白内障患者术前结膜囊细菌的清除方法  

Study of different methods in reducing conjunctival bacteria before cataract surgery

作　　者：黄钰森[1] 代云海[1] 孙士营[1] 蓝婕[1] 谢立信[1] 

机构地区：[1]山东省眼科研究所,青岛266071

出　　处：《中华医学杂志》2009年第35期2458-2461,共4页National Medical Journal of China

基　　金：“十一五”国家科技支撑计划基金（2006BA102B04）

摘　　要：目的了解白内障患者术前结膜囊细菌分布，为感染预防提供参考。方法选择老年性白内障患者135例（135眼），随机分为3组，每组45例，术前分别滴用3种抗菌滴眼液（0．5％左氧氟沙星、0．3％左氧氟沙星、0．3％妥布霉素）。各组再随机分为滴药1d组30例和3d组15例，所有患者术前15min均采用2．5％聚维酮碘消毒液（PVI）洗眼。在各项处理措施前后行结膜囊细菌培养及药敏试验。结果术前结膜囊细菌培养阳性率为66．7％，其中G^＋球菌占87％；3种滴眼液滴眼后，细菌清除率：1d组分别为72．7％、72．7％和61．1％（P=0．667），3d组分别为70．0％、70．0％和55．5％（P=0．751），两组之间差异无统计学意义（P〉0．05）；经PVI洗眼后细菌清除率：1d组分别上升至86．4％、77．3％和88．9％（P=0．564），3d组分别上升至90．0％、80．O％和66．7％（P=0．749），两组之间差异无统计学意义（P〉0．05）。MIC结果显示：G^＋球菌对左氧氟沙星、妥布霉素的敏感率分别为94．8％、74．1％（P=0．000）；G^-杆菌分别为94．4％、83．3％（P=0．289）。结论白内障患者术前结膜囊细菌以G^＋球菌为主，术前1d滴眼和3d滴眼的抗菌效果差异无统计学意义。G^＋球菌和G^-杆菌对左氧氟沙星均有较高敏感性。聚维碘酮清洗结膜囊可提高细菌清除率。Objective To study the coujunctival bacteria flora in eyes of patients undergoing cataract surgery and determine the efficacy of reducing conjunctival bacteria with different methods. Methods A total of 135 eyes of 135 patients scheduled to undergo cataract surgery were randomized into 3 groups （45 each）. They received topical prophylactic treatment with three different kinds of antibiotics （0.5% levofloxacin, 0. 3% levofloxacin and 0. 3% tobramycin）. Each group was randomized into one-day group and three-day group. All the eyes underwent irrigation of fornices with 2. 5% povidone-iodine （PVI） before surgery. Conjunctival cultures were obtained at various time points. Results The total positive rate of conjunctival cultures was 66. 7%. The eliminating rate of conjunctival bacteria in one-day groups were 72.7%, 72.7% and 61.1% （P=0.667）while 70.0%, 70.0% and 55.5% in the three-day groups respectively （P =0. 751 ）. Immediately after PVI irrigation, the eliminating rate in one-day groups added up to 86.4% , 77. 3% and 88.9% （P =0. 564） as compared with 90. 0% , 80. 0% and 66. 7%in the three-day groups respectively（ P = 0. 749）. And there was no statistically significant difference between one-day groups and three-day groups in the eliminating rate of conjunctival bacterial after the topical antibiotic application. The MIC test revealed that the antibiotic sensitivity of Gram-posltive cocci （G^＋ C ） to levofloxaein was 94. 8% versus 74. 1% to tobramycin （P = 0. 000） while the antibiotic sensitivity of Gram-negative bacillus （ G^-B） to levofloxacin was 94.4% versus 83.3% to tobramycin （ P = 0. 289 ）. Conclusion G^＋ C accounts for the most among the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and there is no statistically significant difference in the efficacy of reducing conjunefival bacteria between the application of topical antibiotic for one day and for three days. Both G^＋ C and G^- B retain a high sensitivity to levofloxacin. Topic

关 键 词：白内障 细菌 结膜 左氧氟沙星 

分 类 号：R686[医药卫生—骨科学]