Nkhani

Mbiri ya Kulowetsedwa Kolamulidwa ndi Target

Kulowetsedwa kolamulidwa ndi cholinga (TCI) ndi njira yothira mankhwala a IV kuti akwaniritse kuchuluka kwa mankhwala ("cholinga") komwe kwanenedweratu ndi ogwiritsa ntchito m'thupi kapena minofu inayake yomwe ikufunika. Mu ndemanga iyi, tikufotokoza mfundo za pharmacokinetic za TCI, chitukuko cha machitidwe a TCI, ndi nkhani zaukadaulo ndi malamulo zomwe zafotokozedwa pakupanga zitsanzo. Tikufotokozanso kuyambitsidwa kwa machitidwe omwe alipo pakadali pano azachipatala.

Cholinga cha mtundu uliwonse wa mankhwala ndi kukwaniritsa ndi kusunga nthawi yochiritsira ya zotsatira za mankhwala, pamene kupewa zotsatira zoyipa. Mankhwala a IV nthawi zambiri amaperekedwa pogwiritsa ntchito malangizo okhazikika a mlingo. Kawirikawiri covariate yokha ya wodwala yomwe imaphatikizidwa mu mlingo ndi muyeso wa kukula kwa wodwala, nthawi zambiri kulemera kwa mankhwala oletsa ululu a IV. Makhalidwe a wodwala monga zaka, kugonana, kapena creatinine clearance nthawi zambiri saphatikizidwa chifukwa cha ubale wovuta wa masamu wa covariates awa ndi mlingo. M'mbuyomu pakhala njira ziwiri zoperekera mankhwala a IV panthawi ya anesthesia: mlingo wa bolus ndi infusion yopitilira. Mlingo wa bolus nthawi zambiri umaperekedwa ndi syringe yonyamula m'manja. Infusions nthawi zambiri zimaperekedwa ndi pampu ya infusion.

Mankhwala aliwonse oletsa ululu amasonkhana m'minofu panthawi yopereka mankhwala. Kuchulukana kumeneku kumasokoneza ubale pakati pa kuchuluka kwa mankhwala oletsa ululu komwe dokotala amapereka ndi kuchuluka kwa mankhwala mwa wodwalayo. Kuchuluka kwa mankhwala oletsa ululu a propofol a 100 μg/kg/min kumagwirizanitsidwa ndi wodwala amene watsala pang'ono kudzuka mphindi zitatu atalandira mankhwalawo komanso wodwala amene wagona kwambiri maola awiri pambuyo pake. Pogwiritsa ntchito mfundo zomveka bwino za pharmacokinetic (PK), makompyuta amatha kuwerengera kuchuluka kwa mankhwala omwe asonkhanitsidwa m'minofu panthawi yopereka mankhwalawo ndipo amatha kusintha kuchuluka kwa mankhwalawo kuti akhalebe ndi kuchuluka kokhazikika mu plasma kapena minofu yomwe imakonda kugwiritsidwa ntchito, makamaka ubongo. Kompyutayo imatha kugwiritsa ntchito chitsanzo chabwino kwambiri kuchokera m'mabuku, chifukwa zovuta zamasamu zophatikizira makhalidwe a wodwala (kulemera, kutalika, zaka, kugonana, ndi zizindikiro zina zowonjezera) ndi ziwerengero zazing'ono za kompyuta.1,2 Ichi ndiye maziko a mtundu wachitatu wa mankhwala oletsa ululu, ma infusions olamulidwa ndi cholinga (TCI). Ndi machitidwe a TCI, dokotalayo amalowa mu kuchuluka komwe akufuna. Kompyuta imawerengera kuchuluka kwa mankhwala, operekedwa ngati ma boluses ndi ma infusions, ofunikira kuti akwaniritse kuchuluka komwe akufuna ndipo imatsogolera pampu yothira kuti ipereke bolus kapena infusion yowerengedwa. Kompyuta nthawi zonse imawerengera kuchuluka kwa mankhwala omwe ali mu minofu ndi momwe zimakhudzira kuchuluka kwa mankhwala ofunikira kuti akwaniritse kuchuluka komwe akufuna pogwiritsa ntchito chitsanzo cha ma PK a mankhwala omwe asankhidwa ndipo wodwalayo amafanana nawo.

Pa opaleshoni, kuchuluka kwa kusonkhezera kwa opaleshoni kumatha kusintha mwachangu kwambiri, zomwe zimafuna kusinthasintha kolondola komanso mwachangu kwa mphamvu ya mankhwala. Kulowetsedwa kwachizolowezi sikungawonjezere kuchuluka kwa mankhwala mwachangu mokwanira kuti kuwerengetsere kuwonjezeka kwadzidzidzi kwa kusonkhezera kapena kuchepetsa kuchuluka kwa mankhwala mwachangu mokwanira kuti kuwerengetsere nthawi yochepetsera kusonkhezera. Kulowetsedwa kwachizolowezi sikungathe ngakhale kusunga kuchuluka kwa mankhwala mu plasma kapena mu ubongo panthawi yolimbikitsira kosalekeza. Mwa kuphatikiza mitundu ya PK, machitidwe a TCI amatha kuyankha mwachangu ngati pakufunika kutero komanso mofananamo kusunga kuchuluka kokhazikika ngati pakufunika. Phindu lomwe lingakhalepo kwa asing'anga ndi kukwera kolondola kwa mphamvu ya mankhwala oletsa ululu.3

Mu ndemanga iyi, tikufotokoza mfundo za PK za TCI, chitukuko cha machitidwe a TCI, ndi nkhani zaukadaulo ndi malamulo zomwe zafotokozedwa pakupanga zitsanzo. Nkhani ziwiri zowunikira zomwe zikubwerazi zikufotokoza nkhani zapadziko lonse lapansi zokhudzana ndi kugwiritsa ntchito ndi chitetezo zokhudzana ndi ukadaulo uwu.4,5

Pamene machitidwe a TCI ankasintha, ofufuza anasankha mawu osagwirizana ndi njira imeneyi. Machitidwe a TCI amatchedwa kuti computer-assisted total IV anesthesia (CATIA), 6 titration of IV agents by computer (TIAC), 7 computer-assisted continuous infusion (CACI), 8 ndi computer-controlled infusion pump.9 Potsatira lingaliro la Iain Glen, White ndi Kenny adagwiritsa ntchito mawu akuti TCI m'mabuku awo pambuyo pa 1992. Mu 1997, ofufuzawo adagwirizana kuti mawu akuti TCI agwiritsidwe ntchito ngati kufotokozera kwa ukadaulo.10