Hislop W S, Dutton G N, Douglas P S
Department of Oral and Maxillofacial Surgery, Canniesburn Hospital, Glasgow, UK.
Br J Oral Maxillofac Surg. 1996 Aug;34(4):289-92. doi: 10.1016/s0266-4356(96)90004-2.
Retrobulbar haemorrhage is a rare complication of orbital injury or surgery. After injury the first clinicians to see these patients are often the staff of accident and emergency departments. This survey was instigated after several patients had been referred to our care irreversibly blind. A multiple choice questionnaire was devised and sent to 90 doctors working in accident and emergency departments in Scotland. A total of 57 (63%) were returned of which 55 were complete enough to analyse. The range of respondents was: consultants (n = 6), associate specialists (n = 3), senior registrars (n = 3), registrars (n = 4), senior house officer (n = 35), and clinical assistants (n = 4). Twenty nine of the 35 senior house officers (83%) were unable to diagnose and treat retrobulbar haemorrhage. Most consultants, senior registrars, registrars and associate specialists were significantly better in the diagnosis and treatment of this condition (P = 0.001). We conclude that there is an unacceptably high incidence of blindness as a result of inappropriate diagnosis and treatment of retrobulbar haemorrhage. We have therefore designed a protocol for accident departments which should help reduce the incidence of blindness.
球后出血是眼眶损伤或手术的一种罕见并发症。受伤后，首批诊治这些患者的临床医生往往是急诊科工作人员。在几名患者被转诊至我院时已不可逆失明后，开展了这项调查。设计了一份多项选择题问卷，并发送给在苏格兰急诊科工作的90名医生。共收回57份（63%），其中55份完整到足以进行分析。受访者范围包括：顾问医生（n = 6）、副专科医生（n = 3）、高级住院医师（n = 3）、住院医师（n = 4）、高级住院医生（n = 35）和临床助理（n = 4）。35名高级住院医生中有29名（83%）无法诊断和治疗球后出血。大多数顾问医生、高级住院医师、住院医师和副专科医生在这种病症的诊断和治疗方面明显更胜一筹（P = 0.001）。我们得出结论，由于球后出血诊断和治疗不当导致失明的发生率高得令人无法接受。因此，我们为急诊科设计了一个方案，应有助于降低失明发生率。
