A clinical nursing study on thermostatic conjunctival sac irrigation in preoperative preparation for Smile surgery
Smile手术术前准备恒温调控下结膜囊冲洗的临床护理研究

摘要

目的 探讨在飞秒激光小切口角膜基质透镜取出术（Smile）术前准备中，采用恒温调控（37℃）结膜囊冲洗相较于传统室温冲洗的临床效果，评估其在提升患者舒适度、改善眼表环境及降低术中反应方面的应用价值。方法 采用随机对照研究设计，选取2024年7月至2025年7月期间拟行Smile手术的近视患者200例（400眼），采用随机数字表法分为观察组与对照组，每组各100例（200眼）。对照组患者术前采用室温（22-25℃）生理盐水进行常规结膜囊冲洗；观察组则采用专用恒温加热装置将生理盐水温度恒定控制在37℃后进行冲洗。对比分析两组患者冲洗过程中的舒适度评分、结膜充血程度、睑板腺分泌物性状评分、术中角膜基质透镜取出时的眼球移动发生率、首次固视成功时间以及首次冲洗达标率。结果 观察组患者在冲洗过程中的舒适度VAS评分显著低于对照组（P<0.01），结膜充血程度轻于对照组（P<0.05）。同时，观察组睑板腺分泌物性状评分优于对照组（P<0.05）。观察组术中在角膜基质透镜取出关键步骤时发生眼球移动的比率显著低于对照组（P<0.01）。观察组患者术中的首次固视成功时间显著短于对照组（P<0.01）。两组首次冲洗后的结膜囊细菌培养阴性率无统计学差异（P>0.05）。结论 在Smile手术术前结膜囊冲洗中应用37℃恒温生理盐水，能有效提升患者的术中舒适度，减轻结膜刺激反应，改善眼表油脂分泌环境，稳定患者术中配合，提升手术衔接效率，是一种安全、有效且人性化的护理优化方案，值得在临床推广应用。

Abstract

Objective To explore the clinical efficacy of thermostatic (37℃) conjunctival sac irrigation compared to traditional room temperature irrigation in preoperative preparation for femtosecond laser small incision lenticule extraction (SMILE), and to evaluate its application value in improving patient comfort, improving the ocular surface environment, and reducing intraoperative reactions.
Methods A randomized controlled study was conducted, selecting 200 myopic patients (400 eyes) scheduled for SMILE surgery between July 2024 and July 2025. They were randomly divided into an observation group and a control group, with 100 patients (200 eyes) in each group. Patients in the control group underwent routine conjunctival sac irrigation with room temperature (22-25℃) saline before surgery; the observation group underwent irrigation with saline solution heated to a constant temperature of 37℃ using a dedicated thermostatic heating device. This study compared and analyzed the comfort scores, conjunctival hyperemia, meibomian gland secretion characteristics, incidence of eye movement during lenticule removal, time to first fixation success, and first irrigation success rate between the two groups of patients during irrigation.
Results The VAS comfort score during irrigation was significantly lower in the observation group than in the control group (P<0.01), and the degree of conjunctival hyperemia was less severe (P<0.05). Simultaneously, the meibomian gland secretion characteristics score was better in the observation group than in the control group (P<0.05). The rate of eye movement during the critical step of lenticule removal was significantly lower in the observation group than in the control group (P<0.01). The time to first fixation success was significantly shorter in the observation group than in the control group (P<0.01). There was no statistically significant difference in the negative rate of conjunctival sac bacterial culture after the first irrigation between the two groups (P>0.05).
Conclusion   The use of 37℃ constant-temperature saline during preoperative conjunctival sac irrigation in SMILE surgery effectively improves patient comfort during surgery, reduces conjunctival irritation, improves the ocular surface lipid secretion environment, stabilizes patient cooperation during surgery, and enhances surgical efficiency. It is a safe, effective, and humane nursing optimization plan worthy of clinical promotion and application.