本文总结了15例自膨胀水凝胶眶内植入术患儿围手术期的护理要点。术前主要评估患儿是否完善术前检查，给予患儿及其家属个性化的心理护理，进行术前准备以及禁食禁饮的管理。术后主要给予患儿安全管理，饮食、疼痛、眼部用药以及弹力绷带包扎护理，关注有无并发症的发生及给予相应的护理，并对患儿及其家属做好出院指导。15例患儿均顺利完成手术，术后均出现术眼疼痛，2例出现眶压增高，1例出现呕吐，均得到妥善处理。术后随访3~18个月，患儿均获得了较为满意的眼部外观，生活质量得到了提高。
This paper summarized the nursing experience of 15 children with self-expanding hydrogel orbital implantation during perioperative period. Before operation, children were fully evaluated, given with psychological care, preoperative preparation and management of fasting and drinking. After the surgery, the patients were mainly given with safety management, diet, pain, medicine and elastic bandage dressing care. Nurses should pay attention to the occurrence of complications and give corresponding nursing care and offer useful discharge guidance for the children and their parents. All 15 children completed the operation successfully, postoperative eye pain occurred in 15 cases after operation, and the orbital pressure increased in 2 cases, 1 case vomited, and all cases were properly treated. After postoperative follow-up for 3–18 months, 15 children were satisfied with the appearance of the eye,and the life quality was improved.
目的：探索斜视患者手术治疗后的眼表恢复状况。方法：选取2015年1月至2018年6月于如皋市广慈医院接受门诊手术治疗的92例水平性斜视患者为研究对象，共126眼，按照手术切口将患者分为3组，行角膜缘切口的42例52眼患者为A组，行跨肌止端切口的17例19眼患者为B组，行近穹窿切口的33例55眼患者为C组。再根据手术累及肌肉条数将患眼分为3组，行单条眼外肌的29眼手术者为单肌组，行2条眼外肌的42眼手术者为双肌组，行3条眼外肌的21眼手术者为三肌组。比较不同切口类型和肌肉累及数患者的眼表健康恢复时间。结果：A，B，C3组间首次泪膜破裂恢复时间、泪河高度时间差异有统计学意义(P<0.05)；A组首次泪膜破裂恢复时间(14.33±3.26) d和泪河高度时间(14.54±1.58) d显著低于B组和C组，差异具有统计学意义(F=4.876，P=0.032；F=4.612，P=0.036)。单肌组，双肌组及三肌组3组间首次泪膜破裂恢复时间、泪河高度时间差异有统计学意义(P<0.05)；单肌组的首次泪膜破裂恢复时间(13.42±3.57) d和泪河高度时间(8.65±1.62) d显著低于双肌组和三肌组，差异有统计学意义(F=4.975，P=0.028；F=5.024，P=0.025)。结论：手术累及的肌肉数和手术切口类型对术后眼表健康状况具有重要影响，近穹窿切口的手术方式和累及较少肌肉数量有助于患者术后眼部健康状况的恢复。
Objective: To explore the ocular surface recovery after surgical treatment of strabismus patients. Methods: A total of 92 patients (126 eyes) with strabismus who underwent surgery in our hospital from January 2015 to June 2018 were enrolled. The patients were divided into three groups according to the surgical incision, 42 patients (52 eyes)underwent limbal incision were in group A, 17 patients (19 eyes) underwent trans-muscle end-point incision in group B, and 33 patients (55 eyes) underwent proximal hernia incision in group C. According to the number of muscles involved in the operation, the sick eyes of patients were divided into three groups. The 29 eyes with a single extraocular muscle were a single muscle group, the 42 eyes with 2 extraocular muscles were a double muscle group, and the 21-eye treated with 3 extraocular muscles were a three-muscle group. The ocular surface health recovery time of patients with different incision types and muscle involvement were compared. Results: The first tear film rupture recovery time and tear river height time between group A, B, and C were significantly different,and the data were statistically significant (P<0.05); the first tear film rupture recovery time (14.33±3.26) d and tear river height time (14.54±1.58) d in group A were significantly lower than those in group B and C. The data were statistically significant (F=4.876, P=0.032; F=4.612, P=0.036). The first tear film rupture recovery time and tear river height time between the single, double and three muscle groups were significantly different, and the data were statistically significant (P<0.05); the first tear film rupture recovery time (13.42±3.57) d and tear river height time (8.65±1.62) d were significantly lower in the single muscle group than in the double muscle group and the third muscle group. The data were statistically significant (F=4.975, P=0.028; F=5.024, P=0.025). Conclusion:The number of muscles involved in the operation and the type of surgical incision have an important impact on the health of the ocular surface after surgery. The proximal ankle incision and less number of muscles involved would improve the postoperative recovery of eye health.
孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)是一种严重威胁视力的眼部疾病，目前治疗手段以手术为主，手术方式主要有视网膜气体填充术(pneumatic retinopexy,PR)、巩膜扣带术(scleral buckling,SB)以及经睫状体扁平部玻璃体切割术(pars plana vitrectomy,PPV)。目前对于RRD手术术式的选择仍然存在争议，因此研究及制定RRD手术方式抉择的临床策略具有重要的临床意义。而临床上制定RRD患者手术方案往往与患者的年龄、视网膜脱离时间、裂孔的类型、位置、数量、大小等等临床因素有关，该文就影响孔源性视网膜脱离手术抉择的相关临床因素进行综述。
Rhegmatogenous retinal detachment (RRD) is a serious eye disease threatening vision. Surgery is main treatment currently, and surgery approaches include pneumatic retinopexy (PR), scleral buckling (SB), and pars plana vitrectomy(PPV). There is still controversy over the selection of RRD surgery approaches, so it is great significant to study and develop clinical strategies for RRD surgery approaches. The surgical plans for RRD patients are often related to clinical factors, such as the patient’s age, retinal detachment time, type, location, quantity, size, etc. This article reviews the related clinical factors affecting the surgical decision for rhegmatogenous retinal detachment.
术前有效杀灭或减少眼表微生物的数量是降低术后眼内炎的重要措施。聚维酮碘消毒液和妥布霉素均能有效的降低眼科手术术后眼内炎发生率。笔者通过文献报道，综合分析聚维酮碘消毒液及妥布霉素滴眼液及注射液对眼科手术结膜囊微生物的控制能力，为眼科手术术前准备提供理论依据。
Effectively killing or reducing the number of ocular microbes before surgery is an important measure to reduce postoperative endophthalmitis. Both povidone-iodine disinfectant and tobramycin can effectively reduce the incidence of endophthalmitis after ophthalmic surgery. Through literature reports, the author comprehensively analyzes the control ability of povidone-iodine disinfectant and tobramycin eye drops and injection on the microscopy of conjunctival sac in ophthalmic surgery, and provides theoretical basis for preoperative preparation of ophthalmic surgery
目的：探讨先天性瞳孔残膜围手术期的护理方法。方法：对13例(15眼)先天性瞳孔残膜患儿围手术期给予心理护理、安全护理、优先安排术前检查、术后严密观察病情变化、延续性护理并观察其效果。结果：13例(15眼)先天性瞳孔残膜的患儿手术均顺利完成，术后均无出现并发症，其中6例患者术后视力较术前视力有所提高，住院满意度为92.3%(12/13)。结论：对先天性瞳孔残膜患儿围手术期给予针对性的心理护理、安全护理、延续性护理是瞳孔残膜围手术期的有效护理方法。
Objective: To explore the perioperative nursing methods of persistent pupillary membrane. Methods: In the perioperative period, 13 cases (15 eyes) with persistent pupillary membrane were given preoperative nursing care, psychological nursing, careful observation of the change of condition, safety nursing, continuous nursing and observation of its effect. Results: A total of 13 cases (15 eyes) with persistent pupillary membrane were successfully operated, among which 6 cases had improved postoperative visual acuity compared with preoperative visual acuity, and no postoperative complications occurred. The satisfaction rate of hospitalization was 92.3% (12/13). Conclusion: It is an effective nursing method to give psychological nursing, safety nursing and continuous nursing to children with persistent pupillary membrane in perioperative period.
目的：总结全身麻醉斜视矫正日间手术服务模式的创建与安全管理方法。方法：回顾2015年10月至2018年10月期间全身麻醉下行斜视矫正日间手术患者共9 570例。改革护理管理模式，实施医护一体化，在实施过程中对患者进行严密的术前、术后护理管理：术前评估，健康教育前移、加强核查制度、严格监测患者生命体征；术后病情严格交接，家属及患者同步术后指导、离院后回访。结果：全身麻醉斜视矫正日间手术的9 570例患者，均未发生手术并发症，术后不适34例，占0.36%，其中2例患者离院时出现头晕，2例发生尿储留，30例出现恶心、呕吐。护理人力由开展前16人减少到12人，节约25%；患者等候手术时间缩短了8 d，满意度由70%提高到90%，平均住院时间由3.2 d减少为1 d。结论：全身麻醉斜视矫正日间手术模式是一种新的医疗模式，开展全身麻醉日间手术不但可以节省医疗资源，还可提高患者满意度。
Objective: To summarize the establishment and safety management methods of ambulatory strabismus surgery that can provide the basis for carrying out ambulatory surgery nursing under general anesthesia. Methods: We carried out ambulatory surgery management that reformed nursing management model and delivered the integration of medical care in 9 570 patients undergoing strabismus surgery under general anesthesia from October 2015 to October 2018. In implementation process, we carefully managed the patients before and after operation including performing preoperative assessment and health education in advance, strengthening the verification system, strictly monitoring vital signs of the patients, strict shifting state of patients after operation, providing postoperative guidance to patients and their families, and performing follow-up clinic visits after leaving the hospital. Results: No surgical complications occurred in any of our cases. 34 patients had postoperative discomfort, accounting for 0.36%. Among these 34 patients, 2 had dizziness, 2 had urinary retention and 30 hadnausea and vomiting. After treatments, all patients were discharged on schedule. The number of nurses reduced from 16 to 12 that fell by 25%. Wait times for operation reduced by 8 days. Patient satisfaction was improved from 70% to 90%. The mean length of hospital stay was reduced from 3 days to 1 day. Conclusion: The management of ambulatory surgery under general anesthesia is a new medical care service model. Careful planning and strict preoperative and postoperative safety management can ensure the safe implementation of strabismus surgery. Ambulatory surgery under general anesthesia has benefits to save medical resources and improve patient satisfaction.
目的：评价上睑下垂矫正术后并发上睑内翻倒睫的手术治疗效果，并分析其发生原因。方法：回顾性分析2015年1月1日至2020年6月30日因上睑下垂矫正术后并发上睑内翻倒睫在中山大学中山眼科中心接受手术治疗，随访时间6个月以上的患者资料。患者的内翻倒睫矫正手术方案根据有无合并上睑下垂过矫或者欠矫，以及原上睑下垂矫正的矫正方式进行设计。评价术前、术后患者的睑裂高度、眼睑闭合不全程度、上睑睑缘弧度、内翻倒睫矫正状态和角膜荧光素染色评分。结果：本研究共收录上睑下垂术后并发上睑内翻倒睫患者19例(20眼)，其中额肌肌瓣悬吊术后17例(18眼：上睑过矫8眼，欠矫6眼，睑裂高度正常4眼)，提上睑肌缩短术后2例(2眼：上睑过矫1例，欠矫1例)。所有患者的上睑内翻倒睫经手术治疗均完全矫正，角膜上皮荧光素染色评分显著降低(P<0.05)。上睑下垂过矫或欠矫术后均矫正满意，术前睑裂高度正常的患者矫正内翻倒睫没有改变睑裂高度。总结术中探查所见，上睑下垂矫正术后发生上睑内翻倒睫可能与多个因素相关：上睑皮肤切口位置过低；睑缘眼轮匝肌去除过多；额肌肌瓣分离不佳；额肌肌瓣在睑板上的固定位置过高；术中对睑裂高度评估不准确引起上睑下垂过矫等。结论：上睑下垂矫正术后并发上睑内翻倒睫再次手术可以达到满意的治疗效果，但手术操作较为棘手。为降低此类并发症的发生和患者多次手术的风险，应规范上睑下垂矫正手术操作，总结教训。
Objective: To evaluate the surgical treatment outcome of upper eyelid entropion after ptosis correction and analyze the complicated causes. Methods: A retrospective analysis was performed on patients who underwent surgical treatment for complicated upper eyelid entropion after ptosis correction and were followed up for more than 6 months at Zhongshan Ophthalmic Center from January 1, 2015 to June 30, 2020. Pre- and postoperative lid height, lagophthalmos, upper lid margin curvature, eyelid entropion and corneal fluorescein staining scoreswere evaluated. Results: A total of 18 cases (19 eyes) were included, among which 17 cases (18 eyes: 8 eyes of ptosis overcorrection, 6 eyes of ptosis undercorrection, and 4 eyes with normal eyelid height) were post-frontalis flap suspension, and 2 cases (2 eyes: 1 eye of ptosis undercorrection, 1 eye of ptosis overcorrection) post-levator resection. All patients had a complete correction of upper eyelid entropion and a significant reduction in corneal epithelial fluorescein staining score (P<0.05). Both the complicated ptosis undercorrection and overcorrection were treated with satisfactory outcome. Correction of entropion did not change the eyelid height in patients with preoperative normal height. The intraoperative findings showed that several factors related to original ptosis surgery may be involved in complicated upper eyelid entropion, including: the skin incision too close to the upper lid margin, excessive resection of the orbicularis oculi muscle along the eyelid margin, poor separation of the frontalis muscle flap, inappropriate eyelid plate fixation site of the frontalis muscle flap, and ptosis overcorrection caused by inaccurate evaluation of the intraoperative eyelid height, etc. Conclusion: Surgical treatment of the upper eyelid entropion secondary to ptosis correction is safe and effective, but is complicated and difficult. Skillful ptosis surgery and appropriate surgical techniques are crucial to reduce its occurrence.
上睑下垂是眼整形科最常见的疾病之一，由于儿童处于生长发育阶段的特殊性，不规范的诊疗不仅会影响外观，同时可能会导致视功能发育迟缓。目前关于儿童先天性上睑下垂的手术时机和手术方式的选择尚无统一的标准和共识，本文通过对儿童先天性上睑下垂分类细化，阐明合并不同原因导致弱视的患者手术时机的选择；对比不同手术方式，分析其原理及优缺点，进一步明确矫正重度儿童先天性上睑下垂的手术方式，以期规范儿童先天性上睑下垂手术时机和手术方式的选择，提高手术的成功率，减少弱视的发生。
Blepharoptosis is one of the most common diseases in oculoplastics. Due to the particularity of children in the stage of growth and development, non-standard diagnosis and treatment not only affect the appearance,but also lead to the retardation of visual function development. Currently, there are no uniform standards and consensus on the choice of surgical timing and methods for pediatric congenital blepharoptosis. Here through refined classification of congenital blepharoptosis, we try to elucidate the choice of surgical timing for congenital blepharoptosis patients combined with amblyopia caused by a variety of reasons. By comparing different surgical methods, we analyze their mechanisms and advantages, and illustrate the surgical indication for severe congenital blepharoptosis, so as to standardize the choice of surgical timing and methods for pediatric congenital ptosis,improve the surgical success rate, and reduce the occurrence of amblyopia.
为使眼科手术铺巾方法更安全、便捷、利于操作，本研究团队在原有眼科手术铺巾基础上，增加不同规格尺寸、标识定位、背胶等功能，发明了一种眼科手术铺巾[专利号：国家实用新型专利(ZL 201921410018.3)]。该种眼科手术铺巾采用一次性防水无纺布为主要制作材料，具有规格多样、结构简单、便于操作、无菌屏障功能更强等特点，能更好地满足眼科手术术前消毒铺巾的使用要求。
In order to make ophthalmic surgical draping safer, more convenient and easier to operate, this research team invented an ophthalmic surgical drape [patent number: National Utility Model Patent (ZL 201921410018.3)] based on the original ophthalmic surgical drape, adding functions such as various sizes, marking and positioning,and glutinosity. This kind of ophthalmic surgical drape is made of disposable waterproof non-woven fabric, which has the characteristics of various specifications, simple structure, easy operation and strong function of aseptic barrier, which can better meet the requirements of disinfection drape before ophthalmic surgery than the original drape.
为在眼科日间手术模式下既能满足玻璃体视网膜术后体位需求，又能合理利用有限空间，本研究团队在原有的眼科日间病房座椅的基础上，增加玻璃体手术后体位护理等功能，发明了一种护理座椅[专利号：国家实用新型专利(ZL 2017 2 0942404. 1)]。该座椅采用钢喷塑(或不锈钢)、木板、海绵和人造革皮等材料，其结构主要包括座椅的主体部分、俯卧台、杂物篮、收纳架、输液杆套筒等部分。其制作材料简单，操作方便，安全使用，既能保证临床体位护理需求，又能节省空间，便于病房环境管理。
To meet the needs of the postoperative position nursing after pars plana vitrectomy in the day surgery mode,this research team has designed a nursing chair [patent number: National Uutility Model Patent (ZL 201720942404. 1)] based on the original chair of ophthalmic day ward, adding the functions of postvitreous nursing and so on. The seat is made from steel spray plastic (or stainless steel), wood, sponge and artificial leather, and the structure mainly consists of the main body, the countertop for prone position, the junk basket, the storage rack, and the infusion rod sleeve. The seat can be made by simple materials. The seat is easy to operate and safe to use, which can not only meet the needs of clinical body position nursing care, but also save the ward’ space and facilitate the environmental management of the ward.
