Amakuru

Amateka y'uburyo bwo gutera umuti ugenzurwa n'intego

Gutera umuti ugenzurwa n'intego (TCI) ni uburyo bwo gushyiramo imiti ya IV kugira ngo hagerwe ku rugero rw’umukoresha (“intego”) rw’imiti mu gice runaka cy’umubiri cyangwa ingingo runaka ishimishije. Muri iri suzuma, turasobanura amahame agenga imiti ya TCI, iterambere rya sisitemu za TCI, n’ibibazo bya tekiniki n’amategeko byitabwaho mu guteza imbere imiterere y’imashini. Turasobanura kandi uburyo sisitemu ziboneka ubu mu buvuzi.

Intego ya buri bwoko bw'imiti itangwa ni ukugera no gukomeza igihe cyo kuvura ingaruka z'imiti, mu gihe hirindwa ingaruka mbi. Imiti ikoreshwa mu mibonano mpuzabitsina itangwa hakoreshejwe amabwiriza asanzwe yo kuyikoresha. Ubusanzwe, covariate y'umurwayi ishyirwa mu gipimo ni igipimo cy'ingano y'umurwayi, akenshi uburemere bw'imiti ikoreshwa mu mibonano mpuzabitsina. Imiterere y'umurwayi nk'imyaka, igitsina, cyangwa creatinine clearance akenshi ntishyirwamo kubera isano ikomeye y'imibare hagati y'iyi miti n'umuti. Mu mateka habayeho uburyo bubiri bwo gutanga imiti ikoreshwa mu mibonano mpuzabitsina mu gihe cyo kuruhuka: dose ya bolus n'imiti ikoreshwa mu mibonano mpuzabitsina. Dose ya bolus ikoreshwa mu mashini ifata mu ntoki. Imiti ikoreshwa mu mibonano mpuzabitsina ikoreshwa mu mashini ifata mu minwe. Imiti ikoreshwa mu mibonano mpuzabitsina ikoreshwa mu mashini ifata mu minwe. Imiti ikoreshwa mu mibonano mpuzabitsina ikoreshwa mu mashini ifata mu mibonano mpuzabitsina ikoresheje pompe ikoreshwa mu mashini ifata mu mibonano mpuzabitsina.

Buri muti utera uburibwe wirundanya mu ngingo mu gihe cyo gutanga umuti. Uku gukusanya bivanga isano iri hagati y’igipimo cy’umuti uterwa n’umuganga n’ingano y’umuti mu murwayi. Igipimo cy’umuti uterwa na propofol cya 100 μg/kg/min gifitanye isano n’umurwayi uri hafi gukanguka iminota 3 nyuma yo guhabwa umuti n’umurwayi usinziriye cyane cyangwa usinziriye nyuma y’amasaha 2. Binyuze mu mahame y’imiti (PK) yumvikana neza, mudasobwa zishobora kubara ingano y’umuti wirundanyije mu ngingo mu gihe cyo gutanga umuti kandi zishobora guhindura igipimo cy’umuti kugira ngo zigumane igipimo gihamye mu maraso cyangwa mu ngingo zishishikaje, cyane cyane mu bwonko. Mudasobwa irashobora gukoresha icyitegererezo cyiza cyo mu nyandiko, kuko uburyo bwo gushyiramo imiterere y’umurwayi (uburemere, uburebure, imyaka, igitsina, n’ibindi bipimo by’inyongera) ari imibare yoroheje kuri mudasobwa.1,2 Iyi ni yo shingiro ry’ubwoko bwa gatatu bw’imiti itera uburibwe, itera uburibwe bugenzurwa n’intego (TCI). Hamwe na sisitemu za TCI, umuganga yinjira mu cyiciro cyifuzwa. Mudasobwa ibara ingano y'umuti, utangwa nk'imiti n'imiti ikoreshwa mu gutera umuti, ikenewe kugira ngo igere ku rugero rw'umuti wifuzwa kandi ikayobora ipompo yo gutera umuti kugira ngo itange umuti wifuzwa. Mudasobwa ihora ibara ingano y'umuti uri mu mubiri n'uburyo bigira ingaruka ku rugero rw'umuti ukenewe kugira ngo igere ku rugero rw'umuti wifuzwa ikoresheje icyitegererezo cya PK z'umuti watoranijwe n'umurwayi.

Mu gihe cyo kubaga, urwego rw'ibikorwa byo kubaga rushobora guhinduka vuba cyane, bigasaba ko umuti utera neza kandi vuba. Gutera imiti mu buryo busanzwe ntibishobora kongera urugero rw'imiti vuba bihagije kugira ngo bisobanure ukwiyongera gutunguranye kw'ibikorwa byo kubaga cyangwa kugabanya urugero rw'imiti vuba bihagije kugira ngo bisobanure igihe cyo kubaga gito. Gutera imiti mu buryo busanzwe ntibishobora no gukomeza urugero rw'imiti mu maraso cyangwa mu bwonko mu gihe cyo kubaga kenshi. Mu gushyiramo uburyo bwa PK, sisitemu za TCI zishobora kongera vuba uburyo bwo kubaga uko bikenewe kandi zigakomeza kwiyongera igihe bibaye ngombwa. Inyungu ishobora ku baganga ni ugutera neza uburyo imiti itera uburibwe ikora neza.3

Muri iri suzuma, turasobanura amahame ya PK ya TCI, iterambere rya sisitemu za TCI, n'ibibazo bya tekiniki n'amategeko byitabwaho mu itegurwa ry'ingero. Ingingo ebyiri z'isuzuma zivuga ku bibazo by'imikoreshereze n'umutekano ku isi bifitanye isano n'iri koranabuhanga.4,5

Uko sisitemu za TCI zagendaga zihinduka, abashakashatsi bahisemo amagambo adasanzwe mu buryo bw'ikoranabuhanga. Sisitemu za TCI zagiye zitwa anesthesia ya IV ifashijwe na mudasobwa (CATIA), 6 titration y'ibikoresho bya IV hakoreshejwe mudasobwa (TIAC), 7 computer-assisted continuous infusion (CACI), 8 na mudasobwa-controlled infusion pump.9 Nyuma y'igitekerezo cya Iain Glen, White na Kenny bakoresheje ijambo TCI mu bitabo byabo nyuma ya 1992. Mu 1997, abashakashatsi bagaragaje ko ijambo TCI rigomba gufatwa nk'igisobanuro rusange cy'ikoranabuhanga.10