As the saying goes, how to choose nutritional liquid oral and nasal feeding?

Author:Guangdong Provincial Hospital Time:2022.07.26

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"As the saying goes" is the first Chinese medicine department with inflammatory bowel disease in China, which means "enteritis"; the creative team of "often saying" is the inflammatory bowel disease of Guangdong Hospital with Professor Chen Yan as the main body. The slow disease management team, Professor Chen Yan is the popular popularization of the Chinese Chinese Medicine Society, emphasizing that the professionalism of traditional Chinese medicine science is his style, so this column can also be understood as "intestinal extension"; , Choose a Chinese medicine plan for patients with inflammatory bowel disease.

In the previous tweet, we briefly introduced the characteristics of three commonly used intestinal nutrients from the perspective of traditional Chinese medicine. The nutrient solution has a close relationship with "wet". The function is to choose the appropriate intestinal nutritional preparations and dosage forms according to the patient's condition and personal constitution to play better treatment effects. In addition, the method of intestinal nutritional treatment is also worthy of our attention. According to the patient's specific condition and the patient's tolerance and compliance with the patient's internal nutritional therapy, choose oral or tube feeding for intestinal nutritional therapy as appropriate. "

The intestinal nutrition tube feeding is continuously slowly infused in the intestinal nutritional preparations through the main nutrition tube. The tube feed is necessary to have abnormal patients with abnormal gastrointestinal gastrointestinal stenosis or penetrating lesions. , Do not meet the dietary physiology and psychology of normal people, the price of infusion pumps and feed pipes is expensive, and there are some difficulty in nursing. Therefore, the "Opinions of China's Inflammatory Intelliginal Diet Diet Management Expert" stated: "When implementing the internal nutritional therapy in the bowel, it is advisable to give priority to the intestinal nutritional treatment through oral intestinal nutritional preparations."

Popularly speaking, the treatment of nasal feeding methods has less dependence on gastrointestinal function, which is relatively effective, but because of the entire treatment cycle (usually three months), it is necessary to insert it every day, so people will be more hard. The impact on the quality of life is also greater; the method of oral nutrient solution is more convenient to be more convenient, but the dependence on gastrointestinal function will be higher. So, should patients choose a solution that suits them in these two methods? The following is explained by a case.

Patients began to repeat mucus and blood stools more than 20 years ago, and accompanied by abdominal discomfort. They thought it was hemorrhoids at the beginning, and did not pay special attention. In the later period, due to abdominal pain, it was diagnosed in the spleen and stomach disease in Fangcun Hospital in 2018. Ron's disease (back to the colon, non -narrow and non -penetrating, activity period), the initial use of biological preparation induction and relief, but after the drug antibody occurs, it is replaced with immunosuppressant maintenance treatment. An accidental abdominal colic occurs in an accidental diet, and in August 2021, he went to our hospital for hospitalization to evaluate changes in the condition.

After being admitted to the hospital to improve the relevant examination, it was found that there was a recurrence of the disease, and an incomplete intestinal infarction was accompanied by abdominal infections. According to the preliminary treatment plan and the changes in the condition, the immunosuppressant could not effectively maintain the relief. And adjust to whole gastrointestinal nutritional therapy (oral).

Patients using the whole gastrointestinal nutrition plan (oral) abdominal pain can be relieved, but the increased amount of eating is repeated, and the good times do not have long times. The patient's stool again due to abdominal pain will be admitted to the hospital again in September 2021. The lumen of the colon is narrowed, and the intestinal intestine seeps out of the intestine. Adjustment to the whole gastrointestinal nutritional support and cooperating with traditional Chinese medicine therapy to improve the symptoms of abdominal pain, and review the intestinal color Doppler ultrasound to indicate the external healing. String thin, the patient's own moisture itself is heavy, indicating that the spleen and stomach transportation function is extremely poor. Considering the replacement of oral solutions as a nasal feeding solution, because the nutritional solution can directly get the empty intestine through the infusion pump and the feed tube The burden of transportation, but the patient believes that the intubation is very hard, and it is not psychologically injected into the food through the nasal tube.

In December 2021, he was admitted to the hospital again due to abdominal pain. Because of the narrowing of the intestinal tract, the amount of nutrient solution slightly increased the amount of abdominal pain, which seriously affected the quality of life of the patient, and the patient also had the willingness to surgery. Therefore, we recommend the inner gram of Guangzhou City A hospital with the highest level in Ron's disease surgery conducts evaluation of surgical surgery. The patient was hospitalized in the hospital for review. The CTE examination prompted the intestinal fistula of the blind part, and the occurrence of multiple intestinal fistula and the peripheral abscess formed. At that time, the surgeon told the patient that the patient was not the best time to surgery. The plan is the treatment of whole gastrointestinal nutrition. Patients received tube feed in helplessness. At the beginning of the intubation caused the throat discomfort and the survival of the tube, the patient was really distressed, but fortunately, I insisted on 2 two. After many months of tube feed treatment, the patient's condition has improved significantly, abdominal pain disappears, and weighs to 50kg (10kg from the previous increase). The nutritional state has improved significantly. CTE reviews that intestinal fistula disappear. The improvement of intestinal inflammatory stenosis can temporarily exempt surgical treatment. The opening of the nasal feed tube is removed, and other biological agents are used to maintain treatment.

It can be seen from the above case that it is also nutritional therapy. Different methods of giving (oral and nasal feeding) do have different results. Why does this happen? This is explained from the digestion and absorption of food in the human body. Traditional Chinese medicine believes that the food we eat through the stomach is rotten and rotted with the small intestine to "distinguish different turbidity". Turn into waste. (See the figure below for details)

So how do Chinese medicine know nose feeding and orally?

First of all, briefly introduce how the nasal feed is operated. Nose feeding is inserted the catheter into an empty intestine (small intestine) through the nasal cavity, and the nutrient solution is infused from the catheter to maintain nutritional treatment. This process is surrounded by the adult. The nutrient solution directly enters the small intestine. Perform distinction of different turbidity. At the same time, a nutritional preparation of short peptides or amino acid type (weak wet) type (weak wet) is usually selected during nasal feeding, which largely reduces the burden on the spleen and stomach. The requirements for spleen and stomach function are relatively high. Combined with the above emphasis on the nutritional solution to transform the daily nutritional needs of the adult body, it depends on the transportation function of the spleen and stomach. As a result, the condition is repeated.

Therefore, for patients with poor spleen and stomach transportation function, obvious dampness in the body, patients with fistula and obvious narrowing, and intestinal inflammation load, continuous and slow -to -ductive tube feed can relative to patients to slowly absorb nutrient solution and reduce the burden of spleen and stomach transportation. Essence

"Suggestions for China Inflammatory Intelliginal Diet Management Experts" also pointed out: "For patients with abnormal IBD patients with abnormal IBDs such as high digestive tract or penetrating lesions, and abnormal swallowing dysfunction, it is necessary. Perform the gastric stomach of the endoscopy for an empty intestinal nutrition tube) for tube feed. "

If the spleen and stomach transportation function is acceptable, choosing oral intestinal nutritional therapy is more in line with normal people's diet and physiological needs. In addition to choosing the right nutritional preparation, it can also cooperate with Chinese medicine to improve the spleen and stomach function, make it more adaptable to the intestinal nutrients, reduce abdominal pain and diarrhea, etc. It is not adapted to the situation, but how to take nutrient solution also has another learning. In the next issue, we will teach how to take the nutrient solution, so stay tuned!

Medical Guidance:

Chen Yan, a chief Chinese medicine doctor, a master's degree instructor, director of the Department of Gastroenterology, Fangcun Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine, the heir of academic experience in the academic experience of old Chinese medicine experts, and youth famous Chinese medicine medicine in Guangdong Provincial Hospital of Traditional Chinese Medicine. The person in charge of the management team of inflammatory bowel disease in Guangdong Province. The head of the research team of the Earth Academic College Research Team of Guangdong Hospital of Traditional Chinese Medicine. Popular Popularity of the Chinese Medicine Society, member of the Gastroenterologist Branch of the Guangdong Medical Association, executive director of the World Lianlian Gastroenterology Commission, member of the Chinese Medicine Culture Branch of the Chinese Medicine Society, Deputy Chairman of the Communication Professional Committee of the Guangdong Academy of Traditional Chinese Medicine, The Wu Jieping Medical Foundation of the China Inflammation Intestinal Disease Alliance Traditional Chinese and Western Medicine Integrated Professional Committee, a member of the Spleen and Stomach Disease Branch of the Chinese Academy of Chinese Medicine.

At present, the theoretical research of academic genre in TCM supplement soil supplementation has certain advantages in the theory of traditional Chinese medicine; as the person in charge of the management team of inflammatory bowel diseases, the use of traditional Chinese medicine to treat inflammatory bowel disease (Crotn disease, ulcerative colitis ), Professor Yu Shaoyuan, a famous Chinese medicine medicine in Guangdong Province, is good at using Chinese medicine to treat chronic digestive system diseases such as full, diarrhea, and constipation. The editor -in -chief has 9 monographs in traditional Chinese medicine and wrote more than 60 related papers.

Flame -inflammatory bowel disease clinic: Thursday afternoon, 4th floor of Fangcun Hospital, Fangcun Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine. (Clarifying patients with inflammatory bowel disease, you can add the number to the outpatient clinic.)

Supply: Zheng Jie, Department of Spleen and Stomach Disease, Guangdong Provincial Hospital of Traditional Chinese Medicine