McCrirrick A, Monk C R
Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary.
Br J Anaesth. 1994 May;72(5):529-32. doi: 10.1093/bja/72.5.529.
Adrenaline is the single most important therapeutic agent used in advanced cardiac life support (ACLS). Ideally it should be given into a large central vein but the European Resuscitation Council, the American Heart Association and the Resuscitation Council (U.K.) advise that adrenaline may be given into the trachea if i.v. access is not available. We have studied the effects of intra-tracheal and i.v. adrenaline in 16 patients undergoing mechanical ventilation. Log dose-response curves were constructed for systolic arterial pressure and heart rate responses. Intra-tracheal doses of adrenaline up to 10 micrograms kg-1, approximately one-third of that recommended for resuscitation, had no effect on arterial pressure or heart rate, whereas adrenaline 0.1 microgram kg-1 i.v. produced a mean increase in systolic pressure of 24 mm Hg. The intra-tracheal doses recommended for resuscitation (2-3 mg) are likely to be ineffective and consideration should be given to abandoning the tracheal route for adrenaline in ACLS.
肾上腺素是高级心脏生命支持（ACLS）中使用的最重要的单一治疗药物。理想情况下，应将其注入大的中心静脉，但欧洲复苏委员会、美国心脏协会和英国复苏委员会建议，如果无法建立静脉通路，肾上腺素可经气管给药。我们研究了16例接受机械通气患者经气管和静脉注射肾上腺素的效果。构建了收缩动脉压和心率反应的对数剂量-反应曲线。经气管给予高达10微克/千克的肾上腺素，约为推荐复苏剂量的三分之一，对动脉压或心率无影响，而静脉注射0.1微克/千克的肾上腺素使收缩压平均升高24毫米汞柱。推荐用于复苏的经气管给药剂量（2 - 3毫克）可能无效，在ACLS中应考虑放弃经气管途径给予肾上腺素。
