臨床常用診斷技術(shù)眼底檢查法課件

臨床常用診斷技術(shù)眼底檢查法ppt課件匯報(bào)人：xxx20xx-03-16眼底檢查法簡(jiǎn)介眼底檢查法操作技巧眼底病變識(shí)別與診斷眼底檢查在臨床應(yīng)用中的價(jià)值眼底檢查法發(fā)展趨勢(shì)與展望學(xué)員實(shí)踐操作與考核目錄眼底檢查法簡(jiǎn)介01眼底檢查法是檢查玻璃體、視網(wǎng)膜、脈絡(luò)膜和視神經(jīng)疾病的重要方法。定義通過(guò)眼底檢查，可以及早發(fā)現(xiàn)各種眼底病變，評(píng)估病變的程度及預(yù)后，為臨床診斷、治療提供依據(jù)。目的眼底檢查法定義與目的高血壓、糖尿病、腎病等全身性疾病，視網(wǎng)膜脫離、黃斑病變等眼底疾病。對(duì)于嚴(yán)重的心肺功能不全、休克等危急重癥患者，應(yīng)暫緩眼底檢查。此外，對(duì)于不能配合檢查的兒童或精神異常者，也應(yīng)慎重考慮。適應(yīng)癥與禁忌癥禁忌癥適應(yīng)癥以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書書寫制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.檢查前準(zhǔn)備眼底檢查前需要進(jìn)行視力檢查、裂隙燈檢查等，以了解患者的基本眼病情況。同時(shí)，患者需要配合醫(yī)生調(diào)整好體位，保持舒適的姿勢(shì)。注意事項(xiàng)在眼底檢查過(guò)程中，患者需要保持眼球不動(dòng)，避免眨眼或轉(zhuǎn)動(dòng)眼球。對(duì)于需要散瞳檢查的患者，應(yīng)在檢查前告知醫(yī)生，以便醫(yī)生進(jìn)行相應(yīng)的準(zhǔn)備。檢查后，患者可能會(huì)出現(xiàn)短暫的視力模糊或畏光等不適癥狀，一般休息后可自行緩解。檢查前準(zhǔn)備及注意事項(xiàng)眼底檢查法操作技巧02操作簡(jiǎn)便，易于攜帶，適用于床邊及門診檢查。優(yōu)點(diǎn)操作步驟適應(yīng)癥患者取坐位或臥位，檢查者手持檢眼鏡，將鏡頭置于患者眼前，通過(guò)鏡頭觀察眼底情況。適用于初步篩查眼底疾病，如視網(wǎng)膜脫離、玻璃體出血等。030201直接檢眼鏡檢查法間接檢眼鏡檢查法優(yōu)點(diǎn)視野范圍大，立體感強(qiáng)，可觀察眼底周邊部病變。操作步驟患者取臥位，檢查者手持間接檢眼鏡，將鏡頭置于患者眼前適當(dāng)距離，通過(guò)鏡頭觀察眼底情況，同時(shí)用另一手持筆式電筒照亮患眼。適應(yīng)癥適用于詳細(xì)檢查眼底病變，如視網(wǎng)膜裂孔、黃斑病變等。03適應(yīng)癥適用于對(duì)眼底病變進(jìn)行更深入的檢查和診斷，如視網(wǎng)膜血管病變、視神經(jīng)病變等。01優(yōu)點(diǎn)可觀察眼底深處及周邊部病變，清晰度高。02操作步驟患者取坐位或臥位，檢查者將前置鏡置于患者眼前，通過(guò)前置鏡觀察眼底情況，同時(shí)用裂隙燈顯微鏡進(jìn)行照明和放大。前置鏡檢查法03檢查時(shí)動(dòng)作應(yīng)輕柔，避免壓迫眼球。01操作注意事項(xiàng)02檢查前應(yīng)向患者說(shuō)明檢查目的和方法，取得患者合作。操作注意事項(xiàng)及并發(fā)癥預(yù)防操作注意事項(xiàng)及并發(fā)癥預(yù)防對(duì)于瞳孔較小或眼底病變較嚴(yán)重的患者，應(yīng)先進(jìn)行散瞳處理。02030401操作注意事項(xiàng)及并發(fā)癥預(yù)防并發(fā)癥預(yù)防避免過(guò)度牽拉眼瞼和壓迫眼球，以免引起眼部不適和損傷。對(duì)于有眼部感染或炎癥的患者，應(yīng)先進(jìn)行治療后再進(jìn)行眼底檢查。檢查后應(yīng)告知患者注意事項(xiàng)，如出現(xiàn)眼部不適或視力下降等情況應(yīng)及時(shí)就診。眼底病變識(shí)別與診斷03視盤位于視網(wǎng)膜中央，呈橢圓形或豎橢圓形，邊界清晰，顏色略淡于周圍視網(wǎng)膜。視網(wǎng)膜血管視網(wǎng)膜中央動(dòng)脈和靜脈穿行于視網(wǎng)膜內(nèi)層，分支分布于視網(wǎng)膜各象限。黃斑位于視網(wǎng)膜后極部，是視力最敏銳的區(qū)域，呈暗紅色，中心凹光反射可見(jiàn)。正常眼底解剖結(jié)構(gòu)視網(wǎng)膜神經(jīng)上皮層與色素上皮層分離，可出現(xiàn)閃光感、飛蚊癥、視野缺損等癥狀。視網(wǎng)膜脫離微血管瘤、出血點(diǎn)、硬性滲出、棉絮狀白斑、新生血管等為主要表現(xiàn)，嚴(yán)重時(shí)可導(dǎo)致失明。糖尿病視網(wǎng)膜病變視網(wǎng)膜動(dòng)脈變細(xì)、反光增強(qiáng)、動(dòng)靜脈交叉壓跡等為主要表現(xiàn)，嚴(yán)重時(shí)可出現(xiàn)視網(wǎng)膜水腫、出血等。高血壓性視網(wǎng)膜病變黃斑區(qū)出現(xiàn)盤狀漿液性脫離，視力下降，中心暗點(diǎn)等為主要表現(xiàn)。中心性漿液性脈絡(luò)膜視網(wǎng)膜病變常見(jiàn)眼底病變類型及特點(diǎn)識(shí)別技巧熟練掌握正常眼底解剖結(jié)構(gòu)，了解各種眼底病變的特點(diǎn)，結(jié)合患者病史和臨床表現(xiàn)進(jìn)行綜合判斷。誤診分析眼底病變種類繁多，易與一些其他疾病混淆。如將視網(wǎng)膜脫離誤診為玻璃體混濁，將糖尿病視網(wǎng)膜病變誤診為高血壓性視網(wǎng)膜病變等。因此，在診斷過(guò)程中應(yīng)仔細(xì)詢問(wèn)患者病史，進(jìn)行全面檢查，避免誤診誤治。病變識(shí)別技巧與誤診分析眼底檢查在臨床應(yīng)用中的價(jià)值04眼底檢查可觀察視網(wǎng)膜動(dòng)脈變化，輔助診斷高血壓及評(píng)估病情嚴(yán)重程度。高血壓通過(guò)觀察視網(wǎng)膜微血管病變，可早期發(fā)現(xiàn)糖尿病視網(wǎng)膜病變，為糖尿病的診斷和治療提供依據(jù)。糖尿病眼底檢查可發(fā)現(xiàn)視網(wǎng)膜出血、滲出等病變，為血液病的診斷提供線索。血液病輔助診斷全身性疾病手術(shù)治療對(duì)于嚴(yán)重的眼底病變，如視網(wǎng)膜脫離、黃斑裂孔等，眼底檢查可為手術(shù)治療提供精確的解剖定位和病變范圍信息。藥物治療根據(jù)眼底病變的類型和程度，選用合適的藥物進(jìn)行治療，如抗新生血管藥物、抗炎藥物等。激光治療根據(jù)眼底病變的性質(zhì)和部位，選擇合適的激光治療參數(shù)和方案。指導(dǎo)治療方案制定通過(guò)定期的眼底檢查，觀察病變的改善情況，評(píng)估治療效果。病變改善情況根據(jù)眼底病變的嚴(yán)重程度和治療效果，預(yù)測(cè)患者的視力預(yù)后情況。視力預(yù)后評(píng)估眼底檢查可及時(shí)發(fā)現(xiàn)并處理治療過(guò)程中的并發(fā)癥，保障患者的安全。并發(fā)癥監(jiān)測(cè)評(píng)估治療效果及預(yù)后眼底檢查法發(fā)展趨勢(shì)與展望05123提供高分辨率的眼底斷層圖像，有助于診斷視網(wǎng)膜疾病。光學(xué)相干斷層掃描（OCT）通過(guò)注射熒光素觀察眼底血管情況，診斷眼底血管性疾病。眼底熒光血管造影（FFA）能夠拍攝更大范圍的眼底圖像，有助于發(fā)現(xiàn)周邊部視網(wǎng)膜病變。超廣角眼底相機(jī)新技術(shù)、