RU2045911C1 - Product for enteral nutrition of patients with high metabolic stress "energoplasten" - Google Patents

Abstract

FIELD: food industry. SUBSTANCE: product involves wt.-% mixture of dairy proteins and/or yolk protein (as an average weight 100%) 15.13-16.79; set of crystalline amino acids valine, isoleucine, leucine, arginine, lysine and methionine 1.37-3.24; carbohydrates 61.68-56.79; fat 16.90-17.78; mineral compounds 0.723-1.285; vitamins 0.030-0.072; perfume 0.05, and water the rest. EFFECT: enhanced effectiveness of product. 56 tbl

Description

 The invention relates to food industry and medicine, and in particular to products of specialized, directed action for the enteral nutrition of patients with high metabolic stress (injuries, burns, sepsis, etc.).

 Known amino acid composition for the treatment of stress and trauma. The composition is used for both parenteral and enteral nutrition of patients with burns and injuries. This amino acid composition improves and accelerates wound healing, increases immune resistance, survival. It includes from 70 to 100% valine, isoleucine and leucine in the proportion A: B: C, where A, B, C, each of them independently has a value from 1 to 2. When using this amino acid composition in enteral nutrition due to incomplete dissolution amino acids apply more concentrated solutions of them.

 Amino acid composition analogue has a number of disadvantages, the main of which are the lack of other nutrients (fat, carbohydrate component, minerals, other amino acids) and, as a result, the imbalance of the composition. This significantly limits its use even for patients under stress.

 Known high-calorie product "Biosorb 1500" (the company "Pfrimmer + Co", Germany), taken orally in the form of a drink or through a tube. Biosorb 1500 is recommended for patients with an increased need for nutrients (for symptoms of infection, sepsis, consumption, burns, tetanus, multiple bone injuries, etc.) Biosorb 1500 is bottled in 500 ml bottles. Shelf life of an open bottle is 24 hours.

 The composition of the product "Biosorb 1500" are given in table. 1.

 The analogue product has a number of disadvantages, one of which is inadequate for this category of patients due to the caloric ratio that does not reflect changes in the metabolic status of these patients (protein 20% carbohydrates 60% fat 20%), and the component composition of the protein component. This, in turn, leads to a weakening of the therapeutic effect, a slowdown in wound repair, a decrease in immune resistance, and an increase in the treatment time. The liquid form of the product indicates a short shelf life of one of the serious drawbacks of products for EDS.

 The purpose of the invention is to enhance the therapeutic effect (accelerate wound repair, increase immune resistance), improve product tolerance, shorten treatment time, increase product adaptability (for patients with burn injuries, sepsis).

 The goal is achieved by the following ratio of components in caloric content (protein 14-17% carbohydrates 45-46% fat 38-40%) and using as a protein component a modified nitrogen source of milk proteins or egg protein, or soy protein, or a combination thereof with additives of crystalline amino acids valine, isoleucine, leucine, arginine, lysine and methionine in the following ratio of components shown in table. 2.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 The components in the product are included in ratios that ensure a balanced intake of all nutrients into the body when using the product as the sole source of nutrition. As a source of fat, vegetable oils are used which are characterized by a high content of unsaturated fatty acids, for example, sunflower, corn, hemp, cottonseed oil, or a combination thereof.

 The use of hydrolyzed corn starch as a source of carbohydrates with a polysaccharide protein ratio of 3.3: 1 4: 1 provides a product with the recommended balance of basic nutrients, which is also one of the factors that increase the biological value of the product.

 The product is prepared by intensively mixing the components with a paddle mixer at a rotation speed of 4000-15000 rpm. The components are mixed in the following sequence: proteins are dissolved in water, then amino acids, hydrolyzed corn starch (molasses), minerals, water-soluble vitamins, flavoring additives are added, then a mixture of fat-soluble vitamins in sunflower and / or hemp and / or cottonseed oil is added.

 The product can be prepared by mixing the components in mixers (reactors) of any design with a rotation frequency of more than 300 rpm, followed by passing through a homogenizer (emulsifier, colloid mill).

 The finished emulsion is spray dried and packaged.

 The essence of the invention is illustrated by the following examples.

 PRI me R 1.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. 3.

 Prepare an emulsion product "EnergoplastEN" with the following ratio of components shown in table. 4.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 5.

 The product is prepared as follows.

 Proteins, amino acids, hydrolyzed starch, syrup, minerals, water-soluble vitamins, flavor additives are successively dissolved in water, a mixture of fat-soluble vitamins in sunflower oil is added. The components are mixed and emulsified by a paddle mixer at a rotation speed of 15,000 rpm.

 The resulting emulsion is dried on a spray dryer and packaged.

Ready-to-use rehydrated product is characterized by moderate viscosity, flows freely through a probe with a diameter of 2-3 mm; highly dispersed. The composition of the product corresponds to changes in the metabolic status of patients with burns and injuries. The energy density of the product is very high 2 kcal / ml, the nitrogen content in 1 l of the mixture is 13.4 g. The ratio of non-protein energy and nitrogen is 124: 1, the ratio of total energy to 1 g of nitrogen is 149: 1. Calorie ratio: protein 16.8% carbohydrates 45% fat 38.2%
The product is fragrant, tastes good.

 PRI me R s 2-3.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. 6.

 The preparation of the emulsion product "EnergoplastEN" is analogous to example 1, except that mineral substances are added in the amounts given in table. 7.

 To obtain the above set of minerals, the following salts are used, are given in table. 8.

 PRI me R s 4-6.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. nine.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. 10.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.25.

 To obtain the above set of minerals use the following salts, are given in table. eleven.

The product is prepared as described in example 1. The energy density of the product is 2 kcal / ml, the nitrogen content in 1 l of the mixture is 14.2 g. The ratio of non-protein energy and nitrogen is 117: 1, the ratio of total energy and 1 g of nitrogen is 141: 1. Calorie ratio: protein 18% carbohydrates 45% fat 31%
The product is fragrant, tastes good.

 PRI me R s 7-9.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. 12.

 Prepare an emulsion product "EnergoplastEN" with the following ratio of components shown in table. thirteen.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals use the following salts, are given in table. 14.

The product is prepared as described in example 1. The energy density of the product is 2 kcal / ml, the nitrogen content in 1 l of the mixture is 13.1 g. The ratio of non-protein energy and nitrogen is 127: 1, the ratio of total energy and 1 g of nitrogen is 153: 1. Calorie ratio: protein 16.4% carbohydrates 45% fat 38.6%
The product is fragrant, tastes good.

 PRI me R s 10-12.

 The composition of the finished product "EnergoplasTEN" (dry form) is given in table. fifteen.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. sixteen.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 17.

The product is prepared as described in example 1. The energy density of the product is 2 kcal / ml, the nitrogen content in 1 l of the mixture is 13.7 g. The ratio of non-protein energy and nitrogen is 119: 1, the ratio of total energy and 1 g of nitrogen is 144: 1. Calorie ratio: protein 17% carbohydrates 45% fat 38%
The product is fragrant, tastes good.

 PRI me R s 13-15.

 The composition of the finished product "ElektroplastEN" (dry form) is given in table. eighteen.

 Prepare an emulsion product "EnergoplastEN" with the following ratio of components shown in table. nineteen.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 20.

The product is prepared as described in example 1. The energy density of the product is 2 kcal / ml, the nitrogen content in 1 l of the mixture is 13.3 g. The ratio of non-protein energy and nitrogen is 125: 1, the ratio of total energy and 1 g of nitrogen is 150: 1. The ratio of calories: protein 16.6% carbohydrates 45.1% fat 38.3%
The product is fragrant, tastes good.

 PRI me R s 16-18.

 The composition of the finished product "EnergoplasTEN" (dry form) is given in table. 21. Prepare an emulsion product "EnegoplasTEN" with the following ratio of components shown in table. 22.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 23.

 The product is prepared as described in example 1, except that the mixing of the components and emulsification is carried out with a paddle mixer at a speed of 4000 rpm.

 The ready-to-use rehydrated product is characterized by moderate viscosity, allowing it to flow freely through a probe with an internal diameter of 2-3 mm.

The composition of the product provides adequate nutritional support for patients with high metabolic stress. The energy density of the product is 1.74 kcal / ml, the nitrogen content in 1 liter of the mixture is 11.2 g. The ratio of non-protein energy and nitrogen is 131: 1, the ratio of total energy and 1 g of nitrogen is 156: 1. Caloricity ratio: protein 16, 1% carbohydrates 45.2% fat 38.7%
The product is easily absorbed, well tolerated, and can be administered to patients, including especially weakened ones, in significant quantities, providing correction of metabolic disorders, accelerating wound repair, increasing immune resistance, and shortening treatment time.

 The product is fragrant, tastes good.

 PRI me R s 19-21.

 The composition of the finished product "EnergoplasTEN" (dry form) is given in table. 24.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. 25.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 26.

The product is prepared as described in examples 16-18. The energy density of the product is 1.76 kcal / ml, the nitrogen content in 1 liter of the mixture is 11.8 g. The ratio of non-protein energy and 1 g of nitrogen is 124: 1, the ratio of total energy and 1 g of nitrogen is 149: 1. Calorie ratio: beams 17% carbohydrates 45% fat 38%
The product is fragrant, tastes good.

 PRI me R s 22-24.

 The composition of the finished product "EnergoplasTEN" (dry form) is given in table. 27.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. 28.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 29.

The product is prepared as described in examples 16-18. The energy density of the product is 1.74 kcal / ml, the nitrogen content in 1 liter of the mixture is 11.0 g. The ratio of non-protein energy and 1 g of nitrogen is 133: 1, the ratio of total energy and 1 g of nitrogen is 158: 1. Calorie ratio: protein 16% carbohydrates 45% fat 39%
The product is fragrant, tastes good.

 PRI me R s 25-27.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. thirty.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. 31.

 To obtain the above set of minerals, the following salts are used, are given in table. 32.

 The product is prepared as described in examples 16-18. The energy density of the product is 1.75 kcal / ml, the nitrogen content in 1 liter of the mixture is 11.5 g. The ratio of non-protein energy and 1 g of nitrogen is 127: 1, the ratio of total energy and 1 g of nitrogen is 152: 1. Calorie ratio: protein 16.5% carbohydrates 45% fat 38.5% The product is aromatic, tastes good.

 PRI me R s 28-30.

 The composition of the finished product "EnergoplasTEN" (dry form) is given in table. 33.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. 34.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 35.

The product is prepared as described in examples 16-18. The energy density of the product is 1.74 kcal / ml, the nitrogen content in 1 liter of the mixture is 11.1 g. The ratio of non-protein energy and 1 g of nitrogen is 132: 1, the ratio of total energy and 1 g of nitrogen is 157: 1. Calorie ratio: protein 16% carbohydrates 45% fat 39%
The product is fragrant, tastes good.

 PRI me R s 31-33.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. 36.

 Prepare an emulsion product "EnergoplastEN" with the following ratio of components shown in table. 37.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 38.

 The product is prepared as described in example 1, except that amino acids, proteins, hydrolyzed starch, syrup, minerals, water-soluble vitamins, flavor additives are sequentially dissolved in the reactor, a mixture of fat-soluble vitamins in sunflower and / or corn, and / or hemp is introduced , and / or soybean and / or cottonseed oil.

The mixture is passed through a homogenizer. The resulting emulsion is dried on a spray dryer. The ready-to-use rehydrated product is characterized by moderate viscosity, which ensures its passage through a probe with an internal diameter of 2-3 mm. The emulsion is highly dispersed, which significantly improves the digestibility of fat. The component composition of the product adequately reflects the characteristics of the metabolism of patients with burns and injuries. The product is characterized by a fairly high energy density of 1.5 kcal / ml, the nitrogen content in 1 liter of the mixture is 8.9 g. The ratio of non-protein energy and 1 g of nitrogen is 142: 1, the ratio of total energy and 1 g of nitrogen is 167: 1. Calorie ratio: protein 15% carbohydrates 46% fat 39%
The product is well absorbed, well tolerated, aromatic, tastes good.

 PRI me R s 34-36.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. 39.

 Prepare an emulsion product "EnergoplastEN" with the following ratio of components shown in table. 40.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 41.

 The product is prepared as described in examples 31-33. The energy density of the product is 1.50 kcal / ml, the nitrogen content in 1 liter of the mixture is 9.4 g. The ratio of non-protein energy and 1 g of nitrogen is 135: 1, the ratio of total energy and 1 g of nitrogen is 160: 1. Calorie ratio: protein 16.0% carbohydrates 45% fat 39% The product is aromatic, tastes good.

 PRI me R s 37-39.

 The composition of the finished product "EnergoplasTEN" (dry form) is given in table. 42.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. 43.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei: 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 44.

 The product is prepared as described in examples 31-33. The energy density of the product is 1.48 kcal / ml, the nitrogen content in 1 liter of the mixture is 8.75 g. The ratio of non-protein energy and 1 g of nitrogen is 145: 1, the ratio of total energy and 1 g of nitrogen is 170: 1. Calorie ratio: protein 15.0% carbohydrates 46% fat 39% The product is aromatic, tastes good.

 PRI me R s 40-42.

 The composition of the finished product "EnergoplasTEN" (dry form) is given in table. 45.

 Prepare an emulsion product "EnergoplasTEN" with the following ratio of components shown in table. 46.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. 47.

The product is prepared as described in examples 31-33. The energy density of the product is 1.49 kcal / ml, the nitrogen content in 1 liter of the mixture is 8.8 g. The ratio of non-protein energy and 1 g of nitrogen is 144: 1, the ratio of total energy and 1 g of nitrogen is 169: 1. Calorie ratio: protein 15% carbohydrates 46% fat 39%
The product is fragrant, tastes good.

 PRI me R 43-45.

 The composition of the finished product "EnergoplastEN" (dry form) is given in table. 48.

 Prepare an emulsion product "EnergoplastEN" with the following ratio of components shown in table. 49.

 The branched chain amino acid mixture (ARC) added contains the amino acids valine, isoleucine, leucine in the following proportions: Val Iso Lei = 6.25: 5: 8.75.

 To obtain the above set of minerals, the following salts are used, are given in table. fifty.

 The product is prepared as described in examples 31-33. The energy density of the product is 1.48 kcal / ml, the nitrogen content in 1 liter of the mixture is 8.7 g. The ratio of non-protein energy and 1 g of nitrogen is 146: 1, the ratio of total energy and 1 g of nitrogen is 171: 1. Calorie ratio: protein 15.0% carbohydrates 46% fat 39% The product is aromatic, tastes good.

 PRI me R 46.

 Patient P. was admitted with a clinic of traumatic and hemotragic shock of II-III art with a diagnosis of open comminuted fracture of the right femur, fracture of the pelvic bones without displacement.

 Upon admission, anti-shock measures were taken, blood and plasma substitute transfusions, hemodynamic drugs (polyglucin, gelatinol). An out-of-focal compression-distant osteosynthesis of the right femur was performed using the Ilizarov apparatus. The previous period went smoothly, but on the 7th day the body temperature sharply increased, purulent discharge appeared in the area of two spokes, which were removed. Subsequently, the pain in the thigh intensified, swelling, inflammatory infiltration began to increase, and high hyperthermia (geotic fever) persisted. Ilizarov’s apparatus has been removed. A skeletal traction behind the muscle of the right thigh on the Beler tire was established, and massive antibacterial anti-inflammatory infusion detoxification therapy was carried out. In connection with the formation of an osteomilic ulcer 3 weeks after admission, the abscess was opened. Intensive therapy continued, but the dynamics of the local picture did not improve, purulent-resorptive fever, septic state persisted. The nutritional status of the patient progressively worsened, anorexia, progressive decrease in body weight from 68 kg when entering to 60 kg a month after admission were noted.

Some indicators of nutritional status at the 4th week from the moment of admission: Height, cm 170 Weight, kg 60 OD, cm 18 TKSP, mm 4 Total protein, g / l 58 Serum albumin, g / l 38 Serum transferrin, g / l 1 5 Nitrogen balance, g / day 6
The blood aminogram was characterized by a marked decrease in the level of branched chain amino acids (ARC) and sulfur-containing, as well as amino acids arginine, lysine, alanine, as well as an increase in the level of glycine, aromatic amino acids, glutamate and aspartate.

 Given the presence of severe protein-energy deficiency in the presence of anorexia, it was decided to include enteric support in the complex of therapeutic measures.

 A nasogastric tube was installed and the introduction of the specialized nutritional product EnergoplastEN intended for patients with high metabolic stress (high metabolic rate) was started.

 The nutritional support scheme (forced start mode), given the preservation of the gastrointestinal function, examples 25-27, are given in table. 51.

 Nutritional support was carried out for two weeks, then the patient switched to the oral administration of the product, as an addition to the required diet, receiving up to 1 liter of product per day (1750 kcal).

 Results.

1. Changes in nutritional status: Weight, kg 64 OD, cm 21 TKSP, mm 6 Total protein, g / l 70 Serum albumin, g / l 38 Serum transferrin, g / l 1.8
The nitrogen balance became positive by the fourth day and in the following days remained at the level of (+4) - (+ 6) g / day.

 2. According to the blood aminogram, the content of all amino acids in the blood plasma increased, especially ARC, arginine, lysine, sulfur containing with equalization of the amino acid profile.

 3. Clinical data.

 Active regression of the inflammatory process, a decrease in edema, normalization of body temperature, the appearance of appetite, and normalization of the psychoemotional background were noted.

 Blood biochemical parameters have improved, including indicators that determine the immunological background. The active formation of the primary bone model, the improvement of the effectiveness of specific antibacterial, anti-inflammatory therapy in parallel was noted.

 PRI me R 47. Patient K., 48 years old, was admitted to the clinic with an extensive thermal burn of II-III-a III-b degree with a total area of 45% of the body area. Anti-shock measures, anesthesia, primary treatment of burn surfaces, massive transfusion therapy were carried out.

 In the following days, intoxication and associated cardiovascular and pulmonary insufficiency increased. From the third day, due to the vastness of the lesion and the absorption of decay products in the burn area, fever began to build up. Due to the high loss of protein and plasma through burn surfaces, a progressive increase in protein-energy deficiency was noted. This was greatly facilitated by the development of severe anorexia. The possibilities of parenteral correction of nutritional status were limited due to lack of funds and complications (drug intolerance, allergic reactions, congestion of the pulmonary circulation, etc.). In this regard, it was decided to start enteral nutritional support. Given the intolerance of high water loads, it was decided to use the emulsion product "Energoplast-EN" with a high energy density (2 kcal / ml), examples N 4-6, table. 52.

Thus, by the 5th day, the patient received 5,000 kcal per day, 210 g of protein (100%) with the introduction of 2.5 L of EnergoplastEN product, which did not lead to overhydration. During the nutritional support carried out for 15 days, no dyspeptic disorders were noted, nutrition tolerance was satisfactory. Signs of anorexia decreased, and therefore the nutritional probe was removed 16 days after the start of nutritional support, and the patient was transferred to normal nutrition with a gradual decrease in the proportion of enteral product in the daily diet. It should be noted that when using standard standard enteric products with an energy density of 1 kcal / ml on average, to ensure the necessary daily calorie content and protein would require the introduction of an average of 5 l of solution per day, which would be impossible due to the following reasons:
water overload of the digestive tract with the development of dyspeptic disorders, regurgitation, intestinal colic, flatulence and diarrhea;
overload of the cardiovascular system of the pulmonary circulation, lungs and kidneys;
technical difficulties in administering such a volume of liquids, while the necessary rate of administration would be 200-220 ml / h with round-the-clock administration, which is virtually unbearable to patients.

 The results of nutritional support of the dynamics of nutritional status are given in table. 53.

 Correction of nutritional status was combined with a general clinical improvement (faster epithelization than usual of sites with a superficial burn to the III degree, active granulation of deep burn surfaces with earlier preparation and the possibility of skin autotransplantation, better compressibility of the grafts).

 By 5-6 days of nutritional deficiency, hepatic indices and a number of other biochemical parameters returned to normal, signs of multiple organ failure were stopped, the nitrogen balance corresponding to the 3rd degree of negativity (-10 g / day) before nutritional support by 4 days became positive (+2 g / day) and in the following days remained at the level of (+6) - (+ 8) g / day.

 The enhancement of endogenous protein synthesis, noted clinically and according to biochemical research methods, seems to have been largely due to the correction of the aminogram, which consists in increasing the total amino acid content, in restoring the level of branched chain amino acids, arginine, lysine, and sulfur-containing ones.

 The patient determined the levels of 16 amino acids before nutritional support and at the time of the end of nutrition, table 54.

 PRI me R 48. Patient S. 42 years old was admitted to the department with a diagnosis of putrefactive phlegmon of the pelvis. Upon admission, a wide opening of the cellular spaces was made, a massive antibacterial, anti-inflammatory detoxification therapy was started. Despite the ongoing intensive care, there was a spread of purulent-putrefactive process on the anterior abdominal wall, lumbar region, about which repeated widespread incisions were undertaken. Geotic fever persisted. When examining blood for sterility, Staphylococcus aureus was seeded. Diagnosed with sepsis, septicopyemia. Antibacterial therapy was strengthened, comprehensive corrective, detoxification therapy, and local treatment continued. The inflammatory process was somewhat stabilized, but fever persisted. Due to the development of anorexia against the background of a general severe state and enormous protein-energy, water-electrolyte disorders and vitamin deficiency, the development of severe nutritional deficiency and a decrease in immunocompetence (according to skin immunological tests with antibodies, immunoglobulin studies) were noted.

 In order to correct nutritional status, increase immune resistance, accelerate reparative processes in tissues, enhance the healing process, enteral nutrition with the product "EnergoplastEN" is included in the complex of therapeutic measures (example 1).

 A nasogastric feeding probe was installed (D = 3 mm) and dosed introduction of the EnergoplastEN liquid product with the help of a metering pump was started.

 The nutritional support scheme is given in table. 55.

 From day 14, the patient is fully transferred to normal nutrition.

 The results of changes in nutritional status are given in table. 56.

 Undoubtedly, when intensive enteral support was included in the complex of medical measures, a radical fracture occurred during the clinical picture of the disease and the wound process.

 Most importantly, the ongoing changes in the nutritional status, adequate provision of the body with highly assimilable energy-plastic material dramatically enhance the specific, anti-inflammatory therapy.

 By the end of the first week from the start of nutritional support, purulent discharge from the wounds ceased, perifocal edema decreased, and granulation tissue appeared in the wounds. In repeated blood cultures for sterility at 6 and 9 days from the start of nutritional support, pathogenic staphylococcus was not noted.

 A week after the moment of nutritional support, in parallel with the improvement of the local picture from the side of the wounds, body temperature returned to normal. There were no adverse reactions from the digestive tract, no signs of intolerance to the product.

 From the examples it follows that the emulsion product "EnergoplastEN" for enteral artificial nutrition of patients with high metabolic stress has a high energy density (up to 2 kcal / ml), which allows you to enter an adequate amount of energy-plastic material for this category of patients in a small amount of product; the source and level of α-amino nitrogen most fully (compared with analogues) reflect the specific changes in protein-amino acid metabolism and the needs of this group of patients.

 The protein component of the product is designed in such a way that the amino acid content of valine, isoleucine, leucine, arginine, lysine, methionine is increased, which is due to the peculiar metabolic pathways of this group of patients.

 For the used high amount of protein, the product contains an adequate amount of energy carriers, the ratio of non-protein energy and nitrogen is 117-146: 1, total energy and nitrogen is 141-171: 1, which determines the most complete assimilation of α-amino nitrogen.

 The source of carbohydrates is partially hydrolyzed corn starch or low-sugar molasses, and the source of fat is one of the vegetable oils (corn and / or sunflower, and / or cottonseed and / or soya), which fully provides the patient with essential fatty acids and fat-soluble vitamins in accordance with the needs of this group sick.

 The product is balanced by basic nutrients (carbohydrate: protein: fat ratio = 2.8: 1: 2.4) for this category of patients.

 Ready-to-use rehydrated product is characterized by moderate viscosity, high dispersion, which allows the use of nutrient probes with a small diameter of 2-3 mm for product introduction.

 An important point is the use of various flavoring additives that make the product taste good and its oral administration is possible.

 The proposed product "EnergoplastEN" is metabolically adapted to all the necessary macro- and microelements, vitamins. Their content fully meets the daily requirements of patients with a high level of metabolism and does not require parenteral supplementation.

 A ready-to-use rehydrated product has moderate osmoticity for this class of drugs, which, given the observance of the technical and methodological methods of administration, minimizes side effects from the gastrointestinal tract and improves tolerance.

 The use of the product gives a great clinical effect, will accelerate the recovery of the most severe category of patients, the number of which is growing steadily. The proposed product "EnergoplastEN" has great medical and social significance, especially in conditions of mass destruction of the population (in conditions of natural disasters and military operations).

 The use of the product will give a large technical and economic effect due to the saving of currency, reducing the cost of treatment.

Claims (1)

 A product for the enteral nutrition of patients with high metabolic stress, containing a source of protein nitrogen, carbohydrates, fat, minerals, vitamins and water, characterized in that it additionally contains flavoring, and a mixture of milk proteins and / or egg protein is used as a source of protein nitrogen (in terms of rv 100%) and a set of crystalline amino acids: valine, isoleucine, leucine, arginine, lysine and methionine in the following ratio of components, wt. Milk proteins and / or egg white (in terms of rv 100%) 15.13 - 16.79
A set of crystalline amino acids: valine, isoleucine, leucine, arginine, lysine, methionine 1.37 3.24
Carbohydrates 61.68 56.79
Fat 16.90 17.78
Minerals 0.723 1.285
Vitamins 0.030 0.072
Flavor 0.05
Water Else

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