目的 探讨人工晶状体光学部后囊膜夹持术治疗儿童白内障的手术配合要点与难点,总结经验并提高护理质量。方法 回顾性分析2019年5月—2023年6月行人工晶状体光学部后囊膜夹持术治疗儿童白内障的45例（66眼）患者手术护理难点,并对儿童术前焦虑管理、全麻饮食准备,术中体位、特殊器械管理等提出护理对策。结果 45例患儿顺利完成手术,未发生护理差错及严重并发症,术后随访期间全部患儿人工晶状体均稳定夹持于后囊膜撕开区,未观察到后囊膜混浊、色素性人工晶状体沉积、后粘连、人工晶状体偏转或继发性青光眼。结论 护理人员对白内障患儿特殊心理状态的了解、全麻手术饮食准备的确认、手术特殊体位要求以及眼科特殊器械的管理是该术式的主要护理难点。
Abstract
Objective To discuss the key and difficulty of operative coordination of optical posterior capsule clamp of intraocular lens (IOLs) in the treatment of cataract in children, and to summarize the experience and improve nursing quality. Methods A retrospective analysis was performed on 45 cases (66 eyes) of pediatric cataract patients treated with optical posterior capsule clamp of IOLs from May 2019 to June 2023. The nursing countermeasures for children’s preoperative anxiety management, diet preparation for general anesthesia, intraoperative position management, special instruments management, etc. were put forward. Results Forty-five children successfully completed the operation without nursing errors and serious complications. During the postoperative follow-up, the IOL of all the children was stably clamped in the posterior capsular tear area, and no posterior capsular opacity, pigmentogenic IOL deposition, posterior adhesion, IOL deviation or secondary glaucoma were observed. Conclusion The nurses’ understanding of special psychological state of cataract children, the confirmation of diet preparation for general anesthesia surgery, the requirements of special surgical positions and the management of special ophthalmic instruments are the main nursing difficulties of this operation.
关键词
手术配合 /
白内障 /
儿童 /
晶体囊撕裂术 /
光学部夹持
Key words
surgical cooperation /
cataracts /
children /
capsulorhexis /
optic capture
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Israr M, Zahir KK, Khattak A, et al.Etiology of white pupillary reflex in pediatric age group[J].Rom J Ophthalmol, 2022, 66(1):32-35. DOI:10.22336/rjo.2022.8.
[2] Yen KG, Repka MX, Sutherland DR, et al.Complications occurring through 5 years following primary intraocular lens implantation for pediatric cataract[J].JAMA Ophthalmol, 2023, 141(8):705-714. DOI:10.1001/jamaophthalmol.2023.2335.
[3] Zhao Y, Zhou LF, Yang H.Effects of lens extirpation with anterior vitrectomy on vitreous three-dimensional mesh structure[J]. Int J Ophthalmol, 2017, 10(6):840-846. DOI:10.18240/ijo.2017.06.03.
[4] 董晓津, 葛佳佳, 黄钰森. 晶状体后囊膜连续环形撕除联合人工晶状体光学部夹持术治疗儿童白内障的初步临床观察[J]. 中华眼科杂志, 2020, 56(5):343-348. DOI:10.3760/cma.j.cn112142-20190628-00351.
[5] 王焕, 薛婷婷, 姜云. 基于儿童需求的自主体位管理对眼科低龄患儿全麻术后的效果观察[J].护士进修杂志, 2022, 37(19):1820-1823. DOI:10.16821/j.cnki.hsjx.2022.19.019.
[6] Sadegh Tabrizi J, Seyedhejazi M, Fakhari A, et al.Preoperative education and decreasing preoperative anxiety among children aged 8-10 years old and their mothers[J]. Anesth Pain Med, 2015, 5(4):e25036. DOI:10.5812/aapm.25036.
[7] 韩赛, 任永霞, 刘旭垚, 等. 童趣化情境认知干预在眼科学龄期全麻手术患儿中的应用[J]. 中华护理杂志, 2021, 56(4):539-544. DOI:10.3761/j.issn.0254-1769.2021.04.010.
[8] 宋庆, 聂婷婷, 舒美燕, 等. 童趣化游戏健康教育在学龄前纤维支气管镜手术患儿麻醉诱导中的效果观察[J]. 护理学报, 2023, 30(19):74-78. DOI:10.16460/j.issn1008-9969.2023.19.074.
[9] Baskaran P, Madhanagopalan VG, Ramakrishnan S.A modified air-assisted silicone oil removal from the anterior chamber[J]. Oman [J] Ophthalmol. 2020, 13(3):173-175. DOI:10.4103/ojo.OJO_196_2019.
[10] 田潇潇, 安虹. 小儿头颈外科手术的护理配合及体会[J]. 西南军医,2015,(4):448-450.DOI:10.3969/j.issn.1672-7193.2015.04.035.
[11] 于琼, 王剑锋. 糖尿病性白内障患者超声乳化术后角膜水肿相关因素[J]. 国际眼科杂志, 2018, 18(2):252-254. DOI:10.3980/j.issn.1672-5123.2018.2.11.
基金
青岛市医药卫生科研计划项目（2021-WJZD219）
PDF(589 KB)
