全胃切除术后的饮食精要

全胃切除术后的饮食精要 胃癌病人行全胃切除术后早期经口饮食的护理 发表时间:2010-10-9 11:58:25 来源:创新医学网医学编辑部推荐 作者:吴海燕，刘 燕，刘东霞，梁 勤 作者单位:510060，中山大学肿瘤防治中心。 【摘要】 [目的]探讨全胃切除术后早期经口饮食的实施及护理体会。[方法]对31例行全胃切除术后病人实施早期经口饮食计划,即由营养师根据中国居民平衡膳食和合理营养原则将术后每个阶段的饮食做成食谱，责任护士在术后各个阶段实施饮食管理和护理,观察营养方面康复情况。[结果]31例病人术后测血清清蛋白全部在正常范围，切口甲级愈合29例，乙级愈合2例，出院时均进食半流饮食，平均住院日为21 d;有9例早期进食后出现腹胀，1例出现吻合口瘘。[结论]全胃切除术后早期实施经口饮食的护理，可促进病人的康复。 【关键词】 胃癌;全胃切除术;经口饮食;护理 胃癌是我国最常见的恶性肿瘤之一,其发病率为消化道恶性肿瘤之首[1]。全胃切除术是胃癌根治术最常用的术式之一，术后营养支持是极其重要的环节。目前，国内外学者都强调肠内营养的重要性，首选肠内营养支持途径[2,3]，文献报道多以经营养管和空肠造口管进食为主，提倡早期经口进食报道较少。有研究显示全胃切除术后早期经口饮食安全可行[4]，术后经口饮食的病人吻合口狭窄发生率较低[5]。现我科在全胃切除术后经口饮食的一些临床经验，将护理体会如下。 1 资料与方法 1.1 一般资料 2009年2月—2009年11月我科共行全胃切除术31例，男19例，女12例;年龄34岁,76岁。28例主要症状为食欲缺乏，上腹不适(疼痛)，嗳气反酸，纳差，消瘦，贫血，2例出现黑便，呕吐1例。胃体癌15例，胃底贲门癌8例，胃窦癌侵及胃体5例，残胃癌2例，全胃癌1例。术前均经胃钡餐和电子胃镜检查后病理学证实，病人癌灶范围超过一个胃区或癌灶位于胃体且偏大，均在全身麻醉下经腹行全胃切除术，其中根治性全胃切除24例,姑息性全胃切除7例。 1.2 饮食计划与实施方法 将每阶段的饮食做成食谱，由营养师根据中国居民平衡膳食宝塔食物分类为谷薯、水果、蔬菜、豆类、奶、瘦肉(含鱼虾)、蛋、油脂八大类,每天从每类中选1种,3种食物，适量搭配组成平衡膳食，食谱编制遵循平衡膳食和合理营养的原则。责任护士在全胃切除术后各个阶段实施饮食管理和护理,观察营养方面康复情况。第1阶段(术后1 d,4 d):禁食。第2阶段(术后5 d,8 d):流质饮食。停止胃肠减压后，第1天饮少量温水，首次20 mL,30 mL，严密观察病人饮水后反应，如无诉不适次日给予清流质饮食，米汤40 mL，每日2次，逐日增加量与餐次，至每餐200 mL,250 mL，每日6餐,8餐，流质供能3 344 kJ/d,6 270 kJ/d[6]。一般以高营养、高蛋白、高维生素食物为主，定时定量，多以精细易消化为原则。如有米汤、果汁、豆浆等，临床上常用安素肠内营养粉冲剂。第3阶段(术后8 d至3周):半流质饮食。半流质供能6 270 kJ/d,7 524 kJ/d[6]，每日5餐或6 餐。食物以米粥、藕粉、蒸蛋、面条、碎菜、肉末为主，并选优质蛋白高的鱼、肉、蛋、乳、豆制品作为蛋白质的主要来源，多吃新鲜蔬菜水果，每天增加2次,4次安素营养粉冲剂。第4阶段(术后3周后):软食。大多数病人消化功能恢复正常后，予软米饭、发糕、馒头，各种炖、蒸、禽肉类，豆制品，饺子，包子，各种嫩菜等软食。早餐:馒头或粥、豆浆、鸡蛋、果蔬、饺子;中餐:米饭、发糕、肉、豆腐、菠菜、芹菜、鱼;晚餐:稀粥、包子、鱼、油菜、蘑菇。 the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste 2 结果 31例病人术后经口饮食营养康复情况，术后1周测血清清蛋白全部正常范围。切口愈合情况:二类切口甲级愈合29例，乙级愈合2例。出院时均进食半流饮食，平均住院日为21 d;9例早期进食后腹胀，1例吻合口瘘，其余病人进食后无恶心、呕吐、腹泻、无反流性食管炎、无倾倒综合征的发生。 3 早期经口饮食的护理 3.1 心理护理 胃癌病人除有与其他癌症病人相同的心理反应外，又因其手术主要影响病人的正常饮食，给病人造成很大的心理压力[7]。所以，在饮食方面也存在着不同的心理状态:一种是由于饥饿，迫不及待地想进食,并以验证疾病治愈的感觉[8]，对于此类病人应给予提醒、警告，解释目前吻合口的愈合情况，控制病人强烈的进食愿望;另一类病人表现出胆小、谨慎,不敢进食,害怕再受痛苦[9]，针对这类病人，解释营养物质对促进术后身体康复的重要性，鼓励病人进食。 3.2 各阶段经口饮食的观察和护理 3.2.1 第1阶段(禁食) 该阶段处于手术创伤期，吻合口尚未愈合，肠道功能正在逐渐恢复，予持续胃肠减压，保持胃肠减压管的通畅，减少肠内容物对吻合口的刺激，减轻肠道张力，预防吻合口水肿及吻合口瘘。此期全部靠静脉营养供给机体需要。 3.2.2 第2阶段(流质饮食) 3.2.2.1 首次经口进食的指导 肠道功能已恢复，表现为肛门有排气，病人有食欲。停止胃肠减压后，第1天饮少量温水(20 mL,30 mL)，无不适次日可进食流质，进食时护士应在旁边指导，协助病人采取半卧位，进食不可过急,应缓慢咽下。首次进食量要少，约40 mL左右，特别注意食物的温度，最适宜的流质食物温度为40 ?左右，食物过热容易烫伤口腔及肠道黏膜，特别是更易伤及刚愈合的吻合口，而食物过冷容易刺激肠蠕动，导致腹泻。流质饮食应少量多餐、定时定量，根据年龄、身高、体重及每日活动量计算总能量及各种营养素的需要量。此期经口进食难以满足身体热能的需要，另一部分热能需静脉输液供给。临床上常用安素肠内营养粉冲剂，提供机体全面的营养。 3.2.2.2 首次经口进食后的观察 要严密观察病人进食后反应，如无不适要逐渐增加餐次和进食的量，进食后如出现腹胀、腹痛应减量进食或暂禁食，嘱病人多翻身或下床活动，待肠道功能完全恢复后再进食。要耐心倾听病人进食后的反映,指导病人的应对方式，以助于膳食治疗顺利进行。31例病人早期进食流质时有9例诉有腹胀，经处理后症状缓解，能顺利进流质饮食。 3.2.2.3 倾倒综合征的观察和预防 倾倒综合征常在此阶段发生，尤以进食流质饮食、甜食或站立进食时更容易发生。表现为进食半小时内出现头晕、面色苍白、心悸、出汗、恶心、呕吐等表现，一般予平卧、对症处理都能缓解。原因是全胃切除术后，使食物过快地进入空肠，引起肠道内分泌细胞大量分泌肠源性血管活性物质，加上渗透作用使细胞外液大量移入肠腔，出现一过性血容量不足。为防止倾倒综合征的发生，主要采取饮食调整疗法，应少量多餐，避免进食过快或食用过甜食物，进食时尽量少喝水,防止液体将食品很快溶解而形成高渗溶液排至空肠，进食后采取半卧位，餐后休息15 min,30 min后再活动。31 the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste 例病人进食时进行了指导和预防，没有倾倒综合征的发生。 3.2.3 第3阶段(半流质饮食) 3.2.3.1 半流饮食的实施 流质饮食3 d或4 d，病人无腹胀等不适症状应逐渐过渡到半流质饮食阶段，半流质饮食早期进食的量要从少量开始，逐日增多，一日三餐正餐外，还应在正餐之间加餐，每日增加餐次2次或3次。进食时应细嚼慢咽，食物尽量切碎炖烂，食物烹调时，应少盐，忌辛辣，避免油煎烟熏等。食量大的病人要控制饮食的量，避免暴饮暴食，禁喝碳酸饮料，防止吻合口瘘的发生。大多数病人术后会出现食欲下降，缺少饥饿感，原因与全胃切除后胃肠激素对中枢性摄食调节的改变有关[10]。所以，护士要指导家属在不影响病情的情况下自备一些病人喜爱的食物，努力营造良好的就餐环境，同时注意食物的色、香、味，以刺激病人食欲，增进饮食。术后第10天左右，病人术后留置的各种引流管已基本拔除，静脉输液逐渐停止，营养物质完全依靠经口饮食补充，进食量要逐渐增大，以满足机体的需要。 3.2.3.2 进食后的观察 该阶段早期重点观察进食后有无腹痛、腹肌紧张，伴有恶心、发热、白细胞升高等症状。若出现此情况，应立即停止进食，多考虑吻合口瘘。吻合口瘘是全胃切除术后的严重并发症，也是导致手术死亡的主要因素之一。有文献报道，吻合口瘘的发生率为3.0%,6.6%[11,12]，原因与缝合技术不当、吻合口张力过大、组织供血不足有关，在贫血、水肿、低蛋白血症的病人中更易出现，吻合口瘘一般发生在术后1周左右。做好进食后的观察，有利于及时发现消化道重建后出现的一些问题，及时处理，促进病人的康复。本组发生吻合口瘘 1例，可能与吻合口处张力过大有关，经禁食、胃肠减压、抗感染等治疗后愈合。 3.2.4 第4阶段(软食) 一般从术后第3周开始，病人消化功能恢复正常，各种不适症状消失，逐渐进食软食。此期大多数病人已出院，护士在出院前要做好饮食的指导。90%的病人认为胃切掉了，饮食只进食到半流饮食阶段，再也不敢进食米饭或多进食，结果出现了体重不增或下降，甚至出现吻合口狭窄，直接影响病人的生存质量。全胃切除后消化道重建的方式繁多，目前多采用空肠代胃方式，“贮袋”能很快使病人适应“无胃”情况,迅速提供足够的储存功能[13]。干硬食物能对吻合口和贮袋代胃的容量起到一定的扩张作用，防止吻合口的狭窄和增加贮袋代胃的容量。所以要鼓励病人，每天比前1 d多吃一点，逐渐过渡到手术前的正常饮食。另外，全胃切除术后缺少了幽门，易引起胆汁反流，刺激了食管、吻合口黏膜，引起黏膜充血、水肿、糜烂等，预防主要有食后要静坐或半坐位30 min,60 min，睡觉时垫2个枕头，使头部抬高，以避免食物、胆汁反流至食管引起食管炎、吻合口炎。 4 体会 全胃切除术病人失去了胃的正常解剖结构和生理功能，术后容易引起营养不良，营养不良又易引起切口愈合不良、切口感染、肠功能恢复时间长，严重影响病人的康复及生存质量[14]。术后按制订的饮食计划和方法，在各个阶段实施饮食护理，做好进食的指导，密切观察进食后的反应，并做好饮食的健康教育，有利于病人饮食的顺利过渡，防止营养性并发症的发生，促进病人的康复。 【参考文献】 [1] 裘法祖.外科学[M].北京:人民卫生出版社,1995:83. the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste [2] 黎介寿.肠内营养——外科临床营养支持的首选途径[J].肠外与肠内营养,2003,10(3):129130. [3] Kirby DF,Teran JC.Enteral feeding in critical care,gastrointestinal diseases and cancer[J].Castrointest Endose Clin N Am,1998,8(3):623643. [4] 朱海涛,吴云飞,徐惠绵.早期进食在胃癌全胃切除病人中的应用[J].中国肿瘤临床与康复,2007,14(4):370373. [5] 单吉贤,陈峻青,王舒宝.胃上部癌胃近端大部切除与全胃切除治疗结果对比分析[J].中国肿瘤临床与康复,1995,2(2):89. [6] 黄承钰.医学营养学[M].北京:人民卫生出版社,2003:306350. [7] 薛富善,袁风华.围手术期护理学[M].上海:科学技术文献出版社,2001:792. [8] 马丽峰.老年胃大部切除患者术后的饮食管理[J].护士进修杂志,2003,18(3):283. [9] 彭秀芳,李启勤,王建美，等.胃癌根治术后的饮食护理[J].齐齐哈尔医学院学报,2005,26(10):1128. [10] 任重.全胃切除术后的病理生理改变[J].国外医学:外科学分册,2004,31(6):328331. [11] Edwards P,Blackshaw CR,Leiwis WG,et al.Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma[J].Br J Cancer,2004,90(10):1888 1892. [12] Ichikawa D,Kurioka H,Yamaguchi T,et al.Postoperative complication following gastrectomy for gastric cancer during the last decade[J].Hepatogastroenterology,2004,51(56):613617. [13] 孙田杰,金莹,赫金玲,等.胃癌全胃切除术后肠外营养治疗的临床研究[J].护理研究,2008,22(3A):620621. [14] 蒋文瑞,胡自苗,常明.全胃切除术后经空肠造口行早期肠内营养的临床研究[J].肠外与肠内营养,2002,7(3):165167 胃切除术后，使部分病人不能保持原有体重，由于创伤或不能正常进食，使体内 蛋白质，脂肪等消耗，致使体重下降，还可发生一些维生素缺乏病及胃切除术后 的并发症。 在胃切除术后，通常应禁食禁饮，24小时,48小时后一般情况良好，肠蠕 动恢复，肛门排气，才可给予少量的温开水或葡萄糖饮料。如无不适，次日可给 少量清淡流食，如米汤、菜汤、稀藕粉、淡果子水等，但不能吃蔗糖、牛奶及豆 浆等，因为这些食物可产生腹胀。第四日可仍用流食，但在流食的基础上加用甜 牛奶、甜豆浆等。第五日可用少渣半流食，例如可选择大米粥、碎肉蕃茄汁烩豆 腐、馄饨、内末蕃茄汁或菜汁烩挂面、面包、蛋糕、牛奶、豆浆等。第九日可改 用营养丰富、易于消化、无刺激性、质软一日五餐的胃病饮食。若进食后有恶心、 腹胀等不适，则应减少或停止饮食。待症状消失之后，病情好转，再开始进食。 the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste 胃切除后的恢复饮食十分重要，既要弥补术前疾病的慢性消耗，又要填补手术创伤的损失。因此应在较长时间内采用胃病五次饭，保证有足够的营养、高蛋白、高维生素和维生素A、B、C含量充足的食物，以促进创伤的修复。如蛋类、乳类及其制品、瘦肉类、豆腐、豆浆等豆制品、鲜嫩的蔬菜及成熟的水果等。避免吃刺激性强和不易消化的食物，如辣椒、芹菜、酒、咖啡、浓茶和含粗纤维多的芹菜、韭菜等。 烹调方法更应注意，不要采用炸、煎、烟熏及生拌等方法，以免难于消化，采用蒸、煮、烩、炖等烹调方法。患者要待手术创伤及虚弱的身体完全康复后，再逐渐过度到正常普通饮食。由于胃切除后，容积明显减少，食物营养素的吸收受到了影响，所以每日膳食中注意适量增加维生素D含量多的食物，如动物的内脏及胡萝卜等，以防止手术后的骨软化病。另外，吃饭后不要急于下床活动，应卧床休息，不要吃高糖饮食，防止倾倒综合症。 胃切除术后，最常见的并发症是缺铁性贫血，维生素B族缺乏。有15%的患者有骨软化病，由于维生素D的缺乏，很容易使非常稀薄的骨质发生变化。在一些无明显维生素D缺乏的病人中，早期的骨组织变化可以得到纠正。这就使人们很难推断，在胃切除后所发生的骨质疏松和骨软化病是否与维生素D缺乏，钙吸收有关。但不论怎样，这些病人有明显的钙吸收障碍和维生素D的缺乏。胃切除术后的病人应注意膳食中补钙，维生素D的食物，这对骨骼钙化有利。动物性食品如蛋黄、肝脏，含视黄醇很高。一些植物性食品如黄、红色蔬菜、水果中含β,胡萝卜素，可在肝中转变为维生素A。 含钙较高的食品有各种豆制品，乳制品和燕麦片、卷心菜、白菜、胡萝卜、芹菜、南瓜、萝卜、菠菜、葫芦、韭菜、蒲公英、冬瓜等。某些硬果和种子类食品含钙量也很高，如干杏仁、核桃、榛子、葵花子等。水果类有橙子等。 一些蔬菜和菠菜、苋菜、蕹菜等所含的草酸均影响钙的吸收，对含草酸高的蔬菜可先在沸水中焯一下，使部分草酸先溶于水、滤去水再炒食。注意在面粉、玉米粉、豆粉中加发酵剂，并延长发酵时间，可使植酸水解，游离钙增加，使钙容易吸收。 胃癌患者胃全切除术的饮食 the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste 胃癌患者术后要有正确的日常饮食，对疾病的恢复、减轻术后痛苦以及手术并发症都能起到很大的帮助。不同胃癌手术后的饮食也是不同的。以下是胃癌患者胃全切除术的饮食。 进食原则:少量多餐，循序渐进，进清淡易消化的流食，逐渐过渡到普食。 饮食计划:停胃肠减压后第2天开始进食糖水、米汤 30ml，每2小时交替;第3天60ml，每2小时交替;第4天改为100ml，每2小时交替;第5天流食半量，第6、7、8、9天进流食全量，第10 天改半流食。 以上计划以病人主诉无不适为原则。可根据病入具体情况随时修改，如病入感觉腹胀、腹痛应停止进食，观察有无梗阻症状。 温馨提示:发现了胃癌，不管是手术还是放疗，辅以生物免疫治疗效果显著。生物免疫治疗能够有效的清楚手术后的残留细胞，抑制癌细胞的复发和转移，患者的身体机能通过治疗的提高，会减轻术后可能产生的各种并发症，还能降低放化疗带来的副作用，对患者的康复有着不错的效果。这种新兴技术是通过将自己体内的细胞，经过培育使其恢复免疫功能，然后再回输患者体内，来达到提高免疫力，并对患者进行治疗，是一种安全、有效的技术。 1,红糖煲豆腐:豆腐100克，红糖60克，清水1碗。红糖用清水冲开，加入豆腐，煮10分钟后即成。经常服食，具有和胃止血，吐血明显者可选用此食疗方治疗。 2,桂圆花生汤:花生连红衣250克，大枣5枚，桂圆肉12克。大枣去核，与花生、桂圆一起加水煮熟即可。每日1次，养血补脾，贫血明显者可用此方。 3,芝麻粥:芝麻6克，粳米30克，蜂蜜适量。将芝麻炒香待米煮粥即将熟时加放，再加蜂蜜调匀即成。每日1次，此药膳补血润肠。 4,鱼肚酥:鱼肚(大黄鱼、鲤鱼、黄唇鱼、鳗鱼的鳔均可作原料)，芝麻油。鱼肚用芝麻油炸酥，压碎即成。每日3次，每次10克，用温开水送服。此药膳补肾益精，滋养筋脉，止血、散淤、消肿。 the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste 5,有些蔬菜含有木质素，能促进巨噬细胞吞噬癌细胞的活动，如芦笋、荠菜、芋头、藕、菱角、胡萝卜。 6,食用含钙高的食物能防癌，如鱼、黄豆、叶绿素、芝麻等。 7,增加抗癌能力的食物有胡萝卜、西红柿、红心红薯、深绿色蔬菜和大蒜。 8,茶叶有很好的抗癌作用，尤其是绿茶，应提倡多喝绿茶。 胃癌手术后食谱 一、预防术后倾倒综合症的饮食方法 胃大部分切除的术后患者首先应消除害怕吃东西会影响刀口愈合等心理因素，精神放松，相信医生的科学安排。进餐采取半卧位，进食后要平卧15,30分钟后再活动。这是为了防止残留胃内的食物突然进入十二指肠和空肠而引起的上腹胀满、恶心、呕吐、腹泻和心慌等倾倒综合症。进食内容，最初以高营养易消化的流食、半流食、软食为主，食物应无刺激性，戒烟酒，宜多食含胡萝卜素和维生素C丰富的水果蔬菜。烹调方式忌煎、炸，饮食方式应量少多餐。 二、术后七天内的饮食选择 术后约72小时(排气后)开始进食清流质半量，术后第4,5天给全量清流食，第5,6天可给一般流食，第7天可进半量半流质，以后逐渐增加质和量。进食初期应注意饮食量，一般由一次60毫升，逐渐增至100,200毫升。由清流质逐渐过渡到1号到2号膳食，以后改用少渣低糖半流质，再改为高蛋白半流质食。 术后食谱举例 1、早上7点:5,的甜米汤200毫升;9点:蒸鸡蛋羹40克;11点:麦乳精20克，冲鸡蛋40克;14点:5,甜豆浆200毫升;17点:5,甜米汤200毫升加冲鸡蛋40克。一日总量:蛋白质21(3克、脂肪30(12克、糖64(62克，总热量2572KJ(614(8 千卡)。 2、早上7点:5,甜米汤250毫升;9点:5,甜牛奶250毫升;11点:肉泥20克、豆腐脑200克;14点:5,甜豆浆250毫升;17点:麦乳精20克、冲鸡蛋40克;20点:鸡蓉汤(鸡肉50克十菱粉5克十食油5克)。全天总量:the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste 蛋白质5l(3克、脂肪37(3克、糖98(2克，总热量3905KJ(933(3 千卡)。 3、术后少渣低糖半流质膳食:早上7点:鸡蛋汤(鸡蛋一只)、面条50克;9点:牛奶250毫升、糖20克;11点:面条50克、氽鱼圆75克;14点:肉泥20克、豆腐脑200克;17点:鸡蛋40克、肉泥30克、面片50克。全天总量:蛋白质56(4克、脂肪68(5克、糖24(8克，总热量5600KJ(1338(8 千卡)。 4(术后高蛋白半流质膳食:早上7点:鸡蛋80克、面条100克;9点:牛奶250克、糖15克;11点:菜泥100克、面条100克、炒鱼片150克;14点:豆浆250克、糖15克;17点:菜泥100克、面片100克、肉泥50克、炒鸡蛋40克。总量:蛋白质83(8克、脂肪8l(3克、糖229(9克。总热量8310 KJ(1986 千卡)。 胃癌大部分切除术后保健治疗药膳 山葡萄根、猕猴桃根代茶饮。取二味各40克，常规水煎制剂，调味。每日1剂，分早晚2次服用。 最近研究证明，山葡萄、猕猴桃除含大量维生素和无机盐等营养素外，尚有很多药用功能，都有抗癌抑癌作用，还能补气血、强筋骨，有清热、解毒、利尿等作用。可少量当水果吃，但因它们含果酸较多，易使人反胃酸，损伤牙齿等，不能多食，故可用其根制成煎剂或用保温杯泡当茶饮，可配合治疗胃癌或抑癌复发。 枸杞瘦肉甲鱼汤。枸杞子40克、瘦猪肉150克、甲鱼500克。将枸杞子洗净，猪肉切细丝，甲鱼去内脏切块。齐放锅内，加水适量炖熟，撒食盐等调味，佐餐。每日适量常服。本膳有滋阴养血、补益肝肾，治疗癌肿术后体弱、贫血等功效。 胃癌胃切除手术后的忌口 患者术后胃的生理功能减弱，要特别注意饮食禁忌。 ?平时应忌食生冷、粗硬食物; ?忌吃辛辣刺激性强的调味品，如胡椒、芥末等; ?严禁饮烈性酒、浓茶等刺激性食物; ?避免过油及过于粗糙的食物，如炸鸡、油条等油炸食物。 ?食物质地应细软易消化，不宜食用粗杂粮、干豆、硬果、粗纤维含量多的蔬菜(笋、芹菜等)、辛辣刺激以及产气食物(如萝卜、蒜苗、白薯等)。这些食物并不是完全不可以吃，the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste 只是需要考虑量和个人对这些食物的承受力问题。 具体中药治疗: 药物为:生芪30克、炒白术15克、生苡仁15克、炒莱菔子15克、生山楂15克、猪茯苓各15克、清半夏12克、淡竹茹12克、仙鹤叶15克、石斛15克、鸡血藤15克、白英15克、焦三仙30克、煅瓦楞15克、金乔麦30克、枸杞15克。每日1剂、连服用30天。 化疗后，可服用以下方药，加强抗转移、抗复发功能。生芪30克、炒白术15克、生苡仁15克、佩兰15克、黄连9克、仙灵脾10克、猫爪草12克、土茯苓15克、白英15克、白花蛇叶15克、猪茯苓各15克、炒莱菔子15克、清半夏12克、藤梨根15克、焦三仙30克、枸杞15克。每日1剂，连续服用30天。 同时静脉滴注华蟾素注射液20毫升加入5%葡萄糖500毫升(如有糖尿病则改用生理盐水500毫升)。每日1次，连用30天。 the real implementation of the "quasi, ruthless. Tough," requirement, carry forward the spirit of a nail, and the corrective measures The implementation of the nerve endings, do not let the rectification is not in place, not to retreat, the people are not satisfied. Pin four is to adhere to the reform and innovation. To reform the way of thinking and innovative courage to turn style, against four winds, the courage to face the contradictions, good at solving the chronic ills, dare to break the outdated customs and bad habits Hensha unhealthy tendencies, trees, fresh healthy. The five is to adhere to tackling the problem. That is the wind Su Ji and the education supervision combined, in order to establish a new system to promote the normalization of style building, long-term, to enhance the party spirit of honest and pragmatic people thought conscious action. The six is to insist on the completion of the third grasp the overall situation. Activity and end This year the goal of safety production work plan for next year, work together, to promote the activities and the work of production safety with both hands, two promotion, two not mistake. Two, rectification of the overall objectives and specific objectives: (a) the overall path around the "four focus", carried out the outstanding problems of the special rectification, the full implementation of the central and provincial Party committee clear the rectification task, effectively curb the "four winds", realize the overall improvement of Party and government. The point is: focus on the people, the people, convenience, and resolutely curb the bureaucratic style of work; looking to stimulate grassroots vitality, resolutely curb the Wenshan sea; focus on the cadres honest, clean government, politics, and resolutely curb exceed the standard Quasi occupied office space, Gongjusiyong, public funds, extravagance of the wind; focus on establish a correct view of achievements, the concept of power, and resolutely curb acts against the interests of the masses. Accelerate the system reform and construction, improve the people honest and pragmatic normalization system, constantly consolidate and expand educational practice achievements, make people satisfied. The recent reform goal: Political Quality Bureau and all Party members and cadres, further improve the quality of the business; the "four winds", "two" problem has been effectively solved. The middle goal of the reform: "opposition party and government austerity waste