Efficacy of cyanoacrylate tissue adhesive in the management of corneal thinning and perforation due to microbial keratitis

PurposeReport the efficacy of cyanoacrylate tissue adhesive (CTA) application in the management of corneal thinning and perforations associated with microbial keratitis.MethodsA retrospective review of consecutive patients who underwent CTA application for corneal thinning and perforation secondary to microbiologically proven infectious keratitis between 2001 and 2018 at a single center. We defined successful CTA application as an intact globe without tectonic surgical intervention.ResultsThe cohort included 67 patients, and 37 presented with corneal perforation while 30 had corneal thinning. The perforation/thinning was central/paracentral in 43 eyes and peripheral in 23 eyes. The underlying infectious etiologies were monomicrobial in 42 cases (35 bacterial, 3 fungal, 2 viral, and 2 acanthamoeba cases) and polymicrobial in 25 cases (22 polybacterial cases and 3 cases with a combination of Gram positive bacteria and fungus). The median duration of glue retention was 29 days. The CTA success rate was 73%, 64%, and 44% at 10, 30, and 180 days, respectively. CTA application appears more successful in monomicrobial (vs. polymicrobial) and Gram positive bacterial (vs. Gram negative) keratitis but the differences are statistically non-significant. The location of perforation/thinning and the use of topical corticosteroid were not associated with CTA failure.ConclusionCTA was moderately effective in restoring globe integrity in severe corneal thinning and perforation secondary to microbial keratitis in the short term. However the majority of patients require tectonic surgical intervention within 6 months. CTA application success is not significantly associated with the location of thinning/perforation or the use of topical corticosteroid.     

中医护理技术对粘连型肩周炎患者手法松解术后疗效的影响

目的:观察中医护理技术在粘连型肩周炎患者手法松解术后疗效的影响。方法:选取2016年1月~2017年8月在广州中医药大学第三附属医院运动医学科粘连型肩周炎患者80例,随机分成观察组和对照组各40例。两组患者均行肩关节黏连手法松解术,术后对照组行常规肩关节康复指导训练演示指导护理,观察组在行常规肩关节康复指导训练演示指导的基础上实施中医护理技术操作,具体内容为点穴按摩与中药熏蒸两部分,予以治疗两周后,对两组患者肩关节的疗效评定、肩关节功能Constant-Mur ley评分进行对比。结果:观察组总有效率显著高于对照组(P<0.05);治疗后,两组患者的肩关节疼痛、ADL、活动度、肌力、总分均较治疗前显著升高(P<0.05),且观察组治疗后的肩关节疼痛、ADL、活动度、肌力、总分显著高于对照组(P<0.05)。结论:中医护理技术的点穴按摩与中药熏蒸能更好的促进粘连型肩周炎患者手法松解术后康复治疗,巩固疗效。     

新生儿医用粘胶相关皮肤损伤危险因素分析及其护理对策

目的探讨新生儿医用粘胶相关性皮肤损伤(MARSI)危险因素和护理对策。方法选取2016年4月至2018年5月在本院接受治疗的新生儿483例为研究对象,统计其发生MARSI例数和损伤类型,依据是否发生MARSI将患儿分成MARSI组61例和未发生MARSI组422例,记录患儿温箱、胎龄、抢救台、出生体质量、潮湿多汗、蓝光治疗、感染、留置胃管、禁食、经外周静脉置入中心静脉导管(PICC)、水肿及皮肤干燥情况,对影响患儿发生MARSI的因素进行多因素logistic回归分析。结果患儿皮肤受损类型依次为表皮剥脱伤(6.21%)、皮肤撕裂伤(3.73%)、接触性皮炎1.45%。蓝光治疗、留置胃管、出生体质量<2200 g、胎龄<30周及皮肤干燥为患儿发生MARSI的独立危险因素(P<0.05)。结论临床新生儿MARSI发生率较高,且影响因素多,医护人员应采用有针对性护理措施,加强防范,以降低新生儿MARSI的发生率。