眼科麻醉专题

24 180 例喉罩全身麻醉下接受眼科手术患儿麻醉复苏期的护理体会

Nursing experience of 24,180 children undergoing ophthalmic surgery under general anesthesia with laryngeal mask during anesthesia recovery period

:554-562
 
目的:探讨提高眼科喉罩全身麻醉患儿在麻醉恢复室(post-anesthesia care unit, PACU)复苏质量与效率的整体护理策略。方法:选取2020年1月—2023年12月在中山大学中山眼科中心行眼科全身麻醉并保留喉罩进入PACU复苏的24 180例患儿,总结患儿在PACU复苏的护理措施及复苏质量。结果:所有患儿经复苏期综合护理后均顺利拔除喉罩完成麻醉复苏,未发生苏醒期二次插管或非计划转院治疗。采取个性化的整体护理策略后,喉罩全身麻醉患儿PACU平均复苏时间明显缩短。部分术后常见并发症(术后躁动,低氧血症和呼吸道梗阻)和护理不良事件(留置针脱落和眼包脱落)发生率逐年降低,经治疗和护理后均获得改善。结论:针对眼科全身麻醉的患儿特点,在麻醉复苏期采取个性化的整体护理策略,有利于顺利完成麻醉复苏,降低麻醉并发症和护理不良事件的发生率,提高复苏质量效率,满足眼科日间手术快速康复的需求。
Objective: To explore holistic nursing strategies to improve the quality and efficiency of post-anesthesia care unit (PACU) resuscitation in childrenpatients undergoing ophthalmic laryngeal mask anesthesia. Methods: A total of 24,180 children patients who underwent general anesthesia and retained laryngeal mask airway for PACU resuscitation at Sun Yat-sen Ophthalmic Center of Sun Yat sen University from January 2020 to December 2023 was reviewed and summarized the nursing measures and resuscitation quality of children patients undergoing PACU resuscitation. Results: All patients underwent comprehensive care during the recovery period and successfully removed the laryngeal mask to complete anesthesia recovery. There were no cases of secondary intubation or unplanned transfer for treatment during the recovery period. After adopting personalized holistic nursing strategies, the average recovery time of PACU in children under laryngeal mask anesthesia was significantly shortened.The incidence of common postoperative complications(postoperative agitation, hypoxemia and respiratory obstruction)and adverse nursing events (indwelling needle falls off, eye bandage fall off)had been decreasing year by year. These complications had been improved after treatment and care. Conclusions: Based on the characteristics of children patients undergoing general anesthesia in ophthalmology, adopting personalized holistic nursing strategies during the anesthesia recovery period is beneficial for successfully completing anesthesia recovery, reducing the incidence of anesthesia complications and adverse nursing events, improving the quality and efficiency of recovery, and meeting the needs of rapid recovery in ophthalmic day surgery.
论著

眼科日间病房护理质量指标的构建

Establishing nursing quality indicators for ophthalmic intra-day ward

:558-563
 
目的:构建眼科日间病房护理质量指标,为眼科日间病房的护理质量管理提供理论依据。方法:以Donabedian三维质量结构模式为理论框架,通过查阅文献、小组讨论,初步拟定眼科专科护理质量评价指标。通过专家函询,对指标进行筛选和修订,确定了眼科日间病房护理质量指标。结果:经过2轮函询,专家意见趋向一致,2轮问卷回收率均为100%,协调系数分别为0.129、0.342(P<0.01)。构建的眼科专科护理质量指标包括3项一级指标,分别为结构指标(二级指标2项)、过程指标(二级指标8项)和结果指标(二级指标3项)。结论:该指标具有较高的科学性、可靠性、可行性以及专科特色,可为眼科日间病房护理质量的评价提供良好的方法。
Objective: To set up nursing quality indicators for ophthalmic intra-day ward, providing theoretical basis for nursing quality management in ophthalmic intra-day ward. Methods: Based on the "Donabedian three dimensional quality structure model" as the theoretical framework, the preliminary ophthalmic specialized nursing quality assessment indicators were designed by literature review and group discussion. The ophthalmic nursing quality indicators for intraday ward were finalized by expers consultated, indicators screened and revised. Results: After two rounds of inquration by letters, the opinions from the experts were consistent. Questionnaire response rates were both 100% in two rounds, with coordination coefficients of 0.129 and 0.342 respectively (P< 0.01). The nursing quality indicators for ophthalmic intra-day ward were established, including 3 primary indicators, which are structual indicators (2 secondary indicators), process indicators (8 secondary indicators) and outcome indicatiors(3 secondary indicators). Conclusion: The indicators are scientific, reliable, feasible with specialized characteristics, which can provide a good reference for evaluating the nursing quality in ophthalmic intra-day wards.
论著

眼科成人日间手术患者病区护理管理的最佳证据总结

Nursing management of ophthalmic postoperative adult intra-day ward: a systemic review

:571-579
 
目的:评价并汇总眼科成人日间手术患者病区护理管理的最佳证据,提高临床护理质量。方法:检索国内外数据库建库至2022年6月的日间手术患者病区护理管理的相关证据,包括系统评价、临床决策、证据总结、指南及专家共识。由2名研究人员独立对文献进行质量评价后,根据主题对证据进行提取和汇总。结果:根据纳入标准,共筛选出13篇文献,包括5篇专家共识、3篇证据总结、1篇循证实践、2篇系统评价、1篇指南。通过文献阅读、证据提取和归类,从日间手术护士准入资质、制定临床护理路径、院前管理、病历标准化、手术当日术前管理、术后管理、出院评估、康复及随访指导8个方面形成17条最佳证据。结论:该项目总结了眼科成人日间手术患者病区护理管理的最佳证据,可为护理管理者制定眼科日间手术病区流程方案、实践标准提供循证依据。
Objective: To evaluate and summarize the evidences of nursing management of ophthalmic postoperative adult patients intra-day ward, and improve the quality of clinical nursing. Methods: The related databases were searched from the  establishment to June 2022. The searching contents include systematic review, clinical decision-making, evidence  summary, guidelines and expert consensus on nursing management in postoperative patients intra-day wards at home  and aboard. Based on the theme, the evidences were extracted and summarized after independent literature quality  evaluation was conducted by 2 researchers. Results: Base on the inclusion criteria, a total of 13 pieces of literature were  selected, including 5 expert consensus, 3 evidence summaries, 1 evidence-based practice, 2 systematic reviews and 1  guideline. Through literature review, evidence extraction and classification, a total of 17 pieces of evidence on 8 aspects  were summarized, including admission qualifications for daytime surgical nurses, development of clinical nursing path,  pre-hospital management, medical record standardization, preoperative management on the day of surgery, postoperative  management, discharge assessment, rehabilitation and follow-up guidance. Conclusion: This article summarized the  best evidence of nursing management for ophthalmic adult day surgery patients in intra-day ward,to provide scientific  evidences for nursing managers to develop ophthalmic intra-day ward guidelines and practical standards.
论著

开角型青光眼患者眼部用药规范化护理管理的最佳证据总结

Summary of the best evidence on standardized ocular medication management among open-angle glaucoma patients

:17-24
 
目的:检索并总结开角型青光眼患者眼部用药规范化护理管理的最佳证据,为临床实践提供参考。方法:通过护理循证方法提出实践问题,按照循证证据检索数据库的“6S”分类模型,检索有关开角型青光眼患者眼部用药管理的所有证据资源类型,包括临床指南、最佳实践信息册、证据总结、系统评价和专家共识等。由2名循证护理研究员对纳入文献的质量进行独立评价并进行证据的归纳总结。结果:最终纳入12篇文献,包括4篇指南、3篇证据总结和5篇系统评价;汇总了19条有关开角型青光眼眼部用药管理的最佳证据,包括滴眼技术指导、依从性管理和信息提供3个方面。结论:总结开角型青光眼眼部用药管理的最佳证据,可为临床医务人员管理患者提供参考和借鉴,以达到患者规范用药、控制眼压和延缓疾病进展的目的。
Objective: To retrieve and summarize the best evidence on standardized ocular medication management among open-angle glaucoma patients. Methods: With evidence-based nursing method, practical problemswere identified. According to the “6S” pyramid model of evidence resource, studies on standardized ocular medication management among open-angle glaucoma patients were retrieved, including clinical guidelines, best practice information booklet, systematic reviews, and expert consensus. Two evidence-based nursing researchers independently evaluated the quality of the included literature and summarized the evidence. Results: A total of 12 articles were ultimately enrolled, including 4 clinical guidelines, 3 evidence summaries and 5 systematic reviews. Finally, 3 aspects including 19 pieces of best evidence were summarized, which were Eye drop technical instruction, medication adherence management and related information provision. Conclusion: The best evidence for the medication management of open-angle glaucoma patients were summarized, which provide reference for clinical medical staffs to manage patients, so as to achieve the purpose of standardizing medication,controlling intraocular pressure and preventing disease progression.
论著

老年性糖尿病性白内障患者延续护理

Continuing Nursing Care of Patients with Senile and Diabetic Cataract

:116-118
 
目的:探讨老年性糖尿病性白内障患者治疗及延续护理的措施。
方法:对2014年1月~2014年12月142例老年性糖尿病性白内障患者随机平均分为A组和B组,A组接受常规的出院指导;B组接受常规的出院指导及加强延续护理,根据老年性糖尿病性白内障患者 的具体情况制定护理措施 (眼部的护理、用药指导、饮食护理、心理护理、自我监测指导、定期随访及复查等内容),并进行跟踪处理。
结果:实施延续护理一年后的患者,体重、空腹血糖、餐后2 h血糖与未实施延续护理的患者相比,差异有显著意义 (P<0.05)。
结论:护士对老年性糖尿病性白内障患者及家属进行用眼和糖尿病相关的知识宣教、针对性的心理护理、药物治疗护理及日常生活指导等,老年性糖尿病性白内障患者的遵医率提高,减少了因疾病而对生活工作的影响,生活质量有不同程度的提高。
Purpose: To explore the treatment and continuing nursing of patients diagnosed with senile and diabetic cataract.
Methods: In total, 142 patients diagnosed with senile and diabetic cataract admitted to Zhongshan Ophthalmic Center from January to December 2014 were randomly assigned into groups A and B. In group A, patients received conventional instruction after discharge, and those in group B additionally received continuing nursing care after discharge including ocular nursing, use of anti-diabetic drugs, psychological nursing,  diet nursing, self-monitoring guidance,  re-examination and regular follow-up according to the patients’ conditions.
Results: After one year of continuing nursing care, visual acuity of patients in group B was increased without complications. Body mass index, the fasting and 2h postprandial plasma glucose,  and the systolic and diastolic blood pressure were decreased significantly compared with those in group A (all P<0.05).
Conclusion: Continuing nursing care, including knowledge education related to ocular use and diabetes mellitus, targeted psychological nursing,  medication nursing and daily life guidance,  play a pivotal role in enhancing the compliance rate of the patients,  reducing the influence upon work and life and enhancing the quality of life to varying extent.
眼科护理

20例高度近视固定性内斜视的护理

The Nursing of 20 Cases of High Myopia Complicated with Fixed Esotropia

:119-121
 
     总结20例高度近视固定性内斜视的护理经验。认为术前做好心理护理及自我护理管理教育;术后做好眼部的观察和护理,密切观察眼部症状,及时处理并发症,详细做好出院宣教及电话回访,是保证治疗效果,预防并发症,提高患者生活质量的关键。
To summarize the nursing experience of 20 cases of high myopia complicated with fixed esotropia. Before surgery, psychological nursing and self-care education were necessary. After the operation, ocular symptoms and complications should be closely observed and treatment in a timely manner. Explicit instructions after discharge and telephone follow-up played a pivotal role in improving clinical efficacy, preventing complications and enhancing patients' quality of life. 
眼科护理

眼科病房人文关怀护理模式的建立与实践

Establishment and Implementation of Humanistic Nursing Care in Ophthalmic Ward

:125-127
 
目的:探讨人文关怀护理对提高眼科专科病房护理质量及病人满意度的效果。
方法:建立人文关怀护理模式,优化环境,细化工作流程,注重护士人文关怀技能的培养,应用多元化的宣教工具,实施全程、连续、无缝隙的责任制护理。
结果:人文关怀护理措施落实,护士沟通能力提高,转变过去的被动服务为主动服务,护理的质量及患者满意度明显提高,零差错,零投诉,患者满意度为99%。
结论:将人文关怀护理体现在临床护理工作中才能给患者提供高品质的护理。
Purpose:To discuss the role of humanistic nursing care in improving the nursing quality and patients' degree of satisfaction in ophthalmic ward.
Methods:A mode of humanistic nursing care was established,hospital environment was improved and work flow was arranged in details.Nurses received professional training of humanistic care skills.By using multiple educational approaches,nursing care with responsibility system can be delivered in a continuous and seamless manner.
Results:The measures of humanistic nursing care were fully implemented.The nurses'  communication ability was improved and the nurses worked more actively. The quality of nursing and patients'  degree of satisfaction (99%) were equally significantly improved.No mistake occurred and no complaint was received from the patients.
Conclusion:Proper application of humanistic care in clinical nursing provides high-quality nursing for patients.
眼科护理

角膜胶原交联术的护理

Nursing Experience of Corneal Collagen Cross-linkingin Treating Keratoconus

:128-130
 
目的:总结了角膜胶原交联术治疗圆锥角膜的护理及其效果。
方法:回顾分析30例(31眼)角膜胶原交联术患者术前术后护理记录及病历资料。
结果:30 例(31眼)患者病情得到控制,术后恢复理想,术后一个月复查视力都有提高。
结论:角膜胶原交联术护理重点在于术前协助患者完善各项检查、相关健康知识宣教及有效的心理护理,术后严密观察病情变化、减轻病人痛苦、预防感染及促进角膜上皮修复治疗。
Purpose:To summarize the nursing experience and clinical efficacy of corneal collagen cross-linking in treating keratoconus.
Methods:Preoperative and postoperative nursing and medical record of 30 patients (31 eyes) undergoing corneal collagen cross-linking were retrospectively analyzed.
Results:The the severity of diseases in all 30 patients (31 eyes) was properly controlled.All cases were fully recovered.The visual acuity at postoperative one month was improved in all cases.
Conclusion:assistance in terms of preoperative examination,education of health knowledge and effective psychological nursing play a pivatol role in the nursing before and after corneal collagen cross-linking.Following surgery,postoperative changes in the the severity of diseases should be strictly observed. Much attention should be diverted to ease patients' pain,prevent infection and accelerate the healing of corneal epithelium. 
论著

泪道成形+义管植入日间手术患者的延续性护理

Continuous care of the patients with day surgery of lacrimal duct formed combined tube implantation

:84-87
 
目的:探讨完善泪道成形+义管植入日间手术患者的延续性护理对预防义管意外脱管的重要作用。方法:收集我科2016年1月至12月实施了标准延续性护理的泪道成形+义管植入日间手术患者的意外脱管情况。结果:泪道成形+义管植入日间手术患者随访期间没有发生医源性脱管,有9例9眼带管期间在院外发生脱管,意外脱管率为2.6%。结论:做好泪道成形+义管植入日间手术患者的延续性护理,有效降低义管意外脱出率,有利于患者康复。
Objective: To explore the important role of continuous nursing of the patients with day surgery of lacrimal duct forming combined tube implantation in the aspect of accident prevention to take off the tube. Methods: The information of the patients from Jan. to Dec. 2016 with accident the tube’s takeoff after carrying out the standard continuity of care were collected. Results: There was no iatrogenic but 9 eyes of 9 patients accidentally take off the tube during follow-up period. Accidental decannulation rate was 2.6%. Conclusion: Continuous care of the patients with day surgery of lacrimal duct forming combined tube implantation can effectively reduce the tube accidentally removal rate and be beneficial to patients’ recovery.
论著

甲状腺相关眼病患者的生活质量调查及护理对策

Investigation of quality of life and nursing of patients with thyroid associated ophthalmopathy

:80-83
 
目的:探讨与甲状腺相关眼病患者的生活质量,为做好个体化的护理提供理论依据。方法:采用甲状腺相关眼病的生活质量调查问卷进行调查,用R语言进行数据分析。结果:年龄与视功能评分成负相关(P<0.001,r=–0.504),与社会心理评分成正相关(P=0.002,r=0.327)。文化程度与视功能评分成正相关(P<0.001,r=0.391),与社会心理评分无相关关系(P=0.749)。不同症状的视功能评分之间差异有统计学意义(P<0.001)。结论:通过甲状腺相关眼病的生活质量调查问卷可知,年龄越大,视功能越差,不同症状的患者视功能情况不同,要关注年龄大、复视、视力差患者的安全;在护理上,要做好患者及其有甲状腺功能亢进史家属的健康宣教,尤其关注女性患者的社会心理状况。
Objective: To explore the factors related to the quality of life of patients with thyroid associated ophthalmopathy, and to provide theoretical basis for individual nursing. Methods: The quality of life questionnaire of thyroid associated ophthalmopathy was used to investigate, and the data were analyzed by R language. Results: There was a negative correlation between age and visual function score (P<0.001, r=-0.504), and positively correlated with social psychological score (P=0.002, r=0.327). There was a positive correlation between educational level and visual function score (P<0.001, r=0.391), and had no correlation with social psychological score (P=0.749). There were statistically significant differences in visual function scores among different symptoms (P<0.001).Conclusion: The quality of life of thyroid-related eye disease questionnaire showed that the older, the worse the visual function. Different symptoms of patients had different visual function. We should pay attention to the patients with older, diplopia and poor vision, do health education with the patients and family members with the history of hyperthyroidism as well, especially concern with the social and psychological status of female patients.
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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