目的：探索斜视患者手术治疗后的眼表恢复状况。方法：选取2015年1月至2018年6月于如皋市广慈医院接受门诊手术治疗的92例水平性斜视患者为研究对象，共126眼，按照手术切口将患者分为3组，行角膜缘切口的42例52眼患者为A组，行跨肌止端切口的17例19眼患者为B组，行近穹窿切口的33例55眼患者为C组。再根据手术累及肌肉条数将患眼分为3组，行单条眼外肌的29眼手术者为单肌组，行2条眼外肌的42眼手术者为双肌组，行3条眼外肌的21眼手术者为三肌组。比较不同切口类型和肌肉累及数患者的眼表健康恢复时间。结果：A，B，C3组间首次泪膜破裂恢复时间、泪河高度时间差异有统计学意义(P<0.05)；A组首次泪膜破裂恢复时间(14.33±3.26) d和泪河高度时间(14.54±1.58) d显著低于B组和C组，差异具有统计学意义(F=4.876，P=0.032；F=4.612，P=0.036)。单肌组，双肌组及三肌组3组间首次泪膜破裂恢复时间、泪河高度时间差异有统计学意义(P<0.05)；单肌组的首次泪膜破裂恢复时间(13.42±3.57) d和泪河高度时间(8.65±1.62) d显著低于双肌组和三肌组，差异有统计学意义(F=4.975，P=0.028；F=5.024，P=0.025)。结论：手术累及的肌肉数和手术切口类型对术后眼表健康状况具有重要影响，近穹窿切口的手术方式和累及较少肌肉数量有助于患者术后眼部健康状况的恢复。
Objective: To explore the ocular surface recovery after surgical treatment of strabismus patients. Methods: A total of 92 patients (126 eyes) with strabismus who underwent surgery in our hospital from January 2015 to June 2018 were enrolled. The patients were divided into three groups according to the surgical incision, 42 patients (52 eyes)underwent limbal incision were in group A, 17 patients (19 eyes) underwent trans-muscle end-point incision in group B, and 33 patients (55 eyes) underwent proximal hernia incision in group C. According to the number of muscles involved in the operation, the sick eyes of patients were divided into three groups. The 29 eyes with a single extraocular muscle were a single muscle group, the 42 eyes with 2 extraocular muscles were a double muscle group, and the 21-eye treated with 3 extraocular muscles were a three-muscle group. The ocular surface health recovery time of patients with different incision types and muscle involvement were compared. Results: The first tear film rupture recovery time and tear river height time between group A, B, and C were significantly different,and the data were statistically significant (P<0.05); the first tear film rupture recovery time (14.33±3.26) d and tear river height time (14.54±1.58) d in group A were significantly lower than those in group B and C. The data were statistically significant (F=4.876, P=0.032; F=4.612, P=0.036). The first tear film rupture recovery time and tear river height time between the single, double and three muscle groups were significantly different, and the data were statistically significant (P<0.05); the first tear film rupture recovery time (13.42±3.57) d and tear river height time (8.65±1.62) d were significantly lower in the single muscle group than in the double muscle group and the third muscle group. The data were statistically significant (F=4.975, P=0.028; F=5.024, P=0.025). Conclusion:The number of muscles involved in the operation and the type of surgical incision have an important impact on the health of the ocular surface after surgery. The proximal ankle incision and less number of muscles involved would improve the postoperative recovery of eye health.
目的：探讨专科护士培训方式以提高斜视病区护士的专业技能以及专科理论水平。方法：每次由护士长安排一名护士进入科主任所在的医疗小组进行为期3~4个月的培训，培训内容主要包括与医生一起出门诊、学习术前斜视专科检查、参加患者术前手术方案的制定和术后的查房，定期参加科室的理论培训。结果：实施斜视专科护士培训方法后，经过培训的护士掌握了斜视专科常用的检查方法，能解读本专科的相关检查报告，护士的专科工作能力、应对咨询能力有提高，医生、患者对护士的满意度均有提高。结论：斜视病区专科护士培训方法对临床护理工作有积极的影响，值得临床科室借鉴。
Objective: To improve the professional skills and theoretical level of the nurses, a new training method was adopted in strabismus ward. Methods: The head nurse arranged a nurse to participate in medical team the director of the department for 3–4 months. The medical works that the nurse had to follow included coperative outpatient medical work with the doctors, clinical examination before strabismus surgery, making individual surgical plans, nursing rounds of wards after surgery, and regular theoretical training of the department. Results: After implementing the training method of strabismus specialist nurses, the trained nurses mastered the common examination methods for strabismus patients, and could analyse the relevant examination reports. The ability of the nurses’ professional work and consultative capacity were improved. Furthermore, the satisfaction of doctors and patients on nursing work was improved. Conclusion: The new training method of specialist nurses in strabismus ward exerts positive effect on clinical nursing work, which is worthy of application in clinical practice.
目的：总结全身麻醉斜视矫正日间手术服务模式的创建与安全管理方法。方法：回顾2015年10月至2018年10月期间全身麻醉下行斜视矫正日间手术患者共9 570例。改革护理管理模式，实施医护一体化，在实施过程中对患者进行严密的术前、术后护理管理：术前评估，健康教育前移、加强核查制度、严格监测患者生命体征；术后病情严格交接，家属及患者同步术后指导、离院后回访。结果：全身麻醉斜视矫正日间手术的9 570例患者，均未发生手术并发症，术后不适34例，占0.36%，其中2例患者离院时出现头晕，2例发生尿储留，30例出现恶心、呕吐。护理人力由开展前16人减少到12人，节约25%；患者等候手术时间缩短了8 d，满意度由70%提高到90%，平均住院时间由3.2 d减少为1 d。结论：全身麻醉斜视矫正日间手术模式是一种新的医疗模式，开展全身麻醉日间手术不但可以节省医疗资源，还可提高患者满意度。
Objective: To summarize the establishment and safety management methods of ambulatory strabismus surgery that can provide the basis for carrying out ambulatory surgery nursing under general anesthesia. Methods: We carried out ambulatory surgery management that reformed nursing management model and delivered the integration of medical care in 9 570 patients undergoing strabismus surgery under general anesthesia from October 2015 to October 2018. In implementation process, we carefully managed the patients before and after operation including performing preoperative assessment and health education in advance, strengthening the verification system, strictly monitoring vital signs of the patients, strict shifting state of patients after operation, providing postoperative guidance to patients and their families, and performing follow-up clinic visits after leaving the hospital. Results: No surgical complications occurred in any of our cases. 34 patients had postoperative discomfort, accounting for 0.36%. Among these 34 patients, 2 had dizziness, 2 had urinary retention and 30 hadnausea and vomiting. After treatments, all patients were discharged on schedule. The number of nurses reduced from 16 to 12 that fell by 25%. Wait times for operation reduced by 8 days. Patient satisfaction was improved from 70% to 90%. The mean length of hospital stay was reduced from 3 days to 1 day. Conclusion: The management of ambulatory surgery under general anesthesia is a new medical care service model. Careful planning and strict preoperative and postoperative safety management can ensure the safe implementation of strabismus surgery. Ambulatory surgery under general anesthesia has benefits to save medical resources and improve patient satisfaction.
目的：探讨以Base-out恢复点为目标手术量的急性共同性内斜视(acute acquired comitant esotropia，AACE)的治疗效果。方法：随诊以Base-out恢复点为目标手术量、且术后随访时间超过4个月的AACE患者，分析术前及末次随诊时斜视度、双眼视功能参数及术后立体视恢复的影响因素。结果：将43例患者纳入研究，其中男27例(63%)，女16例(37%)，手术年龄9~53(23.7±11.4)岁，术前斜视持续时间3个月~11年(24.8±24.5个月)，术后随访4~62(15.8±14.5)个月。术前Base-out恢复点比斜视度更大[远距差值(9.3±6.9) PD，P<0.001；近距差值(11.4±6.7) PD，P<0.001]；术前视远和视近斜视度分别为(38.4±13.2) PD和(37.6±13.7) PD，末次随诊时视远和视近斜视度分别为(0.74±2.4) PD和(0.70±2.4) PD(均P<0.001)，38例(88%)患者无眼位偏斜，5例(12%)有轻微内隐斜视。末次随诊时视远和视近立体视锐度显著改善(P<0.001)，末次立体视功能与术前近距立体视水平和术前斜视持续时间相关。结论：以Base-out恢复点为目标手术量的AACE手术能取得较好的矫正效果，未见眼位过矫者；术后立体视恢复与术前近距立体视和术前斜视持续时间相关，提示适当早期手术可能有助于术后立体视功能的恢复。
Objective: To evaluate the effect of using the amount of base-out (BO) recovery point as the surgical target for acute acquired comitant esotropia (AACE). Methods: Patients with AACE underwent surgery based on the target angle of the base-out recovery point and were followed up at least 4 months. The deviation, binocular functions before and after the surgery were analyzed and the factors related the post-operative stereopsis were evaluated. Results: Totally 43 patients were included in the study, including 27 males (63%) and 16 females (37%), aged from 9 to 53 years (23.7±11.4 years), duration of preoperative strabismus ranged from 3 months to 11 years (24.8±24.5 months), and postoperative follow-up ranged from 4 to 62 (15.8±14.5 months). Both distant and near pre-operative Base-out recovery point were larger than the angle of esotropia [(9.3±6.9) PD for distant; (11.4±6.7) PD for near, both P<0.001]. The pre-operative esotropia for distant and near viewing were (38.4±13.2) PD and (37.6±13.7) PD respectively and reduced to (0.74±2.4) PD and (0.70±2.4) PD at the last visit time (P<0.001). Thirty-eight cases were orthosia without any phoria and five cases still had some esophoria or minimal esotropia at the last visit. The stereoacuity improved significantly after the surgery. The post-operative stereopsis significantly correlated with the pre-operative stereopsis and the duration from onset of esotropia to the time of surgery. Conclusion: The acute acquired comitant esotropia can be corrected with strabismus surgery based on the target angle of base-out recovery point. The post-operative stereopsis correlated with the pre-operative stereo function and the time of esotropia lasting. It suggested the earlier esotropia was corrected the better the stereopsis recovered.
目的：探讨光学相干断层扫描血管成像技术(optical coherence tomography angiography，OCTA)在斜视性弱视伴偏中心注视患者中应用的价值。方法：收集2018年1月到2020年5月斜视性弱视伴偏中心注视的患者17人为研究组，采用OCTA系统软件工具，以μm为单位测量视网膜固视点和黄斑中心凹之间的距离，同时收集非斜视、弱视且中心注视健康者17人为对照组，并分析受试者的浅层视网膜血管丛的黄斑中心凹血流长度密度(vessel length density，VLD)、灌注密度(perfusion density，PD)、黄斑中心凹无血流信号区(foveal avascular zone，FAZ)、面积、FAZ周长及FAZ圆形度。结果：斜视组弱视眼偏心距离为(632.18±310.62) μm，黄斑中心凹浅层血管丛VLD为(5.31±3.44) mm?1，PD为0.16±0.08，黄斑中心凹无血流信号区FAZ面积(0.28±0.17) mm2，FAZ周长(2.05±0.56) mm、FAZ圆形度0.67±0.06；与研究组対侧眼和对照组相比，VLD差异有统计学意义(P<0.05)，PD、FAZ面积等差异无统计学意义(P>0.05)。斜视组弱视眼偏心度与偏中心距离显著相关(r=0.834，P<0.001)。结论：OCTA可以量化偏中心距离，斜视性弱视伴偏中心注视眼的黄斑中心凹血流长度密度较対侧眼及健康眼低。
Objective: To explore the application value of optical coherence tomography angiography (OCTA) in patients with strabismic amblyopia accompanied by eccentric fixation. Methods: Seventeen strabismus amblyopia patients with eccentric fixation admitted to our hospital from January 2018 to May 2020 were enrolled as the study group. OCTA software was used to measure the distance between fixation point and macular fovea in micron units. Seventeen non-strabismus and non-amblyopia patients with centric fixation were enrolled as the control group. Vessel length density (VLD), perfusion density (PD), and foveal avascular zone (FOZ) were measured for the superficial retinal vascular cluster. Perimeter of FAZ and circularity of FAZ were analyzed. Results: The eccentric fixation distance was (632.18 ±310.6) μm, the macular fovea retinal thickness was (207.82±17.79) μm, the VLD of the superficial retinal vascular plexus was (5.31±3.44) mm?1, the PD was 0.16±0.08, the FAZ area was 0.28±0.17 mm2, the FAZ perimeter was 2.05±0.56 mm, and the FAZ circularity was 0.67±0.06. These results showed statistically significant differences in the VLD compared with the fellow eyes (P=0.043) and the control group (P=0.049), but there were no statistically significant differences in the PD, or FAZ area. In the strabismus group, the eccentricity of amblyopia was significantly correlated with the eccentric distance (r=0.834, P<0.001). Conclusion: OCTA can quantify the eccentric distance. The blood flow length density of macular fovea in strabismic amblyopia with eccentric fixation is lower than that in contralateral and healthy eyes.
目的：探索局部麻醉辅助小剂量丙泊酚联合瑞芬太尼镇静镇痛在成人斜视矫正术中的应用效果。方法：本研究为前瞻性队列研究，选取2020年10月1日至2021年5月31日于北京同仁医院行斜视矫正术的成年患者24例，单纯局部麻醉组、镇静镇痛组各12例。所有患者均应用2%利多卡因10 mL+0.1% 肾上腺素0.1 mL混合液进行眼部局部浸润注射，静脉滴注昂丹司琼8 mg。镇静镇痛组患者静脉滴注咪达唑仑1 mg、舒芬太尼5 μg，继之以丙泊酚0.6~3 mg/(kg·h)、瑞芬太尼0.01~0.05 μg/(kg·min)持续输注，使Ramsay镇静分级维持在II级。记录两组患者术中视觉模拟评分(visual analog scale，VAS)、脑电双频指数(bispectral index，BIS)、术者满意度评分及调节眼位配合度评分，术中恶心呕吐、眼心反射、呼吸抑制、血压心率等情况，以及丙泊酚、瑞芬太尼输注速度。结果：镇静镇痛组患者丙泊酚持续输注速度为0.6~1.8 mg/(kg·h)，瑞芬太尼持续输注速度为0.01~0.03 μg/(kg·min)。镇静镇痛组患者 术中VAS、BIS、心率增快发生率均低于单纯局部麻醉组(P<0.05)，术者满意度评分、血压下降发生率均高于单纯局部麻醉组(P<0.05)；两组患者术中恶心呕吐、眼心反射、呼吸抑制、血压升高发生率及调节眼位配合度评分差异均无统计学意义(P>0.05)。结论：在成人斜视矫正术中，局部麻醉辅 助小剂量丙泊酚联合瑞芬太尼镇静镇痛可有效减轻患者术中疼痛，作用安全可靠。
Objective: To explore the effect of local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil in adult strabismus surgery. Methods: This study was a prospective cohort study. Twenty-four adult patients who underwent strabismus surgery in Beijing Tongren Hospital from October 1, 2020 to May 31, 2021 were selected and divided into local anesthesia group, and sedation and analgesia group, eachwith 12 patients. All patients received local anesthesia with a mixture of 2% lidocaine 10 mL and 0.1% epinephrine 0.1 mL, and intravenous ondansetron 8 mg. Patients in the sedation and analgesia group received intravenous infusion of midazolam 1mg and sufentanil 5 μg, followed by continuous infusion of propofol 0.6–3 mg/(kg·h) and remifentanil 0.01~0.05 μg/(kg·min) to maintain Ramsay sedation score at grade II. Visual Analogue Scale (VAS), bispectral index (BIS), operator’s satisfaction score, patient’s coordination score, nausea and vomiting, oculocardiac reflex, respiratory depression, blood pressure, heart rate and the infusion rate of propofol and remifentanil during operation were recorded in these two groups. Results: In the sedative and analgesic group, the infusion rates of propofol and remifentanil were 0.6–1.8 mg/(kg·h) and 0.01–0.03 μg/(kg·min), respectively. VAS, BIS and the incidence of increased heart rate in the sedation and analgesia group were lower than those in the local anesthesia group (P<0.05); operator’s satisfaction score and the incidence of decreased blood pressure in the sedation and analgesia group were higher than those in the local anesthesia group (P<0.05); there was no significant difference in the incidence of intraoperative nausea and vomiting, oculocardiac reflex, respiratory depression, elevated blood pressure and patient’s coordination score between the two groups (P>0.05). Conclusion: In adult strabismus surgery, local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil can effectively relieve intraoperative pain, which is safe and reliable.
