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Umlando Wokufakwa Kokulawulwa Okuqondiwe

Ukufakwa okulawulwa yinhloso (I-TCI) kuyindlela yokufaka imithi ye-IV ukuze kufezwe ukuhlushwa kwemithi okuchazwe ngumsebenzisi ("okuhlosiwe") engxenyeni ethile yomzimba noma izicubu ezithakaselwayo. Kulesi sibuyekezo, sichaza izimiso ze-pharmacokinetic ze-TCI, ukuthuthukiswa kwezinhlelo ze-TCI, kanye nezinkinga zobuchwepheshe nezomthetho ezibhekiswe ekuthuthukisweni kwe-prototype. Siphinde sichaze ukuqaliswa kwezinhlelo zamanje ezitholakalayo emitholampilo.

Umgomo wazo zonke izinhlobo zokulethwa kwemithi ukufeza nokugcina isikhathi sokwelapha somphumela wemithi, ngenkathi kugwenywa imiphumela emibi. Imithi ye-IV ivame ukunikezwa kusetshenziswa iziqondiso zokulinganisa ezijwayelekile. Ngokuvamile i-covariate yesiguli kuphela efakwa kumthamo yisilinganiso sobukhulu besiguli, ngokuvamile isisindo semithi yokubulala izinzwa ye-IV. Izici zesiguli ezifana nobudala, ubulili, noma imvume ye-creatinine ngokuvamile azifakwa ngenxa yobudlelwano obuyinkimbinkimbi bezibalo balezi zinto ezihlanganisiwe nomthamo. Ngokomlando kube nezindlela ezimbili zokunikeza imithi ye-IV ngesikhathi sokubulala izinzwa: umthamo we-bolus kanye nokufakwa okuqhubekayo. Imithamo ye-bolus ivame ukunikezwa ngesirinji esiphathwa ngesandla. Imithamo ivame ukunikezwa ngepompo yokufaka.

Yonke imithi yokubulala izinzwa iqoqana ezicutshini ngesikhathi sokulethwa kwemithi. Lokhu kuqongelela kuphazamisa ubudlelwano phakathi kwesilinganiso sokufakwa esibekwe udokotela kanye nokuhlushwa kwemithi esigulini. Izinga lokufakwa kwe-propofol elingu-100 μg/kg/min lihlotshaniswa nesiguli esicishe siphaphame imizuzu emi-3 siqalile ukufakwa kanye nesiguli esithobe kakhulu noma esilele emahoreni ama-2 kamuva. Ngokusebenzisa izimiso ze-pharmacokinetic (PK) eziqondwa kahle, amakhompyutha angakwazi ukubala ukuthi ingakanani imithi eqongelelwe ezicutshini ngesikhathi sokufakwa futhi angalungisa izinga lokufakwa ukuze alondoloze ukuhlushwa okuzinzile ku-plasma noma ezicutshini ezithandekayo, ngokuvamile ebuchosheni. Ikhompyutha iyakwazi ukusebenzisa imodeli engcono kakhulu evela ezincwadini, ngoba ubunzima bezibalo bokufaka izici zesiguli (isisindo, ukuphakama, ubudala, ubulili, kanye nama-biomarker engeziwe) yizibalo ezincane zekhompyutha.1,2 Lesi yisisekelo sohlobo lwesithathu lokulethwa kwemithi yokubulala izinzwa, ukuhlushwa okulawulwa yithagethi (TCI). Ngezinhlelo ze-TCI, udokotela ungena ekuhlushweni okufunwa yithagethi. Ikhompyutha ibala inani lomuthi, olethwa njengama-boluse nama-infusion, adingekayo ukuze kufezwe ukuhlushwa okuqondiwe futhi iqondise iphampu yokufaka ukuze inikeze i-bolus noma i-infusion ebaliwe. Ikhompyutha ibala njalo ukuthi ingakanani umuthi osezicutshini nokuthi lokho kuthonya kanjani inani lomuthi elidingekayo ukuze kufezwe ukuhlushwa okuqondiwe ngokusebenzisa imodeli yama-PK omuthi okhethiwe kanye nesiguli esihambisana nawo.

Ngesikhathi sokuhlinzwa, izinga lokuvuselelwa kokuhlinzwa lingashintsha ngokushesha kakhulu, kudinga ukushintshwa okuqondile nokusheshayo komphumela wesidakamizwa. Ukushintshwa okuvamile akukwazi ukwandisa ukugxilwa kwemithi ngokushesha ngokwanele ukubala ukwanda okusheshayo kokushintshwa noma ukwehla kokugxilwa ngokushesha ngokwanele ukubala izikhathi zokushintshwa okuphansi. Ukushintshwa okuvamile akukwazi ngisho nokugcina ukugxilwa kwemithi okuzinzile eplasma noma ebuchosheni ngezikhathi zokushintshwa okuqhubekayo. Ngokufaka amamodeli e-PK, izinhlelo ze-TCI zingashesha ukuphendula ngokusheshisa njengoba kudingeka futhi ngokufanayo zigcine ukugxilwa okuzinzile lapho kufanele. Inzuzo engaba khona kodokotela ukushintshwa okunembile komphumela wesidakamizwa sokubulala izinzwa.3

Kulesi sibuyekezo, sichaza izimiso ze-PK ze-TCI, ukuthuthukiswa kwezinhlelo ze-TCI, kanye nezinkinga zobuchwepheshe nezomthetho ezibhekiswe ekuthuthukisweni kwama-prototype. Izihloko ezimbili zokubuyekezwa ezihambisana nazo zimboza izinkinga zokusetshenziswa nokuphepha zomhlaba wonke ezihlobene nalobu buchwepheshe.4,5

Njengoba izinhlelo ze-TCI zazithuthuka, abacwaningi bakhetha amagama ahlukile kule ndlela. Izinhlelo ze-TCI zibizwa ngokuthi i-computer-assisted total IV anesthesia (CATIA), i-6 titration of IV agents by computer (TIAC), i-7 computer-assisted continuous infusion (CACI), i-8 kanye ne-computer-controlled infusion pump.9 Ngemva kwesiphakamiso sika-Iain Glen, uWhite noKenny basebenzise igama elithi TCI ezincwadini zabo ngemva kuka-1992. Kwafinyelelwa esivumelwaneni ngo-1997 phakathi kwabacwaningi abasebenzayo sokuthi igama elithi TCI lithathwe njengencazelo ejwayelekile yobuchwepheshe.10