On the injection compound anisodine care treatment of glaucoma optic neuropathy

[Abstract] Objective: The subcutaneous injection of the superficial temporal artery near the compound anisodine observed in patients after surgery for glaucoma optic nerve protective effect. Methods: Retrospective hospital in January 2010 - June 2011 using compound anisodine temporal injection artery next to the summary of 52 patients injected Results: The subcutaneous injection of the superficial temporal artery near the compound anisodine, can effectively protect the optic nerve in patients with glaucoma surgery. Conclusion: Glaucoma patients were treated with subcutaneous injection of the superficial temporal artery near the compound anisodine and make the appropriate care can effectively protect the optic nerve, the condition was under control.

[Keywords: compound anisodine, glaucoma, neuropathy, care

Anisodine is isolated from the Solanaceae plant Anisodus an alkaloid chemical structure similar to scopolamine, atropine compounds with pharmacological effects similar with ease muscle spasms, mydriasis, inhibition of saliva secretion, and its toxicity than scopolamine , atropine low our department from January 2010 June 2011 Application compound anisodine injection subcutaneous injection of the superficial temporal artery near the Treatment of 52 cases of glaucoma optic neuropathy patients achieved good effect, are as follows.

1 Materials and Methods
1.1 General information: 52 patients with glaucoma, optic neuropathy, including 30 males and 22 females, age 40-80 year-old, average age 55 years, of which primary angle-closure glaucoma, 25 cases of primary open-angle glaucoma, 18 cases of secondary glaucoma in 9 patients. diagnostic screening criteria: glaucoma patients after surgery to lift the state of high intraocular pressure, intraocular pressure control in less than 18mmHg, and stable for 2 weeks, no compound anisodine injection contraindications; injection site skin inflammation, the patient informed consent.

1.2 Treatment Methods: Compound anisodine injection of 2 ml, in the ipsilateral superficial temporal artery near the subcutaneous injection, 1 times / day, 14 days for a course of treatment interval between 10 days and record visual acuity before treatment, vision, fundus, the majority of patients were treated with 3 courses, such as the eyes are still changing, may be an additional course of treatment [1].

1.3 Handling Precautions
① position: Assist patients were supine.

② syringe options: with 4 or 4.5-gauge needle.

③ needle angle: 45 ° angle piercing the skin.

④ nurses in aseptic technique, the superficial temporal artery in the affected eye, touch it if dynamic stroke is 1.5 cm at its bottom, 45 ° angle piercing the skin, withdraw blood-free, you can go along the arterial injection the nurse slowly push the drug to form a small Picchu in the process of pushing drugs, to observe the patient's condition, instruct the patient not to stress. push the drug complete, pull out the needle, gently press the pinhole at about 5 minutes, Zhu Huanzhe bed rest, this is normal in patients with head Pipi Qiu, do not stress, rest a few minutes away [2].

⑤ contraindications: cerebral hemorrhage and intraocular hemorrhage disabled, procaine allergy with a history of disabling, atrial fibrillation is disabled.

1.4 nursing
1.4.1 Psychological care: patient eye during injection, mainly for the psychological reactions of anxiety, fear, therefore, the nursing staff to explain the injection before you do the work, explain the purpose of injection, with the methods and operational safety, drug contains a local anesthetic does not cause pain if necessary let it watch the other patients the injection process, so that patients get a sense of security, to eliminate the fear and anxiety.

1.4.2 observe the condition: to observe whether the patient's local skin swelling, pain, ecchymosis, if necessary, local cooling, dry mouth, blurred vision, flushing and other symptoms, Zhu Huanzhe supine rest 20-30 minutes to disappear, if symptoms get worse, report to a doctor to give treatment.

1.4.3 operation guide: this drug in patients with slow, according to adhere to a course of treatment, enhance the confidence of the treatment, pay attention to the prevention of colds, regular feeding, avoid alcohol, maintain a smooth stool, regular follow, if any abnormal situation, timely treatment to avoid delay treatment. Links to free download http://www.hi138.com 1.4.4 complications and care
1.4.4.1 Local swelling: the complete drug push, pull out the needle, gently press the pinhole at about 5 minutes, if any subcutaneous bleeding, can local cooling.

1.4 .. 4.2 infection: attention to aseptic technique, such as infection, oral antibiotics.

1.4.4.3 dry mouth, blurred vision, flushing and other symptoms: the patient is usually injected after eating, supine, Zhu Huanzhe rest for 5-10 minutes after injection, such as dry mouth, blurred vision, red face and other symptoms, tell patients not to stress, supine rest for 20-30 minutes will disappear, drug reactions are normal, if symptoms get worse, Medical treatment should be promptly reported.

1.5 Efficacy criteria: ① markedly: vision: GB standard visual acuity chart by 3 lines, or visual acuity from light perception, light perception uncertainty increased to 0.05, visual acuity from the immediate index increased to 0.1 or increased to 0.2 from 0.02, or increased to 0.3 from 0.05, vision: visual field defects is reduced 15% to 40%. ② Effective: vision: GB standard visual acuity chart by 1 line or 2 lines, or visual acuity from light perception, light perception uncertainty increased to 0.02 , visual acuity from the immediate index increased to 0.02 ~ 0.05, or increased to 0.05 from 0.02 to 0.1, or 0.05 increased from 0.1 to 0.2, or from no light perception become light perception, visual field: visual field defect is reduced less than 15% . ③ invalid: no change or deterioration of visual acuity and visual field [1].

1.6 Data processing: controlled before and after using spss13.0 own t-test.

2 Results
Nurses to take proper procedures applied compound anisodine injection Treatment of 52 cases of glaucoma optic neuropathy patients were cured after treatment in 12 cases (23%, the short duration of glaucoma patients, to a lesser extent, found that early, timely treatment and intervention, surgery fewer complications, effective in 37 cases (71%, 3 cases (5.7%, the longer duration of glaucoma patients, visual acuity, visual field damage heavy, more than in the middle and late postoperative complications is relatively large, the total effective rate: 94.3 % effective in patients with early onset 1 week after injection, at the latest after 2 courses of onset.

3 Conclusion
Glaucoma patients were treated with superficial temporal artery near the right subcutaneous compound anisodine and given appropriate care can effectively protect the optic nerve, the condition was under control.

4 Discussion
Glaucoma is a group of pathological damage to the optic nerve fibers leading to progressive visual field decline in the disease groups, many associated with pathological high intraocular pressure. Anisodine recurrence adjacent subcutaneous injection for superficial temporal artery surgery has been lifted by the state of high intraocular pressure of glaucoma patients, based on the doctrine of blood flow glaucoma, optic nerve blood supply and improve microcirculation, to protect the optic nerve to prevent mechanical damage of high intraocular pressure [3] Clinical studies have shown that recurrence anisodine subcutaneous injection for superficial temporal artery near the adjuvant treatment of glaucoma The exact function of the optic nerve protection effect. ① As the superficial temporal artery through the middle meningeal artery is connected with the orbital artery, so a small amount than intramuscular injection, but the effect is more obvious, with the ball after the injection compared to the next and the ball does not appear bleeding after the ball, damage the optic nerve, the needle into the eye and orbital complications such as hypertension. ② farther away from the eye, the patient psychologically more acceptable. ③ contains a small amount of drug procaine injection in patients with less pain , easy to accept. ④ mastery of timing of treatment should be the sooner the better, the nurse in addition to health education than do the disease, but also good psychological care. Introduction to introduce similar disease patients during the treatment, more persuasive, and enhance patient the confidence to overcome the disease and actively cooperate with each injection, the successful completion of each course, so that vision, vision improved to varying degrees, thereby enhancing the patient's quality of life.

References
[1] Zhou Bing, Qu Xiaoyong, Zhang Hongkui. Anisodine different compound drug delivery treatment of eye disease. Chinese Journal of Practical Medical Journal, 2008,35 (14): 73.

[2] Zhang Dongmei, Liu is Yang, Feng Huiping. Superficial temporal artery near the injection costing nursing services. Journal of nursing Management, 2006,6 (1): 40.

[3] Song Chen. Anisodine compound in clinical Applications. Journal of Ophthalmology, 1985,3 (5:269. Links to free download http://www.hi138.com