论著
目的:分析眼专科医院患者突发急症现状,并探讨防控措施。方法:回顾性分析2017—2018年中山眼科中心82例突发急症事件,具体分析突发急症事件的特点、处置情况及患者转归。结果:眼专科医院中最常见的突发急症事件为药物不良反应(n=38,46.3%),其后依次是晕厥(28.0%)、心脑血管急症(8.3%)、意外事件(6.1%),其中药物不良反应涉及的相关药物最多见于荧光素钠注射液(n=16,42.1%)、局部神经阻滞麻醉相关药物(n=7,18.4%)。突发急症事件集中分布于工作时段8:00—18:00(n=74,91.3%),非工作时段多见于药物不良反应(n=3,42.9%)及心脑血管急症(n=3,42.9%)。门诊是突发急症事件最常发生的场所(n=53,64.6%),其后依次是住院病房(22.0%)、手术室(11.0%)。患者突发急症危急程度轻、中、重度分别占92.7%,4.9%,2.4%。50%的患者需要综合医院急诊人员配合抢救或至综合医院进一步诊治。结论:通过优化患者诊治流程,缩短在院时间,医护人员提高预警意识,明确各岗位潜在急症风险,可降低突发急症事件发生风险。发挥麻醉师专业优势,提高院内应急处理能力,同时签约定点综合医院急救服务,为患者提供快速、准确、高效的救护,保障患者生命安全。
Objective: To analyze the status of medical emergencies of patients in ophthalmic hospitals and put forward suggestions on their prevention and control measures. Methods: The medical emergencies of 82 patients in ophthalmic hospitals in 2017 and 2018 was been analyzed retrospectively, and the characteristics and treatment of emergencies as well as the metastasis and progression of the disease in patients were analyzed specifically. Results: Medical emergencies were caused by druginduced adverse reaction (n=38, 46.3%), syncope (28.0%), cardiovascular emergency (8.3%), accidents (6.1%) in sequence. Fluorescein sodium (n=16, 42.1%) and local anesthesia drugs for nerve block (n=7, 18.4%) were the most common drugs related to drug adverse reaction. Most cases happened at 8:00—18:00 (n=74, 91.3%), and drug adverse reaction and cardiovascular and cerebrovascular emergencies were most common at 18:00—8:00. Medical emergencies happened in outpatient department (n=53, 64.6%), wards (22.0%) and operation rooms (11.0%). There were mild emergencies (92.7%), moderate emergencies (4.9%) and severe emergencies (2.4%) in patients. Among them, 50% of patients need first aid by doctors from general hospitals or to be transferred to the general hospital for further treatment. Conclusion: Through optimizing process, shortening the hospital stay, identifying potential risks and enhancing medical workers’ awareness of safety, the risk of medical emergencies can be reduced. We should give full play to the professional advantages of anesthesiologists, improve the emergency handling capacity of the hospital, and contract the emergency services of designated general hospitals to provide rapid, accurate and efficient rescue for patients to ensure the life safety of patients.
综述
病理性近视相对高度近视而言,更强调眼底并发症的存在。后巩膜葡萄肿(posterior staphyloma,PS)被认为是病理性近视的标志性特征,是眼球后巩膜壁的局部扩张,通常认为与巩膜变薄和脉络膜萎缩等因素相关。近年来研究认为PS的形成可能与局部炎症、Bruch膜缺失等因素密切相关。伴随OCT等检查技术的快速革新以及PS治疗手段的探索,诊断和治疗更加完善。
Pathological myopia emphasizes the existence of fundus complications. Posterior staphyloma, considered as a hallmark of pathological myopia, is a partial extension of the posterior scleral wall, which is believed to be related to the scleral thinning and choroidal atrophy. In recent years, studies have indicated that the formation of posterior staphyloma may closely connected with localized inflammation and defects of Bruch’s membrane. With the rapid innovation of examination technologies such as optical coherence tomography (OCT) and the exploration of treatment for posterior staphyloma. The diagnosis and therapy will be more comprehensive in the future.
综述
视网膜微循环与脑小血管具有相似的特征。视网膜被认为是可检测到的“窗口”,以检测在神经退行性疾病中发生的微血管损伤。光学相干断层扫描血管造影(optical coherence tomography angiography,OCTA)是一种非侵入性成像方式,可提供视网膜、脉络膜和视神经中血流的深度分辨图像。现总结有关OCTA在与眼科相关的阿尔茨海默病、帕金森病、多发性硬化症及视神经退行性疾病等神经系统疾病中的应用,并讨论其可否作为早期诊断和监测神经退行性疾病的重要工具。
Retinal microcirculation shares similar features with cerebral small blood vessels. Thus, the retina may be considered as an accessible ‘window’ to detect the microvascular damage occurred during the development and progression of neurodegenerative disorders. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality providing in-depth and high-resolved images of blood flow in the retina, choroid, and optic nerve. In this review, we summarize the current advances in the application of OCT-A in neurological diseases associated with ophthalmology such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis and optic nerve degenerative diseases. Future directions for evaluating whether OCTA can be used as an important tool to early diagnose and monitor the neurodegenerative disorders are also discussed.
综述
近些年来,眼科疾病的临床诊断治疗及其病理发展的研究对医学影像学技术的要求日益增高,磁共振技术已广泛应用于研究眼科疾病的发病机制、治疗和分析预后。基于体素的形态学分析(voxel-based morphometry,VBM)作为一种新型的磁共振图像的分析方式,VBM可以对活体脑进行无创的形态学研究,定量分析磁共振图像中每一个单独体素内的白质、灰质的密度和体积的变化,从而反映对应区域的解剖学结构差异,能发现常规MRI不能检测到的灰质和白质结构的细微改变。不同于那些只作用于预设的感兴趣区域的分析方法,VBM完全没有偏向性,它探测全脑的异常变化,无需对感兴趣区的先验性假设,不会被研究人员的主观思维影响。这提供了一种全新的方法来探索眼科疾病中的神经病理变化,尤其在青光眼和弱视的研究中应用最多。
With the increasing requirements for medical imaging technologies in clinical diagnosis, treatment and pathological basis research of ophthalmic diseases, magnetic resonance imaging (MRI) has been broadly used in the diagnosis and prognostic evaluation of ophthalmic diseases. As a novel analytic method of MR images, voxel-based morphometry (VBM) quantitatively analyzes the changes in brain gray, white matter density and volume in each individual voxel in MR images to reflect the differences of anatomical structures in the corresponding areas, and it provides a novel way to reveal the neuronal pathological changes in ophthalmic diseases.
医学教育
目前Wetlab眼科手术教学采用猪眼球作为教学模型,与实际手术差别较大,且无法满足外眼手术教学的需求。通过使用带有眼球、眼外肌、眶组织、眶骨及眼睑结构的全眼模型,可高度模拟真实手术场景,覆盖更多眼科手术教学需求。基于全眼模型构建多个眼科手术教学平台,依照培养阶段设计手术课程,创建新的评价体系,改变传统将“内眼”“外眼”分开的教学理念,可使年轻医师从一开始就建立眼科“分科而不分割”的整体思维,从而使眼科手术培训更加规范和完善。
Porcine eyes have been used as animal model in ophthalmic surgery training. However, it differs greatly from real surgery and cannot meet the needs of external eye surgery teaching. Porcine orbit model with eyeball, extraocular muscles, orbital tissue, bones and eyelids can be more realistic simulation of real surgeries and cover more needs for ophthalmic surgery teaching. By setting up ophthalmic surgery teaching platforms, designing staged course and creating new assessment methods based on porcine orbit model, the traditional concept about separation of internal and external eye is changed. This helps young doctors to establish a holistic view from the very beginning, that ophthalmic surgeries should not be split because of subspeciality. In this way, ophthalmic surgery training will become more standardized and perfected.
论著
目的:探讨赋能教育模式在干眼患者健康教育中的应用价值。方法:选取2017年6月至12月期间首诊于南方医科大学珠江医院眼科的干眼患者,按照完全随机分配法分为试验组(n=73)及对照组(n=73),试验组采用赋能教育模式,对照组采用传统健康教育方式。经治疗1周、1个月、2个月及6个月后,分别随访并记录每组患者的眼表疾病指数(ocular surface disease index,OSDI)、泪膜破裂时间值(tear film break up time,BUT),同时记录患者家庭护理(清洁睑缘、热敷、睑板腺按摩)频率以及复诊频率。结果:赋能教育组家庭护理频率及复诊频率均优于传统教育组(P<0.05)。治疗前两组OSDI和BUT差异均无统计学意义(P>0.05),但试验组OSDI随时间的推移呈下降趋势,BUT值呈上升趋势;而对照组OSDI以及BUT值的变化均不明显。结论:运用赋能教育模式有助于提高干眼患者治疗的依从性,提高患者的家庭护理频率和复诊频率,显著改善患者的眼表情况,进而提高长期治疗效果。
Objective: To evaluate the application value of empowerment education mode in health education for patients with dry eye syndrome. Methods: Patients with dry eye syndrome were recruited from Department of Ophthalmology, Zhujiang Hospital, Southern Medical University from June 2017 to December 2017. All patients were randomly divided into the experimental group (n=73), educated with empowerment education mode, and control group (n=73), treated with traditional health education. Patients were followed up after 1 week, 1 month, 2 months and 6 months, respectively. Data were collected in each follow-up visit including ocular surface disease index (OSDI), tear film break up time (BUT), the frequency of home care (cleaning eyelid margin, hot compress, palpebral gland massage) and re-visit frequency. Results: The OSDI and BUT were similar between two groups before corresponding treatment (P>0.05). After the treatment, patients in the experimental group showed a downtrend in the OSDI and uptrend in the BUT. No significant changes were found in the control group during the follow-up. The frequency of family nursing and re-visit in the experimental group was statistically higher than that in the control group. Conclusion: The application of empowering education mode can improve the compliance of dry eye patients, improve the frequency of home care and follow-up visit, and mitigate the ocular surface of patients, thereby enhancing the long-term efficacy.
发明与创新
为满足眼部化学伤患者高效急救的需要,发明一种眼部化学伤结膜囊冲洗器,包括进液管道,冲洗管道,手动加压球,流量调节器和结膜囊冲洗头,避免反复更换冲洗液,减少操作时间,同时有利于冲洗液快速大量聚集,为严重眼部化学伤的患者缩短急救等待时间;手动加压球的设置,实现了冲洗液重力基础上的加压冲洗,为患者眼部急救治疗效果提供了可靠保证。
A new conjunctiva sac irrigation device which includs a liquid inlet pipe, flush pipe, and a manual pressure device, a flow regulator and a flush filter was invented to meet needs of efficient first aid for ocular chemical injuries. It is worth noting to avoid changing fushing fliud frequently and shorten time of operation, which is beneficial to gather a lot of flushing fluid in a short time and shorten the first aid waiting time for patients with severe ocular chemical injuries. For this device, the design of manual pressure ball realizes presure flush based on the gravity of flushing fliud, which confirms a reliable effect on the acute treatment to patients' eyes.
综述
目的:了解儿童罹患青光眼的疾病类型、特点,更好地做到早期发现早期治疗。方法:收集北京同仁医院2014—2019年度834例0~18周岁住院接受抗青光眼手术的患者,回顾性分析患者的人群特点与疾病构成特点。结果:834例患者中,原发青光眼397例(47.6%),继发青光眼429例(51.4%)。另有8例无法明确诊断青光眼类型。原发青光眼中以原发先天性青光眼最常见,继发青光眼中以白内障术后继发青光眼为主,两种类型的青光眼占总患者数的50%。结论:儿童罹患青光眼的疾病种类繁多,其中原发先天青光眼与白内障术后继发青光眼最常见,重视婴幼儿先天青光眼的筛查,监测儿童白内障术后眼压有助于早期发现青光眼,并给予治疗,延缓儿童青光眼患者视功能的损害。
Objective: To understand the types and characteristics of glaucoma in pediatric inpatients to achieve early detection and treatment. Methods: A total of 834 patients aged 0–18 years who underwent anti-glaucoma surgery in Beijing Tongren Hospital from 2014 to 2019 were collected and their population characteristics and disease composition characteristics were retrospectively analyzed. Results: In all of the 834 cases, there were 397 patients (47.6%) with primary glaucoma and 429 (51.4%) with secondary glaucoma. The type of glaucoma could not be definitively diagnosed in 8 cases. Primary infant glaucoma and secondary glaucoma following cataract surgery accounted for above 50%. Conclusion: The causes of pediatric inpatients with glaucoma are various. Screening of primary infant glaucoma should be taken seriously and monitoring intraocular pressure after cataract surgery is also important. Early detection and treatment can prevent further visual loss of pediatric patients with glaucoma.
医学教育
目的:探讨以岗位需求为导向的培训模式在眼科手术室护士上岗前消毒供应专科专项培训中的应用效果。方法:手术室上岗前护士共44名,按随机分配原则,其中23名为实验组,另外21名为对照组。实验组以医院消毒供应中心三大行业标准和医院消毒技术规范为理论依据,以手术室护理岗位需求为目标,制定针对性培训内容,采用多方式培训方法,在消毒供应中心培训3个月考核合格后调入手术室。对照组直接调入手术室工作。采用手术室带教老师对新上岗护士满意度调查作为评价指标。结果:23名学员的理论知识考核、技术操作考核全部合格,小讲课顺利完成。手术室带教老师对实验组的满意度明显高于对照组。结论:建立以岗位需求为导向的眼科手术室护士消毒供应专科培训模式,有助于提高新上岗的手术室护士工作适应性,并提升手术室护士对专科器械的管理能力。
Objective: To explore the application effect of job demand-oriented training model in specialized training of sterile supplying for nurses in the ophthalmic operation room. Methods: A total of 44 nurses who would work in the operating room were randomly divided into the experimental group (n=23) and control group (n=21). Based on the three industrial standards of Central Sterile Supply Department (CSSD) and the technical specifications of disinfection in hospital, and targeting the job requirements of operating room nursing, the experimental group formulates specific training contents and adopts various training methods. The experimental group was transferred to the operating room after being trained in CSSD for 3 months and passing the examination. The control group was transferred directly to the operating room. The degree of satisfaction from the teachers of operating room to new nurses was used as the evaluation index. Results: All the 23 students passed the examination of theoretical knowledge and technical operation, and the small lectures were completed successfully. The degree of satisfaction from teachers in operating room to trainees was obviously higher than that of untrained nurses. Conclusion: The establishment of job demand-oriented training model in specialized training of sterile supplying for nurses in ophthalmic operation room is helpful to improve the work adaptability of the newly-hired nurses in the operation room. It also helps the nurses in the operation room to enhance the management ability on the specialized instruments.
病例报告
患儿因“左眼红肿12 d”就诊。左上睑红肿(++++),眼眶鼻侧可触及约黄豆大小硬结,界不清,质地中等,压痛(?),伴上睑下垂,遮盖角膜下缘。双眼眼位正,左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀,考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor,IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例,提示早期规范治疗是降低此病复发率的关键,尤其是儿童患者。
The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.