消毒时机的选择对内眼手术患者术后眼内感染的影响研究

Study on effect of choosing different disinfection time of intraocular surgery on prevention of postoperative intraocular infection

目的探讨不同消毒时机对内眼手术患者术后眼内感染的预防效果,为减少眼科患者术后感染、提高预后提供参考。方法选择2011年6月-2013年6月眼科行白内障手术的1 264例患者作为观察对象,随机分为3组:A组421例,术前生理盐水冲洗+结膜囊冲洗+无痛碘结膜囊消毒,B组421例,术前生理盐水冲洗+结膜囊冲洗+无痛碘结膜囊消毒,待贴好眼贴膜后再进行生理盐水冲洗+结膜囊冲洗+无痛碘结膜囊消毒,C组422例,术前生理盐水冲洗+结膜囊冲洗+无痛碘结膜囊消毒+术后无痛碘结膜囊消毒;用无菌棉擦拭上下睑弯隆结膜并迅速放入肉汤试管进行结膜囊细菌培养,采用SPSS13.0软件对3组数据进行统计分析。结果 A、B、C 3组患者眼内感染率分别为11.16%、8.31%、5.45%,差异有统计学意义(P<0.05);共检出105株病原菌,以金黄色葡萄球菌为主25株占23.81%,其次为枯草芽胞杆菌黑色变种芽胞19株占18.10%。结论术前生理盐水冲洗+结膜囊冲洗+无痛碘结膜囊消毒+术后无痛碘结膜囊消毒是预防内眼术后感染的有效措施,可以常规实施。

OBJECTIVE To investigate the preventive effect of internal disinfection at different time on postoperative intraocular infection ,in order to provide reference for reducing postoperative infection in patients and improving prognosis .METHODS Totally 1264 patients undergoing ophthalmologic cataract surgery in the hospital from Jun . 2011 to Jun .2013 were selected as the subjects and were randomly divided into group A （n=421 ,preoperative sa‐line flush＋conjunctival sac flush＋painless iodine disinfection for conjunctival sac） ,group B （n=421 ,preopera‐tive saline flush＋conjunctival sac flush＋ painless iodine disinfection for conjunctival sac ,and saline flush＋ con‐junctival sac flush ＋ painless iodine disinfection for conjunctival sac after the eye mask was well pasted ） ,and group C （n=422 ,preoperative saline flush＋ conjunctival sac flush＋ painless iodine disinfection for conjunctival sac;conjunctival fornix on the upper and lower eyelids was wiped with a sterile cotton then the broth tube was quickly carried in for conjunctival sac bacterial culture ） .The SPSS13 .0 statistical package was used for statistical analysis of data of the three groups .RESULTS The rate of intraocular infection was respectively 11 .16% ,8 .31% , and 5 .45% in groups A ,B ,and C ,with significant differences （P〈0 .05） .Totally 105 strains of pathogens were detected ,mainly including 25 strains of Staphylococcus aureus （23 .81% ） ,followed by 19 strains of black variant germ of Bacillus subtillis （18 .10% ） .CONCLUSION The regimen of preoperative saline flush ＋ conjunctival sac flush＋painless iodine disinfection for conjunctiva sac＋postoperative painless iodine disinfection for conjunctiva sac is an effective measure to prevent postoperative infection of the eye ,and can be routinely implemented .