Nhau

Nhoroondo yeKupinzwa kweTarget-Controlled

Kupinzwa kwemvura kunodzorwa nezvinangwa (TCI) inzira yekuisa mishonga yemutsinga kuti uwane huwandu hwemishonga hwakafanotaurwa nemushandisi ("chinangwa") muchikamu chemuviri kana nyama yemunhu anofarira. Muongororo iyi, tinotsanangura misimboti yemishonga yeTCI, kugadzirwa kweTCI systems, uye nyaya dzehunyanzvi nedzemitemo dzakatariswa mukugadzirwa kweprototypes. Tinotsanangurawo kutanga kwesystem dziripo pari zvino.

Chinangwa chemhando yega yega yekupa mushonga ndechekuwana uye kuchengetedza nguva yekurapa yemhedzisiro yemushonga, uku uchidzivirira migumisiro yakaipa. Mishonga yemushonga wechina inowanzopihwa uchishandisa gwara rekuyedza. Kazhinji covariate yemurwere inosanganisirwa mumushonga ichiyero chehukuru hwemurwere, kazhinji huremu hwemishonga yemushonga wechina. Hunhu hwemurwere hwakadai sezera, murume kana mukadzi, kana creatinine clearance hazviwanzo batanidzwa nekuda kwehukama hwakaoma hwemasvomhu hwezvinhu izvi nemushonga. Kare kwave nenzira mbiri dzekupa mishonga yechina panguva yekunzwa kurwadza: bolus dose uye continuous infusion. Bolus doses inowanzopihwa nesirin'i inobatwa neruoko. Infusions inowanzopihwa nepombi yeinfusion.

Mushonga wese unonyaradza marwadzo unoungana munyama panguva yekupa mushonga. Kuunganidzwa uku kunovhiringidza hukama huripo pakati pehuwandu hwemushonga hunoiswa nachiremba uye huwandu hwemushonga mumurwere. Huwandu hwemushonga wepropofol we100 μg/kg/min hunobatanidzwa nemurwere anenge amuka maminitsi matatu mushure mekuiswa mushonga uye murwere anenge arara zvakanyanya maawa maviri gare gare. Nekushandisa nheyo dzemishonga dzinonzwisiswa zvakanaka (PK), makombiyuta anogona kuverenga kuti mushonga wakawanda sei wakaunganidzwa munyama panguva yekuiswa mushonga uye anogona kugadzirisa huwandu hwemushonga kuti arambe akasimba muplasma kana nyama inofarira, kazhinji uropi. Kombiyuta inokwanisa kushandisa modhi yakanakisa kubva mumabhuku, nekuti kuoma kwemasvomhu kwekubatanidza hunhu hwemurwere (huremu, kureba, zera, bonde, uye zvimwe zviratidzo) kuverenga kushoma kwekombuta.1,2 Uku ndiko hwaro hwemhando yechitatu yemushonga unonyaradza marwadzo, target-controlled infusions (TCI). Nemasisitimu eTCI, chiremba anopinda muhuwandu hwaanoda. Komputa inoverenga huwandu hwemushonga, unounzwa semaboluses uye mainfusions, anodiwa kuti uwane huwandu hwaunoda uye inorayira pombi yeinfusion kuti ipe bolus kana infusion yakaverengerwa. Komputa inogara ichiverenga kuti mushonga wakawanda sei uri munyama uye kuti izvozvo zvinokanganisa sei huwandu hwemushonga unodiwa kuti uwane huwandu hwaunoda nekushandisa modhi yePKs yemushonga wakasarudzwa uye murwere anozobatanidzwa.

Munguva yekuvhiyiwa, huwandu hwekukurudzirwa kwekuvhiyiwa hunogona kuchinja nekukurumidza, zvichida titration chaiyo uye nekukurumidza yemushonga. Kuisirwa kwemishonga kwakajairika hakugone kuwedzera huwandu hwemushonga nekukurumidza zvakakwana kuti kuverenge kuwedzera kamwe kamwe mukukurudzirwa kana kudzikisa huwandu nekukurumidza zvakakwana kuti kuverenge nguva yekukurudzirwa kushoma. Kuisirwa kwemishonga kwakajairika hakugone kunyange kuchengetedza huwandu hwakagadzikana hwemushonga muplasma kana muuropi panguva yekukurudzirwa nguva dzose. Nekushandisa maPK models, masisitimu eTCI anogona kukurumidza titration mhinduro sezvinodiwa uye saizvozvo kuchengetedza huwandu hwakagadzikana kana zvakakodzera. Kubatsira kunogona kuwanikwa kune vanachiremba ndiko titration chaiyo yemushonga weanesthetic.3

Muongororo iyi, tinotsanangura misimboti yePK yeTCI, kugadzirwa kwemasisitimu eTCI, uye nyaya dzehunyanzvi nedzemitemo dzakatariswa mukugadzirwa kwema prototype. Nyaya mbiri dzeongororo dzinotevera dzinotaura nezvenyaya dzekushandiswa kwepasi rose uye kuchengetedzeka dzine chekuita netekinoroji iyi.4,5

Sezvo masisitimu eTCI akachinja, vaongorori vakasarudza mazwi akasiyana-siyana enzira iyi. Masisitimu eTCI anonzi computer-assisted total IV anesthesia (CATIA), 6 titration of IV agents by computer (TIAC), 7 computer-assisted continuous infusion (CACI), 8 uye computer-controlled infusion pump.9 Zvichitevera zano raIain Glen, White naKenny vakashandisa izwi rekuti TCI mumabhuku avo mushure megore ra1992. Muna 1997, vaongorori vakabvumirana kuti izwi rekuti TCI rishandiswe setsananguro ye tekinoroji iyi.10