儿童先天性上睑下垂术后角膜炎的发生原因分析与护理

目的 总结儿童先天性上睑下垂术后角膜炎发生的原因及护理对策.方法 选取上睑下垂矫正术的患儿489例,全部病例均在全麻下采用额肌悬吊术,对术后13例发生角膜炎并发症患儿进行回顾性分析,找出发生角膜炎的原因,并探讨护理方法.结果 5例患儿引起暴露性角膜炎,其中2例患儿由于护理不当患儿睡觉时涂眼药膏后牵拉下睑缝线所致,经过护理痊愈；2例患儿术后当天哭闹、自诉眼睛痛,经过细心地护理,第2天患儿自觉症状好转,裂隙灯下角膜点状染色范围缩小,3d后好转；3例由于倒睫刺激角膜引起角膜炎的发生,1例额肌悬吊术后欠矫并有上睑内翻倒睫,经过以上的治疗和护理,患儿角膜炎症状好转,自觉症状消失,检查下所见角膜上皮修复.结论 针对不同原因引起的角膜炎通过早期发现及采取针对性的护理措施,可减少了并发症的发生,为进一步改进护理工作提供依据,提高了手术的成功率.

Cause analysis of contributing to occurrence of postoperative keratitis in children patients with congenital ptosis and the nursing strategies

Objective To summarize and discuss the causes and nursing measures of postoperative keratitis in children patients with congenital ptosis.Methods A total of 489 children patients undergoing surgical correction of congenital ptosis were selected,and all of them received frontalis suspension surgery under general anesthesia.There were 13 cases occurred keratitis complications in 489 postoperative children,and a retrospective analysis was conducted among the 13 patients in order to identify the causes for occurrence of keratitis and to explore nursing measures.Results The most common cause was corneal exposure,which occurred in 5 cases with exposure keratitis.Two cases of children were caused by pulling the lower eyelid suture due to improper nursing when applying ointments in children at the beginning of sleep,who recovered after nursing treatment.Two cases of children cried with eye pain on postoperative day 1,with self-conscious symptoms improvement and narrowing of corneal punctate staining narrow under the slit lamp on postoperative day 2 after careful nursing,and with getting better after 3 days.Three cases of children were caused by trichiasis,and one case was with frontalis suspension undercorrection and upper eyelid entropion and trichiasis.After treating and nursing,the keratitis symptoms of children improved and self-conscious symptoms disappeared,and corneal epithelial repaired.Conclusions The postoperative keratitis from different causes in children patients with congenital ptosis can be cured by early detection and the active treatment and individual nursing measures according to their different causes,which can reduce the incidence of complications,provide a basis for further improvement on nursing work and improve the success rate of surgery.