预防白内障手术后感染的术中应对策略探讨

Investigation on the intraoperative strategies to prevent postoperative infection in cataract surgery

目的探讨老年性白内障临床路径预防术后感染性眼内炎的术中措施及效果。方法选择120例120眼白内障手术患者,随机分为对照组(A组)60例60眼术前、术毕应用复方氯化钠注射液冲洗结膜囊。研究组(B组)60例60眼术前、术毕应用0.1%聚维酮碘溶液(0.1%PVP-I,深圳市安多福消毒高科技股份有限公司生产,批号:粤卫消证字{2016}第9087号)结膜囊进行消毒,同时术中灌洗液中加入妥布霉素。分别取术前、术前冲洗结膜囊后、术毕冲洗结膜囊前后及术后第1天的结膜囊标本做细菌培养及药敏。取术毕前房房水的细菌培养及药敏。结果 1.结膜囊细菌培养:a、术前A组阳性162例,B组阳性17例,两组的差异无明显统计学意义(χ~2=0.04,P>0.05)。b、术前冲洗结膜囊后,A组阳性14例,B组阳性22例,两组的差异有明显统计学意义(χ~2=10.29,P<0.05)。c、术毕A组阳性17例,B组阳性5例,两组的差异明显统计学意义(χ~2=8.02,P<0.05)。d、术毕冲洗结膜囊后,A组阳性15例,B组阳性1例,两组的差异具有明显统计学意义(χ~2=14.14,P<0.05)。e、术后第1天A组阳性19例,B组阳性7例,两组的差异具有明显统计学意义(χ~2=8.51,P<0.05)。2.A组术毕前房水细菌培养阳性率3.33%,而B组房水细菌培养为阴性明显低于A组。所有患者观察术后3个月无眼内炎等并发症。结论白内障术中应用0.1%PVP-I溶液结膜囊进行两次消毒,灌洗液中加入妥布霉素,能够进一步减少结膜囊细菌,保持房水无菌化,在预防感染上实用安全,效果更可靠。

Objective To study the intraoperative strategies and effects to prevent infectious endophthalmitis in age-related cataract clinical pathway. Methods 120 patients （120 eyes） of age-related cataract were observed and randomly divided into two groups. In the control group （group A） with 60 patients （60 eyes）, we flushed the eonjunctiva sac with compound sodium chloride injection before and at the end of the surgery. In the research group （group B） with 60 patients （60 eyes）, 0.1% povidone iodine （PVP-I） solution was used for conjunctiva sac disinfection before and after surgery. Besides, we added tobramycin injection in intraoperative irrigation. We assessment bacterial culture and drug sensitive test in eonjunetiva sac： before and after we flushed the eonjunetiva sac preoperative and postoperative, and 1 day after surgery. The bacterial culture and drug sensitive test were done in aqueous humor at the end of surgery. Results 1. The positive rate of bacterial culture in conjunctiva sac： a. Before surgery the positive cases are 16 in group A, and 17 in group B, there was not significant statistical difference （ X^2=0.04, P 〉 O. 05）. b. After disinfection with PVP-I preoperative, the positive cases are 14 in group A, and 2in group B, there was a significant statistical difference （X^2=10.29, P〈O. 05）. c. At the end of surgery, the positive cases are 17 in group A, and 5 in group B, there was a significant statistical difference （X^2 =8.02, P〈O. 05）. d. After disinfection with PVP-I at the end of surgery, the positive cases arel5 in group A, and 1 in group B, there was a significant statistical difference （ X^2=14-14, P〈0. 05）. e. One day after surgery, the positive cases are 19 in group A, and 7 in group B, there was a significant statistical difference （ X^2 =8.51, P〈0. 05）. 2. In group A, the positive rate of bacterial culture in aqueous humor at the end of surgery was 3.33%, while there was no bacterial exist in group B. All patients were observed until 3 months after surgery, there was not any endophthalmitis complications occurred. Conclusions Ddisinfection with 0.1% povidone iodine （ PVP-I ） solution in conjunctiva sac twice and adding tobramycin injection in intraoperative irrigation could reduce the bacterial in conjunctive sac of cataract surgery. The bacteria-free aqueous humor was practical safety and reliable efficacy on the prevention of infectious.