| Microsurgeries of retinal detachment have changed greatly sincevitreoretinal surgery was carried out in 1970s'. For patients withcomplex retinal detachment, resting in bed before operation, keepingsuitable posture and bandaging eyes to decrease ocular movements mayreduce sub-retinal fluid and set up satisfactory conditions for operation.The purpose of vitrectomy combined with silicone oil or gas filling is tomake the silicone oil or gas upward to compress the detached retina andmake it restoration. Keeping face vertically downward after operation isthe key to success for treatment. Therefore, posture nursing duringperi-operation period may affect success rate of operation directly. Onlyperforming posture according to doctors' instructions strictly may ensurethe hiatus blocked and make the detached retina restoration. While inclinical practice, it is often seen that patients can not endure thediscomfort resulting from keeping such passive crouching posture forlong time and they even give up operation sometimes, which is one ofthe main causes of therapeutic failure. Thus, study on behavior ofmedical compliance is meaningful for efficacy of operation andlong-term recovery. Till now , studies on behavior of medicalcompliance for patients with complex retinal detachment after operationonly include some overviews and general surveys on medication,posture and re-examination et. Investigations on status of posturecompliance during peri-operation period and nursing interventions havenot been reported.The purpose of present study is to investigate the behavior ofmedical compliance in patients with complex retinal detachmentreceiving vitrectomy combined with silicone oil or gas filling and themain related factors, eventually to find out effective measures toincrease the rate of medical compliance by nursing care interventions.Methods: 113 patient(s118 eyes)with complex retinal detachment whoreceiving vitrectomy combined with silicone oil or gas filling weredivided into two groups according to chronological order. Routinenursing care was performed in control group while comfortablenursing care measures were performed in treatment group. Surveys onbehavior of medical compliance before and after operations wereaccomplished and recorded with self-designed questionnaires.The results showed that:(1) Distribution of behavior of medicalcompliance: 48 of 113 (42.5%) patients did not follow doctors'instructions before operation and 43 of 113 (38.1%) after operation;dis-cooperation in ocular immobilization before operation andno-persistence of special posture after operation were the maindisobeying behaviors, respectively;(2) related factors affecting thebehavior of medical compliance: there were no significant differencesin the behavior of medical compliance in spite of different ages,sex, degree of education and economic conditions. While cooperationfrom family and patients' own thought to cooperation did influencetheir behavior of following doctors' instructions;(3) causes ofdisobeying: various physiological discomforts included: muscularsoreness;facial swollen;sleeplessness;headache, ophthalmalgia;fastheart rate and short-breathing;dizziness;nausea and vomiting andconstipation et. Psychological discomforts included: restless, anxietyand fear because of weak willpower as well as dis-adaptation tochanges of posture and visual deprivation;disappointment totherapeutic effect;(4) proportion of disobeying was significantlydifferent between two groups. There were significant differences inbehavior of medical compliance between two groups no matter beforeoperation than keeping posture after operation and the rate of medicalcompliance increased in treatment group.The results demonstrated that for patients with complex retinaldetachment who receiving vitrectomy combined with silicone oil orgas filling, dis-cooperation in ocular immobilization before operationand no-persistence of special posture after operation were the maindisobeying behaviors, respectively. Therefore, nursing care shouldfocus on cooperation in ocular immobilization before operation andpersistence of special posture after operation. Disobeying behaviors inpatients who receiving vitrectomy combined with silicone oil or gasfilling were mainly caused by physiological and psychologicaldiscomfort , thus nursing intervention measures complyingcomfortable nursing patterns may improve patients' behaviors ofmedical compliance. Measures were as following: (1) evaluate therelated factors and define the special population;(2) improve thedegree of patients' physiological comfort to make them cooperateduring treatment. Careful living care should be offered to patient. Forthose who cannot endure or dis-adapt bandaging both eyes, bandagingduration may reduce properly or stenopeic spectacles are taken toimmobilize the eyes. Appliance for posture nursing care should beprovide to patients to relieve their discomfort through altering posture,performing muscle massage and facial fomentation and so on. For thespecial population possible to disobey doctors' instructions ,foreseeing nursing care should be taken actively in order to relievetheir discomfort;(3) offer positive psychological support to maintaintheir psychological well-being and make them to cooperate duringtreatment. Hearing and tactile stimulations should be increased in usualnursing care in order to keep the patients communicating with others,therefore their negative psychological responses because of restrictedposture and visual deprivation will be reduced correspondingly. Adjustthe patients' expected value of operation treatment to increase theirpsychological delight. All above measures are carried out aroundcomfortable nursing patterns, which are adding psychological care toclinical nursing practice. It is simple but practical;moreover, it canimprove the patients' behavior of medical compliance and increasetheir comfort degree. Thus it has certain clinical practical value andprovide some experience and reference for studies on behavior ofmedical compliance and nursing intervention of other diseases.
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