眼科日间手术显著提高了医疗效率、节约了医疗资源,眼科麻醉复苏体系的建立则是眼科日间全身麻醉手术的重要安全保障,也是提高眼科手术室效率的重要举措。在眼科手术结束后,全身麻醉患者被即刻转运至麻醉恢复室(post-anesthesia care unit, PACU),此时患者仍处于麻醉状态,密切的监测和呼吸机辅助通气是必不可少的,从而保障患者从麻醉状态逐渐恢复至清醒状态。当患者清醒后,拔除喉罩,各项监测指标达到PACU的转出标准,可进入到Ⅱ期复苏并日间手术离院。然而,在PACU复苏期间,患者易出现喉罩移位、呛咳等引起急性缺氧等呼吸道不良事件的发生,小儿患者则由于术后眼罩遮盖等原因,出现苏醒期躁动的概率高,从而影响到患者顺利转出PACU,间接影响到手术患者的周转。因此,如何预防这些并发症的发生,对提高眼科麻醉复苏质量显得十分重要。
眼科日间手术显著提高了医疗效率、节约了医疗资源,眼科麻醉复苏体系的建立则是眼科日间全身麻醉手术的重要安全保障,也是提高眼科手术室效率的重要举措。在眼科手术结束后,全身麻醉患者被即刻转运至麻醉恢复室(post-anesthesia care unit, PACU),此时患者仍处于麻醉状态,密切的监测和呼吸机辅助通气是必不可少的,从而保障患者从麻醉状态逐渐恢复至清醒状态。当患者清醒后,拔除喉罩,各项监测指标达到PACU的转出标准,可进入到Ⅱ期复苏并日间手术离院。然而,在PACU复苏期间,患者易出现喉罩移位、呛咳等引起急性缺氧等呼吸道不良事件的发生,小儿患者则由于术后眼罩遮盖等原因,出现苏醒期躁动的概率高,从而影响到患者顺利转出PACU,间接影响到手术患者的周转。因此,如何预防这些并发症的发生,对提高眼科麻醉复苏质量显得十分重要。
总结32例飞秒激光辅助角膜移植术患者的护理,认为做好心理护理、术前完善眼部检查和做好充分的准备,术后严密观察敷料、眼压和角膜植片的情况,做好特殊体位和角膜接触镜的护理,并做好出院指导是提高手术的成功率及预防并发症的关键。
This paper summarized the nursing care of 32 patients received femtosecond laser assisted corneal transplantation. The key points to increase the success rate of surgery and prevent complications were psychological nursing, preoperative examinations and fully prepared, postoperative observation of dressing, intraocular pressure and corneal glass, care of special position and corneal contact lens, and discharge guidance.
Background: Few prevalence studies on intermittent exotropia (IXT) based on Chinese populations. Furthermore, longitudinal change in this pattern within a local setting has not been reported in the past. This study aims to determine the pro?le of children with IXT in China.Methods: A total of 7,537 subjects from nine multi-layer primary and secondary schools participated in this investigation. The position of eyes was examined by using Hirschberg test and alternate cover test. The obtained results were classi?ed according to respective features and analyzed statistically.Results: The prevalence of IXT among the participants was 7.98%, accounting for 73.04% of all types of strabismus. Junior high school students had a lower prevalence of IXT than elementary and senior high school counterparts. Logistic regression analysis showed that IXT was mainly found in male pupils at high grades in rural areas and in male secondary students at high grade in urban regions.Conclusions: IXT was shown to be more prevalent than other types of strabismus in Chinese children. Furthermore, the distribution and characteristics of IXT greatly varied among participants.
Background: Few prevalence studies on intermittent exotropia (IXT) based on Chinese populations. Furthermore, longitudinal change in this pattern within a local setting has not been reported in the past. This study aims to determine the pro?le of children with IXT in China.Methods: A total of 7,537 subjects from nine multi-layer primary and secondary schools participated in this investigation. The position of eyes was examined by using Hirschberg test and alternate cover test. The obtained results were classi?ed according to respective features and analyzed statistically.Results: The prevalence of IXT among the participants was 7.98%, accounting for 73.04% of all types of strabismus. Junior high school students had a lower prevalence of IXT than elementary and senior high school counterparts. Logistic regression analysis showed that IXT was mainly found in male pupils at high grades in rural areas and in male secondary students at high grade in urban regions.Conclusions: IXT was shown to be more prevalent than other types of strabismus in Chinese children. Furthermore, the distribution and characteristics of IXT greatly varied among participants.
Background: Corneal ectasia is a serious complication after laser in situ keratomileusis (LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation (PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN® IIz (Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN® IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.Results: There was no statistical difference between the mean best-fit sphere (BFS) pre-LASIK and 6 years postop (P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm (range, 12 to -31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent (ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK.
Background: Corneal ectasia is a serious complication after laser in situ keratomileusis (LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation (PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN® IIz (Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN® IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.Results: There was no statistical difference between the mean best-fit sphere (BFS) pre-LASIK and 6 years postop (P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm (range, 12 to -31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent (ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK.
目的:比较翼状胬肉两种不同手术方式后巩膜溶解的发生概率,探讨产生巩膜溶解的原因,选择合理手术方式。方法:对本院两年来263例翼状胬肉采用两种不同的手术方式,观察术后发生巩膜溶解的情况,并通过局部药物进行治疗。结果:263例翼状胬肉患者,130例采用胬肉切除+结膜瓣转位术,裸露角膜缘3 mm巩膜,术后局部滴0.02%丝裂霉素C(mitomycin C, MMC),胬肉复发26 例,发生巩膜溶解6例;133例采用胬肉切除+角膜缘干细胞移植术,术后滴0.02% MMC,胬肉复发5例,无1例发生巩膜溶解。结论:翼状胬肉术后发生巩膜溶解,是一种严重的手术并发症,可能与术中过度烧灼巩膜面,巩膜板层暴露于MMC有关。采用胬肉切除+角膜缘干细胞移植术,植片覆盖裸露巩膜,促进巩膜表层愈合,术后避免MMC直接浸润巩膜板层故未见此并发症发生。与传统手术方式相比,复发率低,并发症少,是一种安全、有效的翼状胬肉手术方式。
Objective: To compare the occurrence probability of posterior scleral dissolution in two different surgical methods, and to explore the reasons for the dissolution of the scleral. Methods: Using two different surgical methods on 263 cases of pterygium submitted in our hospital in 2 years, observed the occurrence of scleral at postoperative, and treated with topical drugs. Results: Two hundred and sixty three cases of patients with pterygium, 130 cases of pterygium resection and conjunctival flap transposition, bare 3 mm limbus sclera, postoperative topical mitomycin C (MMC). The recurrence of pterygium in 26 cases, scleral melting in 6 cases; 133 cases of pterygium excision and limbal stem cell transplantation, MMC (0.02% MMC drip after operation, 5 cases of recurrent pterygium, no scleral melting occurred in 1 case. Conclusion: The scleral dissolution occurred after pterygium surgery is a serious complication, which may be related to the excessive burning of the scleral surface, and the lamellar exposure to MMC. Excision of pterygium and corneal limbal stem cell transplantation were used to cover the exposed scleral, promote the surface healing of the wound, and avoid the MMC direct infiltration of the lamina. Compared with the traditional operation mode, the recurrence rate is low, and the complication is little. It is a safe and effective surgical method.
目的:探讨口服25%葡萄糖减轻早产极低出生体重儿在第一次早产儿视网膜病眼底检查时的疼痛 的效果。方法:选取2014年9月至2015年8月在广东省妇幼保健院NICU住院的早产极低出生体重儿,随机分为观察组和对照组,观察组在进行第一次早产儿视网膜病眼底检查前2 min,给予25% 葡萄糖溶液1mL口服;对照组未用任何安慰剂。两组患儿眼底检查后分别进行新生儿疼痛量表的 评估。结果:观察组患儿眼底检查后疼痛评分低于对照组(P<0.001)。结论:眼底检查前2 min口服25%葡萄糖溶液1 mL是缓解早产儿视网膜病检查引起的疼痛的有效措施。
Objective: To explore the analgesic effect of oral glucose 25% on preterm and very low birth weight infants for the first time of fundus examination for retinopathy screening. Methods: Cases of preterm and very low birth weight infants in Guangdong Women and Children’s Hospital NICU from February 2014 to January 2015 were randomly divided into observation group and control group. The observation group was given 1 mL of 25% glucose solution by oral 2 min before the first time of retinopathy screening. The control group was given nothing. Pain was evaluated using the Neonatal Infant Pain Scale immediately after the fundus examination in both groups. Results: The NIPS of the observation group was lower than that of the control group (P<0.001). Conclusion: 1 mL of 25% glucose solution given 2 min before fundus examination for retinopathy of prematurity by oral was an effective measure for pain relief.