急性虹膜睫状体炎

急性虹膜睫状体炎 急性虹膜睫状体炎临床路径 ,2011年版, 一、急性虹膜睫状体炎临床路径标准住院 ,一,适用对象。 急性虹膜睫状体炎,ICD-10 H20.004,～特别是伴有前房纤维素性渗出或前房积脓的重症患者。 ,二,诊断依据。 根据《临床诊疗指南》眼科学分册,中华医学会编著～2006年,。 1.症状:眼红、眼痛、畏光、流泪、视物模糊或视力下降。 2.体征:球结膜睫状充血或混合充血～大量灰白色尘状角膜后沉着物(KP)～前房闪辉～房水炎症细胞～前房纤维素性渗出～前房积脓～瞳孔缩小或不规则～虹膜后粘连～少数患者出现反应性视盘水肿或黄斑水肿。 ,三,治疗的选择。 根据《临床诊疗指南》眼科学分册,中华医学会编著～2006年版,。 1.抗炎:糖皮质激素滴眼液滴眼。 2.散瞳:拉开和预防虹膜后粘连,滴用睫状肌麻痹剂。 3.对于出现反应性视盘水肿或黄斑水肿者～可短期给予the first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note 糖皮质激素口服治疗。 ,四,标准住院日为5–7天。 ,五,进入路径标准。 1.第一诊断必须符合ICD-10 H20.004急性虹膜睫状体炎疾病编码～特别是伴有威胁视功能的体征～如:前房纤维素性渗出～前房积脓～新出现的广泛虹膜后粘连～反应性视盘水肿或黄斑水肿。 2.当患者同时具有其他疾病诊断～但在住院期间不需要特殊处理～也不影响第一诊断的临床路径流程实施时～可以进入路径。 ,六,住院期间检查项目: 1.眼部检查:视力、眼压、裂隙灯检查、眼底检查, 2.辅助检查:不是所有患者均需要做辅助检查～根据眼部炎症及视功能情况～可选择眼底光学相关断层扫描(OCT)、UBM、眼部B超、眼底荧光血管造影, 3.全身检查:HLA–B27、ESR、CRP、RPR、ANA,对于需要短期应用口服糖皮质激素者～应该查血常规、肝肾功能、胸片。对于拟诊强直性脊柱炎者～可以做骶髂关节X光片或CT。 ,七,治疗方案与药物选择。 1.抗炎:应用糖皮质激素。 ,1,1%醋酸泼尼松龙滴眼液:根据炎症情况～可以q1hthe first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note 或q2h滴眼。 ,2,曲安奈德或地塞米松结膜下注射:适用于前房大量纤维素性渗出患者～且既往眼表滴用糖皮质激素无眼压升高病史。 ,3,周身应用糖皮质激素:急性虹膜睫状体炎一般不需要周身应用糖皮质激素。但是～若出现反应性视盘水肿或黄斑水肿～可以口服强的松30–40mg/d～一般不超过2周。 ,4,非甾体类消炎药滴眼剂的应用:可用于辅助抗炎～常用药物为双氯芬酸纳滴眼剂或普拉洛芬滴眼剂～但是要注意多种药物眼表应用的角膜毒性。 2.散瞳: ,1,1%阿托品凝胶滴眼:2–3次/天～适用于发病初期和严重炎症～特别是伴有前房纤维素性渗出、前房积脓或出现虹膜后粘连者。 ,2,强力散瞳剂结膜下注射:适用于新鲜的但难以用1%阿托品滴眼拉开的虹膜后粘连～1%阿托品、1%可卡因、0.1%肾上腺素等量混合～取0.1–0.2ml结膜下注射。 ,3,复方托吡卡胺滴眼:适用于患者眼痛畏光症状明显好转、前房纤维素性渗出或积脓基本吸收、虹膜后粘连已经被拉开者。 ,八,出院标准。 1.患者眼痛、畏光等眼部刺激症状好转。 the first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note 2.前房炎症得到控制～前房纤维素性渗出或前房积脓基本吸收。 3.新出现的虹膜后粘连已经被拉开。 ,九,变异及原因分析。 1.全葡萄膜炎～需要长期周身应用糖皮质激素/免疫抑制剂。 2.感染性葡萄膜炎。 3.伴有全身疾病且需要周身药物治疗者。 the first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note 二、急性虹膜睫状体炎临床路径表单(适用于重症患者) 适用对象:第一诊断为急性虹膜睫状体炎(ICD-10 H20.004) 患者姓名: 性别: 年龄: 门诊号: 住院号: 住院日期: 年 月 日 出院日期: 年 月 日 标准住院日:5–7 天 日期 住院第1天 ? 询问病史，完成体格检查及眼科专科的常规检查，视力(裸视和矫正视力)、眼压、散瞳 主 眼前节、晶体、玻璃体、眼底检查 要 ? 住院医师写病历 诊 疗 ? 完善相关实验室检查 工 ? 上级医师查房，指导诊疗计划 作 长期医嘱: ? 眼科二级护理常规 ? 饮食(普食/糖尿病饮食/其它) 重 ? 1%醋酸泼尼松龙滴眼:q1h或q2h 点 ? 1%阿托品凝胶滴眼:bid或tid 医 嘱 临时医嘱: ? 测眼压、裂隙灯、眼底 ? 血常规、HLA-B27、ESR、CRP、RPR ? 病区环境介绍，指导患者尽快适应病区环境 ? 入院护理评估、介绍责任护士、护士长、主管医生 ? 医院相关制度介绍 主要 ? 执行长短期医嘱、生命体征监测 护理 ? 饮食宣教，指导患者进食易消化吸收食物及多食用富含维生素的水果蔬菜 工作 ? 介绍有关疾病的护理知识 ? 介绍相关治疗、检查、用药等护理中应注意的问题 ? 完成入院第一天交班报告 病情 ?无 ?有，原因: 变异 记录 护士 签名 医师 签名 the first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note 日期 住院第2–3天 ? 观察前房炎症消退情况、虹膜粘连及瞳孔散大情况 主 要 ? 上级医师查房，给予进一步治疗意见，如结膜下注射强力散瞳剂和/或糖皮质激素 诊 ? 追踪血液检查结果，若有异常，行相关疾病的辅助检查，必要时请相关科室会诊 疗 ? 住院医师完成病程记录 工 作 长期医嘱: ? 眼科二级护理常规 ? 饮食(普食/糖尿病饮食/其它) ? 1%醋酸泼尼松龙滴眼:q1h或q2h 重 ? 1%阿托品凝胶滴眼:bid或tid 点 医 ? 角膜上皮保护剂滴眼(必要时) 嘱 临时医嘱: ? 强力散瞳剂结膜下注射(必要时) ? 地塞米松或曲安奈德结膜下注射(必要时) ? 执行长短期医嘱、生命体征监测 主要 ? 健康宣教 护理 ? 观察动态病情变化，及时与医生沟通，执行医嘱 工作 病情 ?无 ?有，原因: 变异 记录 护士 签名 医师 签名 the first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note 日期 住院第4–5天 ? 上级医师查房 主 ? 检查视力、眼压，裂隙灯下观察前房炎症消退情况、虹膜粘连及瞳孔散大情况 要 诊 ? 检查眼底 疗 ? 若视力不佳、眼底黄斑中心凹光反射不清，行OCT检查，必要时行FA检查 工 ? 若发现黄斑水肿，行肝肾功能、血糖、胸片检查后，予口服强的松30–40mg/d 作 ? 住院医师完成病程记录 长期医嘱: ? 眼科二级护理常规 ? 饮食(普食/糖尿病饮食/其它) ? 1%醋酸泼尼松龙滴眼:q2h ? 1%阿托品凝胶滴眼:bid或tid ? 非甾体类滴眼液 ? 角膜上皮保护剂滴眼(必要时) 重 ? 强的松口服(必要时) 点 医 嘱 临时医嘱: ? 测视力、眼压、裂隙灯、眼底 ? 散瞳验光 ? OCT(必要时) ? FA(必要时) ? 检查肝肾功能、血糖、胸片(必要时) 主要 ? 执行长短期医嘱、生命体征监测 护理 ? 观察动态病情变化，及时与医生沟通，执行医嘱 工作 病情 ?无 ?有，原因: 变异 记录 护士 签名 医师 签名 the first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note 住院第6–7天 日期 (出院日) ? 检查视力、眼压，裂隙灯下观察前房炎症消退情况、虹膜粘连及瞳孔散大情况 主 ? 检查眼底 要 诊 ? 上级医师查房，评估患者是否可以出院 疗 ? 住院医师完成病程记录、出院小结、出院带药、出院证明 工 ? 决定出院时间 作 ? 向病人告知出院后遵医嘱用药，按时复查 长期医嘱: ? 眼科二级护理常规 ? 饮食(普食/糖尿病饮食/其它) ? 1%醋酸泼尼松龙滴眼:q2h ? 复方托吡卡胺滴眼:bid或tid ? 非甾体类滴眼液 ? 角膜上皮保护剂滴眼(必要时) 重 ? 强的松口服(必要时) 点 临时医嘱: 医 嘱 ? 测视力、眼压、裂隙灯、眼底 出院医嘱: ? 1%醋酸泼尼松龙滴眼:6–8次/d，逐渐减量 ? 非甾体类眼水滴眼:4次/d ? 复方托吡卡胺滴眼:2次/d ? 角膜上皮保护剂滴眼(必要时) ? 强的松口服，按嘱减量(必要时) ? 门诊复查 主要 ? 执行长短期医嘱、生命体征监测 护理 ? 健康宣教:出院注意事项 工作 病情 ?无 ?有，原因: 变异 记录 护士 签名 医师 签名 the first level to consider when positioning security, roughly the same distance between the point and level to put the stand, can't be moved, dislocation, and so on. Pay attention to the proper use and care of leveling. (6) level: find the anchor position after take levels, in anchor horizontal, horizontal lines with fine steel wire cable, while tightly tightening, ensure the wire level. (7) measurement errors: in horizontal line after the measure on the face. Mainly for horizontal measurement, also check the axis (axis positioning) q errors. By measuring the results of analyzing the cause of error, check the relevant specification (construction) requirements for error values, within the specified error, digestible errors exceeded error shall be settled through consultation with civil party or party. (8) to adjust the error: ... (3) familiar with their location and adjacent location, check the accuracy of segment size. (4) attention to handling errors, strengthen coordination with civil engineering work. (5) check the embedded location is accurate, solid reinforcement. 7. Security, protection: (1) enter the construction site personnel must wear safety helmets, safety belts, shirtless, wearing slippers, slippery-soled shoes is not allowed to enter the site. (2) must be carried out according to the specifications of construction, attention to the safe use of electricity. (3) Note