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Imbali yeThagethi-eLawulwayo kokuTyelwa

Ukufakwa okulawulwayo ekujoliswe kuko (TCI) bubuchule bokufaka amachiza e-IV ukuphumeza ugcino lwechiza oluchazwe ngumsebenzisi (“ithagethi”) kwindawo ethile yomzimba okanye kwithishu enomdla. Kolu hlaziyo, sichaza imigaqo ye-pharmacokinetic ye-TCI, ukuphuhliswa kweenkqubo ze-TCI, kunye nemiba yobugcisa kunye nolawulo olubhekiswe kuphuhliso lweprototype. Sikwachaza nokuqaliswa kweenkqubo ezikhoyo ngoku kwikliniki.

Injongo yalo lonke uhlobo lokunikezelwa kweziyobisi kukuphumeza nokugcina ixesha lonyango lwesiphumo seziyobisi, ngelixa uphepha iziphumo ezibi. Amachiza e-IV adla ngokunikezelwa kusetyenziswa izikhokelo zokudosa ezisemgangathweni. Ngokuqhelekileyo ekuphela kwe-covariate yesigulana esidityaniswe kwidosi yimetric yobungakanani besigulane, ngokuqhelekileyo ubunzima be-IV anesthetics. Iimpawu zesigulana ezifana nobudala, isondo, okanye imvume ye-creatinine zihlala zingabandakanywa ngenxa yobudlelwane obunzima bemathematika kwezi covariates kwidosi. Ngokomlando kukho iindlela ze-2 zokulawula iziyobisi ze-IV ngexesha le-anesthesia: i-bolus dose kunye nokunyuswa okuqhubekayo. Iidosi zeBolus zidla ngokusetyenziswa ngesirinji ephathwa ngesandla. I-infusions idla ngokusetyenziswa ngempompo yokufakelwa.

Lonke iyeza lokuthomalalisa liqokelelana kwithishu ngexesha lokuhanjiswa kwechiza. Oku kuqokelelana kubhidanisa ubudlelwane phakathi kwezinga lokugalela elisekwe ngugqirha kunye nokuxinana kweziyobisi kwisigulana. Umlinganiselo we-propofol we-infusion ye-100 μg / kg / min idibaniswa nesigulane esiphantse siphaphame imizuzu ye-3 kwi-infusion kunye nesigulane esinesigxina okanye esileleyo kwiiyure ze-2 kamva. Ngokusebenzisa imigaqo ye-pharmacokinetic (PK) eqondwa kakuhle, iikhomputha zinokubala ukuba lingakanani iyeza eliye laqokelelwa kwiithishu ngexesha lokungena kwaye zinokuhlengahlengisa izinga lokungena ukuze kugcinwe ukugxila okuzinzile kwiplasma okanye kwizicubu ezinomdla, ngokuqhelekileyo ingqondo. Ikhomputha iyakwazi ukusebenzisa imodeli engcono kakhulu kwiincwadi, kuba ubunzima bemathematika bokufaka iimpawu zesigulane (ubunzima, ubude, ubudala, isondo, kunye ne-biomarkers ezongezelelweyo) zizibalo ezincinci zekhompyutheni.1,2 Esi siseko se uhlobo lwesithathu lonikezelo lweyeza le-anesthetic, i-target-controlled infusions (TCI). Ngeenkqubo ze-TCI, ugqirha ungena kwindawo ekugxilwe kuyo ekujoliswe kuyo. Ikhomputha ibala inani lechiza, elihanjiswa njenge-boluses kunye ne-infusions, efunekayo ukufezekisa ugxininiso olujoliswe kuyo kwaye iqondise impompo yokufakela ukuhambisa i-bolus okanye i-infusions. Ikhompyuter ibala rhoqo ukuba lingakanani ichiza elikwithishu kunye nendlela elichaphazela ngayo inani lechiza elifunekayo ukufezekisa ugxininiso ekujoliswe kulo ngokusebenzisa imodeli ye-PKs yechiza elikhethiweyo kunye nesigulane covariates.

Ngexesha lotyando, inqanaba lokuvuselela utyando lingatshintsha ngokukhawuleza, lifuna ukuchaneka, ukunyanzeliswa ngokukhawuleza kwesiphumo seziyobisi. I-infusions eqhelekileyo ayinako ukunyusa ugxininiso lwechiza ngokukhawuleza ngokwaneleyo ukuxela ukunyuka okukhawulezileyo ekuvuseleleni okanye ukunciphisa ukugxila ngokukhawuleza ngokwaneleyo ukuphendula ixesha lokuvuselela okuphantsi. Ukufakwa okuqhelekileyo kweziyobisi akukwazi nokugcina ukugxilwa kweziyobisi kwi-plasma okanye ingqondo ngexesha lokuvuselela rhoqo. Ngokubandakanya iimodeli ze-PK, iinkqubo ze-TCI zinokukhawuleza ukuphendula ngokukhawuleza njengoko kuyimfuneko kwaye ngokufanayo zigcine ukugxila okuzinzileyo xa kufanelekile. Inzuzo enokubakho koogqirha yeyona nto ichanekileyo yesiphumo seyeza le-anesthetic.3

Kolu hlaziyo, sichaza imigaqo ye-PK ye-TCI, ukuphuhliswa kweenkqubo ze-TCI, kunye nemiba yobugcisa kunye nokulawula ebhekiswe kuphuhliso lweprototype. Amanqaku amabini okuphonononga ahambelanayo aquka ukusetyenziswa kwehlabathi kunye nemiba yokhuseleko ehambelana nale teknoloji.4,5

Njengoko iinkqubo ze-TCI zavela, abaphandi bakhetha amagama angabonakaliyo kwindlela yokusebenza. Iinkqubo ze-TCI zibizwa ngokuba yi-computer-assisted total IV anesthesia (CATIA), i-6 titration of IV agents by computer (TIAC), i-7 computer-assisted infusion infusion (CACI),8 kunye ne-computer-controlled infusion pump.9 Ukulandela isiphakamiso ngu-Iain Glen, White noKenny basebenzisa igama elithi TCI kupapasho lwabo emva ko-1992. Kwafikelelwa kwimvumelwano ngo-1997 phakathi kwabaphandi abasebenzayo ukuba igama elithi TCI lamkelwe njengengcaciso eqhelekileyo yeteknoloji.10