[摘 要] 目的：减轻行角膜移植术的患儿及家属的心理负担，提高患儿对手术的耐受性，减少术后并发症。方法：对45例将进行角膜移植的患儿进行围手术期护理。结果：所有患儿经过精心的治疗和护理后均恢复良好，视力均有提高。结论：术前做好充足的准备、术前心理护理，术后严密观察生命体征和眼部敷料的情况，做好相关的生活和饮食指导，遵医嘱及时有效用药，注意患儿异常的反应及眼部的情况，及时发现并处理并发症，给予细致的出院指导，有利于患儿早日康复。
Abstract Objective: To reduce the psychological burden of the children and families who are scheduled to the corneal transplantation, and to improve the patients’ tolerance and reduce postoperative complications. Methods: The perioperative care was given to 45 patients with corneal transplantation. Results: All children were treated well by careful treatment and care. Conclusion: Before operation, comprehensive preparation and psychological nursing care should be delivered. After operation, the physicians and nurses should guide the patients to live a healthy lifestyle, remind them to take the drugs timely, identify the abnormal symptoms and postoperative complications in children with abnormal responses, implement effective treatment timely to accelerate postoperative recovery
[摘 要] 目的：研究准分子激光原位角膜磨镶术(laser in situkeratomileusis，LASIK)前后角膜滞后量(corneal hysteresis，CH)和角膜阻力因子(corneal resistance factor，CRF)变化量，对其相关因素进行多元线性回归分析。方法：前瞻性研究。纳入行LASIK手术的近视眼及近视散光患者70眼(38例)，术前与术后6个月各项参数分别由眼反应分析仪(ocular response analyzer，ORA)、非接触眼压仪、超声角膜测厚仪及Pentacam眼前节分析仪测量。分析LASIK手术前后△CH，△CRF与术前、手术设计等参数的相关性，并对相关参数进行多元线性回归分析。结果：手术前后CH分别为(10.05±1.36)，(8.15±0.90) mmHg(1 mmHg=0.133 kPa)，CRF分别为(9.91±1.38)，(6.92±0.88) mmHg，差异均有统计学意义(P<0.01)；△CH与△CRF分别为(1.90±1.15)，(2.99±1.23) mmHg。△CH与术前CH，CRF，眼压(intraocular pressure，IOP)，预计切削深度(ablative depth，AD)以及AD/CCT呈正相关；△CRF与术前CH，CRF，IOP，AD，AD/CCT，术前等值球镜(spherical equivalent，SE)以及预计 基质床厚度(residual stromal bed’s thickness，RSBT)有相关性。采用多元线性回归对LASIK手术前后△CH，△CRF与术前、手术设计等各相关参数进行分析，回归方程为：△CH=?6.182+0.658CH术前+8.421AD/CCT (R2=0.639，P<0.01)，△CRF=?0.007+0.725CRF术前?0.014RSBT (R2=0.689，P<0.01)。结论：LASIK术前后CH与预计AD和角膜厚度比值密切相关，CRF变化量与预计角膜RSBT密切相关，在设计手术时应慎重考虑预计AD与预计RSBT。
Abstract Objective: To discuss the change of corneal hysteresis and corneal resistance factor before and after laser in situkeratomileusis (LASIK), and to analyze their related factors by multivariate linear regression. Methods: In this prospective study, 70 eyes (38 patients) with myopia and myopic astigmatism undergoing LASIK were included. Related factors were measured preoperatively and at 6 months postoperatively by ocular response analyzer, noncontact tonometer (NCT), ultrasonic pachymeter, and Pentacam system. The correlation was analyzed between △CH, △CRF and preoperative and operative design’s parameters, and correlative factors analyze. △CH and △CRF were analyzed by the multiple linear regression. Results: CH before and after LASIK were (10.05±1.36) and (8.15±0.90) mmHg, and CRF before andafter LASIK were (9.91±1.38) and (6.92±0.88) mmHg. There was significant difference between preoperative and postoperative CH and CRF (P<0.01). △CH and △CRF were (1.90±1.15) and (2.99±1.23) mmHg. Preoperative CH, CRF, intraocular pressure (IOP), ablative depth (AD) and AD/CCT were positive correlated with △CH. Preoperative CH, CRF, IOP, AD, AD/CCT, preoperative spherical equivalent (SE) and predicted residual stromal bed’s thickness (RSBT) were correlated with △CRF. The regression equation of △CH and △CRF and influencing factors were △CH =?6.182 + 0.658CHpreoperative + 8.421AD/CCT (R2=0.639, P<0.01), △CRF =?0.007 + 0.725CRFpreoperative ? 0.014RSBT (R2=0.689, P<0.01). Conclusion: The change of CH before and after LASIK is correlative with AD/CCT. The change of CRF before and after LASIK is correlative with predicted residual stromal bed’s thickness. Ablative depth and predicted residual stromal bed’s thickness should be considered carefully during the surgical design.
随着科学技术的提高、手术方式的改进，角膜屈光手术成为治疗近视的主要方式。角膜屈光手术后角膜形态及生物力学的变化对于尽早发现术后相关并发症及术后长期稳定性具有重要意义，不同的术式及术后不同的恢复阶段角膜表面非球面参数及生物力学指标的变化存在一定差异，明确其变化的原因及机制可对临床研究提供一定的参考。
With the improvement of science and technology and the improvement of surgical methods, corneal refractive surgery has become the main way to treat myopia. The changes of corneal morphology and biomechanics after corneal refractive surgery are of great significance for early detection of postoperative complications and also affect the long-term stability after corneal refractive surgery. There are some differences in the changes of aspheric parameters and biomechanical properties in different surgical procedures and different postoperative recovery stages. Clarifying the reasons and mechanisms of these changes can provide some reference for clinical research.
目的：总结大批量白内障扶贫手术的护理安全管理经验。方法：回顾性分析2013至2016年中山大学中山眼科中心医疗队完成大批量白内障扶贫手术的经验、针对下乡扶贫的特殊环境、患者入院时间短、手术量大、接台手术多以及患者自我管理能力差等情况，分析其安全隐患，并在护理过程中采取相应的安全措施。术前充分评估和准备，对患者进行健康指导；术中对手术环境规范管理；指导加强术后患者的自我管理。结果：8批次共1 064例白内障摘除联合人工晶体植入术顺利完成，无1例发生术后感染。结论：建立大批量白内障扶贫手术护理安全质量管理的规范流程是扶贫工作的重要环节，做好术前的评估和准备工作，落实患者的健康教育及术后患者自我管理指导，才能确保手术顺利进行。
To assess the safety of mass volume of cataract surgery and to identify the possible factors with enhanced patients’ safety. Methods: This is a retrospective case series. Clinical data of patients undergoing charity cataract extraction by surgeons from Zhongshan Ophthalmic Center between 2013 and 2016 was reviewed. The following factors were analyzed: safety management peri-operatively, educational interventions, intraoperative sterilization, and self-management after operations. Results: A total of 1064 patients (8 sessions) underwent cataract extraction and intraocular lens implantation. No evidence of endophthalmitis in any cases was observed. Conclusion: Establishment of standardized operation procedures for nursing safety management is essential for safety of mass volume of charity cataract surgery in China. Adequate assessment and peri-operative endeavor, educational interventions, nurse guided self-management should be empowered to enhance patients’ safety.
