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研究生:張秀梅
研究生(外文):Shiou-Mei Chang
論文名稱:定量噴霧液於不同管徑氣管內管之輸送效果研究
論文名稱(外文):DURING THE DIFFERENT DIAMETER ENDOTRACHEAL TUBE METERED AEROSOL DELIVERY EFFECT
指導教授:王鐘毅
指導教授(外文):Chung-Yih Wang
口試委員:王鐘毅
口試委員(外文):Chung-Yih Wang
口試日期:2014-01-06
學位類別:碩士
校院名稱:大同大學
系所名稱:生物工程學系(所)
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:53
中文關鍵詞:正壓機械性換氣嬰兒慢性肺疾病
外文關鍵詞:Chronic lung disease of infancyPositive pressure mechanical ventilation
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嬰兒慢性肺疾病是指所有於新生兒時期因肺部傷害所導致最終的肺部異常變化。因肺部呼吸道阻力很高,因此常合併反覆性喘鳴。給於短效吸入性的Beta2-adrenergic agonist可有效緩解支氣管攣縮,而換氣改善換氣量。或者使用吸入類固醇為抗發炎藥物,除了降低支氣管擴張劑的使用率、改善換氣量、並降低氧氣濃度及縮短呼吸器使用天數。
本實驗目的主要為模擬使用正壓機械性換氣經不同氣管內管直接噴入裝置於吸藥輔助器的吸入性皮質類固醇-Duasma藥劑,並以高效能液相層析法(high performance liquid chromatography)所呈現的訊號值分布變化探討經過不同內徑氣管內管,所供應的藥物是否能有較多的劑量進入下呼吸道。實驗推估,氣管內管的管徑越大,藥物輸送量成正比例的增加。
Chronic lung disease of infancy refers to all infants in the neonatal period suffered lung damage caused by the final abnormal lung changes. Due to the high lung airway resistance, the disease is often associated with recurrent wheezing, giveg short-acting inhaled Beta2-adrenergic agonist can relieve bronchial contracture and improve ventilation. Inhaled steroids is also used as anti-inflammatory drugs to reduce bronchodilator usage, improve ventilation, reduce the oxygen concentration and shorten ventilator for several days.
The purpose of this study is to simulate the positive pressure mechanical ventilation through an endotracheal tube which connected with different device directly to assist the delivery of inhaled drugs,corticosteroid-Duasma. High Performance Liquid Chromatography was used to analzye the deposition amount of drug. The influence of inner diameter endotracheal on the delivery efficiency tube was studied. The results suggest that the bigger endotracheal tube increase the drug delivery efficiency.
誌謝 i
中文摘要 ii
ABSTRACT iii
目次 iv
表次 vi
圖次 vii
第壹章 緒論 1
1.1 動機 3
1.2 文獻回顧 4
1.2.1 呼吸系統的介紹 4
1.2.2 小兒及成人之呼吸生理差異性 5
1.2.3 呼吸型態 6
1.2.4 經肺給藥的基礎 8
1.2.5 肺支氣管發育不良 9
1.2.6 Budesonide 10
1.3 本文目的 12
第貳章 理論分析 13
2.1氣動力學與藥物微粒在肺部之沉積 13
2.2 Metered Dose Inhaler 14
2.3霧氣治療傳送設備 17
2.4體外及體內肺部藥物劑量之測量 19
第参章 方法與材料 20
3.1研究設計 20
3.2測量方法 23
3.2.1實驗條件 24
3.2.2實驗結果 25
第肆章 結果與討論 33
4.1藥物微粒在肺部之沉積與研究推估之比較 33
4.2實驗結果討論 34
第伍章 結論 35
第陸章 未來研究的建議 36
參考文獻 37
中文部分 37
英文部分 38

表次
表一: 肺支氣管發展異常之定義 41
表二:影響嬰兒藥物吸入之傳送及沉降的可能因素 42
表三: 霧氣治療時傳送設備與適用年齡之建議 43
表四: 使用定量噴霧器之流程-閉口式吸入法 44
表五: 使用定量噴霧器之流程-使用吸入輔助器吸入法 45
表六: 依照體重及年齡選擇氣管內管尺寸 46

圖次
圖一: 肺支氣管的發育及病程變化 47
圖二: 上、下呼吸系統 48
圖三: 氣動力學與藥物微粒在肺部沉積 49
圖四: 吸藥輔助器的種類 50
圖五: 小兒專用吸藥輔助器 51
圖六: 體外肺部藥物劑量之測量 52
圖七: 圖七: 體內肺部藥物劑量之測量 53
中文部分
方通,潘俊芳&蔣曙光.(2007).HPLC法則定噻托溴铵及有關物質.藥學與臨床研究,124-126.

英文部分
Bancalari et al.(2005).Management of infants with bronchopulmonary dysplasia
in North America.Earl Hum Dev 81,171.

Byron PR.(2004)Drug delivery devices:issues in durg development. Proc 1,321-
328.

Cole C.(2000) Special problems in aerosol delivery:neonatal and pediatric
considerations. RespiCare 45,646-651.

Collis GG et al.(1990). Dilution of nebulised aerosols by air entrainment in
children .Lancet 336,341-343.

Cryan S-A.(2005).Carrier-based strategies for targeting protein and peptide
drugs to the lung.AAPS Journal 7,E20-41.

Fink JB.( 2004). Aerosol delivery to ventilated infant and pediatric patients.
Respir Care 49,653-665.

Garner SS et al.(2006)Effect of heliox on albuterol delivery by metered-dose
inhaler in pediatric in vitro models of mechanical ventilation.Pharmacotherapy
26, 1396-1402.

Geller D.(2005). Comparing clinical features of the nebulizer,metered-dose
inhaler, and dry powder inhaler. Respir Care 50,1313.

Greenough A.(2007).Late respieatory outcomes after preterm bith. Earl Hum Dev
83,785.

Israel Amirav et al.(2012). Deposition of small particles in the developing
lung. Paediatric Respiratory Reviews 13,73–78.

Janssens HM et al.(2003)Aerosol therapy and the fighting toddler: is
administration during sleep an alternative? J Aerosol Med 16,395-400.

Kamrun Nahar et al. (2013)In vitro, in vivo and ex vivo models for studying
particle deposition and drug absorption of inhaled pharmaceuticals. European
Journal of Pharmaceutical Sciences 49,805–818.

Kristin Tanney et.al.(2011). Extremely Low-Dose Dexamethasone to Facilitate
Extubation in Mechanically Ventilated Preterm Babies. Neonatology 100,285-289.

Leversha AM et al.(2000). Costs and effectiveness of spacer versus nebulizer
in young children with moderate and severe acute asthma. J Pediatr 136,497-502.

Lugo RA et al.(2001) Albuterol delivery in a neonatal ventilated lung model:
Nebulization versus chlorofluorocarbon- and hydrofluoroalkane-pressurized
metered dose inhalers. Pediatr Pulmonol 31,247-254.

Newman SP & Busse WW.(2002).Evolution of dry powder inhaler design,
formulation and performance. Respiratory Medicine 96,293-304.

Patton JS & Byron PR..(2007).Inhaling medicine:delivering durgs to the body
throught the lungs.Nat Rev Durg Discovery 6,67-74.

RK TRIVEDI.(2012). A Rapid, Stability-Indicating RP-HPLC Method for the
Simultaneous Determination of Formoterol Fumarate, Tiotropium Bromide, and
Ciclesonide in a Pulmonary Drug Product. Sci Pharm 80, 591–603.

Ruppel GL WD.(2003). The respiratory system. In: Scanlan CL WR, Stoller JK.
Editor: Egan’s fundamentals of respiratory care, ed 8. St. Louis,Mo, Mosby.

Tal A et al.(1996). Deposition pattern of radiolabeled salbutamol inhaled
from a metered-dose inhaler by means of a spacer with mask in young children
with airway obstruction. The Journal of pediatrics 128,479-484.
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