Amakuru

Amateka Yintego-Igenzurwa

Intego igenzurwa nintego (TCI) ni tekinike yo kwinjiza ibiyobyabwenge IV kugirango ugere kubakoresha-bahanuye (“intego”) ibiyobyabwenge byibanda kumubiri cyangwa mubice byinyungu. Muri iri suzuma, turasobanura amahame ya farumasi ya TCI, iterambere rya sisitemu ya TCI, nibibazo bya tekiniki nubuyobozi byakemuwe mugutezimbere prototype. Turasobanura kandi itangizwa rya sisitemu iriho ubu.

Intego yuburyo bwose bwo gutanga ibiyobyabwenge ni ukugera no gukomeza igihe cyo kuvura ingaruka zibiyobyabwenge, mugihe twirinze ingaruka mbi. Imiti ya IV isanzwe itangwa hifashishijwe amabwiriza asanzwe. Mubisanzwe covariate yumurwayi yonyine yinjizwa mumupanga ni metero yubunini bwumurwayi, mubisanzwe uburemere bwa anesthetike ya IV. Ibiranga abarwayi nk'imyaka, igitsina, cyangwa creinine clearance akenshi ntibishyizwemo kubera isano igoye y'imibare y'izi covariates kugirango ikore. Mu mateka habaye uburyo 2 bwo gutanga imiti ya IV mugihe cya anesteziya: dose ya bolus no guhora ushiramo. Indwara ya Bolus isanzwe ikoreshwa hamwe na siringi y'intoki. Infusion isanzwe itangwa hamwe na pompe ya infusion.

Buri muti wa anesthetic urundanya mubice mugihe cyo gutanga ibiyobyabwenge. Uku kwirundanya bitiranya isano iri hagati yikigereranyo cyatewe n’umuganga hamwe n’ibiyobyabwenge by’umurwayi. Igipimo cya propofol ya 100 μg / kg / min ifitanye isano numurwayi hafi yo gukanguka iminota 3 yinjiye kandi umurwayi wicaye cyane cyangwa usinziriye nyuma yamasaha 2. Ukoresheje amahame ya farumasi yunvikana neza (PK), mudasobwa zirashobora kubara umubare wibiyobyabwenge byakusanyirijwe mumyenda mugihe cyo gutera kandi birashobora guhindura igipimo cyo kwinjiza kugirango bikomeze kwibanda kuri plasma cyangwa mubice byinyungu, mubisanzwe ubwonko. Mudasobwa irashobora gukoresha icyitegererezo cyiza kivuye mubuvanganzo, kubera ko imibare igoye yo gushyiramo ibiranga abarwayi (uburemere, uburebure, imyaka, igitsina, hamwe na biomarkers yongeyeho) ni imibare yoroheje kuri mudasobwa.1,2 Iyi ni ishingiro rya a ubwoko bwa gatatu bwo gutanga imiti igabanya ubukana, kugenzura intego (TCI). Hamwe na sisitemu ya TCI, umuganga yinjira mubyifuzo bye. Mudasobwa ibara ingano yibiyobyabwenge, bitangwa nka bolus na infusion, bisabwa kugirango ugere ku ntego kandi bikayobora pompe yo gushiramo gutanga bolus yabazwe cyangwa infusion. Mudasobwa ihora ibara umubare wibiyobyabwenge biri mubice kandi neza nuburyo ibyo bigira ingaruka kumubare wibiyobyabwenge bisabwa kugirango ugere ku ntego ukoresheje urugero rwa PKs yibiyobyabwenge byatoranijwe hamwe na covariates.

Mugihe cyo kubaga, urwego rwo kubaga rushobora guhinduka vuba cyane, bisaba titre yukuri, yihuse yingaruka zibiyobyabwenge. Kwinjiza bisanzwe ntibishobora kongera umuvuduko wibiyobyabwenge byihuse kugirango habeho kwiyongera gutunguranye kubyuka cyangwa kugabanya umuvuduko mwinshi bihagije kugirango ubaze ibihe byo gukanguka gake. Kwinjiza bisanzwe ntibishobora no gukomeza kwibanda ku biyobyabwenge muri plasma cyangwa ubwonko mugihe cyo guhorana imbaraga. Mugushyiramo moderi ya PK, sisitemu ya TCI irashobora kwihutira gutanga igisubizo nkibikenewe kandi kimwe no gukomeza kwibanda kumurongo mugihe gikwiye. Inyungu zishobora kuvurwa kubavuzi nizindi nyito zerekana ingaruka zibiyobyabwenge.3

Muri iri suzuma, turasobanura amahame ya PK ya TCI, iterambere rya sisitemu ya TCI, nibibazo bya tekiniki namabwiriza byakemuwe mugutezimbere prototype. Ingingo ebyiri ziherekeza ingingo zisubiramo zikubiyemo imikoreshereze yisi yose nibibazo byumutekano bijyanye n'ikoranabuhanga.4,5

Nkuko sisitemu ya TCI yagiye ihinduka, abashakashatsi bahisemo imvugo idasanzwe yuburyo bukoreshwa. Sisitemu ya TCI yavuzwe ko ifashijwe na mudasobwa yose hamwe anesthesia ya IV (CATIA), titre 6 ya agent ya IV na mudasobwa (TIAC), 7 ifashwa na mudasobwa ikomeza kwinjizwamo (CACI), 8 na pompe yinjizwa na mudasobwa.9 Nyuma yigitekerezo. na Iain Glen, White na Kenny bakoresheje ijambo TCI mu bitabo byabo nyuma ya 1992. Haje kumvikana mu 1997 mu bashakashatsi bakoraga ko ijambo TCI ryakoreshwa nk'ibisobanuro rusange by'ikoranabuhanga.10