一例機械通氣伴意識障礙患者眼部并發癥的循證護理_《中國循證醫學雜志》

作者：

吳玲玲 ¹ ,  王吉平 ²

1. 復旦大學附屬金山醫院重癥監護室（上海 200540）；2. 復旦大學附屬金山醫院護理部（上海 200540）;

關鍵詞：

眼部護理重癥監護病房角膜炎醫源性眼部并發癥循證治療

DOI：

10.7507/1672-2531.20120197

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目的　為l例機械通氣伴昏迷患者眼部并發癥制定循證護理方案。
方法　按PICO原則，針對患者臨床表現提出問題，計算機檢索Cochrane圖書館（2011年第12期）、PubMed（1980.1～2011.10）、EMbase（1974～2011）及CBM（1978～2011），搜集有關危重患者眼部護理的臨床指南、系統評價和隨機對照試驗。對其進行證據的真實性、重要性和適用性評價后，將最適證據應用于該例患者并觀察患者療效。
結果　共納入3篇臨床指南、2篇系統評價和9篇RCT。當前證據表明：眼部清潔是危重患者眼部護理的重要內容，常用的擦拭或沖洗液為生理鹽水和無菌水；預防角膜干燥常采用保濕膜覆蓋及應用潤滑眼液/膏，聚乙烯保濕膜能有效防止角膜損傷的發生，而潤滑眼液/膏則有利于眼部觀察，應用時應結合患者病情酌情選擇。護士需每日評估患者眼瞼閉合能力并幫助患者眼瞼閉合，但被動性眼瞼閉合預防角膜損傷效果明顯比人工淚液軟膏差，保持眼瞼閉合及形成眼球保濕腔室綜合干預能更有效預防眼部并發癥的發生。我們參照上述循證醫學證據，并根據患者的具體情況，制定如下眼部護理方案：應用0.9%生理鹽水紗布擦拭眼瞼及周圍皮膚，使用無菌聚乙烯薄膜（透明敷貼內含無菌紗布襯墊）覆蓋雙眼，周圍用抗過敏膠帶粘貼加固，每12小時更換一次（污染、破損或敷貼卷邊時及時更換），每日觀察眼瞼閉合情況。實施7天后，該患者眼部癥狀出現明顯好轉，分泌物明顯減少，無球結膜充血及水腫，熒光素染色檢查陰性。
結論　眼部清潔能有效去除分泌物及微生物，而聚乙烯薄膜能防止淚液蒸發并充分發揮淚液免疫功能，減少感染風險，眼瞼保持閉合及局部的濕潤環境有利于角膜上皮的修復。

引用本文： 吳玲玲,王吉平. 一例機械通氣伴意識障礙患者眼部并發癥的循證護理. 中國循證醫學雜志, 2012, 12(10): 1270-1274. doi: 10.7507/1672-2531.20120197 復制

1.	Rosenberg JB, Eisen LA. Eye care in the intensive care unit: narrative review and meta-analysis. Crit Care Med, 2008, 36(12): 3151-3155.
2.	Joyce N. Eye care for the Intensive Care Patient: A systematical review. Australia: The Joanna Briggs Institute for Evidence Based Nursing and Midwifery, 2002, 12.
3.	Cunningham C, Gould D. Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care. Int J Nurs Stud, 1998, 35(1-2): 32-40.
4.	Jbiebnm. Eye care for intensive care patients. JBI Best Practice, 2002, 32(5): 1-6.
5.	Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions. ACP J Club, 2006, 145(3): A8.
6.	Dawson D. Development of a new eye care guideline for critically ill patients. Intensive Crit Care Nurs, 2005, 21(2): 119-122.
7.	Marshall AP, Elliott R, Rolls K, et al. Eyecare in the critically ill: clinical practice guideline. Aust Crit Care, 2008, 21(2): 97-109.
8.	Douglas L, Berry S. Developing clinical guidelines in eye care for intensive care units. Nurs Child Young People, 2011, 23(5): 14-20.
9.	Cortese D, Capp L, Mckinley S. Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care, 1995, 4(6): 425-428.
10.	Lenart SB, Garrity JA. Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. Am J Crit Care, 2000, 9(3): 188-191.
11.	Koroloff N, Boots R, Lipman J, et al. A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med, 2004, 30(6): 1122-1126.
12.	So HM, Lee CC, Leung AK, et al. Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study. Int J Nurs Stud, 2008, 45(11): 1565-1571.
13.	Sorce L R, Hamilton S M, Gauvreau K, et al. Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: a randomized, controlled trial. Pediatr Crit Care Med, 2009, 10(2): 171-175.
14.	Ezra DG, Chan MP, Solebo L, et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med, 2009, 35(3): 455-461.
15.	Kocacal GE, Eser I, Egrilmez S. Effectiveness of polyethylene covers versus carbomer drops (Viscotears) to prevent dry eye syndrome in the critically ill. J Clin Nurs, 2011, 20(13-14): 1916-1922.
16.	Shan H, Sun YZ. Comparison of three types of eye care for preventing exposure keratopathy in the Intensive Care Unit. International Journal of Ophthalmology, 2011, 11(5): 757-759.
17.	李連娣. 自制眼睛保護罩在神經外科昏迷病人中的應用. 現代護理, 2005, 11(18): 1564.
18.	Higgins JP, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6. 2006: The Cochrane Collaboration.
19.	Trees GR, Tomlinson A. Effect of artificial tear solutions and saline on tear film evaporation. Optom Vis Sci, 1990, 67(12): 886-890.

1. Rosenberg JB, Eisen LA. Eye care in the intensive care unit: narrative review and meta-analysis. Crit Care Med, 2008, 36(12): 3151-3155.
2. Joyce N. Eye care for the Intensive Care Patient: A systematical review. Australia: The Joanna Briggs Institute for Evidence Based Nursing and Midwifery, 2002, 12.
3. Cunningham C, Gould D. Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care. Int J Nurs Stud, 1998, 35(1-2): 32-40.
4. Jbiebnm. Eye care for intensive care patients. JBI Best Practice, 2002, 32(5): 1-6.
5. Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions. ACP J Club, 2006, 145(3): A8.
6. Dawson D. Development of a new eye care guideline for critically ill patients. Intensive Crit Care Nurs, 2005, 21(2): 119-122.
7. Marshall AP, Elliott R, Rolls K, et al. Eyecare in the critically ill: clinical practice guideline. Aust Crit Care, 2008, 21(2): 97-109.
8. Douglas L, Berry S. Developing clinical guidelines in eye care for intensive care units. Nurs Child Young People, 2011, 23(5): 14-20.
9. Cortese D, Capp L, Mckinley S. Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care, 1995, 4(6): 425-428.
10. Lenart SB, Garrity JA. Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. Am J Crit Care, 2000, 9(3): 188-191.
11. Koroloff N, Boots R, Lipman J, et al. A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med, 2004, 30(6): 1122-1126.
12. So HM, Lee CC, Leung AK, et al. Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study. Int J Nurs Stud, 2008, 45(11): 1565-1571.
13. Sorce L R, Hamilton S M, Gauvreau K, et al. Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: a randomized, controlled trial. Pediatr Crit Care Med, 2009, 10(2): 171-175.
14. Ezra DG, Chan MP, Solebo L, et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med, 2009, 35(3): 455-461.
15. Kocacal GE, Eser I, Egrilmez S. Effectiveness of polyethylene covers versus carbomer drops (Viscotears) to prevent dry eye syndrome in the critically ill. J Clin Nurs, 2011, 20(13-14): 1916-1922.
16. Shan H, Sun YZ. Comparison of three types of eye care for preventing exposure keratopathy in the Intensive Care Unit. International Journal of Ophthalmology, 2011, 11(5): 757-759.
17. 李連娣. 自制眼睛保護罩在神經外科昏迷病人中的應用. 現代護理, 2005, 11(18): 1564.
18. Higgins JP, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6. 2006: The Cochrane Collaboration.
19. Trees GR, Tomlinson A. Effect of artificial tear solutions and saline on tear film evaporation. Optom Vis Sci, 1990, 67(12): 886-890.

《中國循證醫學雜志》

一例機械通氣伴意識障礙患者眼部并發癥的循證護理

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《中國循證醫學雜志》

一例機械通氣伴意識障礙患者眼部并發癥的循證護理

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