重症监护病房中的眼部护理：叙述性综述与荟萃分析。

Eye care in the intensive care unit: narrative review and meta-analysis.

作者信息

Rosenberg Jamie B, Eisen Lewis A

机构信息

Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.

出版信息

Crit Care Med. 2008 Dec;36(12):3151-5. doi: 10.1097/CCM.0b013e31818f0ee7.

DOI:10.1097/CCM.0b013e31818f0ee7

PMID:18936706

Abstract

BACKGROUND

Patients in the intensive care unit are at increased risk of exposure keratopathy. Untreated, this may progress to microbial keratitis and visual loss.

DATA SYNTHESIS

A total of 20% to 42% of patients in the intensive care unit develop exposure keratopathy. The epidemiology of this underappreciated problem is reviewed. The pathophysiology of microbial keratitis is reviewed with special attention to the multiple risk factors unique to intensive care unit patients. The clinical presentation of exposure keratopathy is reviewed with tips for recognition for the practicing clinician, including suggestions for when ophthalmologic consultation is warranted. Studies and case series of screening and prevention are reviewed in detail. Two of the most studied methods of prevention, moisture chambers and lubricating ointments, are formally compared in a meta-analysis. Eight of 113 (7.1%) patients in the moisture chamber group vs. 32 of 151 (21.2%) patients in the lubrication group developed exposure keratopathy, with a summary odds ratio of 0.208 (95% confidence interval 0.090-0.479, p < 0.001).

CONCLUSION

With application of simple protocols, exposure keratopathy can be prevented, thus improving patient care in the intensive care unit.

摘要

背景

重症监护病房的患者发生暴露性角膜病变的风险增加。若不进行治疗，这可能会进展为细菌性角膜炎并导致视力丧失。

资料综合

重症监护病房中共有20%至42%的患者发生暴露性角膜病变。本文对这一未得到充分重视的问题的流行病学进行了综述。对细菌性角膜炎的病理生理学进行了综述，并特别关注了重症监护病房患者特有的多种危险因素。对暴露性角膜病变的临床表现进行了综述，为临床医生提供了识别要点，包括何时需要进行眼科会诊的建议。详细回顾了筛查和预防的研究及病例系列。在一项荟萃分析中对两种研究最多的预防方法——保湿眼罩和润滑眼膏——进行了正式比较。保湿眼罩组113例患者中有8例（7.1%）发生暴露性角膜病变，而润滑组151例患者中有32例（21.2%）发生暴露性角膜病变，汇总比值比为0.208（95%置信区间0.090 - 0.479，p < 0.001）。