CN105638900A - 一种用于应急状态患者的特殊医学用途食品及其制备方法 - Google Patents
一种用于应急状态患者的特殊医学用途食品及其制备方法 Download PDFInfo
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- CN105638900A CN105638900A CN201610017415.9A CN201610017415A CN105638900A CN 105638900 A CN105638900 A CN 105638900A CN 201610017415 A CN201610017415 A CN 201610017415A CN 105638900 A CN105638900 A CN 105638900A
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- vegetable oil
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Abstract
一种用于应急状态患者的特殊医学用途食品及其制备方法，生产每吨产品的主要原料包括：牦牛奶100-1500kg，鲜牛奶100-2000kg，乳清粉200-500kg，精炼植物油50-200kg，中链甘油三酯1－100kg，白砂糖1-150kg，乳糖1-120kg，氨基酸1-120kg，水解乳清蛋白1-50kg，二十二碳六烯酸DHA1～20kg；花生四烯酸ARA2～40kg；酪蛋白磷酸肽0.1～3kg。本发明利用牦牛奶、鲜牛奶、乳清粉、精炼植物油、中链甘油三酯、白砂糖、乳糖、氨基酸、水解乳清蛋白、二十二碳六烯酸DHA、花生四烯酸ARA、酪蛋白磷酸肽等加入适量的维生素和矿物质或其他营养成分，仅用物理方法加工制成，可以满足营养不良、蛋白质缺乏、毒素蓄积及高分解代谢的创伤、感染、手术及其他应激状态的人群对各种营养成分的需求。
Description
技术领域
本发明属于特殊医学食品生产技术领域，具体分别涉及一种适用于创伤、感染、手术及其他应激状态病人食用的特殊医学用途的全营养配方食品。
背景技术
创伤、烧伤、炎症、感染、外科手术、环境污染、过敏以及辐射等都会使免疫系统被一系列的刺激因素和条件所激活而出现应激状态，是人体产生的所有非特异性改变。创伤和感染是临床病人尤其在是外科中经常发生的两种应激反应，创伤和感染不仅引起发烧、组织破坏、失血、炎症和饥饿等多种病理变化，还会引起疼痛、害怕、失眠等多种心理反应，因此应激反应的影响对患者可能会造成多方面的危害。
在应激反应状态下，机体会产生高分解代谢状态，使患者通过肌肉蛋白质的快速运动，为达到组织修复、应激反应、全身或局部抗感染的目的，患者对能量和营养物质的需求增大，应激时的代谢特点为能量的分解增加，合成减少，代谢率明显升高，严重者能量需求是正常情况下的1倍以上，可达5000～10000kcal/d。应激时高代谢率由儿茶酚胺、糖皮质激素、胰高血糖素及炎性介质的大量释放和胰岛素分泌减少引起。糖原分解及糖异生明显增强，血糖明显升高，有的患者甚至会出现糖尿，脂肪的分解也增加，血液中游离脂肪酸和酮体增加，机体对游离脂肪酸的利用也增加，蛋白质的分解增强，血浆氨基酸水平升高，尿氮排出增加，出现负氮平衡。这一系列的临床及代谢改变，或造成多器官功能衰竭，导致极为严重的后果，如何有效地阻断或减轻此反应的危害，保护各脏器的功能，修复创伤组织，控制炎症与感染，使患者早日康复，通过营养支持，利用营养素在机体创伤修复和抗感染过程中所发挥的作用来减轻应激反应对患者机体的损伤，因此营养支持成为极为重要而有效的辅助治疗手段。
为此类患者提供的能量需要量可在基础代谢消耗能量的基础上，考虑疾病应激程度、体温及体力活动等因素来计算确定，一般供给能量可在2000～2500kcal/d，碳水化合物供给量应占总能量的50～60%，脂肪供给量可占15～20%，蛋白质应占15～20%，或按1.5～2.0g/(kg.d)计算，其中50%以上应为牛乳等所提供的优质蛋白。
根据应激状态下患者的高分解代谢特点，给患者提供高蛋白能促进球蛋白数量增加，若蛋白质缺乏，患者术后易出现低血容量性休克、机体免疫功能损害、出现水肿、伤口不愈合或愈合缓慢、易合并感染等，因此应给患者提供高蛋白的食品才能满足需求。因创伤或感染后，血浆氨基酸水平显著降低，由于出现负氮平衡，肾小管回收能力减低，对一些氨基酸的吸收水平下降，尿中氨基酸的排出增加，同时适量地补充色氨酸、酪氨酸、精氨酸以及谷氨酰胺等，色氨酸可以选择性提高脑组织中色氨酸含量，使5～羟色胺的水平上升，缓解紧张的情绪；补充酪氨酸能够提高人体耐缺氧的能力；精氨酸是含氮丰富的半必需氨基酸，能够促进生长激素、胰岛素以及胰高血糖素等激素的分泌，可促进组织生长和伤口愈合，维持机体的正氮平衡，精氨酸能够降低血液胆固醇水平，提高高密度脂蛋白与低密度脂蛋白的比值；谷氨酰胺是机体含量最丰富的氨基酸，可为增殖免疫细胞和胃肠黏膜细胞等提供能量，参与酸碱平衡的调节，对细胞有直接的保护作用，因此，补充谷氨酰胺可提高免疫力及抗氧化能力，减少多余自由基造成的氧化损伤，能够改善严重颅脑损伤患者的应激状态，提高患者的免疫功能，降低炎症及感染等并发症，有利于康复。对于脂类，应适量多补充多不饱和脂肪酸，如二十二碳六烯酸（DHA）、花生四烯酸（ARA）及二十碳五烯酸（EPA）等，亚麻酸能有效地调节应激反应中脂类的代谢紊乱，具有很强的降低胆固醇作用，再补充中链甘油三酯（MCT）对炎症反应有抑制作用，即可以降低创伤后的炎症反应，减轻对机体的免疫抑制。处于应激状态的患者在高分解代谢中，细胞内的水和电解质随蛋白质的分解代谢而进入细胞外，使患者机体的电解质代谢紊乱，手术后失血和渗出液的问题表现大量丢失钾、钠、镁铁、锌等；对于烧伤的患者，初期血清钠出现了波动，在休克期会下降，随后升高在10天左右达到平衡，对于有水肿和肾功能障碍者应限制钠盐，钾和锌的丢失量都很明显，镁、铁、铜、碘等也易缺乏，因此，在创伤、术后等应激状态下必须给患者补充充足的微量元素。一些维生素对应激反应有一定的作用，维生素与类黄酮及一些微量元素可在体内形成抗氧化的防御系统，应适量增加维生素A、β～胡萝卜素、维生素B2、维生素E、维生素C、肌醇和牛磺酸等，对于烧伤患者，维生素的需要量是正常的几倍，烧伤面积越大、程度越重，需要量越大。
因此特殊医学用途配方食品的开发对临床创伤、感染、手术及其他应激状态患者的肠内营养支持和营养治疗方面有着非常重要的作用。但是，目前市场上还没有见到专门针对创伤、感染、手术及其他应激状态病人的营养食品。
发明内容
本发明的目的在于提供一种专门针对创伤、感染、手术及其他应激状态这类特殊人群而设计的特定全营养配方食品，利用牦牛奶、鲜牛奶、乳清粉、乳清蛋白粉、水解乳清蛋白、精炼植物油、中链甘油三酯、白砂糖、氨基酸、多不饱和脂肪酸、酪蛋白磷酸肽等加入适量的维生素和矿物质或其他营养成分，仅用物理方法加工制成，可以满足需要大量营养的创伤、感染、手术及其他应激状态疾病人群对各种营养成分的需求。本发明的另一个目的是提供一种上述配方食品的制备方法。
为达到上述目的，本发明的实施方案为：一种适用于应激状态患者的特殊医学用途的食品，主要原料包括：
牦牛奶100～1500kg，鲜牛奶100～2000kg，乳清粉200～500kg，精炼植物油50～200kg，中链甘油三酯1～100kg，白砂糖1～150kg，乳糖1～120kg，氨基酸1～120kg，水解乳清蛋白1～50kg，二十二碳六烯酸DHA1～20kg；花生四烯酸ARA2～40kg,酪蛋白磷酸肽0.1～3kg。
作为优化，所述氨基酸为色氨酸、酪氨酸、精氨酸以及谷氨酰胺中的一种或多种。
作为优化，所述乳清粉为D90。
作为优化，所述精炼植物油为富含亚麻酸的大豆油，精炼植物油的反式脂肪酸控制在0.8～1.2%。
作为优化，为了给患者提供均衡及更多的营养物质，还添加有：
醋酸视黄酯20～100g；胆钙化醇10～100g；dl-ɑ-醋酸生育酚40～700g；植物甲萘醌10～200g；盐酸硫胺素5～100g；核黄素40～800g；盐酸吡哆醇4～100g；氰钴胺5～100g；烟酸10～100g；叶酸6～60g；D-泛酸钙15～200g；L-抗坏血酸700～3500g；D-生物素1～60g；肌醇0～700g；牛磺酸1～700g；氯化胆碱200～1500g；碳酸钙1～1000g；硫酸亚铁100～450g；硫酸锌60～330g；硫酸锰1～100g；硫酸铜6～40g；柠檬酸钾200～3000g；氧化镁0～3500g；亚硒酸钠1～200g；碘酸钾1～60g；磷酸氢二钠1～3000g；氯化钾100～5000g；氯化钠100～5000g；核苷酸100～300g。
进一步优化的是，各类营养物质的纯度：醋酸视黄酯9.76%；胆钙化醇0.25%；dl-ɑ-醋酸生育酚50%；植物甲萘醌1.00%；盐酸硫胺素≥99%；核黄素10%；盐酸吡哆醇≥98%；氰钴胺0.1%；烟酸≥99.5%；叶酸10%；D-泛酸钙97～102%；L-抗坏血酸≥98%；D-生物素1%；肌醇≥98%；牛磺酸≥98.5%；氯化胆碱98%；碳酸钙≥98%；硫酸亚铁≥98%；硫酸锌≥98%；硫酸锰10%；硫酸铜≥99%；柠檬酸钾≥98%；氧化镁≥99%；亚硒酸钠1%；碘酸钾10%；磷酸氢二钠≥98%；氯化钾≥99.0%；核苷酸≥98%；二十二碳六烯酸DHA7%；花生四烯酸ARA10%。
本发明的制备方法包括以下步骤：
(1)经杀菌、净化处理的牦牛奶、鲜牛奶、纯水经板式换热器预热至50℃～55℃,吸入真空混料机与混料罐形成闭合循环；
(2)将维生素类和矿物质类外的干粉原料干粉辅料经振动筛机输入到高速在线混合机中，用步骤（1）处理后的牦牛奶和鲜牛奶去混合溶解循环，同时将精炼植物油、中链甘油三酯和溶解好的维生素、矿物质用泵输入到混合机的管路内进行在线混合乳化循环，此配料的浓度应在11～13%之间；
（3）全部溶解混合好的物料进行均质，均质压力14～16Mpa，均质后的物料通过冷却板式换热器将物料温度降到4℃～6℃；
（4）均质后将物料用泵送入蒸发器进行杀菌浓缩，杀菌温度90～93℃，且物料在蒸发器的杀菌管道内的停留时间不能少于36秒，经多流程浓缩后物料浓度在41～44%之间，再经高压泵送入低温干燥塔进行喷雾干燥并通过静床和振动流化床进行二次附聚干燥成粉末状成品。
作为优化，在先溶解好的维生素和矿物质时，先溶解矿物质，再溶解维生素。
对于有应激状态的患者来说，膳食中蛋白质的来源选择非常重要，乳蛋白含丰富的必须氨基酸，生物价值高、利用率好。在本发明中的蛋白质来源选择是动物蛋白中优质的牛奶蛋白，其中一大部分为牦牛奶蛋白，牛奶本身就含有各种必须氨基酸，而牦牛奶中必需氨基酸是黑白花牛奶高1.897倍，并且含有人体所需要的18种氨基酸,包括天门冬氨酸ASP、苏氨酸THR、丝氨酸SER、谷氨酸GLU、甘氨酸、GLY、丙氨酸ALA、缬氨酸VAL、蛋氨酸MET、异亮氨酸ILE、亮氨酸LEU、酪氨酸TYR、苯丙氨酸PHE、赖氨酸LYS、组氨酸HIS、精氨酸ARG、脯氨酸PRO、色氨酸TRP、胱氨酸CYS，其中有8种是人体内不能合成的必须氨基酸，比普通牛奶高1.897倍；其中含色氨酸0.076mg/100g，酪氨酸0.234mg/100g，精氨酸0.162mg/100g，谷氨酸1.046mg/100g，所天然含有的色氨酸、酪氨酸、精氨酸以及谷氨酸等能够促进组织生长、伤口愈合、调节机体代谢平衡、提高患者的免疫功能、降低炎症及感染等并发症，有利于康复等多方面有积极的作用。在创伤、术后等应激状态下必须给患者补充充足的微量元素，牦牛奶和牛奶中都含有丰富的矿物质，通过科学的计算牦牛奶的使用量，也正是由于牦牛奶中天然丰富的矿物质，在产品配方中不用添加过多化学合成的无机盐，就能满足患者对营养的需求，减少了对患者胃肠道的刺激，避免有胃肠出血症状时对食物影响的怀疑，对于有厌食、胃肠不适、吸收不良的患者有很大帮助。本发明中水解乳清蛋白还具有在应激状态下防过敏作用。
具体实施方式
本发明公开了一种适用于创伤、感染、手术及其他应激状态病人的特殊医学用途牦牛奶配方食品的产品配方及生产工艺，本领域技术人员可以借鉴本发明内容，对原料和添加剂在国家相关标准规定范围内做适当的替换和调整，但需要特别说明的是，所有的替换和调整都被视为包括在本发明的范围中。因特殊医学用途配方食品是针对有特殊医学状况的人群而设计的，对其内含营养成分有着严格的控制要求，本发明的配方已经过检测、实践和应用，是符合国家食品安全标准的，并通过较好的实例进行如下描述，相关人员在使用本发明时不应脱离本发明内容和范围进行改动、变更或组合。
实施例1：
适用于创伤、感染、手术及其他应激状态患者的特殊医学用途牦牛奶全营养配方食品，生产原料配方为：
牦牛奶500kg；鲜牛奶2500kg；乳清粉（D90）300kg；精炼植物油100kg；中链甘油三酯40kg；白砂糖80kg；乳糖45kg；水解乳清蛋白19kg；色氨酸15kg；、酪氨酸15kg；精氨酸15kg；谷氨酰胺15kg；二十二碳六烯酸DHA2kg；花生四烯酸ARA5.7kg；酪蛋白磷酸肽1kg；核苷酸220g；维生素类物质：醋酸视黄酯60g、胆钙化醇51g、dl-ɑ-醋酸生育酚450g、植物甲萘醌108g、盐酸硫胺素72g、核黄素530g、盐酸吡哆醇68g、氰钴胺52g、烟酸56g、叶酸21g、D-泛酸钙40g、L-抗坏血酸1600g、D-生物素31g、肌醇450g、牛磺酸400g、氯化胆碱1000g；矿物质类：碳酸钙4500g、硫酸亚铁250g、硫酸锌150g、硫酸锰67g、硫酸铜18g、柠檬酸钾2000g、氯化钾2000g、氧化镁1750g、亚硒酸钠96g、碘酸钾8.5g、磷酸氢二钠2000g、氯化钠3500g。
其制备方法:经杀菌、净化处理的牦牛奶、鲜牛奶和纯净水经板式换热器预热至50℃～55℃,吸入真空混料机与混料罐形成闭合循环；将乳清粉（D90）、白砂糖乳糖、水解乳清蛋白、二十二碳六烯酸、花生四烯酸、酪蛋白磷酸肽等干粉辅料经振动筛粉机输入到高速在线混合机中，用前述处理后的牛奶去混合溶解循环，同时将精炼植物油、中链甘油三酯和溶解好的维生素、矿物质（先溶解矿物质，再溶解维生素）用泵输入到混合机的管路内进行在线混合乳化循环，此配料的浓度应在11～13%之间；全部溶解混合好的物料进行均质，均质压力14～16Mpa，均质后的物料通过冷却板式换热器将物料温度降到4℃～6℃；均质后将物料用泵送入蒸发器进行杀菌浓缩，杀菌温度90～93℃，且物料在蒸发器的杀菌管道内的停留时间不能少于36秒，经多流程浓缩后物料浓度在41～44%之间，再经高压泵送入低温干燥塔进行喷雾干燥并通过静床和振动流化床进行二次附聚干燥成粉末状成品。
上述实施例中提供的创伤、感染、手术及其他应激状态病人的特殊医学用途配方食品的具体食用量与食用方法在产品包装标签上明示，具体食用方法如：“每14g粉用90ml水冲调成液态后再饮用、每日的食用量根据病情如何调整”等应用食用表来明示，产品标签应对产品的配方特点进行说明，且产品的类别和适用人群，同时还在标示“不适用于非目标人群”，应醒目标示：“请在医生或临床营养师指导下使用”，还应标示：“本产品禁止用于肠外营养支持和静脉注射”。
Claims (8)
1.一种用于应急状态患者的特殊医学用途食品，其特征在于，主要原料包括以下重量份的组分：
牦牛奶100～1500kg，鲜牛奶100～2000kg，乳清粉200～500kg，精炼植物油50～200kg，中链甘油三酯1～100kg，白砂糖1～150kg，乳糖1～120kg，氨基酸1～120kg，水解乳清蛋白1～50kg，二十二碳六烯酸DHA1～20kg；花生四烯酸ARA2～40kg,酪蛋白磷酸肽0.1～3kg。
2.根据权利要求所述的用于应急状态患者的特殊医学用途食品，其特征在于，所述氨基酸为色氨酸、酪氨酸、精氨酸以及谷氨酰胺中的一种或多种。
3.根据权利要求所述的用于应急状态患者的特殊医学用途食品，其特征在于，所述乳清粉为D90。
4.根据权利要求所述的用于应急状态患者的特殊医学用途食品，其特征在于，所述精炼植物油为为富含亚麻酸的大豆油，精炼植物油的反式脂肪酸控制在0.8～1.2%。
5.根据权利要求1所述的用于应急状态患者的特殊医学用途食品，其特征在于，原料中还添加有：
醋酸视黄酯20～100g；胆钙化醇10～100g；dl-ɑ-醋酸生育酚40～700g；植物甲萘醌10～200g；盐酸硫胺素5～100g；核黄素40～800g；盐酸吡哆醇4～100g；氰钴胺5～100g；烟酸10～100g；叶酸6～60g；D-泛酸钙15～200g；L-抗坏血酸700～3500g；D-生物素1～60g；肌醇0～700g；牛磺酸0～700g；氯化胆碱200～1500g；碳酸钙0～1000g；硫酸亚铁100～450g；硫酸锌60～330g；硫酸锰1～100g；硫酸铜6～40g；柠檬酸钾200～3000g；氧化镁0～3500g；亚硒酸钠0～200g；碘酸钾0～60g；磷酸氢二钠1～3000g；氯化钾100－5000g；氯化钠100－5000g；核苷酸100～300g。
6.根据权利要求5所述的用于应急状态患者的特殊医学用途食品，其特征在于，各类营养物质的纯度：醋酸视黄酯9.76%；胆钙化醇0.25%；dl-ɑ-醋酸生育酚50%；植物甲萘醌1.00%；盐酸硫胺素≥99%；核黄素10%；盐酸吡哆醇≥98%；氰钴胺0.1%；烟酸≥99.5%；叶酸10%；D-泛酸钙97～102%；L-抗坏血酸≥98%；D-生物素1%；肌醇≥98%；牛磺酸≥98.5%；氯化胆碱98%；碳酸钙≥98%；硫酸亚铁≥98%；硫酸锌≥98%；硫酸锰10%；硫酸铜≥99%；柠檬酸钾≥98%；氧化镁≥99%；亚硒酸钠1%；碘酸钾10%；磷酸氢二钠≥98%；氯化钾≥99.0%；核苷酸≥98%；二十二碳六烯酸DHA7%；花生四烯酸ARA10%。
7.一种用于应急状态患者的特殊医学用途食品的制备方法，其特征在于，包括以下步骤：
(1)经杀菌、净化处理的牦牛奶、鲜牛奶、纯水经板式换热器预热至50℃～55℃,吸入真空混料机与混料罐形成闭合循环；
(2)将维生素类和矿物质类外的干粉原料干粉辅料经振动筛机输入到高速在线混合机中，用步骤（1）处理后的牦牛奶和鲜牛奶去混合溶解循环，同时将精炼植物油、中链甘油三酯和溶解好的维生素、矿物质用泵输入到混合机的管路内进行在线混合乳化循环，此配料的浓度应在11～13%之间；
（3）全部溶解混合好的物料进行均质，均质压力14～16Mpa，均质后的物料通过冷却板式换热器将物料温度降到4℃～6℃；
（4）均质后将物料用泵送入蒸发器进行杀菌浓缩，杀菌温度90～93℃，且物料在蒸发器的杀菌管道内的停留时间不能少于36秒，经多流程浓缩后物料浓度在41～44%之间，再经高压泵送入低温干燥塔进行喷雾干燥并通过静床和振动流化床进行二次附聚干燥成粉末状成品。
8.根据权利要求7所述的用于应急状态患者的特殊医学用途食品的制备方法，其特征在于，在溶解好的维生素和矿物质时，先溶解矿物质，再溶解维生素。
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