目的：调查中山大学中山眼科中心参加分子医学实验技能培训课程的研究生学员上课前的实验基础，为研究生实验技术课程的备课提供参考。方法：对2020年及2021年参加分子医学实验技能培训课程的博士和硕士研究生进行课前问卷调查。从理论知识和操作经验两方面对15个专题课程进行分析。结果：共155名学生完成问卷调查。在全部专业研究生中，25%以上学生对理论知识不了解的专题有14个，而仅有10%以下学生熟练操作的专题有6个；分子医学专业的优于前者，不了解和熟练掌握的专题个数分别是9和12。理论掌握程度最低的4个专题是细胞增殖、流式细胞、图像采集和组学分析。15个小专题整合成7个大专题，操作熟练程度由低到高依次是：眼科实验数据收集、组学技术、数据分析、细胞技术、蛋白技术、组织分析、分子技术。结论：新入学研究生存在分子医学实验技能基础理论知识薄弱以及科研训练不足等问题，迫切需要改善实验技能培训制度，深化课程体系建设。
Objective: To conduct a pre-course survey on the graduate students who participated in the Molecular Medicine Laboratory Skills Training Course in the Zhongshan Ophthalmic Center of Sun Yat-sen University to provide a reference for the preparation of the course. Methods: We asked the doctoral and master’s students who participated in the training courses of molecular medical experimental skills in 2020 and 2021 to take a pre-course questionnaire survey and analyzed the results by the students’ pre-course command of theoretical knowledge and pre-training operational experience in 15 lessons of special topics or techniques. Results: A total of 155 students completed the pre-course questionnaire survey. Our results showed that there were 14 lessons in which more than 25% of the students were not familiar with the theoretical knowledge, whereas there were 6 lessons in which less than 10% of the students had high operational proficiency. The students majoring in the molecular medicine had better prior knowledge of the techniques: there were only 9 lessons in which more than 25% of the students were not familiar with the theoretical knowledge, whereas there were 12 lessons in which less than 10% of the students had high operational proficiency. The four lessons with worst prior knowledge were cell proliferation, flow cytometry, image acquisition, and omics analyses. We grouped the 15 lessons into 7 categories: the ophthalmic experimental data collection, the omics technology, the data analyses, the cell technology, the protein technology, the tissue analyses, and the molecular technology, presenting by the level of the students’ pre-training proficiency from low to high. Conclusion: The first-year graduate students were very weak in basic knowledge and had little experience in techniques before joining the molecular medicine training courses. It is urgent to improve the laboratory skills training system and strengthen the construction of the curriculum system.
目的：了解眼科住院医师规范化培训学员(规培生)的沟通技能态度和人际沟通能力现状。方法：对中山大学中山眼科中心三个年级规培生的沟通态度和人际沟通能力进行问卷调查，并进一步分析其沟通态度与沟通能力的相关性。结果：共纳入196名规培生，沟通积极态度量表总分为51.38±6.52，消极态度为36.80±5.70，人际沟通能力为2.41±0.40，辅导与咨询维度得分为2.50±0.64，提供有效的负面反馈维度得分为2.61±0.50，支持性沟通维度得分为2.29±0.44。沟通技能的积极态度与人际沟通能力和三维度之间显著相关(P<0.01)。人际沟通技能得分与性别、规培年级、喜欢眼科专业的程度、得到家庭的关爱程度、得到朋友的关爱程度等因素显著相关(P<0.05)。结论：眼科规培生对沟通技能的积极态度优秀，但是总体沟通能力较弱，并受到多种因素影响。应充分重视规培生人际沟通能力的培养，开展医患沟通的专业化培训。
Objective: To evaluate the current status and correlations between attitudes and competency for interpersonal communication in ophthalmology standardized training trainee. Methods: A questionnaire survey was conducted on the communication attitudes and interpersonal communication ability of standardized training trainees from three grades in Zhongshan Ophthalmic Center, affiliated to Sun Yat-sen University, and the correlation between communication attitude and communication ability was further analyzed. Results: A total of 196 trainees were included. The scores of positive attitude, negative attitude, and interpersonal communication skills were 51.38±6.52, 36.80±5.70, and 2.41±0.40, respectively. In addition, the dimension of coaching and counseling scores were 2.50±0.64, the dimension of providing effective and negative feedback scores were 2.61±0.50, and the dimension of supportive communication scores were 2.29±0.44. The positive attitudes of communication skills were significantly related to the interpersonal communication skills and three-dimensionality (P<0.01). The interpersonal communication skills were significantly associated with sex, grades, interest in ophthalmology, social support from the family and friends (P<0.05). Conclusion: Ophthalmology trainees have excellent positive attitudes toward communication skills, but the overall communication skills are weak and influenced by a variety of factors. More attention should be paid to the development of interpersonal communication skills of the trainees, and specialized training in doctor-patient communication is warranted.
目的：评估屈光不正患者有晶体眼后房型人工晶体(implantable collamer lens，ICL)植入术后视疲劳症状及调节集合功能、眼表、像差的变化，并探讨其对视疲劳症状的影响。方法：前瞻性病例观察分析。连续收集在沧州市中心医院行ICL手术并完成3个月随访的患者，测定术前、术后1周、1个月、3个月时的视疲劳评分、调节幅度(amplitude of accommodation，AA)、正相对调节和负相对调节(positive/negative relative accommodation，PRA/NRA)、调节灵敏度(accommodative facility，AF)、调节性集合(accommodative convergence，AC)与调节(accommodation，A)比率(AC/A)，Schirmer实验、非侵入性泪膜破裂时间(noninvasive breakup time，NBUT)及高阶像差(higher order aberration，HOA)，进行统计学分析。结果：ICL术后第1周视疲劳症状较术前明显加重，随时间推移逐渐减轻，术后1个月仍高于术前，术后3个月时恢复。AA术后1周时较术前降低，术后1个月、3个月时明显高于术前；AF术后1周时较术前下降，术后1个月比术前水平稍好，3个月时明显高于术前；PRA、NRA无明显变化；AC/A术后1周时较术前下降，术后1个月回复到术前水平，术后3个月较术前提高。术后1周、1个月及3个月的NBUT值均较术前明显下降，术后1周时最低；Schiermer值术后1周时轻度下降，术后1个月、3个月时基本恢复。术后的总HOA均较术前有所增加，但各个时间点之间无明显变化。相关性分析显示ICL术后AF越差、NBUT越低，视疲劳症状越重。结论：ICL术后视疲劳症状一过性加重，AF和NBUT是影响视疲劳变化的重要因素。
Objective: To evaluate the changes of visual fatigue symptoms, accommodative functions, ocular surface conditions, and high-order aberrations (HOA) after implantation of implantable collamer lens (ICL), and to explore their effects on asthenopia. Methods: It was a prospective observational case series. Patients with ametropia who underwent ICL surgeries and completed 3-month follow-up in our hospital were enrolled.Asthenopia scores, amplitude of accommodation (AA), positive/negative relative accommodation (PRA/NRA),accommodative facility (AF), the ratio of accommodative convergence and accommodation (AC/A), Schirmer test, non-invasive breakup time (NBUT), and HOA were examined before surgeries and at 1 week, 1 month and 3 months after surgeries, then statistically analyzed. Results: Symptoms of asthenopia were significantly worse at 1 week after ICL surgeries than those before surgeries, but increased gradually as time went by, eventually recovered at 3 months postoperatively. Among regulatory indicators, AA decreased 1 week postoperatively, but was significantly higher at 1 and 3 months after surgeries; AF was lower 1 week after surgery than baseline, slightly better at 1 month postoperatively, and significantly higher at 3 months postoperatively; PRA and NRA had no significant change; AC/A decreased 1 week after surgeries, returned to the baseline at 1 month postoperatively, and increased 3 months postoperatively. Tears and meibomian gland function index: NBUT values at 1 week, 1 month and 3 months after surgeries were significantly decreased compared with those before surgeries, and NBUT at 1 week postoperatively was the lowest; Schiermer values had a slight decrease at 1 week after surgeries, and basically recovered at 1 and 3 months after surgeries. HOA after surgeries were increased compared with those before surgeries, but there was no significant change between each time point. Correlation analysis showed that the lower AF and NBUT after ICL surgeries, the more severe the asthenopia symptoms. Conclusion: The symptoms of asthenopia aggravated transiently after ICL implantation surgeries, but improved gradually with time. AF and NBUT were important factors affecting the changes of asthenopia.
球后阻滞是眼科手术中常见的麻醉方式之一，若操作不当，可造成严重并发症，包括局部麻醉药物的毒性反应等。现报告1例26岁诊断为“视网膜脱离”拟行眼底手术的女性患者，在球后阻滞10min后，患者出现心率增快、血压升高后下降、吞咽困难、声音嘶哑、呼吸困难及SpO2下降，伴随对侧眼球运动障碍，全身肌力下降等临床表现。及时给予生命支持等对症处理后，患者上述临床表现好转，并随后在全身麻醉下完成手术。
Retrobulbar block is one of the common anesthesia methods in ophthalmic surgery, however, misconducting the procedure would result in severe complications including central toxicity from local anesthetics. This study presented a 26-year-old female patient diagnosed retinal detachment for retinal surgery under retrobulbar block, 10 min after anesthesia, the patient initially exhibited increased heart rate and blood pressure, inability to swallow secretions (sputum), hoarseness, and dyspnea, then SpO2 decreased, the patient displayed contralateral eye movement disorder, reduced systemic muscle strength and other clinical manifestations. The condition was improved with the treatments for life support, and the surgery completed uneventfully under general anesthesia with tracheal intubation.
近年来，眼科手术后的疼痛受到关注，部分患者术后表现出疼痛区域扩大，神经性畏光。术后这种 对伤害性刺激性信号反常性增加的现象称之为痛觉过敏。痛觉过敏的发展会导致患者延迟术后恢 复等问题。此外，痛觉过敏还会引起患者不适，诱使患者使用更多的止痛药而产生相关的不良反 应。而TRPV1/TRPA1是一种伤害性感受器，能够被伤害性刺激特异性激活而诱发痛觉过敏。尽管 如此，目前关于眼科术后的痛觉过敏发病机制未完全阐明，TRPV1如何增敏导致痛觉过敏的分子生 物学过程尚未明确。
The postoperative pain of ophthalmic surgery has been widely concerned in recent years. Some patients show enlarged painful areas and neurophotophobia postoperatively. This abnormal increase in noxious irritant signals after surgery is called hyperalgesia. The development of hyperalgesia can result in delayed postoperative recovery for patients. In addition, hyperalgesia can also cause discomfort for patients, and induce patients to use more analgesics, which can have related side effects. TRPV1/TRPA1 is a nociceptor, which can be specifically activated by nociceptive stimuli to induce hyperalgesia. Nevertheless, the pathogenesis of hyperalgesia after ophthalmology surgery has not been fully elucidated, and the molecular signal pathway of how TRPV1 sensitizes and causes hyperalgesia is not yet clear.
目的：探讨构建眼科高值手术耗材管理体系的思路和具体实践方法，加强眼科高值手术室耗材管理。方法：通过信息化手段，建立眼科高值手术耗材可视化管理系统，与医院各信息系统对接，整合相关数据，建立眼科高值手术耗材合理使用监测系统，将耗材的供应、使用到监测的全生命周期管理与日常监管相结合。结果：通过对眼科高值手术耗材全生命周期体系的建立，实现了术前可控制、术中可监测、术后可追溯的全流程管理。结论：该体系的建立可提高眼科手术高值耗材的管理效率及质量。
Objective: To construct an ideal and practical method for managing ophthalmic high-value surgical supplies to strengthen the management of ophthalmic operating room. Methods: A visual management system of ophthalmic high-value surgical supplies was established by using information technology connected with hospital information systems, then the data were integrated to construct a monitoring system for real-time status of ophthalmic high-value surgical supplies, including the whole life cycle management of the surgical supplies. Results: Through the establishment of the system for whole life cycle of high-value ophthalmic surgical supplies, the whole process management realized the supplies for preoperative control, intraoperative monitoring and postoperative trace. Conclusion: Constructing the system solves the daily management problem of ophthalmic high-value surgical supplies, reduces the blind area of management, and strengthens the supervision of surgical supplies in the ophthalmic operating room.
目的：评估右美托咪定复合舒芬太尼用于老年青光眼患者经巩膜二极管激光睫状体光凝术 (transscleral diode laser cyclophotocoagulation，TDLC)术后自控静脉镇痛(patient-controlled intravenous analgesia，PCIA)的安全性和有效性。方法：选择行TDLC术老年青光眼患者80例，采用随机数字表法将患者分为SD组(n=40)和S组(n=40)。SD组术后PCIA采用舒芬太尼1.5μg/kg+右美托咪定1.5 μg/kg+托烷司琼4mg；S组采用舒芬太尼2μg/kg+托烷司琼4mg。将相应药物置入生理盐水配成100mL混合液加入电子镇痛泵，手术结束即刻行PCIA至术后24h。观察比较两组患者基本情况和手术情况，比较术前(T0)、术后即刻(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)患者的收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、心率(heart rate，HR)、NRS疼痛评分、Ramsay镇静评分及非手术眼的眼内压(intraocular pressure，IOP)，比较术后恶心呕吐、呼吸抑制、躁动等不良反应及使用其他辅助镇痛药物的情况。结果：两组患者基本情况和手术情况的差异无统计学意义。两组各时点DBP、非手术眼IOP及NRS评分差异无统计学意义。SD组T3、T4时点SBP，T2、T3、T4时点HR以及T2、T3时点Ramsay评分均低于S组，差异有统计学意义(P<0.05)。两组患者发生不良反应的总例数差异无统计学意义，但SD组恶心呕吐(1例)和烦躁(2例)发生率均低于S组(分别为6例和9例)，差异有统计学意义(P<0.05)。两组患者呼吸抑制和眩晕嗜睡发生率以及使用其他辅助镇痛药物例数差别无统计学意义，SD组舒芬太尼使用量低于S组(P<0.05)。结论：采用右美托咪定1.5μg/kg复合舒芬太尼1.5μg/kg行PCIA时不影响非手术眼IOP，可安全有效地应用于老年青光眼患者TDLC术后镇痛。
Objective: To evaluate the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) after transscleral diode laser cyclophotocoagulation (TDLC) in elderly patients with glaucoma. Methods: Eighty elderly glaucoma patients undergoing TDLC were selected and randomly divided into a SD group (n=40) and a S group (n=40) by random number table method. In SD group (n=40), sufentanil 1.5 μg/kg, dexmedetomidine 1.5 μg/kg and tropisetron 4 mg were used for postoperative PCIA, and sufentanil 2 μg/kg and tropisetron 4 mg were used in S Group (n=40). The corresponding drugs in saline solution was added into 100 mL solution with electronic analgesia pump. PCIA was performed immediately after the operation until 24 h after the operation. The basic condition and operation situation of the two groups were observed and compared, and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), NRS pain score, Ramsay sedation score and non-operation eye intraocular pressure (IOP) at preoperative (T0), after operation (T1), postoperative 6 h (T2), 12 h after operation (T3) and 24 h after operation (T4) were compared, and postoperative adverse reactions such as nausea and vomiting, respiratory depression, restlessness and use of other auxiliary analgesic drug were also compared. Results: There was no significant difference between two groups of patients’ basic and surgical conditions. There was no significant difference between two groups at each time point DBP, non-operation eye IOP and NRS score. SBP at T3 and T4, HR at T2, T3 and T4, and Ramsay score at T2 and T3 in SD group were lower than the S group, the difference was statistically significant. There was no significant difference in the total number of adverse reactions between two groups, but the incidence of nausea and vomiting and restlessness in group SD were lower than those in group respectively, the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the incidence of respiratory depression, dizziness, lethargy and the use of other auxiliary analgesics. The sufentanil usage in group SD was lower than that in group S (P<0.05). Conclusion: PCIA with dexmedetomidine 1.5 g/kg combined with sufentanil 1.5 g/kg does not affect the non-operation eye IOP. It can be safely and effectively applied to postoperative analgesia for elderly patients with glaucoma after TDLC
目的：探讨“破窗理论”在手术室护理安全管理中的应用，为构建手术期间质量安全保障体系提 供新的管理依据。方法：于2019年2月至2020年6月组织佛山市三水区人民医院手术室医护人员对 “破窗理论”进行学习，调查分析护理质量、护理满意度以及手术室护理中出现的安全问题，进 而分析“破窗理论”在手术室护理安全管理中的应用效果。结果：实施前不安全事件发生率高于 实施后(16.00% vs 4.00%，P<0.05)。实施后手术室护理安全管理、药物使用规范性、感染控制程 度、基础护理质量评分高于实施前(P<0.05)。与实施前相比，实施后手术医生、医护人员、患者 满意度明显上升(P<0.05)。结论：“破窗理论”在传统护理的基础上提供了一种更为积极的干预 模式，其在护理安全管理中的应用值得进一步推广应用。
Objective: To provide a new management system to increase the quality and safety during the operation through applicating the broken window theory in the operating room nursing quality management. Methods: From February 2019 to June 2020, we organized medical staff in the operating room to study the broken window theory, investigated the nursing quality, nursing satisfaction and safety problems in operating room nursing, and then analyze the application effect of the theory in the nursing safety management. Results: The incidence of unsafe events before implementation of the broken window theory were significantly higher than that after the implementation (16.0% vs 4.0%, P<0.05). After the implementation, the scores of nursing safety management, standardized drug use, infection control and basic nursing quality in the operating room were higher than those before the implementation (P<0.05). The satisfaction of surgeons, medical staff and patients increased significantly after implementation as compared with before implementation (P<0.05). Conclusion: The broken window theory effectively provides a more active intervention model than traditional care, and it deserves further application in nursing safety management.
目的：探讨全身麻醉诱导期应用不同种类的非去极化肌松药罗库溴铵、顺式阿曲库铵和米库氯铵对眼压升高的青光眼患者眼内压的影响。方法：将术侧眼眼压>21mmHg青光眼手术患者随机分配到罗库溴铵组、顺式阿曲库铵组和米库氯铵组。靶控输注丙泊酚至患者脑电双频指数(bispectral index，BIS)低于55后，根据组别分别静注0.6mg/kg罗库溴铵、0.1mg/kg顺式阿曲库铵及0.2mg/kg米库氯铵，待4个成串刺激(train of four stimulation，TOF)比值降至0后置入可弯曲喉罩，随后行机械通气并给予芬太尼1.5~2.0μg/kg，2%~3%七氟烷吸入维持麻醉。分别于麻醉诱导前(T0)、镇静后(T1)、肌松后(T2)及喉罩置入后(T3)测量三组青光眼患者术侧眼眼压并记录上述时间点血流动力学参数。结果：罗库溴铵组、顺式阿曲库铵组、米库氯铵组患者的眼压在T1、T2、T3时间点均较T0显著下降，差异有统计学意义(均P<0.001)；三组患者T2时间点眼压与T1相比差异均无统计学意义(P=0.337，P=0.520，P=0.062)；三组患者给予肌松药前后的眼压差值(T2–T1)分别为(0.68±4.39)、(0.36±3.72)和(1.27±3.91)mmHg，组间比较差异无统计学意义(P=0.353)。结论：非去极化肌松药罗库溴铵、顺式阿曲库铵及米库氯铵对眼压升高的青光眼患者的眼压无明显影响，且3种肌松药之间未见显著差异。
Objective: To compare the effects of different types of non-depolarizing muscle relaxants including rocuronium,cis-atracurium and mivacurium on intraocular pressure of glaucoma patients with elevated intraocular pressure during induction of general anesthesia. Methods: Glaucoma patients with intraocular pressure >21 mmHg were randomly assigned to rocuronium group, cis-atracurium group and mivacurium group. After target controlled infusion of propofol until the bispectral index (BIS) lower than 55, 0.6 mg/kg rocuronium, 0.1 mg/kg cisatracurium and 0.2 mg/kg mivacurium were injected intravenously according to different groups. The flexible laryngeal mask was placed after the train-of-four stimulation (TOF) ratio decreased to 0 and the mechanical ventilation was implemented immediately. General anesthesia was maintained by 1.5–2.0 μg/kg fentanyl and 2%– 3% sevoflurane. Intraocular pressure and hemodynamic parameters were measured before anesthesia induction (T0), after sedation (T1), after muscle relaxation (T2), and after laryngeal mask insertion (T3). Results: The intraocular pressure of patients in rocuronium group, cis-atracurium group and mivacurium group at T1, T2, T3 were lower than baseline (T0), and the difference was statistically significant (P<0.001); There was no significant difference in intraocular pressure at T2 compared with T1 in rocuronium group, cis-atracurium group and mivacurium group (P=0.337, P=0.520 and P=0.062 respectively); The difference of intraocular pressure between T2 and T1 in rocuronium group, cis-atracurium group and mivacurium group were (0.68±4.39), (0.36±3.72) and (1.27±3.91) mmHg respectively and there was no significant difference among the groups (P=0.353). Conclusion: The non-depolarizing muscle relaxants rocuronium, cis-atracurium and mivacurium have no significant effect on the intraocular pressure of glaucoma patients with elevated intraocular pressure, and there is no significant difference among the three muscle relaxants.
目的：在麻醉监测管理(monitored anesthesia care，MAC)中，通过与咪唑安定比较，观察右美托咪 定在玻璃体视网膜手术中应用的效果、安全性，探讨其应用可行性。方法：将择期玻璃体视网膜 手术患者40例随机双盲分入咪唑安定组(M组)和右美托咪定组(D组)。每组20例，两组患者均行球 后神经阻滞麻醉，连接脑电双频指数(bispectral index，BIS)监测仪监测并维持BIS值在70~90间， 观察和比较麻醉手术中及复苏期的平均动脉压(mean arterial pressure，MAP)、心率(heart rate， HR)、呼吸频率(respiratory rate，RR)、脉搏氧饱和度(oxygen saturation，SpO2)、Ramsay镇静评 分、疼痛数字评分法(Numerical Rating Scale，NRS疼痛评分)、手术医生和患者麻醉效果评分及不 良反应的差异。结果：与麻醉前比较，手术期D组用药后10 min内的心率、血压下降差异有统计学 意义(P<0.05)，且用药后10 min内D组心率下降幅度较M组更大(P<0.05)。在手术期和复苏期，D组 的NRS疼痛评分均显著低于M组且差异有统计学意义(均P<0.001)，而两组的Ramsay镇静评分差异 无统计学意义(P>0.05)。D组手术期患者的体动发生率和羟考酮使用率显著低于M组(均P<0.05)。 手术医生和患者的麻醉效果评分D组显著高于M组(均P<0.001)。结论：右美托咪定用于玻璃体视 网膜手术，较咪唑安定镇痛效果好且不良反应少，麻醉效果更好。
Objective: The aim of this study was to compare the efficacy and safety of dexmedetomidine versus midazolam for the monitored anesthesia care (MAC) management of patients undergoing vitreoretinal surgery. Methods: Forty patients undergoing selective vitreoretinal surgery were double-blind and randomly dividedinto midazolam group (group M) and dexmedetomidine group (group D), each group had 20 patients. Patients in both groups were anesthetized with posterior bulbous nerve block. Bispectral index (BIS) monitor was connected and the BIS value was maintained between 70 and 90. The mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), Ramsay sedation score, numerical rating scale (NRS), surgeon’s and patient’s anesthesia effect score and adverse reactions were recorded during anesthesia and recovery period. Results: Compared with the data of pre-anesthesia, there were statistical differences of the decrease of HR and MAP in group D within the 10 minutes after medication (P<0.05), and the decrease of HR in group D was greater than that in group M (P<0.05). The NRS pain score in group D was significantly lower than that in group M with statistical significance (P<0.001) during the operation and resuscitation, while there was no significant difference in Ramsay sedation score between the two groups during the operation and resuscitation (P>0.05). In terms of adverse reactions to anesthesia, the incidence of spontaneous movement and oxycodone utilization in group D were significantly lower than those in group M (P<0.05). The anesthesia effect scores of surgeons and patients in group D were significantly higher than those in group M (all P<0.001). Conclusion: Dexmedetomidine has better analgesic effect and less adverse reactions than midazolam in vitreoretinal surgery.
