ICU昏迷患者暴露性角膜病变发生现状及影响因素分析  

Analysis on the status of exposure keratopathy in comatose patients of ICU and its influencing factors

作　　者：李安琪 金培英 谢波[2] 李彩娟 卢玉云 LI Anqi;JIN Peiying;XIE Bo;LI Caijuan;LU Yuyun(Huzhou University,Huzhou,Zhejiang 313000;Huzhou Central Hospital Affliated to Zhejiang University,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州师范学院,浙江湖州313000 [2]浙江大学附属湖州中心医院,浙江湖州313000

出　　处：《护士进修杂志》2022年第8期705-709,717,共6页Journal of Nurses Training

基　　金：浙江省研究生联合培养基地开放课题项目(编号:LHJDKF202003)。

摘　　要：目的了解重症监护室(ICU)昏迷患者暴露性角膜病变(EK)的发生现状,并探讨其影响因素。方法采用便利抽样法,选取2019年12月-2020年12月在湖州市中心医院ICU住院的昏迷患者254例,采用荧光素钠眼科检测试纸及配置钴蓝光源的便携式裂隙灯,根据荧光素钠眼科检测试纸结果将患者分为EK阴性组(178例)和EK阳性组(76例),分析可能影响2组患者EK发生的相关因素。结果ICU昏迷患者EK发生率为29.9%。(1)单因素分析结果显示:入院诊断、ICU入住天数、机械通气天数、使用镇静剂、使用肌松剂、眼睑闭合不全、结膜水肿、有无眼表分泌物、每日眼部护理次数及每日眼部护理方式是患者EK发生的影响因素,差异有统计学意义(P<0.05)。(2)二元logistic回归分析结果显示:眼睑闭合不全、结膜水肿、使用镇静剂、机械通气天数及有无眼表分泌物是患者EK发生的独立影响因素。结论ICU昏迷患者EK发生率较高,主要因素有眼睑闭合不全、结膜水肿、使用镇静剂、机械通气天数及有无眼表分泌物,提示医护人员应加强对患者EK的重点关注及专业评估,并给予患者具体的眼部护理措施及诊疗方法,减少EK的发生。Objective To investigate the current situation of exposure keratopathy(EK)in comatose patients of intensive care unit(ICU)and explore its influencing factors.Methods A total of 254 comatose patients in ICU of Huzhou Central Hospital from December 2019 to December 2020 were selected as the research subjects by convenience sampling method.The patients were divided into negative EK group(178 cases)and positive EK group(76 cases)according to the results of fluorescein sodium ophthalmic test paper and portable slit lamp equipped with cobalt blue light source.Univariate and multivariate logistic regression analysis was performed on the related factors that might influence the occurrence of EK between 2 groups were analyzed.Results The incidence of EK in comatose patients of ICU was 29.9%.(1)The results of single factor analysis showed that the hospital diagnosis,ICU stay days,days of mechanical ventilation,use of sedatives,use of muscle relaxants,eyelid closure insufficiency,conjunctival edema,presence of ocular surface secretions,daily number and methods of eye care were the influence factors of the patients with EK,the differences were statistically significant(P<0.05).(2)Binary logistic regression analysis showed that the occurrence of EK in comatose patients was independently influenced by eyelid incompleteness,conjunctival edema,use of sedatives,days of mechanical ventilation,and presence of ocular surface secretions.Conclusion The incidence of EK in comatose patients of ICU is at a high level.The main factors are eyelids insufficiency,conjunctival chemosis,use of sedatives,days of mechanical ventilation,and presence of ocular surface discharge.Medical staff should pay more attention to EK in comatose patients and make professional assesssment,and give patients specific eye care measures and diagnosis and treatment methods in order to reduce the occurrence of EK.

关 键 词：重症监护室 昏迷 暴露性角膜病变 眼部护理 

分 类 号：R473[医药卫生—护理学] R473.77[医药卫生—临床医学]