情景模拟演练在连台飞秒激光小切口角膜基质透镜取出术中的应用

叶翠芬 黄恩娥 苏丽端

[摘要]目的探討术前情景模拟演练在连台飞秒激光小切口角膜基质透镜取出术中的应用效果。方法选取泉州市妇幼保健院·儿童医院眼科于2017年5—7月进行飞秒激光小切口角膜基质透镜取出术的患者200例作为研究对象，按随机数字表法分组，98例为对照组，102例为观察组。对照组采用常规护理方法;观察组采用情景模拟演练，即术前30 min 在等待手术间进行手术情景模拟演练，包括手术各环节配合和注意事项的讲解、固视训练和深呼吸放松训练等。比较两组患者术中配合情况、术后视力矫正效果、手术时间、患者对护理工作满意度、术后1个月与6个月患者裸眼视力、眼压改变率、中央角膜厚度改变率的变化及角膜地形图变化情况。结果观察组患者术中配合情况、术后视力矫正效果、手术时间、患者对护理工作满意度均优于对照组，差异有统计学意义（ P <0.05）。观察组和对照组各时间点裸眼视力差异均无统计学意义（均 P >0.05）;术后1个月，观察组眼压改变率和中央角膜厚度改变率较对照组低（均 P <0.05）;术后6个月，两组患者眼压改变率和中央角膜厚度改变率较术后1个月减少，差异有统计学意义（均 P <0.05）。结论情景模拟演练应用于连台飞秒激光小切口角膜基质透镜取出术，确实提高患者手术配合依从性，缩短手术时间，提高手术效率，进而提高患者对护理工作的满意度。

[关键词]飞秒激光小切口角膜基质透镜取出术;情景模拟演练;连台手术;眼压改变率;中央角膜厚度

[中图分类号] R779.63  [文献标识码] A   [文章编号]2095-0616（2021）24-0129-05

Application of scenario simulation exercise in continuous femtosecond laser small incision lenticule extraction operation

YE  Cuifen1      Huang  En'e1      SU  Liduan2

1.Department of Ophthalmology， Quanzhou Women's and Children's Hospital， Fujian， Quanzhou 362000， China;

2.Department of Pediatric Respiratory Medicine， Quanzhou Women's and Children's Hospital， Fujian， Quanzhou 362000， China

[Abstract] Objective To investigate the effect of preoperative scenario simulation exercise in continuous femtosecond laser small incision lenticule extraction （SMILE） operation. Methods A total of 200 patients who underwent SMILE in the Department of Ophthalmology of Quanzhou Women's and Children's Hospital from May to July 2017 were selected as the research objects. They were divided into 98 cases as the control group and 102 cases as the observation group by the random number table method. The control group used routine nursing methods， while the observation group used scenario simulation exercise， that is， 30 minutes before operation， surgery simulation exercise in the operating room， including the operation cooperation at various links and the explanation of precautions， fixation training and deep breathing relaxation training. The intraoperative cooperation， postoperative visual acuity correction effect， operation time， patients' satisfaction with nursing work， as well as the changes of naked eye visual acuity， intraocular pressure change rate， central corneal thickness change rate and corneal topography at 1 month and 6 months after operation were compared between the two groups. Results The intraoperative cooperation， postoperative visual acuity correction effect， operation time and patients' satisfaction with nursing work in the observation group were better than those in the control group， with statistically significant differences （P <0.05）. There was no statistically significant difference in naked eye visual acuity between the observation group and the control group at each time point （all P >0.05）. At 1 month after operation， the change rates of intraocular pressure and central corneal thickness in the observation group were lower than those in the control group （all P <0.05）. At 6 months after operation， the change rates of intraocular pressure and central corneal thickness in the two groups were lower than those at 1 month after operation， with statistically significant differences （all P <0.05）. Conclusion The application of scenario simulation exercise in continuous SMILE operation can indeed improve the compliance of patients' intraoperativecooperation， shorten the operation time， raise the operation efficiency， and then enhance the satisfaction of patients with nursing work.

[Key words] Femtosecond laser small incision lenticule extraction; Scenario simulation exercise; Continuous operation; Intraocular pressure change rate; Central corneal thickness

飞秒激光小切口角膜基质透镜取出术（small  incision lenticule extraction， SMILE）是目前精准性、安全性和预测性较高的先进微创屈光手术，该手术利用飞秒激光在角膜基质根据患者术前检查的数据做不同形状的扫描，使其形成透镜后将其从边缘小切口取出的一种屈光手术方式，从而达到矫正近视或近视散光的效果。……