准分子激光原位角膜磨镶术后弥漫性板层间角膜炎暴发原因研究  

Causes of Outbreak of Post-LASIK DLK Complication

作　　者：陈建东[1] 贺征[1] 杨智聪[1] 杨波[2] 龚玉姣[1] 王铮[3] 张晓晓[3] 张健[1] 刘于飞[1] 袁俊[1] 王鸣[1] 

机构地区：[1]广州市疾病预防控制中心医院感染控制科,广东广州510080 [2]广东省卫生厅交流合作处,广东广州510060 [3]中山大学附属眼科中心激光手术室,广东广州510060

出　　处：《中华医院感染学杂志》2010年第22期3489-3491,共3页Chinese Journal of Nosocomiology

摘　　要：目的对某医院准分子激光手术室准分子激光原位角膜磨镶术(LASIK)后暴发弥漫性板层角膜炎(DLK)并发症进行现场流行病学调查,为DLK预防控制提供参考。方法采用现场流行病学研究方法,调查9月21日-10月21日在该医院准分子激光手术室行LASIK后并发DLK者,采用队列研究方法推断病因。结果共发现11例DLK病例,罹患率8.21%;不同负责清洗护士、月份、台序进行手术的两组人群DLK罹患率差异有统计学意义(P<0.05);患者多为一侧眼受累,临床处于Ⅰ、Ⅱ、Ⅲ期各有7眼(46.67%)、2眼(13.33%)、6眼(40.00%),潜伏期1、2、3d各有4例(36.36%)、2例(18.18%)、1例(9.10%),4例潜伏期不明确(36.36%);队列研究表明,C护士负责清洗、前5台及10月份术者是发生DLK的危险因素(P<0.05)。结论微型角膜刀头异体蛋白残留导致该次LASIK术后DLK并发症暴发;微型角膜刀头供需矛盾,清洗不彻底是暴发原因。OBJECTIVE To make a field epidemiological investigation on an outbreak of diffuse lamellar keratitis （DLK）, a complication of LASIK in the excimer laser surgery of a hospital and provide evidence-based measures for the prevention and control of DLK. METHODS A survey on patients complicated with DLK after receiving LASIK in the laser surgery of the hospital from Sep. 21 to Oct. 21 was conducted by using field epidemiological investigations and the potential causes of DLK were identified by cohort study. RESULTS A total of 11 DLK cases were identified, indicating an attack rate of 8. 21%. Different accidence of DLK were found in patients with different nurses assigned to clean the micro keratome heads, operations performed in different months and arrangements in different sequence order , which had shown a statistical significance （P〈0.05）. Majority of the cases had one eye affected, with 7 eyes, 2 eyes and 6 eyes in clinical stage I, II and III, respectively. The latent period of the cases also varies, with 1 day of latency in 4 cases（36.36%）, 2 days in 2 cases（18.18%）, and 3 days in 1 case（9.10%）, respectively. 4 cases （36.36%）had no clearly identified latent period. The laboratory test did not show any significant positive result. The cohort study showed that microkeratome heads cleaned by the nurse surnamed C, laser surgeries performed in the first 5 sequence order and patients operated in Oct. were the risk factors for DLK（P〈0.05）. CONCLUSION The outbreak of post-LASIK DLK complications are caused by the residue of heterogeneous protein on the microkeratome heads. The requirement of microkeratome in conflict with the supply and insufficient cleaning are the causes of the outbraek of DLK.

关 键 词：角膜磨镶术 激光原位 弥漫性板层结膜炎 手术后并发症 暴发 

分 类 号：R619.3[医药卫生—外科学]