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.
报告1例2019年1月因无色素性视网膜色素变性而就诊的病例。患者因发现视力差，常规眼科检查及全身的检查未发现异常，给予眼底荧光造影后确诊。给予眼底荧光造影后最终确诊为罕见的无色素性视网膜色素变性，防止了疾病的漏诊和误诊。对于缺乏视网膜色素变性典型的三联征的无色素性视网膜色素变性患者，临床要谨防漏诊，眼底荧光血管造影(fundus fluorescein angiography，FFA)可明确诊断。
We reported a case of achromatic retinitis pigmentosa admitted to the hospital in January 2019. The patient was diagnosed by fundus fluorescein angiography because of poor vision, and no abnormality was found by routine ophthalmological examination and general examination. After fundus fluorescein angiography (FFA), a rare non-pigmented retinitis pigmentosa was finally diagnosed, which prevented misdiagnosis and missed diagnosis of the disease. For the patients without typical triad of retinitis pigmentosa, we should pay attention to missing the diagnosis in clinical practice. FFA can make a definite diagnosis of retinitis pigmentosa.
真菌性眼内炎是临床上少见的眼内感染疾病。因为其诊断延迟和抗真菌药物的有效性有限，因此真菌性眼内炎常常导致视力严重损害。按照感染性途径，真菌性眼内炎包括内源性和外源性，其中外源性眼内炎常见，进展较快，眼部手术术后感染是常见原因之一。小梁切除术是抗青光眼滤过性手术，是目前手术治疗青光眼的有效方法之一。滤过泡相关性眼内炎是其并发症之一，对患者视功能的损害尤为严重。本文通过回顾1例滤过泡相关性真菌性眼内炎患者的临床病例资料，讨论及分析滤过泡相关性的真菌性眼内炎的危险因素及诊治方法。
Fungal endophthalmitis is a disease which is a rare kind of interocular infection in clinic. Fungal endophthalmitis often results in severe visual impairment because of delayed diagnosis and limited effectiveness of antifungal drugs.Fungal endophthalmitis includes endogenous and exogenous endophthalmitis which is common and progresses rapidly. Postoperative infection is one of the common causes of fungal endophthalmitis. Trabeculectomy is an anti-glaucoma filtering operation, and it is one of the effective methods for glaucoma surgery at present. Glaucoma-filtering bleb infection is one of the complications of trabeculectomy, which can lead to severe visual impairment.In this article, we analyzed and discussed the risk factors, diagnosis and treatment methods about the filtering bleb-associated fungal endophthalmitis.
目的：探讨先天性瞳孔残膜围手术期的护理方法。方法：对13例(15眼)先天性瞳孔残膜患儿围手术期给予心理护理、安全护理、优先安排术前检查、术后严密观察病情变化、延续性护理并观察其效果。结果：13例(15眼)先天性瞳孔残膜的患儿手术均顺利完成，术后均无出现并发症，其中6例患者术后视力较术前视力有所提高，住院满意度为92.3%(12/13)。结论：对先天性瞳孔残膜患儿围手术期给予针对性的心理护理、安全护理、延续性护理是瞳孔残膜围手术期的有效护理方法。
Objective: To explore the perioperative nursing methods of persistent pupillary membrane. Methods: In the perioperative period, 13 cases (15 eyes) with persistent pupillary membrane were given preoperative nursing care, psychological nursing, careful observation of the change of condition, safety nursing, continuous nursing and observation of its effect. Results: A total of 13 cases (15 eyes) with persistent pupillary membrane were successfully operated, among which 6 cases had improved postoperative visual acuity compared with preoperative visual acuity, and no postoperative complications occurred. The satisfaction rate of hospitalization was 92.3% (12/13). Conclusion: It is an effective nursing method to give psychological nursing, safety nursing and continuous nursing to children with persistent pupillary membrane in perioperative period.
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.
干眼是指以泪膜稳态失衡为主要特征并伴有眼部不适症状的多因素眼表疾病。目前干眼的主要治疗手段包括药物治疗(人工泪液替代疗法、抗炎治疗、免疫抑制治疗)和必要时的手术干预治疗。地夸磷索四钠属于P2Y2受体激动剂，是一种治疗干眼的新型药物。它通过刺激位于眼表组织的P2Y2受体，促进泪液、黏液、脂质分泌，增强泪膜稳定性，从而改善干眼的症状和体征。
Dry eye refers to a series of chronic and progressive ocular surface diseases characterized by imbalanced tear film accompanied with ocular discomfort symptoms. The available methods mainly include pharmacotherapy (artificial tears replacement, anti-inflammatory, immunosuppressive therapy) and ophthalmic surgery. P2Y2 receptor agonist is a novel pharmaceutical agent for dry eye treatment, which could stimulate tear fluid secretion and mucin secretion through binding with P2Y2 receptors on the ocular surface, so that improve tear film stability and alleviate symptoms of dry eye. 3% diquafosol ophthalmic solution is the only P2Y2 receptor agonist available for dry eye.
迟发性眼前节毒性综合征(toxic anterior segment syndrome，TASS)是TASS的一种特殊类型，两者既有共同点又有区别，随着人们认识的深入，越来越多的迟发性TASS被报道。迟发性TASS较典型性TASS少见，流行病学特征因人工晶体不同而有差异。几乎所有可引起典型性TASS的因素都可以引起迟发性TA SS，此外铝元素在迟发性TA SS的发生中可能有关键作用。迟发性TA SS临床表现与典型性TASS类似，累及后段更为常见，激素治疗有效。
Late-onset toxic anterior segment syndrome (TASS) is a special type of TASS, which has both similarities and differences. With the deepening understanding, more and more late-onset TASS is reported. Late-onset TASS is less common than typical TASS, and the epidemiological characteristics are vary with intraocular lenses. Almost all the factors that can cause typical TASS can cause late-onset TASS, in addition, aluminum element may play a key role in the occurrence of delayed TASS. The clinical manifestations of late-onset TASS are similar to those of typical TASS, with the involvement of the posterior segment more common and hormone therapy effective.
目的：在推广护理标准预防操作流程(standard operation procedure，SOP)前后对护理人员进行操作情况和针刺伤职业暴露水平对比，探索护理SOP的实用性和有效性。方法：在中山大学中山眼科中心推广护理SOP前后，分别对14名责任护士进行操作考核，并对推广护理SOP前后收治的传染病患者数量和针刺伤职业暴露事件数量进行对比。结果：推行护理SOP前后操作考核平均分分别为82.31分、88.23分，差异有统计学意义(P<0.001)。初高级责任护士考核结果差异无统计学意义。推行护理SOP前后病房收治血液传染性疾病患者总数分别为32例、51例，针刺伤职业暴露事件分别为4例、0例，差异有统计学意义(χ2 =6.698，P=0.020)。结论：护理SOP的推广可使护理人员加强自我防护，减少针刺伤职业暴露，有效降低医源性感染率。
Objective: To compare the operation status and occupational exposure to needle stick injuries level of nursing staff before and after the promotion of nursing standard prevention operation procedure (SOP), and to explore the practicability and effectiveness of nursing SOP. Methods: Before and after the promotion of nursing SOPs at Zhongshan Ophthalmology Center of Sun Yat-sen University, 14 responsible nurses were assessed for operation,and the number of infectious diseases and occupational exposures to needle stick injuries before and after the promotion of nursing SOPs were compared. Results: The average scores of operation and evaluation before and after the implementation of nursing SOP were 82.31 points and 88.23 points, with significant statistical difference(P<0.001). There was no statistical difference in the results of the initial senior responsible nurses. The total number of patients with blood infectious diseases before and after the implementation of nursing SOP was 32 cases and 51 cases. The occupational exposure to needle stick injuries events were 4 cases and 0 and the difference was statistically significant (χ2 =6.698, P=0.020). Conclusion: The promotion of standard preventive procedures can enable caregivers to strengthen self-protection, reduce occupational exposure, and effectively reduce the rate of iatrogenic infection.
目的：探讨标准化沟通模式(SBAR)在眼球穿通伤患者护理交班中的应用效果。方法：60例患者作为对照组，使用传统口头方式交班；60例患者作为观察组，使用SBAR沟通模式进行交接。比较两组交班耗时、两组护士对患者病情掌握程度以及患者对护理服务满意度的差异。结果：观察组与对照组比较，上述指标差异具有统计学意义(P<0.05)。结论：采取SBAR沟通模式交班有助于降低在眼球穿通伤护理中的不良事件发生率，保障了护理质量，提高了交接班效率和患者满意度，适宜推广应用。
Objective: To evaluate the SBAR communication model in the nursing care handover of patients with penetration injuries of eyeball. Methods: Transfer time, receivers’ information retention, and patient’s satisfaction were compared between two groups of patients with penetration injuries of eyeball. A total of 60 patients were handled with the traditional oral communication handover as comparison group and other 60 patients were handled with the SBAR handover as intervention group. Results: When comparing intervention group with comparison group, statistically significant improvements (P<0.05) were observed in all three factors tested. Conclusion:Implementing the communication tool SBAR in the nursing care of patients with penetration injuries of eyeball reduces rate of adverse events, improves patient care quality, enhances transfer efficiency, and boosts patient’s satisfaction.
目的：评估2.2 mm微切口白内障超声乳化摘除(phacoemulsification，Phaco)联合多焦点人工晶状体(multifocal intraocular lens，MIOLs)植入术治疗老年性白内障的临床安全性及疗效。方法：选取于2018年1月1日至2018年6月31日于佛山市第二人民医院行白内障Phaco联合人工晶状体植入的老年白内障患者。将其分为2组：A组31例35眼行2.2 mm微切口Phaco联合MIOLs植入术，B组31例38眼行3.0 mm标准切口Phaco联合单焦点IOLs植入术。2组患者均完善术前、术后的裸眼视力、角膜曲率、眼压、角膜内皮细胞数、离焦曲线等检查，同时记录其手术过程中的参数，进行比较。结果：A组与B组在手术过程中，总超乳时间、总超乳能量、超声乳化累积能量复合参数、有效超乳时间、平均超乳能量、总手术时间对比，差异均无统计学意义(均P>0.05)。2组患者术后较术前比较，角膜内皮细胞数均有所下降，差异有统计学意义(P<0.05)；2组患者间在各时间点的比较，差异均无统计学意义(均P>0.05)。2组患者手术中均未出现后囊膜破裂等并发症。2.2 mm切口与3.0 mm切口术后均增加了角膜散光，与术前比较差异均有统计学意义(均P<0.01)；2组间比较，差异无统计学意义(均P>0.05)。术后3个月，2组间裸眼远视力(uncorrected distance visual acuity，UCDVA)对比差异无统计学意义(t=?1.794，P=0.07)；裸眼近视力(uncorrected near visual acuity，UCNVA)对比差异有统计学意义(t=?25.147，P<0.01)。A组的离焦曲线有2个峰值，分别位于0 D和?3.5 D附近，两峰值间形成一个下降平缓的平台；B组的离焦曲线只有1个峰值，位于0~0.5 D之间，峰值两端下降趋势明显。A组的脱镜率为77.42%(24/31)，B组的脱镜率为12.90%(4/31)，差异有统计学意义(χ2 =26.050，P<0.01)；2组的总体满意度差异无统计学意义(χ2 =1.615，P=0.204)。结论：2.2 mm同轴微切口白内障手术在临床上安全性良好，联合植入MIOLs有较好的疗效，可于临床上广泛推广。
Objective: To evaluate the clinical safety and curative effect of phacoemulsification (Phaco) combined with multifocal intraocular lens (MIOLs) implantation in the treatment of senile cataract with 2.2 mm microincision cataract. Methods: The cataract patients who underwent phacoemulsification and intraocular lens implantation in our hospital were selected from January 1, 2018 to June 31, 2018. They were divided into two groups: group A with 31 patients (35 eyes) undergoing 2.2 mm micro-incision Phaco combined with MIOLs, while group B with 31 patients (38 eyes) undergoing 3.0 mm standard incision Phaco combined with single focus IOLs.The preoperative and postoperative uncorrected visual acuity, corneal curvature, intraocular pressure, corneal endothelium number, and defocus curve were recorded in both groups. The parameters during the operation were also recorded and compared. Results: There was no statistically significant difference in the parameters including total phacoemulsification time, total phacoemulsification energy, phacoemulsification cumulative energy compound parameters, effective phacoemulsification time, average phacoemulsification energy, total surgery time between group A and group B during the operation (all P>0.05). Compared with preoperative, the number of corneal endothelial cells decreased both in the two groups after surgery. The difference was statistically significant (P<0.05). There was no significant difference between the two groups at any time (all P>0.05). There were no complications such as posterior capsule rupture during operation in both groups. The corneal astigmatism was increased after operation both in the 2.2 mm incision and 3.0 mm incision, and the difference was statistically significant compared with pre-operation (both P<0.01). There was no significant difference between the two groups (all P>0.05). At 3 months postoperatively, there was no significant difference in uncorrected distance visual acuity (UCDVA) between the two groups (t=?1.794, P=0.07), and the difference was statistically significant in the uncorrected near visual acuity (UCNVA) (t=?25.147, P<0.01). Defocus curve: The defocus curve of group A had two peaks, which are located near 0 D and ?3.5 D, forming a flat platform with a descent between the two peaks.The defocus curve of group B had only one peak, located at 0–0.5 D, and the downward trend at both ends of the peak was obvious. The rate of off-glasses and satisfaction: the rate of off-glasses in group A was 77.42% (24/31),and the rate of dislocation in group B was 12.90% (4/31). The difference was statistically significant (χ2 =26.050,P<0.01). There was no significant difference in overall satisfaction between the two groups (χ2 =1.615, P=0.204).Conclusion: The 2.2 mm coaxial microincision cataract surgery yields high clinical safety, and the combined implantation of multi-focal intraocular lens has good curative effect and can be widely promoted in clinical practice.
