Bailey Abby M, Baum Regan A, Horn Karolyn, Lewis Tameka, Morizio Kate, Schultz Amy, Weant Kyle, Justice Stephanie N
Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky.
Department of Pharmacy, Charleston Area Medical Center, Charleston, West Virginia.
J Emerg Med. 2017 Jul;53(1):38-48. doi: 10.1016/j.jemermed.2017.01.020. Epub 2017 Mar 1.
Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter.
This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine.
The nasal mucosa is highly vascularized, and the olfactory tissues provide a direct conduit to the central nervous system, bypass first-pass metabolism, and lead to an onset of action similar to IV drug administration. This route of administration has also been shown to decrease delays in drug administration, which can have a profound impact in a variety of emergent scenarios, such as seizures, acutely agitated or combative patients, and trauma management. IN administration of midazolam, lorazepam, flumazenil, dexmedetomidine, ketamine, fentanyl, hydromorphone, butorphanol, naloxone, insulin, and haloperidol has been shown to be a safe, effective alternative to IM or IV administration. As the use of IN medications becomes a more common route of administration in the emergency department setting, and in prehospital and outpatient settings, it is increasingly important for providers to become more familiar with the nuances of this novel route of medication delivery.
IN administration of the reviewed medications has been shown to be a safe and effective alternative to IM or IV administration. Use of IN is becoming more commonplace in the emergency department setting and in prehospital settings.
鼻内给药是包括静脉注射（IV）和肌肉注射（IM）在内的其他给药途径的可行替代方法。鼻内给药途径避免了针刺伤的风险，并减轻了因插入静脉导管可能产生的精神创伤。
本综述旨在评估已发表的关于通过鼻内途径给药且适用于急诊医学实践的文献。
鼻黏膜血管丰富，嗅觉组织提供了一条直接通向中枢神经系统的通道，绕过首过代谢，起效类似于静脉给药。这种给药途径还被证明可减少给药延迟，这在各种紧急情况下，如癫痫发作、急性躁动或好斗的患者以及创伤处理中可能产生深远影响。已证明鼻内给予咪达唑仑、劳拉西泮、氟马西尼、右美托咪定、氯胺酮、芬太尼、氢吗啡酮、布托啡诺、纳洛酮、胰岛素和氟哌啶醇是IM或IV给药的安全、有效替代方法。随着鼻内用药在急诊科环境以及院前和门诊环境中成为更常见的给药途径，医护人员越来越有必要更熟悉这种新型给药途径的细微差别。
已证明鼻内给予所综述的药物是IM或IV给药的安全有效替代方法。鼻内给药在急诊科环境和院前环境中越来越普遍。
