CN111903962A - 一种胃溃疡和十二指肠溃疡专用型临床营养配方及其制备 - Google Patents
一种胃溃疡和十二指肠溃疡专用型临床营养配方及其制备 Download PDFInfo
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Abstract
本发明公开了一种胃溃疡和十二指肠溃疡专用型临床营养配方,包括如下组分及其重量份数:碳水化合物10‑60份、蛋白质30‑60份、脂肪5‑20份、维生素A 0.00003‑0.001份、维生素C 0.6‑2份、维生素E 0.002‑0.04份、维生素D 0.00003‑0.001份、常量元素0.02‑2份、微量元素0.01‑1份、新资源食品2‑10份、药食同源成分4‑30份、膳食纤维10‑25份;所述常量元素包括磷元素。本发明提供的配方通过合理的膳食调配,提供优质蛋白质,n‑3、n‑6和n‑9不饱和脂肪酸,选择多种维生素、矿物质、药食同源和新资源食品,给患者提供所需的营养,改善患者的营养状况,减轻患者不良反应和临床症状,改善患者的预后。
Description
技术领域
本发明涉及特殊医学用途配方食品领域,尤其涉及一种胃溃疡和十二指肠溃疡专用型临床营养配方及其制备。
背景技术
消化性溃疡是一种穿透黏膜肌层的胃肠道黏膜局限性损伤,常发生于胃(胃溃疡)或十二指肠近端数厘米(十二指肠溃疡),亦可发生于食管下端、胃-空肠吻合口附近以及Meckel憩室。这些溃疡的形成均与胃酸和胃蛋白酶的消化作用有关,故称消化性溃疡。消化性溃疡是一种全球性多发病、常见病,发病率男性高于女性,可发生于任何年龄段,包括婴幼儿和儿童,其中以20-50岁最为常见。临床上主要表现为慢性上腹痛,疼痛的特征为慢性、周期性和节律性。疼痛常被描述为烧灼痛、啃噬痛或饥饿感。病程具有长期性和反复性。仅有约半数患者具有典型的症状。并发症有大出血、穿孔、幽门梗阻,约5%的胃溃疡还可发生癌变。
几乎所有溃疡均由幽门螺旋杆菌或使用非激素类抗炎药引起。诊断依靠内镜及幽门螺旋杆菌相关检查。治疗包括抑酸、清除幽门螺旋杆菌和避免使用非激素类抗炎药物。
溃疡大小从几毫米至几厘米不等。溃疡与糜烂的区别在于穿透的深度,其中糜烂更为表浅,不会累及黏膜肌层。胃溃疡症状常无固定形态(如进食有时可加重而非缓解)特别是对幽门管溃疡,后者常伴有因水肿和瘢痕导致的梗阻症状(如胃胀、恶心、呕吐)。十二指肠溃疡所致疼痛持续时间更长。患者晨起时无痛,但午间出现疼痛,进食后缓解,餐后2-3小时又发作。患者常夜间痛醒,十二指肠溃疡的可能性很高。
对于溃疡产生的因素,可能为以下几点:
(1)持久和过度精神紧张、情绪激动等精神因素可引起大脑皮质功能紊乱,使迷走神经兴奋和肾上腺皮质激素分泌增加,导致胃酸和胃蛋白酶分泌增多,促使溃疡形成;
(2)吸烟是发生溃疡及其并发症的危险因素。此外,吸烟也影响黏膜的修复并增加溃疡复发。每日吸烟量与发病的危险直接相关;
(3)幽门螺旋杆菌及非甾体类抗炎药物破坏正常黏膜防御与修复功能,使黏膜更容易受到酸的侵蚀。幽门螺旋杆菌感染见于50%-70%十二指肠溃疡和30%-50%胃溃疡患者。如果幽门螺旋杆菌得以根除,仅10%的患者消化性溃疡会复发,而仅使用抑酸治疗患者中溃疡的复发率为70%。>50%的消化性溃疡由非甾体类抗炎药物引起。50%-60%的十二指肠溃疡患者有家族史。幽门螺旋杆菌相关性溃疡患者以后发生胃癌的危险增加3-6倍。
消化性溃疡的发生发展与营养密切相关,正确的饮食条件有利于促进溃疡愈合,缓解疼痛,减少疾病复发,防止并发症的出现。在疾病的预后方面,患者的营养状况无疑是至关重要的,由于消化吸收不好,营养不良等问题却普遍存在。
因此,研制能提供胃溃疡和十二指肠溃疡患者基础营养素,保证患者的营养需求的技术方案具有重要价值和广阔的市场。
发明内容
本发明为解决现有技术中的上述问题提出的一种胃溃疡和十二指肠溃疡专用型临床营养配方,通过合理的膳食调配,提供优质蛋白质,n-3、n-6不饱和脂肪酸,选择多种维生素、矿物质、药食同源和新资源食品,减轻患者的临床症状,改善患者的营养状况。
为实现上述目的,本发明采用以下技术方案:
本发明的第一个方面是提供一种胃溃疡和十二指肠溃疡专用型临床营养配方,包括如下组分及其重量份数:碳水化合物10-60份、蛋白质30-60份、脂肪5-20份、维生素A0.00003-0.001份、维生素C 0.6-2份、维生素E 0.002-0.04份、维生素D 0.00003-0.001份、常量元素0.02-2份、微量元素0.01-1份、新资源食品2-10份、药食同源成分4-30份、膳食纤维10-25份;
所述常量元素包括磷元素。
优选地,所述常量元素包括铁、锌、钙中的一种或几种。
优选地,所述蛋白质来源于水解乳清蛋白粉、大豆分离蛋白肽、全蛋粉、白蛋白肽、大豆肽、海洋鱼低聚肽、浓缩乳清蛋白粉、牛初乳粉、全脂奶粉、α-乳清蛋白粉、乳铁蛋白中的一种或几种。
优选地,所述新资源食品包括精氨酸、L-谷氨酰胺、益生菌、左旋肉碱和β-羟基-β-甲基丁酸钙中一种或几种。
优选地,所述碳水化合物为麦芽糊精、抗性淀粉、膨化玉米淀粉、麦芽糖醇、山梨糖醇、木糖醇中的一种或几种。
优选地,所述脂肪包括鱼油微囊粉、亚麻籽油微囊粉、月见草油微囊粉、橄榄油微囊粉、链甘油三酯粉、二十二碳六烯酸油脂、花生四烯酸油脂、茶油微囊粉中的一种或几种。
优选地,所述维生素C来源于L-抗坏血酸、L-抗坏血酸钙、L-抗坏血酸钠、L-抗坏血酸钾、维生素C磷酸酯镁、L-抗坏血酸-6-棕榈酸盐中的一种或几种。
优选地,所述维生素A来源于醋酸视黄酯、棕榈酸视黄酯、全反式视黄醇、β-胡萝卜素中的一种或几种。
优选地,所述锌来源于硫酸锌、葡萄糖酸锌、氧化锌、乳酸锌、柠檬酸锌、氯化锌、乙酸锌、碳酸锌中的一种或几种。
本发明的第二方面,提供了上述胃溃疡和十二指肠溃疡专用型临床营养配方的制备方法,其特征在于,包括如下步骤:
S1:称量预定重量的脂肪、维生素A、维生素C、维生素E、维生素D分别采用微囊包埋技术制备并过60-80目筛制成粉末;
S2:称量预定重量的药食同源成分通过粉碎、醇提、水提、喷雾干燥并过60-80目筛制成粉末;
S3:预定重量的其余组分分别制备成粒径为150-250μm的粉末;
S4:将步骤S1-S3中制备的粉末混合均匀后杀菌备用;
S5:将步骤S4混合后的粉末制成可直接食用的配方制剂。
本发明采用上述技术方案,与现有技术相比,具有如下技术效果:
(1)通过合理的膳食调配,提供优质蛋白质,n-3、n-6和n-9不饱和脂肪酸,选择多种维生素、矿物质、药食同源和新资源食品,给患者提供所需的营养,改善患者的营养状况,减轻患者不良反应和临床症状,改善患者的预后;
(2)其中,常量元素铁和锌、微量元素磷结合的技术手段,可以缓解患者在在药物治疗期间带来的不适感;
(3)同时供给的充足的精氨酸、L-谷氨酰胺、益生菌、左旋肉碱,与合理的营养治疗结合后,可降低胃酸和食物对黏膜的侵蚀作用,促进溃疡面愈合,防止疾病复发并改善病人的营养状态。
具体实施方式
本发明提供本发明的第一个方面是提供一种胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,包括如下组分及其重量份数:碳水化合物10-60份、蛋白质30-60份、脂肪5-20份、维生素A 0.00003-0.001份、维生素C 0.6-2份、维生素E 0.002-0.04份、维生素D 0.00003-0.001份、常量元素0.02-1.2份、微量元素0.0001-0.006份、新资源食品2-10份、药食同源成分4-30份、膳食纤维10-25份;
所述微量元素包括磷元素。
消化性溃疡的发生发展与营养密切相关,正确的饮食条件有利于促进溃疡愈合,缓解疼痛,减少疾病复发,防止并发症的出现。
消化性溃疡患者经常用含铝和镁的抗酸药,会影响磷的吸收,服用H2受体阻滞剂会影响铁的吸收。锌的吸收在十二指肠和小肠进行,当其发生溃疡和炎症时可影响吸收。锌对舌味蕾和黏膜提供营养,是促进黏膜修复的重要物质,因此缺锌导致食欲下降,细胞免疫功能下降,妨碍炎症和溃疡部位的黏膜的再生修复。
综上,患者需重视矿物质特别是磷、铁和锌的补充。
因此,本发明一种实施例中,上述常量元素包括铁、锌、钙中的一种或几种。进一步优选地,铁0.01-0.02份、锌0.01-0.02份、钙0.2-2份。
更进一步地,在一种优选的实施例中,锌来源于硫酸锌、葡萄糖酸锌、氧化锌、乳酸锌、柠檬酸锌、氯化锌、乙酸锌、碳酸锌中的一种或几种。
消化性溃疡创面的修复需要蛋白质的参与,但因病人进食量少、消化能力较差,容易发生营养不良或低蛋白血症,因此需摄入足量蛋白质以满足机体的营养需求。应注意过量蛋白质摄入会促进胃酸分泌,加重病情,因而补充丰富的高生物价优质蛋白质才真正的有益于人体消化吸收系统的吸收利用。此外,全面均衡地补充人体所需的8种必须氨基酸,否则容易出现负氮平衡,影响免疫力。
在本发明一种实施例中,蛋白质来源于水解乳清蛋白粉、大豆分离蛋白肽、全蛋粉、白蛋白肽、大豆肽、海洋鱼低聚肽、浓缩乳清蛋白粉、牛初乳粉、全脂奶粉、α-乳清蛋白粉、乳铁蛋白中的一种或几种。
因消化性溃疡病人进食量少、吸收和消化能力较差,常导致碳水化合物不能满足机体需要,病人常伴体重下降或消瘦。碳水化合物的合理补充不仅能保证能量供给,稳定血糖,增加体重,还可以中和胃酸,改善疾病症状。碳水化合物既无刺激胃酸分泌的作用,也不抑制胃酸分泌的作用,可作为溃疡病病人能量供给的主要来源。
在本发明一种实施例中,碳水化合物为麦芽糊精、抗性淀粉、膨化玉米淀粉、麦芽糖醇、山梨糖醇、木糖醇中的一种或几种。
消化性溃疡病人容易发生必需脂肪酸和脂溶性维生素的缺乏,应予以补充适量脂肪。过多脂肪摄入会促进胆囊收缩而抑制胃肠蠕动,延缓胃排空,食物在胃内溜留时间延长,将致胃酸分泌增加并加剧胆汁反流,引起胃胀痛。n-3、n-6、n-9不饱和脂肪酸可以抑制炎症细胞因子的表达,将减轻肠道负担,减轻肠粘膜损伤。
在本发明一种实施例中,脂肪包括鱼油微囊粉、亚麻籽油微囊粉、月见草油微囊粉、橄榄油微囊粉、链甘油三酯粉、二十二碳六烯酸油脂、花生四烯酸油脂、茶油微囊粉中的一种或几种。
维生素是维持人体正常生理功能所必需的重要营养素。消化性溃疡病人因摄食减少、对膳食种类和烹调方法的限制,直接影响了维生素的摄取,如较长时间摄入量低于日推荐摄入量,尤其在合并出血、穿孔、幽门梗阻和癌变等并发症时,很有可能会发生某种维生素缺乏,更需重视及时补充,以利于溃疡面的愈合及术后康复。
其中,脂溶性维生素可以促进溃疡面的愈合,提高机体的抗病能力,例如维生素A。水溶性的维生素C制剂呈酸性,不宜过多摄入,但其有助于促进溃疡面的愈合,临床上应针对具体病情,酌情考虑补充途径和剂量。
维生素E在人体内有以下几点作用:
(1)可直接清除自由基,保护胃上皮细胞膜;(2)维生素E还能传递电子给自由基,从而减少自由基引发的黏膜内脂质过氧化反应,保护了胃粘膜;(3)维生素E能维护神经生物膜的完整性,阻止胃及十二指肠黏膜内末梢神经元遭兴奋性毒性损伤及自由基攻击;(4)维生素E还可抑制幽门螺旋杆菌产生的一些毒性酶和代谢产物,如脂酶、磷脂酶、脂多糖、醇脱氢酶等,这些产物将对胃黏膜的损害作用;(5)维生素E还能清除脂多糖刺激中性粒细胞释放的毒性氧离子,阻止醇脱氢酶氧化乙醇为对胃粘膜有损害作用的乙醛。因此,需要防止患者维生素E的缺乏。
综上,在本发明一种实施例中,维生素A来源于醋酸视黄酯、棕榈酸视黄酯、全反式视黄醇、β-胡萝卜素中的一种或几种;维生素C来源于L-抗坏血酸、L-抗坏血酸钙、L-抗坏血酸钠、L-抗坏血酸钾、维生素C磷酸酯镁、L-抗坏血酸-6-棕榈酸盐中的一种或几种;维生素E来源于d-α-生育酚、dl-α-生育酚、d-α-醋酸生育酚、dl-α-醋酸生育酚、混合生育酚浓缩物、维生素E琥珀酸钙、d-α-琥珀酸生育酚、dl-α-琥珀酸生育酚中的一种或几种。
过粗的食物纤维,可能对胃肠道黏膜、溃疡面会有机械性损伤,但膳食纤维能降低胃酸浓度,加速胃排空:且在口腔中充分咀嚼时可刺激唾液分泌,对消化性溃疡的黏膜能起一定的保护作用,有利于溃疡的愈合,因此膳食纤维的摄入既要保证达到日推荐量,又要合理选择。
在本发明一种实施例中,膳食纤维来源于菊粉、聚葡萄糖、低聚半乳糖、低聚果糖、低聚木糖、低聚异麦芽糖、抗性糊精、大豆纤维等谷物膳食纤维中的一种或几种。
益生菌被称为微生态制剂或活菌制剂,指能在肠道生态系统中存活的正常菌群或具有调节和有益作用的外来菌。益生菌对肠屏障功能的保护作用机制如下:①定植拮抗作用:维持肠内菌群平衡,抑制致病菌繁殖;②促进肠道紧密连接相关蛋白表达;③改善肠道免疫功能,提高机体免疫功能。
L-谷氨酰胺在维持小肠代谢、结构和功能上起重要的作用。既能作为肠黏膜细胞能量代谢的底物,又能为快速周转的蛋白质和核酸提供原料。既可为多种快速分裂细胞如肠黏膜上皮细胞和活化的淋巴细胞等提供能源,又可促进受损肠道的修复以及维持正常的局部免疫功能。
左旋肉碱在生物细胞内主要定位于线粒体的内膜,其功能是以载体形式即脂酸肉碱的形式将长链脂肪酸从线粒体膜外运送到膜内,促进脂肪酸的β-氧化:并起着调节酰基CoA/CoA比率的作用。左旋肉碱和它的酰基还是自由基的清除剂和铁的鳌合剂,具有抗氧化功能;作为长链脂肪酸的载体,参与膜修复过程中膜磷脂的去酰基-重酸化,有利于膜的及时修复,起到次级抗氧化防御屏障的作用;节约游离辅酶A,增加长链酰基辅酶A,恢复酰基酸转位酶的活性,稳定细胞膜,促进支链氨基酸的氧化利用等作用,对肠黏膜屏障具有一定的保护作用。
由于肠道是主要营养物质吸收的场所,消化性溃疡的患者通常伴有少肌症的发生。少肌症与疾病活动性和临床预后密切相关。β-羟基-β-甲基丁酸钙是亮氨酸代谢过程中产生的天然化合物,具有促进肌肉蛋白合成、抑制肌肉蛋白分解、维护细胞完整性、提高免疫功能和降低炎性反应等作用。
在上述技术手段的基础上,在本发明的一种实施例中,新资源食品包括精氨酸、L-谷氨酰胺、益生菌、左旋肉碱和β-羟基-β-甲基丁酸钙中一种或几种。
进一步优选地,益生菌包括双歧杆菌属、乳杆菌属、链球菌属、嗜酸乳杆菌NCFM、动物双歧杆菌Bb-12、乳双歧杆菌HN019、乳双歧杆菌Bi-07、鼠李糖乳杆菌LGG、鼠李糖乳杆菌HN001、发酵乳杆菌CECT5716、短双歧杆菌M-16V中的一种或几种。
在本发明的一种实施例中,药食同源成分包括所述药食同源成分包括百合、薄荷、甘草、茯苓、覆盆子、枸杞、黄精、大枣中的一种或几种。
下面通过具体实施例对本发明进行详细和具体的介绍,以使更好的理解本发明,但是下述实施例并不限制本发明范围。
实施例1
本实施例提供一种胃溃疡和十二指肠溃疡专用型临床营养配方,包括以下组分(如表1所述):
表1实施例1中胃溃疡和十二指肠溃疡专用型临床营养配方
上述胃溃疡和十二指肠溃疡专用型临床营养配方的制备方法,包括以下步骤:
S1:称量预定重量的脂肪、维生素A、维生素C、维生素E、维生素D分别采用微囊包埋技术制备并过80目筛制成粉末;
S2:称量预定重量的药食同源成分通过粉碎、醇提、水提、喷雾干燥并过80目筛制成粉末;
S3:预定重量的其余组分分别制备成粒径为250μm的粉末;
S4:将步骤S1-S3中制备的粉末混合均匀后杀菌备用;
S5:将步骤S4混合后的粉末制成可直接食用的配方制剂。
实施例2
本实施例提供一种胃溃疡和十二指肠溃疡专用型临床营养配方,包括以下组分(如表2所述):
表2实施例2中胃溃疡和十二指肠溃疡专用型临床营养配方
上述胃溃疡和十二指肠溃疡专用型临床营养配方的制备方法,包括以下步骤:
S1:称量预定重量的脂肪、维生素A、维生素C、维生素E、维生素D分别采用微囊包埋技术制备并过80目筛制成粉末;
S2:称量预定重量的药食同源成分通过粉碎、醇提、水提、喷雾干燥并过80目筛制成粉末;
S3:预定重量的其余组分分别制备成粒径为250μm的粉末;
S4:将步骤S1-S3中制备的粉末混合均匀后杀菌备用;
S5:将步骤S4混合后的粉末制成可直接食用的配方制剂。
实施例3
本实施例提供一种胃溃疡和十二指肠溃疡专用型临床营养配方,包括以下组分(如表3所述):
表3实施例3中胃溃疡和十二指肠溃疡专用型临床营养配方
上述胃溃疡和十二指肠溃疡专用型临床营养配方的制备方法,包括以下步骤:
S1:称量预定重量的脂肪、维生素A、维生素C、维生素E、维生素D分别采用微囊包埋技术制备并过80目筛制成粉末;
S2:称量预定重量的药食同源成分通过粉碎、醇提、水提、喷雾干燥并过80目筛制成粉末;
S3:预定重量的其余组分分别制备成粒径为250μm的粉末;
S4:将步骤S1-S3中制备的粉末混合均匀后杀菌备用;
S5:将步骤S4混合后的粉末制成可直接食用的配方制剂。
上述胃溃疡和十二指肠溃疡专用型临床营养配方的制备方法,包括以下步骤:
S1:根据表3称取原料,将维生素、矿物质、药食同源和新资源食品原料进行混合得到第一混合物;
S2:将步骤S1中得到的第一混合物与碳水化合物混合搅拌10min得到第二混合物;
S3:将步骤S2得到的第二混合物与其他物料按照逐级递增的原则投入混合搅拌机,搅拌20min,得到胃溃疡和十二指肠溃疡专用型临床营养配方。
应用实施例
试验对象为45例身体状况相近的胃溃疡和十二指肠溃疡的患者,将患者随机分为三组,每组15人,对比组服用安慰剂,实验组服用实施例1-3所提供的胃溃疡和十二指肠溃疡专用型临床营养配方,一次100mg,连续服用2个月,进行体重称量,结果如下表4所示。
表4实施例1-3胃溃疡和十二指肠溃疡专用型临床营养配方的效果
以上对本发明的具体实施例进行了详细描述,但其只是作为范例,本发明并不限制于以上描述的具体实施例。对于本领域技术人员而言,任何对本发明进行的等同修改和替代也都在本发明的范畴之中。因此,在不脱离本发明的精神和范围下所作的均等变换和修改,都应涵盖在本发明的范围内。
Claims (10)
1.一种胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,包括如下组分及其重量份数:碳水化合物10-60份、蛋白质30-60份、脂肪5-20份、维生素A 0.00003-0.001份、维生素C 0.6-2份、维生素E 0.002-0.04份、维生素D 0.00003-0.001份、常量元素0.02-2份、微量元素0.01-1份、新资源食品2-10份、药食同源成分4-30份、膳食纤维10-25份;
所述常量元素包括磷元素。
2.根据权利要求1所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述微量元素包括铁、锌、钙中的一种或几种。
3.根据权利要求2所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述锌来源于硫酸锌、葡萄糖酸锌、氧化锌、乳酸锌、柠檬酸锌、氯化锌、乙酸锌、碳酸锌中的一种或几种。
4.根据权利要求1所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述蛋白质来源于水解乳清蛋白粉、大豆分离蛋白肽、全蛋粉、白蛋白肽、大豆肽、海洋鱼低聚肽、浓缩乳清蛋白粉、牛初乳粉、全脂奶粉、α-乳清蛋白粉、乳铁蛋白中的一种或几种。
5.根据权利要求1所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述碳水化合物为麦芽糊精、抗性淀粉、膨化玉米淀粉、麦芽糖醇、山梨糖醇、木糖醇中的一种或几种。
6.根据权利要求1所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述脂肪包括鱼油微囊粉、亚麻籽油微囊粉、月见草油微囊粉、橄榄油微囊粉、链甘油三酯粉、二十二碳六烯酸油脂、花生四烯酸油脂、茶油微囊粉中的一种或几种。
7.根据权利要求1所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述维生素A来源于醋酸视黄酯、棕榈酸视黄酯、全反式视黄醇、β-胡萝卜素中的一种或几种。
8.根据权利要求1所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述维生素C来源于L-抗坏血酸、L-抗坏血酸钙、L-抗坏血酸钠、L-抗坏血酸钾、维生素C磷酸酯镁、L-抗坏血酸-6-棕榈酸盐中的一种或几种。
9.根据权利要求1中所述的胃溃疡和十二指肠溃疡专用型临床营养配方,其特征在于,所述新资源食品包括精氨酸、L-谷氨酰胺、益生菌、左旋肉碱和β-羟基-β-甲基丁酸钙中一种或几种。
10.一种如权利要求1-9中任一项所述的胃溃疡和十二指肠溃疡专用型临床营养配方的制备方法,其特征在于,包括如下步骤:
S1:称量预定重量的脂肪、维生素A、维生素C、维生素E、维生素D分别采用微囊包埋技术制备并过60~80目筛制成粉末;
S2:称量预定重量的药食同源成分通过粉碎、醇提、水提、喷雾干燥并过60-80目筛制成粉末;
S3:预定重量的其余组分分别制备成粒径为150~250μm的粉末;
S4:将步骤S1-S3中制备的粉末混合均匀后杀菌备用;
S5:将步骤S4混合后的粉末制成可直接食用的配方制剂。
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