全麻患者手术中暴露性角膜炎的预防

暴露性角膜炎是角膜失去眼睑保护而暴露在空气中,引起干燥、上皮脱落进而继发感染的角膜炎症.据有关资料报道[1],近70％的全麻患者双眼睑不能完全闭合,若不采取对角膜保护,导致暴露性角膜炎的比例高达40％～66.4％.暴露性角膜炎具体表现为眼睛畏光、流泪、异物感以及视物模糊,给患者带来一定程度的痛苦.近年来,为预防全麻手术患者暴露性角膜炎的发生,同仁们对其相关因素及预防措施进行了大量研究,现综述如下.     

3例应用自体血清治疗全麻术后暴露性角膜炎的效果观察与护理

目的探讨应用自体血清治疗全麻暴露性角膜炎的效果及护理要点。方法对3例全麻后发生暴露性角膜炎的患者应用自体血清治疗,通过患者主诉和观察眼部症状了解使用效果。结果 3例应用自体血清治疗的暴露性角膜炎2d后不适消失,症状缓解。结论应用自体血清治疗暴露性角膜炎效果显著。保持角膜湿润,预防感染,做好心理护理和血清的保存对提高暴露性角膜炎治疗效果具有积极意义。     

预防全麻手术患者暴露性角膜炎的方法

暴露性角膜炎是角膜失去眼睑保护而暴露在空气中,引起干燥、上皮脱落进而继发感染的角膜炎症。全麻手术中麻醉插管系深度麻醉,因麻醉药品的肌松作用导致眼睑松弛,消除眼睑正常闭合作用,若手术时间较长,导致角膜外露,或手术中无意磨擦角膜可引发暴露性角膜炎。为此我们在术中使用眼药膏和输液贴膜对全麻患者的眼部进行保护,取得了良好的效果,现将方法介绍如下。     

全麻患者暴露性角膜炎的发生与手术时间的相关性分析

目的 探讨全麻患者暴露性角膜炎的发生与手术时间的相关性.方法 将150例非眼科仰卧位气管插管全麻手术患者,按手术时间随机分为A组(手术时间＜2 h),B组(手术时间2～4 h)和C组(手术时间～6h)各50例.观察各组手术患者术后第2天的暴露性角膜炎的发生情况.结果 A、B、C组手术患者暴露性角膜炎的发生率分别为26％、46％和80％,不同手术时间患者暴露性角膜炎发生率比较差异显著.结论 随着手术时间的延长,手术患者暴露性角膜炎的发生率明显增加,主要表现为畏光、流泪、刺痛、结膜充血等.采用结膜囊内涂红霉素眼膏并贴薄膜贴能够有效预防暴露性角膜炎的发生.     

红霉素眼膏和蝶形胶布用于全麻术中眼部护理

暴露性角膜炎是全麻术后眼部常见的并发症,严重者可导致角膜炎甚至角膜溃疡一。甚至眼部检查发现角膜上皮点状浸润,严重者上皮剥脱,治疗及护理不当可致角膜溃疡,甚至视力丧失。本文对红霉素眼膏和蝶形胶布用于全麻术中眼部护理总结如下。     

全麻体外循环病人使用保鲜膜预防暴露性角膜炎的护理

目的 探讨全麻体外循环手术的心脏病病人暴露性角膜炎的预防方法.方法 对59例全麻体外循环手术中,或术后麻醉未清醒的心脏病病人,采用病人左右眼自身对照法,左眼为对照组,共59只,方法是自然闭眼,如有眼部异常报告医生,遵医嘱予滴入眼药水；右眼为实验组,共59只,前瞻性使用保鲜膜覆盖,每4h用无菌生理盐水棉球清洗眼部一次.结果 该组病人左右眼的暴露性角膜炎的发生率差异有显著意义,x2=4.027,P＜0.05.结论 对全麻体外循环手术中及术后麻醉未清醒的心脏病病人,前瞻性使用保鲜膜预防暴露性角膜炎有明显效果,且取材方便,价格便宜,具有可操作性和推广性.     

全麻术后暴露性角膜炎12例临床分析

目前全麻已经成为外科手术常用的麻醉方式之一,但是很少有麻醉师在全麻过程中对眼睛采取防护措施,故术后暴露性角膜炎时有发生。我院2007年有12例全麻术后发生暴露性角膜炎,通过及时治疗全部治愈,现报告如下。1临床资料1.1一般资料本组12例,男7例,女5例;年龄12～74岁。双眼发病8例,单眼4例(右眼3例,左眼1例)。普外科手术6例,骨科3例,妇科、耳鼻喉科及口腔科各1     

肝移植病人术中角膜保护措施的改进

目的:减少肝移植病人暴露性角膜炎的发生率。方法:将200例病人分为未使用橡皮膏组和使用橡皮膏组。全麻后,未使用橡皮膏条组,眼部未采取保护措施或仅用红霉素眼膏;使用橡皮膏条组在病人眼部用长约3 cm,宽约0.5 cm橡皮膏条拧成麻花状,粘住病人上下眼睑,使其双眼闭合。结果:未使用橡皮膏条组暴露性角膜炎发生率为68%;采用橡皮膏条后,暴露性角膜炎发生率为2%。结论:使用橡皮膏条粘闭双眼保护角膜符合人的生理,方法简单,效果满意,取材方便,可以推广到所有全麻病人。     

两种方法在全麻妇科手术患者头面部保护中的效果观察

目的 比较两种方法在全麻妇科手术患者头面部中的应用及效果.方法 对200例全麻妇科手术患者根据手术日分为两组.A组眼部使用3M透明敷贴,手术巾覆盖头面部上空.B组采用保鲜膜覆盖头面部,对比两组暴露性角膜炎及口唇干裂发生率,比较术后撕开保护膜后眼部并发症(眼睑皮肤撕脱、眼睫毛撕脱)发生的差异性.结果 两组均可预防暴露性角膜炎,B组口唇干裂发生率,及术后揭开保护膜时引起眼部并发症(眼睑皮肤撕脱、眼睫毛撕脱)发生率明显低于A组,差异具有统计学意义(P<0.001).结论 采用保鲜膜覆盖头面部在全麻妇科手术患者预防暴露性角膜炎、口唇干裂、避免术后揭开保护膜时引起眼部并发症(眼睑皮肤撕脱、眼睫毛撕脱)有明显效果,取材方便,具有可操作性和推广性.     

ICU病人暴露性角膜炎早期监测及护理干预研究进展

对重症监护室病人发生暴露性角膜炎的临床特点、早期监测及常用护理干预手段进行综述,以期使医务人员深入地、全面地了解重症监护室(ICU)病人暴露性角膜炎的相关知识,为制定针对暴露型角膜炎的早期监测及干预策略提供理论依据。     

上睑下垂矫正术后并发角膜炎的原因分析和护理对策

目的探究上睑下垂矫正术后并发角膜炎的原因,并提出相应的护理对策。方法对384例接受上睑下垂矫正术的患者术后角膜炎发生率和原因进行回顾性分析,针对引起患者角膜炎的不同原因采取相应的护理措施,对护理前后患者角膜炎症状和体征的严重程度进行统计比较。结果上睑下垂矫正术后并发角膜炎的原因包括术后角膜暴露、角膜损伤、个人卫生和生活方式、环境因素等;不同矫正术引起术后角膜炎的发生率不同;积极有效的护理措施可以降低严重性角膜炎比例(P<0.01)。结论有效的护理干预措施能减轻上睑下垂矫正术后角膜炎并发症的严重程度,从而提高手术疗效。     

真菌性角膜炎病原菌的分布及耐药性分析

目的分析真菌性角膜炎病原菌的构成情况及耐药性变迁,为临床治疗提供依据。方法选取2013年2月至2015年1月真菌性角膜炎患者138例,进行病原菌检测和药敏分析。按年统计真菌性角膜炎病原菌构成谱的变化,分析真菌性角膜炎病原菌构成及耐药性发展趋势。结果 138例真菌性角膜炎患者共培养分离出168株真菌,其中2013年49株,2014年51株,2015年64株。3年病原菌构成差异无统计学意义(P0.05)。真菌性角膜炎主要病原菌对常见抗菌药物的耐药率均呈上升趋势,不同年份的耐药率比较差异有统计学意义(P0.05)。结论真菌性角膜炎病原菌谱基本稳定,但耐药性呈上升趋势。     

单纯疱疹病毒性角膜炎的中药治疗概述

<正>单纯疱疹病毒性角膜炎(Herpes Simplex Virus,HSK)是因单纯疱疹病毒侵袭角膜而引起的眼病,其主要特点为高发病率、难治愈性和易复发性,其发病率和致盲率皆居角膜病之首~([1])。治疗该病使用的西药主要为各种抗病毒药、抗生素、免疫制剂和激素等,虽有一定的疗效,但也存在一些副作用或不良反应。中医认为HSK属"聚星障"之范畴,医者常使用中药治疗HSK,屡见奇效,有其独到之处。笔者对该病的中药治疗进行了总结归纳,现综述如下:     

超声乳化白内障吸除术后单纯疱疹病毒性角膜炎的诊疗观察

目的回顾分析超声乳化白内障吸除+人工晶体植入术后患单纯疱疹性角膜炎(HSK)患者的病例资料,对其诊疗进行总结归纳并分析探讨。方法 2009年4月至2010年4月眼科门诊随访超声乳化白内障吸除+人工晶体植入术的患者,术后发生HSK 4眼。诊断明确给予抗病毒药物及角膜修复药物治疗。结果 4只眼均为单眼发病,其中2眼合并2型糖尿病。1眼表现为角膜上皮点状缺损,3眼表现为树枝状角膜浸润,荧光素染色均为(+)。经抗病毒治疗7~21 d角膜修复,荧光染色(-)。随访3~6个月未见复发。结论尽管白内障术后HSK发生少见,但对合并糖尿病等全身抵抗力下降的患者,医师仍须警惕术后诱发HSK的可能。发现病毒感染后及时给予抗病毒治疗至关重要。     

In vivo challenging of polymyxins and levofloxacin eye drop against multidrug-resistant Pseudomonas aeruginosa keratitis

The purposes of this study were to establish a rabbit multidrug-resistant Pseudomonas aeruginosa (MDRP) keratitis model, and test the efficacy of levofloxacin, colistin methanesulfate (CL-M), colistin sulfate (CL-S) and polymyxin B (PL-B) against MDRP infection. In a rabbit eye, making a 2-mm circular corneal excision, and MDRP strain #601 or representative P. aeruginosa strain IID1210 were instilled into the corneal concavity. IID1210 was used to confirm this model developed P. aeruginosa keratitis. After MDRP keratitis developed, we treated the eyes with levofloxacin, CL-M, CL-S or PL-B eye drops. The infected eyes were evaluated by clinical score, histopathological examination and viable bacterial count (CFU). Rabbits developed MDRP keratitis reproducibly after instilled the bacteria into the corneal lesion. MDRP produced severe keratitis similarly with IID1210, as shown by slit lamp examination and clinical score. In MDRP keratitis models, clinical scores and viable bacterial counts were significantly lower in levofloxacin- and CL-M-treated groups compared with PBS-treated group, but the magnitudes of reduction were not remarkable. However, clinical scores were dramatically lowered in CL-S- and PL-B-treated groups compared with PBS-treated group. CL-S- and PL-B-treated group were kept corneal translucency and little influx of polymorphonuclear neutrophils in histopathological examination. In addition, both CL-S- and PL-B-treated groups were not detected viable bacteria in infected cornea. Using our MDRP keratitis model, we showed that topical levofloxacin and CL-M are not adequately effective, while CL-S and PL-B are efficacious in controlling MDRP keratitis. Especially, PL-B, which is commercially available eye drop, might be most effective against MDRP.     

Clinical experience in managing Fusarium solani keratitis

Fusarium solani keratitis is a rare ocular infectious disease. The clinical characteristics and treatment methods of 18 patients with culture proven F. solani keratitis between July 1997 and December 2003 and with a follow-up period of more than 4 months were analysed retrospectively. The patients were divided into two groups based on the severity of keratitis. Group A (n = 13) displayed non-severe keratitis and were treated with debridement, lamellar keratectomy and antifungal medication. Group B (n = 5) displayed severe keratomycosis and were treated with lamellar keratectomy combined with amniotic membrane transplantation (AMT) and antifungal medication. In group A, wound healing did not interfere with the integrity of the anterior chamber. The mean re-epithelialisation time was 12.67 days (range: 5-21 days). All patients were free of major immediate postoperative complications. In group B, AMT preserved the anterior chamber integrity in two cases, but failed to do so in the other three cases. Therapeutic patch grafts were required in these three cases. Non-severe F. solani keratitis is best treated with superficial keratectomy. Timely AMT combined with lamellar keratectomy appears to be an adjuvant therapy for severe keratomycosis and avoiding emergent therapeutic penetrating keratoplasty. However, AMT was effective in cases involving non-suppurative Fusarium keratitis.     

误诊为角膜炎的干眼症及唯地息凝胶疗效分析

摘　要:目的:分析误诊为角膜炎的干眼症原因并探讨其治疗。方法:以干眼症的三项检查结果(泪液分泌试验、泪膜破裂时间、角膜荧光素染色)为诊断标准，收集反复用药2月以上且误诊为角膜炎的干眼症患者，并给予唯地息眼膏治疗，观察用药后2周疗效。结果：9眼（6例）误诊为病毒性角膜炎，58眼（29例）误诊为点状角膜炎，误诊时间2个月～1年6个月； 停用所有抗感染眼药水后给予唯地息眼膏点眼，患者自觉症状减轻，角膜染色减少。结论：对于角膜染色阳性患者应该结合临床症状及传统的干眼症诊断试验以免误诊；唯地息凝胶用于干眼症患者能明显改善症状和体征。     

The inhibitory effect of vancomycin ointment on the manifestation of MRSA keratitis in rabbits

The purpose of this study was to investigate an experimental model of methicillin-resistant Staphylococcus aureus (MRSA) keratitis, and to evaluate the inhibitory effect of vancomycin ointment on the manifestation of keratitis in this model. For the development of the MRSA keratitis model, 16 rabbits received 0.3-ml intrastromal injections of 1 × 10⁷ colony forming units/ml MRSA inoculated to each of their corneas. After the MRSA inoculation, the rabbits were examined for a period of 14 days. Vehicle only was applied to each left eye for 2 days as an experimental control. Prototype vancomycin ointments, at concentrations of 0.03%, 0.1%, 0.3%, and 1.0%, were applied to each right eye for 2 days. The treatment commenced immediately after the MRSA inoculation and was administered five times a day at 2-h intervals. Four rabbits were used for each vancomycin ointment concentration. Anterior segments were examined daily, and the minimum inhibitory concentration of vancomycin (percentage in the ointment) for treating MRSA keratitis was determined on day 2. On day 14, no recurrences of infection were observed in the eyes that had not exhibited keratitis on day 2. Forty-eight hours post-inoculation, all left eyes demonstrated severe conjunctivitis, stromal infiltrates at injection sites, and fibroid reactions in the anterior chamber. MRSA keratitis was completely inhibited by 0.3% and 1.0% vancomycin ointments. Although the 0.1% ointment generally could prevent keratitis, punctate infiltrates were found in some eyes. Numerous infiltrates were found in eyes treated with 0.03% ointment. In conclusion, the present study substantiates the view that vancomycin ointment has a potent inhibitory effect upon the manifestations of MRSA keratitis, and indicates that a 0.3% concentration is necessary for effective treatment.     

麻痹性角膜炎21例报告

目的　总结并探讨麻痹性角膜炎的成因及治疗。方法　对21 例麻痹性角膜炎者,局部以抗炎、滋润、营养角膜类药物滴眼及庶眼法保护性治疗为主,配合全身的抗炎及维生素等药物治疗。结果　18 例治愈,3 例因继发角膜溃疡,4个月后形成角膜白斑,严重影响视力。结论　麻痹性角膜炎应以早期预防为主,发病后及时采取有效的治疗措施,防止造成严重的失明后果,并应随访观察到角膜失代偿期恢复为止,以防复发。