角膜病患者滴眼液使用规范现况的调查分析

Investigation and analysis of the current situation of standardized use of eye drops in patients with keratopathy

目的调查角膜病患者滴眼液规范使用现况,为正确使用滴眼液的健康教育提供指导。方法将2021年8月至2022年2月在济南市第二人民医院眼科病房接收的角膜病患者346例作为调查对象,由经过培训后的1名眼科专科护士观测患者未开展滴眼液使用相关教育前的滴眼液使用过程,并评价其眼药水滴注行为的规范性;采用济南市第二人民医院眼科病房设计的《滴眼液规范使用认知调查表》调查角膜病患者滴眼液规范使用相关认知。结果346例患者中,男156例(45.09%),女190例(54.91%);年龄30岁及以下36例(10.40%),>30~40岁32例(9.25%),>40~50岁47例(13.58%),>50~60岁87例(25.14%),>60~70岁94例(27.17%),>70岁50例(14.45%)。专科护士对346例角膜病患者1次滴眼液使用行为观测发现,43.93%(152/346)的患者在滴注眼药水前未洗手;41.53%(49/118)的患者滴注混悬液型眼药水前未摇匀;41.62%(144/346)的患者滴注眼药水未选择正确的仰卧头后仰位;43.93%(152/346)的患者滴注眼药水时眼睛未向头顶方向看;43.06%(149/346)的患者眼药水孔直接与眼球接触;53.47%(185/346)的患者滴注时瓶口和睫毛接触;63.29%(219/346)的患者眼药水滴注时未按压鼻泪管;仅27.27%(42/154)的患者在眼药水外溢后正确选择了纸巾擦拭;36.13%(125/346)的患者滴注后立即揉按眼睛;69.08%(239/346)的患者滴注完毕后未执行牵拉眼睑并闭眼1 min以上的正确行为。问卷调查显示,346例患者中,34.97%(121/346)的患者认为滴注2种及以上眼药水时,间隔时间>10 min;53.18%(184/346)的患者认为滴眼液需兼顾温度、光线,参考说明书妥善保存;56.36%(195/346)的患者认为需根据医生或滴眼液说明书的建议滴眼;55.49%(192/346)的患者认为滴眼液开封后,需注意保质期;56.07%(194/346)的患者认为在2种及以上滴眼液滴注时需先滴刺激性弱的,后滴刺激性强的;58.96%(204/346)的患者认为每次眼药水滴注量为1~2滴;73.41%(254/346)的患者认为滴眼后出现异常症状需立即停药/就医;73.70%(255/346)的患者认为滴眼液药品颜色改变、浑浊时立即停用;47.40%(164/346)的患者认为滴眼液使用期间,无需限制饮食,52.60%(182/346)的患者认为滴眼液使用期间应根据说明书或医嘱限制某些食物摄入;仅56.36%(195/346)的患者在使用滴眼液前阅读了说明书。结论角膜病患者滴眼液规范使用行为及认知并不理想,眼科护理人员需重视滴眼液使用的相关宣教,促进滴眼液的规范使用。

Objective To investigate the current situation of standardized use of eye drops in patients with keratopathy,and to provide guidance for health education of the correct use of eye drops.Methods From August 2021 to February 2022,346 cases of keratopathy in the ophthalmology ward of Jinan Second People's Hospital were selected as the survey subjects.One trained ophthalmological nurse observed the use of eye drops before the patients received relevant education on the use of eye drops,and evaluated the standardization of eye drops instillation behaviors.The relevant perceptions of standardized use of eye drops in patients with keratopathy were investigated by the Eye Drops Standardized Use Cognition Questionnaire designed by the ophthalmology ward of Jinan Second People's Hospital.Results Among the 346 patients,156(45.09%)were males and 190(54.91%)were females;there were 36 cases(10.40%)≤30 years old,32 cases(9.25%)over 30-40 years old,47 cases(13.58%)over 40-50 years old,87 cases(25.14%)over 50-60 years old,94 cases(27.17%)over 60-70 years old,and 50 cases(14.45%)over 70 years old.The specialist nurse observed 346 cases of keratopathy using eye drops once and found that 43.93%(152/346)of the patients did not wash their hands before instilling the eye drops,41.53%(49/118)of the patients did not shake the suspension eye drops well,41.62%(144/346)of the patients did not choose the correct supine head back position when instilling the eye drops,43.93%(152/346)of the patients did not look towards the top of their heads when instilling the eye drops,43.06%(149/346)of the patients had direct contact with the eyeballs,53.47%(185/346)of the patients had contact between the bottle mouth and the eyelash during instillation,63.29%(219/346)of the patients did not press the nasolacrimal tube when instilling the eye drops,only 27.27%(42/154)of the patients correctly chose to wipe with tissues after the eye drops overflowed,36.13%(125/346)of the patients rubbed and pressed their eyes immediately after instillation,and 69.08%(239/346)of the patients did not perform the correct behaviors of pulling the eyelid and closing the eye for more than 1 min after instillation.The questionnaire survey showed that 34.97%(121/346)of the 346 patients believed that the interval between two or more eye drops was more than 10 min,53.18%(184/346)of the patients believed that the eye drops should take into account the temperature and light,and should be properly stored according to the instructions,56.36%(195/346)of the patients believed that the frequency of instilling the eye drops should be according to the doctor's recommendation or the instruction manual,55.49%(192/346)of the patients believed that the shelf life of eye drops should be paid attention to after opening,56.07%(194/346)of the patients believed that the less irritating ones should be dropped first when two or more kinds of eye drops were infused,58.96%(204/346)of the patients believed that the dosage of eye drops was 1-2 drops each time,73.41%(254/346)of the patients believed that immediate drug withdrawal/seeking medical advices was required when abnormal symptoms occurred after the eye drops used,73.70%(255/346)of the patients believed that the eye drops should be discontinued immediately when the color changed or became cloudy,47.40%(164/346)of the patients believed that there was no need to restrict diet during the use of eye drops,52.60%(182/346)of the patients believed that the intake of certain foods should be restricted according to the instructions or doctor's orders during the use of eye drops,and only 56.36%(195/346)of the patients read the instructions before using the eye drops.Conclusion The standardized use behaviors and cognition of eye drops in patients with keratopathy are not ideal,and ophthalmological nurses should pay attention to the relevant education on the use of eye drops to promote the standardized use of eye drops.