角膜清创术联合那他霉素治疗真菌性角膜炎的临床疗效观察

Outcomes of patients with fungal keratitis following combination treatment with debridement and natamycin

目的探讨角膜清创术联合那他霉素治疗真菌性角膜炎的临床疗效。方法收集山东省潍坊市益都中心医院五官科于2008年7月至2013年7月期间收治的44例(44只眼)真菌性角膜炎患者的临床资料,按照数字表法将患者分为对照组和观察组,每组各22例(22只眼)。治疗前进行常规角膜刮片检查以明确诊断。观察组给予角膜清创术联合那他霉素进行治疗;对照组给予单纯那他霉素进行治疗,术后对患者随访3个月。记录两组患者的平均住院时间、视力恢复情况及角膜溃疡直径以均数±标准差(x珋±s)的形式表示,并采用独立样本t检验的方法进行比较;两组患者的临床疗效按照显效、有效和无效分为3类数据,以例数和百分比的形式表示,并采用Kruskal-Wallis H秩和检验的方法进行比较;两组患者真菌阳性率以例数和百分率的形式表示,并采用χ2检验的方法进行比较。结果观察组患者的平均住院时间为(9.34±2.11)d,对照组患者的平均住院时间为(12.32±3.01)d,两组比较,差异有统计学意义(t=2.04,P<0.05)。观察组患者的视力为(0.42±0.07),对照组患者的视力为(0.39±0.03),观察组患者的视力改善情况优于对照组,差异有统计学意义(t=3.89,P<0.05)。治疗1个疗程(30 d)后,观察组患者的角膜溃疡直径为(3.34±0.47)mm,对照组患者的角膜直径为(4.21±0.67)mm,两组比较,差异有统计学意义(t=2.03,P<0.05)。观察组显效者15例(15只眼),占68.18%;有效者6例(6只眼),占27.27%;无效者1例(1只眼),占4.55%;对照组显效者8例(8只眼),占36.36%;有效者10例(10只眼),占45.46%;无效者4例(4只眼),占18.18%。两组患者临床疗效比较,差异有统计学意义(Hc=-2.74,P<0.05)。观察组真菌培养为阳性者21例(21只眼),阳性率为95.46%;其中镰刀菌感染者11例(11只眼),曲霉菌属感染者6例(6只眼),链格孢霉感染者4例(4只眼),未知菌属感染者1例(1只眼);对照组真菌培养阳性者18例(18只眼),阳性率为81.82%;其中镰刀菌感染者12例(12只眼),曲霉菌属感染者7例(7只眼),链格孢霉感染者1例(1只眼),未知菌属感染者1例(1只眼)。两组比较,差异有统计学意义(χ2=20.43,P<0.05)。结论角膜清创术联合那他霉素治疗真菌性角膜炎的临床疗效优于单纯那他霉素治疗,可改善患者的眼部症状,值得临床推广应用。

Objective To evaluate the efficacy of corneal debridement combined with natamycin in the treatment of fungal keratitis. Methods A total of 44 patients（ 44 eyes） with fungal keratitis who were seeking care in the Department of Otolaryngolog,Yidu Central Hospital of Weifang between July,2008 and July,2013 were randomized to receive debridement and natamycin（ n = 22） or natamycin only（ n = 22）.After follow-up for three months,data on the average length of hospital stay,visual acuity recovery,corneal ulcer,fungal infection and effectiveness were comparatively analyzed. Results The average length of hospitalization was 9. 34 ± 2. 11 days in patients receiving debridement and natamycin and（ 12. 32 ± 3. 01）days in patients receiving natamycin only（ P〈0. 05）. The average visual acuity after treatment was（ 0. 42 ±0. 07） in patients receiving debridement and natamycin and（ 0. 39 ± 0. 03） in patients receiving natamycin（ P〈0. 05）. The average ulcer diameter was（ 3. 34 ± 0. 47） mm in patients receiving debridement and natamycin and（ 4. 21 ± 0. 67） in patients receiving natamycin（ P〈0. 05）. The combination treatment was very effective in 15（ 68. 18%） patients,moderate effective in 6（ 27. 27%） patients and not effective in 1（ 4. 55%） patients while the monotherapy was very effective in 8（ 36. 36%） patients,10（ 45. 46%）patients and not effective in 4（ 18. 18 %） patients. Fungal infection was observed in 21（ 95. 46 %） ofpatients receiving debridement and natamycin and in 18（ 81. 82%） of patients receiving matamycin,（ P〈0. 05）. Conclusion Corneal debridement combined with natamycin treatment is more effective than natamycin treatment alone in managing fungal keratitis and would have a wider application in clinical settings.