Nkhani

Mbiri ya Kulowetsedwa Kolamulidwa ndi Chandamale

Kulowetsedwa koyendetsedwa ndi cholinga (TCI) ndi njira yophatikizira mankhwala a IV kuti akwaniritse kuchuluka kwa mankhwala omwe amadziwikiratu ("chandamale") mugawo linalake la thupi kapena minofu yosangalatsa.Mu ndemanga iyi, tikufotokozera mfundo za pharmacokinetic za TCI, chitukuko cha machitidwe a TCI, ndi nkhani zaukadaulo ndi zowongolera zomwe zikukambidwa pakukula kwa prototype.Timalongosolanso kukhazikitsidwa kwa machitidwe omwe alipo panopa kuchipatala.

Cholinga cha mtundu uliwonse wa kuperekera mankhwala ndi kukwaniritsa ndi kusunga nthawi yochizira ya zotsatira za mankhwala, ndikupewa zotsatira zoipa.Mankhwala a IV nthawi zambiri amaperekedwa pogwiritsa ntchito malangizo anthawi zonse.Kawirikawiri covariate wodwala yekhayo amene amaphatikizidwa mu mlingo ndi metric ya kukula kwa wodwala, makamaka kulemera kwa IV anesthetics.Makhalidwe a odwala monga zaka, kugonana, kapena chilolezo cha creatinine nthawi zambiri sichimaphatikizidwa chifukwa cha ubale wovuta wa masamu wa ma covariateswa kuti adziwe.M'mbiri pakhala pali njira ziwiri zoperekera mankhwala a IV panthawi ya anesthesia: bolus mlingo ndi kulowetsedwa kosalekeza.Mlingo wa Bolus nthawi zambiri umaperekedwa ndi syringe yapamanja.Infusions nthawi zambiri amaperekedwa ndi pampu ya infusions.

Mankhwala aliwonse ophatikizika amawunjikana mu minofu panthawi yopereka mankhwala.Kuchulukaku kumasokoneza mgwirizano pakati pa kuchuluka kwa kulowetsedwa komwe kumayikidwa ndi dokotala komanso kuchuluka kwa mankhwala kwa wodwalayo.Kulowetsedwa kwa propofol kwa 100 μg / kg / min kumagwirizanitsidwa ndi wodwala pafupifupi wogalamuka 3 mphindi mu kulowetsedwa ndi wodwala kwambiri kapena wogona 2 maola pambuyo pake.Pogwiritsa ntchito mfundo zomveka bwino za pharmacokinetic (PK), makompyuta amatha kuwerengera kuchuluka kwa mankhwala omwe apezeka m'matenda panthawi ya kulowetsedwa ndipo amatha kusintha mlingo wa kulowetsedwa kuti asunge ndende yokhazikika mu plasma kapena minofu yokondweretsa, makamaka ubongo.Kompyutayo imatha kugwiritsa ntchito chitsanzo chabwino kwambiri kuchokera m'mabuku, chifukwa masamu ovuta kuphatikizapo makhalidwe a odwala (kulemera, kutalika, zaka, kugonana, ndi zina zowonjezera) ndizowerengetsera zazing'ono pakompyuta.1,2 Ichi ndi maziko a a mtundu wachitatu wa mankhwala ochititsa dzanzi, target-controlled infusions (TCI).Ndi machitidwe a TCI, dokotala amalowa m'malo omwe akufuna.Kompyutayo imawerengera kuchuluka kwa mankhwala, omwe amaperekedwa ngati ma bolus ndi ma infusions, omwe amafunikira kuti akwaniritse zomwe akufuna ndikuwongolera pampu yolowetsera kuti ipereke bolus yowerengeka kapena kulowetsedwa.Kompyutayo imawerengera nthawi zonse kuchuluka kwa mankhwala omwe ali mu minofu ndi momwe zimakhudzira kuchuluka kwa mankhwala omwe amafunikira kuti akwaniritse cholinga chake pogwiritsa ntchito chitsanzo cha ma PK a mankhwala omwe amasankhidwa ndi odwala omwe amayenda nawo.

Pa opaleshoni, mlingo wa opaleshoni kukondoweza angasinthe mofulumira kwambiri, amafuna yeniyeni, mofulumira titration wa zotsatira za mankhwala.Kulowetsedwa wamba sikungachulukitse kuchuluka kwa mankhwala mwachangu kotero kuti kuwerengetsera kuwonjezereka kwadzidzidzi kwa kukondoweza kapena kutsika kwapang'onopang'ono kokwanira kuwerengera nthawi zokondoweza.Ma infusions ochiritsira sangathe ngakhale kusunga mankhwala okhazikika mu plasma kapena ubongo panthawi ya kukondoweza kosalekeza.Mwa kuphatikiza mitundu ya PK, machitidwe a TCI amatha kuyankha mwachangu ngati kuli kofunikira ndikusunganso kukhazikika koyenera.Phindu lomwe lingakhalepo kwa asing'anga ndilodziwika bwino kwambiri la zotsatira za mankhwala ochititsa dzanzi.3

Mu ndemangayi, tikufotokoza mfundo za PK za TCI, kakulidwe ka machitidwe a TCI, ndi nkhani zaukadaulo ndi zowongolera zomwe zimayankhidwa pakukula kwachitsanzo.Nkhani ziwiri zowunikira zomwe zikutsatizana nazo zikukhudzana ndi kugwiritsa ntchito padziko lonse lapansi ndi chitetezo zokhudzana ndi ukadaulo uwu.4,5

Pamene machitidwe a TCI adasinthika, ofufuza adasankha mawu osagwirizana ndi njirayo.Machitidwe a TCI atchedwa makompyuta-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 maganizo ndi Iain Glen, White ndi Kenny adagwiritsa ntchito mawu akuti TCI m'mabuku awo pambuyo pa 1992. Chigwirizano chinafikiridwa mu 1997 pakati pa ofufuza omwe akugwira ntchito kuti mawu akuti TCI avomerezedwe ngati kufotokozera kwachidziwitso chaukadaulo.10