazoline ngaphezulu kwe-counter 0.05% yokutshiza ngeempumlo) ngokuthe ngqo kwaye ngokuqinileyo kwindawo yokopha ngomnwe omnye ngelixa ubiza i-19/12 Gcina isigulana sithe tyaba nemilenze iphakanyisiwe (bona i-esophageal varices kunye ne-cirrhosis yokopha).

Ukwahlukana kwe-mucocutaneous kunye nokurhoxiswa kwe-stoma¶

Kwiiveki zokuqala ezi-2 ukuya kwezi-4 emva kokuhlinzwa, izibonda ezibambe umgca we-stoma kwisikhumba sesisu zingakwazi ukuhlukana (** ukuhlukana kwe-mucocutaneous ), okanye i-stoma inokucwina ngaphantsi kwenqanaba lesikhumba ( retraction **).

• Umahluko oyingozi: Ukwahlulwa okunzulu ukusuka kumaleko angaphezulu kwesikhumba kulawulwa ngumongikazi weWOC esebenzisa i-calcium alginate yokufunxa okanye i-hydrofiber powder. Nangona kunjalo, ukuba i-stoma ** ikhupha ngokupheleleyo malunga ne-360 degrees kwaye ihla ngaphantsi kwe-muscle fascia kwi-peritoneal cavity , isitulo sigalela ngqo kwisisu ( peritonitis **). Ukuba ubona umngxuma onzulu ongenanto kunye neentlungu ezibuhlungu zesisu kunye nomkhuhlane, tsalela i-ambulensi ngokukhawuleza.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

• I-United States kunye neKhanada: Fowunela 911 ye-stoma emnyama / emfusa ye-ischemia, i-parastomal hernia evalelwe, ukopha okukhulu kwesisu, okanye ukuphelelwa ngamandla kwamanzi kunye ne-syncope. Inxeba, i-Ostomy, kunye ne-Continence Nurses Society (WOCN) kunye ne-American Society of Colon kunye ne-Rectal Surgeons (ASCRS) ivumela ukususwa ngokukhawuleza kwee-wafers ezixinzelelayo, ukunciphisa i-osmotic ye-supine kunye ne-sucrose ye-granulated ye-stomas esebenzayo, kunye nonyango lokubuyisela emlonyeni kwi-ileostomi ephezulu.
• EUnited Kingdom: Fowunela 999 ngenxa ye-peritonitis ebukhali, i-necrotic stoma, okanye umothuko onzima, okanye ufowunele 111 / iNgcali yoMongikazi wakho we-NHS Stoma wokhathalelo olungxamisekileyo lwesibhedlele sosuku olunye lwe-prolapse okanye ukuphuma okuphezulu. Umbutho waseBrithani we-Gastroenterology (BSG) kunye nezikhokelo zeSibhedlele saseSt Mark's zilungelelanise isisombululo se-electrolyte yaseSt Mark kunye nokunciphisa i-hypotonic fluid kwi-stomas ephezulu.
• ** IManyano yaseYurophu:** Fowunela 112. European Society for Clinical Nutrition and Metabolism (ESPEN) kunye neEuropean Crohn's and Colitis Organisation (ECCO) izikhokelo ziqondisa kwangethuba isotonic/high-sodium ORS (90 mmol/L sodium), loperamide/antisecretory titration phantsi kweliso lonyango, kunye nophononongo olungxamisekileyo lotyando lwe-ischemic okanye i-stomas ethintelweyo.
• Ostreliya neNew Zealand: Fowunela 000 e-Australia okanye 111 eNew Zealand. Iiprothokholi ze-Australian Association of Stomal Therapy (AASTN) zigxininisa ukwandiswa kwesixhobo se-edematous/prolapsed stomas kunye nokubuyisela okungxamisekileyo kwe-intravenous kwi-ileostomy ephezulu ene-oliguria.
• ** I-Indiya kunye ne-Asia-Pacific: ** Fowunela ** 112 ** eIndiya, ** 995 ** eSingapore, ** 119 ** eJapan naseMzantsi Korea, okanye ** 999 ** eMalaysia naseHong Kong. Bona uluhlu lwethu olupheleleyo lwe iinombolo zikaxakeka zamazwe ngamazwe.

Imibuzo edla ngokubuzwa¶

Kutheni ukugalela iswekile yetafile emhlophe kwi-stoma ekhukhulayo yenza ukuba iyancipha?¶

Umphezulu we-stoma yinwebu yangaphakathi ye-mucous yamathumbu, esebenza njengesithintelo semipermeable. Xa i-stoma iphuma kwisisu, ukuxinana kwe-venous kubamba amanzi amaninzi ngaphakathi kwezicubu, kuyenze idumbe kakhulu ukuba ibuyele umva ngokuvula izihlunu. Ukwambathisa i-mucosa emanzi ngeekristale ezomileyo ze-sucrose ze-sucrose kudala i-hypertonic osmotic gradient enamandla ethi itsale ngokukhawuleza amanzi avaleleke kudonga lwamathumbu adumbileyo iwafake eswekileni, ingcolise inyama phakathi kwemizuzu eli-15 ukuya kwengama-20 ukuze ikwazi ukutyibilika kakuhle umva ngaphakathi ngelixa ilele tyaba.

Kutheni umntu onayo i-ileostomy engenako ukusela amanzi amaninzi xa isikhwama sakhe sigcwalisa imveliso yamanzi?¶

Ngokungafaniyo nekholoni ephilileyo, amathumbu amancinci aphezulu awakwazi ukufunxa amanzi alula ngokwawo; iiseli zayo zifuna i-concentration ephezulu ye-sodium (i-60 ukuya kwi-90 millimoles ilitha nganye) idibene ne-glucose encinci ukutsala amanzi ngaphaya kodonga lwamathumbu ukuya egazini. Xa isigulana se-ileostomy sisela amanzi alula, iti, okanye iziselo zezemidlalo eziphantsi-sodium, isodiyam ivuza egazini layo iye emathunjini ukuze ilingane netyuwa, iwagungxule amanzi abawasele nje kunye netyuwa yomzimba wayo ngqo kwingxowa ye-ostomy kwaye iba mandundu.

Ndingawubona njani umahluko phakathi kwebeetroot eqhelekileyo/ibala lokutya kunye negazi lokwenyani okanye istoma esifayo?¶

Ukutya iibeet ezibomvu, i-gelatin ebomvu, idayi yokutya ebomvu, i-licorice, okanye iipilisi zentsimbi zihlala zijika isitulo okanye ulwelo ngaphakathi kwebhegi ye-ostomy ebomvu ebomvu okanye i-pitch emnyama, enokubonakala isothusa. Nangona kunjalo, ukutya kunye ne-iron kuphela umbala ophumayo ngaphakathi kwesingxobo; aziwutshintshi umbala we-stoma tissue ngokwayo. Sula ngobunono umphezulu we-stoma bud ngethishu emanzi: i-stoma esempilweni iya kuhlala ikhangeleka iqaqambile, ibomvu-bomvu, ifumile, kwaye ishushu, ngelixa ischemic stoma siya kubanombala omfusa, omdaka, okanye omnyama apha kudonga lwamathumbu.

Kutheni iipilisi zamayeza ngamanye amaxesha ziphuma ziphelele ngaphakathi kwengxowa ye-ileostomy, kwaye zeziphi iipilisi eziyingozi?¶

Ngenxa yokuba i-ileostomy isusa okanye idlule amathumbu amakhulu kwaye ifinyeze ixesha lokuhamba kwamathumbu, ukukhutshwa okwandisiweyo (ER, XR, SR, XL) kunye neepilisi ezigqunywe yi-enteric zihlala zidlula ngqo kwisingxobo se-ostomy singanyibiliki ngokupheleleyo, okubangela ukurhoxiswa kwamayeza ayingozi okanye ukusilela kunyango. Ungalokothi uthathe iipilisi ezikhutshwe ixesha elide okanye i-enteric-coated-coated nge-ileostomy ngaphandle kokuba ihlanjululwe ngokuthe ngqo ngusokhemesti (cela iipilisi ezikhutshwa ngokukhawuleza, ulwelo, okanye iipatches), kwaye ungalokothi uthathe i-laxatives yomlomo, enokuthi iqalise ukuchithwa kwe-electrolyte esongela ubomi.

Ngaba kuqhelekile ukuba i-stoma entsha itshintshe ubungakanani kwiinyanga ezimbini zokuqala emva kotyando?¶

Ewe. Kwakamsinyane emva kotyando, sonke i-stoma sidumbile ngenxa yokuphathwa kotyando kwaye sicutheka kancinci ngobubanzi kwiiveki ezi-6 ukuya kwezisi-8 de sifikelele kubungakanani baso besiseko obusisigxina. Ngezo nyanga zimbini zokuqala, kufuneka ulinganise i-diameter ye-stoma ngesikhokelo sokulinganisa kulo lonke utshintsho lwe-wafer ukuze indawo yokuvula ingabi banzi kakhulu (ebonisa ulusu lwe-peristomal kwi-enzymes yokugaya ukutya) okanye iqine kakhulu (enokuthi ikrwise i-stoma ukuba idumbile okwethutyana).

Imithombo kunye nezikhokelo ezisemthethweni¶

• ** Inxeba, i-Ostomy, kunye ne-Continence Nurses Society (WOCN, eUnited States): ** * I-WOCN Society Isikhokelo seklinikhi: Ukulawulwa kwesigulane esiDala nge-Fecal okanye i-Urinary Ostomy * (I-Triage ye-stoma ischemia, ukuhlukana kwe-mucocutaneous, i-prolapse, kunye ne-peristomal varices).
• ** I-American Society of Colon kunye ne-Rectal Surgeons (ASCRS, eUnited States): ** *Izikhokelo zeKlinikhi zokuSebenza kwi-Ostomy Surgery * (Uvavanyo lwe-superficial vs. sub-fascial stomal necrosis, i-hernia strangulation, kunye nokuphazamiseka kwesisu).
• ** IBritish Society of Gastroenterology (BSG) kunye neSibhedlele saseSt Mark's I-Intestinal Failure Unit (eUnited Kingdom):** Izikhokelo zoLawulo lweZigulana ezineThumbu eliMfutshane kunye ne-High-Output Stoma (Nightingale J et al., Amathumbu: i-jejunal sodium-glucose cotransport physiology, i-hypotonic ye-electromagnetic solution, i-hypotonic fluid kunye ne-Stoma ye-reutput.
• ** I-European Society for Clinical Nutrition and Metabolism (ESPEN, Europe): ** * Isikhokelo se-ESPEN kwiSondlo seKliniki kwi-Acute and Chronic Intestinal Failure * (I-High-output ileostomy fluid kunye ne-magnesium / potassium resuscitation protocols).
• ** I-Myers JO & Rothenberger DA / Desai DC (* Izifo zeColon & Rectum * / * Ijenali yaseMelika yoTyando *): ** * UkuNcitshiswa kwe-Osmotic ye-Edematous Prolapsed Stomas Ukusebenzisa i-Topical Granulated Sucrose *.

Izikhokelo ezinxulumeneyo¶

• Ukuvaleka kwamathumbu, i-hernia ekrwitshiweyo, kunye neempawu ezingxamisekileyo zevolvulus
• I-acute mesenteric ischemia, i-bowel infarction, kunye nentlekele yesisu yasemva kokutya
• Ityhefu yokutya, i-gastroenteritis ebukhali, kunye nokuphelelwa ngamanzi emzimbeni
• Ukuqhawuka komqala wommizo, ukopha kwe-cirrhosis, kunye ne-hepatic encephalopathy
• Ukukhutshwa kwesisu kunye nokunakekelwa kwenxeba elivulekileyo lesisu