眼科急会诊医师应具备的专科知识维度及技能储备
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摘要
目的调查眼科急会诊的疾病构成情况及处置方法,探讨眼科急会诊医师应具备的专科知识维度及技能储备。方法回顾性分析1年间眼科急会诊患者的眼科病种构成比及相应的处置方法,统计前五位眼科急会诊疾病及需紧急进行的急诊处置方式。结果眼科急会诊就诊的主要病种归纳为6大类:各种类型的机械性眼外伤388例(45.3%)、眼表炎症169例(19.7%)、各种类型的非机械性眼外伤136例(15.9%)、急性青光眼96例(11.2%)、视网膜血管急性病变40例(4.7%),以及其他眼病27例(3.2%)。在眼科急会诊就诊的具体病种中,居于前五位的眼病分别是:角膜异物伤189例(22.1%)、眼睑裂伤133例(15.5%)、急性结膜炎109例(12.7%)、原发性闭角型青光眼急性发作86例(10.0%)、开放性眼球伤42例(4.9%)。前五项专科操作分别是:裂隙灯显微镜下角膜异物取出术178例(20.8%)、单纯眼睑皮肤裂伤清创缝合术109例(12.7%)、前房穿刺放液术59例(6.9%)、开放性眼球伤一期清创缝合术42例(4.9%)、复杂眼睑裂伤手术处理24例(2.8%)。结论眼科急会诊具有病种多、情况急等特点,这要求眼科医师遇事要镇定,不仅要快速诊断,而且要准确诊断,因地制宜、有效处置,并且根据病情合理安排下一步诊疗措施。同时在较为复杂的医疗环境下,应拥有与患者及家属进行良好沟通的能力。
Objective To explore the specialized knowledge dimension and skill inventory required for an urgent consultation ophthalmologist by investigating the urgent consultation diseases and corresponding treatments.Methods A retrospective study of patients applying for ophthalmological urgent consultation in the past 1 year was underwent to investigate the constituent ratio of urgent diseases and proportion of corresponding urgent treatments.Results 6 kinds of principal diseases in ophthalmological urgent consultation were categorized:different kinds of mechanical ocular injury(388 cases,45.3%),ocular surface inflammation(169 cases,19.7%),non-mechanical ocular injury(136 cases,15.9%),acute glaucoma(96 cases,11.2%),acute retinal vasculopathy(40 cases,4.7%),and miscellaneous(27 cases,3.2%).The top five categories were corneal foreign-body injury(189 cases,22.1%),palpebral laceration(133 cases,15.5%),acute conjunctivitis(109 cases,12.7%),primary acute closure glaucoma(86 cases,10.0%),open globe injury(42 cases,4.9%).Top five corresponding urgent treatments were removal of corneal foreign-body under slit-lamp microscopy(178 cases,20.8%),debridement and suturing of simple palpebral laceration(109 cases,12.7%),paracentesis of anterior chamber(59 cases,6.9%),primary debridement and suturing of open globe injury(42 cases,4.9%),primary surgery for complex palpebral laceration in operating room(24 cases,2.8%).Conclusion Ophthalmological urgent consultation is widely distributed and emergent,thus a calm demeanor is vital for performing aquick but also accurate diagnosis.Taking effective measurements adjusting to local medical condition and arranging properly further treatments are basic skills.Meanwhile,effective communication with patients and their relatives is requisite and will facilitate the progress of diagnosis and treatment in the sharp medical environment.
Objective To explore the specialized knowledge dimension and skill inventory required for an urgent consultation ophthalmologist by investigating the urgent consultation diseases and corresponding treatments.Methods A retrospective study of patients applying for ophthalmological urgent consultation in the past 1 year was underwent to investigate the constituent ratio of urgent diseases and proportion of corresponding urgent treatments.Results 6 kinds of principal diseases in ophthalmological urgent consultation were categorized:different kinds of mechanical ocular injury(388 cases,45.3%),ocular surface inflammation(169 cases,19.7%),non-mechanical ocular injury(136 cases,15.9%),acute glaucoma(96 cases,11.2%),acute retinal vasculopathy(40 cases,4.7%),and miscellaneous(27 cases,3.2%).The top five categories were corneal foreign-body injury(189 cases,22.1%),palpebral laceration(133 cases,15.5%),acute conjunctivitis(109 cases,12.7%),primary acute closure glaucoma(86 cases,10.0%),open globe injury(42 cases,4.9%).Top five corresponding urgent treatments were removal of corneal foreign-body under slit-lamp microscopy(178 cases,20.8%),debridement and suturing of simple palpebral laceration(109 cases,12.7%),paracentesis of anterior chamber(59 cases,6.9%),primary debridement and suturing of open globe injury(42 cases,4.9%),primary surgery for complex palpebral laceration in operating room(24 cases,2.8%).Conclusion Ophthalmological urgent consultation is widely distributed and emergent,thus a calm demeanor is vital for performing aquick but also accurate diagnosis.Taking effective measurements adjusting to local medical condition and arranging properly further treatments are basic skills.Meanwhile,effective communication with patients and their relatives is requisite and will facilitate the progress of diagnosis and treatment in the sharp medical environment.
引文
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[2]魏波,卫洪波,邓美海,等.重视外科住院总医师培训培养素质全面的外科人才[J].中国医疗前沿,2012(12):86-87.
[3]王艳玲,罗丽华.眼科临床教学医患沟通能力培训课程的探索[J].临床和实验医学杂志,2012(22):1836-1837.
[4]马志中.我国眼外伤近五年研究进展[J].中华眼科杂志,2010,46(10):911-914.
[5]Pieramici DJ,Sternberg Jr P,Aaberg TM,et al.A system for classifying mechanical injuries of the eye(globe)[J].Am J Ophthalmol,1997,123:820-831.