眼球穿孔伤患者早期前房水及玻璃体细菌学培养分析

Analysis of bacterial culture of aqueous humor and vitreous in patients with early penetrating eye trauma

目的了解眼球穿孔伤患者早期眼内组织细菌学培养及药物敏感情况。方法前瞻性地对本院2003年7月至9月收治的受伤时间在24h以内的45例(45眼)眼球穿孔伤患者的前房水或玻璃体进行细菌培养及药敏实验,并对其结果进行分析。结果共15例(33.3%)患者(玻璃体培养8例、房水培养7例)细菌培养结果阳性,其中10例为表皮葡萄球菌(67.7%)。所有细菌均对环丙沙星、氧氟沙星敏感,对头孢哌酮较为敏感,大部分对庆大霉素、氯霉素、利福平耐药。球内有异物存留(χ2=6.544,P=0.016)、伤口累及巩膜(χ2=4.500,P=0.034)者细菌培养结果阳性率高,而致伤物类型(χ2=1.667,P=0.197)、有无合并晶状体损伤(χ2=1.125,P=0.289)、取材部位(χ2=1.667,P=0.197)对细菌培养结果无明显影响。结论表皮葡萄球菌是眼球穿孔伤后进入眼内的主要细菌。对眼球穿孔伤患者预防性用药可首选喹诺酮类药物,次选头孢哌酮。

Objective To analyze the bacterial culture of aqueous humor and vitreous as well as their sensitivity to antibiotics in patients immediately after penetrating eye trauma.Methods Bacterial culture of aqueous humor and vitreous as well as their sensitivity to antibiotics were taken at 45 cases（45 eyes） within 24 hours after penetrating eye trauma from July 2003 to September 2003.And the results were analyzed.Results Fifteen cases,including eight cases with bacteial culture of vitreous and seven cases with bacterial culture of aqueous humor,were found to be positive with bacterial infection.Staphylococcus epidermidis was the most frequently bacteria and identified in ten cases,which accounted for 67.7% of these 15 cases.All the identified bacteria were sensitive to Ciprofloxacin and Ofloxacin,and less sensitive to Cefoperazone,while most of them were resistant to Gentamycin,Rifapine and Chlororamphenicol.Whether combined intraocular foreign body and sclera wound or not were significantly associated with the occurrence of positive bacterial identification（χ1^2=6.544,P1=0.016;χ2^2=4.500,P2=0.034）.Causes of injury（χ^2=1.667,P=0.197）,lens rupture（χ^2=1.125,P=0.289） or the location of specimen（χ^2=1.667,P=0.197） where harvested from did not contribute to the difference in the rate of positive bacterial identification（χ1^2=1.667,P1=0.197;χ2^2=1.125,P2=0.289;χ3^2=1.667,P3=0.197）.Conclusion In patients with penetrating eye trauma,the major bacteria entering into the eye was staphylococcus epidermidis.As for prophylactic antibiotics,Fluro-Quinolones can be used as the first line antibiotics,and Cefoperazone can be the second line.