Kev Pluas Mov rau Kev Tshawb Tshuaj Nero Nervosa
Malnutrition uas accompanies anorexia nervosa tuaj yeem cuam tshuam tag nrho lub cev ntawm lub cev. Yog li ntawd, restoration ntawm qhov hnyav thiab kev noj haus yog ib qho tseem ceeb ntawm kev kho mob rau kev mob anorexia. Kev kho lub cev tsis zoo los ntawm kev mob anorexia nervosa yuav siv sij hawm ntau lub hlis los yog xyoo txawm. Cov neeg mob nrog anorexia nervosa feem ntau yuav tsum yog nyob hauv kev saib xyuas ntawm pab pawg kho mob, feem ntau muaj xws li ib tus kws kho mob, ib tus kws kho mob noj haus , ib tus kws kho mob hlwb, thiab ib tug kws kho mob hlwb.
Txhua tus neeg pib noj zaub mov zoo yuav tsum paub txog qhov uas yuav ua rau tus neeg mob tuag taus. Tsab ntawv no pib nrog kev tiv thaiv tsim nyog kom tsis txhob muaj qhov phom sij no. Tom qab ntawd nws muaj cov tswv yim rau kev noj qab haus huv kev noj qab haus huv, qhia txog kev npaj zaub mov noj, ntxiv cov tswv yim ntxiv, thiab cov lus pom zoo rau txoj kev sib tw ua kom rov zoo li qub.
Tsis Tiv Thaiv Kev Tiv Thaiv Syndrome
Ib qho kev pheej hmoo yuav tau xav txog ua ntej pib kev noj qab haus huv yog rov zoo li muaj tus mob syndrome. Txoj kev mob plab (Reforming syndrome) yog tshwm sim los ntawm kev ceev nrooj ntawm ib tus neeg hauv lub xeev ntawm kev tshaib plab, feem ntau muaj mob, thiab nws yuav ua kom tuag taus. Nws yog tsi ntsees los ntawm roj ntsha thiab kua dej hloov nrog metabolic abnormalities nyob rau hauv cov neeg muaj mob tsis txaus ntseeg kev noj zaub mov.
Yuav ua li cas thaum kawg noj mov tom qab ib qho kev tshaib plab puas tsim kev puas tsuaj rau lub cev? Biochemistry qhia peb tias lub cev ketone thiab dawb fatty acids uas yog los ntawm kev rhuav tshem (catabolism) ntawm cov nqaij thiab cov ntaub so ntswg los hloov cov piam thaj los ua qhov loj zog qhov hauv kev tshaib plab.
Thaum lub sij hawm rov qab, muaj kev hloov ntawm roj los ntawm cov kab mob carbohydrate. Cov kua dej uas tsim tawm los ntawm cov txiav ua rau cov cellulose nce siab, phosphate, potassium, magnesium, sodium, thiab dej. Lub cev kuj hloov mus rau hauv ib lub tsev (anabolic) xeev ntawm cov protein synthesis, uas yuav tsum tau muaj kev noj qab haus huv ntxiv rau hauv lub hlwb.
Lub cev ces yuav muaj kev pheej hmoo kom tsis muaj txaus cov kev lag luam tseem ceeb hauv cov ntshav. Cov kev mob tshwm sim muaj xws li lub plawv dhia tsis haum, kev mob plawv tsis ua hauj lwm, kev ua pa tsis ua hauj lwm, coma, qaug dab peg, pob txha tsis muaj zog, kev tswj kev lub cev, thiab kev puas hlwb.
Yuav tsum tsis txhob rov qab chiv mob dua, theem ntawm phosphorus, magnesium, potassium, calcium, thiab thiamin yuav tsum tau saib xyuas thawj 5 hnub thiab txhua txhua hnub ob peb lub lis piam. Electrocardiogram (EKG) yuav tsum tau ua. Yuav tsum tau saib xyuas kev kho mob nruj heev.
Lub koom haum National Health and Clinical Excellence Cov Kev Cai rau cov neeg mob tau qhia tias muaj kev pheej hmoo rau kev kho mob syndrome yog tias koj qhov chaw pib muaj 1,000 lossis tsawg dua cov calories ib hnub twg. Txoj kev pheej hmoo yuav rov qab muaj zog tuaj yeem nce nrog cov hauv qab no:
- Cov neeg mob uas muaj ib qho ntawm cov cim nram qab no:
- Lub cev huab hwm coj ntawm tsawg tshaj 16
- Qhov poob ntawm ntau tshaj 15 feem pua ntawm 3-8 lub hlis dhau los
- Me me los yog tsis muaj khoom noj haus ntau tshaj 10 hnub
- Tsawg theem ntawm cov poov tshuaj, phosphate, thiab / los yog magnesium ua ntej refeeding
- Cov neeg mob uas muaj ob lossis ntau dua ntawm cov ntsuas nram qab no:
- Lub cev huab hwm coj ntawm tsawg dua 18.5
- Qhov poob ntawm ntau tshaj 10 feem pua ntawm 3-6 lub hlis dhau los
- Me me los yog tsis muaj khoom noj haus ntau tshaj 5 hnub
- Keeb kwm ntawm kev siv dej cawv los yog siv yeeb siv tshuaj, xws li insulin, chemotherapy, antacids los yog diuretics
Cov lus qhia ntxiv hais txog kev tiv thaiv ntawm tus kabmob kheesxaws muaj nyob rau ntawm Lub Tsev Kawm Noj Zaubmov Ntsuas Cov Lus Qhia Txog Kev Kho Mob. Raws li cov hauv qab no, kev noj zaub mov zoo yuav tsum maj mam mus kom tsis txhob muaj peev xwm zoo dua. Cov kws kho mob yuav tsum muaj xws li tus kws kho mob thiab tus kws kho mob Registered Dietitian Nutritionist (RDN) los xam xyuas, saib, thiab nce txhua hnub cov khoom noj thiab dej haus kom tau zoo thiab saib xyuas cov ntshav thiab urinary electrolytes, plasma glucose, cov haujlwm tseem ceeb, thiab lub plawv dhia ua ntej thiab thaum refeeding.
Vim tias qhov kev pheej hmoo rau kev mob plawv thiab lwm qhov teeb meem kev mob nkeeg uas muaj feem rau kev tshaib nqhis, ntau tus neeg mob uas muaj anorexia nervosa lawv pib kho lawv cov khoom noj haus hauv cov tsev kho mob lossis chaw kho mob hauv tsev.
Qhov seem ntawm tshooj no yog qhia rau cov neeg uas tsis muaj feem yuav rov qab kho cov mob hnyuv thiab tau kho mob kom pib los yog mus ntxiv los ntawm kev noj zaub mov.
Kev Tiv Thaiv Kev Noj Qab Haus Huv
Cov kev tshawb fawb tsis ntev los no tau qhia tias cov neeg mob tsis muaj kev pheej hmoo rau txoj kev pheej yig rau qhov mob hlwb, kev txhim kho thiab ceev dua cov txheej txheem ua rau kom rov qab tau zoo dua thiab zoo dua txhua yam tshwm sim. Nws tsis yog tsawg dua rau cov neeg xav tau kev pab txhua hnub ntawm cov neeg mob qog mus rau 3,000 rau 5,000 calorie txhua hnub rau ib phaus ib nrab rau ib phaus ob ntawm ib lub lis piam nyhav kom txog thaum mus cuag lub hom phiaj ntawm qhov siab. Qhov no yog qhov tseeb tshwj xeeb rau cov hluas uas tseem tab tom loj hlob thiab cov laus.
Cov tub ntxhais hluas uas koom rau hauv Tsev Neeg Tsim Kev Kho Mob nrog cov niam txiv uas saib xyuas kev txhawb nqa kev noj qab haus huv feem ntau yuav muaj peev xwm pib muaj kev nyab xeeb ntawm 2,000 mus txog 2,500 calories ib hnub. Nrog rau cov neeg pab txhawb nqa kev saib xyuas thiab kev saib xyuas, cov niam txiv tau nquag nqua hu kom nce kev noj haus rau 3,000 mus rau 5,000 calories ib hnub rau qhov kev kho mob hnyav.
Cov niam txiv thiab cov neeg mob feem ntau muaj kev nyuaj siab ntawm cov kev xav tau ntawm cov caloric ntau li cov kev ua tau zoo. Vim li cas lawv ho siab? Cov neeg uas mob anorexia nervosa feem ntau ua hypermetabolic, uas txhais tau hais tias lawv cov metabolism tau ncaws mus rau hauv high iav vim lub cev sim ua kom tiav tag nrho cov ntaub so ntswg uas ploj thaum lub sij hawm tshaib plab. Cov neeg feem ntau ua siab kub cev li lub zog ua kom tau hloov mus rau hauv tshav kub, tsis yog siv los tsim cov ntaub so ntswg. Qhov kev mob tshwm sim no ua rau rov qab tuaj yeem zog.
Tsis tas li ntawd, ntau tus neeg mob uas muaj anorexia nervosa koom nrog ntau lub cev txawm tias muaj mob loj heev. Xws li kev qoj ib ce yuav raug muab zais thiab ntxiv tau ntxeev dua siab rau kev loj hlob ntawm qhov hnyav nce los ntawm kev siv calorie ntau dua. Kev qoj ib ce feem ntau tsis yog kev mob nkeeg hauv thawj theem ntawm kev noj zaub mov, tab sis cov neeg mob yuav tsum tau xyuas kom tiv thaiv tau nws.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias vim tias muaj caloric tsawg zog ua rau muaj kev ntxhov siab rau cov neeg uas muaj anorexia nervosa, ua kom cov caloric cov hom phiaj yuav nyuaj heev txawm tias muaj kev pab ntxiv. Txawm li cas los xij, nws yog ib qho tseem ceeb uas yuav tsum tau cia kom txaus caloric rau lub cev kom zoo txaus. Cov phom hom phiaj yuav tsum tau them los ntawm koj pawg kho mob. Ib tug xa rov qab ntawm ments nyob rau cov pojniam tseem ceeb heev . Dua ib tus kws kho mob tau txais kev pom zoo los xyuas koj tus neeg calorie xav tau raws li lawv ua haujlwm thaum txoj kev rov qab los.
Piav Qhia Kev Noj Zaub Mov
Yog tias koj noj ntau tshaj 1,000 calories ib hnub twg thaum koj pib taw tes, tsis yog qhov kev pheej hmoo rau qhov kev mob plawv li tau hais los saum no, thiab tau muab kho kom zoo li ntawd, ces koj yuav xav txog kev noj zaub mov pib thaum pib.
Thov nrog ib tus kws kho mob thiab tus kws qhia noj zaub mov rau cov tswv yim tshwj xeeb rau koj lub cev. Piv txwv li, ib qho kev qhia txog kev noj haus zoo rau ib tus neeg mob 90-phaus tsis muaj qhov kev pheej hmoo rau qhov kev mob ntshav qab zib yog raws li nram no.
- Hnub 1-4: 1,200-1,600 calories / hnub
- Hnub 5-7: Yog tias tsis muaj qhov hnyav nce, nce 400 tauj calor ib hnub rau 1,600-2,000 calories / hnub (Yog tias qhov hnyav nce zuj zus koj yuav nce ntxiv maj.)
- Hnub 10-14: Yog tias qhov hnyav nce tsis tau txog li 1 mus txog 2 phaus hauv ib lub lis piam, nce txhua hnub kom rov ua dua li 400-500 calorie / hnub rau 2,000-2,500
- Hnub 15-21: 2,500-3,000 calories / hnub
- Hnub 20-28: 3,000-3,500 calorie / hnub
Nco ntsoov caloric xav tau feem ntau nce raws li qhov hnyav tau txais. Yog li cov neeg mob recovering los ntawm anorexia nervosa feem ntau yuav tsum tau kom cov kab mob caloric kom thiaj li tswj tau qhov qub nce phaus nce. Vim li no, txhua lub sijhawm hnyav hnyav ntawm qhov kev kawm tau zoo yog qhov txaus. Yog tias thiab thaum twg qhov hnyav nce zuj zus los yog nres, cov khoom noj yuav tsum tau ntxiv.
Daim Hom Phiaj Qhia Pluas Mov rau Kev Ua Tau Zoo
Txij thaum noj zaub mov calorie tsom xyuas yuav ua rau cov neeg tau rov qab los ntawm kev mob anorexia, nws tsis yog qhov kev xaiv ua ntej rau cov kws qhia noj zaubmov uas tau pom zoo. Txawm li cas los xij, nws yuav pab tau kom muaj ib lub tswv yim ntawm seb calorie suav rau lub hom phiaj, tshwj xeeb tshaj yog thaum nyeem cov ntawv sau zaub mov thiab cov ntawv teev cov khoom noj. Lub sijhawm zoo tshaj plaws ntawm tus ntiv tes xoo yog 500- txog 800-calorie zaub mov thiab yam tsawg kawg yog peb 300-calorie khoom noj txom ncauj (tom qab pib ntawm caloric kwv yees raug xam thiab saib xyuas thiab rov qab tau tus mob syndrome lawm). Ib zaug dua, calorie ntau ntau yog ib lub hom phiaj mus, nyob ntawm seb qhov hnyav nce li cas.
Hom kev noj zaub mov zoo dua rau cov kev ua kom rov zoo li qub yog qhov hloov pauv . Nws yog siv rau hauv tsev kho mob, chaw nyob thiab kev noj zaub mov tsis tuaj yeem kho. Ameslikas tsim los rau cov neeg mob ntshav qab zib, lub cev muaj ntau yam hauv kev zoo rov qab vim tias nws yuav tsum siv cov tshuaj (macronutrient) (proteins, carbohydrate, rog) tsis muaj kev tsom ncaj qha rau calories. Tshawb nrhiav ntau lub hom phiaj kom ncav cuag 50-60% tag nrho cov calories ntawm carbohydrates, 15-20% ntawm cov protein, thiab 30-40% ntawm kev noj haus roj rau cov metabolic efficiency. Txhua "sib pauv" (nplej siab, txiv hmab txiv ntoo, zaub, mis nyuj, rog, protein / nqaij) sib npaug rau tej khoom noj thiab nws qhov loj me. Qhov no yuav ua rau pom tseeb ntawm kev xaiv cov zaub mov zoo ntawm cov zaub mov thaum lub sij hawm npaj zaub mov noj.
Txawm li cas los xij, kev noj cov zaub mov tsis yog qhov tseem ceeb npaum li cov pa roj carbon ntau kom tsawg thaum lub sijhawm rov ua kom yuag. Ib tus kws sau ntawv noj zaubmov uas tuaj noj zaubmov (Loger Dietitian Nutritionist) tuaj yeem pab xam thiab tsim qauv npaj zaubmov noj mov nrog rau qhov no.
Ib qho piv txwv ntawm 3,000-calorie Exchange System Pluag Mov rau ib hnub twg yuav muaj xws li 12 nplej siab, 4 txiv hmab txiv ntoo, 4 mis nyuj, 5 zaub, 9 nqaij, thiab 7 rog. Ib qho txhua txhua hnub yuav sib faib cov khoom noj rau hauv pluas noj thiab khoom noj txom ncauj raws li nram no:
Noj Tshais: 2 Nchuav, 1 Rog, 2 Nqaij, 1 Mis, 2 Txiv Hmab Txiv Ntoo
- 2 daim ntawm cov ci ci (2 lauj laub sib hloov) nrog 1 tsp. butter (1 rog sib pauv)
- 2 nkas qe (2 nqaij sib pauv) ua nrog 2oz mis nyuj ntxiv nrog 6oz ntawm tag nrho cov mis nyuj rau sab haus (tag nrho-1 mis nyuj hloov),
- 4 ooj kua txiv kab ntxwv & 1/2 khob txiv hmab txiv ntoo nyias (tag nrho-2 txiv hmab txiv ntoo sib hloov)
Noj su: 2 Starch, 2 Zaub, 3 Nqaij, 2 Rog, 1 Mis
- Grilled cheese sandwich: 2 daim khob cij (2 pob hmoov txhauv), 2 tsp butter (2 roj sib pauv), 3 daim ntawm cheese (3 nqaij sib hloov)
- Txiv lws suav kua zaub (1 khob lee kua zaub kua condensed-2 zaub sib hloov) ua nrog 1 khob mis nyuj (1 mis nyuj hloov)
Noj hmo: 4 Starch, 3 Nqaij, 3 Rog, 2 Zaub, 1 Txiv Hmab Txiv Ntoo
- 1 khob cov khoom qab zib (2 txho hmoov txhuv)
- 2 daim qej ci (2 hmoov txhuv nplej siab) + 2 tsp butter (2 roj sib pauv)
- 3 oz ntawm av nyuj los yog qaib cov txwv (3 nqaij sib pauv) browned 1 tsp txiv roj roj (1 rog pauv)
- ½ khob txiv lws suav nrog ½ khob zaub qhob noom (2 zaub txauv)
- 1 txiv kab ntxwv (1 txauv txi txiv)
Khoom txom ncauj # 1: 2 Starch, 1 Mis
- 1 pob muffin loj loj (2 hmoov txhuv nplej siab)
- 1 khob mis nyuj (1 mis nyuj hloov - ib nrab & ib nrab yuav muab ntxiv rau ntau calorie ntau ntau)
Khoom txom ncauj # 2: 1 Txiv hmab txiv ntoo, 1 Mis
- ½ txiv tsawb (1 txauv txi txiv ntoo)
- 1 khob mis nyuj yogurt (1 mis nyuj hloov)
Khoom Noj Khoom Haus # 3: 1 Nqaij, 2 Starch, 1 Zaub, 1 Rog
- 1 tsp txiv laum huab xeeb los yog almond butter (1 nqaij sib pauv)
- 2 khob cij slices (2 hmoov txhuv nplej siab)
- 1 khob nyom carrots (1 zaub hloov pauv), 1 oz hummus (1 rog pauv)
Lwm Cov Poob Hlwb Tswv Yim
Yuav kom mob caloric kom tsawg dua los ua kom tau ib tus neeg mob hnyav, koj tuaj yeem nco ntsoov tej tactics yooj yooj yim:
- Ua rau kom noj mov ntau dua (ntawm peb zaug ib hnub rau ib zaug rau ib hnub twg)
- Ua kom raws li qhov me me
- Ua kom caloric ceev (ntxiv roj thaum ua mov noj xws li roj, butter, qab zib, cheese uas muaj peev xwm nce calorie tsis ua qhov loj me)
- Txiav rov qab ntawm cov txiv hmab txiv ntoo thiab cov zaub uas tau tuaj yeem ua rau kom tiav rau thaum ntxov
- Ntxiv nrog cov khoom noj ua kua (Ua Tau Ntxiv, Boost Plus) uas muab 350-360 calories rau ib 8 ooj yuav pab tau zoo heev rau cov caloric censure. Kev noj zaub mov nyob hauv daim ntawv no yog pom zoo tam sim ntawd los ua ib qho kev hloov rau cov khoom noj los yog cov khoom noj txom ncauj tsis tiav los yog tsis muaj khoom noj.
Txoj Kev Raug Teeb Meem ntawm Txoj Kev Mus Txog Qhov Cawm Rov Qab
Vim ib txoj kev mob tshwm sim ntawm kev tsis meej yog kev txwv kev noj zaub mov, tus neeg mob uas mob anorexia puas kam noj ntau dua? Kev ua haujlwm zoo ib yam thiab hu rau kev them nyiaj yug ncaj qha los ntawm cov neeg hlub thiab ib pab neeg ua haujlwm uas tuaj yeem pab tuav cov neeg mob kom paub txog kev noj haus thiab kev hnyav nce thiab kev sib tw rau kev noj qab nyob zoo siab thiab txhawb kev noj kev haus txhua hnub. Neeg tsis noj nqaij, tsis muaj rog, thiab tsis muaj cov khoom noj uas tsis yog khoom noj haus yuav tsum tsis txhob poob siab (tshwj tsis yog tias muaj kev txhaum fab hnyuv) tsuas yog thaum lawv muaj teeb meem ntawm cov teeb meem tsis raws li cov kev txhawj xeeb ntawm kev noj qab haus huv.
Tshaj tawm ntawm gastric nchuav lossis gastroparesis yog hom mob anorexia nervosa thiab tuaj yeem pab ua kom ntxov thiab tsam plab. Qhov no tseem ua rau cov txheej txheem ua kom rov noj mov dua yog tias noj cov zaub mov uas yuav tsum tau noj kom ntau yuav ua rau lub cev tsis xis nyob. Cov khoom noj txom ncauj thiab cov khoom noj txom ncauj uas nquag tuaj yeem ua rau me me feem ntau yam tsis tau pabcuam kom muaj calorie cov ntsiab lus yog qhov tseem ceeb rau kev kov yeej qhov teeb meem no. Kev noj qab nyob zoo pawg neeg tuaj yeem pab txhawb cov kev xav ntawm lub cev los ntawm kev puas siab ntsws xws li kev puas siab puas ntsws rau txoj kev rov zoo li no. Pab pawg neeg feem ntau muaj xws li ib tus kws kho mob, kws qhia noj zaub mov noj haus, kws kho mob, thiab kws kho mob hlwb. Thaum tshawb nrhiav thiab tsim cov pab pawg sab nrauv, nws yog ib qhov zoo kom paub tseeb tias cov kws kho mob muaj kev paub txog kev noj zaubmov.
Muab ib tus neeg uas tau hlub los pab nrog kev lav paub thiab muab kev pab txhawb nqa rov qab yuav ua tau zoo rov qab los. Family-Based Treatment (FBT los yog Maudsley) yog ib qho qauv ua pov thawj raws li cov niam txiv uas yog thawj qhov kev txhawb nqa rau cov me nyuam yaus thiab cov tub ntxhais hluas uas muaj kev ntxhov siab rau lub cev. Lwm cov qauv ntawm kev kho mob uas muab kev txhawb nqa rau tsev neeg rau cov neeg laus uas muaj qhov mob anorexia raug tsim tawm thiab.
Txoj kev rov qab los tsis yog txheej txheem thiab yuav qeeb. Nco ntsoov tias lub neej kev nyuab siab thiab kev hloov loj hauv lub neej muaj peev xwm ua rau mob huam tuaj . Kev txhawb thiab rov qab soj ntsuam ntawm kev nce qib thiab cov hom phiaj yog tas mus li. Ua kom muaj kev thaj yeeb nrog kev noj zaub mov thiab rov qab kho lub hlwb, kev xav, thiab kev noj qab haus huv thiab kev noj qab nyob zoo yog tau.
> Qhov chaw:
> Miskas Kev Sib Koom Tes. (2006). Kev kho mob ntawm cov neeg mob uas muaj kev noj qab nyob zoo, koob thib 3. American Journal of Psychiatry, 163 (7 Khoom), 4-54.
> Crook, MA, V. Hally, thiab JV Panteli. "Qhov tseem ceeb ntawm txoj kev Reforming Syndrome." Nutrition 7-8 17 (nd): 632-37. Hopkinsmedicine.org . Elsevier Science Inc., 2 Jan. 2001. Web.
> Garber, AK, Mauldin, K., Michihata, N., Buckelew, SM, Shafer, M.-A., & Moscicki, A.-B. (2013). Cov Khoom Noj Muaj Yeej Ua Tau Qis Muaj Nuj Nqes Qis thiab Cov Tsev Kho Mob Mob Nkeeg Nyob Hauv Tsev Kho Mob Cov Tub Hluas Cov Tsev Kawm Ntawv Norea. Cov Ntawv Tshaj Tawm Rau Cov Hluas Kev Noj Qab Haus Huv: Kev Tshaj Tawm Xov Tooj ntawm Lub Koom Haum rau Cov Hluas Tshuaj , 53 (5), 579-584.
> Marzola, E., Nasser, JA, Hashim, SA, Shih, PB, & Kaye, WH (2013). Kev noj qab nyob zoo hauv kev mob anorexia: saib ntawm cov ntaub ntawv thiab qhov cuam tshuam rau kev kho mob. BMC Psychiatry , 13 , 290.
> Mehanna, Hisham M., Jamil Moledina, thiab Jane Travis. "Reforming Syndrome: Nws Yog Dab Tsi, thiab Yuav Tiv Thaiv thiab Kho Li Cas." BMJ: British Medical Journal . BMJ Publishing Group Ltd., 2008. Web site. 27 Nov. 2016.
> Waterhous, T. & Yakhauj, Melanie A .. "Nutrition Intervention nyob rau hauv kev kho mob noj haus." Xyaum sau ntawv ntawm American Dietetic Association: American Dietetic Association, thiab qhov Web site. 27 Nov. 2016.