鐧界櫆椋庡悆鑽兘濂藉悧 http://m.39.net/pf/a_7549893.html
上图：Specialtyendotrachealtubeswithirrigation/drugdeliverylumens.A,Hi-LoJetTrachealTube(Nellcor,Pleasanton,CA).Thistubeisdesignedforbronchoscopyandhastwoadditionalports,oneforjetventilationandoneforirrigation.Thisisanuncuffedtubeanddoesnothaveaballooninflationport.B,EMTEmergencyMedicineTube(Nellcor,Pleasanton,CA).Thistubeisdesignedspecificallyforendotrachealdrugadministrationandhastwoports:oneforballooninflationandonefordruginstillation.
上图：TheMucosalAtomizerDevice-EndotrachealTube(MADett,LMANorthAmerica,SanDiego,CA).TheL-shapedportattachestoboththebag-valve-maskdevice(BVM)andendotrachealtube(ETT)andallowsuninterruptedventilationduringdrugadministration.Thecathetershouldbeinserteduntiltheblackdepthmarkerisatthe26-cmmarkontheETT.
资料介绍
Certaindrugscanbedeliveredsimply,rapidly,andeffectivelytothecentralcirculationbywayoftheETtube.BecausetheefficacyofETmedicationadministrationisnotclear,thismethodisbestreservedforsituationsinwhichapatient’sconditionwarrantsimmediatepharmacologicinterventionbutmoreconventionalmeansofdrugdelivery,suchasIVandIO,arenotreadilyavailable.Suchcircumstancesfrequentlyariseintheprehospitalorcardiacarrestsetting.Knowledgeoftheappropriatedrugsanddosagesthatcanbedeliveredeffectivelybythisroutemayprovetobelifesaving.HistoricalPerspectiveETdrugadministrationdatesto,whenBernarddemonstratedthatthelungcouldrapidlyabsorbasolutionofcurare.Inthishistoricalexperiment,heinstilledafatalsolutionintotheupperrespiratorytractofdogsbywayofatracheostomy.Overthefollowingdecades,otherinvestigatorsexpandedthisworkanddemonstratedthatsolutionscontainingsalicylates,atropine,potassiumiodide,strychnine,andchloralhydratewerealsorapidlyabsorbedfromthelungandexcretedintheurineafterinjectingaqueoussolutionsintothetracheasofexperimentalanimals.Theuseofintrapulmonarymedicationforthetreatmentoflungdiseasegainedfurtheracceptancewhenstudiesdemonstratedthatinhalingepinephrinemistdramaticallyrelievedthesymptomsofasthma.Inthelatesands,severalimportantobservationsweremadeconcerningETdrugtherapy:(1)penicillindeliveredbytheETroutedemonstratedadepoteffect,whichresultedintherapeuticbloodlevelsthatlastedtwiceaslongasthosewithintramuscular(IM)injection;(2)variousdiluentsmixedwithpenicillinaffectedboththerateandthedegreeofabsorptionfromthelungs;and(3)higherserumdruglevelswereattainedwithdirectETdrugadministrationthanwithaerosolizedadministration.Inthesitwasnotedthatdrugsdeliveredendotracheallywereabsorbedmuchmorerapidlythanthoseappliedtotheposteriorpartofthepharynx.Drugsappliedlocallytothelarynxandtracheawereabsorbedrapidlyandevenresultedinbloodlevelssignificantenoughtocauseadverseanestheticreactions.In,ReddingandcoworkersstudiedtheuseofETadministrationasarouteofdrugdeliveryinacaninemodelofcardiopulmonaryarrest.TheyadministeredepinephrinebytheIV,intracardiac,andintratrachealroutestoresuscitatedogsthathadundergonebothrespiratoryandcirculatoryarrestsecondarytohypoxia.Theythenevaluatedtheeffectivenessoftheepinephrineafteradministrationofthedrugbyallthreeoftheseroutes.Theirstudyrevealedthatallthreeroutesofdrugadministrationwereequallyeffectiveinrestoringthecirculationofdogsinhypoxia-inducedcardiacarrest,againdemonstratingthattheETrouteofdrugdeliveryprovideseffectiveaccesstothesystemiccirculation.Inthelates,Roberts,Greenberg,andcolleaguesstudiedETdrugdeliveryinaseriesoflaboratoryexperimentsandclinicalapplicationsofETepinephrine.Sincethattime,anumberofimportantanimalandhumanstudies,aswellascasereports,havebeenpublishedinwhichthevariousaspectsofETdrugadministrationwereinvestigated.Thesestudieshaveaddressed(1)theappropriatedoseofdrugtoadminister;(2)theeffectofthedrugsolution’svolume;(3)theeffectofdifferentdiluentsolutions;(4)theroleofdifferentETdrugdeliverytechniques;and(5)theeffectsofhypoxia,hypotension,shock,andcardiopulmonaryarrestontheabsorption,distribution,andefficacyofendotracheallyadministereddrugs.Re