目的：分析日间病房模式下原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction, PANDO)患者行经鼻内镜下泪囊鼻腔吻合术（endoscopic dacryocystorhinostomy, En-DCR）的术后自我护理现状并进行早期效果评价。方法：纳入2021年11月—2022年8月在中山大学中山眼科中心眼整形与泪道科日间病房行En-DCR手术治疗的90例PANDO患者，术后常规给予术后自我护理指导。术后1个月复查，采用调查问卷的方式记录患者的术后自我护理情况及不适症状，评估患者手术效果，并进一步探究术后自我护理因素与手术效果及术后不适症状的相关性。结果：90例行En-DCR手术治疗的PANDO患者共计90眼，术后1个月手术总成功率为92.22%（其中治愈率为65.56%、好转率为26.67%）。术后自我护理与手术效果的特征分析显示，术后遵嘱鼻腔冲洗每日至少1次（P = 0.002）、遵医嘱喷鼻每日至少1次（P = 0.008）、术后无上呼吸道感染（P = 0.047）的患者手术效果更好。术后自我护理与术后不适症状的特征分析显示，每日至少1次鼻腔冲洗（P = 0.006）和义管在位（P = 0.003）的患者术后不适症状较少。同时对置管患者进行心理负担相关性分析，结果显示置管不适与心理负担呈正相关（r = 0.421, P < 0.001）。结论：在日间病房模式下，医护人员对En-DCR术后患者进行详细的自我护理指导，有助于患者的术后恢复及保证良好的手术疗效。指导重点包括术后1个月内每日至少1次鼻腔冲洗，规律使用抗炎喷鼻剂并防止上呼吸道感染；另外应重点关注泪道置管患者术后局部不适症状，针对术后不适症状优化用药，使用互联网护理门诊或电话随访做好护理指导和心理疏导，促进患者术后康复。
Objective: To investigate postoperative self-care practices and evaluate the early outcomes of patients with Primary Acquired Nasolacrimal Duct Obstruction (PANDO) undergoing Endoscopic Dacryocystorhinostomy (En-DCR) in a day ward setting. Methods: 90 PANDO patients who underwent En-DCR surgery at the Oculoplastic and Lacrimal Surgery day ward at Zhongshan Ophthalmic Center, Sun Yat-sen University, between November 2021 and August 2022, were enrolled in this study. All patients received standardized postoperative self-care instructions. At the one-month follow-up, a questionnaire survey was used to record patients' self-care adherence to self-care practices, postoperative discomfort symptoms, and assess surgical outcomes. Furthermore, the correlation between self-care factors and surgical outcomes/discomfort symptoms was explored. Results: A total of 90 eyes from 90 PANDO patients undergoing En-DCR were included. The overall surgical success rate at one month was 92.22% , comprising a cure rate of 65.56% and an improvement rate of 26.67%. Analysis of self-care practices related to surgical outcomes showed significantly better results in patients who adhered to nasal irrigation at least once daily (P = 0.002), used prescribed nasal spray at least once daily (P = 0.008), and avoided upper respiratory tract infections (P = 0.047). Regarding postoperative discomfort, patients who peformed nasal irrigation at least once daily (P = 0.006) and had the lacrimal stent (tube) in situ (P = 0.003) experienced significantly fewer symptoms. Furthermore, correlation analysis in stented patients indicated a positive correlation between stent discomfort and psychological burden (r = 0.421, P < 0.001). Conclusion: In the day ward model, detailed self-care guidance provided by healthcare professionals for En-DCR patients contributes to postoperative recovery and ensures favorable surgical outcomes. Key instructions include performing nasal irrigation at least once daily, using anti-inflammatory nasal spray regularly, and preventing upper respiratory infections during the first postoperative month. Additionally, particular attention should be paid to localized discomfort in patients with lacrimal stents. Optimizing medication regimens for discomfort, utilizing internet-based nursing clinics or telephone follow-ups for guidance and psychological support are crucial to promote postoperative rehabilitation.
