SU1479055A1 - Method of producing nutritive mixture for intraintestinal tube feeding - Google Patents

Abstract

The invention relates to nutrition, namely to the production of nutritional mixtures for intraintestinal feeding of surgical patients in the postoperative period. The purpose of the invention is to reduce the cost of the mixture and increase the nutritional properties and absorption. The method of obtaining the nutrient mixture involves mixing the egg product, salt, fatty and protein components, the carbohydrate component, which is starch and distilled water, and is characterized by the fact that, when preparing the mixture, carbohydrate components are also added to it. and oatmeal, as a protein component - sunflower oil, and from the egg product - egg powder. The resulting mixture is heated, homogenized and subjected to enzymatic hydrolysis with pancreatin under optimal conditions of the enzyme, which is administered from the calculation of trypsin activity of 25-27 units. PA for 1-1.2 ml of the mixture, the process is carried out until 40-42% of amino nitrogen is accumulated in the medium, the ratio of true protein and total amino nitrogen is set at 2: 1.1-2: 1.3, the content of reducing substances is 20-25% with subsequent thermal inactivation of the enzyme, while the components are introduced into the mixture in the following ratio, g / l: boiled beef s with 155-175

blackberry 35-40

reconstituted cream 115-120

egg powder 40-50

block mashed potatoes 50-80

starch 4-9

Cooking salt 2-3, distilled water to 1 l. 6 tab.

Description

The invention relates to nutrition, namely to the production of nutritional mixtures for intraintestinal feeding of surgical patients in the postoperative period.

The purpose of the invention is to reduce the cost of the mixture and increase the nutritional properties and absorption.

According to the proposed method, the production of a nutrient mixture is reduced to barely

The following scheme: preparation of raw materials (inspection, cleaning, boiling), processing of meat (deboning, trimming, boiling, grinding), mixing the components of the proposed mixture, wiping, homogenizing, hydrolysis with pancreatinum, drying and grinding. Dry cream, egg powder, oatmeal, potato starch are inspected, cream is mixed with egg powder and reconstituted with warm water and brought to a boil with constant stirring. Potato starch in pasteurized form is passed for mixing. The prepared blocks are boiled soft and rubbed. M with cut into a piece, and cook t until cooked and crushed. The prepared raw material is thoroughly mixed in a mixing machine, with sunflower oil, adding the required amount of water, brought to a boil and transferred to homogenization under a pressure of 10-15 P. After homogenization, the mixture is transferred to a fermenter, heated to 37 ° C, added with constant stirring. Pancreatin, previously diluted in water in the amount of 1 mg / ml of the mixture, is hydrolyzed for 40-50 minutes with constant stirring, which provides a hydrolysis depth of nutrient smaga that satisfies the physiological possibilities of the intestine according to nutrient substrates due to an optimal ratio of poly-, oligo- and monomers of nutrients (similar to that observed in the chyme of the small intestine in natural digestive conditions). Upon expiration

the time of hydrolysis, the mixture is heated to 80 ° C to inactivate pakreatin and transfer to drying.

To prepare such a mixture

Erute the following composition of food products, g / l:

Boiled beef mso155-175 Oat flour 6-10 Reconstituted cream115-120 Egg powder40-50 Sunflower oil32-34 Applesauce50-80 Starch4-9 Cooked salt2-3 Distilled water To 1 l.

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It is known that the proportional and intensive absorption of nutrients from the lumen of the small intestine into the internal environment of the body occurs only when the ratio between nutrients, their poly-, oligo-, monomers and electrolytes, similar to those observed in chyme.

The aforementioned set of food products in a mixture provides such ratios of nutrients that are observed in the chyme in vivo digestion. So, the starch should be present in the mixture in the amount of 4-9 g, which ensures, with the safety of the other components, the ratio of proteins, fats and carbohydrates, like 1: 1, 6: 0.6, i.e. similar to that observed in chyme. With an increase in the starch content in the mixture above the upper limit (i.e. more than 9 g / l), the ratio of proteins: fats: carbohydrates changes and becomes equal to 1: 1.6:: 0.8 (Table 1), i.e. . does not provide a mixture of the ratio observed in the chyme and providing intensive and proportional absorption in the small intestine.,

This composition creates a 1: 1.6: 0.7 ratio of proteins, fats and carbohydrates, which is not optimal for absorption processes in the small intestine, since it does not provide for a similar chyme. The ratios observed in chyme can be provided, for example, by the following composition, the data are given in Table 3.

The other main component, mso, must be present in the mixture in the amount of 155-175 g / l, which does not yet change the required ratio of nutrients in the diet. The total amounts below and above these values change the ratio of nutrients in the mixture, see the data in Table 4.

The oatmeal may be present in the mixture in the amount of 6-10 g. Otherwise, the chemical-like ratio of proteins and fats is also violated. and carbohydrates, as can be seen from the table.5.

To provide ratios of poly-, oligo- and monomers, similar to those observed in chyme, the mixture is subjected to preliminary enzymatic treatment in the developed mode.

In this case, the standard enzyme preparation, pacatin, was used.

1 g of which contains 25-27 units of PA.

The optimal conditions for the enzyme are: pH 6-8, temperature 37-37.5 ° C. Experiments are performed as follows. A series of tubes was filled with 10 ml of the nutrient mixture. Incremental doses of the enzyme preparation, mg / ml: 0.5; 0.8; 1.0; 2.0; 5.0; 10.0; 20.0; 40.0 For standardization of the conditions for the hydrolysis of the test tube with samples, thermostatically controlled at 37 ° C and under constant stirring in a joke apparatus. The proteolytic effect of the added drug is assessed by the amount of protein hydrolyzed as a result of the action of the administered enzymes. The percentage of protein hydrolysis is determined to determine the dosage of the enzyme preparations administered as the ratio of the mass difference of the uncleaved protein before and after the introduction of the preparation to the weight content of protein in the initial sample (i.e., the sample taken of the addition of enzyme preparations), according to the formula:

% protein hydrolysis

 NJ N.

100%,

where N (- the original protein nitrogen to enzymatic hydrolysis; N t protein nitrogen after enzymatic hydrolysis.

The percentage of carbohydrate hydrolysis is determined in a similar way, examine the carbohydrate hydrolysis index for glucose resulting from cleavage. Glucose is determined by the glucose method. In addition, the content of the amino nitrogen in the reducing sugars in the mixture is determined.

The results of such experiments showed that the optimal dose is 1 mg / ml of a 20% mixture (or 20-25 units of PA per 1-1.2 g of the mixture).

Strictly speaking, in order to achieve this goal, to obtain a mixture of natural products suitable for intraintestinal administration, i.e. in accordance with fundamental physiological studies, a similar ratio of electrolytes of proteins, fats, carbohydrates and their poly-, oligo- and monomers is characteristic for

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natural digestion conditions to the chyme - it is necessary to ensure the composition of the products given above and the optimum (as in the chyme) hydrolysis depth of polymers

By reducing the concentrated indicators of the ingredients of the composition below the lower limit, it is not possible to provide enteral nutrition in full, which makes it necessary to administer additional nutrients to patients by parenteral route, which is associated with post-transfusion complications and prolongs the normalization of nutritional status.

With an increase in the concentration indicators of the ingredients above the upper limit, the functional stress of the digestive systems increases, leading to impaired absorption of the intraintestinal nutrients and dyspeptic disorders.

With respect to the ratios of the composition given in the composition of the diet, it is possible to carry out a complete enteral feeding, avoiding the complications associated with impaired absorption and resembling food intolerance, which contributes to favorable outcomes of surgical interventions.

Example 1. M co is subjected to toilet and trimming, cut into pieces weighing 50-100 g, crushed on top with holes of 4-5 mm grating and cook until ready for 20 minutes. Egg powder is mixed with dry cream and reduced by adding water heated to 35 ° C. Apples are washed, cut into slices, steamed in a small amount of water, wiped on a wiping machine. Potato starch jj is diluted in water and heated to obtain a paste. Oatmeal is mixed with water and brought to a boil. The prepared components are mixed with sunflower oil, added Q calcium chloride, table salt and baking soda. The mixture is well stirred, heated and passed through a homogenizer at a pressure of 15 Pa in order to obtain a homogeneous g of suspension. The temperature was adjusted to 37 ° C and pancreatin was introduced in an amount of 0.1 g per 100 ml of the mixture with constant stirring. Duration of hydrolysis 4-0 minutes. After hydrolysis

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the mixture is heated to 80 ° C for the purpose of in-contains proteins of 67 g / l; fat

activating the enzyme to stop; 108.6 g / l; carbohydrate 44 g / l; sodium

hydrolysis reactions and pass on sous-180-200 mg%; potassium 180 mg.%; kalshilku (roller). For example, the proposals 38-40 mg.%. We offer a mixture

The following ingredients are g / l:

Soy bean

Dry cream

Egg powder

Applesauce

Starch

Oatmeal

Sunflower oil

Salt

Water

155

115

40

50

four

6

32

2

Rest

up to 1 l

Example 2. The preparation of the components is the same. M cook up to readiness 25 min. Egg powder and dry cream are restored by adding heated to 30 ° C water. After thoroughly mixing the components, the mixture is preheated and passed through a homogenizer at a pressure of 15 Pa. After hydrolysis with pancreatin 0.1 g

ABOUT

100 ml for 50 minutes at 37.5, the mixture is further heated to 80 ° C and transferred to a roller dryer. For example, the following composition of ingredients is suggested, g / l:

Soy bean

Dry cream

Apple n-, g

Oil porg lnechnoe

Egg ps.

Starch

Oatmeal

Salt

Water

175 120 80 34 50 9

10 3.0

The rest is up to 1 l.

As a result of the technology outlined in examples 1 and 2, as well as the selected formulations, a nutritious mixture is obtained with 6% moisture in the finished product. The composition of 100 g of dry product contains 20.9% of proteins, 42% of non-essential amino acids from total nitrogen, 37.9 % fat, 36.9% carbohydrates, incl. starch 2.9%, dextrins 3.7%, sucrose 1.0%, reducing sugars 24.1%. The product requires minimal time for the preparation of ready-to-use mixture, is restored to a homogeneous consistency with water heated to 37 ° C (at the rate of 500 ml of water per 100 g of dry product). Nutritional mix prepared in this way.

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has a high nutritional value, is well balanced in amino acid composition and provides 1100- (1150 kcal.) for 1 liter intake. Proteins provide 14% of the caloric content of the mixture, while animal proteins make up 87% of their total amount. High content of animal protein provides the necessary the amount of essential amino acids in the mixture and their optimal ratio.

The total amount of essential amino acids in the mixture is 39.4% of their total amount. Fats provide up to 57% of the caloric content of the mixture. Animal fat is 58% of total fat. This proportion

5 animal and vegetable fats provide the necessary amount of polyunsaturated fatty acids. The share of carbohydrates is 25-27% of the caloric content of the mixture. Carbohydrates are presented in

0 as poly- and oligo-saccharides (starch, sucrose, fiber) and monosaccharides. Such a combination of carbohydrates is beneficial for their utilization. Amount of mineral substances

, complies with norms balanced0

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food and concentration indices approach the content of the small intestine in the chyme. The main part of calcium salts is contained in dairy products in the form of well-digestible calcium lactic acid. About 50% of potassium is provided by products of plant origin, where it is in the form of easily digestible potassium carbonate and potassium salts of organic acids.

As a result of applying the mixture obtained, a very pronounced positive effect is observed.

Prior to clinical trials, the effectiveness of the use of the mixtures obtained by the proposed method was evaluated in animals according to generally accepted methods. For rats, we studied the parameters of body weight, final weight, weight gain for the experiment, average daily gain, protein efficiency ratio. For dogs, the rate at which the ingredients of the mixture from the enteric medium enter the blood was studied, the rate of absorption of the mixture as a whole, and the evacuation rate of the mixture was measured.

At the same time, in experiments on dogs, the rate of admission of the protein component from the enteral to the internal environment corresponded to 275.7i6.1 9 mg / mi lipids - 172.9 ± 3.5 mg / min, carbohydrates 29016.55 mg / min, the rate of absorption of the mixture volume amounted to 3,5i tO, l ml / min with a coefficient of evacuator activity of the small intestine 1.4-1.6. The proposed nutritional mixture was also tested in young growing male rats.

When evaluating the mixture according to growth parameters, the following results are obtained. The animals completely eat the mixture, their general condition and behavior are satisfactory, the administration of the gastrointestinal tract is not disturbed, the stool is decorated and has a dense texture. Growth rates of rats are presented in table.6.

The data obtained indicated the high nutritional quality of the mixture and served as the basis for more detailed studies in the conditions introduced. Dip it directly into the human digestive tract.

The results of the intraintestinal therapy with the proposed mixture

showed that the postoperative peri- ,, laziness of the mixture, its low cost,

One of all patients who received enteral tube feeding proceeded favorably, patients had no signs of intestinal paresis. Already by the end of the first day the gases departed, on the third day a self-contained stool appeared. Patients were active in bed. The results of balanced studies showed that on the 2nd day a positive water-electrolyte balance was established: and by the end of the 2nd or 3rd day there was a positive nitrogen balance. By the time the enteral feeding was completed, the deficiency of circulating protein fell from 18.1 ± 1.1 to 12.4 ± 1.5%, the deficit of circulating blood volume - from 16.2 ± 1.1 to 9.011.2%.

These data indicate the effectiveness of the proposed mixture.

Example 1. Patient A. was admitted to the hospital with a diagnosis of gastric ulcer disease, acute profuse bleeding. After surgery in te40

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the use of domestic base materials for its preparation, the absence of deficient components in the mixture and the presence of a good clinical effect makes it possible to give preference to this mixture over the known mixtures. It has enhanced nutritional properties and digestibility. The mixture is convenient to use: it is diluted immediately before the introduction at the patient's bed in warm water and introduced through a probe.

The use of this mixture avoids complications imitating food intolerance and arising from digestive and absorption disorders in the postoperative period, and can be recommended not only when the intestinal function of the small intestine is maintained, but also when the intestinal function is depressed in the early postoperative period.

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For the next 20 days, the patient was given an enteral probe feeding with the proposed mixture. Already on the 3rd day from the start of feeding, the wilsse chair revealed a positive nitrogen balance. In the blood test: total protein was 63 g / l; creatinine 5.2 mg / l; erythrocytes 4,2-1 O1 l; ESR 6 mm / h. Bilirubin - 0.0088 g / L, direct reaction. By the time of discharge, the daily administration of a 2.0-2.5 l nutrient mixture resulted in the normalization of metabolic parameters, providing a positive electrolyte and nitrogen balance.

Example 2. Patient B. was in the clinic for gastric blastoma. During the operation, the patient is fed a nutritional probe below the anastomosis zone into the small intestine. From the 1st day after the operation, the patient received enteral probe feeding with the proposed mixture. With this on the 4th

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the day after surgery, the volume of circulating protein and hemoglobin were within the normal range; there was a normalization of water and electrolyte balance, which suggests that the

enteral nutrition provides

plastic and energy needs of the body.

Thus, the simplicity izgotov0

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the use of domestic base materials for its preparation, the absence of deficient components in the mixture and the presence of a good clinical effect makes it possible to give preference to this mixture over the known mixtures. It has enhanced nutritional properties and digestibility. The mixture is convenient to use: it is diluted immediately before the introduction at the patient's bed in warm water and introduced through a probe.

The use of this mixture avoids complications imitating food intolerance and arising from digestive and absorption disorders in the postoperative period, and can be recommended not only when the intestinal function of the small intestine is maintained, but also when the intestinal function is depressed in the early postoperative period.

Claims (1)

Invention Formula A method of obtaining a nutrient mixture for intraintestinal probe feeding, comprising mixing an egg product, table salt, fatty and protein components, a carbohydrate component comprising starch, and distilled water, characterized in that, in order to reduce the cost of the mixture and increase nutrient properties and digestibility, in the preparation of the mixture, carbohydrate components are added to it, which use block puree and oatmeal, boiled beef meat and reconstituted cream are used as a protein component, sunflower oil is used as a fat component, and products, powdered egg, the mixture is heated, homogenized and subjected to enzymatic hydrolysis. cream1152649 M so16332,613,5 Egg powder43,57,113,6 Oatmeal 8,160,990,47 Apple puree550,16- Cooking salt 2.72-- VodoD 1 l Atin, which is administered on the basis of trypsin activity of 25-27 units. PA for 1-1.2 ml of the mixture, and the process is carried out until 40–42% of the amine nitrogen is accumulated in the medium, the ratio of true protein to total amine nitrogen is set at 2: 1.1–2: 1.3, the content of reducing substances is 20–25 % followed by thermal inactivation of the enzyme and drying of the mixture, with the components taken in the following quantities, g / l: Boiled beef m155-175 5 Tolokno6-10 Recovered cream115-120 Egg powder 40-50 Applesauce 50-80 0 Sunflower oil32-34 Starch4-9 Cooking salt 2-3 Distilled 5 waterUp to 1 l. Table 1 table 2 Mixture with increased amount of oatmeal Mix with a reduced amount of oatmeal 67: 12J, 45 + 66.01.0.69 + 107.7, 8.19 + 38.4, 1: 1.6: 0, 7 . - 67108,2246 66 407.28 34 1: 1,6: 0,5 Table 3 407.28 34 1: 1,6: 0,5