Transcript 第12回ストレスと外科の栄養

Lecture 12
Stress and surgical nourishment
物理的：外傷、
火傷、手術
Stressor
Action of
the inside
of the body
organ
system on
cause of
causing
stress ,that
is, to
stressor
Cerebral limbic system
Discharge neurotransmitter
and neuromodulator
化学的：感染、
中毒、無酸素
心理的：不安、
緊張、怒り
Hypothalamus
CRH secretion
Pituitary
ACTH Secretion
Adrenal cortex
Glucidic cortisol
secretion
Immunity
system
Automatic nervours system
Noradrenaline
secretion
Adrenal medulla
Adrenaline and noradrenaline
secretion
A surgical operation is a typical stress.
The correspondence method becomes the example of all stresses
Absorption protein
Operation
Protein
Nitrogen
receipts and
disbursemen
ts after it
operates
Fever after operation (up to 38c)
Relieving pain
equilibrium
Primary healing of
operation wound
Intestine activity
positive
Removing the stitches
Anabolism
gluconeogenesis
day
negative
Dissimilation
protein
day
The tenth of the adrenocortical hormone decrease of → period the ninth
of adrenal skin quality period the fourth → assimilation period > 10 days
Yasuo KAGAWA. “Nourishment biochemistry”
KAGAWA Nutrition publishing, 1970, p.263
Surgical operation
It operates safely by using the operation monitor for the animal
that can measure the density of oxygen and the temperature the
ventricular rate, the electrocardiogram, the blood pressure, the
number of breaths, the breath gas carbon dioxide concentration,
the pulse, and in blood at the same time. The artificial respirator
is attached to the anesthesia apparatus
Adrenal cortex
It is possible to swim for as
much as three days by
giving the adrenocortical
hormone though it will die
in three hours when the rat
is put in cold water.
As for the adrenocortical
hormone, the serious case
was called the new
medicine of
the miracle whose it was
able to be vigor. The
inflammation is suppressed.
However, it weakens, the
diabetic and osteoporosis
are caused easily, and it is
harmful in infection when
using it at a long term
Hypothalami
Adrenocortical hormone
Aldosterone
Glucidic cortisol
Androgen
(male hormone)
Adrenal medulla
Adrenal
gland
Kidney
Adrenal medullary
hormone
Adrenaline
(epinephrine)
Noradrenaline
(norepinephrine)
Fluid infusion and transfusion
treatment in intraoperative period
Abdomen general surgery
Intraoperative period
management
Figure 2
Coexisting illness and density of serum albumin
Frequency of Coexisting illness
Contrast
(Stomach, Colon)
Gullet
Pancreas
Serum albumin
Organization
Fatty
acid
glycerol
Amino acid
Protein
Lipid
Oxygen
bilirubin
Ammonia
Cholesterol
bile
Toxic substance
Detoxi
cation
Keto protist substance
hepatic artery
Energy
product
monosaccharide
Urine
Lactic acid
Glycogenic
substance
Portal vein
kidney
Alanine
Ketone body
Blood
of sugar Plasma protein, lipid
Review of
alimentary
system
Hepatic vein
Role of liver
Liver
Processing
Storing
Transportation
Bile secretion
Glucose
Digestive tube
Yasuo KAGAWA. “Nourishment biochemistry”
KAGAWA Nutrition publishing, 1970, p.286
Administering necessity amount according to stress
energy
protein
kcal/kg/hr
kcal/kg/d
g/kg/d
1
24
0.8
Rest
1.10
26
0.6-1.0
Light
1.25
30
1.0
Middle
1.50
36
1.2
Heavy
1.75
42
1.4
Fundamental
If the amount of the basal metabolic rate of one hour per weight kg is seen,
one‘s twenties becomes the man and woman and 1kcal/kg/the hour
Rest ： Hospitalization, Light infectious disease
Light : Damage, Middle level infectious disease
Middle : Fractures, heavy infectious disease
Heave : Burn, various stresses
Percutaneous endoscopic gastrostomy ＰＥＧ
Stomach
Outer of
the body
Walls of the
abdomen
Source）PEG Doctor’s network
PEG (Hospitalization plan)
The keeping biliary damage is in the passing tube nourishment the
digestive tube immunity function compared with the center vein
nourishment and there is not infection few either. PEG is widely done now
Day before operation
Explanation
Explanation
Test
Test
Drip
Day of operation
Day after
operation
Explanation when
Agreement
hospitalization Please take a stamp
From doctor
We explain the method
Of PEG administration
Please ask
Uncertin point
Explanation when hospitalization
X rays
Electrocardiogram
X rays
Blood test
Blood test
Start drip for 24 Intradermal testing Drip for 24 hoursDrip for 24 hours Drip for 24 hours
of antibiotic
Hours
Gauze exchange
Of PEG
Meal
2 days after
operation
Fast
Fast
Fast
Gauze exchange
Of PEG
begins the moisture
injection on two days
after it operates
Cause of burn of serious illness
(in-patient)
Bomb
Electricity
Chemical
High temperature
solid
High temperature
liquid
Fire
(Data: Tokyo burn emergency liaison council assembly)
Structure of skin and level of burn
hair
Depth of burn
Epidermal
Corium
Sweat
gland
Hair pus
Hypodermissubcutaneous
tissue
Treatment of burn
(by Doctor)
It is an inhalation of oxygen, and an airway management in the burn of the
respiratory tract and CO intoxication
Body fluid replenishment in 10% or more of
area of body surface with drip
After an enough washing, the wound of the burn is disinfected
Excising the pollution organization (Debridman)
Covering with ointment and dressing (prevent of infection)
Drug therapy :
Antibiotic and tetanus inoculation to analgesic and polluted wound
It excises and three degrees are grafted to the burn at the early stage
Prevention of cicatrice (pressure, internal medicine)
Emergency measure of burn
The fire of clothes is put out (Burn due to a fire)
cooling by water at once. (Ice is unnecessary)
Hand, leg
Head, face, whole body
Eye, ear
It encompasses it with a clean towel etc.
without treating anything.
And go to the hospital
Symptom that appears from the first stage of stress
(order of frequency)
Easy tiring eyes
Easy stiff shoulders
Pain in the back and waist
not possible to get up pleasantly in the morning
The head is not refreshing (The head is heavy)
Orthostatic dizziness
Dreaming very often
Feel cold hands and legs often
Food often weighs heavy on the stomach
Investigation : psychosomatic medicine (Nihon University)
Symptom that appears in state of chronic stress
(order of frequency)
Tiredness cannot be taken easily
When something is done, it becomes tired at once
The belly puts, it hurts, and there are often diarrhea and constipation
It is angry with a few and seems to get irritated
Meeting person became troublesome
The working nature doesn't happen
It is sore and often gets rough in the mouth
It catches a cold well and it doesn't recover easily
The tongue becomes white
Recently, weight has decreased
It is not possible to go to sleep easily after it awakes at midnight
The favorite one doesn't think that it eats too much either
Investigation : psychosomatic medicine (Nihon University)
Reaction by stress
Adrenal
cortex
Internal
secretion
system
Hypothalamus
(corticosteroid )
secretion
increase
Sympathetic
nervous system
Sympathetic
nervous system
Automatic
Nervous
system
Cortisol
Tension
Facilitation
Adrenal
cortex
An adrenaline
secretion
increase
Immune system
Immunocompetent
cell
Living body
cell
Various symptoms of the whole body
(Stress disease)
Stressor
anterior
pituitary gland
Sickness that is often psychosomatic disease
Alimentary system
gastric ulcer , irritable bowel syndrome, ulcerative colitis
Circulatory organs
system
essential hypertension, Low blood pressure, Angina, Arrhythmia
Respiratory system
bronchial asthma, hyperventilation syndrome
Urinary systerm
Bed-wetting, Impotence,Nervous pollakisuria
Internal secretion
system
Nervous system
Obesity, Diabetics, hyperthyroidism
Headache, Dizziness, Cold character, Chronic fatigue
Obstetrics and
gynecology area
Dysmenorrhea syndrome, Perimenopausal symptom, Frigidity
Dermal system
Neurodermatitis, Atopic dermatitis,
Round alopecia, Essential hyperhidrosis
Bone muscle system
Otorhinolaryngology area
Ophthalmologic field
chronic rheumatism , writer's cramp
Meniere's disease, allergic rhinitis , tinnitus
Asthenopia, Ptosis, blepharospasm
Appearance of disease of depression
Inherited
constitution
Gene related to character
such as serotonin dopamine
Upbringing
Potential cerebral
infarction,
Medicine, Disease
Weakness
to stress
Cause of body, medicine
Bereavement with parents
of early days.
Cruelty. Disregard
Stress
Depression
Multipronged understanding is necessary
Lose job, Overwork,
Promotion, Death of
a familiar person,
Moving, Divorce
Probability of depression
appearance of disease
Gene-environmental interaction
or more
Non cruelty
Possibility
+
Heavy cruelty
Number of events
in full stress life
The appearance of disease rate of depression by the stress is
different because of the individual variation of the serotonin
transporter gene (character and relation)
Treatment method of stress symptom
Drug therapy
Antianxiety medicine
Antidepressant
medicine
Mental therapy
Counseling
Sleeping medicine
Autonomous
training therapy
Autonomic adjustment
medicine
Behavior therapy
Treatment medicine
of physical illness
etc
etc.
Invitation to self-destroyed life
The nutrition education of S/S type man thrown easily by the
waywardness is a large problem
1. Immoderate eating and drinking is borne in mind.
(overweight is good thing)
2. It doesn't move so much. (Sitting is great position)
3. It eats a lot of sweet one and the cakes. (Communication
is also important)
4. It eats a lot of animal fats. (epicure's honor)
5. A lot of hoochs are drunk. (cannot defeat by alchol)
6. I like cigarette smoke. (This dose is a salt of life)
7. It eats a lot of salty foods. (It is good for the switch of
alcohol)
8. I like staying up late. (It's my free time)
9. I stick to small thing (I always complains and bully
someone)
10. Attention "Quiet murderer" etc. of the checkup are
disregarded. (I will know myself)
「Maihichi life」: 8, 1994 p.24