Clinical data of 1
There were 65438 09 cases (24 eyes) in this group. Male 1 1, female 8. Ranging in age from 6 to 55. Alkaline chemical injury 10 cases 12 eyes; Acid chemical injury in 6 cases (8 eyes); Three cases (4 eyes) were caused by hot steam injury.
2 disposal
It is particularly important that the severity of eye chemical injury is related to the nature, concentration, time, early treatment and correct method of injury. Every second counts.
2.65438+ Once admitted to the hospital, first distinguish the nature of chemicals and take appropriate materials. For alkaline chemical injury, 3% boric acid water is preferred; Acid injury, choose 2% soda water. When washing, the movement should be light, accurate and steady to avoid causing excessive pain and tension to patients. If one eye is injured, tilt the patient's head to the affected side to avoid washing out liquid and hurting healthy eyes. When both eyes are injured, the patient takes the supine position, and the water receiver is placed on both sides of the temporal side, which requires the assistance of one person. Patients can fold the auricle forward with both hands to block the ear canal. When washing, first open the eyelid, inject the washing liquid along the eyelid conjunctiva, and ask the patient to keep turning the eyeball and wash it repeatedly from the inside out. Liquid cannot be injected directly into cornea, so as not to aggravate irritation and cause corneal perforation. Rinse time ≥3 min, rinse solution ≥ 1000 ml. When seriously injured, the patient has intense pain, photophobia, eyelid spasm and difficulty in supporting his eyes. First, he should use 1% tetracaine solution for eye drops, and then rinse thoroughly after topical anesthesia. Clinical verification shows that whether the irrigation is thorough or not is directly related to the degree of vision recovery after injury.
2.2 Drug therapy includes local administration and systemic administration. Immediately after emergency irrigation, vitamin C 100 ~ 250 mg was injected under the bulbar conjunctiva, once a day, for 5 ~ 7 days. Related experiments have proved that the pH value of vitamin C injection is 6'' and that of 3% boric acid solution is 5''. Although vitamin C is an acidic drug, compared with boric acid solution, it will not damage the eye tissue and can quickly correct the lack of vitamin C in aqueous humor and eye tissue after injury. Subconjunctival injection is a treatment for ischemia caused by chemical injury, which can promote collagen synthesis and accelerate tissue repair. Commonly used eye drops are 0.25% chloramphenicol solution, runshu solution or 5 mg flumethasone. Add chloramphenicol solution to form chlorine fluoride eye drops, once every 2 hours, and double-star eye drops twice a day to keep pupils dilated and prevent posterior adhesion of iris. At the same time, it is supplemented by intravenous dilution and drip of vitamin C, dexamethasone and antibiotics. After routine application of antibiotic eye ointment to conjunctiva and eyelid, it is simply bandaged or covered with sterile gauze four times a day, so it takes a long time to lubricate, thus reducing the degree of intraocular inflammatory reaction and promoting vision recovery.
3 nursing experience
3. 1 psychological nursing Most of these patients are worried about their vision and anxiety after injury. First of all, we should patiently comfort patients, explain the development process of the disease, do a good job in health education and guidance, explain matters needing attention, avoid emotional tension and prevent intraocular pressure from rising.
3.2 In order to prevent infection and cross-infection, medical personnel should strictly carry out aseptic operation when contacting patients. First, wash and disinfect their hands. When using eye drops, soak them in disinfectant. When making eye drops, the medicine bottle should not touch the eyelids and eyelashes. Separate the upper and lower eyelids with sterile cotton swabs, keep the wound clean and dry at any time, and often wipe off secretions with sterile cotton swabs. If the cornea is exposed, it should be covered with sterile gauze in addition to antibiotic ointment. When doing eye drops, the head will be biased to the affected side. When more than two kinds of eye drops are used at the same time, the liquid medicine should be used first, and then the ointment should be used, with an interval of 5 min, so as to give full play to the curative effect. Tell the patient not to squeeze, rub or press the eyeball. Don't wipe your eyes with dirty towels, don't cross wards and articles, reduce exploration and escort, keep wards and bed units clean and tidy, and prevent cross infection.
3.3 Do a good job of healthy diet guidance. Early after the injury, give a digestible diet, quit smoking alcohol and spicy food, eat more fresh vegetables and fruits, and prevent dry stool from raising intraocular pressure. After the illness is stable, give a diet with high nutrition and vitamins to enhance the body's resistance and promote early recovery.
[References]
Hui Yannian. Ophthalmology, 5th edition. Beijing: People's Health Publishing House, 200 1, 1.