老年性白内障围手术期预防性应用左氧氟沙星滴眼液不同给药时机的临床观察

Dosing time of levofloxacin eye drops in the perioperative period of senile cataract

目的:分析老年性白内障术前局部应用左氧氟沙星滴眼液不同给药时机对术后感染的影响,得出最优给药时机,合理指导临床用药。方法:回顾性分析某医院711例(711眼)老年性白内障并行手术治疗患者的临床资料,根据术前应用左氧氟沙星的时间分为术前用药≥3 d组(A组,221例)及术前用药<3 d组(B组,490例),比较术后2组患者结膜囊细菌培养阳性率及分析白内障术后眼部主要菌株分布情况。结果:在711例患者中仅A组有1例并发眼内炎。A组术后细菌培养阳性61例(27.60%),B组术后细菌培养阳性142例(28.97%),2组间差异无统计学意义(P>0.05)。培养结果显示以革兰阳性球菌及革兰阴性杆菌多见,主要包括表皮葡萄球菌、金黄色葡萄球菌、大肠埃希杆菌等,2组间菌株数量比较差异无统计学意义。结论:老年性白内障术前应用左氧氟沙星滴眼液超过2 d并不能减少细菌培养的阳性率,即并不能减少患者术后感染率,同时也不影响术后结膜囊细菌分布情况,建议老年性白内障患者术前预防性应用左氧氟沙星滴眼液不超过3 d。

OBJECTIVE To investigate the effect of different dosing times of levofloxacin eye drops against postoperative infection and to guide the clinical use of drugs reasonably.METHODS A retrospective analysis was performed on711 cases（711 eyes）of cataract surgery in a hospital.According to the times of preoperative application of levofloxacin,the patients were divided into two groups：dosing≥3 d group（group A,n=221）before surgery;dosing3 d group（group B,490 cases）before surgery.Then the positive rates of bacterial culture and the distribution of major strains were compared in the eyes after cataract surgery.RESULTS Of the 711 patients,only one patient in group A had endophthalmitis.In group A,61 cases（27.60%）were positive for bacterial culture and 142 cases（28.97%）in group B（P0.05）.The results of culture showed that gram positive cocci and gram negative bacilli were more common,including Staphylococcus epidermidis,Staphylococcus aureus,Escherichia coli,etc.CONCLUSION Levofloxacin eyedrops can not reduce the positive rate of bacterial culture in patients with senile cataracts more than two days before operation,or the postoperative infection rate.Prophylactic application of levofloxacin eye drops in patients with senile cataract is recommended within 3 days before operation.