剪除睫毛对白内障手术野细菌分布的影响

The influence of eyelash removal on bacterial distribution in surgical field of cataract

目的探讨剪除睫毛对白内障手术野细菌分布的影响,为白内障围手术期感染控制措施制定提供依据。方法选取2017年3月-5月于我院行白内障手术的患者280例(280只眼)。根据患者手术意愿分为剪睫毛组(128例)和不剪睫毛组(152例),均行白内障超声乳化吸除术并人工晶体植入术。术毕采集医用手术薄膜睑缘粘贴面及下穹窿部结膜囊拭子标本进行细菌培养,观察2组细菌培养结果。比较2组患者术后眼部刺激及充血情况。结果与剪睫毛组相比,不剪睫毛组手术薄膜睑缘粘贴面细菌培养阳性率[13.16%(20/152)vs.29.69%(38/128)]、结膜囊拭子和医用薄膜检出同种细菌比例[2.63%(4/152)vs.7.81%(10/128)]均明显降低(均P<0.05)。术毕结膜囊中检出细菌与手术薄膜上检出细菌同种,均为表皮葡萄球菌。术后第1、7天,不剪睫毛组患者眼部刺激症状及充血程度均较剪睫毛组明显改善。结论白内障患者手术前剪除睫毛可增加医用薄膜结膜粘贴面及术毕结膜囊拭子细菌阳性检出率,且术后眼部刺激症状及充血程度较不剪除睫毛者严重,眼内炎感染的菌株来源于术眼睑缘周围可能性极大。

Objective To investigate the effect of eyelash removal on the bacterial distribution in cataract surgery field and provide a basis for the infection control measures in the perioperative period of cataract.Methods A total of 280 patients of cataract surgery in our hospital were chosen in this study.The patients were divided into eyelash removal group(n=128)and non-eyelash removal group(n=152).All the patients underwent phacoemulsification and intraocular lens implantation for cataract.The specimens of the operation paste surface and the conjunctival sac were collected for bacterial culture.The bacterial culture results were observed in the two groups.Meanwhile,the postoperative eye symptoms were compared between the two groups.Results The positive rate of bacterial culture[13.16%(20/152)vs.29.69%(38/128),respectively]and the proportion of the same species of bacteria in the conjunctival sac and the operation paste surface[2.63%(4/152)vs.7.81%(10/128),respectively]in the non-eyelashe removal group were significantly lower than those of the eyelash removal group(P<0.05).The bacteria in conjunctival sac after operation were the same species as those on surgical film,all of which were staphylococcus epidermidis.On the first postoperative day and the seventh postoperative day,the symptoms of eye irritation and the degrees of hyperemia were significantly improved in the non-eyelash removal group than those of the eyelash removal group(P<0.05).Conclusion In the eyelash removal group,the distribution of bacteria is higher in the operative field of cataract patients than that in the non-eyelash removal group,and the strain of endophthalmitis is highly likely to originate from the orbital margin.In addition,the eyelashes retention can reduce postoperative eye irritation and conjunctival hyperaemia.