目的：构建眼科日间病房护理质量指标，为眼科日间病房的护理质量管理提供理论依据。方法：以Donabedian三维质量结构模式为理论框架，通过查阅文献、小组讨论，初步拟定眼科专科护理质量评价指标。通过专家函询，对指标进行筛选和修订，确定了眼科日间病房护理质量指标。结果：经过2轮函询，专家意见趋向一致，2轮问卷回收率均为100%，协调系数分别为0.129、0.342(P＜0.01)。构建的眼科专科护理质量指标包括3项一级指标，分别为结构指标(二级指标2项)、过程指标(二级指标8项)和结果指标(二级指标3项)。结论：该指标具有较高的科学性、可靠性、可行性以及专科特色，可为眼科日间病房护理质量的评价提供良好的方法。
Objective: To set up nursing quality indicators for ophthalmic intra-day ward, providing theoretical basis for nursing quality management in ophthalmic intra-day ward. Methods: Based on the "Donabedian three dimensional quality structure model" as the theoretical framework, the preliminary ophthalmic specialized nursing quality assessment indicators were designed by literature review and group discussion. The ophthalmic nursing quality indicators for intraday ward were finalized by expers consultated, indicators screened and revised. Results: After two rounds of inquration by letters, the opinions from the experts were consistent. Questionnaire response rates were both 100% in two rounds, with coordination coefficients of 0.129 and 0.342 respectively (P< 0.01). The nursing quality indicators for ophthalmic intra-day ward were established, including 3 primary indicators, which are structual indicators (2 secondary indicators), process indicators (8 secondary indicators) and outcome indicatiors(3 secondary indicators). Conclusion: The indicators are scientific, reliable, feasible with specialized characteristics, which can provide a good reference for evaluating the nursing quality in ophthalmic intra-day wards.
目的：分析不同程度2型糖尿病视网膜病变的血清生化全套指标，探讨各生化指标与糖尿病性视网膜病变(diabetic retinopathy，DR)程度的相关性。方法：回顾性收集2018年5月至2020年10月在福建医科大学附属第二医院就诊的2型糖尿病患者。根据眼底情况分为3组：糖尿病不伴视网膜病变(non-diabetic retinopathy，NDR)组(17例)、糖尿病伴非增殖性视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(29例)、糖尿病伴增殖期视网膜病变(proliferative diabetic retinopathy，PDR)组(34例)。采用SPSS 24.0分析比较3组血清生化全套各指标水平，对差异指标与DR相关性采用Pearson相关分析与多重线性回归分析。结果：3组年龄差异无统计学意义(P>0.05)；3组的总蛋白、白蛋白、白球比、钙浓度差异均有统计学意义(均P<0.05)。组间比较发现NPDR和PDR组总蛋白、白蛋白、白球比、钙浓度低于NDR组，差异有统计学意义(P<0.05)。Pearson相关分析显示总蛋白(r=?0.290)、白蛋白(r=?0.304)，钙浓度(r=?0.252)与DR呈负相关(均P<0.05)，多重线性回归提示总蛋白、白蛋白及血钙浓度是DR保护因素(P<0.05)。结论：血清指标总蛋白、白蛋白及血钙浓度与DR成负相关，在生理范围内将这些指标维持相对较高的水平，或许可以为糖尿病视网膜病变的防治提供新思路。
Objective: To analyze the serum biochemical indexes of different degrees of type 2 diabetic retinopathy, and the correlation between biochemical indexes and the degree of diabetic retinopathy (DR). Methods: Patients with type 2 diabetes admitted to the Fujian Medical University 2nd Affiliate Hospital from May 2018 to October 2020 were retrospectively collected. The patients were divided into 3 groups according to fundus conditions: non-diabetic retinopathy (NDR) group (n=17), diabetes with non-proliferative diabetic retinopathy (NPDR) group (n=29),diabetes with proliferative diabetic retinopathy (PDR) group (n=34). SPSS 24.0 was used to compare the levels of a complete set of serum biochemical indexes in the three groups. Pearson correlation analysis and multiple linear regression analysis were used for the correlation between the different indexes and DR. Results: There was no statistically significant difference in age between the three groups. The differences in total protein, albumin, white sphere ratio, and calcium concentration of the three groups were statistically significant (P<0.05). The comparison between the groups showed that the total protein, albumin, white sphere ratio, and calcium concentration in the NPDR and PDR groups were lower than those in the NDR group. The difference was statistically significant (P<0.05). Pearson correlation analysis showed that total protein (r=?0.290), albumin (r=?0.304), andcalcium concentration (r=?0.252) were negatively correlated with DR (all P<0.05). Multiple linear regression indicated total protein, albumin and blood calcium concentration were the protective factors of DR (P<0.05).Conclusion: This study found that serum levels of total protein, albumin, and blood calcium levels are negatively correlated with DR. Maintaining a relatively high level of these indexes within the physiological range may provide new ideas for the prevention and treatment of diabetic retinopathy.
目的：探讨光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)在糖尿病性视网膜病变中的应用。方法：选取2021年中山大学附属第七医院眼科63例糖尿病患者为研究对象，分为无糖尿病性视网膜病变(T0，21眼)、轻度非增殖期(T1，21眼)、中重度非增殖期(T2，14眼)及增殖期(T3，7眼)。收集各组生化指标，包括空腹血糖、糖化血红蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、血清尿素氮、肌酐、尿素氮肌酐比值，及OCTA数据，即中心视网膜厚度、Angiography3×3及Angiography6×6血管线性密度及血管灌注密度等。采用单因素方差分析比较各组间差异。结果：T2组、T3组与T0组相比，T3组与T1组相比，糖尿病病程延长；T3组与其他各组相比，尿素氮升高；T1组、T2组、T3组与T0组相比，T3组与T1组相比，6 mm ×6 mm外层血流线性密度减少；与T0组相比，T1组、T2组及T3组6 mm ×6 mm完整血流线性密度减少；与T0相比，T2组、T3组6 mm ×6 mm外层血流灌注密度减少；与T0组相比，T3组6 mm ×6 mm完整血流灌注密度减少；T2组、T3组与T0组相比，T3与T1相比，3 mm ×3 mm内层血流线性密度明显减少；T3组与T0组及T1组相比，3 mm ×3 mm完整血流线性密度减少。结论：随着糖尿病性视网膜病变的进展，患者的尿素氮及肌酐逐渐升高，OCTA的血流线性密度及血流灌注密度逐渐减少。与血流灌注密度相比，血流线性密度对于早期糖尿病性视网膜病变筛查可能更为敏感。而利用Angiography6×6模式可能可以更早地发现糖尿病性视网膜病变的视网膜血流变化。
Objective: To explore the applications of optical coherence tomography angiography (OCTA) in diabetic retinopathy. Methods: A total of 63 diabetic patients in the Department of Ophthalmology, Seventh Affiliated Hospital of Sun Yat-sen University in 2021 were divided into 4 groups: the patients without diabetic retinopathy (T0, n=21), mild non-proliferative diabetic retinopathy (T1, n=21), moderate-to-severe non-proliferative diabetic retinopathy (T2, n=14) and proliferative diabetic retinopathy (T3, n=7). Biochemical Indicators were collected in all patients, such as fasting plasma glucose (FPG), glycated hemoglobin A1c (HbA1c), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), the blood urea nitrogen (BUN), creatinine (CRE) and the ratio of blood urea nitrogen and creatinine (BUN/CRE). The Macular Cube 521×128, Angiography3×3, and Angiography6×6 models of OCTA were used to obtain central retinal thickness (CRT), vascular density (VD) and perfusion density (PD) of each group. The data of all subjects was applied to do one-way ANOVA. Results: Prolonged duration of diabetes in T2 and T3 compared to T0 and in T3 compared to T1. Elevated BUN in T3 compared to all other groups. When T1, T2 and T3 were compared to T0, and T3 was compared to T1, the VD of the 6 mm ×6 mm outer layer decreased. Reduced VD of intact 6 mm ×6 mm region in T1, T2 and T3 compared to T0. Declining PD of the 6 mm ×6 mm outer layer in T2 and T3 compared to T0. Diminished PD of whole 6 mm ×6 mm area at T3 compared to T0. The VD of 3 mm ×3 mm inner layer was significantly reduced in T3 compared to T0 and T1. The VD of 3 mm ×3 mm intact area gradually dwindled in T3 compared with T0 and T1 (P<0.05). Conclusion: With the progression of diabetic retinopathy, the levels of BUN and CRE gradually increased, and the OCTA-derived vascular density and perfusion density gradually decrease. Vascular density may be more sensitive for early diabetic retinopathy screening than perfusion density.The use of the Angiography6×6 model may result in an earlier detection of changes in retinal blood flow in diabetic retinopathy.
