眼科护理

视网膜激光光凝相关眼心反射的临床观察与护理

Clinical observation and nursing intervention of retinal photocoagulation associated oculocardiac reflex

:44-47
 

目的:探讨视网膜激光光凝发生眼心反射的发生情况及护理。方法:选择佛山市第二人民医院 2015 年 1 月至 2018 年 6 月行视网膜激光光凝患者 5 600 例,记录眼心反射发生率、临床特点、血压脉搏变化及现场抢救、护理情况。结果:所有视网膜激光光凝患者中,21 例出现眼心反射症状,发生率为 0.38%,年龄(32.5±14.8)岁,其中 42.9% 为 18~25 岁年轻女性,90.5% 为视网膜变性裂孔,66.7% 为视网膜颞下方病变。眼心反射发生时平均收缩压(76.7±11.3)mmHg,舒张压(52.9±10.5)mmHg,脉搏(58.0±7.3)min-1。患者均自行缓解,未出现心搏骤停及紧急抢救情况。结论:视网膜激光光凝中有眼心反射发生的风险,尤其是年轻女性或颞下方视网膜变性裂孔患者,应当重点关注和加强心理护理,并作好急救准备。

Objective: To explore the clinical characteristics and nursing measures in patients with oculocardiac reflex during retinal laser therapy. Methods: A total of 5 600 patients during retinal laser therapy during January 2015 to June 2018 were included. Incidence of oculocardiac reflex, clinical characteristics, changes in blood pressure and pulse, and nursing measures were recorded in this study. Results: Among 5 600 patients during retinal laser therapy, 21 cases (0.38%), aged (32.5±14.8) years old on average, presented with oculocardiac reflex, including 42.9% of them were young female patients aged 1825 years; 90.5% of patients with oculocardiac reflex suffered from retinosis or retinal tear, and 66.7% of the retinal lesions were located in the inferotemporal region. The mean systolic pressure was (76.7±11.3) mmHg when oculocardiac reflex occurred, and the mean diastolic pressure was (52.9±10.5) mmHg, and the mean pulse was (58.0±7.3) min-1. The symptoms of oculocardiacreflex in all patients spontaneously restored with time. No patient had cardiac arrest or needed emergency rescue. Conclusion: Oculocardiac reflex may occur in patients during retinal photocoagulation, especially in young female patients or those presenting with inferotemporal retinosis or retinal tear. More attention and psychological nursing care should be paid before laser and the emergency rescue should be prepared.

多点电凝视网膜切开术治疗眼外伤复发性视网膜脱离的围手术期护理

Perioperative nursing care for recurrent retinal detachment using radial retinotomies

:48-51
 

目的:探讨多点电凝视网膜切开术治疗眼外伤复发性视网膜脱离的护理。方法:回顾总结眼外伤复发性视网膜脱离患者行多点电凝视网膜切开术的围手术期护理。结果:9 例患者中 7 例获得视网膜复位,视网膜再次复位率达到 78%,围手术期无明显并发症。结论:做好术前的心理护理及健康指导,术中配合及术后的体位护理,病情观察,出院后随访等护理措施对巩固手术效果,促进康复起重要作用。

Objective: To explore the key procedures of perioperative nursing care for recurrent retinal detachment in patients with ocular trauma by using radial retinotomies. Methods: Perioperative nursing care data of 9 ocular trauma patients who underwent radial retinotomies in Zhongshan Ophthalmic Center from 2014 to 2016 were retrospectively analyzed. Results: Among 9 patients, 7 cases achieved retinal reattachment with a success rate of 78%. No significant complications were observed during the perioperative period. Conclusion: Preoperative psychological nursing and health guidance, intraoperative cooperation, correct body position for postoperative nursing, monitoring of physical conditions and postoperative follow-up can enhance the surgical efficacy and accelerate postoperative recovery.

综述

甲状腺相关眼病的治疗进展

Progress in the treatment of thyroid-associated ophthalmopathy

:52-56
 

甲状腺相关眼病是最常见的眼眶疾病,公认是一种自身免疫性疾病,因眶内免疫及增殖反应而致突眼、压迫性视神经病变等各种临床表现。近年眼科、内分泌科、核医学科、放疗科针对该疾病开展了一系列的临床研究,制定了相应的临床处理指南。研究显示,被转诊到三级中心的甲状腺相关眼病患者的严重度和活动性有下降的趋势,这可能与对该疾病认识的增强、甲亢和甲状腺相关眼病的早期诊断和治疗以及更有效地使用预防措施有关。但国内临床工作中碰到严重的甲状腺相关眼病患者反有增加的趋势,这可能与临床对该疾病的重视和规范化诊治程度不够有关。

Thyroid-associated ophthalmopathy is the most common orbital disease. It is recognized as an autoimmune disease, which causes exophthalmos, oppressive optic neuropathy and other clinical manifestations due to infraorbital immunity and proliferation reaction. In recent years, ophthalmologists, endocrinologists, nuclear medicine doctors and radiotherapists have carried out a series of clinical studies on the disease and formulated corresponding clinical treatment guidelines. Overseas reports indicate that the severity and activity of thyroidassociated ophthalmopathy patients referred to tertiary centers are declining, which may be related to increased awareness of the disease, early diagnosis and treatment of hyperthyroidism and thyroid-associated ophthalmopathy, and more effective use of preventive measures. However, the number of patients with severe thyroid-associated ophthalmopathy is increasing in our clinical work, which may be related to our lack of attention to the disease and standardized diagnosis and treatment. 

临床病例讨论

内源性毛霉菌眼内炎1例

Endogenous mucoraceous endophthalmitis: A case report

:57-60
 

临床上内源性真菌性眼内炎很少见,其早期临床表现类似于葡萄膜炎等常见眼病,误诊率很高。遵义医学院附属医院收治了一位 48 岁女性患者,发病 3 个月内先后被诊断为急性视网膜坏死综合征、新生血管性青光眼等,最终丧失视力手术剜除患眼眼球内容物,术后病理检查发现毛霉菌而确诊为内源性毛霉菌眼内炎。

Endogenous fungal endophthalmitis is easy to be misdiagnosed because it is quite rare and early clinical features resembling uveitis. A 48-year-old female patient was admitted to the Affiliated Hospital of Zunyi Medical College, who was diagnosed as acute retinal necrosis syndrome and neovascular glaucoma. The patient finally lost her sight and had an evisceration. Postoperative pathology showed the mucor infection.

医学教育

广州中医药大学开办眼视光学四年制本科教育的可行性

Feasibility of establishing four-year undergraduate education of optometry in Guangzhou University of Chinese Medicine

:61-64
 

眼视光学是一门现代光学技术和现代眼科学相结合,并运用光学理论和先进的科学技术解决视觉障碍的新兴、交叉学科。眼视光学专业在发达国家已成为眼科学领域眼保健的必要组成部分,近年来,我国与视觉健康和视功能有关的眼病患者日益增多,青少年近视患病率已高居世界第一,且随着人们生活质量的提高,人们对视觉的要求也不断提高。从治疗到预防的不断过渡,眼视光学人才的重要性日益凸显,但目前中国眼科医师和视光师人才缺口还很大,国内多所院校已相继开展视光学教育以满足视光人才需求,在我国,这个专业将成为一个新兴的热门学科。

We discussed the necessity and social demand of undergraduate education of optometry according to the current development of optometry education at home and abroad. The feasibility of setting up the four-year undergraduate education of optometry was evaluated in our university from the excellent teachers, diversified teaching modes, extensive practice base and education experience. The training mode of four-year professional development of optometry was also explored, based on humanity quality education, professional theory and practical skills.

眼健康专栏

青光眼患者配戴太阳镜有讲究

Rational selection and wear of sunglasses for glaucoma patients

:3-5
 
佩戴太阳镜对眼疾患者的眼睛起保护作用。但并非所有青光眼患者适合佩戴太阳镜,闭角型青光眼患者佩戴需慎重。青光眼患者应根据病情合理地佩戴使用太阳镜。正确地选择和佩戴太阳镜才能对眼睛达到最好地保护作用。

The patients with eye diseases can wear sunglasses to protect their eyes. Not all patients with glaucoma are suitable for wearing sunglasses, especially for patients with untreated angle-closure glaucoma. Patients with glaucoma should select and wear the appropriate types of sunglasses according to individual conditions. Proper selection and wearing of sunglasses exert the optimal effect upon protecting the eyes.

封面故事
论著

小儿角膜移植围手术期护理

Perioperative care for corneal transplantation in children

:219-222
 
目的:减轻行角膜移植术的患儿及家属的心理负担,提高患儿对手术的耐受性,减少术后并发症。方法:对45例将进行角膜移植的患儿进行围手术期护理。结果:所有患儿经过精心的治疗和护理后均恢复良好,视力均有提高。结论:术前做好充足的准备、术前心理护理,术后严密观察生命体征和眼部敷料的情况,做好相关的生活和饮食指导,遵医嘱及时有效用药,注意患儿异常的反应及眼部的情况,及时发现并处理并发症,给予细致的出院指导,有利于患儿早日康复。
Objective: To reduce the psychological burden of the children and families who are scheduled to the corneal transplantation, and to improve the patients’ tolerance and reduce postoperative complications. Methods: The perioperative care was given to 45 patients with corneal transplantation. Results: All children were treated well by careful treatment and care. Conclusion: Before operation, comprehensive preparation and psychological nursing care should be delivered. Affer operation, the physicians and nurses should guide the patients to live a healthy lifestyle, remind them to take the drugs timely, identify the abnormal symptoms and postoperative complications in children with abnormal responses, implement effective treatment timely to accelerate postoperative recovery.
述评

大批量白内障扶贫手术的护理安全管理

Safety management of nursing for mass volume of charity cataract surgery

:195-198
 
目的:总结大批量白内障扶贫手术的护理安全管理经验。方法:回顾性分析2013至2016年中山大学中山眼科中心医疗队完成大批量白内障扶贫手术的经验、针对下乡扶贫的特殊环境、患者入院时间短、手术量大、接台手术多以及患者自我管理能力差等情况,分析其安全隐患,并在护理过程中采取相应的安全措施。术前充分评估和准备,对患者进行健康指导;术中对手术环境规范管理;指导加强术后患者的自我管理。结果:8批次共1 064例白内障摘除联合人工晶体植入术顺利完成,无1例发生术后感染。结论:建立大批量白内障扶贫手术护理安全质量管理的规范流程是扶贫工作的重要环节,做好术前的评估和准备工作,落实患者的健康教育及术后患者自我管理指导,才能确保手术顺利进行。
Objective: To assess the safety of mass volume of cataract surgery and to identify the possible factors with enhanced patients’ safety. Methods: TTis is a retrospective case series. Clinical data of patients undergoing charity cataract extraction by surgeons from Zhongshan Ophthalmic Center between 2013 and 2016 was reviewed. TTe following factors were analyzed: safety management peri-operatively, educational interventions, intraoperative sterilization, and self-management after operations. Results: A total of 1 064 patients (8 sessions) underwent cataract extraction and intraocular lens implantation. No evidence of endophthalmitis in any cases was observed.Conclusion: Establishment of standardized operation procedures for nursing safety management is essential for safety of mass volume of charity cataract surgery in China. Adequate assessment and peri-operative endeavor, educational interventions, nurse guided self-management should be empowered to enhance patients’ safety. 
论著

眼科住院医师委托培养效果的评估研究

Study of the effectiveness of entrusted standardized training for ophthalmic residents

:251-258
 
目的:住院医师委托培养是我国医学教育标准化和国际化的重要举措。本研究采用客观考核和主观问卷两种方法评估我国眼科住院医师委托培养效果。方法:本研究对象为广东省深圳市政府于
2012年8月至2015年7月期间委托中山大学中山眼科中心进行眼科住院医师规范化培训的9名学员。本研究对所有学员的基本信息、临床培训情况、以及考核成绩等客观指标进行统计分析,同时设 计了一份包含13个问题的调查问卷,对每位学员的培训情况进行主观评估。结果:本研究纳入9名研究对象,包括2名男性和7名女性,平均年龄为(26±3)岁,学历水平情况为学士7名和硕士2名,其中有7名毕业于国家重点医学院校。3年内人均轮转眼科亚专科超过10科,平均主管病人数及参加手术例数分别为736和1 219例,门诊工作总量人均6 274人次,所有学员均按规定至少完成综 述1篇。8名(88.89%)学员认为可以独立诊断并治疗大部分常见眼科疾病,而且能独立完成大部分眼科基本临床操作,5名(55.56%)学员可以单独完成翼状胬肉切除术、霰粒肿刮除术、前房穿刺术等。6名(66.67%)学员认为培训时间安排合理。8名(88.89%)学员对这次委托培养总体比较满意。 所有9名培训学员中,最终有7名(77.8%)顺利通过中山大学第一阶段住院医师规范化培训考核。结论:培训学员对现行的眼科住院医师规范化培训方案的接受程度较高,基本达到预期的培训效果,对常见眼病能独立进行诊治。委托培养学员的学历和学习能力的差异在一定程度上影响了最终的培训考核通过率。
Objective: The entrusted standardized training for residents is an important measure to gear the medical education in China to the international conventions. In this study, the effectiveness of standardized training for entrusted ophthalmic residents in China was evaluated both objectively and subjectively. Methods: Nine ophthalmic residents, commissioned by Shenzhen government of Guangdong Province, studied at Zhongshan Ophthalmic Center, Sun Yat-sen University during August 2012 to July 2015 were included in this study. The objective indicators of all participants were analyzed, including the basic information, clinical training, the score of examination, etc. The subjective self-assessment was also implemented thought a questionnaire including 13 designed questions.Results: All 9 participants included 2 males and 7 females, 2 medical masters and 7 bachelors, and the mean age was 26±3 years. Seven of them graduated from the national key medical universities. The mean number of rotated sub-clinical departments was 10.3, the mean number of managed inpatients and the participated operations were 736 and 1,219, respectively. The total number of managed outpatients was 6,274 in average. All participants completed at least one review article. Eight (88.89%) participants could independently diagnose and treat the most common ophthalmic diseases, they also could complete the basic clinical ophthalmic operation independently. Five (55.56%) participants could independently manage the pterygium excision, curettage of chalazion, anterior chamber penetration, etc. And 6 (66.67%) of the participants believed that the training length was reasonable. Eight (88.89%) of them were satisfied with the standardized training for residents on the whole. Finally, 7 participants successfully passed the first stage of standardized training program in Sun Yat-sen University. Conclusion: There was a high level acceptance rate of the standardized training programs for entrusted ophthalmic residents. The participants achieved the expected training effects, and could managed the diagnosis and treatment of common ophthalmic diseases independently. But the training effects and passing rate of examination were partly affected by the learning ability of the training students.
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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