CN1167358C - 治疗压迫溃疡的营养组合物 - Google Patents

治疗压迫溃疡的营养组合物 Download PDF

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CN1167358C
CN1167358C CNB998008508A CN99800850A CN1167358C CN 1167358 C CN1167358 C CN 1167358C CN B998008508 A CNB998008508 A CN B998008508A CN 99800850 A CN99800850 A CN 99800850A CN 1167358 C CN1167358 C CN 1167358C
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玛丽亚·安那·费尔霍伊尔－科特
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昌塔尔·内勒克·克洛伊尔
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罗伯特·约翰·约瑟夫·哈格曼
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鲁洛夫·安德烈·博克
莫尔德·格塔尔斯
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Abstract

本发明公开了一种适用于治疗压迫溃疡的营养辅助组合物，其含有蛋白质、碳水化合物和脂肪，且其日剂量中含有：3-15克精氨酸或其等同物，180-840毫克抗坏血酸等同物，50-400毫克α-生育酚等同物，且还含有：0.8-16毫克类胡萝卜素、无机物和/或8-40毫克黄酮类化合物，所述无机物添加量为：钠120-2400毫克、氯化物180-2000毫克、钾200-2000毫克、钙300-1500毫克、磷200-1400毫克以及镁80-600毫克。该组合物日剂量中还可含有8-80毫克锌，以及一些其它化合物。

Description

治疗压迫溃疡的营养组合物
技术领域
本发明涉及一种适于治疗及防止压迫溃疡的营养组合物。
背景技术
压迫溃疡(褥疮)较经常发生，特别是在那些不得不长期卧床的外科病人和不能运动的人，如部分老年人中。人体的一些部位，例如肘、足跟、髋部、尾骨、肩胛骨会受到身体重量的压力作用。严重的压迫溃疡可分为几个阶段：第一阶段，压力和剪切力引起了皮下组织的收缩、毛细管和淋巴管的闭塞以及在深组织层形成较差的血管分布。长期的压力引起皮肤表层组织的损伤，从而减少了表皮细胞的生成并使皮肤变薄，皮肤的血管受到损害并使皮肤发红；第二阶段，基膜从表皮脱落，引起水肿和水疱；第三阶段，表皮损坏更严重，并影响了皮肤表层；下一阶段，在皮肤表面可观察到深组织层的坏死。由于外科手术后的营养不充分、营养不良、伤口组分的损失、不能运动、体质虚弱或其它障碍，通常导致褥疮病人的营养条件差。
防止和治愈压迫溃疡首先需要改善伤口面的外部因素，如减少压力、摩擦和剪切力、湿度和温度。
EP-A-564804中公开了一种通过使用锌、维生素A和C、硒、β-胡萝卜素和硫胺素促进伤口愈合的方法。可使用含62.5克/升(25能量％)蛋白质、34克/升(30能量％)脂肪和113克/升(45能量％)碳水化合物的液体组合物。该组合物也可含有其它维生素和痕量元素。在这种改善伤口愈合所需条件下提及了压迫溃疡。
EP-A-367724公开了每单位剂量(1.5升)中含3-40克(18.75克)精氨酸、0.1-4克(1.9克)RNA、0.1-20克(3克)ω-3多不饱和脂肪酸(pufa’s)的免疫刺激组合物，其中ω-3多不饱和脂肪酸含1-2克EPA、0.25-1克DHA和0.1-20克(3.6克)ω-6不饱和脂肪酸(亚油酸)。该组合物含22能量％的蛋白质、28能量％的脂肪和53能量％的碳水化合物。在这种免疫刺激组合物的适用情况中并没有提及压迫溃疡。
US5,053,387公开了一种治疗外伤的组合物，该组合物含有精氨酸(1-3能量％)、完整蛋白质(20-30能量％)、脂肪(7-15能量％，含ω-6/ω-3比率约1.5的EPA和亚油酸)和碳水化合物(65-70能量％)，还含有锌、维生素A和维生素C。
在WO 93/16595中公开了一种含精氨酸的液体营养组合物，可用于外伤和外科病人，但不包括压迫溃疡病人。该组合物含有20能量％的蛋白质、24能量％脂肪和56能量％的碳水化合物。精氨酸提供了能量的1-3能量％。亚油酸与α-亚油酸的比率介于3.5-5.5。热量密度为1.2-1.5千卡/毫升，卡(路里)对氮的比率介于112-145。组合物还含有1-2倍于推荐日用量的维生素和痕量元素。
WO 96/08966公开了一种通过一氧化氮(NO)型化合物加速伤口愈合的方法，该方法包括摄入NO型加速化合物如亚硝基化胺、有机抗氧剂如维生素C和E以及其它组分如止痛剂。在该文献中并未提到压迫溃疡和营养组合物。
发明内容
现已发现能有效抗压迫溃疡的组合物应含有一组营养素，这些营养素不仅可促进伤口愈合，还能在前述阶段中改善血液循环并控制炎症。这种有效组合物，当以液体形式存在时，应含有精氨酸(3-15克/升，优选5-10克/升)、维生素C(3-14倍于推荐日剂量，RDA)、维生素E(5-40倍于RDA)，并优选含有至少8毫克/升或/天的锌，并具有适当锌/铜比率。进一步改进的组合物还含有增加剂量的类胡萝卜素、无机物(Na、K、Cl)和/或黄酮类化合物(8-40毫克/升)。具体地说，本发明提供一种适用于治疗压迫溃疡的营养辅助组合物，其含有蛋白质、碳水化合物和脂肪，且其日剂量中含有：3-15克精氨酸或其等同物，180-840毫克抗坏血酸等同物，50-400毫克α-生育酚等同物，且还含有：0.8-16毫克类胡萝卜素、无机物和/或8-40毫克黄酮类化合物，所述无机物添加量为：钠120-2400毫克、氯化物180-2000毫克、钾200-2000毫克、钙300-1500毫克、磷200-1400毫克以及镁80-600毫克。
具体实施方式
本发明组合物中所用的精氨酸可为游离氨基酸形式，或为富含精氨酸的肽或蛋白质如豌豆蛋白质，或为精氨酸的代谢物等同物如鸟尿酸或瓜氨酸形式。精氨酸的用量为3-15克/天，优选5-10克/天。
此处所述的维生素C的级别为抗坏血酸等同物，可含有维生素C(抗坏血酸)和可在体内转化为抗坏血酸的化合物，如脱氢抗坏血酸、坏血酸棕榈酸酯和其它抗坏血酸酯。抗坏血酸等同物的用量从180毫克/天或200毫克/天高达至840毫克/天或更多。优选的范围为300-780毫克/天，更优选350-700毫克/天。
此处所述的维生素E的级别为生育酚等同物，可含有α-生育酚及其等同物。因此，1毫克α-生育酚等同物(TE)(＝1.5IU的维生素E)对应于1毫克D-α-生育酚、2.0毫克D-β-生育酚、10毫克D-γ-生育酚、30毫克D-δ-生育酚、2毫克D-α-生育三烯酚或18.6毫克D-β-生育三烯酚。生育酚等同物的用量为50-400毫克/天。优选最小用量为100毫克/天，更优选为120毫克/天，特别优选为180毫克/天，优选的最高限度为320毫克/天，更优选250毫克/天。
上述组合物的效力还可通过添加黄酮类化合物而提高，例如8-40毫克/天，特别是10-30毫克/天。根据本发明，黄酮类化合物可理解为含有具有黄酮结构(2-苯基-色酮＝2-苯基-苯并吡喃酮)的羟基取代的化合物及其异构体，如异黄酮类(3-苯基色酮类)、查耳酮类(2-肉桂酰-苯酚类)和奥弄类(2-次苯甲基-苯并呋喃酮)。黄酮类化合物中也可含花色素(由于吡喃鎓部分代替了吡喃酮部分，因此其不同于黄酮)。在天然化合物中，如花色素类(＝糖基化花色素类)和糖基化黄酮醇类，黄酮类化合物的羟基官能团优选为部分烷基化或糖基化。这些黄酮类化合物中，优选黄酮醇，特别优选黄酮四醇和更高级羟基化的类似物，如山奈酚、栎精和杨梅酮(myrecitin)，并优选甲基化类似物，如华报春花苷(sinensetin)、柑桔黄酮和川皮苷，以及糖甙如芸香甙和杨梅甙。这些异黄酮类化合物中，黄豆甙原和金雀异黄素是优选的化合物。花色素类化合物中，优选芍药素、花色素、花葵素、翠雀次碱、3’-甲花翠素和缬胆碱(valvidin)。黄烷酮(＝2，3-二氢黄酮类)如橙皮素和柚皮甙是其它优选的黄酮类化合物。使用黄酮类的混合物，如天然植物的抽提物或植物(如柑橘属果树、茶叶、葡萄)抽提物的混合物是有利的。优选本发明的黄酮类化合物分别含有至少40％黄酮醇类和至少10％花色素类，更优选分别含有至少60％和至少15％。优选不含有如儿茶素、原花色素(proanthocyanidins)和其它鞣酸，即小于黄酮类化合物总量的3％。
本发明组合物的目的在于改善血液循环，加快愈合并增强免疫力，补偿疾病期间损失的营养组分。该组合物还稳定了细胞膜对抗意外的攻击。除了生育酚和抗坏血酸盐，谷胱甘肽和NADPH也可增强该功能，谷胱甘肽和NADPH可通过注入蛋氨酸、辅因子和能量(碳水化合物)而得到。
另外优选的化合物为维生素B6(吡哆醛)、B12(氰钴胺)和叶酸，每种含量均为约推荐的平均日摄入量(如RDA)的三倍。维生素B1(硫胺素)和B2(核黄素)、铜、锌和锰分别优选为两倍于RDA的量添加。锌和铜的比率优选为7-14，特别是8-11。铁、钴、碘、铬、硒、氟、钼和泛酸、维生素A(以维生素A等同物，RE)、维生素D、维生素K、烟酸(以烟酸等同物NE)、维生素H和肌醇分别优选以0.5-4倍于，特别是两倍于RDA值的量添加。无机物优选按下述数值添加(每日用量)：钠200-1200毫克、氯化物240-1400毫克、钾500-1800毫克、钙500-1000毫克、磷400-900毫克以及镁150-400毫克。
类胡萝卜素(为达到本发明的目的，包括植物黄质和叶黄素)优选以0.8-16毫克/天，优选1-6毫克/天添加。类胡萝卜素以天然形式使用较有利，如从植物如西红柿、胡椒、金盏花和油棕的果实的抽提物中得到的。优选将这种抽提物混合，且该混合物可含有如黄体素(20-60％)、番茄红素(1-30％)、α-胡萝卜素(5-25％)、β-胡萝卜素(5-40％)、隐黄质(1-15％)和玉米黄质(1-15％)。
胆碱或其代谢等同物如甜菜碱或磷脂酰胆碱优选以20-3000毫克/天添加，其可含有如1克或更多的磷脂酰胆碱。肉毒碱、肌酸和牛磺酸可分别以每天10-100毫克、100-1000毫克和10-100毫克存在。
作为本发明的组合物的一个具体例子，可以含有50-100克/升蛋白质，60-180克/升碳水化合物和20-40克/升脂肪，该脂肪含有0.05-0.5克/升DHA。ω-3系列的长链不饱和脂肪酸的，特别是EPA和DHA的存在也是有利的。EPA和DHA的总量介于0.1-1.0克/天是有利的。长链不饱和脂肪酸中ω-6/ω-3的比率介于1-6，优选介于2-5。也可含有亚油酸(ω-6)，优选为至少0.1克/天。
本发明组合物其它有利的组分为食用纤维质，其可包括可溶性非淀粉多糖如阿拉伯胶或果胶；不溶性非淀粉多糖如纤维素、半纤维素和木素；低聚糖如菊粉或半乳低聚糖和/或稳定的淀粉。优选食用纤维质的用量为3-20克/天或3-120克/升。
碳水化合物、调味品和酵母抽提物还可增强所述组合物的营养和感官性。产物优选以避免氧气和光，特别是紫外线的形式，以100-1000毫升为单位进行封装。较小的剂量适用作食品添加剂，而较大的剂量适用作完全食物如肠内应用。
重要组分精氨酸、维生素C和维生素E的量也可以单位能量含量(1000千卡)或单位体积(1升)定义。相似的定义可给予优选的组分，如黄酮类化合物(16-60毫克/1000千卡，16-80毫克/升)，类胡萝卜素(1.6-20毫克/1000千卡，1.6-24毫克/升)、锌(18-60毫克/1000千卡，18-75毫克/升)和铜(2.5-10毫克/1000千卡，2.5-12毫克/升)。
本发明的组合物在其日剂量中还可以含有选自于0.8-5克(优选1-3克)蛋氨酸，0.4-1.2毫克叶酸，4-10毫克维生素B6和2-20微克维生素B12中的至少一种。
本发明的组合物每1000毫升中还可以含有选自于0.2-1.5毫克维生素A1等同物，8-20毫克维生素D，2-5毫克维生素B1，1.7-5毫克维生素B2，80-200毫克胆碱等同物，6-24毫克泛酸，50-500微克维生素H，4-20毫克锰，5-20毫克铁和70-140微克硒中的至少一种。
本发明的组合物可以每1000千卡能量含有：6-18克精氨酸，400-1500毫克抗坏血酸等同物、100-500毫克α-生育酚等同物和18-60毫克锌。
本发明的组合物可以每升含有：6-20克精氨酸，400-1800毫克抗坏血酸等同物、100-600毫克α-生育酚等同物和18-75毫克锌。
本发明的组合物每毫升含有0.9-1.3千卡的能量，即含有0.9-1.3千卡/毫升的能量。
综上所述，表1列出了组合物的推荐和优选的范围，以及可以液体组合物形式使用的配方的实施例，该组合物可提供每天最小需求的营养物质的总量，并可用所需的能量进行补充。
                                    表1
营养素 单位 推荐日用量*  用量范围(每天) 优选用量范围(每天)   实施例II饮用辅助组合物(400毫升/天)     实施例I管饲法辅助组合物(1升/天)
    能量 千卡     300-1300     500     1000
   蛋白质碳水化合物脂肪  克克克     25-9040-1605-36     405614     6412627
   精氨酸蛋氨酸抗坏血酸生育酚(TE)黄酮类化合物  克克毫克毫克毫克 50-608-10  3-150.8-5180-84050-4008-40     5-101-3300-70080-25010-30     60.950020023 1.853020023
维生素A(RE)维生素B1维生素B2维生素B6维生素B12维生素D叶酸泛酸维生素H维生素K1烟酸(NE)肉碱肌醇月桂精胆碱(等同物)类胡萝卜素镁锌铁铜钴锰碘硒铬钼氟化物氯化物钠钾钙磷 微克毫克毫克毫克微克微克微克毫克微克微克毫克毫克毫克毫克毫克毫克毫克毫克毫克毫克微克毫克微克微克微克微克毫克毫克毫克毫克毫克毫克   800-10001.1-1.51.3-1.81.4-225-10150-2004-730-10045-8012-20270-40012-1510-151-32-515040-7050-20075-2501.5-4800-1200800-1200  200-15001-91-104-252-1001-40300-20004-4040-80020-2406-8010-10010-2504-10020-30000.8-1680-6008-805-601-120-101-3025-50035-30010-10035-3000.5-16180-2000120-2400200-2000300-1500200-1400     400-12002-51.7-55-102.5-208-20400-12006-2450-50050-12035-7510-4020-2508-4080-10001-8150-40014-455-202-101-62-2050-25050-25015-7540-2000.5-2.5240-1500200-1200500-1800500-1000400-900     5003.03.06.03.010600876565115501510041602283.038.010010033800.6350250800820720     9003.63.76.84.2136801013660641550151000436036143.939.8160126541602.0130010001500650500
*标准推荐日用量，如RDA
实施例I
在一罐中将表1中所列的成分混合，其用量为表1中最后一列所示量的1000倍。用本领域已知的方法均匀化，并使总体积达到1000升。混合物封装在500毫升瓶中，用作管饲法。
实施例II
在一罐中将表1中所列的成分混合，其用量为表1中第6列所示量的1000倍。用本领域已知的方法均匀化，并使总体积达到400升。将混合物封装在200毫升纸盒中。
实施例III
将下列成分：钠600克、氯化物900克、生育酚150克、胆碱800克，不加黄酮类化合物和类胡萝卜素，以及其它组分按表1中第6列所示量的1000倍进行混合，并如实施例II中所述进行封装。产物为白色的饮品，特别适用于在损失大量无机物后，如在慢性开口伤口的情况下治疗褥疮。

Claims (15)

1、一种适用于治疗压迫溃疡的营养辅助组合物，其含有蛋白质、碳水化合物和脂肪，且其日剂量中含有：3-15克精氨酸或其等同物，180-840毫克抗坏血酸等同物，50-400毫克α-生育酚等同物，且还含有：0.8-16毫克类胡萝卜素、无机物和/或8-40毫克黄酮类化合物，所述无机物添加量为：钠120-2400毫克、氯化物180-2000毫克、钾200-2000毫克、钙300-1500毫克、磷200-1400毫克以及镁80-600毫克。
2、如权利要求1所述的组合物，其日剂量中含有5-10毫克精氨酸或其等同物。
3、如权利要求1所述的组合物，其日剂量中含有300-700毫克抗坏血酸等同物。
4、如权利要求1所述的组合物，其日剂量中含有80-250毫克生育酚等同物。
5、如权利要求1所述的组合物，其日剂量中还含有14-45毫克锌。
6、如权利要求1所述的组合物，其日剂量含有10-30毫克的黄酮类化合物。
7、如权利要求1所述的组合物，其日剂量中还含有14-45毫克锌，和2-10毫克铜，其中锌和铜的比率为7-14。
8、如权利要求1所述的组合物，其中类胡萝卜素含有20-60％的黄体素、1-30％的番茄红素、5-25％的α-胡萝卜素、5-40％的β-胡萝卜素、1-15％的隐黄质和1-15％的玉米黄质。
9、如权利要求1所述的组合物，其日剂量中还含有选自于0.8-5克蛋氨酸，0.3-2毫克叶酸，4-25毫克维生素B6和2-100微克维生素B12的至少一种。
10、如权利要求1所述的组合物，其每1000毫升中还含有选自于0.2-1.5毫克维生素A1等同物，8-20毫克维生素D，2-5毫克维生素B1，1.7-5毫克维生素B2，80-200毫克胆碱等同物，6-24毫克泛酸，50-500微克维生素H，4-20毫克锰，5-20毫克铁和70-140微克硒中的至少一种。
11、如权利要求1所述的组合物，其中所述无机物添加量为：钠200-1200毫克、氯化物240-1400毫克、钾500-1800毫克、钙500-1000毫克、磷400-900毫克以及镁150-400毫克。
12、如权利要求1所述的组合物，含有50-100克/升蛋白质，60-180克/升碳水化合物和20-40克/升脂肪，该脂肪含有0.05-0.5克/升DHA，且其ω-6/ω-3比率为2-5。
13、如权利要求1所述的组合物，其每1000千卡能量含有：6-18克精氨酸，400-1500毫克抗坏血酸等同物、100-500毫克α-生育酚等同物和18-60毫克锌。
14、如权利要求1所述的组合物，其每升含有：6-20克精氨酸、400-1800毫克抗坏血酸等同物、100-600毫克α-生育酚等同物和18-75毫克锌。
15、如权利要求1所述的组合物，其含有0.9-1.3千卡/毫升的能量。
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NO20000128D0 (no) 2000-01-10
HUP0003265A2 (hu) 2001-02-28
ES2369970T3 (es) 2011-12-09
PT2277394E (pt) 2014-07-11
EP0960572A1 (en) 1999-12-01
HU229066B1 (en) 2013-07-29
EP1018896B1 (en) 2011-07-20
NZ502235A (en) 2001-11-30
US20050136129A1 (en) 2005-06-23
CN1272043A (zh) 2000-11-01
HUP0003265A3 (en) 2001-03-28
EP2277394B1 (en) 2014-04-23
US7695732B2 (en) 2010-04-13
CA2296669A1 (en) 1999-11-18
NO20000128L (no) 2000-03-09
AU3960499A (en) 1999-11-29
NO318672B1 (no) 2005-04-25
JP2002514574A (ja) 2002-05-21
ID24710A (id) 2000-08-03
US8163303B2 (en) 2012-04-24
US20080020062A1 (en) 2008-01-24
US6846494B1 (en) 2005-01-25
EP1018896A1 (en) 2000-07-19
PT1018896E (pt) 2011-10-13
WO1999058000A1 (en) 1999-11-18
PL194179B1 (pl) 2007-05-31
CZ292240B6 (cs) 2003-08-13
TR200000077T1 (tr) 2000-11-21
ATE516715T1 (de) 2011-08-15
EP2277394A1 (en) 2011-01-26
AU753543B2 (en) 2002-10-24
CA2296669C (en) 2009-01-27
BR9906438A (pt) 2000-07-11
CZ2000108A3 (cs) 2000-12-13

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