2017年9月 第32卷 第3期

主管:中华人民共和国教育部
主办:中山大学
承办:中山大学中山眼科中心
主编:葛坚 刘奕志
论著

医护一体化管理模式在眼底病中心日间病房的应用

Application of the medical integration mode in the day ward of ophthalmic fundus center

:148-151
 
目的:探讨医护一体化管理模式在眼底病中心日间病房中的应用与成效。方法:2015年6月至2016年6月于眼底病中心实行医护一体化管理模式,通过问卷调查比较实施前后医生和患者对护理工作的满意度。结果:医护一体化管理模式实行后,医生满意度显著提高,差异有统计学意义(t=?4.412,P<0.01),患者满意度有所提高,差异有统计学意义(t=2.592,P=0.01)。结论:采用医护一体化管理模式对眼底病日间手术住院患者进行管理,加强医护沟通,可有效提高护理质量,保障患者医疗、护理的安全性。
Objective: To explore the effect of the medical integration mode applying in the day ward of ophthalmic clinical key specialty. Methods: The ophthalmic fundus center started to carry out the medical integration mode from June 2015 to June 2016. Doctors’ and patients’ satisfaction towards nurses were surveyed before and after the implementation. Results: The doctors’ satisfaction towards nurses was statistically higher than before (t=?4.412, P<0.01). TTe patients’ satisfaction also improved, and the difference was statistically signiffcant (t=2.592, P=0.01). Conclusion: The medical integration mode strengthens the communication with doctors and patients, improves the nursing quality, and ensures the medical safety.

缺氧诱导因子-1信号通路在高眼压模型中的表达

Expression of HIF-1 signaling pathway in the intraocular hypertension model of rats

:125-133
 
目的:研究缺氧诱导因子-1(hypoxia inducible factor-1,HIF-1)信号通路在高眼压状态下的表达情况。方法:利用前房注射磁性微球法建立大鼠高眼压动物模型,通过荧光金逆行标记观察视网膜神经节细胞(retinal ganglion cells,RGCs)的存活情况,提取视网膜组织行Western印迹检测HIF-1α、血管内皮生长因子-A(vascular endothelial growth factor A,VEGF-A)-和促红细胞生成素
(erythropoietin,EPO)的表达,并分析HIF-1α的变化趋势与眼压之间的关系。结果:高眼压1 d时平均眼压为(40.33±2.94) mmHg,第3天为(68.83±2.85) mmHg,第10天时下降至(43.67±3.67) mmHg,后趋于稳定,与对照眼相比差异均有统计学意义(P<0.01)。高眼压2周时中央、中间和周边视网膜的RGCs存活率分别为61.1%±1.1%,68.5%±8.5%和73.6±3.6%,至高眼压3周迅速下降,分别为33.2%±3.2%,43.4%±3.4%和51.4%±2.1%。高眼压3 d时,眼压值达最高,HIF-1α,VEGF-A和EPO的表达亦达高峰,与对照组相比差异均有统计学意义(P<0.01);后随着眼压值下降,表达也随之逐渐减少。眼压升高3 d,7 d,2周分别与对照组的HIF-1α/GAPDH的蛋白灰度比和眼压值间的相关系数为0.977,0.886,0.763,差异具有统计学意义(P<0.01)。结论:HIF-1α的表达在一定条件下与眼压值呈正相关,该通路的早期激活可能在高眼压病程中扮演重要的角色。
Objective: To evaluate the expression of hypoxia inducible factor-1 (HIF-1) signaling pathway in the state of intraocular hypertension. Methods: We established an intraocular hypertension model of BN rats model of BN rats through the injection of magnetic microspheres into anterior chamber angle, and then evaluated this  model by measuring the survival rates of retinal ganglion cells (RGCs) through retrograde Fluorogold labelling. Western blot was used to detect the protein expression of HIF-1α, vascular endothelial growth factor A (VEGF-A) and erythropoietin (EPO) in the retinal tissue, and HIF-1α protein’s alterable trend as well as its relationship with intraocular pressure (IOP) was analyzed. Results: The IOP was (40.33±2.94) mmHg at the ffrst day affer elevation, (68.83±2.85) mmHg at the third day, and (43.67±2.94) mmHg at the tenth day, then kept stable later. TTe survival rates of RGCs among central, middle and peripheral retina decreased from 61.1%±1.6%, 68.5%±2.0%, 73.6%±1.5%, at the second week to 33.2%±1.8%, 43.4%±2.4%, 51.4%±2.1% at the third week, the differences were statistically signiffcant (P<0.01). The protein expression of HIF-1α, VEGF-A and EPO reached the peak at the third day when the IOP was at the highest level, then decreased with the drop of IOP. The correlation coefffcient between the protein gray value of HIF-1α/GAPDH and IOP among the 3rd day, 7th day, 2 weeks and the control was 0.977, 0.886, 0.763 respectively (P<0.01). Conclusion: The expression of HIF-1α had a positive relationship with IOP in certain condition, and the early activation of HIF-1 signaling pathway might play an important role in the process of glaucoma.

眼科全身麻醉手术患儿的个性化护理

Individual nursing on ophthalmic children under general anesthesia operation

:152-155
 
目的:探讨个性化护理在眼科患儿全身麻醉手术中的应用效果。方法:选取于2015年7月至2016年8月中山大学附属第一医院收治的50例眼科全身麻醉手术患儿,按手术例数单、双号顺序分组,单 数为对照组,采用传统常规护理,双数为观察组,采用个性化护理。比较两组麻醉配合度与家属对护理满意度。结果:50例患儿手术顺利。对照组在麻醉及复苏过程出现烦躁与躁动情况的患儿18例,观察组为3例,对照组明显高于观察组;观察组麻醉配合度与家属对护理满意度明显高于对照组,差异均有统计学意义(P<0.05)。结论:眼科全身麻醉手术患儿运用个性化护理,可改善患儿心理状态,提高配合度,增加患儿家属的满意度。
Objective: To detect the effect of individualized nursing on ophthalmic children under general anesthesia operation. Methods: Ophthalmic children under general anesthesia operation in First Afifliated Hospital of Sun Yat-sen University were included from July 2015 to August 2016. All of children were divided into odd and even groups by the operation sequence number. The children with odd numbers were in control group and accepted traditional nursing. The children with even numbers were in experimental group and accepted individualized nursing. Anesthesia cooperation degree and family members’ satisfaction on nursing were compared between the two groups. Results: Fifty operations were proceeded successfully. 18 children appeared irritability and restlessness during anesthesia and recovery process in the control group. Irritability and restlessness were only showed in 3 children in the experimental group. The satisfaction in experimental group was much higher than  the control group, the differences were statistically signiffcant (P<0.05). Conclusion: Individualized nursing can improve the mental state and the degree of cooperation. It can also improve family members’ satisfaction.  

大批量白内障扶贫手术的手术器械管理

Management of surgical equipment in large quantities of cataract poverty alleviation surgery

:167-170
 
目的:探讨下乡行大批量白内障扶贫手术的手术器械管理方法。方法:对大批量白内障扶贫手术专用的眼科器械实施规范化管理流程,运输过程严格保护,并培训当地护理人员、定人定岗,实行责任制管理,对清洗流程的质量检测及术中严格的无菌操作把控,确保手术安全进行。结果:眼科手术器械得到规范处理和保养,基层护理人员的规范培训提升其对眼科手术器械处理的能力。结论:建立下乡扶贫规范化的手术器械管理流程和培训制度,是大批量白内障扶贫手术顺利完成的基础保障。
Objective: To investigate the methods of management of surgical equipment in large quantities of cataract poverty alleviation surgery for the countryside patients. Methods: The standardized management of cataract poverty alleviation surgery was implented, the ophthalmic equipment on the transport was strictly protected, and nursing training, fixed posts, responsibility system management, cleaning process quality testing and aseptic control were performed to ensure the safety of operation. Results: The processing and maintenance of the surgical equipment were standardized. Nursing training enhanced their ability to manage ophthalmic surgical equipment. Conclusion: A standardized system of surgical equipment management guarantees the successful completion of large quantities of cataract poverty alleviation surgery.

表格式护理记录单在眼底病中心日间病房精细化管理的应用

Application of eye nursing record sheets in the fine management of ophthalmic fundus center

:156-160
 
目的:自行设计并应用眼科表格式护理记录单,探讨眼科日间病房精细化护理管理工作的方法。方法:于中山大学中山眼科中心眼底病中心,根据日间手术流程,设计和运用眼底病中心24 h出入院护理记录单、眼底病中心日间病房交班记录单和眼底病中心日间病房手术记录单,书写方法基本以打勾、数字或简单文字记录为主。结果:新的表格式护理记录单大大节省护理记录和交班时间,提高护理工作效率,得到临床护理人员的广泛认可,提高医护对护理工作的满意度。结论:突出专科特色的表格式护理记录单能统一规范临床护理工作,提高护理工作效率和护理质量,保障护患安全,落实精细化护理管理。
Objective: To explore ffne management method of day ward in ocular department, through applying self-designed table format of eye nursing records. Methods: According to the day surgery process, the tables of 24-h nursing records and shifting records and surgery records were designed and applied to day ward of the ophthalmic fundus center. The basic writing methods included ticking, number and filling in the blanks. Results: The new nursing records tables decreased the time consumed in recording and shifting, improving the work efficiency, accepted widely by clinical staffs. Conclusion: The new table format with highlight of special features of the nursing records can unify and standard the clinical nursing work, improve the nursing work efficiency and nursing quality, ensure patients’ safety, and implement fine management. 

Smart plug泪小管塞治疗水液缺乏型干眼的长期并发症

Long-term complications of Smart plug insertion in the treatment of aqueous tear deficiency dry eye

:134-137
 
目的:评估Smart plug泪小管塞治疗水液缺乏型干眼的长期并发症。方法:收集汕头国际眼科中心2011至2016年门诊确诊的水液缺乏型干眼患者300例(600眼),进行Smart plug泪小管塞治疗,随访观察术后临床并发症,中位随访时间为术后3年(术后1~5年)。结果:3例患者(3眼)术后患有泪小管炎(0.5%),发病时间为术后1~3(中位2)年,取出泪小管塞后并给予局部抗生素滴眼液治愈。2例患者 (4眼)因植入上下泪小管塞后流泪症状不能耐受,单纯取出下泪小管塞后症状缓解(0.7%);4例患者(8眼)因只植入下泪小管塞症状未能明显好转,1个月后再次植入上泪小管塞(1.3%);291例患者干眼主观症状改善,有效率为97.5%,长期随访未发现并发症。结论:虽然Smart plug泪小管塞治疗水液 缺乏型干眼具有明确的疗效,但Smart plug泪小管塞植入后的长期并发症不容忽视,需要长期观察。
Objective: To evaluate the long-term complication associated with the use of the Smart plug in the treatment of aqueous tear deficiency dry eye. Methods: A total of 300 patients (600 eyes) were collected in Joint Shantou International Eye Center from 2011 to 2016, all the patients accepted the treatment with Smart plug, and were followed up for clinical complications. The median follow-up time was postoperative 3 years (1–5 years after surgery). Results: Three patients (3 eyes) developed canaliculitis, the rate was 0.5%. The median time from Smart plug insertion to the onset of canaliculitis was 2 (1–3) years, leaving the Smart plug and resolved the application of topical antibiotics. Two patients (4 eyes) could not suffer from implantation of the upper and lower Smart plug, removed the below, the ratio was 0.7%; 4 patients (8 eyes) need upper Smart plug insertion after implantation of the lower one month later, the rate was 1.3%; 291 cases of dry eye improved by long-term followup, the effective rate was 97.5%. Conclusion: Although the Smart plug is effective in the treatment of aqueous tear deffciency dry eye, the later complications of Smart plug insertion cannot be neglected and need the long-term follow-up.

不同病变阶段中心性晕轮状视网膜脉络膜萎缩的临床表现

Fundus ffuorescein angiography in different stages of central areolar choroidal dystrophy

:138-142
 
目的:探讨中心性晕轮状视网膜脉络膜萎缩不同病变阶段的眼底影像学特征。方法:回顾分析中心性晕轮状视网膜脉络膜萎缩患者眼部检查及眼底荧光血管造影(fundus fluorescein angiography,FFA)检查,分析不同病变阶段荧光素眼底血管造影的影像学特征,总结该病发展转归的临床规律。结果:I期:眼底彩色照相:黄斑区轻度色素紊乱,可累及或未累及中心凹。FFA示:中心凹附近高荧光,RPE和脉络膜毛细血管的萎缩面积及程度尚不足以透见下方粗大的脉络膜血管。II期:眼底可见一类圆形的低色素区域,荧光造影可见与眼底彩照对应的高荧光区,随造影过程延长可见萎缩区荧光素渗漏。III期:黄斑区萎缩灶外围边界模糊,其中可见一部分边界清晰、稳定的完全萎缩灶。FFA:萎缩灶内边界清晰的部分视网膜色素上皮细胞(retinal pigment epithelium,RPE)及脉络膜完全萎缩,周边在造影晚期可见未完全萎缩的脉络膜毛细血管渗漏区域。IV期:黄斑区边界清晰的视网膜脉络膜萎缩灶,黄斑中心凹累及。FFA可见与眼底像相对应的脉络膜萎缩灶,其中可透见粗大的脉络膜血管。周围部分未见活动性荧光素渗漏,病变稳定。结论:荧光素眼底血管造影能反映的脉络膜萎缩程度是不同阶段病变阶段的主要指标。
Objective: To investigate the imaging features of fundus fluorescein angiography in central areolar choroidal dystrophy at different stages. Methods: Ocular examination and fundus fluorescein angiography were carried out, imaging features of fundus ffuorescein angiography were retrospectively analyzed. Results: Stage I: fundus photography showed mild macular pigment disorders, which was involved with the fovea. Fundus fluorescein angiography (FFA): high fluorescence was close to the fovea, the area and the extent of RPE and choroidal capillaries atrophy were insufffcient to see through the thick choroidal vessels beneath. Stage II: fundus showed a round of low pigment area, fluorescein angiography showed high fluorescence corresponding region, with the angiography procedure the ffuorescein leakage could be observed. Stage III: boundaries of macular atrophy lesions were unclear which showed part of a clear boundary, stable completely atrophy lesions. FFA: part of retinal pigment epithelium (RPE) and choroidal uncompletely atrophy surrounded was visible, in the late of angiography choroidal atrophy capillary leakage could be seen. Stage IV: boundary of macular retinal choroidal atrophy was clear, foveal involvement. FFA: choroidal atrophy lesions were clear which could be seen through the thick choroidal vessels. Fluorescein leakage disappeared and the disease was stable. Conclusion: The extend of choroidal atrophy in fundus ffuorescein angiography is an important indictor reflecting the progression of different stages. 

门诊重症疑难眼病的会诊现状

Present situation of the consultation for severe eye disease in outpatients

:161-166
 
目的:了解中山大学中山眼科医院门诊重症疑难眼病会诊的现状,探讨门诊重症疑难眼病会诊亚专科的分布情况及会诊效果,为建立科学的门诊重症疑难眼病会诊体系提供支持和依据,同时也为合理安排会诊流程提供依据。方法:对中山大学中山眼科医院2016年3月至2017年4月收集的265例门诊重症疑难病例,通过时间、地区、性别、年龄、会诊原因、会诊亚专科、会诊后的转归及效果等方面进行统计分析,所有数据均通过Excel软件进行录入,根据分析目的和资料的类型,采用相应的统计指标进行描述,并进行统计推断,检验水准为α=0.05。结果:2016年3月至2017年4月期间中山大学中山眼科医院门诊重症疑难眼病会诊人数265例。在地区分布中,广东省地区最多,为145例,外国最少,为3例。人群分布中,男167例,女98例,男女比例为1.70:1。年龄分布中,30~44岁及45~59岁的病例数最多,均为53例(20%),70岁以上老年病例最少,为13例(4.9%)。中山大学中山眼科医院门诊重症疑难眼病会诊中,2016年3月至2017年4月期间,各眼科亚专科共参加会诊714次,眼底外科参加会诊次数最多,为147次(20.5%),结膜科参加会诊的次数最少,为1次(0.1%)。在分析会诊原因方面,因诊治涉及多个专科而会诊的病例数最多,为161例,因病因不明会会诊的病例最少,为20例;会诊后比会诊前明确治疗方案的病例数增加190例。结论:中山大学中山眼科医院门诊组织实施重症疑难眼病会诊使明确治疗方案率大幅提高,在提高疑难眼病治疗效果方面起到一定的促进作用。
Objective: To understand the current situation of the consultation for outpatients with severe eye disease in Zhongshan Ophthalmic Center, and to explore the distribution and effects of sub-specialty consultation for outpatients with severe eye disease. To set up a scientific system of the consultation for outpatients with severe eye disease, and also provide a basis for reasonable arrangement of consultation process. Methods: We analyzed 265 severe cases from March 2016 to April 2017 in Zhongshan Ophthalmic Center by time, region, gender, age, cause of consultation, sub-specialty, and outcomes after consultation. And all data was analyzed by Excel software, according to the purpose and the type of data, and the corresponding statistical index and statistical inference, inspection level for α=0.05. Results: There were 265 cases with severe eye disease from March 2016 to April 2017. As for the regional distribution, Guangdong province was the largest, with 145 cases, while the lowest number was from foreign countries, which was 3 cases. In the population distribution, 167 cases were males, 98 were females and the ratio was 1.70. In age distribution, patients aged from 30 to 44 years and 45 to 59 years predominated and the number of cases were both 53, accounting for 20% of the total number. Patients over 70 were the least which were 13 cases, accounting for 4.9% of the total number. From March 2016 to April 2017, all sub-specialties attended consultation for 714 times, as Ocular Fundus Department attended the most, accounting for 20.5% of the total number while Conjunctive Department attended the least, for only one, accounting for 0.1% of the total number. As for the reason of the consultation, the number of cases involving multiple specialties was the largest, with 161 cases, while the lowest number of cases due to unexplained causes, which were 20 cases. The number of cases of explicit treatment was increased by 190 after consultation. Conclusion: Consultations organized by Zhongshan Ophthalmic Center improves the treatment for outpatients with severe eye disease.

眼外伤门诊急诊与住院病房一体化管理的实践与探讨

Discussion of integrated management of emergency department and wards for patients of ocular trauma

:143-147
 
目的:探讨眼外伤门诊急诊与住院病房一体化管理模式。方法:中山大学中山眼科中心于2015年4月成立眼外伤急诊部,组建眼外伤急诊队伍,实现眼外伤门诊急诊与住院病房一体化管理,即眼外伤患者从门诊到病房的接诊、治疗、随访进行一体化管理,简化急诊诊疗流程,最大限度保证医疗护理质量。结果:眼外伤门诊急诊与住院病房一体化管理模式是一种以患者为中心的新型管理模式。该模式能保障急诊患者诊治的及时性、连贯性;缩短急诊患者就诊到等候手术的时间,提高患者就诊满意度;在保证医疗质量的同时,医护人力资源得到合理高效使用;并取得较好的社会效益与经济效益。结论:眼外伤门诊急诊与住院病房一体化管理模式具备长远发展及推广的价值。
Objective: To discuss the integrated management in emergency department and wards for patients of ocular trauma. Methods: The emergency department and the team were organized in April 2015 to simplify the process of treatment for patients of ocular trauma, and to improve the benefit and outcome for those patients. Results: The integrated management of emergency department and wards for patients of ocular trauma was a new management model focusing upon the benefit of patients. This model could guarantee the timeliness and continuity by reducing waiting time for diagnosis or operations. The integrated model had obvious economic and social benefits by improving quality of care and reasonably using human resource. Conclusion: TTe integrated management model in emergency department and wards for patients of ocular trauma is worthy of further application. 
综述

叶黄素类物质对视觉功能的保护作用及其在青少年视力维护中的应用

Protective effect of xanthophylls on visual function and its application in adolescent vision maintenance

:171-175
 
      叶黄素类物质为膳食类胡萝卜素,主要存在于视网膜组织中,为黄斑色素发挥抗氧化活性和蓝光滤过作用。近年来,有研究证实,叶黄素类物质可降低色差,提高视力及对比敏感度等功能,并对于年龄相关性黄斑变性、视网膜光损伤等疾病具有防治作用。
Xanthophylls is a kind of dietary carotenoid, which is mainly located in retina, and plays an important role in antioxidant and blue light ffltration. Lutein, zeaxanthin and meso-zeaxanthin can enhance visual performance by decreasing chromatic aberration and enhancing contrast sensitivity, and they can also prevent age-related macular degeneration and retinal light-induced injury. 
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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