CN113616772A - Enteral nutrient for critical patients with surgical trauma - Google Patents

Enteral nutrient for critical patients with surgical trauma Download PDF

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CN113616772A
CN113616772A CN202110851518.6A CN202110851518A CN113616772A CN 113616772 A CN113616772 A CN 113616772A CN 202110851518 A CN202110851518 A CN 202110851518A CN 113616772 A CN113616772 A CN 113616772A
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enteral nutrient
critically ill
ill patients
water
vitamin
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魏玲
娄健
李佳
王玉珍
付娟娟
刘皎
李孟坤
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Yanan Hospital of Kunming City
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/02—Peptides of undefined number of amino acids; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/66—Microorganisms or materials therefrom
    • A61K35/74—Bacteria
    • A61K35/741—Probiotics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/02—Nutrients, e.g. vitamins, minerals

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  • Proteomics, Peptides & Aminoacids (AREA)
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  • Orthopedic Medicine & Surgery (AREA)
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Abstract

The invention discloses an enteral nutrient for critically ill patients with surgical wounds, which is characterized by comprising the following raw materials: 65-70% of short peptide, 10-17% of oryzanol, 10-17% of water-soluble vitamin, 10-15% of milk calcium, 25-30% of oligomycin and 10-15% of whey protein; the formula of the invention can promote the functional repair of gastrointestinal tract in early stage after the operation of traumatology department, and the planting of beneficial bacteria can avoid the displacement and disorder of intestinal flora; the formulas of the early short-peptide nutrient solution and the later high-protein enteral nutrient solution can promote postoperative wound healing and reduce the incidence of infection; high calcium formulations may promote rapid healing of bone fragments when later gastrointestinal function permits.

Description

Enteral nutrient for critical patients with surgical trauma
Technical Field
The invention belongs to the field of nutrition supplement for critically ill patients with trauma, and particularly relates to an enteral nutrient for critically ill patients with surgical trauma.
Background
Patients with surgical trauma, especially patients with severe bone trauma, have urgent, critical and complicated conditions, and most of them need emergency operation treatment. Due to limited mobility, long time spent in bed after operation, and gastrointestinal mucosa damage caused by stress; the patient has limited food intake and insufficient intake; impaired organ function; surgical blood loss, poor incision healing, infection and the like are related, and are one of the main reasons influencing the treatment and prognosis of patients. Researches show that the incidence rate of malnutrition of traumatology and orthopaedics patients is between 20.5 and 55.8 percent, and 16.2 percent of patients have potential malnutrition risks. Malnutrition is one of the common complications of surgical diseases, and is balanced with negative nitrogen caused by high catabolism.
Under surgical disease conditions, the nutrient consumption of patients is increased, the intestinal function is reduced due to the damage of intestinal mucosa, and the digestion, absorption and immune functions are reduced. Meanwhile, when the body of a patient is in a stress state, an inflammatory reaction system in the body can be activated, and a large amount of proinflammatory factors are promoted to be released to cause a systemic inflammatory reaction; causing ischemia and hypoxia changes of intestinal mucosa to cause injury of the intestinal mucosa, and in addition, various nutrient intakes caused by disease states cause atrophy, permeability increase and barrier function damage of the intestinal mucosa, so that a large amount of D-lactic acid, DAO and the like enter blood circulation through the damaged intestinal mucosa, and can also cause displacement of endotoxin of bacteria in the intestinal tract to cause infection complications. The body of a patient is in a vicious circle state, so that the wound of the patient is not healed, the hospitalization time is prolonged, the clinical treatment cost is increased, and the medical resources are over-used. Malnutrition is also associated with postoperative complications and significant increases in mortality rates in surgical patients.
Disclosure of Invention
In order to solve the technical problems, the invention provides an enteral nutrient for patients with critical surgical wounds, which adopts the enteral nutrient supplement combining probiotics, prebiotics, glutamine and short peptides to regulate gastrointestinal tracts and enhance the gastrointestinal tract immune function through effective and accurate enteral nutrient support.
In order to achieve the technical effects, the invention is realized by the following technical scheme: an enteral nutrient for critically ill patients with surgical wounds is characterized by consisting of the following raw materials: short peptides, oryzanol, water-soluble vitamins, milk calcium, oligomycin, whey protein; the raw materials comprise 65-70% of short peptide, 10-17% of Guwei-Yiwei, 10-17% of water-soluble vitamin, 10-15% of milk calcium, 25-30% of oligomate and 10-15% of whey protein;
preferably, the cereal will provide glutamine and probiotics;
preferably, the water-soluble vitamins include, but are not limited to, vitamin C, vitamins, vitamin B2, vitamin B6, vitamin B12;
preferably, 65% of short peptide, 16.5% of oryzanol and 16.5% of water-soluble vitamin;
preferably, the feed additive comprises 12.5% of the corn food, 12.5% of water-soluble vitamin, 15% of whey protein, 10% of milk calcium, 25% of the Iigo and 25% of the Iigo.
Glutamine (gin), 2-amino-4-carboxamidobutyric acid, is synthesized in the human body from glutamic acid, valine, and isoleucine. Under stress states such as sepsis and trauma, a large amount of skeletal muscle is decomposed and synthesized into Gln, but Gln in body cells is still deficient, and a large amount of researches show that the Gln of patients suffering from acute pancreatitis, burn, sepsis, stress, malnutrition and multi-organ dysfunction is reduced commonly and is related to the increase of death rate of elderly, shock and hospitalization diseases. Research shows that the addition of glutamine into enteral nutrition can raise the plasma glutamine level of critically ill patients, improve the intestinal mucosa barrier function, and improve the immune globulin level of the body and the cellular and humoral immune functions through increasing ATP content in immune cells, promoting the production of heat shock proteins and other ways. Gln-enhanced nutritional therapy within 48h after surgery can partially alleviate the suppression of immune function in patients after surgery. It has considerable effects in improving the utilization rate of enteral nutrition, shortening the healing time of wound surface, reducing the incidence of complications, etc.
The probiotics are microbes which can be planted in the intestinal tract and the reproductive system of a human body and can generate definite health efficacy, thereby improving the micro-ecological balance of a host and playing a beneficial role. The research shows that: the probiotics can adjust intestinal flora and inhibit the growth of pathogenic bacteria; reduce the displacement of intestinal bacteria and endotoxin after operation and reduce the occurrence of infection; can be used for regulating immune response, and treating food allergy and inflammatory bowel disease. The addition of probiotics in the early enteral nutrition helps to reduce inflammatory reaction and endotoxin level, is beneficial to controlling infection and accelerating wound healing, and has the following two main mechanisms: the probiotics can repair the network of interstitial cells (ICC) of the intestinal plexus of small intestine, promote the recovery of gastrointestinal motility, reduce the atrophy of intestinal mucosa, improve the absorption of nutrient substances by the intestinal tract, improve the local immune function of the intestinal tract and relieve inflammatory reaction. And live bacteria, bacterial structural molecules, genomic DNA and the like of the probiotics have the immunoregulation function and certain strain specificity. The probiotic bacteria also can improve imbalance and distribution of intestinal flora, remove endotoxin, mutagen, and carcinogen, reduce blood toxin, and improve symptoms by competitively inhibiting adhesion of pathogenic bacteria.
The short peptide is a compound which is generated by hydrolyzing protein and is formed by connecting 2-10 amino acids by peptide bonds, and has the characteristics of easy absorption and high physiological potency. The data report that the absorption capacity of the organism to the short peptide is stronger than that of common food, the oligopeptide in the short peptide can enter the blood by the peptidase hydrolysis at the brush border of the small intestinal mucosa, the osmotic pressure is relatively low, the side effect of the gastrointestinal tract can be reduced, and the tolerance of a patient to the enteral nutrition preparation is facilitated. The emergency coefficient of severe patients is high, the digestive absorption function compliance is reduced, the short peptide type enteral nutrition preparation can reduce the digestive absorption burden, can provide energy and protein for organisms, and also has the functions of maintaining the digestive tract barrier and preventing intestinal bacteria from shifting.
The invention has the beneficial effects that:
1) the formula of the invention can promote the functional repair of gastrointestinal tract in early stage after the operation of traumatology department, and the planting of beneficial bacteria can avoid the displacement and disorder of intestinal flora; the formulas of the early short-peptide nutrient solution and the later high-protein enteral nutrient solution can promote postoperative wound healing and reduce the incidence of infection; under the condition that the later gastrointestinal function allows, the high-calcium formula can promote the rapid healing of the broken bone end;
2) compared with the prior art, the nutritional food is different from the conventional nutritional food which supports or supplements glutamine and probiotics or probiotics and prebiotics, four substances which can improve immunity and gastrointestinal microenvironment are added in a combined manner, namely glutamine, probiotics and short peptide, the combined formula is carried out according to the nutritional state of diseases, and the scientific property and the practicability are achieved;
3) through the comparison of multiple groups of effects, the effects of the glutamine, the probiotics and the short peptide supplement on the nutritional status, the gastrointestinal tract function and the immunity recovery of different patients are proved, a theoretical basis can be provided for the rapid rehabilitation surgery, and a professional team engaged in enteral nutrition support can be cultured through the project, so that the hospitalization time and the hospitalization cost of the patients are reduced. Has better economical efficiency.
Detailed Description
The following provides specific embodiments to explain the technical solutions and effects of the present invention in detail.
Example 1
An enteral nutrient for patients with critical surgical wounds is characterized by being prepared from the following raw materials in proportion: 65% of short peptide, 16.5% of oryzanol, 16.5% of water-soluble vitamin, 10% of milk calcium, 25% of oligomycin and 15% of whey protein.
Example 2
An enteral nutrient for patients with critical surgical wounds is characterized by being prepared from the following raw materials in proportion: 65% of short peptide, 16.5% of oryzanol and 16.5% of water-soluble vitamin; example 2 was used at this stage of one week post-surgery.
Example 3
An enteral nutrient for patients with critical surgical wounds is characterized by being prepared from the following raw materials in proportion: 12.5 percent of oryzanol, 12.5 percent of water-soluble vitamin, 15 percent of whey protein, 10 percent of milk calcium, 25 percent of incretin and 25 percent of incretin; example 3 is used one week after surgery, in convalescence.
Example 4
Clinical case 1, Bai Yi, Man, 53 years old, 2020, 11 months and 25 days, left lower femoral segment open and comminuted fracture, debridement, fracture reduction, and external bracket adjustment for fixation;
in 12 months and 18 days in 2020, the left humerus upper fracture of general anesthesia is cut and reset by steel plate screws for internal fixation, and the bones of the ilium at both sides are taken and bone grafting is carried out;
the formula in example 3 is applied after the Baizhi operation, the Baizhi is orally taken with warm water of 150ml twice a day, and the clinical nutrition index and the stress index of the Baizhi are recorded, and the record is shown in the following tables 1 and 2:
TABLE 1 clinical Nutrition index I
Figure BDA0003182484880000041
Figure BDA0003182484880000051
TABLE 2 stress index I
Serial number Date C reactive protein Procalcitonin Fasting blood sugar
1 30/11 31.1 0.284 3.97
2 7/12 7.9 1.020 4.13
3 28/12 4.3 0.329 4.04
4 5/1 3.4 0.234 3.76
And (4) analyzing results: as can be seen from tables 1 and 2, after a patient takes the formula of example 3, the vital signs gradually tend to be stable, the body temperature gradually decreases from the postoperative infection state, the respiration and the blood pressure are stable, and the gastrointestinal nausea, vomiting, regurgitation, abdominal distension and diarrhea gradually decrease; the red swelling and the heat pain of the wound disappear gradually after the operation;
and (4) testing indexes: 1) nutritional status index: the total protein, the prealbumin and the albumin are gradually increased, which shows that the effect of repairing gastrointestinal mucosa is better by adding the nutrition in the intestines and only benefiting the grains, and the negative nitrogen balance of the organism is gradually corrected;
2) infection index: the neutrophilic granulocyte, the C-reactive protein and the procalcitonin are gradually reduced, which shows that the nutrient in the formula can effectively control infection and enhance the immunity of the organism;
3) the immunity index is as follows: the absolute value of the lymphocyte is gradually increased, which indicates that the immunologic function of the organism is gradually changed from the severe immunologic function after operation into the normal immunologic function;
4) muscle damage index: the creatine kinase is gradually reduced, which shows that the condition of skeletal muscle injury is gradually improved, and shows that the formula of the invention has better effect of skeletal muscle repair after trauma;
5) the antibiotic time is shortened, and the medical expense is reduced;
6) the wounded skeleton can gradually perform progressive functional exercise, and the bed-lying time is gradually reduced.
Example 5
Clinical case 2, a certain generation, male, car accident caused open pelvic fracture, left femoral shaft fracture, left femoral neck fracture, right radial shaft fracture, traumatic urethral fracture; postoperative weakness, the formula of example 2 was administered twice daily with 150ml of warm water, and the results are reported in tables 3 and 4;
TABLE 3 clinical Nutrition index II
Figure BDA0003182484880000061
TABLE 4 stress indices
Serial number Date C reactive protein Procalcitonin Fasting blood sugar
1 15/5 55.7 2.67 4.15
2 25/5 1.28 2.79 3.88
3 29/5 3.2 0.49 4.04
4 1/6 2.7 0.38 4.27
And (4) analyzing results: as can be seen from tables 3 and 4, after taking the formula of example 2 instead of a certain formula, the vital signs gradually tend to be stable, the body temperature gradually decreases from the postoperative infection state, the respiration and the blood pressure are stable, and the nausea, vomiting, reflux, abdominal distension and diarrhea of the gastrointestinal tract gradually decrease; the red swelling and the heat pain of the wound disappear gradually after the operation;
and (4) testing indexes: 1) nutritional status index: the total protein, the prealbumin and the albumin are gradually increased, which shows that the effect of repairing gastrointestinal mucosa is better by adding the nutrition in the intestines and only benefiting the grains, and the negative nitrogen balance of the organism is gradually corrected;
2) infection index: the neutrophilic granulocyte, the C-reactive protein and the procalcitonin are gradually reduced, which shows that the nutrient in the formula can effectively control infection and enhance the immunity of the organism;
3) the immunity index is as follows: the absolute value of the lymphocyte is gradually increased, which indicates that the immunologic function of the organism is gradually changed from the severe immunologic function after operation into the normal immunologic function;
4) muscle damage index: the creatine kinase is gradually reduced, which shows that the condition of skeletal muscle injury is gradually improved, and shows that the formula of the invention has better effect of skeletal muscle repair after trauma;
5) the antibiotic time is shortened, and the medical expense is reduced.

Claims (6)

1. An enteral nutrient for critically ill patients with surgical wounds is characterized by consisting of the following raw materials: short peptides, oryzanol, water-soluble vitamins, milk calcium, oligomycin, whey protein; the raw materials comprise 65-70% of short peptide, 10-17% of Guwei-Yiwei, 10-17% of water-soluble vitamin, 10-15% of milk calcium, 25-30% of oligomate and 10-15% of whey protein.
2. The enteral nutrient for critically ill patients with surgical trauma according to claim 1, wherein the cereal provides glutamine and probiotics.
3. The enteral nutrient for critically ill patients with surgical wounds, according to claim 1, wherein the water-soluble vitamins include, but are not limited to, vitamin C, vitamins, vitamin B2, vitamin B6, and vitamin B12.
4. The enteral nutrient for critically ill patients with surgical wounds, according to claim 1, wherein the enteral nutrient is composed of 65% of the short peptides, 16.5% of the cereal virucides and 16.5% of water-soluble vitamins.
5. The enteral nutrient for critically ill patients with surgical wounds, according to claim 1, wherein the enteral nutrient is characterized by comprising 12.5% of the cereal fruits, 12.5% of water-soluble vitamins, 15% of whey protein, 10% of milk calcium, 25% of igo, and 25% of igo.
6. An enteral nutrient for critically ill patients with surgical trauma according to any of claims 1 to 5, which has been disclosed for use in the field of nutritional supplementation of critically ill patients with trauma.
CN202110851518.6A 2021-07-27 2021-07-27 Enteral nutrient for critical patients with surgical trauma Withdrawn CN113616772A (en)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111334433A (en) * 2020-03-14 2020-06-26 昆明市延安医院 Method for efficiently collecting microorganisms on surface of freshly picked tea leaves

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111334433A (en) * 2020-03-14 2020-06-26 昆明市延安医院 Method for efficiently collecting microorganisms on surface of freshly picked tea leaves

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