Te Hītori o te Whaowhia e Whakahaerehia ana e te Whāinga
Te werohanga e whakahaerehia ana e te whāinga (TCI) he tikanga werohanga rongoā IV hei whakatutuki i te kukū rongoā kua tohua e te kaiwhakamahi ("whāinga") ki roto i tētahi wāhanga tinana, kiko rānei e hiahiatia ana. I roto i tēnei arotake, ka whakaahuahia e mātou ngā mātāpono pharmacokinetic o te TCI, te whanaketanga o ngā pūnaha TCI, me ngā take hangarau me ngā take ture e arohia ana i roto i te whanaketanga tauira. Ka whakaahuahia hoki e mātou te whakarewatanga o ngā pūnaha e wātea ana i roto i te rongoā.
Ko te whāinga o ia momo tuku rongoā ko te whakatutuki me te pupuri i te roanga o te pānga rongoā, me te karo i ngā pānga kino. Ko ngā rongoā IV ka hoatuhia mā te whakamahi i ngā aratohu horopeta paerewa. Ko te tikanga ko te tauwehenga tūroro anake e whakaurua ana ki te horopeta ko te ine i te rahi o te tūroro, ko te taumaha mō ngā rongoā whakangote IV. Ko ngā āhuatanga o te tūroro pēnei i te tau, te ira tangata, te whakakorenga creatinine rānei kāore i te whakaurua nā te mea he uaua te whanaungatanga pāngarau o ēnei tauwehenga ki te horopeta. I mua, e rua ngā tikanga mō te tuku rongoā IV i te wā whakangote: te horopeta bolus me te werohanga tonu. Ko ngā horopeta bolus ka tukuna mā te whakamahi i te ngira ringaringa. Ko ngā werohanga ka tukuna mā te whakamahi i te papu werohanga.
Ka kohia ngā rongoā whakangote katoa ki roto i te kiko i te wā e tukuna ana te rongoā. Ka whakapoauau tēnei kohi i te whanaungatanga i waenga i te tere werohanga i whakatakotoria e te tākuta me te kukū o te rongoā ki te tūroro. Ko te tere werohanga propofol o te 100 μg/kg/min e pā ana ki te tūroro tata ara ake i muri i te 3 meneti ki te werohanga me te tūroro tino moe, moe rānei i muri i te 2 hāora. Mā te whakamahi i ngā mātāpono pharmacokinetic (PK) kua mārama pai, ka taea e ngā rorohiko te tatau i te nui o te rongoā kua kohia ki roto i ngā kiko i te wā e werohanga ana, ā, ka taea te whakarerekē i te tere werohanga kia mau tonu te kukū pumau i roto i te plasma, i te kiko rānei e hiahiatia ana, ko te roro te nuinga. Ka taea e te rorohiko te whakamahi i te tauira pai rawa atu mai i ngā tuhinga, nā te mea he iti noa ngā tātaitanga pāngarau o te whakauru i ngā āhuatanga o te tūroro (taumaha, teitei, tau, ira tangata, me ngā tohu koiora tāpiri) mō te rorohiko.1,2 Koinei te pūtake o te tuatoru o ngā momo tuku rongoā whakangote, ngā werohanga e whakahaerehia ana e te ūnga (TCI). Me ngā pūnaha TCI, ka whakauru te tākuta i te kukū ūnga e hiahiatia ana. Ka tatau te rorohiko i te nui o te rongoā, e tukuna ana hei porus me hei werohanga, e hiahiatia ana hei whakatutuki i te kukū ūnga, ā, ka tohutohu i te papu werohanga ki te tuku i te porus kua tatauhia, i te werohanga rānei. Ka tatau tonu te rorohiko i te nui o te rongoā kei roto i te kiko, me te pēhea o te awe o tēnā ki te nui o te rongoā e hiahiatia ana hei whakatutuki i te kukū ūnga mā te whakamahi i tētahi tauira o ngā PK o te rongoā kua tīpakohia me ngā taurangi ōrite o te tūroro.
I te wā pokanga, ka tere te huri o te taumata o te whakaohooho pokanga, me te hiahia kia tika, kia tere te ine i te pānga o te rongoā. Kāore e taea e ngā werohanga tikanga te whakanui ake i te kukū o te rongoā kia tere ai te whakaaro mō te pikinga ohorere o te whakaohooho, te whakaiti rānei i te kukū kia tere ai te whakaaro mō ngā wā o te whakaohooho iti. Kāore e taea e ngā werohanga tikanga te pupuri i te kukū o te rongoā pumau i roto i te toto, i te roro rānei i ngā wā o te whakaohooho tonu. Mā te whakauru i ngā tauira PK, ka taea e ngā pūnaha TCI te ine tere i te urupare e tika ana, ā, ka taea hoki te pupuri i te kukū pumau ina tika. Ko te painga pea ki ngā tākuta ko te ine tika ake o te pānga o te rongoā whakangote.3
I roto i tēnei arotake, ka whakaahuahia e mātou ngā mātāpono PK o te TCI, te whanaketanga o ngā pūnaha TCI, me ngā take hangarau me ngā take ture e arohia ana i roto i te whanaketanga tauira. E rua ngā tuhinga arotake e haere tahi ana me tēnei arotake e kapi ana i ngā take whakamahinga me te haumaru o te ao e pā ana ki tēnei hangarau.4,5
I te whanaketanga o ngā pūnaha TCI, i whiriwhiria e ngā kairangahau ngā kupu motuhake mō te tikanga. Kua kiia ngā pūnaha TCI ko te rorohiko-āwhina katoa IV anesthesia (CATIA),6 te titration o ngā kaihoko IV mā te rorohiko (TIAC),7 te rorohiko-āwhina tonu whaowhia (CACI),8 me te papu whaowhia whakahaeretia e te rorohiko.9 Whai muri i te whakaaro a Iain Glen, i whakamahia e White rāua ko Kenny te kupu TCI i roto i ā rāua tuhinga i muri i te tau 1992. I tae ki te whakaae i te tau 1997 i waenga i ngā kairangahau hohe kia tangohia te kupu TCI hei whakaahuatanga whānui mō te hangarau.10
Wā tuku: Whiringa-ā-rangi-04-2023