目的：比较轻、中、重度近视患儿之间的视觉功能的差异，探索虚拟现实下的短期可塑训练对近视视觉功能的改善效果。方法：选择2022年6月—2022年9月就诊于苏州大学附属儿童医院的6~16岁儿童102例，按照屈光度分为正常对照组、轻度近视组和中重度近视组，进行眼科常规检查和视知觉功能检查，并进行视觉短期可塑训练。结果：近视患儿存在立体视功能缺损，近视程度与精细立体视功能损害呈正相关，各组之间比较差异具有统计学意义(P<0.05)，部分患儿存在中心凹抑制。训练后，轻度近视组的中距离精细立体视功能得到改善，比较差异具有统计学意义(P<0.05)。结论：近视患儿存在立体视功能异常和中心凹抑制，且立体视功能的损害随着近视程度的增加而加重。轻度近视患儿部分精细立体视功能经过虚拟现实短期可塑训练可得到改善，而中重度近视患儿精细立体视功能改善不明显。
Objective: To compare the difference of visual function among children with myopia in different diopter, and explore the effect of short-term plastic training of virtual reality on visual function improvement. Methods: The 102 children aged 6-16 years who admitted to Children's Hospital of SoochowUniversity from June 2022 to September 2022 were recruited and divided into control group, mild myopia group and middle and high myopia group according to diopter. Routine ophthalmologic examination and visual perception function examination were carried out, and short-term plastic training was implemented. After the training, visual perception function examination was completed again. Results: There were significant differences in stereoscopic function defect at different distances among myopic children, a negative correlation between myopia and stereoscopic function was found. while there were several cases have foveal suppression. After training, the fine stereopsis at medium distance of the mild myopia group was significantly improved with significance statistical difference. Conclusions: Myopia can lead to the abnormality of stereopsis and foveal suppression in children. The defect of binocular visual function increases with the increase of myopia. Short term plastic training of virtual reality can partially improve the fine stereoscopic function of mild myopia children whileshowsnosigni ficanceimprovementof the fine stereoscopic function in middle and high myopia group.
本文总结了15例自膨胀水凝胶眶内植入术患儿围手术期的护理要点。术前主要评估患儿是否完善术前检查，给予患儿及其家属个性化的心理护理，进行术前准备以及禁食禁饮的管理。术后主要给予患儿安全管理，饮食、疼痛、眼部用药以及弹力绷带包扎护理，关注有无并发症的发生及给予相应的护理，并对患儿及其家属做好出院指导。15例患儿均顺利完成手术，术后均出现术眼疼痛，2例出现眶压增高，1例出现呕吐，均得到妥善处理。术后随访3~18个月，患儿均获得了较为满意的眼部外观，生活质量得到了提高。
This paper summarized the nursing experience of 15 children with self-expanding hydrogel orbital implantation during perioperative period. Before operation, children were fully evaluated, given with psychological care, preoperative preparation and management of fasting and drinking. After the surgery, the patients were mainly given with safety management, diet, pain, medicine and elastic bandage dressing care. Nurses should pay attention to the occurrence of complications and give corresponding nursing care and offer useful discharge guidance for the children and their parents. All 15 children completed the operation successfully, postoperative eye pain occurred in 15 cases after operation, and the orbital pressure increased in 2 cases, 1 case vomited, and all cases were properly treated. After postoperative follow-up for 3–18 months, 15 children were satisfied with the appearance of the eye,and the life quality was improved.
目的：利用儿童Glasgow受益调查问卷(Glasgow Children’s Benefit Inventory，GCBI)评估先天性上睑下垂手术后儿童健康相关生活质量(health-related quality of life，HRQOL)的受益，并探索受益的影响因素。方法：验证GCBI中文版评估先天性上睑下垂矫正术后长期患儿生活质量的信效度，并用其评估术后儿童HRQOL受益与性别、手术年龄、术后随访时间等相关性。结果：共178名先天性上睑下垂接受下垂矫正术后儿童完成问卷，结果显示不同性别、年龄均有正性受益，术后短期(<1年)受益更明显(P<0.05)。结论：GCBI中文版具有良好的信度和效度，适用于评估先天性上睑下垂儿童术后受益结果。先天性上睑下垂儿童接受下垂矫正术后不同性别均有正性受益，术后短期(<1年)受益更明显。
Objective: To explore the benefits of children’s HRQOL after congenital ptosis surgery using the Glasgow Children’s Benefit Inventory (GCBI) and the factors influencing the benefits. Methods: To verify the reliability and validity of the Chinese version of GCBI in evaluating the long-term life quality of children after correction of congenital ptosis, and to evaluate the correlation between the HRQOL benefit of children after surgery and gender, surgical age, postoperative follow-up time, etc. Results: A total of 178 children after congenital ptosis surgery completed the questionnaire. Different genders or ages of children with congenital ptosis both showed positive benefit after ptosis correction, and the short-term (<1 year) benefit was more obvious after surgery (P<0.05). Conclusion: The Chinese version of GCBI has good reliability and validity,and is suitable for evaluating the postoperative benefit results of children with congenital ptosis. All the children with congenital ptosis received positive benefit after ptosis correction, and the short-term benefit (<1 year) was more obvious.
目的：调查眼病患儿家长在患儿手术前的健康教育需求，为责任护士开展个性化、高质量的健康教育提供依据。方法：采用自制的眼病儿童手术前家长的健康教育需求调查问卷对2020年4月至2020年6月的眼病手术患儿家长进行问卷调查，并对调查结果进行统计分析。结果：家长对眼病患儿手术术前健康教育需求排名前3位的是手术治疗的效果、意义及眼病相关专科健康知识。医疗付费方式的差异、患儿年龄、疾病的差异及家长年龄、职业状态的差异对术前健康教育需求得分差异有统计学意义(P<0.05)；家长获取健康教育知识的途径以医务人员讲解和公众号等网络平台为主。结论：眼病患儿家长对患儿术前健康教育需求较高，医务工作者应丰富知识层面，加强专科学习及相关知识培训，把专科知识与健康教育有机地结合，并探索有效的线上健康教育方式，更好地为患者服务。
Objective: To investigate the health education needs of parents of children with eye diseases before operation, and to provide basis for more targeted and high-quality health education for primary nurses. Methods: A self-made questionnaire was used to investigate the health education needs of parents of children with ophthalmopathy before surgery from April 2020 to June 2020, and the results were statistically analyzed. Results: The top three of parents’ needs for preoperative health education of children with eye diseases were the effect and significance of the surgery and the related professional health knowledge of eye diseases. The differences of medical payment methods, children’s age, diseases, parents’ age, and occupational status was significant in the scores of preoperative health education needs (P<0.05). The main ways of parents obtaining health education knowledge were network platforms such as medical staff explanation and official accounts. Conclusion: The parents of children with eye diseases have a high demand for preoperative health education. Medical workers should enrich their knowledge, strengthen specialty learning and related knowledge training, organically combine professional knowledge with health education, and explore the methods of effective online health education to serve patients better.
目的：运用Lea Symbols视力表、HOTV视力表对2.5~5.0岁正常儿童视力发育情况进行探究，并评价2种视力表的应用效果。方法：以随机顺序先后应用Lea Symbols视力表与HOTV视力表对广州地区2所早教中心及3所幼儿园共461例儿童(922只眼)进行单眼视力检查，所有儿童提前1 d行小瞳下检影验光、眼前节裂隙灯检查、眼底情况、眼球活动、眼位检查，筛选无器质性眼病、屈光度在正常范围的儿童作为研究对象。视力值采用5分记录方法表示。结果：1 )可测率(视力表使用配合程度)。407名儿童完成Lea Symbols视力检查，总体可测率92.08%；402名儿童完成HOTV视力检查，总体可测率90.95%；前者可测率高于后者，差异无统计学意义(χ2 =0.417，P=0.580)。进一步研究发现2种视力的可测率随年龄增长不断提高，儿童3岁之后基本都能完成2种视力的检查。2)2种视力结果及比较(5分记录法表示)。Lea视力值：右眼为4.89±0.05，左眼为4.90±0.05；HOTV视力值：右眼为4.84±0.05，左眼为4.85±0.04；前者视力好于后者，差异有统计学意义(右眼：t=3.171，P=0.003；左眼：t=3.230，P=0.003)。3)视力发育与年龄的相关性。2种视力发育与年龄存在显著正相关(P<0.001)，即随着年龄的增长，视力水平逐渐提高。4)视力发育与眼别、性别的关系。左右眼之间的视力发育差异无统计学意义(P>0.05)；男性儿童的视力发育好于女性，且差异有统计学意义(P<0.05)。结论：Lea Symbols及HOTV视力表建议用于年龄大于3岁儿童的视力检查，且儿童更容易接受Lea Symbols视力表的检查。伴随年龄的增长，儿童的视力发育呈现提高的趋势；Lea视力优于HOTV视力。视力的发育与眼别无关，男性儿童的视力发育快于女性儿童。
Objective: To conduct a preliminary study of the Lea Symbols and HOTV charts to explore the visual development of children aged 2.5 to 5.0 years, and evaluate the application values of the two charts. Methods: A total of 461 children (922 eyes) in 2 early education centers and 3 kindergartens in Guangzhou were examined by using the Lea Symbols visual acuity chart and HOTV visual acuity chart in random order. All the children underwent low-pupil photometry, anterior section slit-lamp examination, retinal condition, eye movement, and eye position examination 1 day in advance. Children with no organic eye disease and normal diopter were selected as subjects. Visual acuity was recorded with 5 points. Results: 1) Measurable rate (visual acuity chart use degree of cooperation). 407 children completed visual examination of Lea Symbols, with an overall detectable rate of 92.08%; 402 children completed HOTV vision examination, with an overall detectable rate of 90.95%. The detectable rate of the former was higher than that of the latter, but the difference was not statistically significant (χ2 =0.417, P=0.580). Further study found that the detectable rate of both visual acuities increased with age, and children were able to complete both visual acuity tests after the age of 3. 2) Results and comparison of two visual acuity (5-point recording method). The visual acuity of Lea was 4.89±0.05 in the right eye and 4.90±0.05 in the left eye. HOTV visual acuity was 4.84±0.05 in the right eye and 4.85±0.04 in the left eye. The visual acuity of the former was better than that of the latter, the difference was statistically significant (right eye: t=3.171, P=0.003; left eye: t=3.230, P=0.003). 3) Correlation between visual development and age. There was a significant positive correlation between the two types of visual development and age (P<0.001), that is, visual acuity gradually improves with age. 4) The relationship between visual development and eye and sex. There was no difference in visual development between the left and right eyes, but male children had better visual development than female, and the difference was statistically significant (P<0.05). Conclusion: Lea Symbols and HOTV visual acuity charts are recommended for visual acuity examination of children over 3 years old, and children are more likely to receive examination of Lea Symbols visual acuity chart. With the growth of age, the visual development of children shows a trend of improvement. Lea vision is superior to HOTV vision. Vision development has nothing to do with the eye, male children’s vision development is faster than female children.
非器质性视力下降也称为心因性或功能性视力下降，除视力下降外，还可伴有视野缺损，多由于精神心理疾患导致的转换障碍引起，部分患者为诈病以获取利益。本文报道1例6岁的女性患者，主诉双眼反复视力下降1年余，早期被误诊为儿童视神经炎，给予糖皮质激素冲击治疗，治疗后稍有好转。通过本例患者误诊的教训，提醒我们在遇到儿童出现不明原因的视力下降时，在没有明确器质性疾病证据时要想到非器质性视力下降的可能，掌握识别非器质性视力下降的检查方法，不能忽略相对性传入性瞳孔障碍等基础的神经眼科检查。
Non-organic vision loss is also known as psychogenic or functional vision loss. In addition to vision loss, it can also be accompanied by visual field defect. It is mostly caused by conversion obstacles caused by mental and psychological diseases. Some patients cheat to obtain benefits. This paper reports a 6-year-old female patient who complained of repeated visual acuity decline for more than one year. She was misdiagnosed as pediatric optic neuritis in the early stage and was treated with glucocorticoid shock therapy, which her condition improved slightly after treatment. The misdiagnosis of this patient teaches us that when children have unexplained visual acuity decline, we should think of the possibility of non-organic visual acuity decline when there is no clear evidence of organic diseases, master the examination methods to identify non-organic visual acuity decline, and cannot ignore the basic neuro-ophthalmic examination such as relative afferent pupillary defect (RAPD).
目的：探索智能语音随访系统在医疗场景中的新型应用服务模式并分析其在新冠肺炎疫情期间的应用效果，以此评估该系统应用于互联网医院开展医疗咨询服务的实际效能。方法：本研究应用智能语音随访系统针对先天性白内障患儿术后的常见问题进行回访。首先，针对随访目的，设计出完善的结构化随访内容与步骤。其次，部署智能外呼系统自动拨打用户电话，并通过语音识别技术对用户的每次应答进行识别，根据用户的应答自动跳转到下一个随访步骤，在完成一系列问答后根据用户的回答给出恰当的建议，实现电话随访的自动化与智能化。收集2020年2月24日至2月28日期间，智能语音随访系统随访的电话内容、呼叫时间、患儿资料等数据，采用描述性统计分析。结果：2020年2月24日至2月28日期间，中山大学中山眼科中心应用智能语音随访系统电话共随访1154例，其中收到有效回访数据561例，平均有效回访率48.6%。有效回访人群中，有204位(36.4%)家属认为疫情期间复诊时间延长，对宝宝眼睛的恢复有影响，309位(55.1%)家属认为对宝宝眼睛的恢复没有影响。360位(64.2%)先天性白内障患儿眼睛恢复情况良好，没有出现不良反应，169位(30.1%)患儿出现不良反应和体征，包括瞳孔区有白点，眼睛发红和有眼屎流眼泪等。统计患儿不同行为显示，有417位(74.3%)患儿佩戴眼镜，135位(24.1%)患儿没有佩戴眼镜，另有9位(1.6%)患儿佩戴眼镜情况不清楚，经常揉眼的患儿更容易出现眼睛发红(20.4%)、眼睛有眼屎或流眼泪(17.0%)和瞳孔区有白点(6.8%)等不良反应。结论：智能语音随访系统在临床随访中显示出巨大的应用潜力，可作为一种新型的智能医疗服务模式。
Objective: This study was designed to explore its potential value for new medical service model based on the intelligent voice follow-up system and analyze its application effect during the outbreak of COVID-19. The actual effectiveness of this intelligent voice follow-up system applied in the Internet hospital to carry out medical consultation service was discussed. Methods: In this study, an intelligent voice follow up system was developed for postoperative follow-up of children with congenital cataract. First, a well-designed and structured questionnaire contents were developed for postoperative follow-up. Secondly, the intelligent voice follow-up system was deployed. The system would automatically jump to the next follow-up step according to the user’s response, and give appropriate suggestions. Finally, the data of telephone recording, call time, children’s attributes were collected and statistically analyzed. Results: From February 24 to March 15, 2020, 561 families of children with congenital cataract from Zhongshan Ophthalmic Center were recruited by using the intelligent voice follow-up system. The system completed a total of 1 154 calls, of which 561 cases received follow-up data, reaching an average effective call rate of 48.6%. Among 561 cases, 204 (36.4%) thought that the extended time of follow-up visit would affect the recovery of children, while 309 (55.1%) thought that it exerted no effect on the recovery. 360 children (64.2%) achieved good ocular recovery without complications, whereas 169 cases (30.1%) developed ocular symptoms. These include white spots in the pupil area, redness and eye secretions. Statistics of different behavior of children showed that there were 417 (74.3%) children wearing glasses, 135 (24.1%) children did not wear glasses, another 9 (1.6%) children wearing glasses were not clear, often rubbing the eyes of children were more likely to appear redness (20.4%), eye secretions (17.0%) and white spots in the pupil area (6.8%) and other adverse reactions. Conclusion: The intelligent voice follow-up system shows great application potential in clinical follow-up, which can be employed as a new service mode of intelligent medical treatment.
目的：观察学龄儿童的近视进展情况，分析近视进展的危险因素。方法：于2014年纳入温州2所小学二、三年级近视儿童，每年随访1次，直至小学毕业。检查内容包括非睫状肌麻痹主觉验光、双眼视功能检查(隐斜、调节性集合/调节、正负相对调节、正负融像性聚散)和问卷调查。采用无序多分类logistic回归分析近视进展速度的危险因素。结果：共纳入152名近视儿童[年龄7~9岁，95名(62.5%)男性]，初始屈光度为-1.30±0.95屈光度(diopter，D)，年近视进展量为-0.68±0.35 D。回归分析表明：与慢速组相比(年近视进展量>-0.50 D)，中速组(-1.00 D<年近视进展量≤-0.50 D)与快速组(年近视进展量≤-1.00 D)中初始屈光度≤-1.00 D的儿童占比更大(中速组：OR=3.51，P=0.003；快速组：OR=3.29，P=0.044)，快速组中女性占比更大(OR=4.52，P=0.012)，基线双眼视功能参数在不同组间差异均无统计学意义(均P>0.05)。结论：学龄儿童近视进展速度与性别、初始屈光度相关，与基线双眼视功能无关。女孩、初始近视程度大(7~9岁时，屈光度≤-1.00 D)的儿童近视进展快。
Objective: To investigate myopia progression and analyze the risk factors associated with myopia progression in a cohort of primary schoolchildren. Methods: The study was conducted in two primary schools in Wenzhou. Schoolchildren from grades 2 and 3 were examined in 2014 and were followed up annually until primary school graduation at grade 6. Children who were myopic at baseline were included in this study. The examination included non-cycloplegic subjective refraction, questionnaire survey, and binocular visual function parameters such as phoria, accommodative convergence/accommodation, positive relative accommodation, negative relative accommodation, and fusional convergence range. Multinomial logistic regression analysis was conducted to investigate the risk factors associated with various myopia progression speeds. Results: A total of 152 myopic schoolchildren [baseline age range 7–9 years; 95 male (62.5%)] were included in this study. The average refractive error (spherical equivalent refraction, SER) at baseline was -1.30±0.95 D, and the average annual myopia progression was -0.68±0.35 D. Multinomial logistic regression analysis showed that compared to the slow myopia progression group (annual myopia progression >-0.50 D), the moderate myopia progression group (-1.00 D < annual myopia progression ≤-0.50 D) and the fast myopia progression group (annual myopia progression ≤-1.00 D) were associated with having SER values ≤-1.00 D at baseline (moderate: OR=3.51, P=0.003; fast: OR=3.29, P=0.044); the fast myopia progression group was also associated with female sex (OR=4.52, P=0.012); baseline binocular visual function parameters were not related to various myopia progression speeds (P>0.05 for all). Conclusion: Sex and baseline refractive error were associated with various myopia progression among primary schoolchildren. No correlation between baseline binocular visual functions and myopia progression was found in this study. Myopia progressed faster in girls and children who had greater myopia (SER values ≤?1.00 D at age 7–9 years) at baseline.
克服现有婴幼儿眼科手术病号服存在的穿脱不便、容易着凉、无法避免患儿抓挠术眼等问题，提供一种便于穿脱、保护胸腹部和术眼的婴幼儿眼科手术病号服*。
Abstract Present patient clothing for infants and children with ophthalmic surgery have several limitations, which is inconvenient to wear, hard to keep warm and difficult in preventing patients from scratching eyes underwent surgery. A modified patient clothing for infants and children is designed to overcome these existing problems.
目的：观察盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术中的临床应用效果，评价盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术麻醉中的有效性和安全性。方法：选择2020年11月至2021年7月在佛山市第二人民医院择期行眼睑肿物刮除术的70例患儿，随机分为A组和B组，每组35例。A组采用七氟烷联合丙泊酚复合麻醉，B组采用盐酸艾司氯胺酮联合丙泊酚复合麻醉。记录两组患儿诱导时间、手术时间、苏醒时间、复苏总时间；监测麻醉前、麻醉后5 min、手术开始前、手术结束后患儿血流动力学及呼吸频率变化；记录两组患儿苏醒后即刻、返回病房即刻的东安大略儿童医院疼痛评分量表(Children’s Hospital of Eastern Ontario Pain Scale，CHEOPS)疼痛评分、躁动评分、恶心呕吐评分。结果：两组患儿麻醉诱导时间比较差异无统计学意义(P>0.05)；两组患儿麻醉过程中血流动力学水平、呼吸频率差异无统计学意义(P>0.05)；B组患儿苏醒时间、复苏总时间均明显低于A组(P<0.05)；B组患儿苏醒后即刻及返回病房即刻CHEOPS疼痛评分、躁动评分、恶心呕吐评分均明显低于A组(P<0.05)。另外，B组患儿术后出现恶心呕吐概率低于A组(P<0.05)。结论：盐酸艾司氯胺酮联合丙泊酚应用于小儿眼睑肿物刮除术麻醉，能提供良好麻醉镇痛效果，降低躁动反应和恶心呕吐的发生
Objective: To investigate the anesthetic effect and to evaluate the efficacy and safety of combination application of esketamine and propofol in curettage of eyelid tumors of children. Methods: This study selected 70 children who underwent elective eyelid tumor curettage in Foshan Second People’s Hospital from November 2020 to July 2021. They were randomly divided into group A and group B, with 35 cases in each group. Patients in Group A were anesthetized with sevoflurane combined with propofol. Patients in Group B were anesthetized with esketamine combined with propofol. The anesthetic induction time, operation time, recovery time and total recovery time of the two groups were recorded. The haemodynamics and respiratory frequency changes of patients were being monitored before anesthesia, 5 minutes after anesthesia, before the operation and after the operation. The scores of Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) pain, agitation and nausea and vomiting were recorded immediately after the patients awakened and were sent back to the ward. Results: There was no significant difference in anesthesia induction time between the two groups (P>0.05). There was also no significant difference in the haemodynamics and respiratory frequency changes during the anaesthetic process between the two groups (P>0.05). The recovery time and total recovery time in group B were significantly lower than those in group A (P<0.05). The scores of CHEOPS pain, agitation and nausea and vomiting in group B were significantly lower than those in group A immediately after the patients awakened and were sent back to the ward (P<0.05). Besides, the probability of nausea and vomiting after curettage of eyelid tumors was lower in group B than in group A (P<0.05). Conclusion: Combination application of esketamine and propofol in curettage of eyelid tumors of children can provide good anesthetic and analgesic effect and reduce the occurrence of restlessness, nausea and vomiting.
